Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature

Decreasing Prejudicial Attitudes of Fear and Avoidance Toward Those Who Live with a Mental Illness-A Quasi-Experimental Controlled Study

The undergraduate mental health nursing course is an optimal time to address stigma and prejudice, while developing positive student attitudes toward those who live with mental health conditions. A quasi-experimental, pretest-posttest, nonequivalent-group study with a sample of undergraduate nursing students in New York City (N = 126) was conducted to determine the impact of an undergraduate mental health nursing course on attitudes toward people living with a general mental illness, depression, or schizophrenia. The intervention resulted in a significant reduction in total prejudice scores toward those with a general mental illness when compared to the control (p = 0.033, partial η2 = 0.062). The intervention had no significant impact on total prejudice scores regarding those with depression, or schizophrenia. Subscale analysis revealed the intervention significantly reduced attitudes of fear/avoidance regarding general mental illness (p = 0.040, partial η2 = 0.058) and schizophrenia (p < 0.001, partial η2 = 0.164). There was no impact on authoritarian or malevolent attitudes. Though some attitudes were not amenable to change, this study provides evidence that positive attitudes can be cultivated through undergraduate nursing education. Curricular reform is needed to reduce all facets of prejudice and best prepare future nurses to care for those with mental health conditions.

Substance use Attitudes, Beliefs, Experience, and Knowledge Among Nursing and Nursing Assistant Students

Stigma is a public health concern. Stigmatizing attitudes toward persons with substance use disorders (SUDs) can adversely impact clinical care and outcomes. Beliefs about SUD, prior experience and familiarity to persons with SUD, and educational curricula drive attitudes among health-care workers. In 2019, nursing and nursing assistant students were recruited through an online survey platform. Participants completed an SUD knowledge test and a survey assessing education, beliefs, personal experience, and confidence in recognizing the signs and symptoms of SUD. One hundred and ten health-care students (nursing students, n = 67 and nursing assistant students, n = 43) completed the survey. Among nursing assistant students, endorsing a disease model of addiction (F(2, 40) = 5.83, p < .001, R2 = .23), and personal familiarity with SUD (F(2, 40) = 4.46, p < .001, R2 = .18), were significantly positively predictive of positive regard toward working with persons with SUD. For nursing students, endorsing a disease model of addiction, educational curricula involving persons with SUD, and personal familiarity were significantly positively predictive of positive regard toward working with persons with SUDs (F(2, 61) = 11.52, p < .001, R2 = .36). Interventions to mitigate drug-related stigma among health-care students should center students with personal familiarity, promote the disease concept of addiction, and incorporate contact-based training.

Mental health stigma and its relationship with mental health professionals - A narrative review and practice implications

The extent and magnitude of the mental health stigma are enormous, with substantial clinical and social implications. There is a complex relationship between mental health stigma and mental health professionals (MHPs); MHPs can be anti-stigma crusaders, victims of stigma, and even a source of stigma. Unfortunately, literature is scarce talking about the relationship between stigma and MHPs. Hence, the current review aims to bridge the existing gap in the literature on various aspects of stigma and the role of MHPs. For the current review, we ran a search in PubMed and Google Scholar databases; we restricted our study to records focusing on the interplay of mental health stigma and the MHPs, published during 2012-2022, in English, and having a full text available. We found that MHPs (psychiatrists, psychologists, and psychiatric nurses) can also be the recipients of the stigma. The stigma faced by the MHPs is determined by the negative stereotypes set by the media, or medical students, or other health professionals; the marginal position of psychiatry in the health system; difficult-to-treat mental disorders; MHPs' own experience of stigma; and the attitude or beliefs of various caders of the MHPs, their professional experience, and expertise in managing various mental health conditions. Notably, MHPs can also be a source of stigma (stigmatizers). MHPs need to be sensitized concerning this, and the anti-stigma interventions must incorporate this aspect of stigma. Novel interventions, such as digital-based programs, should be used instead of traditional anti-stigma programs in order to decrease stigma around mental health issues and make anti-stigma initiatives more appealing and scalable. To address the issues of stigma, there has to be more communication between MHPs, other health professionals, service users, and policymakers.

Opportunities for Nurses to Decrease the Stigma Associated with Housing Instability and Homelessness

The number of people experiencing homelessness (PEH) in the United States has increased in the past 5 years. PEH have a higher disease burden and early mortality compared to people who are housed. Stigma adds to the burden of disease and disease management for PEH. In this article the authors review stigma, define housing and homelessness, describe the health and health care disparities PEH experience, and using the socio-ecological model as a framework, offer opportunities for nurses to intervene in efforts to decrease the stigma that PEH and housing instability encounter to improve health outcomes.

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences

BACKGROUND

Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers.

OBJECTIVE

This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention.

METHODS

The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach.

RESULTS

Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation.

CONCLUSIONS

The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it

BACKGROUND

Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic.

AIMS

This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities.

METHODS

An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated.

RESULTS

Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues.

CONCLUSION

The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

Admitting the heterogeneity of social inequalities: intersectionality as a (self-)critical framework and tool within mental health care

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities.

Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students

BACKGROUND

Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students' perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes.

METHODS

Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis.

RESULTS

In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to 'how best to support students to prevent negative attitudes from forming' was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum.

CONCLUSIONS

The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes.

