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Mental health related stigma and discrimination is a universal phenomenon and a contributor to the adversity experienced by people with schizophrenia. Research has produced inconsistent findings on how discrimination differs across settings and the contextual factors that underpin these differences. This study investigates the association between country-level Human Development Index (HDI) and experienced and anticipated discrimination reported by people with schizophrenia.
This study is a secondary data analysis of a global cross-sectional survey completed by people living with schizophrenia across 29 countries, between 2005 and 2008. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale (DISC-10). Countries were classified according to their 2006 HDI. Negative binomial and Poisson regression analyses with a robust standard errors approach were conducted to investigate associations between country-level HDI and discrimination.
In the regression analyses, no evidence was found for a linear association between HDI and experienced or anticipated discrimination. Further exploratory analyses showed a significant non-linear association between HDI ratings and experienced discrimination. Participants in “high” and “very high” HDI countries reported more experienced discrimination compared to those in “medium” HDI countries.
HDI does, to some extent, appear to be associated with how far discrimination is experienced across different contexts. More high-quality cross-national research, including research focused on “medium” and “low” countries, is needed to substantiate these findings and identify underlying factors that may explain the pattern observed for experienced discrimination, including generating new datasets that would enable for these analyses to be repeated and contrasted with more recent data. An in-depth understanding of these factors will further aid the adaptation of cross-cultural and context specific anti-stigma interventions in future.
Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs).
MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to ‘stigma and discrimination’, ‘intervention’, ‘indirect social contact’, ‘mental health’ and ‘low- and middle-income countries’. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results.
Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations.
ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.
To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials.
Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO ‘Evidence to Decision’ framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677).
The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders.
These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.
We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.
We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.
Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
The final Educational objective of this Course is to provide the methodological and practical skills to enable the participants to plan and evaluate community mental health services. In particular, the Course will: 1) provide a background knowledge on conceptual and methodological issues regarding community mental health services satisfaction; 2) summaries the main relevant research findings
3) present a summary of relevant research instruments, 4) give a paradigm to understand the relationship between service development and mental health service research.
Course methods and material:
The course will be delivered through lectures with a strong interactive element during each session. The course material will relate to the following background texts
• Knudsen H. & Thornicroft G. (1996) Mental Health Service Evaluation. Cambridge University Press, Cambridge. (translated into Italian).
• Goldberg D. & Thornicroft G. (1998) Mental Health in Our Future Cities. Laurence and Erlbaum, London.
• Slade M. & Thornicroft G. et al (1999) Camberwell Assessment of Need (CAN). (Translated into Italian)
• Tansella M. & Thornicroft G 9 (1999) Common Mental Disorders in Primary Care. Essay in Honour of Professor Sir David Goldberg. Routledge, London. (Translated into Portuguese)
• Thornicroft G. & Tansella M. (1999) The Mental Health Matrix. A Manual to Improve Services. Cambridge University Press, Cambridge. (Translated into Italian, Rumanian, Russian and Spanish)
• Reynolds A. & Thornicroft G. (1999) Managing Mental Health Services. Open University Press, Milton Keynes. (Translated into Italian) (Highly Commended in BMA Medical Book Competition, 2000).
• Thornicroft G. & Szmukler G. (2001) Textbook of Community Psychiatry. Oxford University Press, Oxford. (Highly Commended in BMA Medical Book Competition, 2002)
• Thornicroft G. & Tansella M. & Thornicroft G (2001) Mental Health Outcome Measures (2nd Edition). Gaskell, Royal College of Psychiatrists, London.
• Thornicroft G (2001) Measuring Mental Health Needs (2nd edition). Gaskell, Royal College of Psychiatrist, London.
• Thornicroft G, Tansella M: The components of a modern mental health service: a pragmatic balance of community and hospital care. British Journal of Psychiatry 2004.
• Thornicroft G, Becker T, Knapp M, Knudsen HC, Schene AH, Tansella M et al.: International Outcome Measures in Mental Health. Quality of Life, Needs, Service Satisfaction, Costs and Impact on Carers. London: Gaskell, Royal College of Psychiatrists; 2006.
• Knapp MJ, McDaid D, Mossialos E, Thornicroft G: Mental Health Policy and Practice Across Europe. Buckingham: Open University Press; 2006.
• Thornicroft G: Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press; 2006.
• Tansella M, Thornicroft G, Barbui C, Cipriani A, Saraceno B: Seven criteria for improving effectiveness trials in psychiatry. Psychol Med 2006, 36: 711-720
The Course is directed to psychiatrists, psychologists, social workers, psychiatric nurses, educators, and rehabilitation workers with a research interest.
No specific knowledge is requested beside the basic professional skills.
