Using Contact Intervention to Reduce Stigma on Mental

Health

By
Jane H. Chung

English 202A/B
June 28, 2016

Abstract
The purpose of this paper is to inform the public on the increasing problem of stigma on
mental health. It relays the negative effect of stigma on mental health, which is the ability for
stigma to prevent a potential patient from receiving mental health services. Also, this paper will
present three possible strategies to reduce this stigma. The possible strategies are educational
intervention, contact intervention, and protest intervention. The advantages and disadvantages of
each intervention are reviewed, and then the best strategy will be presented. The best strategy to
reduce stigma in the mental health field, which would help to reduce the barrier in receiving
help, is to utilize contact intervention.

Using Contact Intervention to Reduce Stigma on Mental Health

By Jane Chung
Recently, stigma has not only become a popular topic to talk about, but it has also
become an important subject to discuss. Most Americans nowadays have an idea that stigma
exists in our society due to its appearances in social media. For example, the Black Lives Matter
movement was created after a police officer was discharged for the death of an African American
teen. This movement focused on police brutality against African Americans is linked to the
stigma against African Americans. Also, most people have an idea of the inequalities between
females and males and the unfair treatment against homosexuals. All these link back to stigma
specific issues. Because it has been broadcasted publicly, most Americans are aware of the
stigmas against these groups of people. However, there are more groups of people that stigma
has claimed and harmed. One group is people with a mental illness. Stigma against mental illness
is rarely ever mentioned. Mental illness is usually seen in the news only when a tragedy occurs,
which further deepens the stigma. For example, little is known about the why behind the
shooter of the Sandy Hook Elementary School shooting. The only indication social media
offered was his mental illness. Tragedies like these further the stigma against mental illness
because it deepens the fear that people with a mental illness is dangerous. This stigma will be
further discussed along with its effects in this paper. Also, educational intervention, contact
intervention, and protest intervention will be defined and analyzed. Finally, a conclusion will be
made to which intervention is best to use.
As mentioned previously, stigma can be broadly applied to a spectrum of topics like race,
gender, and many others. Stigma can be defined as an umbrella term that encompasses
stereotypes or lack of knowledge, negative attitudes or prejudice, and behavioral problems like

discrimination (Thornicroft, Rose, Kassam, Sartorius, 2007). However, when it comes to mental
health, there are two stigmas that affect mental health. These two stigmas are public stigma and
self-stigma.
Public stigma is seen as the reaction of others to people with mental illness (Corrigan &
Watson, 2002). First, stigma can be seen through a stereotype like all people with a mental illness
is dangerous. Then, it can be seen through prejudice in the public manifested as fear. People act
upon the fear by discriminating against people with mental illness, refusing to hire them for
example (Corrigan, 2007). There are studies that found that a majority of the population in the
United States has stigma towards mental illness. Even mental health professionals are no
exception. Interestingly, there are several misconceptions involved in handling people with
mental illness. Corrigan and Watson (2002) categorize into fear and exclusion, authoritarianism,
and benevolence. It is important to note that public stigma against mental health, though judged
harsher than people with physical disabilities, varies depending on the type of mental illness
(Corrigan, 2007). For example, there are more negative attitudes toward people with
schizophrenia compared to people with anxiety. This can be partly attributed to the manifestation
of psychiatric symptoms that are considered abnormal behavior. For example, one psychiatric
symptom is inappropriate affect. Someone may assume the individual has a mental disorder if he
starts yelling at a cashier and upheaving furniture because the cashier was to slow in taking his
order. Cues like the presence of abnormal behavior in addition to poor social skills, physical
appearance, and labels lead to stereotypes in society. However, it is important to remember that
these attributes are not indicative of someone with a mental health disorder.
Self-stigma can be defined as the prejudice that people with a mental illness may have on
themselves (Corrigan & Watson, 2002). To better understand self-stigma, the three components

of stigma are incorporated into the following example made by Patrick Corrigan. There is a
known stereotype that all people with a mental illness are incompetent. A mentally ill patient
would adopt the stereotype as fact that he is not competent, which self-identifies himself based
on his disease. Then, the mentally ill patient will self-discriminate. He will not try to apply for a
job because he thinks he is incompetent (2007). Because public stigma is the reaction of others to
mental illness, it influences the occurrence of self-stigma while the increase of self-stigmatizing
attitudes encourages public stigma.
With these two types of stigma working together, one can imagine its deleterious effects
on the mentally ill. Based on research, discrimination by the general population can manifest in
four different ways. One way is by not helping people with a mental illness. Another way is
avoiding people with mental disorders. A General Social Survey in 1996 found that more than
half its participants would refuse to work next to, hangout with, or have a relative marry
someone with a mental illness. In the same survey, about 40% of the participants showed
discrimination by agreeing to forced treatment for people with schizophrenia despite the lack of
evidence for efficacy in research studies. Additionally, the public displayed their prejudice by
promoting segregation in institutions for people with severe psychiatric disorders. Because of
these discriminating habits, mentally ill people tend to have negative experiences with law
enforcers, potential friends, and health care providers (Collins, Wong, Cerully, Schultz, Eberhart,
2012). Also, people with mental illnesses have difficulty finding good jobs or good housing
because of the employers and landlords (Corrigan & Watson, 2002). Not only is it difficult for
them to find good jobs and housing, but also it is harder to sustain their jobs and friends due to
the internalization of the stigma. These attitudes, displaying that the mentally ill are not valued,
severely deprecates self-esteem, and self-efficacy. Diminishing the sense of self leads to greater

