Evidence for effective interventions to reduce mental-health-related stigma and discrimination

Thornicroft, Graham; Mehta, Nisha; Clément, Sarah; Evans‐Lacko, Sara; Doherty, Mary; Rose, Diana; Koschorke, Mirja; Shidhaye, Rahul; O’Reilly, Claire; Henderson, Claire

doi:10.1016/s0140-6736(15)00298-6

Cited by 851 publications

(806 citation statements)

References 87 publications

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“…This finding is in line with a recent cross-sectional study carried out in Spain [50], with a similar methodology to those adopted in our study. It also confirms the positive impact that social media can have in challenging stigma attached to mental disorders [7] and supports the findings that at a population level it is possible to obtain a pattern of benefits for positive attitude changes [24]. It is interesting as in an omnibus survey carried out in the general population in England, a different pattern of change in attitudes was found [39], confirming that some contextual events -such as mass media coverage and reporting on mental health issues -can have an impact on attitudes toward mental illness [30,54].…”

Section: Discussionsupporting

confidence: 82%

“…Moreover, as pointed out by Thornicroft et al [23], in the attempt to overcome stigma attached to mental disorders at the population level, interventions using a social marketing approach are increasingly being used and proofs of efficacy have been collected [24,25].…”

mentioning

confidence: 99%

“…The novel aspect of TTC programme is the explicit target to change behaviour. The key active ingredients are forms of contact between people with and without experience of mental illness [24][25][26][27][28].…”

mentioning

confidence: 99%

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The Impact of Social Marketing Campaigns on Reducing Mental Health Stigma: Results From the 2009–2014 Time to Change Programme

et al. 2017

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BackgroundIn England, during 2009–2014 the ‘Time to Change’ anti-stigma programme has included a social marketing campaign (SMC) using mass media channels, social media and social contact events but the efficacy of such approach has not been evaluated yet.MethodsThe target population included people aged between mid-twenties/mid-forties, from middle-income groups. Participants were recruited through an online market research panel, before and after each burst of the campaign (with a mean number of unique participants per each burst: 956.9 ± 170.2). Participants completed an online questionnaire evaluating knowledge [Mental Health Knowledge Schedule (MAKS)]; attitudes [Community Attitudes toward Mental Illness (CAMI)]; and behaviours [Reported and Intended Behaviour Scale (RIBS)]. Socio-demographic data and level of awareness of the SMC were also collected.ResultsA total of 10,526 people were interviewed. An increasing usage of the SMC-media channels as well as of the level of awareness of SMC was found (P < 0.001). Being aware of the SMC was found to be associated with higher score at MAKS (OR = 0.95, CI = 0.68 to 1.21; P < 0.001), at ‘tolerance and support’ CAMI subscale (OR = 0.12, CI = 0.09 to 0.16; P < 0.001), and at RIBS (OR = 0.71, CI = 0.51 to 0.92; P < 0.001), controlling for confounders.ConclusionThe SMC represents an important way to effectively reduce stigma. Taking into account these positive findings, further population-based campaigns using social media may represent an effective strategy to challenge stigma.

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Section: Discussionsupporting

confidence: 82%

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confidence: 99%

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The Impact of Social Marketing Campaigns on Reducing Mental Health Stigma: Results From the 2009–2014 Time to Change Programme

et al. 2017

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“…By targeting all individuals, rather than just those with mental health conditions, the campaign might be successful at changing the entire campus climate surrounding stigma. In fact, many researchers have discussed and documented the importance of similar types of processes in meso-level contexts to help reduce mental illness stigma (Cook et al 2014;Corrigan and Fong 2014;Kosyluk et al 2016;Thornicroft et al 2016). …”

Section: Conclusion and Discussionmentioning

confidence: 99%

“…Research suggests that among college students, efforts at mental health education are more effective in reducing stigma than efforts at increasing contact with others who have a mental health condition and overall, targeted interventions are more effective than broad interventions (Mittal et al 2012;Thornicroft et al 2016). These findings suggest that colleges and universities might reduce stigma by investing in localized anti-stigma campaigns with physical and digital materials conveying facts and statistics about mental health.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses

Gaddis

Ramirez

Hernandez

2018

Social Science & Medicine

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Scholars suggest that public mental health stigma operates at a meso-level and is associated with severity of symptoms, disclosure, self-esteem, and treatment-seeking behavior. However, the operationalization of public stigma nearly always comes from an individual-level generalization of what others believe. Using data from over 60,000 students on 75 U.S. college and university campuses between 2009-2015, we contextualize public stigma by creating a school-level measure of students' individual-level endorsed mental health treatment stigma. We present multilevel logistic regression models for 21 different dependent variables. We find that even after controlling for individual-level stigma scores, school-level stigma is negatively associated with self-reports of suicidal ideation and self-injury, although not associated with screens for depression or anxiety. Moreover, school-level stigma is negatively associated with medication use, counseling and therapy visits, and to a lesser degree, informal support. We suggest that future research should continue to examine the contextual environment of public stigma, while policymakers may be able to implement changes to significantly reduce stigma at this level.

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Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

et al. 2021

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IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTSThis pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirtyfour facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were −10.6 points (95% CI, −14.5 to −6.74 points) in RESHAPE and −2.79 points (−8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events.(continued) Key Points Question Does involvement of people with lived experience of mental illness in cofacilitation of trainings for primary care practitioners reduce stigma and improve mental health services? Findings In this pilot cluster r...

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Evidence for effective interventions to reduce mental-health-related stigma and discrimination

Cited by 851 publications

References 87 publications

The Impact of Social Marketing Campaigns on Reducing Mental Health Stigma: Results From the 2009–2014 Time to Change Programme

The Impact of Social Marketing Campaigns on Reducing Mental Health Stigma: Results From the 2009–2014 Time to Change Programme

Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

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