CWRU researcher studies ways to help teens overcome fears and stigmas of mental illness

(Press-News.org) When teens start experiencing changes in moods or emotions, they tend to fear sharing their blue days with their families and adults who can help them. As a consequence, they often suffer in silence.

Case Western Reserve University KL2 Clinical Research Scholar and Instructor Melissa Pinto-Foltz from the Frances Payne Bolton School of Nursing wants to find the magical elixir that helps teens speak up, seek help and then stick with treatments that get them feeling better.

"About one in five Americans has a mental illness, with half of these individuals first experiencing symptoms of mental illness in their teen years," she said.

Pinto-Foltz's research contributes to efforts nationwide to combat a public health issue, stigma and mental health literacy, made a priority in a U. S. Surgeon General's Report and the President's New Freedom Commission on Mental Health.

She found that a good way to reach teens to help them learn about mental illness and improve negative attitudes about mental illness was through their school.

She studied 156 girls in the 9th and 10th grade in a research project set in public high schools in Louisville, Ky. About half the group participated in a special national program called In Our Own Voice, offered by the National Alliance for Mental Illness, and the other half did not see the program.

More than 200,000 people across the U.S. have seen the In Our Own Voice program, which is frequently given in schools, churches and other community settings. The one-hour program involves learning through storytelling and changing attitudes through interacting with people who are in sustained recovery from mental illness. These individuals tell their personal stories of what it was like to first discover the illness and get through their recovery from the illness.

While the program is widely used across the U.S., no evidence exists that it is effective with teens, nor has the impact of the program been examined for an extended time period.

Pinto-Foltz used the In Our Own Voice program with the teens and reported her findings from the study, "Feasibility, Acceptability, and Initial Efficacy of a Knowledge-Contact Program to Reduce Mental Illness Stigma and Improve Mental Health Literacy in Adolescents," in Social Science and Medicine.

"We tell stories every day to friends, family and co-workers," she said. "The whole idea behind this approach is that people learn about the world through stories, and interacting with people with mental illness may violate previously held stereotypes. We wanted to see if teens responded to these interactions with and stories told by people with mental illness in such a way that it decreased stigma associated with mental illness and improved their knowledge of mental illness."

She followed participants four times over 10 weeks: first to study what stigmas and knowledge they had about mental illness, then in response to the In Our Own Voice program. She conducted follow-up interviews shortly after girls saw the program and again at weeks 4 and 8 to see if there were changes in the their level of stigma associated with mental illness and whether their knowledge of mental illness increased.

Pinto-Foltz's 10-week study found that the girls liked and learned from the In Our Own Voice storytelling program, but the program was too short to change some of the girls' stigmas that they would be more accepting of individuals with mental illness.

"This was our first assessment of In Our Own Voice as it's currently given, and it's a starting point to tackle stigma and improve mental health literacy among adolescents using existing approaches," she said.

In the future, she added that we can increase our chance of combating stigma and increasing mental health knowledge by providing more opportunities for adolescents to interact with the presenters following the program.

She suggested continued interaction with the presenters through projects with the girls or visits to their health classes for further discussions about mental illness.

"The girls were eager for more interaction with the presenters," Pinto-Foltz explained. "They kept asking me when the presenters would return to tell more stories. After the program, the girls had many lingering questions about mental illness. Increasing their interaction with the presenters would allow an opportunity to clarify their questions about mental illness, increase their comfort in interacting with individuals with mental illness, and decrease stigma."

Meanwhile in the follow-up with the girls at four and eight weeks, Pinto-Foltz found that girls who participated in In Our Own Voice had improved mental health knowledge when compared to the girls who did not receive the program.

Stigma levels for both groups remained the same, calling for further examination of approaches to tackle this important and pervasive problem, Pinto-Foltz said.

### This research was support by the Midwest Nursing Research Society and the Iota Chapter of Sigma Theta Tau.