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Attitudes Toward Mental Illness

People’s beliefs and attitudes toward mental illness set the stage for how they interact with, provide opportunities for, and help support a person with mental illness. Attitudes and beliefs about mental illness are shaped by personal knowledge, knowing and interacting with someone living with mental illness, cultural stereotypes, and other factors.

Stigma has been described as "a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses" (President's New Freedom Commission on Mental Health, 2003). When stigma leads to social exclusion or discrimination, whether from mental illness or some other condition, it results in unequal access to resources that all people need to function well, adversely affecting quality of life.

This report examines individual and state-level predictors of attitudes toward mental illness to highlight subgroups that might benefit from educational programs and services.

Results from the Behavioral Risk Factor Surveillance System — 2007, 2009

In 2005, the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated to track state-level attitudes toward mental illness. Following recommendations from the 2002 President’s New Freedom Commission on Mental Health, these agencies sought to examine public perceptions regarding treatment effectiveness and perceptions regarding people being caring and sympathetic to people with mental illness. This collaboration paralleled the release of a SAMHSA national anti-stigma campaign, What a Difference a Friend Makes, designed to help young adults support friends with a mental health problem. Two questions that asked about attitudes toward mental illness, along with other questions about mental illness symptoms, were included on the CDC-supported Behavioral Risk Factor Surveillance System (BRFSS). These questions comprised the BRFSS Mental Illness and Stigma Module.

Attitudes were assessed by asking respondents to indicate their level of agreement with two statements. The first statement assessed attitudes toward the effectiveness of treatment: "Treatment can help people with mental illness lead normal lives." The second statement assessed the respondent's perception of public attitudes toward persons with mental illness: "People are generally caring and sympathetic to people with mental illness."

In 2007, 35 states, the District of Columbia, and Puerto Rico received SAMHSA support to collect data using the BRFSS Mental Illness and Stigma Module, and, in 2009, 16 states received support to do so. While a 2010 CDC study published in the MMWR(CDC, 2010) described some limited findings, the goals of this study were to expand on the previous analysis to (1) provide state-level estimates of attitudes toward mental illness by select sociodemographic factors, mental illness symptoms, and mental health treatment; (2) examine individual (e.g., age, race/ethnicity) and state-level predictors (e.g., per capita expenditures on mental health services; the average annual unemployment rate; and exposure to the What a Difference a Friend Makes campaign) on attitudes toward mental illness; (3) highlight population subgroups who strongly disagree with the statements (i.e., a vulnerable group) for each state; and (4) provide resources and strategies for targeting these groups, and combating stigma in general.

This report examines individual and state-level predictors of attitudes toward mental illness to highlight subgroups that disagreed with the attitudinal statements and, therefore, might benefit from educational programs and services. The report’s eight sections include the following:

  1. Background: This section provides information about stigma as it interferes with public health prevention efforts and the rationale for the selection of study questions.
  2. Study Methodology: This section describes the source of questions used for this study, participating states, data collection methods, individual-level predictors, and state-level predictors (Appendix A) used in the analysis as well as analytical strategies used.
  3. Key Findings: This section briefly summarizes the main study findings.
  4. State-Specific Findings (Graphs): This section provides a one-page graphical overview of key findings on total disagreement for each attitudinal question by the state overall and by age, sex, race/ethnicity, serious psychological distress (SPD), frequent mental distress (FMD), and receipt of mental health treatment for each state participating in this study. This section also includes a Call to Action subsection that highlights groups found to significantly differ in their responses from the state average. Additionally, this section provides resources targeting these groups.
  5. Discussion: This section compares and contrasts these findings in relation to other research, reviews the implications of these findings, and describes study limitations.
  6. Resources: This section provides links to resources for those interested in strategies to combat mental illness stigma.
  7. References: This section cites other published studies and resources for those who wish to delve further.
  8. Appendix B: State-Specific Data Tables: This section tabulates detailed results by state for attitudes toward mental illness by age, sex, race/ethnicity, educational level, household income, employment status, veteran status, diabetes, cardiovascular disease, asthma, arthritis, FMD, SPD, and receipt of mental health treatment (adjusted for sex, age, racial/ethnic group, education, and household income).

    Understanding attitudes toward mental illness at the state level can help identify and inform priorities that support the efforts of mental health state agencies, providers, policymakers, educators, and others to reduce stigma. The collection and the analysis of state-level data can provide valuable insight into the unique needs of various subgroups, such as racial and ethnic minorities as well as people living with chronic disease and co-occurring mental illness. It is our hope that this information can help shape initiatives effective in reducing stigma and removing barriers for those seeking or receiving treatment for mental illness.



New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003. View report. Html 
PDF [PDF - 1.35MB]

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