Interprofessional education in mental health: An opportunity to reduce mental illness stigma

Implementing interprofessional education in the nursing and pharmacy curricula: An evaluation of a workshop focused on optimising of medicines prescribed for mental health problems

BACKGROUND

An inter-professional education (IPE) workshop centred around mental health scenarios was attended and assessed by 70 Nursing and Pharmacy students at the University of Huddersfield.

AIM

The aim of this study was to evaluate the implementation of a curricula IPE workshop for undergraduate nursing and pharmacy students, focussing on the optimal use of medicines with mental health problems utilising clinically based scenarios.

METHODS

The workshop was evaluated using an internally produced cross-sectional questionnaire completed by student participants from both pharmacy and mental health nursing disciplines, scoring on Process/Knowledge and Relationships domains.

RESULTS

70 participants (41 Mental Health Nursing students; 29 Pharmacy students) completed the questionnaire, who rated the content highly. Scores indicative of positive perception were reported by 65 respondents (92.9 %) on the Process/Knowledge domain and by 66 respondents (94.3 %) on the Relationships domain. Qualitative analysis of student evaluations demonstrated that both cohorts highly valued the workshop, with a shared appreciation of what each student group contributed. There was strong overall positivity toward working inter-professionally.

CONCLUSION

IPE workshops act as a useful tool for promoting positive working relationships and collaboration to aid the effective sharing of knowledge and skills between differing professions.

Attitudes and Knowledge of Electroconvulsive Therapy: An Exploration of Medical Students' Perspectives

AIMS

To explore knowledge and attitudes of medical students before and after exposure to a technology-enhanced learning and teaching (TELT) session about electroconvulsive therapy (ECT).

BACKGROUND

Adequate knowledge of and attitudes toward ECT is essential for medical students. However, the impact of teaching on knowledge and attitudes is infrequently studied.

METHODS

Fourth- and fifth year medical students at the University of Glasgow were provided with an online questionnaire before and after engaging in a remote TELT session, led by a consultant psychiatrist with expertise in ECT. The online teaching session used resources developed by a multidisciplinary team who specialize in ECT. The teaching session lasted around 1 hour. The questionnaire contained 3 sections: baseline demographics, knowledge of ECT, and attitudes toward ECT. Changes in scores were analyzed.

RESULTS

Sixty-seven students completed the teaching session. Response rate to the precourse questionnaire was 68.7% (n = 46), and the postcourse questionnaire was 44.8% (n = 30). Prior to engaging with the learning materials, 9 students reported no knowledge of ECT and a third believed that ECT did not cause a seizure. In general, students who had personal experience of mental illness (friend, relative, or self) had more positive attitudes toward ECT and higher knowledge scores. In general, an increase in knowledge and attitude scores was found in the postcourse questionnaire.

CONCLUSIONS

Exposing medical students to a TELT session focused on ECT during their psychiatric placement appeared to improve knowledge and attitudes surrounding ECT.

Assessing and improving students' collaborative skills using a mental health simulation: A pilot study

People with severe mental illnesses have complex needs that require coordinated care. However, students in different health professions are usually educated in silos without an emphasis on collaborative skills. Students would benefit from exposure to other disciplines that would increase appreciation of collaboration. This pilot study sought to understand how a mental health simulation (SIM) would influence a student's perception of collaboration. The mental health SIM involved nursing, social work, occupational therapy and public health students who worked with standardized patients. Students were given the Interprofessional Socialization and Valuing Scale-21 (ISVS-21) that measures attitudes, values, and feelings about interprofessional collaboration. A baseline of 113 students in the four health professions were administered the pretest and a subset of nine who participated in the SIM completed the posttest. This study suggests that SIM may be a promising way of improving attitudes toward collaborative care, though it is important for the SIM to reflect real life treatment conditions.

Nursing students' attitudes towards mental illness: A multi-national comparison

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness.

