views of the literature indicate a relationship between media exposure and the formation of gender stereotypes (Signorielli, 2001), aggression and desensitization to violence (Bushman & Anderson, 2001), particularly among children and young adolescents (Roberts, Henriksen, & Foehr, in press), and body image in adolescent women (Groesz, Levine, & Murnen, 2002). Furthermore, the media serve as a source of information for youth; over half of teenage women report learning about sex and birth control from TV, movies, and magazines (discussed in Brown & Witherspoon, 2001). Similar findings have been observed for knowledge about mental illness. In a qualitative study with 12-to 14-year-olds, all of the participants reported that television was their primary source of information about mental illness (Secker, Armstrong, & Hill, 1999). These findings suggest that the media can influence adolescent beliefs about mental illness, perhaps in a positive way. This notion will be discussed in more detail below.

Various approaches to reducing stigma of mental disorders have been attempted, mostly in the areas of education and promoting personal contact (Corrigan & Penn, 1999). Educational interventions have included various strategies, ranging from those that are brief (e.g., fact sheets, brochures; Penn et al., 1994; 1999) to more extensive interventions (e.g., semester-long courses) that provided factual information on mental illness and dispelled myths (e.g., Holmes, Corrigan, Williams, Canar, & Kubiak, 1999; reviewed in Corrigan & Penn, 1999; Hinshaw & Cicchetti, 2000; Mayville & Penn, 1999). In general, education appears to have a short-term impact on attitudes; however, the longitudinal stability of the findings has not been adequately evaluated (Corrigan & Penn, 1999). There is some evidence that education also has an effect on helping behaviors (e.g., donating money to the National Alliance for the Mentally Ill (NAMI); discussed in Corrigan, 2002), but the impact of education on specific discriminatory behaviors (e.g., treatment at work) has to this point not been assessed.

Promoting personal contact between a stigmatized group and community members is based on the “contact hypothesis,” which has an extensive history in the study of racism (Jackson, 1993; Kolodziej & Johnson, 1996). According to this hypothesis, contact effects will be strongest when the individuals meet as equals, have a chance to work cooperatively, rather than competitively, on a task, and when the target person mildly disconfirms the stereotype. The last criterion refers to the finding that encountering someone who greatly disconfirms a stereotype may result in categorizing that target as an “exception” to the rule. Therefore, positive experiences with the target individual will not generalize to the broader group (Johnstone & Hewstone, 1992).

With respect to mental illness stigma, contact has been provided in the context of volunteer activities, classroom experiences, job training, and simulated laboratory encounters (reviewed by Couture & Penn, 2003; Kolodziej & Johnson, 1996). The findings suggest that contact effects are especially impressive and robust (Corrigan, 2002; Couture & Penn, 2003); a recent meta-analysis of the literature reported that the average effect size of contact on attitudes was .34 (Kolodziej & Johnson, 1996). These effects were largest when the contact was provided to students, rather than professionals, especially if the contact was not a required part of the classroom or training experience (Kolodziej & Johnson, 1996). These findings indicate that promoting personal contact can reduce stigma toward persons with mental illness.

Most of these studies were conducted with either college-age student samples or with adults in the community. In addition, there have been numerous grass roots or community efforts to reduce stigma, some focused on children and adolescents (Estroff, Penn, & Toporek, in press; WPA, 2002). However, most of these community efforts either did not collect outcome data or are in the process of collecting it. Therefore, we will report on the few studies that have been conducted with younger adolescents that evaluated outcomes related to stigma.

Petchers, Biegel, and Drescher (1988) imple

mented a video-based educational program in two high schools. The program included a videotape of teenagers discussing their experiences of having a person with mental illness in the family, along with a six-lesson educational supplement. The results of a posttest-only design showed that participation in the video-based program was associated with higher ratings on a measure that assessed both knowledge about and attitudes toward mental illness, relative to participants who did not participate in this program. These findings are limited by the posttest-only design and use of a nonstandard measure of stigma.

Esters, Cooker, and Ittenbach (1998) assigned two classes of rural high school students to receive either 3 days of instruction on mental health, which included an instructional video, and information pertaining to sources of help in the community, or instruction unrelated to mental health. Participants completed measures that assessed attitudes toward receiving treatment and to persons with mental illness, prior to and following the course instruction and at 12-week follow-up. The results showed that the mental health instruction was significantly associated with improved attitudes both toward persons with mental illness and with seeking professional help; findings that held at follow-up.

Schulze, Richter-Werling, Matschinger, and Angermeyer (2003) also implemented an educational intervention, but one which included a contact component. Ninety high school students signed up for a program entitled Crazy? So What, a 5-day program that involved the presentation of information about mental illness, meeting someone with schizophrenia (who discussed their personal experiences with the illness, treatment, and stigma), and group discussions. Participants in this program were compared to high school students who chose to sign up for non–mental health–related projects. The results showed that Crazy? So What produced a significant reduction in negative stereotypes and a trend toward less social distance after participation in the project. These results remained stable at 1-month follow-up. Interpretation of these findings needs to be tempered by the fact that participants self-selected into the project. Thus, the preexisting characteristics that led to partic ipation in the mental health project may have also been the underlying mechanism by which the program exerted its effects.

Finally, Pinfold et al. (2003) evaluated the effectiveness of two mental health awareness workshops on attitudes toward and knowledge of mental illness in 472 secondary school children in the United Kingdom. An individual who worked in the mental health field led the first workshop, which included viewing a videotape about people living with mental illness and challenging negative stereotypes of mental illness. An individual who shared her or his personal experience with having a mental illness facilitated the second workshop. The results showed that the workshops had a positive impact on attitudes and knowledge of mental illness, with attitudinal changes remaining stable across 6-month follow-up. These results were especially strong for individuals who reported previous contact with someone with a mental illness. Again, the value of these findings was circumscribed by the uncontrolled design.

