Changing Knowledge and Attitudes with a Middle School Mental Health Education Curriculum

Otto F Wahl, Janet Susin, Lorraine Kaplan, Amy Lax, Dayna Zatina


Purpose: This research tested the effectiveness of a widely used mental health education curriculum in changing knowledge and attitudes about mental illness.

Method: Middle school students from four schools were provided the Breaking the Silence: Teaching the Next Generation About Mental Illness mental health instruction while students from other classes at the same schools received usual class instruction. Students completed questionnaires assessing knowledge, attitudes, and social distance preferences before, immediately after, and six weeks after the instruction was given.

Results: Students given the Breaking the Silence instruction showed improvements in knowledge about mental illness, attitudes toward mental illness, and willingness to interact with people with mental illnesses. Students in the comparison classes showed no changes.

Conclusions: Breaking the Silence was an effective means of improving the knowledge and attitudes of middle school students about mental illness.

Implications: An easy-to-administer and effective curriculum, Breaking the Silence is available to teachers and schools to help improve understanding and acceptance of people with mental illness. Such a curriculum, introduced during childhood and adolescence, may help to prevent the negative attitudes and misunderstanding that characterize adult perceptions of mental illness.



Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59, 614–625. doi: 10.1037/0003-066X.59.7.614. PMid: 15491256.

Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma. Psychological Review, 96, 608–630. doi: 10.1037/0033-295X.96.4.608.

Crocker, J., & Major, B. (2003). The self-protective properties of stigma: Evolution of a modern classic. Psychological Inquiry, 14, 232–237. doi: 10.1207/S15327965PLI1403&4_9.

Farina, A. (1982). The stigma of mental disorders. In A. G. Miller (Ed.) In the eye of the beholder (pp. 305–363). New York: Praeger.

Farina, A., & Felner, R. D. (1973). Employment interviewer reactions to former mental patients. Journal of Abnormal Psychology, 82, 268–272. doi: 10.1037/h0035194. PMid: 4754367.

Fink, P. J., & Tasman, A. (Eds.) (1991). Stigma and mental illness. Washington, DC: American Psychiatric Press.

Link, B. G., Cullen, F. T., Mirotznik, J., & Struening, E. (1992). The consequences of stigma for persons with mental illness: Evidence from the social sciences. In P. J. Fink & A. Tasman (Eds.) Stigma and mental illness (pp. 87–96). Washington, DC: American Psychiatric Press.

Link, B. G., Phelan, J., Bresnahan, M., Stueve, A., & Pescosolido, B. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89, 1328–1333. doi: 10.2105/AJPH.89.9.1328. PMid: 10474548. PMCid: 1508784.

Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30, 511–541. PMid: 15631243.

Milich, R., & McAninch, C. B. (1992). Effects of stigmatizing information on children’s peer relations: Believing is seeing. School Psychology Review, 21, 400–409.

New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. Executive Summary. Rockville, MD: U. S. Department of Health and Human Services.

Nunnally, J. C. (1961). Popular conceptions of mental health. New York: Holt, Rinehart & Winston.

Olshansky, S., Grob, S., & Malamaud, I. T. (1958). Employers’ attitudes and practices in the hiring of ex-mental patients. Mental Hygiene, 42, 391–401. PMid: 13589669.

Page, S. (1977). Effects of the mental illness label on attempts to obtain accommodations. Canadian Journal of Behavioral Science, 9, 85–90. doi: 10.1037/h0081623.

Phelan, J. C., Link, B. G., Stueve, A., & Pescosolido, B. A. (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared? Journal of Health and Social Behavior, 41, 188–207. doi: 10.2307/2676305.

Rabkin, J. G. (1974). Public attitudes toward mental illness: A review of the literature. Schizophrenia Bulletin, 10, 9–33. PMid: 4619493.

Sartorius, N., & Schulze, H. (2005). Reducing the stigma of mental illness. New York: Cambridge University Press. doi: 10.1017/CBO9780511544255.

Scheff, T. (1999). Being mentally ill: A sociological theory. (3rd ed). New York: Aldine De Gruyter.

Sones, S. (1999). Stop pretending: What happened when my big sister went crazy. New York: HarperCollins Publishers.

Thornicroft, G. (2006). Shunned: Discrimination against people with mental illness. New York: Oxford University Press.

U. S. Department of Health and Human Services (1999a). Mental health: A report of the Surgeon General. Rockville, MD: U. S. Department of Health and Human Services.

U. S. Department of Health and Human Services (1999b). Mental health: A report of the Surgeon General – Executive Summary. Rockville, MD: U. S. Department of Health and Human Services.

U. S. Public Health Service (2000). Report of the Surgeon General’s conference on children’s mental health: A national action agenda. Rockville, MD: U. S. Department of Health and Human Services.

Wahl, O. F. (1995). Media madness: Public images of mental illness. New Brunswick, NJ: Rutgers University Press.

Wahl, O. F. (1999a). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25, 467–478. PMid: 10478782.

Wahl, O. F. (1999b). Telling is risky business: Mental health consumers confront stigma. New Brunswick, NJ: Rutgers University Press.

Wahl, O. F. (2002). Children’s views of mental illness: A review of the literature. Psychiatric Rehabilitation Journal, 6, 134–158.

Wood, A. L., & Wahl, O. F. (2002). Teacher ratings of a curriculum for educating children about mental illness. Technical report for NAMI-Queens/Nassau.

Full Text: PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivs 3.0 License.