Our social marketing campaign will focus on Americans with mental health disabilities in the work place. Like other Americans, people with mental health disabilities want the opportunity to work. Ironically, over half of the costs associated with mental health are due to their high rate of unemployment and under employment. This problem has not been unique to people with mental health disabilities. The United States has had a history of right to work struggles: slavery, discrimination against immigrants, women in the work place, and the disability rights movement. People with mental health disabilities continue to be the last group to be accommodated. A 1991 survey ranked the public's comfort level for people with different disabilities: people in wheelchairs (59%), blind (47%), deaf (39%), mentally retarded (33%), and mentally ill (19%). To maximize success in the work place, it is vital that attitudes towards people with mental health disabilities be examined and changed.
People with mental health disabilities have a wide range of social skills, education, and work experience; however, they're frequently judged on the basis of stigmas which dehumanize them rather than on what they can do as individuals. The terms "crazy", "insane", "looney", "violent", and "phonies" have all been used to describe people with mental health disabilities. In an attempt to escape stigma, many people with mental health disabilities try to hide their disability and remain invisible. Fear of stigmatization is frequently so intense that people will not seek treatment. Family members invent cover stories to hide mental health problems or treatment from strangers, friends, and other family members. Invisible people are powerless to change how others view them interpersonally or in the media. Furthermore, if someone with a mental health disability does come forward to advocate for themselves, their act of advocacy is frequently viewed as evidence that they do not have a mental disability since people with mental health disabilities can not have good judgment. Alternatively, their arguments are dismissed on the grounds that mentally ill people don't have good judgment. Thus stigma forms a hegemony which blocks communication about people with mental health disabilities in the work place.
An examination of the attitudes and behaviors associated with the "psycho" stigma will reveal the strong impact stigma has on the employment of people with mental health disabilities. Violent behavior continues to be associated with people who are mentally ill. News stories, movies and television shows routinely depict people with mental illness as being among the most violent in our society. In contrast, recent studies show a modest link between some mental illnesses and violence; however, the same studies conclude demographics and past histories of violence have a significantly higher correlation with violent behavior in people with and without mental illness. Nevertheless, employers still screen out the mentally ill to reduce their litigation liability and to maintain a peaceful work environment. Consequently, people with mental health disabilities remain in the closet and out of the work place.
I. Opening Up the Work Place for People with Mental Health Disabilities
The Americans with Disabilities Act of 1990 (ADA) can have a significant impact on how mental health is treated in the work place. The ADA is the first federal law which seeks to address hiring, retention, and promotion of people with mental health disabilities. In the hiring process, the ADA seeks to eliminate disability as a consideration nor is affirmative action a part of the law.
Due to the stigma of mental illness, aspects of the ADA which concern the disclosure of disabilities play a central role for people with mental health disabilities. Employers can not ask questions about a persons disability in application materials or during interviews. Once a job is offered, a person with a disability can request a reasonable accommodation from their employer as long as they document and disclose their disability to the employer. An employee does not have to request a reasonable accommodation nor disclose their disability or accept a reasonable accommodation provided by the employer. An employer does not have to accommodate someone if the reasonable accommodation is too expensive or too difficult to implement. To disclose or not to disclose is the question. Is it better to hide in the closet or come out to ask for a reasonable accommodation?
What is a reasonable accommodation? A reasonable accommodation is a change an employer makes in the workplace to enable the disabled employee to perform the essential functions of the job. What are reasonable accommodations for people with mental health disabilities? This is a relatively uncharted area. For example, (as of March 1994) the EEOC which is charged with enforcing the employment aspects of the ADA has not developed recommendations about reasonable accommodations for people with mental health disabilities. Preliminary research indicates that stress, concentration, side effects of medication, and odd behavior are some common problems the employer may need to accommodate. Some suggested accommodations include, alternate schedules, enclosed offices or cubicles, and the orientation of supervisors and co-workers. Clearly, closer communication between government agencies, business organizations, and mental health support groups is needed to develop reasonable accommodations for people with mental health disabilities.