ABSTRACT

INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective.

AIM

To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA.

METHOD

In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries.

RESULTS

Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest.

DISCUSSION

Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences.

IMPLICATIONS FOR PRACTICE

It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

Development and Preliminary Validation of Scales to Measure Enacted, Perceived, and Experienced Hearing Loss Stigma in Health Care Settings

OBJECTIVES

Qualitative evidence suggests that stigma experienced by people who are d/Deaf and hard of hearing (d/DHH) can reduce willingness to engage with health services. Quantitative evidence remains lacking, however, about how health care providers (HCPs) perceive societal stigma toward people who are d/DHH, how HCPs might enact d/DHH stigma within provider-patient encounters, and what patients who are d/DHH share with providers about those patients' perceptions and experiences of stigma. Such quantitative evidence would allow HCPs to understand if and how stigma influences hearing health decisions made by people who are d/DHH. It could also shape practices to reduce d/DHH stigma within clinical encounters and guide providers in considering stigma as a driving force in their patients' hearing health care decisions. Building that evidence base requires validated quantitative measures. In response, the present study initiated an iterative process toward developing and preliminarily validating HCP self-report measures for different forms of d/DHH stigma. These measures draw upon HCPs' own perspectives, as well as their reports of secondhand information about stigma shared during clinical conversations. We developed and preliminary validated four measures: (1) provider-perceived stigma (HCPs' perceptions of the existence of negative attitudes and stereotypes toward d/DHH individuals in society), (2) provider-enacted stigma (self-reported subtle or indirect acts of stigma HCPs might commit during clinical encounters), (3) secondhand patient-experienced stigma (external acts of stigma reported to HCPs by patients who are d/DHH during clinical encounters), and (4) secondhand patient-perceived stigma (perceptions of negative attitudes and stereotypes reported to HCPs by patients who are d/DHH during clinical encounters).

DESIGN

Scale items were extracted from a comprehensive literature review of stigma measures. Question stems and individual items were adapted for HCPs, cognitively tested on 5 HCPs, and pretested with 30 HCPs. The 4 scales were then validated on a sample of primary care providers and hearing care specialists (N = 204) recruited through an online survey. All data were collected in the United States.

RESULTS

We conducted an exploratory factor analysis of the four proposed d/DHH stigma HCP stigma scales. Scale items loaded satisfactorily with ordinal alphas ranging between 0.854 and 0.944.

CONCLUSIONS

The four measures developed and preliminarily validated in this study can provide opportunities for HCPs to develop a more nuanced understanding of stigma experienced and perceived by their patients who are d/DHH and how that stigma manifests across social contexts, including health care settings. Further, the ability to assess forms of d/DHH stigma in clinical encounters, as well as their association with patient disengagement and resistance to advanced hearing care, could lead to innovative stigma-reduction interventions. Such interventions could then be evaluated using the measures from this article and then applied to clinical practice. We envision these measures being further refined, adapted, and tested for a variety of health care contexts, including primary care settings where hearing difficulties may first be identified and in hearing health care settings where audiologic rehabilitation is initiated.

Anti-stigma advocacy for health professionals: a systematic review

BACKGROUND

Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients.

AIMS

The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts.

METHODS

Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out.

RESULTS

The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general.

CONCLUSIONS

Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.

What works for whom, how and why in mental health education for undergraduate health profession students? A realist synthesis protocol

INTRODUCTION

It has been shown that mental health education can support positive attitudes of health profession students towards people with mental health challenges, which supports them to provide optimal healthcare to this group. There are many different approaches to designing and delivering mental health education to health profession students. Each has their own advantages and disadvantages, and often mental health education programmes incorporate a multimodal approach in order to reap the benefits of a variety of teaching and learning approaches. The aim of this study is to understand the current landscape of teaching and learning approaches to mental health education for undergraduate health profession students. We will examine the features of successful outcomes for health profession students for:Learning environment.Knowledge development and retention.Confidence.

