Public prejudice and discrimination toward mental illness have a profound effect on the lives of people with serious mental illnesses (SMI), including self-stigma, damaged self-esteem, social isolation, impaired vocational and social functioning, and reduced community participation. However, effective interventions have not yet been developed that reduce these negative effects. This project will evaluate the effects of a 10-week, peer-developed and peer-led group program, Combating Prejudice and Discrimination through Photovoice Empowerment, which blends Photovoice, a novel public health participatory action research methodology, with psychoeducation and teaching proactive coping strategies to empower individuals with serious mental illnesses to resist public prejudice and discrimination, and participate in the community as equal members. The Photovoice program has been manualized, and its feasibility and potential benefits have been established in a pilot randomized controlled trial (n=82) conducted at the Center for Psychiatric Rehabilitation at Boston University, in which participants showed significantly greater reduction in self-stigma and increase in proactive coping with public prejudice and discrimination. The proposed project will extend previous research on the Photovoice program by evaluating it in the context of a large public mental health agency (Riverside Community Care, Inc.), and determining whether improvements in self-stigma and proactive coping also lead to improved community functioning and integration, and psychological well-being and growth. We will conduct a randomized controlled trail with a total of 192 individuals with SMI (50% schizophrenia-spectrum), comparing the Photovoice program to services as usual (SAU), enhanced by the provision of a peer-led educational session about understanding and confronting public prejudice and discrimination. Assessments will be conducted at baseline, post-treatment, 3- and 6-month follow-ups. The primary hypotheses are that the Photovoice program is more effective than the SAU at reducing internalized stigma, enhancing proactive coping with public prejudice and discrimination, and increasing community functioning and integration. A secondary hypothesis will examine the impact of the Photovoice program on psychological well-being, personal growth and recovery. The Photovoice program is the first peer-led program for people with SMI that specifically targets empowerment to resist and confront public prejudice and discrimination in social situations. The proposed research will shed light on the effectiveness of an innovative, peer-led program that has already shown promise for addressing the pressing problem of prejudice and discrimination toward people with SMI.

Public Health Relevance

Psychiatric stigma is a major barrier to the treatment engagement and community integration of individuals with serious mental illnesses (SMI). The proposed study will test the efficacy of an innovative peer-led group program which is based on Photovoice - a promising public health participatory action research method. We expect that this project will advance current knowledge about effective ways to foster the capacity of individuals with SMI to resist public prejudice and discrimination, and as a result enhance their psychosocial functioning, community integration, psychological well-being, and personal growth and recovery.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Mental Health Services Research Committee (SERV)
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Juliano-Bult, Denise M
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Boston University
Schools of Allied Health Profes
United States
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