In the accommodation process, medical professionals are often caught in the middle between the employer and employee. For example, the role of psychiatrists in the courtroom is often controversial. One psychiatrist represents the defendant and another represents the plaintiff. This adversarial relationship often makes it difficult to resolve the conflicts and emphasizes the need to resolve differences between employees and employers before they reach the courtroom. Since lawyers, employers, and employees have different perspectives and goals in the situation, it is vital that a common ground be established to make the process of establishing reasonable accommodations a smooth one.
At the level of the individual and specific jobs, trust and credibility become crucial issues. The degree of trust between the employee, supervisor, and co-workers will strongly influence whether or not someone decides to disclose their disability and what level of accommodation they will receive. In addition, the employee may not be able to hide or feel they can't hide their disability and may seek a reasonable accommodation or a new job with a different employer. Therefore, strong interpersonal communication skills will greatly enhance the success of people with mental health disabilities in the work place.
II. Goals for Employment & Mental Health Disabilities Campaign
1. To initiate a self sustaining working relationship between human resource managers and the following organizations in order to facilitate the employment of people with mental health disabilities:
Government Agencies-- EEOC, NIMH, CMHS, State & County Mental Health Service Departments and Rehabilitaion Departments.
Mental Health Support Groups: DMDA, NAMI, MHA
Health Plans & Insurance Companies Medical Associations: AMA, APA, NASW.
2. Distribute "Mental Health & the Work Place" kits to 25% of the human resource departments in the United States in order to counteract the stigmas associated with mental illness in the work place so that people with mental health disabilities will be evaluated on their ability to do the job.
III. Defining the Target Audience
The primary target for our campaign will be the managers of human resources departments. We selected this audience because they serve as employment opinion leaders for their organizations. They gather information about legal requirements, play a central role in formulating the organization's employment policies and implement those policies.
IV. Message Design
The theoretical framework that was used to design the messages in this campaign was the theory of reasoned action. This theory postulates that people's behavior is dependent upon their Attitude Toward Behavior (AB) and their Subjective Norms (SN). The Attitude Toward Behavior depends upon the belief that a specific behavior has certain consequences (BC) and the evaluation of the effect of those consequences (EC). The Subjective Norm is the product of the belief that others want you to react to specific situations in a certain way (NB) and the person's motivation to comply with those people's expectations (NC). Thus, behavior can be changed by manipulating any of the four independent variables BC, EC, NB, or NC.
In the case of this campaign, the variable are as follows:
BC = How knowledgeable are human resource managers about mental health disabilities?
EC = How will people with mental health disabilites perform on the job?
NB = What stigmas are associated with mental health disabilities?
NC = What will happen to the organization if stigmas are perpetuated?
(Law suits, loss of productive workers, and bad publicity for their organization)
In order to evaluate the effectiveness of our manipulation of these variables on behavior change, we will pre-test the message in two different ways. There will be pre-screening of the TV commercial and radio PSA with human resource managers. Proto-type mental health disability resource kits will be distributed to 150 randomly selected human resource managers. We anticipate getting back a third of these surveys. There will be a survey included in these kits to receive feedback about the comprehensibility, attractiveness, and utility of the kits. We will modify the materials to accommodate the feedback received during the focus groups and from analyzing the surveys.
V. Choice of Communication Channels
A multiple channel approach will be used to diffuse the campaign's message throughout the target population. Ads will be placed in the Big Five newspapers, The Wall Street Journal, the New York Times, the L.A. Times, the Chicago Tribue, and the Washington Post. We will also place editorials in these newspapers with the expectation that the issue will diffuse to other publications who follow their lead.
To place our message in publications relied upon by human resource managers, we will contact influential resource managers sympathetic to our campaign about submitting articles or editorials. Our pre-test survey should enable us to identify some of these leaders.
