Every year, the Hogg Foundation gives the Frances Fowler Wallace Memorial Award for Mental Health Dissertation Research to eligible doctoral candidates at institutions of higher education in Texas. Awardees receive a scholarship to help cover research-related expenses. One of our 2020 recipients is Jesse Starkey, a PhD candidate in Media and Communication at Texas Tech University. We talked with Jesse about her latest research.
Your project explores how individuals associated with a community mental health clinic communicate about mental illness stigma. What led you to take a professional interest in this topic, and what questions are you trying to answer with this research?
When I was eight years old, my half-brother was murdered. His death caused my dad to descend into a deep depression, yet in the mid-80s, for a family living well below the poverty line in a rural community, there were no resources to help with my dad’s grief. My mom scraped together enough money to get my dad one month’s worth of an anti-depressant, but he refused to take it—saying he didn’t want to be labeled as crazy. That early experience with someone refusing to seek treatment because of the stigma surrounding depression, coupled with the fact my husband and partner in life has chosen a career in mental health (he is a Licensed Professional Counselor and a professor in a clinical mental health program at a university) spurred me to explore how perceptions of stigma interact with individuals’ will and ability to seek assistance with their mental health.
Additionally, when I was first beginning to explore this topic, I noticed that stigma towards mental illness was not limited to the general population—even folks in the profession of providing mental health services seemed to fall into stigmatizing conceptualizations of mental illness, although it was likely unconscious. Much of the research related to mental health issues agrees that stigma is a primary barrier for seeking help, yet strategies for breaking down stigma towards mental illness have not been thoroughly explored, especially from an organizational and non-professional perspective.
Therefore, with my research I am trying to look at the ways stakeholders in a community mental health clinic discuss mental illness stigma as it relates to seeking help. Specifically, I am looking at the ways internal stakeholders (board members, clinicians, and staff) discuss mental illness stigma and advocacy to better understand the communication surrounding mental health issues and how targeted communication can work to lessen stigmatizing attitudes and thus lower barriers to accessing services to mental health services before a crisis occurs.
How do you think your research methods and approach will help you answer the questions you’re posing?
Through the qualitative methods of in-depth interviews, focus groups and ethnographic field observations, I can both elicit narratives and conversations as well as observe them in action to begin to understand how mental illness stigma is communicated. This approach will begin to offer insights on how strategic advocacy messages can be crafted where there is a goal of increasing access to mental health services before a crisis occurs.
Additionally, I am approaching this research from a participatory model, meaning I am actively involved with the organization I am studying. I am currently serving on the board of directors for the organization as the External Communication Committee Chair. This means that the findings from my research are being funneled directly back to the organization to inform our advocacy efforts. As a case in point, the early stages of my data collection over the past few months served to frame the board of director’s messaging for an annual funding review from one of the clinic’s primary funding organizations. According to more senior board members and the executive director of the clinic, this year’s funding review presentation was one of the best on record—we presented a more unified, streamlined narrative that highlighted the strengths of the clinic in ways that resonated more deeply with the non-mental health experts on the funding board.
What, from your perspective, is the biggest area of need — or the greatest opportunity — related to this topic? In other words, how could we really move the needle on this front?
I love this question, because this really gets to the crux of what I’m after—how can social change occur in relation to mental illness stigma? While I think a more nuanced answer will emerge as I begin to sift through my data, my gut response to this question is that we need to normalize discussions surrounding mental health. In general, in American society, the pursuit of mental health—accessing counseling services, for example—is a privilege reserved either for people with insurance or with enough cash on hand to pay for ongoing therapy sessions. This inability of a large swath of our society to access mental health services before they are in some sort of crisis feeds into the stigma that seeking mental health services means you are sick or crazy—for the simple reason that services intended to treat mental illness are often associated with hospitals. The organization that is serving as the case study for my dissertation is a model for breaking down those barriers to service—they offer services based on a sliding scale, or even provide services (facilitated through counseling interns from area universities) free of cost. So, to come back to your question—how we can move the mark on getting people access to mental health services? Two primary things: (1) normalize accessing mental health services before someone is in a crisis, and (2) identify and support organizations that are actively working to provide mental health services to all segments of our society, especially those that are historically underserved in every other way (e.g., health access, social services, etc.).
Can you suggest a few readings/resources for those who are interested in learning more about this topic?
In terms of advocacy communication strategies for non-professional advocates, or for organizational advocacy strategies, there is a lack of academic literature with concrete suggestions for action, which is one of the gaps I hope my dissertation will fill. Some of the academic literature that does examine some of the intricacies of advocating for mental health access are listed below.
Gen, S., & Conley Wright, A. (2013). Policy advocacy organizations: A framework linking theory and practice. Journal of Policy Practice, 12(3), 163–193. http://ro.uow.edu.au/sspapers/898
Goodman, L. A., Wilson, J. M., Helms, J. E., Greenstein, N., & Medzhitova, J. (2018). Becoming an advocate: Processes and outcomes of a relationship-centered advocacy training model. The Counseling Psychologist, 46(2), 122–153. https://doi.org/10.1177/0011000018757168
Servaes, J., & Malikhao, P. (2010). Advocacy strategies for health communication. Public Relations Review, 36(1), 42–49. https://doi.org/10.1016/j.pubrev.2009.08.017
Stylianos, S., & Kehyayan, V. (2012). Advocacy: Critical component in a comprehensive mental health system. American Journal of Orthopsychiatry, 82(1), 115–120. https://doi.org/10.1111/j.1939-0025.2011.01143.x
Additionally, for a more general readership, some national or global organizations have published guidelines for mental health advocacy: