The present study investigated the effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and their attitudes about seeking professional help for emotional problems. Forty students enrolled in a rural Mississippi high school participated. Twenty were designated as the treatment group and twenty served as the control group. Results indicated that scores on both dependent variables (attitudes about seeking professional help and conceptions of mental illness) increased significantly for the treatment group and, further, these scores did not decrease significantly when the students were tested again twelve weeks later. The findings are discussed in the context of educating rural youth about mental illness with the express purpose of removing the stigma associated with the help-seeking process.
According to recent estimates of the prevalence of mental disorders and data collected on the use of mental health services, it is clear that resources designed to assist those in need of care are underutilized (Horwitz, 1987). One factor thought to contribute to the underutilization of mental health services, especially among rural Americans, is the stigma attached to mental illness and the associated help-seeking process.
Wodarski (1983) has suggested that the very act of seeking help, whether a diagnosis of mental illness is substantiated or not, may initiate social bias directed at the help seeker. Rural Americans, perhaps more so than other groups, are susceptible to the effects of stigma associated with mental illness. Certain characteristics of rural residents, such as their high regard for autonomy and self-help, are reportedly related to the propagation of stigma (Kelleher, Taylor, & Rickert, 1992). Stigma tolerance has been cited as a mediator of help-seeking behavior, which perhaps explains why proportionately fewer rural residents use mental health services than do urban residents (Flaskerud & Kviz, 1982). It would seem that a logical step in removing the stigma, and thus in removing an obstacle to service delivery, is to promote positive attitudes about seeking psychological help and to foster a less stereotypical and myth-laden view of mental illness (M. O. Wagenfeld, personal correspondence, 1994).
Napoletano (1981) has indicated that five factors influence attitudes about mental illness: classroom instruction, age, contact with mental patients, fear reduction, and length of practicum in mental health. Adolescence is a prime time to influence attitudes related to mental illness and help seeking, especially since few adolescents perceive therapeutic methods as an option when faced with emotional problems. Changing attitudes is particularly important because behavioral problems have replaced infectious disease as the major cause of morbidity and mortality among adolescents. Several researchers have noted that depression, substance abuse, physical and sexual abuse, and teenage pregnancy are the "new morbidities of youth" (Battaglia, Coverdale, & Bushong, 1990; Blum, 1987; Offer & Schonert-Reichl, 1992).
The purpose of the present study was to determine if a unit of instruction designed to change conceptions of mental illness and attitudes about seeking professional help was effective. The changes facilitated by the intervention were also tested for durability over time.
Forty adolescents, 13 to 17 years of age (M = 14.7 years), participated in this study. The school from which participants were recruited was located in a rural area near a northern Mississippi township with a population of less than 700. Of the families living within the school district, 14.17% had incomes below the poverty level.
All students in the ninth grade who were enrolled in health classes, who had parents' or guardians' permission to participate, who themselves agreed to take part, and who were present during the entire treatment period were included in the study. …