Although limited in number and by methodological limitations, these findings are nevertheless promising. The findings also converge on a number of themes. In particular, consistent with previous findings obtained from adult samples (Couture & Penn, 2003), promoting contact seems to be a key element in reducing stigma. In addition, there is indirect evidence that demonstrating the effectiveness of psychiatric and psychological treatments, either through direct instruction (Esters et al., 1998) or via role models (Schulze et al., 2003), may reduce stigma, a finding consistent with the survey data reported earlier in this chapter (Table 27.4). Therefore, facilitating personal contact between members of the community and individuals with mental illness, and promoting the effectiveness of treatments for mental illness, may be crucial to reducing stigma among youth.

Because adolescents are heavy media users, greater use of mass media to reduce, rather than augment, stigmatizing attitudes should be explored. This can be done in a number of ways. First, the media can serve as a resource for adolescents with a mental illness. For example, Gould, Munfakh, Lubell, Kleinman, and Parker (2002) found that nearly one fifth of New York

adolescents reported using the Internet to help with emotional disorders. Unfortunately, over 20% of the respondents were not satisfied with the information they found, which suggests that the content and links provided by some of the Web sites were inadequate. Second, the media can be educated to report on mental illness responsibly (Gould & Kramer, 2001; Salter & Byrne, 2002). This has been advocated in the context of suicide in adolescents by addressing contagion, the increase in suicides that follow from the reporting of suicide stories in the news media (Gould & Kramer, 2001; Gould, Jamieson, & Romer, 2003). Such responsible reporting can also be extended to presenting information about mental illness with the aim of educating the public about the efficacy of treatment for mental disorders, providing the information in a more balanced manner, and avoiding attention-grabbing, pejorative headlines (Gould et al., 2003; Wahl, 1995).

Stigma reduction may also be achieved by integrating mental illness messages into the entertainment value of film and television. Anecdotally, this appears to be the case with the film A Beautiful Mind, which seems to have served the dual purpose of both entertaining and educating audiences about mental illness. Another recent example is the collaboration between Barbara Hocking from www.sane.org with the staff of Home and Away, the most popular soap opera in Australia. This collaboration resulted in a storyline of a current character, Joey Rainbow, who gradually develops schizophrenia. Hocking consulted with the program's staff and provided educational materials on schizophrenia to the 18-year-old actor who played the character who developed schizophrenia. This culminated in a more accurate portrayal of schizophrenia (e.g., prodromal symptoms, acute episode, residual symptoms) than typically manifest on screen. What is especially appealing about this approach is that the character was already well established on the program, so the development of his schizophrenia was arguably comparable to observing a family member or friend develop the disorder. Thus, it would appear the producers for Home and Away provided an opportunity to promote a mediated form of contact between the audience and someone with mental illness.

We recently investigated the effects of a documentary film about schizophrenia on the attitudes of undergraduates toward schizophrenia (Penn, Chamberlin, & Mueser, 2003). The documentary I'm Still Here depicts individuals with schizophrenia in a balanced light; individuals with both remitted and acute symptoms are portrayed, with both humor and sensitivity. These depictions were supplemented by interviews with family members and mental health professionals. The results showed that this documentary resulted in more benign attributions about schizophrenia (i.e., that persons with schizophrenia are not to blame for having this disorder and that they are not responsible for causing it themselves) relative to two control documentary films. The film did not have a significant effect on participant attitudes toward individuals with schizophrenia, although the pattern of performance (i.e., task means) was in the expected direction. Participant ratings revealed that they found this film enjoyable, suggesting that documentaries can be an effective and entertaining medium for delivering information about mental illness.

This chapter has reviewed evidence that addressing the stigma of mental illness in adolescence is a worthy endeavor. It is likely that adolescents who are informed about mental illness, both in terms of facts and the dispelling of myths, will be less likely to stigmatize others and more likely to seek and stay in treatment for their own symptoms. In particular, there is promising evidence in both our survey findings and the results of interventions that increasing awareness of the efficacy of treatment can reduce the role of stigma in inhibiting help seeking and in discriminating against persons with mental disorders.

This chapter has also highlighted the potential role of mass media in destigmatizing mental illness, a role that will be more effective if expressed in partnerships between media and mental health professionals. Of course, the media can only do so much to address stigma; much is also dependent on educators and the mental health field. For example, bringing persons with mental

illness to the classroom as guest speakers and providing opportunities for adolescents to volunteer with persons with mental illness have shown promise as stigma reduction strategies (Couture & Penn, 2003). In sum, the high school and classroom can promote activities that may challenge negative stereotypes.

In a similar manner, mental health professionals should strive to make the process of seeking and staying in treatment as destigmatizing as possible. Part of the challenge is developing liaisons between primary-care practitioners and school counselors, the gatekeepers who may be the first to encounter adolescents with emotional problems. This will facilitate appropriate mental health referrals and reduce the time from symptom onset and treatment. In addition, there have been recent efforts to provide treatment at home or in settings that are not identified as psychiatric facilities to address the stigma or shame of seeking treatment for physical disorders (e.g., AIDS; Gewirtz & Gossart-Walker, 2000) or psychiatric disorders (prodromal symptoms; McGorry, Yung, & Phillips, 2001). These approaches, coupled with early education and contact opportunities, and working with the media to provide balanced views of mental illness, are important steps in addressing stigma and ensuring that adolescents get early treatment for mental disorders.