Mental Health: Reducing stigma and raising awareness through

health communication
Alesha L Cooke
The University of North Carolina at Greensboro
April 2015

Murphy Sullivan, Preceptor

Vincent Francisco, PhD, Co Preceptor

Abstract
This paper examined the internship experience of one graduate student at The University of North
Carolina Greensboro. The internship was the culminating experience of the Master of Public Health
degree. The internship took place at the Mental Health Association of Greensboro and had a health
communications focus. The Mental Health Association in Greensboro was established over seventy years
ago with the goal of promoting mental wellness and supporting recovery from mental illness. However,
due to lack of knowledge and access to mental health services the Greensboro community is not
benefiting from organizations such as MHAG. Thus, the goals of the internship were to increase
awareness of the Mental Health Association in Greensboro as a trusted resource for mental health and
reduce stigma related to mental illness. To achieve outlined goals a small scale health communications
campaign was undertaken. The campaign involved creation of a health communications plan for a major
annual summit, development of marketing materials for community events and distribution of materials.
Due to budgeting constraints the organization did not have marketing materials; however, the results of
the campaign show that health marketing materials to promote the organization and raise mental health
awareness are needed to reach members of the community and ultimately reduce stigma.

Introduction
At least half of the adult population in the US has had or will have a psychiatric disorder at some
point in their life. Currently 25 % of American adults are living with mental illness (Centers for Disease
Control and Prevention [CDC], 2013). In any one year, one in five adults will experience a mental
illness. Forty-five million Americans suffer from depression, anxiety, schizophrenia and PTSD. The
statistics are not discriminatory. Young people are affected at similar rates as adults. According to the
CDC mental illness is defined as collectively all diagnosable mental disorders or health conditions that
are characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired
functioning, (CDC, 2013). While the research surrounding mental illness and available resources have
increased over the years there is still much to be done to promote mental health among Americans
(Harvard mental health letter). Mental illness can be associated with increased occurrence of chronic
diseases such as cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer (CDC, 2013).
Serious mental illness (SMI) is defined by federal regulations as any psychiatric disorder experienced by
people aged 18 years and older that substantially interferes with the ability to participate in major life
activities
In North Carolina approximately 9.2 million residents, close to 335,000 adults and an estimated
99,000 children live with serious mental illness. North Carolinas public mental health system renders
services to only 34% of the adults in the state (National Alliance on Mental Illness, 2010). In a report
published by the Cone Health Foundation many residents of Guilford County, NC expressed
discontentment over the quality of mental health services. There are a large number of mental health
services offered but not a sufficient amount of health providers and physicians. More specifically, the
behavioral health providers in Guilford County are not accessible by many subsets of the population
including children, immigrants/refugees and homeless. The limits of accessibility extend beyond
diversity. There are also gaps in mental health access as it relates to costs, waiting lists, transportation and

location of services (Cone Health Foundation, 2010). Overarching most of the barriers to mental health
care and recovery are stigma.
Stigma
People with mental illness are at a disadvantage in a society with a prevailing stigma of mental
illness. Stigma has been cited as a psychosocial issue whose effects are more disastrous to health and
wellbeing than the condition itself (Chronister et al., 2013). Individuals with a mental illness diagnosis are
less likely to be hired, less likely to be approved for lease of an apartment and more likely to have charges
pressed against them for violent crimes (Corrigan, 2000)
Newsworthy evens such as the bombing at the Boston marathon in 2013, Colorado movie
shooting in 2012, second Fort Hood shooting in 2014 and most recently the suicide plane crash in
Germany all paint a grisly picture of those suffering from mental illness. Details of these tragic events
were announced from varying news broadcasts and articles. Around the world people gain knowledge
through various forms of media, if employed properly media could create a perception of mental illness
grounded in reality and through a positive restorative lens. Negative depictions of mental illness from
sources such as the news, radio and television are often the result of industry pressures. Most stories are
sensationalized to spark interest and increase ratings and viewership, but at what cost? Directors of
movies such as A Beautiful Mind, Melancholia, Silver Linings Playbook and many more have tackled the
topic of mental health without perpetuating stereotypes but by evoking empathy and understanding from
viewers. The bottom line is there is power in communications, such as the media. Positive, supportive
messages can be presented or negative stereotypical images can be created. However, despite how many
positive messages are communicated all it takes is one devastating news report of a murder suicide by a
suspect identified as mentally ill to perpetuate the surge of stigma related to mental illness.
There are many supporters of mental health care and the mental health community that work
behind the scenes to ensure people are receiving the care and recovery services they need. Some of these
supporters include famous celebrities speaking out about their own battles with mental illness and
politicians beginning to address policy surrounding mental health care. During the 2013 National
4

