Strategies to Overcome the Barriers

Discussions at both roundtables culminated in the recommendation to form a consortium among those present to coordinate anti-stigma and anti-discrimination efforts targeting older adults. Such a consortium would be a collaboration among government agencies, policymakers, provider organizations, consumers, advocates, foundations, and others to focus attention on the issues of stigma and discrimination surrounding mental illnesses and aging. Collaborating helps avoid duplication of effort.

The roundtables decided on two central initiatives to combat stigma and discrimination against older adults with mental illnesses. One initiative is a campaign to empower and educate older adult consumers. The second initiative is a targeted media campaign to combat misperceptions of older adults with mental illnesses.

1. Empower and Educate Older Adults with Mental Illnesses

Efforts must be undertaken to reach older adults who are isolated, who do not know much about aging and mental health, or who may fear identifying themselves as possibly suffering a mental illness. An empowerment and education campaign must reach not only older adults but also those who work with them, who volunteer to help them, or who provide physical and mental care for them.

“As a society, we’re going through a redefinition of work in this age group, and retirement is becoming obsolete. You may not be able to say to someone you’re treating for depression that ‘You may be able to go back to your old job.’ But you are saying, ‘You need to get treated for your depression so that you can participate fully in the community, so you can make a contribution, so you can have a purpose, so you can have meaningful relationships with others. In a sense, so that you can make the most of your life.’ “

—Abigail Trafford, Health Columnist, The Washington Post

Target Audience

To reach the goal of empowering and educating older adults, the education initiative must target many community members. Primary partners in the campaign to empower and activate older adult consumers would be consumer groups that are already working in the area of advocating for older adults with mental illnesses, including the Older Adult Consumer Mental Health Alliance (OACMHA), the National Alliance for the Mentally Ill, (NAMI), the National Mental Health Association (NMHA), the Bazelon Center for Mental Health Law, and others.

Other partners in the education campaign would be community-based organizations and faith-based organizations. The community organizations include Rotary, Kiwanis, Elks, Lions, Seroptomists, Granges, the Urban League, and others. The faith-based organizations include, but are not limited to, outreach programs such as national parish nurses, Jewish Family Services, and Stephen Ministries.

The Message

Although the message to these various groups must be further refined, the groups recommended that it include the following themes:

1. Treatment works. Older adults with mental illnesses can improve and recover.

2. Older adults with mental illnesses must strive to meet challenges with courage to overcome fear, isolation, and lack of resources.

3. Helping others helps you (The Helper’s Principle). If you are an older adult with a mental illness, you will help yourself if you help others. If you are in a position to help an older adult with a mental illness, doing so will boost your self-esteem and sense of self-worth.

4. It is important for an older adult to live at home, with no fear of inappropriate or premature institutionalization.

5. There is hope for improvement, for recovery, for feeling better about yourself. “Can I get better?” Yes.

“I’m very heartened to see a national campaign about stigma. Our research shows that older people don’t really identify themselves as old until they have a major health crisis, so there’s a lot of people over 55 who don’t think they’re old.”

—Alixe McNeill, Assistant Vice President for Program Development

National Council on the Aging

General Strategies

In order to empower older adults with mental illnesses, educators must engage existing groups who are in contact with older adults. These groups of people can be divided into community organizations, as mentioned above, and home-based workers and volunteers servicing older adults, such as home health care aides, meals-on-wheels volunteers, and health care providers, all of whom must be sensitized to mental health issues in older adults.

Community groups, in particular, present an opportunity to reach many older adults through their social events and community service projects. One idea mentioned was a “Senior Mental Health Corps” of older adults, made up of both consumers and others, who can talk about the importance of mental health in older adults. Members of the corps can be trained to present programs on mental health issues to community groups and encourage these groups to take on like-minded community service projects. Corps members would bolster the ranks of the current overextended group of older adult consumer advocates at local, State, and national levels.