Challenges and opportunities for improvement when people with an intellectual disability or serious mental illness also need palliative care: A qualitative meta-ethnography

BACKGROUND

People with diagnoses of intellectual disability or serious mental illness have higher mortality rates due to physical comorbidities; better understanding is needed to guide best practice in provision of palliative care for these populations.

AIMS

To identify multivoiced perspectives, drawn from lived experience of: what works, and what does not, in palliative care for people with intellectual disability or serious mental illness; challenges in, and opportunities to improve, palliative care.

DESIGN

A systematically constructed qualitative meta-ethnography. Protocol published (PROSPERO: CRD42021236616).

DATA SOURCES

MEDLINE, PsychINFO, CINAHL PLUS and Embase used without date limitations. Papers published in English, containing qualitative data on palliative care provision for people with a diagnosis of intellectual disability or serious mental illness were included. Global five-point strength score applied for relevance/quality appraisal.

RESULTS

Familiarity (of location, people and/or things) is important for good palliative care. Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common. Adapting training for palliative care staff to address concerns and beliefs about mental illness is one of the methods that helps avoid diagnostic overshadowing. Proactive identification of service arrangements to meet needs of persons with personality, psychotic, delusional and bipolar affective disorders will help optimise care.

CONCLUSIONS

Evidence, including the voices of people with intellectual disability or serious mental illness is urgently needed to guide efforts to improve their access to and experience of palliative care. More evidence is especially needed to understand, develop and implement best practice for people with psychosis, bipolar affective disorder, mania and personality disorder.

The prevalence of and perception toward mental illness: a cross-sectional study among Indonesian mental health nurses

BACKGROUND

The emergence of the Coronavirus disease 2019 (Covid-19) pandemic has affected nurses' mental and psychological health. This study investigates the prevalence of depression, anxiety, and stress among Indonesian mental health nurses and their perception of mental illness.

METHODS

A cross-sectional study was conducted shortly before the height of the Covid-19 outbreak in Indonesia. The data were collected using the 21 items of the Depression, Anxiety, and Stress Scale (DASS-21), the questionnaire on perception toward mental illness, and demographic information.

RESULTS

Approximately 2.5%, 6.5%, and 1.9% of the nurses had the symptoms of depression, anxiety, and stress, respectively. The vast majority of them perceive that society should treat well people with mental illness (94.8%) and that the government should protect them (94.8%). More than half also believe that they can eat anything but seldom get physically ill (62.1%) and that in Islam, people with mental illness are innocent and are destined for paradise (61.1%).

CONCLUSIONS

A considerably low prevalence of mental distress was discovered, which might be attributed to the nurses' implementation of mental health skills and effective coping mechanisms. Further training and awareness-raising campaigns are needed to address their misconceptions about mental illness.

Attitude of Syrian medical specialty trainees toward providing health care services to patients with mental disorders

BACKGROUND

The stigma associated with mental diseases in the healthcare system and among healthcare professionals has been identified as a significant barrier to treatment and rehabilitation and to the provision of substandard physical care for persons with mental illnesses. The goal of this study is to assess the attitude of physicians in Syria towards individuals with mental health disorders.

METHODS

An online cross-sectional survey was conducted among phyisicians in Syria to evaluate their attitudes toward patients with mental health disorders and their provided treatment in the time period between August 16 and October 1, 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were all medical specialist trainees from all specialties and residents who had direct contact with people suffering from mental health disorders. The questionnaire was divided into two sections; the first included sociodemographic data on the participants and the second assessed physician's attitudes toward mental illness patients. With the IBM SPSS V. 28.0 package tool (IBM Corporation, Armonk, NY, USA), descriptive and multivariate logistic regression analyses were used to analyze the data.

RESULTS

539 medical residents participated in this research; their average age was 26.11 (+- 1.74) years, and 50.27% were males. City residents had the highest stigma score on the third question (2.66 ± 1.06, P value < 0.05) in the 'social distance' domain. The mean stigma scores for these three items in the recovery area were (2.76 ± 1.15, 2.51 ± 0.92, and 3.73 ± 0.83), respectively, for city residents. In the 'social distance' domain, the stigma score of two questions (the first and fourth questions) was associated with the resident's specialty, with dermatology residents having the highest mean score in both questions (mean = 3.6 ± 1.12, 3.43 ± 1.19, respectively). Only the second item in the 'Detection' domain was scored higher (mean = 3.850.81) by surgery residents than other residents. The stigma in the 'Recovery' domain was greatest among dermatology residents (mean = 3.710.94) than among other residents. There was a statistically significant relationship between residency and the Detection stigma scale (p = 0.03, Adj R2 = 0.008). There was a moderate correlation (Adj R2 = 0.048) between the Recovery scale and three of the six predictors (location, marital status, and the number of years living in the current residence). Two demographic factors (country of residence and marital status) were significantly correlated (p0.05) with the Social Responsibility Scale, and the Adjusted R-Squared Value was 0.006.

CONCLUSION

Our findings indicate substantial stigma among resident physicians who treat patients with mental illnesses, which might negatively impact both the efficacy of therapy and the phyisician's mental health. It is important to educate medical residents on mental health issues so that they can treat their patients appropriately. It is suggested that mental health concerns be included in the curriculum of residency programs for physicians so that they have adequate perspectives and attitudes about treating these patients.