Conference on Mental Health President Obama thoroughly expressed the steps necessary to move the
nation into a better predicament for mental health care. As he stated many people do not hesitate to go to
the doctor for physical ailments such as broken bones and ligaments, but many rarely seek care for mental
illness. There are countless commercials broadcasted depicting physical illness and options for help and
recovery, but very few commercials related to mental health. Mental illness is not just an individual
concern. A diagnosis can affect the family, friends and community of those suffering. Also, he discussed
the large majority of those suffering mental illness are non violent. While there are individuals with
mental illness that are violent there is not a gap between those with and without diagnosed mental illness.
President Obama also discussed improvements in science and research that would aid in diagnosing and
treating mental illness early. Also, there is an initiative underway to develop tools that would allow
scientists and researchers to investigate areas of the brain related to mental health. Under the Affordable
Care Act 60 million more Americans will be receiving mental health and substance abuse benefits.
Insurance companies are now required to cover depression screenings for adults and behavioral
assessments for children (The White House, 2013). Though it is a long process there are strides being
made to move the nation to a better place in mental health care. The rise in interest related to mental care
is also related to elevated numbers of military veterans returning home with illnesses such as PTSD (The
White House, 2013). Using the powerful force of the media to portray mental illness in a positive light
and communicate the work being done in the field would make an indelible impact on mental health
stigma.
Health Communication
Research identifies three approaches as best strategies for reducing stigma surrounding mental
illness within communities: protest, education and contact (Corrigan, 2000). Of these three, education and
contact are the most successful strategies. Education involves increasing knowledge of mental illness to
erase false information and negative stereotypes. It is believed that the more information the public can
gain on a topic, the less likely they are to support discrimination and prejudice leading to more informed
decision making (Corrigan, 2000). Positive communities that possess factual knowledge of mental illness
5

create an environment that is healing to its members with a mental health diagnosis (Chronister et al.,
2013).
The contact strategy involves interaction among members of a community and individuals with
diagnosed mental illness. This interaction would facilitate a positive interaction changing negative
attitudes towards the group that the individual represents. This can be achieved through presenting
positive images through the media of persons with mental illness, hosting diverse community events and
introducing people with whom a community is familiar that has a mental health diagnosis (i.e. celebrity,
political figure, etc.) Also, increased social support has been shown to speed the mental health recovery
process (Chronister et al., 2013).
Researchers examined the impact of a national mental health arts festival on reducing negative
attitudes towards mental health and increased education. They examined the demographic likely to attend
mental health events. The authors found that the festival had a positive impact on attitudes towards mental
health. Respondents also revealed greater acceptance towards people with mental health concerns (Quinn,
N., Shulman, A., Knifton L., & Byrne, P., 2011). Combining education and contact, health communication
covers all of the aspects of impact. Messages can be communicated through community social and arts
events or through print and social media.
Much research on social media and mental health has shown that social media and media in
general have a positive effect on mental health. This positive effect can be contributed to an influx of peer
support present on social media sites. Peer support is vitally important to recovery from and management
of mental illness. Within sites such as Face book and YouTube there are channels and groups dedicated to
the support of those suffering from all forms of mental illness. In these spaces individuals can connect and
reach out to others suffering from similar diagnoses without leaving the comfort of their homes. On the
Contrary, it is acknowledged that a lack of anonymity can make one susceptible to negative experiences.
In an article published by (Stuart H., 2006) authors state that the media is no more of an enemy to
the mental health community than any other group. However, the negative depictions of mental illness in

the media, which then trickle down to social media, are often the result of industry pressures. Most stories
are sensationalized to spark interest and increase ratings and viewership. Research also highlights that
within social media there are more supportive commentary than inappropriate comments. However, this
raises the concern of anonymity and freedom of speech. Comments can be flagged inappropriate and
removed; however, at that point damage may have already been done if the comment has been seen.
In using health communications to combat stigma it is important to keep in mind cultural
variations. Approaches used to address an entire population of people should be adjusted to account for
these differences. In an article by (Knifton, L., Gervais, M., Newbigging, K., Mirza, N., Quinn, N.,
Wilson, N., & Hunkins-Hutchison, E., 2010) researchers found than when catering interventions to suit
the ethnic group represented there changes in attitudes and beliefs towards. However, overriding cultural
accommodation was the use of community workshops, which researchers state work better than top down
approaches such as national campaigns.
Mental Health Association in Greensboro
The Mental Health Association in Greensboro is one of many organizations across the nation
working to improve mental health recovery outcomes and eliminate stigma related to mental illness. The
mission of the Mental Health Association in Greensboro is to provide leadership in identifying and
addressing mental health needs in Greensboro and serve as an advocate for the mentally ill. The
Association seeks to maximize the mental wellness of individuals, families and communities through
education, services, and collaboration with mental health professionals. The Association serves as a portal
for those seeking mental health information and services. The organization envisions a just, humane, and
healthy society in which all people are accorded respect, dignity, and the opportunity to achieve their full
potential free from stigma and prejudice, (MHAG, 2014).
Currently, to fulfill its mission and vision MHAG offers education classes and programs covering
topics from wellness and suicide prevention to peer support. Along with classes the association hosts