MOTIVATION

Preparedness for professional practice.

METHODS

For this, a realist synthesis has been chosen in order to review the literature. Realist synthesis lends itself to the review of complex interventions such as mental health education for undergraduate health profession curricula because it seeks to uncover the range of different mechanisms and context configurations that produce different outcomes. Health profession education and education practice, in general, is complex. A patient and public involvement (PPI) group is involved throughout this study and includes undergraduate health profession students, and members of the St John of Gods Hospital Consumers and Carers Council who are involved at every stage of the research. This study will engage with a stakeholder group who will support the refining of the programme theory.

ETHICS AND DISSEMINATION

Ethical approval has been sought and approved by Royal College of Surgeons, Ireland Ethical Committee (REC number: 212622783). We will aim to write up and publish the full synthesis as a journal article. We will also discuss ways of dissemination outside of academia with our PPI group.

Barriers and facilitators of older adults for professional mental health help-seeking: a systematic review

BACKGROUND

Older adults are at an increased risk for mental health issues, yet they are less likely to seek professional help. This systematic review aims to identify and summarize literature on the barriers and facilitators that older adults face when seeking professional mental health help.

METHODS

A comprehensive literature search was conducted using multiple databases including PubMed-Medline, EMBASE, ProQuest central, CINAHL and Scopus to identify relevant studies published between 2010 and 2021 that focused on barriers and/or facilitators to seeking help for depression, anxiety, and psychological distress among older adults aged 65 years or older. Studies' risk of bias was assessed using the Newcastle-Ottawa Scale and results of studies were synthesized guided by the methodological framework of Rodgers and colleagues.

RESULTS

A total of eight cross-sectional studies, from Australia, United States, Mexico, Netherlands, and Malaysia met the inclusion criteria for this review. Included studies reported that the majority of their participants had anxiety or depression, yet they exhibited a preference for informal mental health help over professional help. Stigma, negative beliefs about mental health professional services, and cost were the most reported barriers. Main reported facilitators were prior positive experience with mental health services and high socioeconomic status.

CONCLUSION

Older adults are in need of interventions normalizing mental health help seeking and ensuring these services are accessible in terms of costs. This should be the focus of policy makers, healthcare providers, and public health practitioners working with older adults.

PROTOCOL REGISTRATION

PROSPERO 2021 CRD42021238853.

"Attitudes to voices": a survey exploring the factors influencing clinicians' intention to assess distressing voices and attitudes towards working with young people who hear voices

Introduction

Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth.

Method

Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention.

Results

Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention.

Discussion

Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.

Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners

BACKGROUND

Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.

OBJECTIVES

To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.

METHODS

In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.

RESULTS

The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.

CONCLUSION

This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.

Effectiveness of a Co-Production with Dialogue Program for Reducing Stigma against Mental Illness: A Quasi-Experimental Study with a Pre- and Post-Test Design

For people with mental illnesses, stigma represents a barrier to social participation. Health professionals, including students, often hold stigma toward such individuals, Further, people with a mental illness often have self-stigma. This study aimed to both develop and examine the effectiveness of a new program based on co-production with dialogue for reducing stigma among both health science students and people with mental illnesses. This was a quasi-experimental study, with a pre- and post-test design and no control group. The sample comprised 28 university students majoring in occupational therapy and 20 community-dwelling people with mental illnesses. The Co-Production with Dialogue Program for Reducing Stigma (CPD-RS) was administered to this sample. Link's Devaluation Discrimination Scale (DDS) was used to assess whether the program reduced stigma. Compared to their preintervention scores, the students' postintervention DDS scores significantly decreased, persisting for at least one month, but those of people with mental illnesses showed no significant change. Both the students and the people with mental illnesses evaluated the program as "positive" through a questionnaire administered two months after the intervention. These results suggest that the CPD-RS reduces health science students' stigma toward people with mental illnesses and fosters mutual understanding between the two groups.

