1
|
Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Binder A, Mick I. Shaping and shifting schemas on supervised injectable opioid treatment: findings from a cross-sectional qualitative study in two German treatment facilities. Addict Sci Clin Pract 2024; 19:45. [PMID: 38802962 PMCID: PMC11129426 DOI: 10.1186/s13722-024-00475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Supervised injectable opioid treatment (SIOT) is a promising alternative for people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral opioid substitution treatment. Yet, SIOT utilization remains limited in Germany. We propose that this is due to beliefs, or schemas, on SIOT among people living with OUD. Drawing from medical sociology and social psychology, this study explores the emergence and evolution of such schemas on SIOT. METHODS We conducted semi-structured interviews with 34 individuals currently in or eligible for SIOT in two German outpatient treatment facilities and paralleled an inductive qualitative content analysis with the exploration of individual cases. RESULTS The analysis revealed that peer-to-peer interaction and individuals' practical experiences in therapy are crucial in constructing and changing idiosyncratic and shared schemas of SIOT. When facing ambiguous information, cognitive strategies like subtyping served to mitigate uncertainty. CONCLUSION This research has important practical implications for integrating experiential knowledge into clinical care and improve information sharing among people living with OUD. A nuanced understanding of the complex network of informal advice-seeking and -giving among people living with OUD is indispensable to adequately expand treatment modalities of proven effectiveness.
Collapse
Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (outpatient clinic for addiction medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Annette Binder
- Universitätsklinikum Tuebingen, Sektion Suchtmedizin und Suchtforschung (addiction medicine and addiction research department, Medical University Hospital Tuebingen, University of Tuebingen), Calwerstraße 14, 72076, Tuebingen, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
2
|
Rai S, Gurung D, Kohrt B. The PhotoVoice method for collaborating with people with lived experience of mental health conditions to strengthen mental health services. Glob Ment Health (Camb) 2023; 10:e80. [PMID: 38161746 PMCID: PMC10755382 DOI: 10.1017/gmh.2023.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
There is a growing recognition of the benefits of collaborating with people with lived experience (PWLE) of mental health conditions in mental health research and implementation of services. Such collaboration has been effective in reducing mental health stigma and improving the quality of mental health care. Here, we describe using PhotoVoice as a collaborative method in which PWLE use visual narratives to tell their recovery stories for promoting social contact, debunking myths and reducing stigma. First, we outline the framework of this collaboration, drawing on theories from medical anthropology and social psychology and focusing on reducing mental health stigma among primary healthcare workers. Then, we describe the process using our learnings from implementing PhotoVoice in Nepal, Ethiopia and Uganda. We highlight collaboration in five key steps with associated considerations: (1) identifying PWLE for collaboration; (2) training in photography, distress management and presentation skills; (3) developing a photographic recovery story; (4) training healthcare workers using the PhotoVoice narratives; and (5) ongoing support of mental health systems strengthening in collaboration with PWLE. Then, we critically reflect on the process, highlighting the benefits and challenges to the participants and researchers, thereby paving the way for expanding collaborations with PWLE using the PhotoVoice method.