Stigmatizing attitudes toward mental disorders among non-mental health nurses in general hospitals of China: a national survey

Background

Negative attitudes of nurses toward mental disorders have been reported in various countries. Nurses' stigmatizing attitudes can harm patients with mental disorders (PWMD), thereby delaying the provision of help to patients and leading to decreased quality of care. In this study, we aimed to assess Chinese nurses' stigmatizing attitudes toward patients with mental illness and provide a basis for future development and testing of appropriate and culturally adapted interventions to reduce it.

Objective

This study aimed to assess the attitudes of Non-mental Health Nurses (NMHNs) in general hospitals in China toward the stigma of PWMD and determine the factors influencing them.

Methods

A cross-sectional survey of NMHNs in general hospitals were conducted. A self-designed WeChat-based questionnaire was used that included demographic information about the need for training on mental health issues. Participants were provided with a vignette of a depression case with suicidal thoughts. The Depression Stigma Scale (DSS) and Social Distance Scale (SDS) were used to assess attitudes toward mental disorders. Nine questions on the adequacy of knowledge about anxiety and depression and the current status of scale use were used to assess the current status of training needs for mental disorders. Descriptive analysis, chi-square test, and multivariate logistic regression were used for the table.

Results

A total of 8,254 nurses in non-mental health professions participated in this study. The mean DSS score of NMHNs was (17.24 ± 6.700), and the SDS score was (10.34 ± 3.154). The total detection rate of stigma among the survey respondents was 13.40% (1,107/8254). Multivariate logistic regression showed that age between 30 and 39 years [p = 0.001, OR = 1.427 (1.154-1.764)], 4 years of work experience and above [p = 0.018, OR = 1.377 (1.056-1.796)], having a bachelor's degree [p < 0.001, OR = 0.742 (0.647-0.851)], adequate psychological knowledge [p < 0.001, OR = 1.567 (1.364-1.799)], full knowledge of communication with patients with anxiety and depression [p < 0.001, OR = 1.848 (1.389-2.459)], and the need to acquire skills to identify anxiety and depression were the influencing factors associated with stigma [p < 0.001, OR = 0.343 (0.236-0.499)].

Conclusion

Stigmatizing attitudes toward PWMD exist among NMHNs in general hospitals in China. Thus, more mental health education programs for NMHNs are needed. Factors associated with higher morbidity stigma can be used to develop appropriate interventions to improve NMHNs' stigmatizing attitudes and provide better quality care to PWMD.

The Role of Self-Determined Motivation and the Potential for Pre-registration Student Learning: A Comparative Study within a Mental Health Clinical Placement

Developing therapeutic relationship skills as well as clinical skill confidence is critical for nursing students. While the nursing literature has examined multiple factors that influence student learning, little is known about the role of student motivation in skill development in non-traditional placement settings. Although therapeutic skills and clinical confidence are vital across a variety of contexts, here we focus on its development in mental health settings. The present study aimed to investigate whether the motivational profiles of nursing students varied with the learning associated with developing (1) a therapeutic relationship in mental health and (2) mental health clinical confidence. We examined students' self-determined motivation and skill development within an immersive, work-integrated learning experience. Undergraduate nursing students (n = 279) engaged in five-day mental health clinical placement, "Recovery Camp," as part of their studies. Data were collected via the Work Task Motivation Scale, Therapeutic Relationship Scale and the Mental Health Clinical Confidence Scale. Students were ranked into either high (top-third), moderate (mid-third) or low (bottom-third) motivation-level groups. These groups were compared for differences in Therapeutic Relationship and Mental Health Clinical Confidence scores. Students higher in motivation reported significantly higher therapeutic relationship skills (Positive Collaboration, p < .001; Emotional Difficulties, p < .01). Increased student motivation was also associated with greater clinical confidence compared to each lower-ranked motivation group (p ≤ .05). Our findings show that student motivation plays a meaningful role in pre-registration learning. Non-traditional learning environments may be uniquely placed to influence student motivation and enhance learning outcomes.

Attitudes of Italian mental health nurses towards mental illness and recovery: a cross-sectional study

Background

Mental health nurses' (MHNs) stigma and discrimination against people with mental illnesses are obstacles to recovery and the development of effective care and treatment. Although many authors have been interested in exploring stigma among general health professionals, paradoxically, less and non-generalizable evidence is available on this phenomenon among MHNs. Understanding the factors associated with stigma and its relationship to recovery attitudes among MHNs could allow for more accurate interventions and improve patient care outcomes.

Objective

This study conducted on a sample of Italian psychiatric nurses had the objective of analyzing the aptitude for recovery and the tendency towards stigma of these professionals towards mental illness.

Methodology

A cross-sectional web survey was conducted on a sample of Italian MHNs, who were administered two validated tools, the RAQ-7 (assessment of recovery aptitude) and the WHO-HC-15 (assessment of stigma) respectively.

Results

A total of 204 MHNs were interviewed. The analysis showed positive overall scores (high recovery aptitude and low stigma levels) among participating MHNs. The attitude to recovery appeared to be directly related to a lower tendency to stigma towards mental illness. It has been observed that MHNs with advanced levels of education appear to be more predisposed to recovery, as well as generally less stigmatizing. There is evidence that the setting in which care is provided, marital status and age can play a significant role in the tendency to stigmatization.

Conclusion

Our manuscript could assist nursing executives, leaders or educators in making decisions about managing and preventing stigma among MHNs.

