Fighting Stigma

by Susan Rogers

HE NATIONAL MENTAL HEALTH CONSUMERS'
SELF-HELP CLEARINGHOUSE
1211 CHESTNUT STREET
PHILADELPHIA, PA 19107
PHONE: (800) 553-4539
FAX: (215) 636-6312
E-MAIL: info@mhselfhelp.org

Funded by the Community Support Program of CMHS
The Center for Mental Health Services.

The Random House Dictionary defines "stigma" as "a blemish on one's record or reputation." Such a stigma affects anyone who has a psychiatric history.

There are myths that have become part of American "folklore" that contribute to this stigma. The main ones are (1 ) that people with mental illness are violent and (2) that people with mental illness don't recover. So, to fight stigma, the two major messages to communicate are that these myths are false -- that (1) statistics show that "mental disorders ... account for a minuscule portion of the violence that afflicts American society," according to a statement issued by the National Stigma Clearinghouse; and that (2) people with mental illness do recover, and return to their communities to lead productive lives.

There are many ways we all can fight stigma. The simplest way is to "come out of the closet" and present "positive visibility" in the community and the media. Positive visibility is loosely translated as "your best foot forward." When you let people in your community know that you, who have been leading a blameless life right next door, have a mental illness, it will make them question and (we hope) ultimately reject the stigmatizing myths.

Following are some other suggestions about how you and your group can fight stigma.

Using the Media

The media too often focuses on the most negative aspects of anything, in order to sensationalize it. (They think it sells more papers, attracts more viewers, whatever -- and they're probably right.) Cases in point are the portrayal of mental patients as "psychopathic" killers on such shows as "Hill Street Blues" and the late, unlamented "Jessie" and as buffoons on other shows, e.g., "Night Court." Other examples include the sensationalized coverage of such tragic -- and extremely rare -- incidents as the 1985 Springfield Mall shooting in Delaware County, Pennsylvania, when a woman with a psychiatric history named Sylvia Seegrist killed three people and injured seven others. The point to make is that such tragic incidents are extremely rare.

You can use the media to get our messages across to the general public. There are a number of avenues for doing this, such as appearing on talk shows, taping a public service announcement, or getting interviewed by your local newspaper.

Contact local television and radio talk shows and suggest that they do a show on a topic concerning mental illness. Such topics, particularly concerning homeless people who have mental illnesses, are hot right now, so you have a good likelihood of getting on. Offer your most articulate group member as a guest.

Studies have shown that the way to counter negative stereotypes is not to discuss them but to replace them with positive images. In other words, "I'm not here to discuss Sylvia Seegrist but to talk about the thousands of mental health consumers who lead productive lives." Don't you bring up Sylvia Seegrist (or similar incidents) if the interviewer doesn't.

In order to counteract these negative images, it's good to be as positive as possible when dealing with the press or appearing on television or radio. In interviews, stress examples of people with mental disabilities who have overcome their problems and are "making it" in the community. You yourself are such an example. Tell your "story." Talk about how you were helped by the self-help/advocacy movement.

Remember: No matter what they ask you, you can still get your message out. If the interviewer asks a question you don't want to answer, you can give the question short shrift and then switch the focus to what you do want to say. (You might say something like, "That's an interesting question, but did you know that. . ." and then get your point out.) If the interviewer asks a question you don't know the answer to, say you don't know but that you will find out and get back to them later. (This works better in print interviews than on TV or radio, naturally.)

Let's say the interviewer is asking about the Galioto case -- a case argued before the Supreme Court in which the National Mental Health Consumers' Association filed an amicus brief. (This case revolved around the fact that, until recently, people with psychiatric histories were denied the right to own guns under any circumstances, although convicted felons had the right to have their cases reviewed. The law has since been changed so that this is no longer true.) Let's say the interviewer asks, "Isn't it dangerous to allow mental patients to have guns?" Naturally, you should make the point that studies have shown that there is only a weak link between mental illness and violence. (Be prepared to cite these studies if you are challenged.) But don't get involved in defending the position that people with mental illnesses should be allowed to have guns. The real issue, you would tell the interviewer, is that people with psychiatric histories should have the same rights as all other citizens. That is, if the Supreme Court denies them the same right of review as a convicted felon, it would set a dangerous precedent, so that soon they might be denied other rights. Guns are not the issue; rights are.

