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Effective Mental Illness Education Makes a Difference

A two-year study sponsored by the National Institute of Mental Health (NIMH) to assess changes in knowledge, attitudes, and behavior relating to mental illness in middle school students through instruction with “Breaking the Silence” (BTS) lessons has concluded that the BTS program is effective in promoting growth in these areas.

“Results of our study show that even brief instruction (2 ½-3 hours) can produce change in how students understand mental illnesses. BTS is a very promising approach to improving the way children perceive and respond to mental illnesses,” stated Otto Wahl, Ph.D., professor of psychology, University of Hartford and principal research investigator. Dr. Wahl added, “Although the BTS program has been around for many years and has received much praise, it has not previously received a careful empirical assessment of its effectiveness. It was important to address the question of whether this widely used program is accomplishing its goals. Middle school students from different parts of the U.S. were the focus of the research and we can now statistically document that instruction in BTS does result in improvements in knowledge, attitudes, and/or behavior related to mental illnesses.”

As Janet Susin, president of NAMI (National Alliance on Mental Illness) Queens/Nassau and NAMI New York State observes, “Substantial research has established that the public holds inaccurate negative beliefs about those with mental illnesses, seeing them as dangerous, unpredictable, unattractive, unworthy, and unlikely ever to be productive members of society; creating an environment that impedes both treatment seeking and recovery. Children and adolescents are particularly sensitive to public opinion and attitudes. Ostracism, rejection, teasing, and damage to self-esteem, as well as reluctance to seek or accept mental health treatment, are among the possible consequences. The results of this study establish that, by educating children about mental illnesses, we can change attitudes and foster more accurate understanding and acceptance of people with psychiatric disorders.”

Research methodology included the development and pilot testing of questionnaires about mental illnesses, in middle schools in Connecticut and South Carolina. Following revision of the questionnaires, two groups of students from middle schools in New York, Florida, South Carolina and New Mexico were administered questionnaires; one group received BTS instruction, the other (control group) did not; both groups received the questionnaires a second time after BTS instruction for the first group; both groups completed questionnaires a third time, six weeks post instruction.

Students in the groups that received BTS instruction showed a statistically significant increase in accurate knowledge of mental illness and improved attitudes toward mental illness after receiving the BTS instruction. Those in control groups showed no significant improvement. Improvements were maintained through the six-week follow-up period.

BTS is an innovative teaching package which includes lesson plans, games, and posters on mental illness for three grade levels—upper elementary, middle school, and high school. Students learn the warning signs of mental illnesses, learn that mental illness can be treated successfully, and learn how to recognize and combat stigma. The BTS program also has the relatively unique feature that it is delivered by the school’s own teachers rather than by outside experts.

NAMI is a nationwide grassroots, self-help and advocacy organization dedicated to improving the lives of all those affected by severe mental illness.

For more information on BTS visit For NAMI Queens/Nassau call 516-326-0797, 718-347-7284 or visit