The horror of stigma: psychosis and mental health care environments in twenty-first-century horror film (part II)

Using Twitter to assess attitudes to schizophrenia and psychosis

Aims and methodSchizophrenia is a psychotic disorder that is stereotypically stigmatised as untreatable and associated with violence. Several authorities have suggested that changing the name, for example to psychosis, would reduce such stigmatisation. We aimed to compare attitudes to schizophrenia and psychosis on Twitter to see if psychosis was associated with less negative attitudes. Tweets containing the terms 'schizophrenia', 'schizophrenic', 'psychosis' or 'psychotic' were collected on www.twitter.com and were captured with NCapture. On NVivo, tweets were coded into categories based on user type, tweet content, attitude and stigma type by two independent raters. We compared the content and attitudes of tweets referring to schizophrenia/schizophrenic and psychosis/psychotic. RESULTS: A total of 1120 tweets referring to schizophrenia/schizophrenic and 1080 referring to psychosis/psychotic were identified over two 7-day periods; 424 original tweets for schizophrenia and 416 original tweets for psychosis were included in the analysis. Psychosis was significantly more commonly included in tweets expressing negative attitudes (n=131, 31.5%) than schizophrenia (n=41, 9.7%) (χ² = 237.03, P < 0.0001). Of the personal opinions or dyadic interactions, 125 (53.4%) in the psychosis data set were stigmatising, compared with 33 (24.6%) of those in the schizophrenia set (χ² = 44.65, P < 0.0001).Clinical implicationsThe terms psychosis/psychotic are associated with a significantly higher number of tweets with negative content than schizophrenia/schizophrenic. Together with other evidence, this suggests that changing the name of schizophrenia to psychosis will not reduce negative attitudes toward the condition.Declaration of interestS.L. has received personal fees from Otsuka and Sunovion, and personal and research fees from Janssen.

Improving access to specialized care for first-episode psychosis: an ecological model

Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.

Determining the effectiveness of a video-based contact intervention in improving attitudes of Penang primary care nurses towards people with mental illness

BACKGROUND

Mental illness-related stigma is common, and is associated with poorer outcomes in people with mental illness. This study evaluated the attitudes of primary care nurses towards people with mental illness and its associated factors; and the effectiveness of a short video-based contact intervention (VBCI) in improving these attitudes using a Malay version of the 15-item Opening Minds Stigma Scale for Healthcare Providers (OMS-HC-15-M).

METHODS

A 5-minute VBCI was developed comprising elements of psychoeducation and interviews of people with mental illness and the people they interact with, relating to experience of mental illness and recovery. A pre-post cross-sectional study was conducted on 206 randomly selected primary care nurses in Penang, Malaysia. The OMS-HC-15-M questionnaire was administered before and immediately after participants viewed the VBCI. The difference in mean pre-post VBCI scores using paired t-tests, effect size and standardised response mean (SRM) were obtained. Factors correlating to attitudes were obtained using univariate and multivariate regression analyses.

RESULTS

Differences in pre-post VBCI score were statistically significant (p<0.001) with a 14% score reduction, a moderate effect size and SRM at 0.97 (0.85-0.11) and 1.1 (0.97-1.2) respectively. By factoring in the Minimal Detectable Change statistic of 7.76, the VBCI produced a significant improvement of attitudes in 30% of the participants. Factors associated with less stigmatising attitudes at baseline were previous psychiatry-related training, desiring psychiatric training, and positive contact with people with mental illness.

CONCLUSIONS

This is the first study in Malaysia to show that a brief VBCI is effective in improving attitudes of primary care nurses towards people with mental illness in the immediate term. Further studies are needed to determine if these results can be sustained in the longer term and generalizable to other health care professionals. Qualitative studies are warranted to provide insight to the factors correlating to these attitudes. (300 words).

The Missing Thread - How Fiction Cheats Mental Health Nursing

Mental health nursing occupies an important place in mental health care, and nurses perform valuable work, yet fiction writers tend to rely on outdated imagery to portray the profession. This imagery reinforces negative stereotypes of mental health nursing. This article examines the problem and explores the implications for the profession, particularly in relation to stigma and public confidence. It outlines a significant gap in narrative literature, specifically in relation to the therapeutic relationship, and asks what can be done to encourage more realistic portrayals of the role.

Newspaper reporting of mental illness

Purpose

The purpose of this paper is to examine a time trend in newspaper reporting of mental illness in Japan between 1987 and 2014.

Design/methodology/approach

Four high-circulation national newspapers (the Yomiuri newspaper, the Asahi newspaper, the Mainichi newspaper and the Nikkei Newspaper) were selected for analysis. Articles were analysed using qualitative content analysis (n=448).

Findings

Whilst articles concerning the dangerousness of those with mental illness occupied a high proportion of coverage between 1987 and 2014, an overall shift is apparent whereby there is now more reporting of mental illness in relation to stress than in relation to dangerousness, particularly for depression. In contrast, schizophrenia was often reported in the context of violent crime. Information on the treatment, symptoms and prevalence of mental illness was rarely reported.

Social implications

While the nature of newspaper coverage of mental illness has been changing, there still is over-representation of dangerousness of mental illness, particularly of schizophrenia. For improving the public’s images of mental illness, it is hoped to reduce the proportion of reporting about dangerousness and to increase the proportion of reporting about treatment, symptoms and prevalence of mental illness and personal stories of those affected.

Originality/value

The present study is the first to examine changes in Japanese newspaper coverage over time and at the variation in reporting among diagnoses.

Adolescents' and Young Adults' Beliefs about Mental Health Services and Care: A Systematic Review

BACKGROUND

Adolescents and young people are known to hold negative views about mental illness. There is less known about their beliefs about mental health services and care.

OBJECTIVE

The aim of this study was to systematically examine literature on the beliefs of adolescents and young people from the general population about mental health services and care. Factors that positively and negatively influence these beliefs are also explored.

METHODS

Relevant electronic databases were searched for papers published in the English language between January 2004 and October 2015.

RESULTS

Culture seemed to influence how adolescents and young adults perceived mental health interventions. This was particularly evident in countries such as Palestine and South Africa where prayer was highly valued. Adolescents and young people were uninformed about psychiatric medication. They believed that accessing mental health care was a sign of weakness. Furthermore, they viewed psychiatric hospitals and various mental health professionals negatively. Film was found to have a negative impact on how adolescents and young people perceived mental health services, whereas open communication with family members was found to have a positive impact.

CONCLUSION

Adolescents and young adults hold uninformed and stigmatizing beliefs about mental health treatments, mental health professionals, and access to care. The sources of these beliefs remain unclear although some at least seem influenced by culture. Further research, (particularly qualitative research) in this area is recommended in order to address current gaps in knowledge.