Another key to a successful interview is to have a few colorful phrases memorized -- lines that get your message out and are also exciting, so that the interviewer will want to use them. I have heard people at demonstrations giving interviewers long involved explanations of what was going on, the history of the conflict, etc. This is great for background, to educate the reporter about the issues -- but what the radio stations use on the air is the next person's comment, "We are here to demand our rights!" So phrase your comments to the press in 15-second, quotable "sound bites."

For example, a good, lively phrase is "the last civil rights movement." More and more people have been using this phrase in interviews to describe the consumer movement, and it has been quoted in articles around the country.

If you are being interviewed as a representative of your group or organization and you offer certain opinions that are not those of the group or organization, make sure you identify them as your own opinions.

Don't forget to identify your group or organization, and arrange in advance to have its name, address and phone number flashed on the screen, or repeated over the radio, or printed in the newspaper. (If it's impossible to get all this information out, at least make sure the name of the group and the city it is located in are identified, so people can find it through Directory Assistance.) You can thus use the media to publicize the existence of your organization, so that you can strengthen it by attracting new members.

Don't forget that a picture is worth a thousand words. If you are on television or sitting across from a reporter and are well-dressed with your hair neatly combed and your best foot forward, so to speak, this goes a long way toward convincing an audience that we are human. The next time someone wants to open a halfway house in their neighborhood, for example, maybe they'll remember you and let it happen. That's really what positive visibility boils down to.

More Media Tips

(Editor's Note: The following seven tips were prepared by the Robert Wood Johnson Foundation, Boston, Massachusetts.)

1. Avoid answering the reporter's questions on the first telephone call. It's to your advantage to have a few minutes to gather your thoughts and clarify the message you want to send; otherwise you may phrase something in a way you did not intend. If a reporter catches you off-guard on the telephone, just say, "I'm in the middle of something right now. What information do you need?" After the reporter gives you that information, say, "Fine, let me wrap this up and I'll call you back in 10 minutes." And do call them right back. Delays tend to make a reporter wonder if you're hiding something.
2. Stick to answering only the questions for which you are prepared. You shouldn't be afraid to say, "I don't know, but I'll be happy to check that out and get back to you." Then be prompt in getting that answer, or direct the reporter to the person who does have the answer.
3. Don't make "off-the-record" comments. If you don't want it broadcast or in print, don't say it. It is very possible that there could be conftusion between you and the reporter as to what's on and off the record. [Journalistic ethics require that it you identify a comment as "off the record" before you say it -- afterwards doesn't count -- a reporter may not use it. But mistakes do happen.]
4. Make your point in 15 seconds or less. Anything longer and the reporter will have to edit your answers.
5. Be precise and avoid jargon. Generalities can be misinterpreted. Use specific examples that clarify and make the audience care about your point of view. Speak in terms the general public will understand.
6. Don't let the reporter put words in your mouth. If a reporter says, "So you're saying . . ." answer with, "I'm saying . . ." and, in a friendly way, restate your position.
7. Take time to educate the reporter. Reporters are often sent out on a story with little background information on the topic. They won't be offended by a friendly briefing on what has transpired to date; they'll appreciate it.

Community Service

Your group should volunteer its services in the community in some substantive way. For example, you can volunteer in hospitals or public park clean-up units, or to collect and sort trash for recycling, or to visit shut-ins or read to the blind, or in any number of other worthwhile efforts. And when you make it known that you are a group of mental health consumers -- people with mental illnesses -- who are performing this service and people get to know you as good citizens of their community, this goes a long way toward fighting stigma.

Media Watch

Everyone should be on the lookout for stigmatizing stories, cartoons, editorials, movies, television shows, even greeting cards -- that is, anything in the media that portrays people with mental illness in a negative light. Then write letters, and get everyone you know to write letters, protesting such stigmatizing material.

For example, in July 1987, the Atlantic published a piece of short fiction called "Inn Essence" by Ralph Lombreglia. The story was about a man who had just been released from a mental hospital and was working as a chef, who attacked several of the restaurant's workers with a carving knife. We wrote to the magazine, stating the point that people with mental illnesses are no more violent than the general public, and that this myth makes it difficult for us to live in the community.* The Atlantic published the letter in November, along with a response from Mr. Lombreglia, in which he said that we had a good point and he regretted any offense he had given. Ideally, every time anything like this appears, the perpetrator should be flooded with letters. When the media understand that they can't get away with this anymore, they'll stop.

*Editor's Note: In 1987, the most recent research indicated this. However, more recent studies (most notably, the MacArthur study) have shown that, when you factor out drugs and alcohol, there is only a weak link between mental illness and violence.

Pie-in-the-Face and Pie-a-la-Mode Citations

When your group identifies particularly horrible examples of stigmatizing, sensationalized coverage of mental health issues, or particularly good coverage, you can condemn or congratulate the perpetrators, appropriately. For example, the Mental Health Association of Southeastern Pennsylvania called attention to the issue of stigma by issuing Pie-in-the-Face and Pie-a-la-Mode awards. (Pie was actually an acronym, PI&E for Public Information and Education.) PI&E-a-la-mode recipients (good guys) received a framed citation and an apple pie; PI&E-in-the-face recipients (bad guys) got a framed citation and a lemon meringue pie, with instructions on applying it.

Your group can issue such awards, then do a press release, which will kill two birds with one stone: You will make the point that the media should not stigmatize people diagnosed mentally ill, and you may get some positive publicity for your group.

Respond to TV Editorials

When a Philadelphia TV station ran an editorial suggesting that Pennsylvania should broaden its commitment laws, we immediately wrote an editorial contradicting this position, backing up our points with facts, and contacted the station manager. Within days, we were invited to the station to tape an editorial response, which was aired several times over the next week. (TV editorials and responses are roughly 200 words; they must be read in a minute and a half or less. Time yours before submitting it.)

Damage Control

When someone with a psychiatric history commits a crime, the newspapers always run long, sensationalized accounts with headlines like "Mental Patient Runs Amok." When this happens, your group can gear up for a media blitz, stressing the point that, when you factor out drugs and alcohol, there is only a weak link between mental illness and violence.

For example, after the mall shooting (described above), Project SHARE mobilized its forces. We contacted the Philadelphia Inquirer the major Philadelphia daily) and arranged for a reporter and photographer to visit our group. The Inquirer ran an excellent story under the headline "Group fears public will link mental illness, violence," and made the point that such a link would be inaccurate (which was the state-of-the-art knowledge at the time). Within days of the event, we also appeared on newscasts of all three major TV stations and on a couple of talk shows. Besides fighting stigma, the publicity attracted people interested in our group.

If there is time, write a press release with lots of pithy quotes in response to whatever the situation is and send it to reporters. But if this is not possible, don't hesitate to call radio stations, TV stations, newspapers, etc., ask for the reporter who's covering the story, tell them that you have something to say about the subject and ask if they would like a quote from you as a representative of your group. For example, when the closing of Philadelphia State Hospital was announced, we at Project SHARE called the newspapers, wire services, and radio and TV stations and asked, "Would you like some input from a former mental patients about the closing of the state hospital?" Many did.

Before calling, write out a two-or three-sentence quote; this way, if they do want a quote, you'll be prepared and won't have to fumble for words.

Public Service Announcements

Radio and television stations are required to run public service announcements (PSAs), which are "commercials" for services or causes of some sort. They may range from 10 seconds to about a minute in length. You can videotape a PSA about your group -- if you don't have the equipment or the expertise to do this yourselves, you can ask professionals to donate their services. (Many will do work of this kind pro bono publico [for the good of the public].)

Contact the station manager at a local station and ask if they will run your PSA. The PSA might include a couple of members of your group talking about how they have been hospitalized for psychiatric illness, and that it is important to bring these issues out of the closet, in order to fight stigma. You can talk about the fact that people with mental illnesses are organizing, mention the name of your group and where and when it meets, and give a phone number for information.

