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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

Chris Marshall

Consumer Affairs Specialist

Center for Mental Health Services


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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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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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  • Technical Assistance anti-stigma initiatives

  • Training Teleconferences

  • Informational Updates

  • Web site

  • Database

  • Collaboration with EBI and NASC

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Elimination of Barriers Initiative (EBI) anti-stigma initiatives

  • 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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Ohio anti-stigma initiatives







North Carolina

EBI Pilot States

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EBI Results anti-stigma initiatives

  • 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 anti-stigma initiatives

    • 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 anti-stigma initiatives

    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 anti-stigma initiatives

    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 anti-stigma initiatives

    15. Provide forums for peer-to-peer information sharing

    16. Additional training may be required in the development and ongoing operation of speakers’ bureaus

    17. Recognize that messages directed at media gatekeepers may vary from those directed at the general public

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    NASC Toolkit anti-stigma initiatives

    • 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- anti-stigma initiatives

    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 anti-stigma initiativesMental Health Information Center

    www.mentalhealth.samhsa. gov


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    Chris Marshall anti-stigma initiatives

    Consumer Affairs Specialist


    1 Choke Cherry Road,

    Room 6-1071

    Rockville, MD 20857

    Phone: 240-276-1947