Collapse
Affiliation(s)
- Sauharda Rai
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| |
Collapse
|
3
|
Hartog K, Peters RMH, Tukahiirwa RK, Jordans MJD. Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention. PLoS One 2023; 18:e0292064. [PMID: 37906579 PMCID: PMC10617710 DOI: 10.1371/journal.pone.0292064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Stigmatisation impedes health and quality of life. Evidence regarding stigma reduction interventions is, albeit growing, limited. There is a gap in the availability and evidence of interventions for reducing stigma among children and adolescents, especially in low- and middle-income countries. This paper describes the process that led to a stigma reduction intervention impacting children and adolescents in low- and middle-income countries, following previously conducted formative research. METHODS In this study, we conducted (i) online stakeholder consultations (FGD) (n = 43), including a survey assessing intervention acceptability, appropriateness, feasibility and scalability (n = 16); and (ii) preliminary field-testing of intervention content online and in a refugee settlement in Uganda. FINDINGS Stakeholder consultation showed the initial version of STRETCH (Stigma Reduction to Trigger Change for Children), albeit positively received, required adaptations. We made adjustments to i) take into account implementation duration, intervention flexibility and intersectionality; (ii) strengthen the involvement of individuals, including adolescents/youth, with lived stigma experience; (iii) target people close to individuals with lived stigma experience; and (iv) address feasibility and sustainability concerns. Preliminary field-testing simplified STRETCH while adding a community outreach component and revisiting the intervention setup, to ensure STRETCH can also be applied from a modular perspective. CONCLUSION We conducted a process to develop a child-focused multi-component stigma reduction intervention, with intended applicability across stigmas and settings. This paper provides an overview of the intervention development process, generating intervention-specific learnings with generic value. STRETCH aims to reduce stigmatisation at the implementing organisation, create community-wide reflection and stigma reduction demand, and reduce stigmatisation among various target groups.
Collapse
Affiliation(s)
- Kim Hartog
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ruth M. H. Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Mark J. D. Jordans
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
Collapse
Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| |
Collapse
|
5
|
Jenkins M, Gardiner T, Pekepo C, Ramritu P, Drysdale B, Every-Palmer S, Chinn V. Developing a System of Health Support for Young People Experiencing First-Episode Psychosis: Protocol for a Co-design Process. JMIR Res Protoc 2023; 12:e44980. [PMID: 37129953 DOI: 10.2196/44980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND People living with psychosis face a substantially increased risk of poor psychological well-being and physical health and premature mortality. Encouraging positive health behaviors from an early stage is crucial to the health and well-being of this population but is often overshadowed by symptom management within early intervention services. OBJECTIVE Experience-based co-design is a participant-centered approach that aims to combine service user narratives with service design methods to design systems of support for health and well-being. This study aims to use experience-based co-design principles to co-design a system that supports the health and well-being of young people experiencing first-episode psychosis (FEP), which considers the lived experience of these people within the context of early intervention services. We also aim to develop a set of principles to guide future systems to support the health and well-being of young people experiencing FEP. METHODS Up to 15 young people living with FEP aged 16 to 24 years who are service users of early intervention services in psychosis, their immediate support networks (family or friends), and health professionals involved with early intervention services in psychosis will be invited to participate in a series of co-design workshops. Data will be collected in various forms, including expressive forms (eg, art and spoken word) and traditional methods (interview transcription and surveys), with phenomenographic and thematic analyses being used to understand these data. Furthermore, the co-design process will draw upon indigenous (Māori) knowledge and the lived experience of mental health services from the perspectives of the members of the research team. The co-design process will be evaluated in terms of acceptability from the perspective of service users via rating scales and interviews. The study will be conducted within the Lower North Island in Aotearoa New Zealand. RESULTS Data collection will be performed between August 2022 and February 2023. Drawing from extended consultations with service users and service providers, we have developed a robust co-design process with which we intend to collect rich qualitative and quantitative data. The results of this process will be used to create a system of support that can be immediately applied and as preliminary evidence for funding and resource applications to deliver and evaluate a "full" version of the co-designed system of support. CONCLUSIONS The co-designed system of support and accompanying set of principles will offer a potentially impactful health and well-being intervention for young people experiencing FEP in Aotearoa New Zealand. Furthermore, making the co-design process transparent will further the field in terms of providing a blueprint for this form of participant-focused research. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001323718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44980.
Collapse
Affiliation(s)
- Matthew Jenkins
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Tracey Gardiner
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | | | - Pāyal Ramritu
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Briony Drysdale
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Victoria Chinn
- School of Health, Te Herenga Waka Victoria University of Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| |
Collapse
|
6
|
Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| |
Collapse
|
7
|
Walsh D, Foster J. Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10618. [PMID: 36078334 PMCID: PMC9518073 DOI: 10.3390/ijerph191710618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public's deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students' shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public's multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.
