Current strategies in the reduction of stigma among caregivers of patients with mental illness: a scoping review

Abstract

Mental healthcare and wellness are a global concern and have increasingly become an essential service and priority from a human rights perspective. However, negative attitudes towards mental health, such as stigmatisation and discrimination from communities and family members, continue to pose challenges for deinstitutionalisation and home care of mentally ill persons. This study aimed to review the literature on the content and implementation methods of stigma reduction interventions for family/community caregivers of patients with mental illness to inform the development of an anti-stigma intervention for such caregivers in low- and middle-income countries like South Africa. A scoping literature review was conducted of English language studies published from 2008 to 2019 in peer-reviewed journals, using established guidelines for the study objectives. Primary interventions targeting caregivers of mental health patients were searched from PsycINFO, ScienceDirect, CINAHL, and Medline. In total, nine full-text articles were extracted for inclusion in the review, indicating a scarcity of literature on anti-stigma interventions aimed at primary caregivers of mental health patients. Interventions varied in terms of educational content, duration, delivery methods, and sample sizes. Intervention delivery was primarily through face-to-face, telephone, and online methods. Anti-stigma interventions for caregivers of patients with mental illness are varied and show positive short-term impacts on mental health stigma reduction among family caregivers. The evolution of health systems is a feasible approach towards integrating learning and trials that are needed to assess long-term impacts.

Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation

“…Several other studies have reported high implicit stigma among family members of mental health service users (González-Sanguino et al, 2019;Singh et al, 2016;Tawiah et al, 2015;Zhang et al, 2018). Given the continued prevalence of mental health stigma, especially in African communities, it is understandable how non-disclosure is an appealing stigma prevention strategy (Abdullah & Brown, 2011;Dako-Gyeke & Asumang, 2013;MacGregor, 2018;Mavundla et al, 2009;L. H. Yang et al, 2013).…”

“…The World Health Organisation (WHO) developed the 2019-2023 Special Initiative for Mental Health to reiterate the significance of comprehensive, integrated, and responsive community-based mental health services (WHO, 2019). These global efforts aim to build on the momentum and progress achieved to date, especially in developing countries where funding for mental health services remains constrained (Monnapula-Mazabane et al, 2021).…”

“…These services include day-care, supervised residential services, halfway houses, group homes, rehabilitation services, and mobile crisis teams. In Africa, including in South Africa, these 'formal' community services are, however, scarce, with a reliance on informal community mental health services, provided by natural caregivers or family members in the community (Dako-Gyeke & Asumang, 2013;MacGregor, 2018;Mavundla et al, 2009). Within this context, where family members become the main, if not the only support, for mental health service users (Dako-Gyeke & Asumang, 2013;MacGregor, 2018;Mavundla et al, 2009), the role played by mental health stigma in hampering the capacity of these natural caregivers within Africa communities requires urgent attention.…”

Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation

“…The intervention covered five critical topics for caregivers that addressed common misconceptions about mental illness: general mental health education, mental health stigma, communication and behaviour management, caregiver well-being, and coping strategies. The selection of the topics was based on a recent review of mental health anti-stigma interventions in LMICs, 21 contextualised and informed by a formative study conducted within our study population. 15 Development of the training manual and considerations for training facilitators were guided by adult learning principles.…”

“…20 A recent review on stigma reduction interventions in LMICs identified only nine studies that varied in their educational content, and only three explicitly included stigma sessions. 21 The deinstitutionalisation of mental health services requires community-level anti-stigma interventions to accompany this process to aid the reintegration of service users within their communities, inclusive of service users themselves, caregivers and their families. Therefore, our study qualitatively evaluated the feasibility and acceptability of a community-delivered mental health intervention for family caregivers from low-income South African communities.…”