Peer-based approaches to reducing mental health stigma in adolescents

Losing the Mental Health Stigma for Adolescents

Mental health issues are not uncommon in society. As such, they present a significant problem to society as a whole, as well as to the members of its population that are most vulnerable to it. One of the areas of mental health problems that has received a fair amount of attention in recent years is mental health issues that explicitly relate to adolescents. This statement is certainly verifiable when viewing this issue through the perspective of the humanities -- which includes a psychological, counseling, and educational perspective that informs the present paper. There are several different reasons that mental health issues for adolescents are a significant problem in society today. Firstly, such issues are related to "delayed school progression" (Tempeelar et al., 2014, p. 2). Secondly, these individuals are in the process of transforming from children to adults. Their cognitive, behavioral, and emotional states are not fully formed as those of an adult's are, which makes them particularly susceptible to the influence of whatever mental health issues from which they suffer. Moreover, during the pivotal period of adolescence in which the opinions of others have a significant impact upon adolescents, the stigma associated with mental health is perhaps at its worse. There are a number of different publications and articles within the fields of psychology, counseling and education that imply that if one were merely able to remove this stigma, adolescents would become more prone to seek the sort of treatment required to effectively deal with these issues (Bulanda et al., 2014, p. 73). It is the express opinion of the author of this document that the best approach to removing the mental health stigma that is magnified in adolescence is by utilizing a peer-based approach in which the very conception of mental health issues is changed with adolescents. Doing so would involve the educational system and the support of teenagers themselves. However, by getting adolescents to work with one another to not associate a stigma with mental health issues, they would surely seek and respond better to conventional treatments for this problem.

Perhaps the most cogent piece of evidence to support the aforementioned thesis statement pertains to some of the research conducted on a peer-based approach to mitigating mental health issues among adolescents. Specifically, there is empirical, statistic-based research that indicates that adolescents can help one another to reduce the stigma associated with mental health issues. The implications are that without such a stigma, young people will become more prone to seek mental health earlier and thereby increase the efficacy of this assistance. An article entitled "Addressing mental health stigma among young adolescents: evaluation of a youth-led approach" contains original research in which older teenagers (in high school) educated younger teenagers about the realities of mental health. The younger students were in middle school. The crux of the statistical data is based on the results of both a pretest and a posttest that measured "knowledge about mental illness as well as social distance" (Bulanda et al., 2014, p. 73). Both of these variables pertain to the sort of stigma attached to mental health issues for adolescents. Although education about the subject can reduce it, social distance is probably the more effective measure of the impact of such counseling on the part of teenagers. The results of this study certainly confirmed the thesis within this paper. Granted, these tests were extremely simplistic in nature and were composed of four questions for both of the variables. Still, the preferred answer for the pretest question of evaluating the statement that there is a stigma associated with mental health evinced an increase of nearly 44 percentage points for the preferred answer (that there is not one) (Bulanda et al., 2014, p. 73). The differences between the pretest and the posttest answers generally showed an average of about 20% of students selecting the preferred answer aligned with the notion that there is not, or should not be, a stigma associated with mental health in adolescents.

Unfortunately, there are a bevy of shortcomings with this particular study. Its strengths, of course, are evinced in its results and in the fact that the pretest and posttest instrument stemmed from a previous study on a different population. In this respect the methodology was credible. However, the instrument used was altered in the study by Bulanda et al., which made it impossible to determine either a reliability or validity of this instrument. The authors (2014) noted that "Construct and criterion validity for these scales is unknown" (p. 76). There does appear to be an element of bias in the fact that the survey was conducted on a relatively small population that was a "convenience sample" (Bulanda et al., 2014, p. 76) not representative of the overall population. In summary, the study could certainly have been conducted better, although it merely paves the way for further study into the positive correlation between adolescents teaching each other about mental health in order to de-stigmatize the perceptions of mental health illnesses and the need for treatment.

Another piece of evidence that helps to support the principal notion advanced within this document that youths can actually help one another to obliterate the stigma associated with mental health among adolescents pertains to the fact that such help need not take the formal implementation of a class or a workshop. Instead, it is possible for youths to decrease the stigma associated with mental health problems simply by changing one another's conception of this issue with a few well-placed statements and mechanisms for support (Ross et al., 2012, p. 229). This notion was propagated in a study by Ross et al. which contained original, empirical evidence about this subject. The whole appeal to this approach is that it can simply occur on a friendly basis between adolescents, so that teenagers are equipped to deal with the issues of mental health as it relates to their own peer group. Moreover, this study was based on a Delphi panel, in which a group of experts on mental health were sent a variety of statements (which the authors researched on their own and utilized for the purpose of an original questionnaire). The valuation of these statements for adolescent peers as a way to help them deal with others with mental health was ranked according to a scale. The results indicated that the experts believed approximately 80% of the statements to be of merit for peers to teenage peers to employ on one another (Ross et al., 2012, p. 236).

There were a variety of strengths associated with this study. Firstly, the researchers developed their own statements which certainly add to the body of knowledge of means in which adolescent peers can help one another. Moreover, the experts were based from two different countries, Australia and Canada, so that the results of the study have an international appeal. Perhaps most eminently for the purpose of the document that the present author is writing, one of the categories of the statements that were approved by the experts was "Don't Stigmatize" (Ross et al., 2012, p. 234) -- six of those statements were specifically designed to reduce the degree of stigma attached to mental health illnesses among teens. However, the limitations of the study included the fact that with the experts comprising of only two nationalities, further research is needed with more nationalities of experts to truly make the statements have a global appeal. Additionally, there was no mention of reliability or validity in the study. However, the researchers did account for bias. The experts consisted of a group of "36 youth mental health consumer advocates and the other of 97 youth MHFA instructors" (Ross et al., 2012, p. 229). Since there were considerably more of the former than the latter, the "ratings of consumer advocates were given equal weighting to those of the instructors" (Ross et al., 2012, p. 238), which prevented any bias in the ratings due to the size of the groups.

