MENTAL HEALTH AND ENGAGEMENT
DAY 2, 5E: MENTAL HEALTH STIGMA
Purpose: The purpose of this segment is two-fold: to enable participants to safely
acknowledge that, as professionals, we may hold the same biases regarding mental
illness that is present in our larger society; and to deepen our awareness of the impact
that mental health stigma has on our client families, on their ability to trust us, and on
the relationships we work to develop with them.
Approximate Time: 15 minutes
Materials: PowerPoint Slides: 32-47, electronic clicker set programmed with slides 4145, Fact Sheet and References.
Learning Objectives addressed in this segment:
Participants will value the benefit of addressing mental health stigma in aligning with
and developing good working relationships with families. (V8)
Participants will value becoming aware of how their own bias toward mental health
issues may have an impact on the services identified as needed and then offered to
participants. (V9)
Participants will understand the impact of mental health stigma that families face, and
develop an awareness of their own mental health bias. (K8)
Didactic:

Overview: This exercise is designed to engage participants and enable us to
safely acknowledge that as professionals, we may hold the same biases
present in our larger society. This exercise will also help jumpstart
participants’ thinking about how bias might effect engagement: we can get
stuck on symptoms or behaviors, and miss a family member’s underlying
need. LA County’s Department of Mental Health is in a transitory period,
moving from an earlier deficit based and somewhat medical model, into a
strengths based, public health model. It is important to stress that the
medical model cannot be completely abandoned since some family members
take medication, thus the medical model has its appeal). The shift from a
medical model to a public health model is part of a larger social change
campaign that focuses on community building, engagement and family
strengthening (Pat Brown Institute, 2010). These transformations tend to
occur in “chunks”, so if participants were to find themselves more aligned
with some and not other concepts, this would be understandable. The
challenge is to get participants to:
1) Think about where they might be able to apply the research offered
during discussion and included in the Fact Sheet and References handout;
2) Become more aware of their own bias, without feeling a sense of
shame or embarrassment, and understand how it might have an impact
of the services offered;
3) Value addressing stigma in their professional communications and
relationships with families and community partners;
4) Understand that the families they work with face mental health
stigmas in a variety of ways; and
5) Use this information when they engage children and families to help
them get mental health treatment.

Sync the clicker box with the computer before beginning Day 2 and
distribute the clickers during the break just before this segment.
The trainer will need to know how to set up the clicker exercise by syncing
the clicker box with the computer. This should be done as the trainer
prepares for Day 2. Clickers need to be distributed to the participants.

