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 nonstigmatizing 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 a control arm or to read one of three brief narratives about SMI emphasizing violence, systemic barriers to treatment, or successful treatment and recovery. Narratives, or stories about individuals, are a common communication strategy used by policy makers, advocates, and the news media. Study results showed that narratives emphasizing violence or barriers to treatment were equally effective in increasing the public's willingness to pay additional taxes to improve the mental health system (55 percent and 52 percent, vs. 42 percent in the control arm). Only the narrative emphasizing the link between SMI and violence increased stigma. For mental health advocates dedicated to improving the public mental health system, these findings offer an alternative to stigmatizing messages linking mental illness and violence.

Keywords: advocacy; communication; mental illness; policy; stigma; violence.

Exhibit 2

Narrative effects on willingness to pay any additional taxes to improve the mental health system, compared to the control arm¹ (N=1,326) *p<0.05, **P<0.01, **p<0.001 ¹This figure shows predicted probabilities calculated from the logistic regression model assessing the effects of narratives on respondents’ willingness to pay any additional taxes to improve the US mental health service system, compared to the control arm.

Figure 1

Baseline Public attitudes about willingness to pay for mental health system improvements, stigma and policies to expand mental health services in the no-exposure control arm (N=342) *Serious Mental Illness ¹Respondents were first asked, “Would you be willing to pay any additional taxes to improve the mental health service system in the United States?” (Y/N). Those who answered yes were then asked, “Would you be willing to pay $50 per year more in taxes to improve the mental health service system in the United States?” (Y/N). ² “How willing would you be to have a person with serious mental illness marry into your family?” 1 (definitely unwilling) – 5 (definitely willing); “How willing would you be to have a person with serious mental illness start working closely with you on a job?” 1 (definitely unwilling) – 5 (definitely willing); and “People with serious mental illness are, by far, more dangerous than the general public” 1 (strongly disagree) – 5 (strongly agree). The figure shows the percent of respondents reporting 4 or 5 on each scale. ³Do you favor or oppose: “Expanding outpatient public mental health treatment options in the community;” “Expanding public programs to find housing and to help subsidize the housing costs for people with serious mental illness;” “Expanding public programs to help people with serious mental illness find jobs and provide on the job training and other support if needed;” “Expanding community crisis-response programs to help people with serious mental illness manage crises and connect to services;” “Creating more long-term psychiatric hospitals where people with serious mental illness can stay for long periods of a month or more;” “Reducing legal restrictions on involuntary treatment to make it easier to treat someone with serious mental illness without their permission because they are considered a dangerous threat to themselves or others;” and “Reducing legal restrictions on involuntary treatment to make it easier to treat someone with serious mental illness without their permission because they are considered incompetent to make treatment decisions” 1 (strongly oppose) – 5 (strongly favor). The figure shows the percent of respondents reporting 4 or 5 on each scale.

Figure 2

Narrative effects on willingness to pay additional taxes to improve the mental health system, compared to the control arm¹ (N=1,326) *p<0.05, **P<0.01, **p<0.001 ¹This figure shows predicted probabilities calculated from the logistic regression model assessing the effects of narratives on respondents’ willingness to pay $50 per year more in taxes to improve the US mental health service system, compared to the control arm.