In rural Virginia the delivery of comprehensive mental health services often is made difficult by the stigma still attached to attending a mental health center by a lack of understanding of community mental health programs, and by the residents attitude that we must take care of our own.
The Brunswick Mental Health Center in Virginia was seeing only 1% of the population of its catchment area and acceptance of the center services by other agencies especially law enforcement and the courts, was low.
In order to determine how to address the situation the Brunswick Mental Health Center sponsored a needs assessment in Brunswick County. Due to lack of financial resources and staff time a key informant method was chosen as being most cost effective. While this method suffers some bias and may not be generalizable to the population as a whole it does provide insight into attitudes of significant individuals in the community and begins to tap the attitudes of the people as well.
In order to accomplish this survey a student was assigned the task of interviewing 20 community leaders. This student was not employed by the mental health center and not perceived as being associated with it. The leaders included not only those traditionally chosen in key informant surveys such as county administrator, educators, public health officials, social service workers, agency heads etc. but also representatives from the natural helping networks (e.g. the owner of a funeral home that serves the Black community In the county,) this individual has taken on the additional responsibility of handling emergencies of a financial and shelter nature in the community). These individuals were asked open-ended questions (e.g. what in your opinion should be the role of the mental health program in this community?) that were designed to elicit their opinions about mental health programs in the county and about what needed to be done to improve them. A result of the survey that was most surprising and also most relevant to this article was the fact that 70% of the respondents felt that the primary role of the mental health center was education and prevention. Specifically many of the respondents felt that the people in the community needed an increased level of information about mental health services before they would utilize them. This of course placed the agency in a position of having to develop an increased Consultation and Education (C & E) component.
Rural areas experience some problems in delivery C&E services. Since C & E services do not generate fees they often have low priority in mental health centers. It has been the experience of the workers in this area that traditional consultation and education activities such as workshops, speaking engagements, public forums etc. are poorly attended. Additionally the people who do attend these activities do not come from those populations that are at highest risks for emotional and behavioral disturbances; the poor, the undereducated, the unemployed, and the underserved. Lack of public transportation, poverty, lack of a strong community services network and a forced sense of self-reliance due to the prior absence of formal mental health and mental retardation services all have had their stultifying effects on traditional mental health education activities.
In order to reach the most people in the shortest amount of time and with the lowest expenditure of funds this center determined that use of the mass media would be the most efficacious means of accomplishing our end.
The editors of two small local newspapers were contacted. The newspapers have a combined circulation of less than 5 000 out of the total population of 16,000 in the county. However the papers were well read by many people in the community and it was felt that weekly mental health education articles would be well received. While the editors would not commit themselves to a weekly column they printed free of charge any column that we presented to them. The articles basically were oriented toward increasing awareness in the population of those types of problems that can be helped at the community mental health center. Specifically the articles were on alcohol and substance abuse, depression, depression in the elderly, communication skills with children etc. The articles provided both information on coping skills and a new awareness that not only crazy people came to the mental health center but many people with problems of daily living. In addition it was hoped that the articles would have a primary prevention effect in that it would stimulate the readers to develop those skills necessary to prevent problems from occurring. Implementation of this part of the program was quite easy in that the newspapers often were looking for free, well written copy that they could print without investment of their own staff time. The articles were short, concise and easy to read. The articles were well received as several positive comments were relayed to us. Total investment of staff time was 1 to 2 hours of clinician time and an additional 4 hours of clerical time each week.
The only other form of mass media available to the center was two local radio stations. Many of the people in the community rely on the radio as their major source of information. The radio was free and low-income families who have difficulty in making ends meet can always receive their information on the radio rather than spending 15 or 25 cents for a newspaper. Demographically the radio station that we utilized has a listening range that is 75% age group 16 to 45 and 75% low income. This population was deemed to be a high risk population using most conventional standards of risk factors.
Implementation of a radio program was somewhat more difficult than the newspaper articles. The center utilized a personal relationship that one of the staff members had with the program director of the station and sold him on the program. In addition the radio station had done its own needs assessment and had discovered that its listeners were interested in information regarding substance abuse and teenage problems. They felt that our program could help meet their requirement for public service programming as established by the Federal Communications Commission. The station also was quite excited about our show in that it utilized contemporary music to highlight some of the points made in discussion. They viewed it as a natural bridge between the religious and public affairs programming that the station put on in the morning and the top 40 format that was heard in the afternoon. Thus, while we were getting our needs met so was the radio station.