Peer counseling, peer support, and mentoring programs are valuable strategies to reach older adults experiencing mental illnesses. An education and empowerment campaign can identify some of the quality programs already in place.

“There are some good models out there; we don’t have to reinvent the wheel. What we do need to know is what works and what is working in certain communities.”

—Laurie Moore, Senior Mental Health Outreach Program Director Southern Nevada Adult Mental Health Services

Finally, any education and empowerment campaign undertaken must have a multicultural approach in order to reach different subpopulations of older adults.

“In the Latino community, we have difficulty really acknowledging mental illness and access to health care services. It is a stigma in our population and it’s something we really don’t cope with. Whatever plans are developed have to have some sensitivity to cultural competency and cultural diversity because we do view life from different perspectives.”

—Rose Gonzalez, Director of Government Affairs, American Nurses Association

Options

An empowerment and education campaign should include the following approaches:

• Preparing tapes/videos/training materials for paraprofessionals working with older adults.

• Writing letters to newspaper editors and writing guest columns for newspaper editorial pages.

• Reaching subpopulations of older adults by tapping into ethnic radio stations and newspapers.

• Providing sensitivity training for older adults and people who come in contact with them, including those working in peer-to-peer programs.

Resources

Existing resources for a campaign targeting older adults need to be identified. Efforts would attempt to dovetail with existing peer counseling and mentoring programs. Encouraging local, county, and State mental health agency support would also assist the campaign.

2. Educate the Public on Mental Health and Aging

A public education media campaign targeted at older adults, their families, and the general population must be undertaken to underscore the message of mentally healthy aging.

Target Audience

The target audience for this public education media campaign is older adults, their families, and the general population. Through experience, the roundtable participants have found that the parents of the baby boomers are less likely than younger people to accept or seek services. The aim of the media campaign would be to reach those in need of services, whether by reaching the older adults themselves, their spouses, siblings, or children. The campaign would project the image of healthy aging to influence these adults and raise their expectations of continued good mental health in their later years. A clear message of healthy aging would be a step towards combating the stigma of mental illness that prevents older adults from acknowledging their need for treatment and from seeking care.

Another target of the campaign would be the children of older adults, who are sometimes called “The Sandwich Generation.” These adults are much more likely to seek, or in fact demand, mental health services for themselves. However, they may be less successful in getting care for their parents or in acknowledging that treatment is critical to the continued healthy aging of their parents.

Stigma Reduction Strategies Protest against inaccurate and hostile representations reduces the frequency of publicly endorsed stereotypes and diminishes negative attitudes, but fails to promote positive attitudes. Education • Allows the public to make informed decisions. • Gives people a better understanding of mental illnesses so that they are less likely to endorse stigma and discrimination. Face-to-face contact with persons with mental illnesses is a promising strategy associated with improved attitudes. (Corrigan & Penn, 1999)

Finally, the campaign must focus on the general population through a message of health, fitness, and maintaining an active mind during aging. Targeting the general population with a positive message of healthy aging would help to dispel false beliefs about older adults experiencing mental illnesses.

The Message

The opportunity to capitalize on the common interest of all for overall health, fitness, and independence does exist. Any successful message must be concise, crisp, and focused. It must be framed positively and touch on the themes of mental health, independence, and aging well. Such a message will have more mass appeal than one that stresses the negative.

Slogans that a media campaign could adopt that emphasize the positive are the following:

• Help works

• Strong mind/strong bodies

• You deserve to feel well

• Here’s to your mental health

• When you need help, get help

• Got health? Got hope?

• No shame campaign

• Aged to perfection, mind and body, together at last

• Aging, aren’t we all?

• Never too old to live well

General Strategies

Three initial steps should be taken in formulating the general strategies of a media campaign:

First, the message must be clearly defined. Advertising expertise must be used to develop and refine the message of the media campaign. A logo should be developed to clearly brand or label the campaign. Developers of the media campaign should investigate using AD Council resources and should contact advertising agencies to see if they would provide pro bono work.