District Nurses' Experiences of Practice in Caring for People with Mental Ill-Health in Swedish Primary Care

Mental ill-health is one of the greatest public health challenges in Sweden, and it is estimated that every third person seeking primary care in the country suffers from mental ill-health. Without proper treatment at an early stage, mental ill-health may lead to long-term illness and have a significant impact on functional ability. As district nurses are specialists in public health nursing, they have been pointed out as having a key role in the prevention and management of mental ill-health. The aim was to explore district nurses' practice in caring for people with mental ill-health within primary health care. Individual semi-structured interviews were conducted with district nurses (n = 18) and the transcribed text was subjected to qualitative content analysis. The result was formulated as several subthemes, eventually developed into three themes: Practicing within an organisation where traditional attitudes are impediments, Perceiving mental healthcare as not being an obvious part of district nursing, Working as fellow human beings rather than "professionals". The findings indicate that district nurses feel uncertainty in their practice in this area. Working independently with mental ill-health was not always considered socially acceptable among district nurses. Despite these challenges they tried to remain involved without becoming emotionally overwhelmed. They also strived to meet the needs of these patients with 'small things', that could be effective and a part of recovery-oriented practice, even if they might be defined as unprofessional, and their efficacy negated.

The stereotype content model and mental disorders: Distinct perceptions of warmth and competence

This work investigates the perception of eight different mental disorders within the Stereotype Content Model (SCM). The presented study (N = 297) includes a sample representative for the German population in terms of age and gender. Results reveal distinct warmth and competence evaluations for people with different mental disorders, e.g., people with alcohol dependence were seen as less warm and less competent than people with depression or phobia. Future directions and practical implications are discussed.

Stigma towards patients with mental illness: An online survey of United States nurses

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma-related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact-based and educational anti-stigma interventions for nurses in order to reduce stigma towards mental illness.

Second-year undergraduate nursing students' experiences with clinical simulation training in mental health clinical practice: A focus group study

AIM

The aim of this focus group study was to investigate second-year undergraduate nursing students' experiences with clinical simulation training as part of their clinical practice in acute mental health care.

BACKGROUND

The quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students' experiences with clinical simulation training as an integrated part of nursing students' clinical practice in acute mental health wards.

DESIGN

Explorative qualitative focus group study.

METHOD

Three focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.

RESULTS

Clinical simulation training as part of the clinical practice increased the students' preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.

CONCLUSION

Clinical simulation training as part of clinical practice contributed to increasing the students' self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.

Mental Health Nurses' Social Representations of People Who Experience Mental Illness: A Story of Paradoxes

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses' representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses' social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses' social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.

Raising Suicide in Medical Appointments-Barriers and Facilitators Experienced by Young Adults and GPs: A Mixed-Methods Systematic Review

The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults' views, four on GPs, and one considered both GP and young adults' viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP's responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.

The use of digital escape rooms in nursing education

Negative attitudes and prejudices towards people with a mental disorder are common across cultures and societies. The stigma associated with mental illness leads to a lower quality of life, given the discrimination and social exclusion suffered by people with this type of disorder. In the field of health, research has shown that doctors and nurses also manifest these types of stigmatizing behaviors and attitudes. The present study aims to create and apply an educational escape room for the purpose of training nursing students in mental health, promoting positive attitudes towards people who have a mental disorder. To do so, a pre-post study was conducted with an experimental group and a control group to determine whether the escape room was effective for the modification of stigmatizing behaviors compared to transmissive lecture class, and a third measurement was made at 6 months only to the experimental group to evaluate whether the changes produced by the escape room were maintained in the long term. The results indicate that the students participating in the study obtained better scores in sensitization and these remain better over time. It is concluded that the escape room used is suitable for the training and sensitization of future nursing professionals in the field of mental health, facilitating the learning of knowledge and positive attitudes towards severe mental disorder.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study

Background

International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.

Methods

Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.

Results

Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.

Discussion

Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Prejudice towards people with mental illness, schizophrenia, and depression among mental health professionals and the general population

The aim of the study was to measure and compare prejudice towards people with specific mental illnesses between mental health professionals and the general population, and examine personality, ideological, and attitudinal antecedents of prejudice. To do so, we also aimed to validate three shortened scales of prejudice. A sample of mental health professionals (N = 299) and a sample from the general population (N = 427) completed shortened versions of the Prejudice towards People with Mental Illness, Prejudice towards People with Schizophrenia, and Prejudice towards People with Depression scales. They also completed measures of validity criteria and demographics. The scales demonstrated construct validity in both samples. Although prejudice was highest towards people with schizophrenia and lowest towards people with depression, mental health professionals demonstrated significantly less prejudice overall than the general population. Prejudice was associated with higher social dominance orientation, right wing authoritarianism, ethnocentrism, conservatism, and generalized prejudice, and lower agreeableness, openness to experience, and contact. These antecedents of prejudice were better predictors than any demographic or profession-related variables examined. This study contributes increased knowledge of the structure and correlates of prejudice towards people with mental disorders. This knowledge should inform more nuanced and effective interventions, therapy, and training.