difficulty in mental illness recovery along with an increase in stress (Markowitz, 1998). As
shown by the many negative effects of stigma, the quality of life for people with a mental illness
is quite low. These are only some of the major effects stigma has on people with a mental illness.
However, there are about forty negative consequences found in research (Corbire, Samson,
Villotti, Pelletier, 2012). In the following paragraph, one effect will be identified and further
discussed due its double impact on both society and mentally ill people.
One effect of stigma that is highly concerning is that it discourages people with a mental
health disorder to seek help or continue treatment. About 46% of the homeless people living in
shelters have a serious mental illness and or substance abuse disorders while 20% of the state
prisoners have a recent history of a mental condition (National Alliance On Mental Illness,
2013). Without seeking help, mental illness contributes to a $193.2 billion loss in earnings per
year (National Alliance on Mental Illness, 2013). Through the implications of these statistics, not
seeking mental health services pour into problems of other sectors such as homelessness/poverty
and the law/public safety. Also, mood disorders are ranked third on the most common
hospitalizations in the U.S. while suicide is the tenth leading cause of death in America. Note
90% of the people who commit suicide have a mental health condition. Additionally, a research
study conducted by Colton and Manderscheid found that there is an association between mental
and physical health. People with mental illness have a higher risk of death than people without a
mental illness. On average, people with a mental health disorder died at a younger age from
natural causes (2006). Having a mental health problem has obvious deleterious effects on ones
health, and 31% of the population in the United States has a mental illness each year
(Thornicroft, 2008). However, what is frightening is that only 67% of the population with a
mental illness does not seek treatment (Thornicroft, 2008). The National Alliance on Mental

Illness states that there is effective treatment available, but people wait sometimes for decades
after symptom onset to seek help (2013). The number one barrier based on the 1999 U.S Surgeon
Generals report that explains the 67% and why people wait so long to seek help is stigma
Therefore, it is of dire importance to counteract this stigma against mental health.
Though there has been much research involving the effects of stigma on mental health,
investigating strategies in reducing this stigma has been limited. Currently, research is still
focused on examining stigma and different demographics. In literature, the most popular
interventions suggested and researched are educational intervention, contact intervention, and
protest intervention.
First, educational intervention is a strategy based on educating people on mental illness
and debunking any misconceptions on mental health. It is easily implemented because it can be
incorporated into existing class curricula and trainings. Its advantages are that it is cost effective
and can be widely distributed. However, there have been mixed reviews and uncertainties on its
effectiveness. On one hand, improving mental health literacy has been successful in changing
attitudes. When educational programs were applied to medical health care professionals in
training, there was a positive change in attitudes after a few weeks (Collins et al., 2012). Also,
graduate students showed positive attitudes towards people with psychiatric disorders after
attending short classes about mental illness (Corrigan, River, Lundin, Penn, Uphoff-Wasowski,
Campion, Mathisen, Gagnon, Bergman, Goldstein, & Kubiak, 2001).
On the other hand, there is little research on the long-term effects of these educational
programs and whether the positive attitudes translate to behavioral changes as well. Also, there
have been several studies that showed an association between an increase in mental health
knowledge and an increase in negative attitudes. These results are interesting to note because

educational intervention is the most common strategy brought up by the general population as an
effective way to reduce stigma (Corbire et al., 2012). Additionally, the methods of teaching in
educational interventions vary in efficacy. For example, educational interventions emphasizing
mental illness as primarily from ones biology show an improvement in some stigmatizing
attitudes while deepening others (Collins et al., 2012). It seems like simply educating the public
about mental health is not enough to reduce stigma against mental illness. There appears to have
many variables that influence the differences in effectiveness. However, research has yet to
identify all these variables. Because of its unreliability in being effective, educational
intervention is not the best method in reducing stigma.
Next, protest intervention has been suggested as a method to decrease stigma on mental
illness. Protest intervention is when a group denounces false information and offensive
representations of mental illness to challenge the established stereotypes, but they fail to promote
positive attitudes. These campaigns focus on media to change its representation of mental illness
while telling the public to stop believing those negative attitudes (Corrigan, 2004). There has
been little research involving the efficacy of protest interventions, but what research is available
shows mixed reviews. For example, the UK had a Defeat Depression campaign, and it was
effective in reducing stigmatizing attitudes toward depression and reduced suicide rates. Though
there were positive changes in attitudes, evaluations for Defeat Depression and other public
campaigns (not for research purposes) may not be reliable because unrelated factors that may
have influences the results cannot be controlled (Collins et al., 2012). Unrelated factors may
have been a cause of the results in Defeat Depression because in controlled studies, protest
interventions worsened stigmatizing attitudes. This is due to a rebound effect where people react
adversely to being told what to do. Because there has been limited research done on protest