Collapse
Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK
| | | |
Collapse
|
8
|
Strategies to Reduce Mental Illness Stigma: Perspectives of People with Lived Experience and Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031632. [PMID: 35162655 PMCID: PMC8835394 DOI: 10.3390/ijerph19031632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reducing the stigma surrounding mental illness is a global public health priority. Traditionally, anti-stigma campaigns were led by mental health professionals/organisations and had an emphasis on increasing mental health literacy. More recently, it has been argued that people with lived experience have much to contribute in terms of extending and strengthening these efforts. The purpose of this paper was to elicit views and suggestions from people with lived experience (PWLE) as well as from informal caregivers of people with mental health conditions, on effective strategies to combat the stigma surrounding mental illness. METHODS Six focus group discussions (FGDs) were carried out with PWLE recruited at outpatient services at the Institute of Mental Health, Singapore, and five FGDs were carried out with informal caregivers who responded to advertisements for the study between March and November 2018. In all, the sample comprised 42 PWLE and 31 caregivers. All the FGDs were transcribed verbatim and were analysed using thematic analysis. A pragmatic approach was adopted for the study, and the researchers did not assume any particular philosophical orientation. RESULTS Four overarching themes depicting strategies to combat stigma were identified through thematic analysis. They were (1) raising mental health awareness, (2) social contact, (3) advocacy by influential figures or groups, and (4) the legislation of anti-discriminatory laws. CONCLUSIONS These strategies were in line with approaches that have been used internationally to disrupt the process of stigma. Our study has further identified nuanced details on how these strategies can be carried out as well as possible areas of priority in the Singapore landscape.
Collapse
|
9
|
Grandón P, Saldivia S, Cova F, Bustos C, Vaccari P, Ramírez-Vielma R, Vielma-Aguilera A, Zambrano C, Ortiz C, Knaak S. Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente. Psychiatry Res 2021; 305:114259. [PMID: 34752990 DOI: 10.1016/j.psychres.2021.114259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.
Collapse
Affiliation(s)
- Pamela Grandón
- Psychology Department, Universidad de Concepcion, Concepcion, Chile.
| | - Sandra Saldivia
- Psychiatric Department, Universidad de Concepcion, Concepcion, Chile
| | - Felix Cova
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Claudio Bustos
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Pamela Vaccari
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | | | | | | | - Camila Ortiz
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Stephanie Knaak
- Social Sciences Department, University of Calgary, Calgary, Canada
| |
Collapse
|
10
|
Newton-Howes G, Senior J, Beaglehole B, Purdie GL, Gordon SE. Does a comprehensive service user-led education programme effect more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress in medical students? A comparative cohort study. Aust N Z J Psychiatry 2021; 55:903-910. [PMID: 33459033 DOI: 10.1177/0004867420987886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes. METHOD A comparison cohort study was used to compare the attitudes of two cohorts of medical students who received this programme as part of their fifth (the fifth-year cohort) or sixth (the sixth-year cohort) year psychological medical education attachment (programme cohorts) with two cohorts of equivalent students who received a standard psychological medical attachment (control cohorts). Attitudes to recovery (using the Recovery Attitudes Questionnaire) and stigma (using the Opening Minds Scale for Healthcare Providers) were measured at the beginning and end of the attachments for each year and compared both within and between the cohorts using Wilcoxon signed-rank or Wilcoxon rank-sum tests. RESULTS With sample sizes ranging from 46 to 70 across all cohorts, after their psychological medicine attachment both the programme and control cohorts showed more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress. Significant differences between the programme cohorts and the control cohorts were found for recovery attitudes (median difference of 2, p < 0.05 in both fifth and sixth year), with particularly large differences being found for the 'recovery is possible and needs faith' subdomain of the Recovery Attitudes Questionnaire. There were no significant between cohort differences in terms of stigmatising attitudes as measured by the Opening Minds Scale for Healthcare Providers. CONCLUSION The introduction of a comprehensive service user-led anti-stigma and education programme resulted in significant improvements in recovery attitudes compared to a control cohort. However, it was not found to be similarly superior in facilitating less stigmatising attitudes. Various possible reasons for this are discussed.