Barriers to mental health care and stigma perception in doctor of pharmacy students across the United States

INTRODUCTION

Pharmacy students are significantly less likely than medical students to seek on-campus mental health services, though barriers are not well known. This study's objective is to expand on perceived barriers to seeking care for mental health concerns among doctor of pharmacy students in the United States.

METHODS

An institutional review board-exempt, online survey was disseminated to eight pharmacy programs' students assessing mental health barriers to care, resource interest, attitudes towards treatment, and stigma. Quantitative data were analyzed aggregately and by gender, program type, employment status, and education year. Free-text response analysis used thematic coding.

RESULTS

Common barriers to care included lack of time (20.2%), financial support or resources (13.2%), and preferring to solve the issue independently (13.2%). About half agreed their programs had sufficient resources to support mental health (58.4%). Suggested resources included on-site counselors (14.5%), pet therapy (13.4%), and wellness activities (12.3%). Students reported high rates of perceived internal stigma, yet low rates of stigma towards others. No significant differences were found among employment status or program type, but first-year students had more positive attitudes towards mental health treatment. Females were significantly more likely to agree mental health treatment was effective and less likely to view someone differently who received treatment.

CONCLUSIONS

Common barriers to care included lack of time, finances or resources, and concerns of being viewed differently. Additionally, substantial stigma exists, particularly public perception and concern for negative impact on future opportunities. Programs should take initiative to understand students' needs and interest in support services.

Exploring a collaborative approach to the involvement of patients, carers and the public in the initial education and training of healthcare professionals: A qualitative study of patient experiences

OBJECTIVE

This study aimed to explore patients' experiences of their involvement in the design and delivery of interprofessional education interventions focussing on mental ill-health for students studying in undergraduate healthcare and healthcare-related programmes.

DESIGN

A qualitative methodology using a Grounded Theory approach was used to undertake an iterative series of focus groups with members of a university's Patient, Carer and Public Involvement (PCPI) Group who have a history of mental ill-health and were involved in the development and delivery of educational interventions for students on undergraduate healthcare and healthcare-related programmes. Their experiences of being involved in teaching and learning activities, collaboration with academic staff and integration into the academic faculty were explored. Constant comparative analysis facilitated the identification and prioritisation of salient themes.

RESULTS

Five salient inter-related themes emerged from the data: (1) reduced stigma and normalisation of experience of illness; (2) enhanced self-worth; (3) improved well-being; (4) community and connection; and (5) enduring benefits.

CONCLUSIONS

A supportive university community and a designated academic PCPI co-ordinator facilitate a supportive environment for patients and carers to develop as educators, contribute to the training of future healthcare professionals and improve their own personal well-being. Appropriately resourced and well-supported initiatives to integrate patients, carers and the public into the functions of an academic faculty can result in tangible benefits to individuals and facilitate meaningful and enduring connections between the university and the wider community within which it is situated.

PATIENT AND PUBLIC INVOLVEMENT

Patients have been involved in the design of the teaching and learning initiatives that this study was primarily focused on. Patients were given autonomy in determining how their experiences should be incorporated into teaching and learning experiences.

Learning from a situation of discomfort - a qualitative study of physiotherapy student practice in mental health

Purpose: This qualitative study aimed to explore how physiotherapy students learn during practice as physical activity mentors for mentally ill individuals. The practice took place in an everyday environment without the presence of a supervisor.Methods: Information was collected through three focus group interviews with 16 students in their second year of study. The data were analyzed using thematic analysis, based on a sociocultural learning perspective.Results: Three main categories summarize the students' experiences. 1) Experimenting and adapting the activities. The students were challenged through communication and relationship-building, and they had to adapt the activities to the clients' state of mind; 2) Experiencing clients breaking social and cultural codes. The students felt responsible for ensuring the clients did not draw unwanted attention to themselves, which forced them to explore creative solutions; and 3) Learning from situations of discomfort. The students learned from having to cope with unpredictable and embarrassing situations without a supervisor present.Conclusions: Practice as physical activity mentors for mentally ill individuals can stimulate students' learning through reflection in and on action. To avoid stigmatizing behaviors, process experiences and enhance learning, we suggest a frequent and standardized access to supervision.

