What Has the Stigma and Discrimination Reduction Initiative Done So Far?

The California Mental Health Services Authority* (CalMHSA) — a coalition of California counties designed to provide economic and administrative support to mental health service delivery — formed the statewide Prevention and Early Intervention (PEI) Implementation Program to reduce adverse outcomes for Californians who experience mental illness. CalMHSA's focus is on three strategic initiatives that aim to (1) reduce stigma and discrimination toward those with mental illness, (2) prevent suicide, and (3) improve student mental health. CalMHSA has engaged community agencies as PEI program partners to achieve the goals of each initiative. In 2011, the RAND Corporation was asked to design and implement a three-year statewide evaluation of the three initiatives in terms of their content, reach (e.g., who receives services or is exposed to resources and trainings), and outcomes (e.g., whether the activities reduce mental illness-related stigma and discrimination).

For the Stigma and Discrimination Reduction (SDR) Initiative, first-year evaluation efforts have focused on programs and efforts being implemented by a number of program partners:

• Disability Rights California
• Entertainment Industries Council, Inc.
• Integrated Behavioral Health Project/Center for Care Innovations
• Mental Health Association of San Francisco
• Mental Health America of California
• National Alliance on Mental Illness
• Runyon Saltzman & Einhorn
• United Advocates for Children and Families
• The SDR Consortium.

What Have the SDR Initiative Program Partners Accomplished So Far?

Program partners have focused their efforts on four core activities (i.e., major PEI activities that RAND is evaluating): (1) development of policies, protocols, and procedures; (2) informational/online resources; (3) training and educational programs; and (4) media and social marketing campaigns. While many efforts have been implemented in the past year, others are still in development, with implementation planned for the coming year. Thus, the evaluation is ongoing, and the results are preliminary. Evaluation in the first year has focused on the content of activities in all core areas — reviewing materials and comparing them to the evidence base. The evaluation has also begun to assess the early reach of the initiative. Short- and long-term outcomes will be assessed in subsequent evaluation years.

Content Review. SDR program partners have developed content in all the core activities. Efforts related to policies, protocols, and procedures for reducing stigma range from developing toolkits for various audiences (e.g., journalists, communities wanting to hold mental health roundtables) to stakeholder trainings, meetings, and educational presentations. The first-year evaluation assessed the activities in terms of content, purpose, and structure; target population for the policy, procedure, or best practice; early implementation findings; and how much the policy, procedure, or best practice is evidence-based and adapted for the target population.

Four program partners are generating a range of informational/online resources targeted toward general audiences: Disability Rights California developed fact sheets; Mental Health Association of San Francisco–RD is compiling a stigma reading list; Runyon Saltzman & Einhorn is creating special reports for LA Youth and developed the Each Mind Matters website; and United Advocates for Children and Families is working on expansion and enhancement of its current website and on publications, calendars, services, and forums. RAND selectively reviewed the key informational resources to determine the topics covered; whether the topics, policies, and laws addressed are consistent with the empirical and theoretical literature; the breadth of the stigma and discrimination issues addressed (e.g., do they address the needs of the general population and the needs of specific populations); and the intended audience.

SDR program partners are also making available a host of training and educational programs for a wide variety of audiences, such as people with mental health challenges, family members of people with mental health challenges, landlords, health providers, county mental and behavioral health service managers, teachers, and students. Many of these trainings incorporate contact with people with mental health challenges to help reduce stigma and discrimination (an evidence-based practice).

Finally, as for media and social marketing, two SDR program partners are implementing media-related stigma and discrimination reduction strategies: Entertainment Industries Council, Inc., is providing media training to journalism and entertainment professionals, and Runyon Saltzman & Einhorn is conducting a social marketing campaign differentially targeting Californians in four different age ranges and covering the full life span.

Reach. In terms of reach, the first-year evaluation has focused on using Google Analytics — the industry-standard application for web analytics, capturing metrics on use of, and interaction with, web properties and traffic sources.

As noted above in the media and social marketing core activity, Runyon Saltzman & Einhorn is conducting a four-pronged marketing campaign directed at parents of youth 0–8, youth 9–13, transitional age youth 14–24, and adults 25 and over with influence over those with mental health challenges. The campaign includes bloggers, print articles, ads in multiple media, a public television documentary, a theater presentation at schools, speaker events, and four websites. Websites include a speaker's bureau for locating local presenters; a site for youth 9–13 to learn about mental health challenges; a web discussion forum for youth 14–24 to get and give emotional support; and Each Mind Matters, which serves as the hub for CalMHSA outreach across programs and activities. The assessment of the Each Mind Matters website — www.eachmindmatters.org — using Google Analytics found the following:

• There were 11,000 site visits between May 6, 2013, and June 7, 2013.
• 55 percent of visits were from searches by individuals, most of whom seemed to be looking specifically for Each Mind Matters.
• 35 percent of visits were from other websites, with about 1,700 visits from Facebook, 329 from Twitter, and 223 from the Northern California public television affiliate, KQED.

The table below captures some data on the viewing of the public television documentary: "A New State of Mind: Ending the Stigma of Mental Illness," which is available on the Each Mind Matters website.

What Are the Plans for Future Evaluation of the SDR Initiative?

SDR program partners have expanded and built new capacities and developed materials for reducing mental health stigma and discrimination in California, and we have begun evaluating the content of these materials (as discussed above); we will continue evaluating content as the program partners introduce new tools, materials, and trainings. Although preliminary evidence of the reach of some of these capacities is available and has been evaluated, many evaluation tools — such as a document tracking tool that tracks policies, protocols, and procedures and hard-copy and online information resources — were in the implementation phase at the time of writing. Thus, we will not fully understand the nature or the reach of the programs' activities until the end of Year 3. Similarly, we do not yet have information about the effects of activities on short-term outcomes of interest. The main evaluation tool here will be the pre-post survey (also used to evaluate reach), which assesses the most central aspects of stigma as indicated by theory and prior research and is designed for use with trainings and educational programs. To assess changes in behavior or practice, we are employing the SDR follow-up survey, which collects, at six-month intervals, information from those who received policy papers or reports, accessed toolkits, attended stakeholder trainings, or visited CalMHSA-funded SDR websites. The survey gathers data on whether and how they used what they learned and also collects information on stakeholder roles and demographics. The statewide survey will enable us to examine shifts in attitudes, knowledge, and beliefs about mental illness and to assess the extent to which media messages may be responsible for these shifts. The survey assesses exposure to other SDR efforts (e.g., training attendance) so that attitudinal shifts associated with this exposure can be estimated. Complete results will be available at the end of Year 3 as well. However, we will have more preliminary results for reach and some results for short-term outcomes of interest in Year 2.

Topics

• California
• Discriminatory Practices
• Health Care Program Evaluation
• Mental Health and Illness