conferences, mental health screenings and other events throughout the year across the Greensboro area.
MHAG encourages the use of referrals to increase access to mental health care, recovery and support.
Historically, majority of the program participants are through referral. However, as the landscape of
medical providers changes the presence of the Mental Health Association of Greensboro as a trusted
resource in the community diminished due to little to no incoming referrals. Also, there are not many
activities generating participants from the community at large. Using heath communication to raise
awareness of mental health and reduce stigma coupled with increasing medical provider referrals will
establish the Mental Health Association in Greensboro as a resource for mental health and lead to healthy
mental health outcomes for the city of Greensboro. The purpose of this paper is to address the utility of
health communications in an effort to reduce stigma related to mental illness and to raise awareness of
organizations and resources, such as the Mental Health Association in Greensboro, as a support for those
suffering from mental illness.

Methods
The graduate student developed a health communications plan that would be used for the Mental
Health Recovery Summit hosted by the Mental Health Association in Greensboro and partner agencies.
The Mental Health Recovery Summit is a conference attracting health professionals from different
specialties with a focus on mental health and substance abuse. The conference for 2015 would be a
collaborative effort between The Mental Health Association in Greensboro, AHEC and Cone Health. The
health communications plan was developed with assistance from the internship preceptor. The health plan
outlined the ways in which the organizations would work to reach the target audience for recruitment for
the summit.
Data Analysis
There was not a formal study conducted to evaluate which strategies work best to reach the target
population for the summit. However, through development of the communications plan a small literature
review was carried out to find best modes of contact for health professionals such as psychologists, social
8

workers and nurses. Also, staff at MHAG contributed past successful contact strategies. Due to the move
towards health technology to communicate information to patients and among providers many modes of
contact involve email and internet based contact. Table 1 depicts identified contact methods.

Target Audience
Physicians
Nurses
-Congregational Nurses
-Psychiatric Nurses
-School Nurses

Psychologists
Social Workers

Counselors
-Substance Abuse Counselors
-Mental Health Counselors
-Rehabilitation Counselors
-School Counselors

Peer Support Specialists

Emergency Professionals
-Paramedic
Academic Professionals
-UNCG
-NCAT
-Guilford College
-Greensboro College
-GTCC
Coalitions
- Guilford Nonprofit Consortium
- NC ROCS Statewide Coalition
-Partners for Healthy Youth
-Cottage Grove Initiative
-Partnership for Community Care
Mental Health Organizations
-MHAG
-Guilford Center
-Family Services of the Piedmont
-NAMI Greensboro
-Sanctuary House
-Cone Health
-Day mark
-Salvation Army
-Greensboro Urban Ministry
-Community Clinics
-NC A&T Center for Behavioral

Recommended Communication
Strategies
-Email
-Fliers/Posters in Work/Break areas
-Email
-Email to local colleges (UNCG, NC A
&T, Greensboro College, etc.)
-Fliers/Posters/Palm Cards in
UNCG/NC A&T Nursing Departments
Fliers/Posters/Palm Cards in
Break/Work areas
Career Counseling Center
-Email
-Fliers/Posters in Work/Break areas
-Email
-Fliers/Posters in Work/Break areas
Career Counseling Center
-Email
-Email to local colleges (UNCG, NC A
&T, Greensboro College, etc.)
-Fliers/Posters in Work/Break areas
-Fliers/Posters/Palm Cards in
UNCG/NC A&T Counseling
Departments
-Career Counseling Center
-Email
-Fliers/Posters in Work/Break areas
-Word of Mouth
-Email
-Email
-Fliers/Posters in academic departments
-Presentation on college campuses
-Campus Newsletters and Campus radio

-Email
-Presentation to coalition

-Email
-Fliers/Posters in Work/Break areas
-Post information to organization
website
-Presentation to organization