Nurses' leadership in psychiatric care-A qualitative interview study of nurses' experience of leadership in an adult psychiatric inpatient care setting

WHAT IS KNOWN ON THE SUBJECT?: Previous studies on leadership in psychiatric care have focussed on a diversity of staff and on different healthcare settings. Nurses in both Sweden and internationally, working with patients newly diagnosed with psychosis and addiction, describe an overwhelming workload. Existing research points out that experience and leadership training are the most important factors to exert a good nursing leadership. In Sweden, requirements for leadership exists already from the first day of a nurse's career. The relationship and communication between nurses in psychiatric care and members of the staff is decisive for whether the leadership will work. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study adds knowledge regarding the challenges leading the nursing care for patients diagnosed with psychosis and addiction. Ambivalence in the leadership role is prominent among nurses in psychiatric care and feelings of responsibility and meaningfulness are mixed with feelings of powerlessness and uncertainty. Swedish psychiatric nurses lack mandate to lead psychiatric nursing care. This may increase the feelings of uncertainty in their leadership role. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A mandate to lead as well as a leadership guidance in communication and teambuilding will enhance the leadership, especially among newly graduated nurses. Heightened awareness within the healthcare organization about nurse's experience of difficulties in leading the psychiatric nursing care of the most severe psychiatric illnesses could increase the right prerequisites for leadership. ABSTRACT: Introduction Research shows that psychiatric nursing care puts additional demands on the nurse as a leader due to the psychological complexity of care. Experience and leadership training are most important to exert leadership. In Sweden, demands for leadership exist already at the beginning of a nursing career, and in psychiatry, it may lead to an overwhelming workload. Aim/Question The aim of the present study is to highlight nurses' experiences of leading the psychiatric nursing care in an adult psychiatric context. Method A qualitative interview study of eleven registered nurses within psychiatric inpatient care. Content analysis was used for analysis. Results Leading with combined feelings of both meaningfulness and uncertainty were the theme arising from the result. Discussion Findings from Swedish and international studies stress special demands on leadership in psychiatric care. The result shows that nurses perceived an ambivalence of their leadership in terms of both meaningfulness and uncertainty. Implications for Practice An official mandate to lead as well as leadership guidance in communication and teambuilding will enhance leadership, especially among newly graduated nurses. Heightened awareness within healthcare organizations about difficulties in leading psychiatric nursing care could increase the possibility to create right prerequisites for leadership.

The development of positive attitudes toward mental health among university nursing students: Countering the role of social desirability

PURPOSE

This study analyses the evolution of attitudes of nursing students towards mental health, paying particular attention to the influence of social desirability.

DESIGN AND METHODS

Prospective longitudinal repeated-measures study in a sample of nursing students who completed the Community Attitudes toward Mental Illness scale and The Social Desirability Scale.

FINDINGS

After their training, and after adjusting for social desirability, students of female gender recognized attitudes that foster humanistic values than their male counterparts. However, attitudes of restrictiveness and authoritarianism continued to be manifested significantly when the students themselves had mental health problems (MHPs), had had previous training, or were older.

PRACTICE IMPLICATIONS

University courses should continue to foster attitudes of acceptance and destigmatization of people with MHPs, through responses that value authenticity.

The effectiveness of mental health disorder stigma-reducing interventions in the healthcare setting: An integrative review

Individuals with mental health disorders frequently seek medical treatment in health care settings other than a mental health facility. However, mental health disorder stigmatization is prevalent in the healthcare setting across the globe. Stigmatizing attitudes remain widespread among healthcare professionals who are responsible for delivering patient-centered, quality care. Stigma in the healthcare setting can undermine effective diagnosis, therapy, and optimum health outcomes. Addressing stigma is critical to delivering quality health care in both developed and developing countries. Therefore, it is important to deliver successful anti-stigma education, along with practical strategies, to reduce the stigma of mental health disorders among healthcare professionals. An integrative review was conducted to identify the effectiveness of various interventions used in 10 different countries globally to reduce the stigma of mental health disorders in the healthcare setting.

A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm

OBJECTIVES

People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm.

METHOD

Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted.

RESULTS

Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies-safety planning and follow-up contact-were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear.

CONCLUSIONS

There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts. HIGHLIGHTSMore RCTs are needed to improve the evidence base for ED providers managing self-harmSafety planning and follow up contacts are linked to reductions in repeat suicide attemptsFuture research should investigate the impact of staff training on patient outcomes.

Mental health stigma at primary health care centres in Lebanon: qualitative study

BACKGROUND

Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme.

METHODS

Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework.

RESULTS

The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs.

CONCLUSION

This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.

Behavioral Health Professionals' Perceptions on Patient-Controlled Granular Information Sharing (Part 1): Focus Group Study

BACKGROUND

Patient-controlled granular information sharing (PC-GIS) allows a patient to select specific health information "granules," such as diagnoses and medications; choose with whom the information is shared; and decide how the information can be used. Previous studies suggest that health professionals have mixed or concerned opinions about the process and impact of PC-GIS for care and research. Further understanding of behavioral health professionals' views on PC-GIS are needed for successful implementation and use of this technology.

OBJECTIVE

The aim of this study was to evaluate changes in health professionals' opinions on PC-GIS before and after a demonstrative case study.

METHODS

Four focus groups were conducted at two integrated health care facilities: one serious mental illness facility and one general behavioral health facility. A total of 28 participants were given access to outcomes of a previous study where patients had control over medical record sharing. Participants were surveyed before and after focus groups on their views about PC-GIS. Thematic analysis of focus group output was paired with descriptive statistics and exploratory factor analysis of surveys.

RESULTS

Behavioral health professionals showed a significant opinion shift toward concern after the focus group intervention, specifically on the topics of patient understanding (P=.001), authorized electronic health record access (P=.03), patient-professional relationship (P=.006), patient control acceptance (P<.001), and patient rights (P=.02). Qualitative methodology supported these results. The themes of professional considerations (2234/4025, 55.5% of codes) and necessity of health information (260/766, 33.9%) identified key aspects of PC-GIS concerns.