No other sponsor, except the individual teachers' universities
Forty-five cases of psychotic patients with admission urinalysis positive for cannabis were compared with psychotic controls without evidence of cannabis use. Cases and controls were matched for age, sex and year of admission, and were compared for socio-demographic data, circumstances of admission, diagnosis, and symptoms at admission. Three differences were found: cases were more likely to be Afro-Caribbean than white (P = 0.01), to manifest incoherence of speech (P= 0.02) and agitation (P= 0.01). In other respects the case and control groups were indistinguishable, and no pattern of symptoms characterised the “cannabis psychosis“group. These findings do not support the view that “cannabis psychosis” has a distinct psycho-phenomenological pattern Epidemiological studies are required to further clarify the association for psychotic patients between Afro-Caribbean ethnic groups and the likelihood of having a positive urine test for cannabis.
To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.
We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).
Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).
There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.
Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.
There is an absence of instruments to assess the complex needs of pregnant women and mothers with severe mental illness. We aimed to develop a standardised assessment of need for pregnant women and mothers with severe mental illness.
Staff and service users identified relevant domains of need. Professional experts and service users were then surveyed and asked to rate the importance of the domains of the CAN-M (Camberwell Assessment of Need – Mothers). Reliability was established using 36 service user-staff pairs. Concurrent validity was assessed with the Global Assessment of Functioning.
Inter-rater and test-retest reliability coefficients for unmet needs indicated excellent reliability. Relevant CAN-M domains correlated with the Global Assessment of Functioning symptom (p=0.05) and disability (p <0.01) subscales.
The CAN-M is a reliable, valid instrument for assessing the needs of pregnant women and mothers with severe mental illness.
An ‘advance statement’ allows a patient to state treatment preferences in anticipation of a time in the future when, as a result of a mental disorder or disability, he or she may no longer be able to make treatment decisions. A number of types of advance statements in psychiatry can be described: ‘advance directives’ (and ‘facilitated advance directives’), ‘crisis cards’ and ‘joint crisis plans’. They differ according to a number of characteristics – the degree to which they have legal force, whether the clinical team is involved in their formulation, and whether a third party acts as a facilitator. There is accumulating evidence that some forms of advance statement empower patients and reduce the need for coercive treatments. The results of a randomized controlled trial of ‘joint crisis plans’ carried out by our research team in SE England will be discussed. A significant reduction in compulsory admissions to hospital was an important finding.
Social contact is one of the most effective strategies for improving inter-group relations and is supported by decades of positive evidence. Several studies specifically support social contact interventions as a way of reducing stigma against people with mental health problems. Despite the effectiveness of this approach, some social groups have few opportunities for social contact in the real world.
Using the England Time to Change anti-stigma campaign as an example, we investigate the feasibility and effectiveness of delivering social contact interventions at the mass population level to reduce stigma and discrimination against people with mental health problems.
To investigate: (i) the feasibility of scaling up social contact interventions to reduce stigma and discrimination against people with mental health problems and (ii) the effectiveness of mass population social contact interventions to: improve intended stigmatising behaviour, increase willingness to disclose mental health problems and to promote engagement in antistigma activities.
Two types of mass participation social contact programmes within England's Time to Change campaign were evaluated via self-report questionnaire. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health, and intended behaviour towards people with mental health problems.
Findings on feasibility and effectiveness of social contact programmes will be presented.
This study suggests that social contact interventions can be used by anti-stigma campaigns to reduce stigma and discrimination against people with mental health problems. Further investigation is needed regarding the maintenance of these changes
IDEA project is the outcome of Association for the Improvement of Mental Health programme and coordinated at Institute of Psychiatry, King's College London.
Are to explore experience of people treated in a mental health setting across nations, determine how inpatient experiences can be improved. Experience gained from interviews will be used to propose questionnaire for routine use, develop versions of interview for other services, inform a possible follow-up study.
30 consecutive patients are interviewed on day of discharge in own language. Semi-structured interview covers physical condition in institutions, experiences of treatments like medication, satisfaction with staff, privacy, dignity and whether rights were respected. Responses are summarized on several visual analogue scales and quantitative analysis will be performed. The scale will also be analysed by demographic indices within centres to see whether different groups have different experiences.
Qualitative responses will be analysed thematically, both within and between centres, identifying core themes for each domain and core themes for the protocol as a whole.
10 countries are participating, 577 interviews are completed. It is noticed a large disparity between institutions in regards to the amount of contact patients have with family, access to phone, quality of food, surroundings and view of medication and therapy.
It will be a better understanding of the size, structure and staffing of the institutions included in the study, which will help us with our observations about inpatient experiences by putting them in context and make recommendations to institutions.
Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD).
Materials and methods:
This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment.
Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r = –0.72, P < 0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r = 0.38, P < 0.001).
Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.