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Results
Creation of the health communication plan consumed most of the internship and was the primary
activity. However, along with the health communications plan, health marketing materials were created
and distributed throughout Greensboro. Each year a local grocery store, Whole Foods, votes on an
organization to receive 5% of its profit for one day. This year, The Mental Health Association in
Greensboro was the chosen organization. In preparation for the event the intern brainstormed ideas for
setting up a table to inform consumers about the 5% day. The final set up involved the use of a large,
colorful spin wheel to draw individuals to the table. The spin wheel was a part of trivia game that would
allow table visitors to answer questions related to the organization, mental health recovery and mental
illness. The winner would receive a pen with the organizations logo imprinted. In the days leading up to
the 5% shopping day the table was staffed form 10am-7pm by volunteers, staff and the intern.
Also, there was an annual auction event. The Art of Healthy Living Auction was an annual
fundraising event hosted by the organization. The event brought together several business owners,
organizations, philanthropists, volunteers, staff and community members to purchase items through silent
and live auction to be donated to The Mental Health Association in Greensboro. The event was advertised
on the organizations website and donors were contacted via phone and email. Over the course of the
internship the student also maintained a database of potential grant opportunities and donors. This will
continue to be updated after the internship and will provide a great source of future funding opportunities
to increase the visibility of the organization and mental health as a whole.
In preparation for the Mental Health Recovery Summit and after creation of the health
communications plan brochures were created to advertise for the conference. The brochure was sent via
email to several designees and printed to be distributed throughout Greensboro. The brochure was
disseminated to several nonprofit organizations, doctors offices, hospitals, clinics and colleges and
universities in the area. Registration is still underway for the event but there are currently a successful
number of registrants for the summit. The initial goals and objective for the internship are outlined below.

11

All of the impact objectives except for one were completed. There was not an assessment of the
communitys current position on mental health as no data was collected. This objective was not attempted
partly due to time restraints and goals of the staff and preceptor at the organization site. One of the
outcome objectives was completed. There was not enough time to create an evaluation proposal and
therefore the second objective was not attempted. If the objectives were successful in leading to
completion of proposed goals the goals should be accomplished. However, because there was not a formal
evaluation it is not confirmed that the proposed internship goals were accomplished. The first two goals
of increasing awareness and reducing stigma were the focus of the internship. This is due to the fact that
these goals most aligned with the vision and mission of the organization.
Goals:
1. To increase awareness of the Mental Health Association in Greensboro as a trusted resource for mental
health recovery and support.
2. To reduce stigma among the Greensboro population through education and contact.
3. To increase number of direct referrals from medical providers.
Impact Objectives:
1. Engage stakeholders in the planning and implementation process
2. Use social marketing (SMART) to launch campaign
3. Assess the communitys current position on mental health (what is known and unknown/beliefs and
attitudes towards mental health)
Outcome Objectives:
1. Launch a health communication campaign to raise awareness about the Mental Health Association in
Greensboro and to provide education to the Greensboro population.
2. Develop an evaluation proposal that can be used at a later time to evaluate the effectiveness of the
health communication campaign

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Discussion
The purpose of this paper was to address the utility of health communications in an effort to
reduce stigma related to mental illness and to raise awareness of organizations and resources, such as the
Mental Health Association in Greensboro, as a support for those suffering from mental illness.
Overcoming the stigma surrounding mental illness will have a significant impact on mental health in
communities here in the US and across the globe. Stigma stifles mental health treatment and recovery.
Many individuals do not seek treatment for fear of being labeled. Seeking mental health services in a
stigmatized environment can produce feelings of shame, fear and guilt (Stickney, S., Yanosky, D., Black,
D., & Stickney N., 2012). Thus, reducing stigma will increase mental health care and overall mental
health. This internship produced several health communication materials such as brochures, community
event items and a health communications plan.
However, the most valuable results of the internship were intangible. Through the use of a small
scale health communication plan the organization in conjunction with partners Cone Health and AHEC
were able to have successful numbers for registration for the mental health recovery summit. Items
created for the Whole Foods 5% day contributed to a generous donation to the Mental Health Association
in Greensboro. All in all it was revealed that investing in communicating information related to mental
illness and organizations such as The Mental Health Association in Greensboro will lead to healthier
recovery for those diagnosed with mental illness and better mental health for everyone. Health
communication creates conversation. In these conversations facts and positive images are tossed around
working to slowly tear down the greatest barrier to mental health recovery and awareness, stigma.
Limitations
The major limiting factor for complete evaluation of the impacts of health communications during the
internship was time. At the start of the internship it appeared that 180 hours is a large amount of time and
it was expected that an evaluation of the health communications plan and other activities would be
plausible. However, unforeseen challenges such as the interest of organization staff, life events and
13

scheduling were not fully accounted for. All health communications were completed; however, there is
not a formal report of the success of these activities on raising awareness of The Mental Health
Association in Greensboro or reducing stigma in the Greensboro area.
Implications
The internship highlighted the need for greater access to health marketing materials and funding
for mental health and organizations serving the mentally ill. During the internship the graduate student
continuously updated the organizations grant/donor data base and performed several grant searches.
While searching for grants there were a tremendously lower amount of grants available for mental health
than other areas such as chronic disease and cancer. As mentioned in the National Conference on Mental
Health as a nation we would not feel comfortable knowing thousands of Americans diagnosed with cancer
are not receiving care, so we should feel the same uneasiness knowing that only forty percent of
Americans with mental illness receive treatment and only half of the children with mental illness receive
treatment (The White House, 2013).

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