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Transforming Mental Health Care in America: The First Steps. Chris Marshall Consumer Affairs Specialist Center for Mental Health Services HHS/SAMHSA. Substance Abuse and Mental Health Services Administration. Who is SAMHSA?.

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Transforming Mental Health Care in America: The First Steps

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Transforming Mental Health Care in America: The First Steps

Chris Marshall

Consumer Affairs Specialist

Center for Mental Health Services


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Substance Abuse and Mental Health Services Administration

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Who is SAMHSA?

SAMHSA consists of three Centers and supporting Offices that administer and fund grant programs to support States’ efforts to address substance abuse and mental health issues.

  • Center for Mental Health Services (CMHS)

  • Leads Federal efforts to provide community-based services for adults with serious mental illnesses and children with serious emotional disturbances.

  • Center for Substance Abuse Prevention (CSAP)

  • Works to improve the quality of substance abuse prevention practices in every community, nationwide, through its discretionary grant programs.

  • Center for Substance Abuse Treatment (CSAT)

  • Promotes the quality and availability of community-based substance abuse treatment services for individuals and families who need them.

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The Matrix

SAMHSA’s budget, programs, and policies have been aligned to match a series of core priority issues and cross-cutting principles. These priorities are represented on the SAMHSA matrix—an evolving tool that keeps the Agency’s work focused on the most critical issues in behavioral health.

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Mental Health System Transformation

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Bridging the Quality Chasm


The behavioral health care that

we know to be


The behavioral

health care that Americans receive

Focus on recovery




Health IT

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Addressing Stigma & Discrimination as Central for Recovery

  • In this transformed system, stigma and discrimination against people with mental illnesses will not have an impact on securing health care, productive employment, or safe housing.

  • Our society will not tolerate employment discrimination against people with serious mental illnesses – in either the public or private sector.

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Recommendations & Federal Action Steps

Recommendation 1.1

Undertake a national campaign to reduce stigma.

“Americans must understand and send this message: mental disability is not a scandal –it is an illness. And like physical illness, it is treatable.”

President George W. Bush

April 29, 2002

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Stigma: a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.

Source: Achieving the Promise:

Transforming Mental Health Care in America

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Public Attitudes

  • Surveys since the 1950s

  • Mental illness as stigmatized condition

  • No scientific understanding

  • Unable to identify persons with MI

  • Could not distinguish between MI and worry

  • Fear of unpredictable violence

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MacArthur Mental Health Module, General Social Survey, 1996

  • Greater scientific understanding

  • Able to distinguish between MI and worry

  • Mix of biological and psychological stress

  • Social stigma unchanged

  • Belief that violence associated with mental illnesses nearly doubled

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Internalizing Stigma

  • Embarrassment, Shame, Isolation

  • Nearly two-thirds of all people with diagnosable mental health problems do not seek treatment (Regier et al., 1993; Kessler et al., 1996).

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Reducing Stigma

  • Public Education Campaigns

  • Reward / Protest

  • Contact Approach

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History of National Efforts

  • Spring to Action 2001

  • EBI and ADS Center

  • Older Adults Stigma Roundtables

  • President’s New Freedom Commission on Mental Health / Federal Action Agenda

  • SAMHSA National Anti-Stigma Campaign

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SAMHSA Programs to Address Stigma

  • ADS Center (Resource Center to Address Discrimination and Stigma)

  • EBI (Elimination of Barrier Initiative)

  • NASC (National Anti-Stigma Campaign)

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  • Help States, organizations, individuals design and implement anti-stigma initiatives

  • Gather and maintain best information, policies, research, practices, and programs to counter stigma and discrimination

  • Actively disseminate anti-stigma and discrimination information and practices

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  • Technical Assistance

  • Training Teleconferences

  • Informational Updates

  • Web site

  • Database

  • Collaboration with EBI and NASC

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  • Web site:

  • Email:

  • Telephone: 1-800-540-0320

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Elimination of Barriers Initiative (EBI)

  • Eight State Demonstration

  • Test Public Education Messages

  • Reduce stigma and discrimination associated with mental illnesses using tools such as public education and contact

  • Provide Evidence-base for National Campaign

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North Carolina

EBI Pilot States

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EBI Results

  • More than 273 million audience impressions

    • TV – 207 million

    • Radio – 67 million

  • Equivalent airtime/advertising value: nearly $3 million

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    EBI Lessons Learned

    • Use a multifaceted approach

    • Use a participatory process

    • Involve consumers

    • Work closely with a smaller subgroup of key partners

    • Involve stakeholders early and often throughout the creative process

    • Identify your audience(s) and speak to them in their own language

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    Lessons Learned

    7. Focus on positive, strength-based messages that demonstrate that recovery is both real and possible

    8. Localize and personalize educational strategies

    9. Choose a campaign theme that can be tailored to specific audiences

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    Lessons Learned

    10. Develop and implement a comprehensive evaluation

    11. Use existing commemorative events

    12. Generate and maintain enthusiasm

    13. Provide basic training and tools on media outreach

    14. Utilize train-the-trainer opportunities

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    Lessons Learned

    15. Provide forums for peer-to-peerinformation sharing

    16. Additional training may be required in the developmentand ongoing operation ofspeakers’ bureaus

    17. Recognize that messages directedat media gatekeepers may varyfrom those directed at thegeneral public

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    NASC Toolkit

    • Section 1: Introduction

    • Section 2: Mounting a Statewide

      Anti Stigma Campaign

    • Section 3: Outreach Materials

    • Section 4: Best Practices

    • Section 5: Resources

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    The First SAMHSA-

    Sponsored Voice Awards

    • Film, TV, and radio writers and producers who have created respectful, accurate, and dignified portrayals of people with mental illnesses

    • Mental health advocates whose efforts have expanded public understanding of mental illnesses

    • Others whose activities promote mental health awareness

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    SAMHSA’s National Mental Health Information Center

    www.mentalhealth.samhsa. gov


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    Chris Marshall

    Consumer Affairs Specialist


    1 Choke Cherry Road,

    Room 6-1071

    Rockville, MD 20857

    Phone: 240-276-1947


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