Collapse
Affiliation(s)
- Giles Newton-Howes
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Jessica Senior
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Gordon L Purdie
- Dean's Department, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Sarah E Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| |
Collapse
|
11
|
Gordon SE, Kininmonth LA, Newton-Howes G, Purdie GL, Gardiner T. A comparative analysis of two alternative programmes to counter stigma and discrimination associated with mental illness delivered to medical students. Australas Psychiatry 2021; 29:357-360. [PMID: 33231093 DOI: 10.1177/1039856220971935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess and compare attitudes of medical students in response to two service-user-led anti-stigma and discrimination education programmes. METHOD Two programmes, consistent with the key elements of effective contact-based anti-stigma and discrimination education programmes for healthcare providers, were delivered to medical students in their penultimate and final year: a more intensive version of the programme in 2015/2016 and a briefer programme in 2016/2017. Attitudes were assessed using the Recovery Attitudes Questionnaire (RAQ) and the Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) at the beginning and end of their final year. RESULTS There were no significant differences between the years in initial scores on either scale. Both cohorts showed statistically significant reductions in scores on both scales after completion of the programme, indicating overall improvements in students' attitudes with reductions in stigma, and more positive attitudes towards recovery of those in mental distress. The more intensive programme led to significantly greater improvement in reductions in stigma than the less intensive programme. CONCLUSION Findings support the need for contact-based anti-stigma and discrimination education programmes for medical students that are both intensive and repeated over time.
Collapse
Affiliation(s)
- Sarah E Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Leah A Kininmonth
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Gordon L Purdie
- Dean's Department, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Tracey Gardiner
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| |
Collapse
|
12
|
A randomized controlled trial testing a virtual perspective-taking intervention to reduce race and socioeconomic status disparities in pain care. Pain 2020; 160:2229-2240. [PMID: 31568099 DOI: 10.1097/j.pain.0000000000001634] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We conducted a randomized controlled trial of an individually tailored, virtual perspective-taking intervention to reduce race and socioeconomic status (SES) disparities in providers' pain treatment decisions. Physician residents and fellows (n = 436) were recruited from across the United States for this two-part online study. Providers first completed a bias assessment task in which they made treatment decisions for virtual patients with chronic pain who varied by race (black/white) and SES (low/high). Providers who demonstrated a treatment bias were randomized to the intervention or control group. The intervention consisted of personalized feedback about their bias, real-time dynamic interactions with virtual patients, and videos depicting how pain impacts the patients' lives. Treatment bias was re-assessed 1 week later. Compared with the control group, providers who received the tailored intervention had 85% lower odds of demonstrating a treatment bias against black patients and 76% lower odds of demonstrating a treatment bias against low SES patients at follow-up. Providers who received the intervention for racial bias also showed increased compassion for patients compared with providers in the control condition. Group differences did not emerge for provider comfort in treating patients. Results suggest an online intervention that is tailored to providers according to their individual treatment biases, delivers feedback about these biases, and provides opportunities for increased contact with black and low SES patients, can produce substantial changes in providers' treatment decisions, resulting in more equitable pain care. Future studies should examine how these effects translate to real-world patient care and the optimal timing/dose of the intervention.
Collapse
|
13
|
Guan Z, Huang C, Wiley JA, Sun M, Bai X, Tang S. Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China. J Psychiatr Ment Health Nurs 2020; 27:224-236. [PMID: 31639239 DOI: 10.1111/jpm.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.
Collapse
Affiliation(s)
- Ziyao Guan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China.,Department of Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoling Bai
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| |
Collapse
|
14
|
Newton-Howes G, Gordon S, Fedchuk D. Making the World of Difference: a service user-led education programme reshaping the learning environment in psychiatry. Australas Psychiatry 2020; 28:226-228. [PMID: 31578869 DOI: 10.1177/1039856219878647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the implementation of a service user-led learning programme implemented within the education of undergraduate medical students and psychiatric registrars. CONCLUSION This programme has the potential to impact on the learning of those early in their medical career and future consultant psychiatrists. Ongoing research will help to explain the reach and depth of the programme and the elements of greatest benefit.
Collapse
Affiliation(s)
- Giles Newton-Howes
- Senior Lecturer, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Sarah Gordon
- Research Fellow, World of Difference, University of Otago, Wellington, New Zealand
| | - Dasha Fedchuk
- Assistant Research Fellow, University of Otago, Dunedin, New Zealand
| |
Collapse
|
15
|
Abstract
This study considers two of many messages that are used in antistigma campaigns: normalcy, that mental illness is like most kinds of illness-"You are just like me," and solidarity, that one's mental illness is accepted-"I stand with you." This study examined how research participants rated message merit: understandable, effective, and compelling. We particularly examined how views on message merit varied by whether participants reported previous mental health experience. Three hundred seventy-three participants rated the merit of the two messages provided in random order. They also reported previous experience with mental health services. Overall, participants viewed solidarity messages with greater merit than normalcy. Participants with self-reported mental illness viewed the solidarity message even better than participants without mental illness; this pattern varied by specific mental health experience. Findings suggest a greater understanding of stigma reduction methods from those who are more likely to have experienced stigma.
Collapse
|
16
|
Yamaguchi S, Ojio Y, Ando S, Bernick P, Ohta K, Watanabe KI, Thornicroft G, Shiozawa T, Koike S. Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2019; 54:33-42. [PMID: 30315333 DOI: 10.1007/s00127-018-1609-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE There is a critical need to clarify the long-term effects of anti-stigma interventions. The study aimed to assess the long-term effects of repeated filmed social contact or internet-based self-study on mental health-related stigma through a randomised controlled trial with 2-year follow-up. METHODS We randomly allocated 259 university or college students to a filmed social contact group, an internet-based self-study group, or a control group. The filmed social contact and internet-based self-study groups each received a 30-min initial intervention followed by emailed interventions every 2 months over a 12-month period. The Japanese version of the Reported and Intended Behaviour Scale (RIBS-J) and the Mental Illness and Disorder Understanding Scale (MIDUS) were used to assess behaviour, behavioural intentions (attitudes), and knowledge regarding mental health. RESULTS Of the 259 original participants, 187 completed the 24-month follow-up assessment. Mean scores for the RIBS-J future domain and MIDUS peaked at 1 month after initial intervention. Compared with baseline, at 24-month follow-up, we found a significant difference in RIBS-J future domain scores between the filmed social contact and control groups at 24-month follow-up (B = 0.95, 95% CI = 0.01,1.90, p = 0.049), while MIDUS scores in the filmed social contact group (B = - 4.59, 95%CI = - 6.85, - 2.33, p < 0.001) and the internet-based self-study group (B = - 4.51, 95%CI = - 6.86, - 2.15, p < 0.001) significantly decreased compared with the control group. CONCLUSION While outcome scores peaked at 1 month after initial intervention, results suggest that filmed social contact might have a long-term effect on behavioural intentions, and both filmed social contact and internet-based self-study may contribute to improved knowledge of mental health.
Collapse
Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Yasutaka Ojio
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Shuntaro Ando
- Department of Psychiatry, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Peter Bernick
- Student Accessibility Office, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan
| | - Kazusa Ohta
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| | - Kei-Ichiro Watanabe
- Office for Mental Health Support, Division for Counseling and Support, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Takuma Shiozawa
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,Institute for Diversity and Adaptation of Human Mind (UTIDAHM), The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.,UTokyo Center for Integrative Science of Human Behavior (CiSHuB), 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| |
Collapse
|