In return for the program the radio station donated use of the production facilities technical assistance and air time. Our staff provided a weekly 25-minute broadcast on mental health issues. Topics included substance abuse, depression, problems with children, problems with the elderly and social and human services problems in the community. The programs utilized general discussion interviews with local experts role playing and psychodrama, and contemporary music selections to drive home the point. The inclusion of music was planned as a way to increase listeners interested in the program as well as make the show more marketable for the radio station.
The emphasis of the radio programs as well as the newspaper articles was again on attitude change and acquisition of basic mental health information. The show was well received at a radio station that broadcast it and we have received many requests for additional information as a result of these programs. The program Is not very time intensive for the center requiring only 2 to 4 hours of staff time a week in developing the program. This requirement may increase as we syndicate the show for playback on other radio stations in the catchment area.
Assessing the impact of the media approach to mental health
education has been difficult. Our utilization rates have increased dramatically.
Referrals for this agency as a whole are up about 35% over the year preceding
the implementation of the program. Self-referrals have increased by 50%.
Of these, 70% had seen one of the newspaper articles or heard the radio
show or another C & E presentation. The program has been in full operation
now for approximately 1 year. It has been difficult to assess level of
behavior change and coping skill acquisition as a result of the programs
due to lack of availability of staff and funding for a formal evaluation
procedure. However people do know where we are now and people do call up
requesting additional information. We have even received requests for more
traditional C & E activities as a result of the newspaper articles
and the radio show from both individuals in the community and other human
services agencies. In particular a series of shows on the hyperactive child
resulted in many requests for additional information and resulted in several
referrals to other agencies.
The literature albeit slight is beginning to show that the mass media can be an effective tool in the mental health field. Awareness of community programs seems to have been the chief aim of mass media approaches in mental health used to date. Schanie and Sundel (1978) have shown that use of the mass media particularly radio and television increased the community's utilization rate of community mental health services. Their program used brief public service announcements of less than 60-second duration to provide mental health education. They found only a moderate change in public attitudes. However, utilization rate of the community mental health center was increased dramatically. Morrison and Libow (1977) have shown that there can be a dramatic increase in community awareness after appearance of a newspaper article on a community mental health center. Weal (1978) has listed a number of effective public relations programs being developed in community mental health centers across the country. While community awareness is certainly an appropriate goal it may be a disservice to the community to limit media campaigns to public relations.
Our needs assessment revealed a strong desire in our sample for basic mental health information. Awareness meets but one need. The people wanted to know about new coping skills where to go for help etc. Meyer (1980) has shown that the mass media can be very effective in increasing knowledge of risk factors in heart disease which leads to subsequent behavior change. Monaghan, Shun Wah, Stewart, and Smith (1978) have shown that training professional call in announcers to handle mental health information can be very effective in developing short term behavior change. Mendelsohn (1973) has indicated that effective public information programs can be developed in such areas as self-awareness, dissipation of apathy, etc. He calls for a close collaboration between social scientists and communication specialists to help effect change.
Using the media can increase public awareness, can affect
attitude change, and can lead to behavior change. Documentation of these
aspects of our program needs to be accomplished. In the meantime though
it certainly seems that the media are an inexpensive readily available
source that can be used by the rural mental health practitioner to get
his message to the people. They are a source that should be utilized and
the increased use of the media will generate more comprehensive studies
of their effect on individuals and social systems.
Mendelsohn, H. Some reasons why information campaigns
can succeed. Public Opinion
Quarterly, 1973, 37(1), 50-61.
Meyer, A.J. Skills training in a cardiovascular health education campaign. Journal of Consulting and Clinical Psychology, 1980, 48(2), 129-142.
Monaghan, J., Shun Wah, A., Stewart, I., & Smith, L. The role of talkback radio: A study. Journal of Community Psychology 1978, 6, 351-356.
Morrison, J.K., & Libow, J. The effect of newspaper publicity on a mental health center's community visibility. Community Mental Health Center Journal, 1977, 13, 58-62.
Schanie, C.F, & Sundel, M. A community mental health
innovation in mass media preventive
education The alternative project. American Journal of Community Psychology, 1978, 6(6), 573-581
Weal, E. PR for mental health: CMHCs spread the word. Innovations 1978, 5(3), 22-28.
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