Mental Health Players

Your group can form a Mental Health Player troupes, which is an excellent community education tool. The players are an improvisational theater group that can perform in churches, schools, or other community gatherings.

It works like this: The actors perform a few five-minute sketches to dramatize problems that people may face. For example, one sketch that is often performed by various players troupes shows two people visiting their neighbor, who has just returned home after six months in a mental hospital. The visitors at first pretend to be welcoming the neighbor back; but they grow increasingly hostile as the visit progresses, demanding to know if the neighbor had had shock treatment or perhaps a lobotomy, and asking how long he was planning to remain in the neighborhood, since there were a lot of children living there. Their host tries in vain to reassure them that he is no threat to their children or their property values.

Another sketch might show a man returning to work after psychiatric hospitalization, and having the personnel director interview him.

After each sketch, the narrator invites the audience to question the performers, who respond in character, giving the answers the characters might have given. This often makes the audience confront their own prejudices, since the prejudices expressed by the characters give the audience permission to express their own. Then, when the performance has concluded, the players "unmask," identifying themselves. The audience then realizes that some of the views expressed, for instance by the visitors in the "Returning Mental Patient" sketch, are ignorant; if they agreed with these opinions, they have some serious thinking to do about their own ideas.

Players troupe exist around the country, and often include mental health professionals and other volunteers. However, while the Mental Health Players fight stigma through the information the audience grasps by watching the sketches, the Players are even more effective when the troupe members are consumers themselves. For example, when the Project SHARE players have identified themselves as consumers, some audiences have audibly gasped.

For more information about how to start a Players troup, contact the Mental Health Association in New Jersey, 60 S. Fullerton Avenue, Montclair, NJ 07042, which has a manual on this subject.

Editorial Board Meetings

Write to the editorial board of your local newspaper and request a meeting. Bring press kits -- clippings about your group, a brochure, a newsletter, whatever you have. You can also bring clippings about the National Mental Health Consumers' Self-Help Clearinghouse and our brochures, to show that your group is in the context of a national movement. Your local paper may not be aware there is a consumer movement; it's time they found out.

Often, stigma is perpetuated through ignorance. It may be news to the editors of your newspaper that people with psychiatric histories are living productive lives in the community. How are they going to find out if you don't tell them?

You will also have an opportunity to educate them about the issues. For example, after the Philadelphia Inquirer ran some bad editorials about the proposed changes in the Pennsylvania commitment laws, Project SHARE met with the Inquirer editorial board and supplied them with some information, such as the testimony from Professor Mary Durham about the disastrous effects that broadening the Washington State commitment laws had on the state's mental health system. Shortly thereafter, the Inquirer ran a balanced editorial, and quoted from the Durham testimony.

Write Articles and Op-Ed Pieces

Newspapers run "guest editorials," or articles on issues in the news, opposite their editorial page. You can write such an article; and submit it to the Op-Ed Editor of your newspaper, for possible publication.

You can also write articles for other local magazines and newspapers. (First, call or write for their editorial guidelines -- that is, the rules they want contributors to follow [such as double-spaced copy, margins of a certain width, etc.].)

Cable TV Shows

If your area has cable TV, write to some of the stations and suggest an idea for a show on mental health issues. You may end up hosting it.

Demonstrations and Protests

One way to fight stigma and educate the public is through staging an event, such as a demonstration or a protest. For example, at Alternatives '88, we staged a candlelight vigil against stigma on the steps of the Utah state capitol. Some 300 people, most of whom were consumers, attended. We had publicized it well, through ads in the entertainment sections of the two Salt Lake City dailies (since we had arranged for folk singers to entertain) and a press release to Utah newspapers, TV stations and radio stations. Two nights before, we mentioned the vigil on a local talk show. We also handed out flyers about the event.

The press release won us articles in both local dailies. The Salt Lake City Tribune article appeared the morning of the vigil, and the mention of the event attracted additional participants from the community. The vigil itself received excellent TV coverage.