Second, the media campaign should encompass a range of tactics. The same message, once developed, should be placed in various media markets, in multiple venues. Emphasis should be on market saturation, on developing an integrated campaign that makes use of at least three different media in the same market. For example, television spots, radio public service announcements, and bus stop advertisements can all deliver the same message (such as a phrase and a logo) during the same calendar time frame.

Third, a successful media campaign must identify the markets that reach older adults. Resources such as Nielsen (television), Arbitron (radio), and ABC Audit (print media) must be consulted to determine the most effective way to reach the target audience.

Options

Each medium calls for a specific set of strategies to deliver the message most effectively. What works in the print media will not be as effective on television. An approach tailored to each medium will enhance the chances of a message being delivered effectively.

Press/Written Media

1. Create well-written, up-to-date materials to post on a Web site that can give journalists and editors in the mainstream press access to experts who can provide quotes and information on the topic of mental health and older adults.

2. Post articles on a Web site that targets other segments of the written media, such as the senior press, local community newspapers, and newsletters in senior citizen centers. Quickly and conveniently accessible online, these articles and graphics (charts and graphs) must be well designed and formatted, easily downloadable, and able to be pasted into existing publications at no cost.

3. Identify journalists and editors who are familiar or want to be familiar with the issue of mental health and older adults. Host meetings for journalists to talk about trends and recent research in mental health and aging issues, and provide fact sheets pitching story ideas. Such gatherings will help develop allies and nurture relationships with the print media.

4. Develop awards for excellence in journalism covering mental illnesses and older adults. Create the award independently or piggyback on existing prestigious awards by creating a subcategory of writing distinction in this area.

Radio

Develop public service announcements (PSAs) using celebrities as spokespersons. Radio presents a less expensive alternative to television PSAs, allowing for greater circulation. Using a variety of spokespersons will widen audience appeal.

Television

The efficacy of public service announcements is debatable, based on the high cost to produce them and the lack of control over when they are aired. A more sophisticated approach to using television to deliver a message about older adults experiencing mental illnesses is to “embed” the message on television shows. A guest character on a show can be an older adult with a mental illness, or a show story line can tackle the issue. Programs that would be very suitable for embedding such a message include “Monk,” “Wonderland,” “Law and Order,” or “ER.”

The message is even more effective if the show ends with a spot, ideally featuring a character from the episode, detailing a toll-free number and Web site that people can use to learn more about mental illnesses in older adults. This spot could then be followed up by the late evening newscast featuring a story on the same subject.

Aside from embedded messages in television shows, another strategy is to give an award annually for the best script portraying mental health and aging. This strategy should include a watchdog effort to flag repeated stereotypical portraits of older adults with mental illnesses.

Resources

Resources to produce a media campaign are slim. A collaboration among stakeholder groups and pro bono support from advertising agencies may be the best plan for getting such an effort underway.

Conclusion

Roundtable participants agreed that the key to implementing these two initiatives would be to form a consortium among the many stakeholders working in the area of older adults experiencing mental illnesses. A consortium involving government agencies, policymakers, provider organizations, consumers, advocates, foundations, and others could focus attention on the issues of stigma and discrimination towards those aging with mental illnesses.

Both roundtables recommended that they themselves could form a consortium to coordinate anti-stigma and anti-discrimination efforts targeting older adults. The initial steps of issuing a call to action and discussing the structure, purpose, and funding of the coalition have already taken place. Many of the roundtable participants contributed to a special edition of the American Society on Aging (ASA) Dimensions newletter. As a result, ASA requested a workshop on mental health, stigma, and aging at its 2005 annual meeting.

Many of the roundtable participants stated that even though the effort to stop stigma and discrimination against older adults experiencing mental illnesses will be long, it is especially necessary to take on the challenges now. Delay, they said, means another generation of older adults may be unable to recognize the need for their own good mental health care, unable to access that care, and unable to live the fuller and more productive lives they deserve.