intervention and mixed reviews with a probable direction towards poor efficacy, protest
intervention is not the best method in reducing stigma. There is too much uncertainty to deem it
as a solution to changing negative attitudes towards mental illness. Potentially, if research
investigates this strategy further, then protest intervention should be revisited as a possible
option.
Lastly, contact intervention has also been studied as a way to reduce stigma against
mental illness. Contact intervention directly involves interacting with someone with a mental
illness to create a positive personal experience. This interaction, a key component to its success,
allows the predisposed notions about mental illness dissipate as people see that mentally ill
people do not fit those stereotypes. Multiple studies have verified its efficacy in decreasing
stigmatizing attitudes. In a randomized control trial, people participated in a shared activity with
someone with a mental illness and had positive changes in their attitude after one week. They
also had an increase in desire to help people with mental illness (Mann & Himelein, 2008).
Contact intervention has also been applied positively to other groups of people like different
ethnic minorities to decrease prejudice (Corrigan et al., 2001). Contact intervention seems to be
the best solution to reducing stigma on mental health because of all the positive relationships
found between reducing stigma and contact. There is little mixed reviews compared to
educational and protest intervention. However, it is important to note that contact intervention is
not time efficient as formations of positive interactions between people with mental health
disorders and the public takes time. Also, it cannot be as wide spread as educational
interventions, as it requires people to push against public and self stigma to self-disclose their
mental illness to the community.

Additionally, positive attitudes from contact intervention have lead to sustained positive
attitudes in the long term along with behavioral changes, unlike educational programs. In one
study, a 30-minute contact intervention yielded greater decrease in negative stereotypes
compared to an education-focused session (Collins et al., 2012). When comparing educational,
contact, and protest interventions, research has been pointing to contact intervention as the most
effective out of these three strategies. For example, Corrigan et al. (2001) compared these three
strategies in a randomized controlled study for different types of attributions like cancer, AIDS,
depression, mental retardation, psychoses. The investigators found that protest had no change in
any stigmatizing attitudes while education and contact had an effect. Education had low
significance changes over a broad range of attributions, but Contact had the most significant
change focused primarily on stigmatizing attitudes toward mental illness.
As mentioned previously, research is still limited on the effectiveness of all the possible
interventions to reduce stigma. Years from now, there could be a new intervention that has a
higher success rate than contact intervention. Nonetheless, programs need to be implemented
now to start reducing stigma against mental health and improve the lives of many Americans
suffering from mental illness. Therefore, based on the most current research, contact intervention
yields the best results in changing stigmatizing attitudes on mental illness. Though there are
many different areas to incorporate contact. It would be wise to start in educational areas that
may unintentionally promote stigma and professions that commonly mistreat people with mental
health disorders. For example, contact programs should be used in classrooms teaching
psychology and law enforcement training.

References
Collins, R. L., Wong, E. C., Cerully, J. L., Schultz, D., Eberhart, N. K. (2012). Interventions to
reduce mental health stigma and discrimination. Retrieved from
http://www.rand.org/pubs/technical_reports/TR1318.html
Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years
of potential life lost, and causes of death among public mental health clients in eight
states. Preventing Chronic Disease, 3(2), A42.
Corbire M., Samson, E, Villotti, P., & Pelletier, J. F. (2012). Strategies to fight stigma toward
people with mental disorders: Perspectives from different stakeholders. The Scientific
World Journal, 2012, 1-10.
Corrigan, P. W. (2004). How stigma interferes with mental health care. The American
Psychologist, 59(7), 614-625.
Corrigan, P. W., & Watson A. C. (2002). Understanding the impact of stigma on people with
mental illness. World Psychiatry, 1(1), 16-20.
Mann, C. E., & Himelein, M. J. (2008). Social Psychiatry & Psychiatric Epidemiology, 43, 545551.
Markowitz, F. E. (1998). The effects of stigma on the psychological well-being and life
satisfaction of persons with mental illness. Journal of Health and Social Behavior, 39(4),
335-347.
National Alliance on Mental Illness. (2013). Mental illness facts and numbers [Fact sheet].
Retrieved from http://www2.nami.org/factsheets/mentalillness_factsheet.pdf
Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care.
Epidemiologia e Psichiatria Sociale, 17(1), 14-19.

Thornicroft G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: Ignorance, prejudice or
discrimination? British Journal of Psychiatry, 190, 192-193.