Stigma around mental health can keep people from seeking help or following a doctor's treatment plan. But a new study published in Academic Psychiatry shows that public education initiatives could improve the picture.

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"Although mental health disorders are common, treatable medical illnesses, lack of information can often lead to misunderstanding and stigma," says Stephanie Salazar, MPH, the University of Michigan Depression Center's program manager for community outreach.

"Creating an open atmosphere for discussing these topics and empowering people with knowledge can help to reduce the stigma that often prevents people from seeking help."

The new study looked at the effect of a public education initiative, Bright Nights, launched by Depression Center as part of its strategic goals around reducing stigma. To kick off the initiative, the center partnered with the Ann Arbor District Library for an event on new treatments for seasonal affective disorder in 2006. It was such a success, the events continued.

About Bright Nights

Since its inception, Bright Nights has held more than 65 events, reaching an estimated 5,000 attendees, according to a report from U-M and the library. Events are held several times a year with the goal of raising awareness, creating an open atmosphere for discussing a variety of mental health issues, and getting people involved in mental health-related issues.

Bright Nights provides the community with the latest information on topics such as depression and bipolar disorder through presentations and panel discussions. The forum has grown to include topics including anxiety disorders, substance use, the relationship between cardiovascular disease, mental health and sleep and activity in adolescents. Clinicians, researchers, library staff and the general public are solicited for topic suggestions.

This helps keep community engagement high and address issues relevant to different individuals. Historically, however, generic sessions on depression, bipolar and anxiety have drawn the largest crowds. This could be because the majority of the individuals who attend these forums are more interested in gaining background knowledge on mental health, as opposed to learning more about a specific issue, the team says.

Each forum begins with an overview of the topic that will be discussed, presented by a content expert from Michigan Medicine. The overview addresses the latest research, best practices, treatment updates and emerging evidence in the field. Following the forum, a panel of experts conducts a discussion and takes questions from attendees. The panel is diverse, with individuals from within and outside Michigan Medicine to keep Bright Nights a truly communitywide forum.

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To further increase engagement and encourage a judgment-free environment, attendees have the opportunity to share anecdotes and offer advice. Time is reserved at the end of the forum for attendees to speak with medical experts and panelists on a one-on-one basis and to visit the Depression Center's information table for further information or assistance.

"Using a trusted public space to bring issues and concerns forward for discussion with experts in a field proved to be successful on many levels. An important one was establishing a positive 'town and gown' conversation about health issues in our community," says Josie Parker, director of the Ann Arbor District Library. The "town" institution of the public library, and the "gown" institution of the university, truly come together for each event, she says.

Evaluation: Attendees

The study describes what community members took away from the events. Of 109 Bright Nights attendees in 2016 and 2017, 34 respondents (31 percent) completed a 19-item survey distributed at the conclusion of each forum. Seventy-six percent of respondents were female and 24 percent were male, and they ranged in age from teenagers to older adults.

A majority of respondents (74 percent) rated the ease of understanding of the material as outstanding, and nearly all respondents (97 percent) felt that the presentation improved their understanding of the topic. Most said the 90-minute length was just right, and most lived within five miles of the venue.

Evaluation: E-advisors and faculty speakers

The study also includes views from the Depression Center's Patient and Family Centered Care e-advisors, who help give the center consumer feedback by serving as advisors on clinical committees and boards. They felt that Bright Nights represents an opportunity to help reduce stigma around mental health by bringing these issues into prominent places, and they suggested obtaining more patient and family input regarding topics of interest.

Seven U-M faculty who had participated as Bright Nights speakers from 2013 to 2017 also answered a survey about the experience.

Most agreed that mental health faculty and staff should be offered training in public education. Nearly all said they thought their audience had learned something new during the presentation.

"I like the real and raw nature of the questions and exchanges. It is a comfortable forum for me and offers an opportunity to demystify psychiatry and present a 'real person' view of psychiatry," noted one of the past presenters.

Lessons for other institutions  

Salazar says the sustainability of these programs relies on lasting partnerships, program accessibility, audience engagement and affordability.

To be able to provide this service for the greatest number of people possible, it's important to keep in mind a wide spectrum of individuals and their circumstances. Those that come from low-income situations may not have access to medical experts outside Bright Night forums.

"Therefore, a crucial aspect of public health forums is to allow the chance for individual questions from attendees to be answered. According to the survey results, the chance to ask questions and engage in conversation with experts is greatly valued by the people that attend these forums," Salazar says.

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Partnering with trusted public spaces that engage with the community is a great way to increase forum attendance and access, Salazar says. But the effort goes far beyond the in-person event. Each forum is recorded and posted in an online archive to attendees and the general public free of charge.

Salazar suggests forums have fewer speakers rather than more, and that they make sure to share information in a dynamic and compelling way, avoiding talks that are too technical. Strengthening evaluation efforts will increase forum effectiveness, satisfaction and impact in the community, and this is the only way a program can grow, she says.

"I would encourage any public library near a research institution to invite that knowledge and thinking into their spaces as forums," Parker says. "The results will manifest differently based on the community, but a sure outcome will be a great partnership and better access to cutting-edge information about serious topics."

Salazar adds: "By bridging the gap between research and dissemination, the Bright Nights Community Forums align well with the Depression Center's mission to detect depression and bipolar disorders earlier, treat more effectively, prevent recurrences and progression, counteract stigma, and improve public policy. For institutions with similar missions, this model is a good example of a low-cost, easily implemented strategy for providing high-quality information in an easily digestible way for the benefit of the whole community."

The dates for the 2018-2019 Bright Nights forums at the downtown Ann Arbor library are Oct. 9 and Nov. 13, 2018, and March 19, 2019.