Mental Health Professionals' Attitudes to Severe Mental Illness and Its Correlates in Psychiatric Hospitals of Attica: The Role of Workers' Empathy

To describe mental health workers' attitudes to severe mental illness and to explore its socio-demographic and professional correlates, including the influence of empathy. A total of 127 mental health staff working on the psychiatric hospitals of Attica participated in the study. Stigma was assessed with the Attitudes to Severe Mental Illness scale (ASMI) and the Greek Social Distance scale; whilst Empathy with the Interpersonal Reactivity Index. Participants' unfavourable attitudes to severe mental illness were limited to pessimism about recovery, difficulty in viewing people with mental illness as similar to other people and desire to keep distance in intimate encounters. Professional group and personal experience with mental illness were found to predict stigma. Only perspective taking was associated with both stigma measures; while Fantasy was positively correlated with social distance. Anti-stigma interventions in mental healthcare should prioritize nurses and psychiatrists and aim at enhancing perspective taking.

Supporting the end of prostitution permanently (SEPP) prostitution court: examining inter-professional collaboration within alternative criminal justice settings

Problem-solving courts such as prostitution courts are becoming an important feature of the American court landscape. Internationally, while there is a great deal of skepticism regarding problem solving courts, at least five countries (e.g., England, Scotland, Ireland, Australia, and Canada) are deliberating whether this "revolutionary panacea" which has swept America's criminal justice system is the right approach for them. Few studies have explored the benefits and challenges of problem solving courts (i.e. prostitution court) using an interprofessional collaborative framework. The purpose of this case study is to examine contemporary issues related to prostitution courts using Bronstein's model of interprofessional collaborative framework which identifies five components that facilitate optimum IPC: 1) interdependence, 2)newly created professional activities, 3)flexibility, 4)collective ownership of goals, and 5) reflection on the process. Some benefits of IPC include working collaboratively, adaptability, adjusting expectations, investment in the process and making changes as needed. Some of the challenges of IPC were coercive power, dual roles, bait and switch, hierarchy, and push for outcomes at the expense of clients. As criminal justice systems nationally and internationally contemplate widespread implementation of different kinds of problem-solving courts, these benefits and challenges need to be considered before states and countries adopt these courts.

Bridging the Behavioral Health Gap in Serious Illness Care: Challenges and Strategies for Workforce Development

Comorbidity with behavioral health conditions is highly prevalent among those experiencing serious medical illnesses and is associated with poor outcomes. Siloed provision of behavioral and physical healthcare has contributed to a workforce ill-equipped to address the often complex needs of these clinical populations. Trained specialist behavioral health providers are scarce and there are gaps in core behavioral health competencies among serious illness care providers. Core competency frameworks to close behavioral health training gaps in primary care exist, but these have not extended to some of the distinct skills and roles required in serious illness care settings. This paper seeks to address this issue by describing a common framework of training competencies across the full spectrum of clinical responsibility and behavioral health expertise for those working at the interface of behavioral health and serious illness care. The authors used a mixed-method approach to develop a model of behavioral health and serious illness care and to delineate seven core skill domains necessary for practitioners working at this interface. Existing opportunities for scaling-up the workforce as well as priority policy recommendation to address barriers to implementation are discussed.

Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists

OBJECTIVES

To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness.

METHODS

Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia).

RESULTS

A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC "disclosure/help-seeking" subscale were higher compared with the "attitudes towards people with mental illness" subscale. There was no correlation between the OMS-HC and IAT.

CONCLUSIONS

These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma.

Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions

Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.