CONCLUSIONS

Behavioral health professionals agreed that a trusting patient-professional relationship is integral to the optimal implementation of PC-GIS, but were concerned about the potential negative impacts of PC-GIS on patient safety and quality of care.

Stigma: A Barrier in Supporting Nurse Well-Being During the Pandemic

Public media and the nursing literature are replete with data and anecdotal stories evidencing the overwhelming impact to nurses’ well-being during the COVID-19 pandemic. Although many organizations have rallied and are providing robust services to support nurses through the pandemic, stigma (negative perceptions, attitudes, and discrimination) about mental health support is contributing to nurses’ reluctance to use the many resources available to them. This article outlines strategies for reducing the stigma and eliminating the barriers associated with obtaining the mental and emotional well-being support and services that nurses need and deserve.

Analysis of Stigma in Relation to Behaviour and Attitudes towards Mental Health as Influenced by Social Desirability in Nursing Students

The training undergraduate nursing students receive, both in terms of theoretical input and clinical practice, may help to instil a less stigmatising perception of mental health. To analyse the perceived evolution of attitudes and expected behaviours, a longitudinal repeated measures study was conducted in a population of student nurses during their undergraduate mental health education. The Mental Illness: Clinicians’ Attitudes Scale, a Scale for measuring attitudes to the mentally ill among future Health workers, and the Reported and Intended Behaviour Scale were completed. A mixed linear model was used to assess the effect of each factor in the questionnaires before and after the various stages of the students’ training in mental health. The overall effect of each factor was assessed by testing the interaction between factor and group, both with and without adjustment with the Social Desirability Scale. The results showed that the clinical practice stage, due to the proximity to care for people with mental health problems, improves attitudes and behaviours towards mental health in students who have not had mental health problems, and also in younger students. In conclusion, integrated, holistic training during the period of clinical practice was associated with positive changes in the attitudes and intended behaviour.

Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis

Stigma is one of the main barriers to prevention, treatment and recovery from mental illness. However, bibliometric studies in this area are still scarce. Therefore, our aim was to quantify and analyze the scientific literature on the stigma of nursing students and professionals towards mental disorders. To this purpose, bibliometric indicators of scientific production, impact and collaboration were used. Among our results, it stands out that only 14.3% of the total number of studies analyzed measure the efficacy of the interventions carried out to reduce stigma. Furthermore, with exceptions such as Happell B and Byrne L, collaborations between authors and institutions are limited. “Service user involvement” appeared as a prominent keyword in 2018, coinciding with the increase in publications on the effectiveness of interventions. Interventions based on the involvement of people with psychiatric diagnoses in the design of nursing curricula seem to become a promising line of research. More studies measuring the efficacy of such interventions are needed. Knowledge of the lines of research that are being developed and of the researchers and institutions involved can contribute to creating synergy between the different researchers and to continue adding projects to the existing ones, thus contributing to the generation of more robust results that show the most indicated interventions to reduce the still present stigma and improve care for people with psychiatric diagnoses.

Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework

Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.

“Suffering as a Lifelong Companion: A Phenomenological-Hermeneutic Study of Men Living With Severe Psychiatric Illness”Lidelse som livslang følgesvenn: En fenomenologisk-hermeneutisk studie av menn som lever med alvorlig psykiatrisk sykdom

Accumulation of suffering in later life due to severe psychiatric illness has received surprisingly little interest in nursing research. Suffering in daily living seems to be more demanding for men, a phenomenon still debated in the literature. This phenomenological-hermeneutic study aims at describing and interpreting the perspectives of adult men and their experiences of suffering in daily living with severe psychiatric illness, diagnosed as schizophrenia. Data were collected in dialogical conversations with four men aged between 20 and 40 years, living alone in northern Norway. The themes created from the structural understanding illuminate the participants’ suffering as simultaneously struggling against the grasp of the illness and for reshaping the future. The theoretical interpretation unfolds the multidimensionality of their suffering and the need for confirmation of the suffering and reconciliation with the losses from illness, thus making reorientation to the future possible.

Internalized stigma in mental health staff with lived experience of mental crises-Does the professional role protect against self-stigmatization?

OBJECTIVE

The stigma of mental illness is widespread in the general population and also among healthcare and psychiatric professionals. Yet, research on the self-stigma of the latter is still limited. The purpose of this article was to assess self-stigma and its correlates in mental health professionals with lived experiences of mental crisis and treatment.

METHODS

In a cross-sectional exploratory research project, 182 mental health professionals with lived experiences of mental crisis and treatment from 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg were surveyed on their lived experiences, self-stigma, perceived stigma in the workplace, subjective vulnerability to crises, and meaningfulness of lived experiences. To investigate the relationships between the variables, manifest and latent correlation analyses were calculated.

RESULTS

Results showed low levels of self-stigma and perceived public stigma in the workplace. Self-stigma was significantly and positively associated with workplace stigma and subjective vulnerability to crisis, but not with identification with lived experiences.

CONCLUSION

The relationship between self-stigma, workplace stigma, and vulnerability should be investigated in terms of mutual causality in order to derive possible strategies of reducing self-stigma along with its detrimental effects. Possible reasons for the low levels of self-stigma are discussed in the light of limitations, including processes of self-selection, with highly self-stigmatizing individuals being possibly discouraged from participating. Strategies to enhance sampling quality are briefly discussed.

Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review

Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all.

The psychological impact of the COVID-19 pandemic and a SARS-CoV-2 testing programme on obstetric patients and healthcare workers

Objectives:

The aim of this study was to describe the psychological impact of the COVID-19 pandemic and the specific impact of a universal SARS-CoV-2 testing programme on obstetric patients and healthcare workers at The Ottawa Hospital.

Methods:

This was a follow-up survey study of obstetric healthcare workers and then-pregnant patients who participated in a SARS-CoV-2 testing programme conducted in The Ottawa Hospital obstetrical triage units from 19 October to 17 November 2020. Surveys explored the effects of the COVID-19 pandemic and the testing programme on participants’ psychological well-being. Responses were collected from April to September 2021. Descriptive summary statistics were calculated for both groups.

Results:

During hospitalization for delivery, obstetric patients (n = 143) worried about giving COVID-19 to their new baby (88.11%), catching COVID-19 (83.22%), and giving COVID-19 to their partner (76.22%). Patients felt relief at being tested for COVID-19 during the universal testing programme (24.65%) and at getting their results (28.87%). Patients also believed that universal SARS-CoV-2 testing was a good way to slow COVID-19 spread (79.72%), reduce anxiety (75.52%), and increase relief (76.22%). In addition, patients felt good about participating in research that could help others (91.61%). Among obstetric healthcare workers (n = 94), job satisfaction decreased and job stress increased during the COVID-19 pandemic. The universal testing programme led to minor increases in healthcare worker job stress and burden, particularly among nurses, but the majority (85.23%) believed it was a valuable research initiative.

Conclusion:

The COVID-19 pandemic has had a negative psychological impact on obstetric patients and healthcare workers. Universal SARS-CoV-2 testing was generally viewed favourably and may serve as an effective strategy for estimating COVID-19 prevalence without adding undue stress onto patients and healthcare workers during the pandemic.

Shame in the treatment of patients with psychogenic nonepileptic seizures: The elephant in the room

Previous research has established a link between psychogenic nonepileptic seizures (also known as dissociative or functional seizures) and abnormal emotion processing. In a companion article to this multidisciplinary narrative review, we have argued that, in the context of a biopsychosocial understanding of the condition, the emotion of shame is particularly likely to contribute to the aetiology, manifestation, semiology and perpetuation of psychogenic non-epileptic seizures (PNES). Here we demonstrate how unrecognised and unaddressed shame may cause difficulties when clinicians explain the diagnosis, attempt to engage patients in psychological treatment, construct a diagnostic formulation and undertake psychotherapy. Case vignettes are used to bring theoretical considerations to life and to illustrate the complex interactions which may be observed between high shame proneness, chronic and dysregulated shame, stigma and PNES. The particular focus on shame does not mean that recent explanatory models of PNES are obsolete. Rather, we demonstrate how the inclusion of shame helps to embed the emotional, cognitive and behavioural aspects of the Integrative Cognitive Model (ICM) of PNES in a social / interpersonal context. While we describe how a number of different psychotherapeutic approaches can help to address shame-related processes we conclude that specific modalities are less important than the eventual enhancement of emotional literacy and tolerance through a healing relationship with the psychotherapist.

Perceptions of ASHA workers in the HOPE collaborative care mental health intervention in rural South India: a qualitative analysis

OBJECTIVE

The main objective of this exploratory study was to investigate the overlooked perspectives and beliefs of Accredited Social Health Activists (ASHA workers) regarding a collaborative care mental health intervention (HOPE: Healthier Options through Empowerment), mental illness and the health of their rural communities.

DESIGN

Semi-structured, one-on-one, qualitative interviews.

SETTING

Seven primary health centres (PHCs) in rural Karnataka, India. All PHCs had previously completed the HOPE study.

PARTICIPANTS

15 ASHA workers, selected via purposive sampling. ASHAs are high school-educated village women trained as community health workers. ASHAs were included if they had previously participated in the HOPE intervention, a collaborative-care randomised controlled trial that aimed to integrate mental healthcare into existing primary care systems in rural Karnataka.

INTERVENTIONS

No interventions were introduced.

RESULTS

ASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking on the patients frequently. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though gaps remained in their understanding of aetiology and treatment. Several expressed interest in receiving additional mental health training. Overall, ASHAs viewed the HOPE study as a necessary and effective intervention, and requested that it expand.

CONCLUSIONS

This paper discusses the perspectives of ASHAs who participated in a novel effort to extend the collaborative care model to their own communities. ASHA workers help maintain relationships with patients that encourage participation, and the efforts of ASHAs often aid in mitigating common barriers to treatment. ASHA workers' beliefs and knowledge regarding mental illness can be changed, and ASHAs can become effective advocates for patients. Future collaborative care interventions would likely benefit from involving ASHA workers in community outreach efforts.

Original Research: Suicidal Ideation and Attitudes Toward Help Seeking in U.S. Nurses Relative to the General Working Population

PURPOSE

Although previous studies have revealed professional consequences of burnout among nurses, less is known about the potential personal consequences. This study investigated the prevalence of suicidal ideation and attitudes toward help seeking among U.S. nurses relative to other workers, and the extent to which personal and professional factors, including burnout, were related to suicidal ideation.

