Communicating about Mental Illness and Violence: Balancing Stigma and Increased Support for Services

Abstract

In the ongoing national policy debate about how to best address serious mental illness (SMI), a major controversy among mental health advocates is whether drawing public attention to an apparent link between SMI and violence, shown to elevate stigma, is the optimal strategy for increasing public support for investing in mental health services or whether non-stigmatizing messages can be equally effective. We conducted a randomized experiment to examine this question. Participants in a nationally representative online panel (N=1,326) were randomized to read one of three brief narratives about SMI emphasizing violence, systemic barriers to treatment, or successful treatment and recovery or to a control arm. Narratives, or stories about individuals, are a common communication strategy used by policymakers, advocates, and the news media. Study results showed that narratives emphasizing violence and barriers to treatment were equally effective in increasing the public’s willingness to pay additional taxes to improve the mental health system (55% and 52% versus 42% in the control arm). Only the narrative emphasizing the link between SMI and violence increased stigma. For the mental health advocates dedicated to improving the public mental health system, findings offer an alternative to stigmatizing messages linking mental illness and violence.

Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis

“…This suggests that fiscal concerns are not the only core attribute of this segment. Attitudes towards people with mental illness (e.g., perceptions of the extent to which their problems are the result of individual versus structural issues) [ 5 , 26 , 72 ] and other characteristics often associated with people with mental illness (e.g., low social class, minority race/ethnicity) [ 73 ] potentially play an important role and should be considered in dissemination strategies.…”

“…Narratives are important in policymaking processes because they are engaging and evocative, can humanize abstract problems, and illustrate how contextual factors (that can often be modified by policies) affect individuals [ 81 , 82 ]. Two experiments have tested the effects of narrative-focused dissemination materials on support for evidence-based policies among state legislators (one study focused on cancer [ 65 ], one focused on obesity [ 50 ]), and numerous studies have tested the effects of narratives about behavioral health issues on policy support among the general public [ 26 , 83 – 85 ].…”

“…A review of policy dissemination research funded by the National Institutes of Health between 2007 and 2014 did not identify any projects focused on disseminating behavioral health evidence to legislators or other policymakers in the USA [ 16 ]. Effective policymaker-focused dissemination strategies are presumably different for behavioral health than physical health because stigma towards people with behavioral health conditions is pervasive [ 13 , 21 – 26 ] and because willingness to allocate financial resources is lower for behavioral health than physical health services [ 27 , 28 ]. Furthermore, while policy dissemination research is a rapidly growing field outside of the USA [ 18 ], these studies have primarily focused on administrative officials who have specialized knowledge about health.…”

Political Science and U.S. Health Policy in the Era of the Affordable Care Act

“…Policy feedback effects reshape the political environment and interactions with this environment via resource effects, interpretative effects, and institutional supports (Patashnik & Zelizer, ). Some of the specific effects that researchers have identified are the extent to which policies create their own constituencies, or vested interests (Campbell, ; Kelly, ), the distribution of tangible resources (Campbell, ; Kelly, ; Mettler, ), the degree of visibility of government intervention (Campbell, ; Mettler, ), the perception of government (Mettler, ), political mobilization and demobilization (Campbell, ), and interpretations of deservingness as well as real or perceived stigmatization (McGinty, Goldman, Pescosolido, & Barry, ).…”

“…Indeed, particularly on contentious issues like health reform, individuals see themselves confronted with an onslaught of competing frames (McGinty, Wolfson, Sell, & Webster, ). Various articles addressed the effects of competitive framing in a diverse set of contexts including such issues as gun violence and gun control (McGinty et al, ), sugary drinks (Gollust, Barry, & Niederdeppe, ), perception of the connection between serious mental illness and violence (McGinty et al, ), and opioid abuse by pregnant women (Kennedy‐Hendricks et al, ).…”