Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study

Abstract

Purpose: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. Methods: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. Results: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. Conclusions: Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing antistigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.

Effects of diagnostic label construction and gender on stigma about borderline personality disorder.

“…Men with alcohol use disorder, which is considered masculine-typical, are perceived as more dangerous and are less tolerated than women with the disorder (Phelan & Basow, 2007). However, gender typicality is not always associated with greater stigma (e.g., Boysen & Logan, 2017; Murney et al, 2020).…”

Development and validation of a Context-sensitive Positive Health Questionnaire (CPHQ) to measure health

“…However, as we did not find a strong correlation with other validation scales, this factor may represent a distinct environmental stressor related to perception instead of actual exposure and act more as a personal conversion factor that impacts mobility decisions (e.g., a chosen mode of transportation), for example, due to noise and traffic pollution and dissatisfaction related to relaxation (Marquart et al, 2021). Exclusion on the other hand was significantly but weakly related to Anxiety/Depression, Achievements, and Loneliness which was in the expected direction as discrimination have been found to affect mental health (Murney et al, 2020) as well as human capital (Caputo, 2002). In this situation, the domain Exclusion can act as a conversion factor whereas the domain Social support, which was related to the items Loneliness (HR-SWB), Attachment (ICECAP-A), and Anxiety/Depression (EQ-5D), included items such as "feeling supported if needed" and "ability to find people to engage with" which combines personal conversion factor and capabilities.…”

Protocol: a cluster randomised control trial study exploring stigmatisation and recovery-based perspectives regarding mental illness and substance use problems among primary healthcare providers across Toronto, Ontario

“… 13–15 Our recent research revealed that the levels of stigmatisation towards persons with MHSUP among health professionals within local community health centres (CHCs) were similar to those reported among other health workers in Canada. 16 17 Stigmatising attitudes and practices among health professionals are well documented throughout the literature, 18 and clients with MHSUP have reported stigmatising treatment from a variety of healthcare professionals 19 . One study found that stigmatisation may result in clients being threatened with coercive treatment, being provided with insufficient information, being regarded as lacking the capacity for responsible action or being patronised and/or humiliated.…”