To make sure everyone in our target audience is exposed to our campaign message we will:
1. Mail "Mental Health & the Work Place" information kits to the human resource departments of Fortune 500 companies.
2. Televise PSA spots during business oriented programs such as "Wall Street Week" and "Meet the Press".
3. Produce radio PSA spots to be broadcast during commute hours.
VI. Message Production
RADIO PSA
The radio PSA Will be a sound only version of the TV commercial.
TV Commercial
The television PSA has three objectives:
1. To promote awareness of mental health disabilities on the job.
2. Use social modeling to show that people with mental health disabilities are not that different from other workers.
3. To provide an "800" number where people can get information about ordering a "Mental Health & the Work Place" kit.
The following is a 45 second spot:
The spot opens in an office with a half dozen people talking on the phone, typing, doing data-entry, or meeting with clients. Some of the workers are discussing the company's business plans. There are people representing different ages, ethnicities, gender, and disabilities. Staff and management are represented. This scene evokes the feelings of a normal day at the office. The camera doesn't focus on any particular person.
The sound of the people working in the office fades into the background as the narrator asks the viewer, "Can you tell which of these people has a mental health disability?" The office sounds fade back in while the focus shifts to the face of each worker as the camera looks into their face. The camera pans back to show the whole office. One of the people steps forward to identify her/himself. They greet the viewer, say their first name, and tell how long they've worked for the company. The other workers stand behind her/him as the scene fades to black. "Together Everyone Achieves More" appears in large bold white letters across a black screen. This is replaced with the campaign logo and the text, "For more information on mental health in the work place call, the Mental Health Association at 1-800-555-2121" and a graphic of the campaign logo. The text is accompanied by a voice-over of the same message.
We will produce three versions of this commercial using real people who are co-workers in well respected companies. The commercials will share the same narration and plot, but they will occur in three different work settings: an office, a manufacturing plant, and a retail store. The participation of people from diverse backgrounds, work settings, and companies will have a synergistic effect on the viewers. They will relate to people with mental health disabilities on the job.
When people call, they will be able to receive a "Mental Health in the Work Place" kit. We will produce two different kits. One kit for human resource professionals and another for workers. There are three objectives we'll try to achieve with the kits:
1. Inform the audience about a range of different mental health disabilities.
2. Inform the audience about laws which cover mental health issues on the job.
3. Inform the audience about local resources for mental health support.
The kit for the human resource professionals will contain pamphlets about applicable laws and regulations for mental health in the work place. This is used to inform or remind human resource professionals about their responsibilities and options. The language used in this version of the kit will parallel that found in the resource materials currently used by these professionals to accommodate people with other barriers to employment.
In contrast, the kit for workers will have a much more personal rather than personnel flavor to it. There will be no obscure jargon in this version of the kit. It will talk about different mental health disabilities and how to work with people who have them.
Conclusion
Our social marketing campaign will attempt to effect change in the employment of people with mental health disabilities. We will do so by attempting to shift the subjective norm on people with mental health disabilities from one of fear and incompetence to one of acceptance and productivity. We will do so by targeting human resource personnel and the general public using a multi-media approach. The human resources personnel will receive specific information about laws and regulations associated with mental health disabilities as well as specific, practical information about how to implement policies to accommodate people with mental health disabilities in the workplace. They will then be able to educate other people in their organization with respect to their employees with mental health disabilities.
We will target the general public by displaying a wide variety of people with mental health disabilities in a wide range of employment situations. The central idea is to allow the general public to identify with people who have mental health disabilities so that they will be seen as similar rather than being significantly different from themselves. The goal will be to displace current negative beliefs about people with mental health disabilities with the belief that people with mental health disabilities can be productive employees and co-workers because they're not too different from the rest of society.
Survey: Louis Harris and Associates, Inc. for the National Organization on Disability, 1991