Another reason that a peer-based approach to eliminate the stigma associated with mental health for teenagers is likely to generate a degree of efficacy that other methods might not is because of the very nature of adolescence itself. Approximately one in every six adolescents suffered from mental health issues at the beginning of this decade (Walley and Grothaus, 2013, p. 3). Adolescence is a time when children are in the process of becoming adults. As such, they attempt to learn about themselves and to figure out ways of relating to others that is conducive to the person that they want to become (Zhao et al., 20015, p. 1). Thus, teenagers bond with one another naturally in a variety of ways. The approach advocated and evinced in the research for the present document posits utilizing mental illness and the varying ramifications of this health issue as simply one of many points that adolescents can utilize to bond with one another. The reality of the situation is that mental illnesses not only affect adolescents but also their family members -- specifically their siblings and parents. Enabling and empowering adolescents with the coping skills to de-stigmatize mental illness not only among teenagers, but also among their families, is another avenue for reducing the stigma associated with this health issue. There is empirical evidence that buttresses this statement, and which finds that when adolescents whose family members are exposed (in a structured, positive environment) to others in this same situation, that they "made connections with others in the program, developed personal strengths, and learned how to contribute to others' well being" (Foster et al., 2014, p. 61). The ramifications of such a statement are that adolescents can bond over this point of commonality, and through that bonding come to understand some of the realities of mental illness while eschewing its stigmatization.

What is interesting about this piece of evidence is that it involved a qualitative research in the form of personal interviews of adolescents who were in a camp that was helping them to deal with the issues that accompanied living with family members who had mental health problems. In this sort of environment, the adolescents were able to interact with one another freely while knowing that each and every one of them was experiencing some variation of what the others were experiencing. Granted, this particular study was purposefully small and only included interview with 14 participants in the camp. Moreover, the environment in which these individuals interacted with one another was decidedly closed and one in which everyone knew the others were dealing with family members with mental illnesses. Despite these limitations, the study found that it greatly relieved and improved the outcome of the adolescents to simply know that there were others going through what they were going through (Foster et al., 2014, p. 63) -- which is the whole basis of the approach documented in the present research paper. Moreover, those results indicated that adolescents felt they gained a significant degree of coping skills simply from interacting with others and discussing various aspects of the consequences of living with family members with mental illnesses. Finally, the results showed that these teens felt empowered to help others who were going through something similar simply by interacting with one another (Foster et al., 2014, p. 64). Nonetheless, one must acknowledge the inherent bias in the way that the interview format could have predicted answers that emphasized the positivity of the camp. But these limitations and the previously mentioned ones do not lessen the fact that in each of the pieces of evidence reviewed in the present document thus far, there has been a positive correlation between peer support and the coping/de-stigmatization of issues of mental health for teenagers.

Another point of conviction that corroborates the notion that reducing the stigmatization of mental health illness can improve the treatment of those suffering from these various disorders in adolescence pertains to actually seeking treatment. Quite often, issues of mental health go unidentified in adolescents despite the fact that the prevalence of these disorders is increasing (Spooner and Martinovich, 2014, p. 217). Or, when these issues are identified, frequently it comes after some sort of noxious act. These acts might include instances of violence or other offenses which can result in incarceration (Spooner and Martinovich, 2014, p. 17). The implications of these facts are that due in part to the stigma associated with mental illness in adolescence, behavior that might reflect these illnesses is dismissed simply as a part of adolescence or as acts of volition on the part of the individual committing them. However, if there was a decreased sense of stigma about these issues, or if that stigma was altogether eradicated, one can infer that abnormal behavior would be more readily identifiable as possibly stemming from mental health issues. Subsequently, adolescents who engaged in the aforementioned behavior (such as "conduct disorder") (Spooner and Martinovich, 2014, p. 17) could get diagnosed quicker and seek the help they need prior to committing some regrettable offense.

Another piece of evidence that attests to the efficacy for treating mental disorders in adolescents by reducing the stigmatization associated with these condition pertains to the nature of stigma itself among this population. In many ways, the conception of marijuana and cannabis use amongst adolescents is the opposite of the stigma attached to mental disorders among this audience; other than alcohol and cigarette use, the use of cannabis is one of the most frequently used means of adolescents 'getting high' (Serafini et al., 2013, p. 125). Smoking cigarettes, drinking alcohol, and consuming marijuana is a triad of the most time honored -- and highly revered -- forms of intoxication that help to constitute the notion of what is regarded as 'partying'. Conversely, mental health issues have as much negativity attached to their stigma as there is a perception of fun and recreation associated with the aforementioned recreational drugs. However, there is academic literature that reveals that aside from its recreational use, the employment of cannabis (especially regularly) functions as both a crutch and a means of coping for individuals who are possibly suffering from mental disorders (Serafini et al., 2013, p. 2). Were it possible to get teens to de-stigmatize mental health issues, there is the possibility that they could help discern them in repeated or prolonged marijuana use -- and help those individuals get the mental health that they need.