Tackling Stigma: Learning From Lived Experience to Be Part of the Solution

PURPOSE: Stigma affects persons with mental health concerns, and stigmatizing attitudes on the part of health care professionals are sadly not uncommon (Henderson et al., 2014). Henderson et al. (2014) showed that individuals with mental health concerns struggle with access to services and have compromised health and well-being compared with the general population. One barrier is stigmatizing attitudes from health professionals. Krupa (2008) called on occupational therapy (OT) practitioners to be part of the solution to stigma. One way to answer Krupa’s call is to address student attitudes during entry-level education. The researchers wanted to know if a contact-based stigma reduction intervention in which persons with lived experience of mental health concerns worked as teaching instructors in a mental health class would change students’ attitudes. The presentation will report on two parallel studies, one American and one Canadian, using the same design and measures and similar, but not identical, interventions.

DESIGN AND METHOD: This study used a mixed-methods, one-group pre–post design. In the Canadian study, OT students completed the 20-item version of the Opening Minds Scale for Health Care Providers (OMS–HC; Kassam, Papish, Modgill, & Patten, 2012), the Words That Come to Mind question, as well as open-ended questions related to attitudes and experiences. Student groups worked with client-educators—individuals with lived experience of mental health concerns. Students interviewed client-educators over two to three sessions and presented about the client-educator to the class. The same measures were administered after the course, along with additional open-ended questions about the client-educator experience. These questions were readministered 3 mo later.

In the American study, researchers used a 15-question version of the OMS–HC, the Words That Come to Mind question, and five open-ended questions related to student attitudes and experiences. The intervention was similar but not identical; students interviewed client-educators, administered a variety of assessments, and prepared a presentation about the client-educator, along with suggested actions to address issues identified by the client-educator. Quantitative data was analyzed using paired t tests to determine whether there were significant changes in responses to OMS–HC items. Additional analysis focused on whether there were changes in the proportion of students who exceeded the threshold of 80% favorable responses on the OMS–HC. Researchers compared words listed pre- and postintervention on the Words That Come to Mind question and conducted a thematic analysis of answers to open-ended questions.

RESULTS: In the Canadian study, there were significant pre–post differences on items related to helping and changes in a positive direction related to social distance and discrimination; however, the latter changes were not sufficiently large to meet criteria for significance. A greater proportion of students had a >80% overall positive response postintervention. Attitudes continued to improve after 3 mo. Qualitative analysis showed changes in types of words used to describe persons with mental health concerns. In a pilot test of the 15-item scale in the American study, there were changes not only in helping but also in social distance and discrimination. Data collection and analysis are under way and will be reported alongside the Canadian results.

CONCLUSION: One solution to the problem of stigma could be through interventions during entry-level education.

IMPACT STATEMENT: Addressing stigma may influence OT practice, lead to clients have a more positive experience of OT, and possibly influence students’ choice of practice area.

References

Henderson, C., Noblett, J., Parke, H., Clement, A., Caffrey, S., Gale-Grant, O., . . . Thornicroft, G. (2014). Mental health–related stigma in health care and mental health-care settings. Lancet Psychiatry, 1, 467–482. https://doi.org/10.1016/S2215-0366(14)00023-6

Kassam, A., Papish, A., Modgill, G., & Patten, S. (2012). The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The Opening Minds Scale for Health Care Providers. BMC Psychiatry, 12, 62. https://doi.org/10.1186/1471-244X-12-62

Krupa, T. (2008). Part of the solution . . . or part of the problem? Addressing the stigma of mental illness in our midst. Canadian Journal of Occupational Therapy, 75, 198–206. https://doi.org/10.1177/000841740807500404