Writing a Press Release

A press release is like a little newspaper article. In fact, a small newspaper may decide to run it word for word. It should be roughly 300 words -- no more than 400 to 500 words; (there are roughly 250 to 300 words on a 8-1/2 x 11. page, double spaced). Press releases must be typewritten, and should be on your group's letterhead (if your group doesn't have a letterhead, type your group's name and address at the top). Under this, type, "For Immediate Release," and list at least one contact person, with this person's phone number. Then make sure this phone is covered, either by the contact person or an answering machine -- and return calls promptly.

For the candlelight vigil against stigma in Salt Lake City, our press release started off like this:

MENTAL PATIENTS* STAGE DEMONSTRATION FOR CIVIL RIGHTS AND TO KICK OFF NATIONAL CONFERENCE

SALT LAKE CITY, UTAH -- Mental patients from all over the country will demonstrate against the stigma of mental illness on the south steps of the Utah state capitol on Wednesday, August 3,at 7 p.m.

"Mental patients face discrimination and rejection in every area of their lives," said Joe Rogers, President of the National Mental Health Consumers' Association (NMHCA), the first national organization of present and former mental patients, which is organizing the event. "We are denied jobs, housing and insurance. We are mercilessly stereotyped on television, on the radio, in movies, novels and newspapers. Now we are sending a strong message to this country that we refuse to be treated as second-class citizens any longer.

The press release continued, talking about Alternatives '88 and the national consumer movement. (Notice that the date, time and place of the event that we were publicizing were in the first paragraph.) Your press release must get to the point immediately, since busy editors may not read past the first paragraph.

* Editor's Note: When this press release was written (in 1988), we were using the phrase "mental patients" because we felt it was the most communicative and might capture the attention of the press more easily than a phrase such as "mental health consumers," which would need an explanation. Now, however, we have moved toward such phrases as "people with mental illnesses," "people with psychiatric histories," or "people with mental disabilities," rather than "mental patients," which some people find stigmatizing.

Other Weapons Against Stigma

Two excellent ways to fight stigma are through publishing a newsletter and organizing a speakers' bureau. For more information, see "How to Develop a Consumer-Run Our Sponsors "* and Organizing and Operating a Speakers' Bureau. Both of these Technical Assistance Pamphlets are published by the National Mental Health Consumers' Self-Help Clearinghouse.

*Editor's Note: This particular pamphlet is geared toward people who do not have access to a computer. However, there are many excellent guides to publishing a newsletter, some of which are available on the Web.

Speaking for Ourselves

Not very long ago, many mental health advocacy organizations used the slogan "Speaking for those who cannot speak for themselves." The consumer movement has changed that. As more and more of us are out there, speaking for ourselves in judicial and legislative forums, on boards and committees, before groups in the community and professional organizations, through our own articles and letters in newspapers and magazines, in our own newsletters, on television and radio and in the print media -- or even to our neighbors -- we are fighting stigma. And we must.

FIGHT STIGMA!

References

1. <Channels (monthly newsletter), Public Relations Society of America, Inc., 845 Third Avenue, New York, NY 10022.
2. A Communications Manual for Non-Profits (1981), by Lucille Maddalena, American Management Associations, AMACOM Division, 135 W. 50th Street, New York, NY 10020.
3. Guide to Public Relations for Nonprofit Organizations and Public Agencies (1977), Grantsmanship Center, 1031 S. Grand Avenue, Los Angeles, CA 90015.
4. If You Want Air Time (1982), National Association of Broadcasters, 1771 "N" Street, NW, Washington, DC 20036.
5. Publicity Guide for Fundraisers (1981), by J.M. Williams, Training for Living Press, Mattituck, NY 11952.
6. Public Relations Guides for Nonprofit Organizations, Foundation for Public Relations, 575 Madison Avenue, Suite 1006, New York, NY 10022.
7. Successful Public Relations Techniques, Public Management Institute, 333 Hayes Street, San Francisco, CA 94102.
8. We Interrupt This Program . . . A Citizen 's Guide to Using the Media for Social Change, by Robbie Gordon, Citizen Involvement Training Project, Cooperative Extension Service, University of Massachusetts at Amherst