What is a stigma? Slides 14 and 15 set up the exercise by defining what a
stigma is. Reinforce that stigmas focus on behaviors and distract us from
dealing with unmet needs. They can get in the way of seeking or providing
help. Our community partners, such as foster parents may also perpetuate
biases about mental health treatment. Be prepared with an example that
illustrates this point. While the trainer will want to normalize the prospect of
the participants carrying some of the same biases as the general population,
the first step in dealing with them is to be willing to look at our own bias.
Training Activity: Large Group
Purpose and Objectives: To introduce the participants to the prospect of their
own and other’s mental health biases/ stigmas. The clicker provides them with
an opportunity to share their beliefs honestly, anonymously and in a group.
Participants can consider how stigmas may affect the services that are offered or
available. This exercise should help participants become more comfortable in
addressing stigma with families and community partners.
Instructions: The participants already have the clickers and the clicker box is
already synced with the computer. The trainer will explain that right after the
clicking (voting on the level of agreement, neutrality or disagreement with the
statement), the trainer will share some pertinent research that is factual and will
help shed light on the issue. Tell the participant that they will get a fact sheet
with all this research at the end of the exercise. In addition, the trainer will also
role model venturing a “hunch” about possible CSW and family reactions to the
statement or possible stigma. Challenge the participants to begin to think of
one case where they might be able to recognize that some stigma is operating
and then begin to think of how they might utilize the research offered by
engaging with that family. Conduct the exercise by beginning with the practice
statement that is on slide 17 and continue on for the remaining 9
statements/slides. Trainer notes beneath each slide should be reviewed with the
group after each slide. Address any audience discussion that surfaces as a result
of the statement. At some point, the trainer should comment on the changing
Mental Health System on the local level, and how this is a part of a larger
change. The last clicker statement is on slide 24.
Conduct the clicker exercise by beginning with this practice question and
continue through each item (there are nine additional slides/questions). You will
review each trainer note for each slide as well as integration of discussion from
the audience. After you have gone through all clicker slides and reviewed each
response, direct the participants the Fact Sheet and References that is in their
packet that has the factual information for each item.
According to an article published by the Centers for Disease Control and
Prevention (CDC) in their monthly journal Preventing Chronic Disease,
“Definitions of mental illnesses have changed over the last half-century. Mental
illness refers to conditions that affect cognition, emotion, and behavior (eg,
schizophrenia, depression, autism). Formal clinical definitions now include more
information (ie, we have moved from a partial to a more holistic perspective and
transitioned from a focus on disease to a focus on health)” (Evolving Definition of
Mental Illness and Wellness, 7(1), 2010).
Possible CSW/Family Perspectives:
CSW: This is saying that we have moved from a medical and deficit model to a
holistic perspective and a focus on health. Do I believe in the medical/ deficit
model or am I more aligned with a model that emphasizes what an individual/
family can do? We can’t move totally away from the medical model, as many of
our families understand it in terms of taking medication.
Family: I am not sure about the medical model if it is saying I am sick. Are sick
and crazy the same things? I am not crazy, and I do recognize that I have to
attend to certain things in order to stay healthy.
According to a study published in the American Journal of Psychiatry, “The
prevalence of homelessness in persons with serious mental illness is 15 percent”
(Prevalence and Risk Factors for Homelessness and Utilization of Mental Health
Services, 162, 2005).
Possible CSW/Family Perspectives:
CSW: While only 15% of individuals with serious MI are homeless, I believe there
are high rates of MI (diagnosed and undiagnosed) among the homeless
population.
Family: Just because I am homeless, it does not mean I am crazy. And, if I am
told I have MI, it does not mean I am headed for homelessness.
Possible CSW/Family Perspectives:
CSW: We can’t automatically assess parents with MI as inadequate. The
evidence shows they are motivated and often competent. The needs of the child
are the key to engaging these parents.
Family: I can still be a good parent even though I have a MI diagnosis;
succeeding at parenting is very important to me.
According to the National Alliance on Mental Illness: “Of all people diagnosed as
mentally ill, 29 percent abuse either alcohol or drugs” (Dual Diagnosis and
Integrated Treatment of Mental Illness and Substance Abuse Disorder, 2003).
Possible CSW/Family Perspectives:
CSW: Not everyone with an addiction is self medicating for MI. Some may be….
While the DSM classifies substance abuse as a disorder, people abuse drugs for a
variety of reasons. ..
Family: Just because I sometimes drink or use drugs (minimization) that does
not make me crazy or sick. Most of the people I know do use (minimization)
alcohol or drugs.
 Application to work with clients: End the exercise by asking participants how
they can use this information when they engage families and children in
getting mental health treatment. For example, at this point, the trainer can
ask if someone is willing to share their reaction and any thoughts about
application to one case. The next 2 slides are for use in a didactic discussion
related to mental health stigma and navigating communication with a family
about getting mental health services.
 In presenting slide 25 (Encouraging Participation in Mental Health Services)
and 26 (Addressing Needs Through Community Partnerships) the trainer should
highlight the following points:
1. Families need to know the purpose and goals of mental health
treatment and how they relate to the unmet, underlying needs that
you have already discussed with them.
2. Participants now have some tools to openly discuss stigma with their
clients, community partners and colleagues.
3. Discuss how formal (mental health agencies, school services, medical
clinics, foster parents) and informal (family, friends, church members)
community partners can support the family. How can they help in the
plan to address the family’s needs? Ask participants to share what
their experience has been (pro and con) in working with formal and
informal community partners.
4. Similarly, families can benefit from an open discussion of ambivalence
about obtaining mental health treatment (by examining the pros and
cons). If it has not been addressed yet, ask what ideas participants
have for explaining some of these concepts in language that anyone
can understand.
5. Once a plan is agreed to, it needs to be regularly reassessed and
adapted, when necessary.
6. Participants also need to have strong working relationships with all
community partners. Relationships begin with engaging our partners.
The trainer should be prepared with a specific example that illustrates
the challenges or difficulties of this kind of facilitation. Stress that
even if sometimes exhausting, this approach bodes well for success.
At this point, the trainer should ask for one or two of the participants
to share a similar experience. The trainer can draw upon the themes
that emerge.
7. It may be worth noting some good news: More funding is in the
pipeline for Wraparound Services. More community partners will be
funded for this.
8. Remind the participants that the training on Teaming is coming up
and that this will provide some additional engagement tools they can
use with community partners.
9. Finish by telling participants that being able to asses the family’s
stage of change and working incrementally to motivate a family
member to consider more change will be our next topic after lunch.