METHODS

In November 2017, a cross-sectional survey was sent to 86,858 nurses who were members of the American Nurses Association and to a probability-based sample of 5,198 U.S. workers. The survey included questions regarding suicidal ideation, burnout, symptoms of depression, individual and professional characteristics, and willingness to seek professional help if a serious emotional problem arose. Multivariable logistic regression analyses were conducted to identify factors associated with suicidal ideation after controlling for other factors.

RESULTS

Among the 7,378 nurse respondents, 403 (5.5%) reported having suicidal ideation within the past year. Most nurses (84.2%) indicated willingness to seek professional help for a serious emotional problem. Yet nurses with suicidal ideation were less likely to report that they'd seek such help (72.6%) than nurses without suicidal ideation (85%). In a multivariable analysis of nurses' data, after controlling for other personal and professional characteristics, we found that burnout was strongly associated with suicidal ideation. Adjusted combined multivariable analyses showed that nurses were more likely than other workers to have suicidal ideation. Both nurses and other workers who reported suicidal ideation were less likely to seek help than were those who did not report such ideation.

CONCLUSIONS

Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it. Burnout contributes to the risk of suicidal ideation. These issues warrant greater attention. Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalences of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help.

Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe

BACKGROUND

Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction.

METHODS

Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis.

RESULTS

Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner.

CONCLUSIONS

Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis.

A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals

WHAT IS KNOWN ON THE SUBJECT?: A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision-making capabilities and avoiding paternalistic or stigmatizing attitudes. ABSTRACT: Introduction A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community-based mental health services and other healthcare services. Data were analysed using the content analysis method. Results Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.

Depression among healthcare workers in the Eastern Mediterranean Region: a systematic review and meta-analysis

BACKGROUND

Depression is a major population health challenge globally. This systematic review and meta-analysis aims to (i) determine depression prevalence and (ii) identify the risk and protective factors of depression among healthcare workers (HCWs) in the Eastern Mediterranean Region (EMR).

METHODS

The protocol was registered on Open Science Framework (registration ID: https://osf.io/rdv27 ). We searched five databases (PubMed, Embase, PsycINFO, Al Manhal, Google Scholar) till July 22, 2020 without language restrictions. We included studies from the EMR using a depression screening or diagnostic instrument to measure the depression prevalence among HCWs. Studies were assessed and data were pooled using random-effects meta-analysis based on the Cochrane handbook.

RESULTS

The systematic review identified 108 studies from 12 EMR countries with varying quality. Working long hours, poor sleep quality and being female were risk factors for depression in EMR HCWs. The meta-analysis comprised 77 studies providing 122 prevalence measures across 7 EMR countries. The pooled prevalence of depression among EMR HCWs was 33.03% (95% CI = 27.40-39.19%). Emergency HCWs had markedly higher rates of depression [53.14% (95% CI = 26.63-77.99%)] compared to HCWs of other specialties. Most studies had an appropriate sample size.

CONCLUSIONS

Depression among EMR HCWs is a major concern. Steps must be taken to prevent, identify, and manage depression among HCWs. Fostering a compassionate and empathetic environment is critically important to building a resilient healthcare system. Generating high-quality regional data from longitudinal studies on mental health will further contribute to a better understanding and management of depression among EMR HCWs.

[Stigma in psychiatry]

Mental illness affects 48.9 % of the Moroccan population. Despite this significant figure, mental illness remains unrecognized. The patients suffering from mental disorders are therefore subject to stigma and social rejection. A descriptive study was conducted at the consultation service of the psychiatric Ibn Nafiss hospital of the CHU of Marrakech. We chose as a sample 100 stabilized patients, followed on an outpatient basis. The study included the three mental disorders: depressive disorder, bipolar disorder, and schizophrenia. The number of patients in each group had been fixed beforehand; and we tried to get a fairly even distribution between the two genders. The questionnaire had three main axes: (1) Sociodemographic data of the patient. (2) Knowledge of the disease. (3) Evaluation of the experience of stigma. The results of our sample were as follows: For both sexes the age extremes were 19 to 68 years with an average of 38.5 with a clear predominance of women. For the entire population, most patients were single with a percentage of 60 %. Two thirds of the patients, i.e. 59 %, did not exceed primary school. For personal medical history, endocrine pathologies were the most prevalent, at 18 % of cases, while depression was the most common family psychiatric history in our study. We noticed that our population suffered more discrimination and disclosure from those around them regardless of family, social and professional with less appreciation of the positive aspects.

A multicentric study on stigma towards people with mental illness in health sciences students

BACKGROUND

There is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology.

METHODS

A comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians' Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain.

RESULTS

We found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour.

CONCLUSIONS

Our study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

A dis-ordered personality? It's time to reframe borderline personality disorder

WHAT IS KNOWN ON THE SUBJECT

Integrating strengths-based, co-produced, consumer-driven resources into mental health workforce education has the potential to dissolve hierarchical mental health care relationships.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Humanities-based pedagogy that draws from photography and multi-voiced narratives is a powerful reflective learning tool to bridge clinical and human experiences of Borderline Personality Disorder (BPD). The Depth of Field reflective learning methodology aims to provoke, prod, reveal and challenge assumptions and/or unconscious bias towards BPD and stimulate raw and reflective discussions that have the potential to inspire critical reflection and move health professionals towards more humanistic, recovery centred models of mental health care.

WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING

At the core of co-production in research, education and practice lies a reciprocal, transformational learning experience. This relationship needs to be further explored in order to reframe mental health education that honours and legitimizes consumers as experts of their own lives and recovery experiences.