Lessons Learned from Diverse Efforts to Change Social Norms and Opportunities and Strategies to Promote Behavior Change in Behavioral Health Proceedings of Two Workshops (2017) / Chapter Skim
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7 Domestic Perspectives
7 Domestic Perspectives
Pages 65-78
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From page 65... ...
Lawrence Yang, associate professor of epidemiology, Columbia University, conducts research on how culture relates to stigma and how to implement interventions to improve social and symptomatic recovery among people with such stigmatizing conditions as mental illness and HIV/AIDS. His particular focus is on psychosis in Chinese groups.
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From page 66... ...
She spoke about structural competency, an approach to helping clinicians work better with community organizations, policy makers, and other nonhealth providers so as to work toward improving the mental health of patients in a more holistic and culturally sensitive way. STRUCTURAL STIGMA AND THE HEALTH OF LESBIAN, GAY, AND BISEXUAL POPULATIONS: IMPLICATIONS FOR CHANGING SOCIAL NORMS Hatzenbuehler began by stating that research on LGB populations offers important insights relevant to the topic of improving behavioral social norms related to mental illness and substance use.
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From page 67... ...
. Social Policies Shape Social Norms About Members of Stigmatized Groups On his second point, Hatzenbuehler remarked that it seemed intuitive that policies reflect social norms, but that emerging evidence shows that social policies in many ways also shape social norms about members of stigmatized groups.
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From page 68... ...
Hatzenbuehler closed by suggesting that further research on the factors that explain the large group differences in changes in prejudice toward LGB individuals compared with those with mental illness might increase understanding of these factors and provide strategies for improving social norms related to mental illness and substance use disorder. PEER COUNSELOR: WOUNDED HEALER PLEASE APPLY Swarbrick began by explaining that peer counseling is based on the premise that having people in recovery help others pursue their recovery fosters hope and optimism, and that those who bear a wound are most sensitive to those with a similar wound.
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From page 69... ...
She asserted that providers sometimes insinuate that peer counselors are in a "less-than" role. She stated that peer counselors are intended not to replace professionals, but to be a strong complement or alternative to traditional roles that often may pathologize and further stigmatize people.
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From page 70... ...
Also, these social networks offer opportunities to obtain key life statuses (such as work or marriage partners)
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From page 71... ...
But if the person is still able to engage in these core activities within a core cultural group, the stigma of mental illness is mitigated. Identifying "what matters most" in a cultural group therefore provides a roadmap for countering stigma toward mental illness within different cultural settings.
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From page 72... ...
As an example, she cited provisions in the Affordable Care Act incentivizing clinics to track and approve patient outcomes at the population rather than the individual level. National polls of physicians, she noted, such as a Robert Wood Johnson study, have found that physicians do recognize social causes as major barriers to improving their patients' health (Robert Wood Johnson Foundation, 2011)
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From page 73... ...
Finally, Hansen said, the fourth part is to develop structural humility, which means helping practitioners recognize the limits of their clinical expertise and the need to collaborate with experts on community and institutional dynamics, and expect gradual rather than dramatic sudden change from this work. To illustrate how this scheme might work in practice, Hansen presented two snapshots from her research on addiction treatment and explained how they led her to structural interventions.
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From page 74... ...
These two findings led Hansen to join "From Punishment to Public Health," an advocacy coalition of clinicians, public health researchers, and disillusioned corrections officers who are working with policy makers to realign drug policy away from criminal justice and toward mental health interventions. Through this group, she testified to the State Assembly in New York and also collaborated with policy makers and policy analysts around reducing disparities and prescriber liability in buprenorphine treatment.
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From page 75... ...
He noted that researchers in the sociology of social movements look to the LGBT movement as one of the real success stories in motivating political will to change norms and ultimately policies that had been having negative impacts on that group. Judith Warner asked Hatzenbuehler to elaborate on ways in which policies shape social norms.
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From page 76... ...
She observed that engagement in a structural intervention at any of the levels she had mentioned in her presentation heightens clinicians' awareness of the structural causes behind their patients' difficulties and of the stigma they experience, and also reduces individual blame. Hansen said she could answer the question about the incremental changes in practice that can be made by such medical education bodies as the Association of American Medical Colleges, which certifies medical schools, and the Accreditation Council for Graduate Medical Education, which certifies residency programs, rather than addressing how higherlevel government policy can effect changes in practice.
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From page 77... ...
Hatzenbuehler added that laws that confer protection around employment, nondiscrimination, hate crimes, and antibullying protections in schools, and even same-sex marriage laws, tap into a broader notion of belongingness, inclusion, and feeling protected in one's environment. Yang added that messaging focused on addressing stigma around mental illness should be based on more thorough and complex research that can yield understanding of the nuances involved, especially for the various communities the messaging is trying to reach, such as African Americans, Chinese groups, LGBT individuals, and many others.
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