When mental health care is stigmatizing: A participative study in schizophrenia.

OBJECTIVES: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. METHOD: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. RESULTS: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Part of the solution yet part of the problem: factors of schizophrenia stigma in mental health professionals.

BACKGROUND: Stigma is highly prejudicial to persons with schizophrenia, their families, the society and the health care system. Mental health professionals (MHP) are considered to be one of the main sources of schizophrenia stigma. OBJECTIVES: The aim of the study was to identify individual and contextual factors associated with stigma in MHP in its three dimensions (stereotypes, prejudices, discrimination, Fiske, 1998). METHODS: An online survey was conducted with specific measures of MHP stigma (stereotypes, prejudices and discrimination). Four categories of potential associated factors were also measured: sociodemographic characteristics, contextual characteristics (e.g., Work setting), individual characteristics (e.g., Profession, Recovery-oriented practices) and theoretical beliefs (e.g., Biological beliefs, Perceived similarities, Continuum versus Categorical beliefs). RESULTS: Responses of 357 MHP were analysed. Factors that were the most strongly associated with MHP stigma were Perceived similarities, Categorical beliefs, Biological beliefs, Recovery-oriented practice and Work setting (independent practice). Conversely, Gender, Specific trainings in stigma or recovery and Cognitive aetiology beliefs showed no association with any of MHP stigma dimension. Remaining factors show associations with a weak effect size. CONCLUSIONS: The survey results suggest that MHP stigma is more influenced by individual factors such as theoretical beliefs and recovery-oriented practices than contextual factors. These original results provide perspectives for reducing stigma in mental health practices.Key pointsMental health professionals (MHP) considering they share similarities with persons with schizophrenia or believing that schizophrenia is not a discrete social category but rather the extreme on a continuum between 'normal' and 'pathologic' reported less stigmatisation.MHP holding higher professional utility beliefs and using recovery-oriented practice reported fewer stereotypes, prejudice and discrimination.Other factors such as age, academic level, contact frequency, familiarity and multidisciplinary practice show associations with a weak effect size.

[Social representations of psychiatric care in Tunisia]. / Représentation sociales des soins psychiatriques en Tunisie.

BACKGROUND: The progress in the field of the treatment of the mental illnesses is considerable. However, the clinical reality confirms the delay in access to care for numerous patients. This avoidance is due,in big part, to the pejorative representations of the psychiatrics'system care. AIM: To assess the social images in the Tunisian population, regarding 3 stereotypes: "insane", "mentally ill" and "depressive". METHODS: The used instrument is the socio-anthropological questionnaire of the " Mental health in general population: images and realities" survey. RESULTS: The medicinal treatment occupies the first place of the planned care for an "insane" and for the "mentally ill". For the "depressive" and for our self, population would rather use relational support. Also, we notice that the family, in spite of its suffering and of the undergone daily load, is given is a central place in perception of the care for psychiatric pathologies. CONCLUSION: Finally, an "insane" is not perceived as possibly cured while it is more expected for the "mentally ill" and even more for the "depressive", even without any medical intervention. In the term of our analysis, let us underline the misunderstanding of the available therapeutic possibilities in psychiatry and the necessity of large-scale raising awareness.

[Social representations of the psychiatric diseases in Tunisia]. / Représentations sociales de la santé mentale en Tunisie.

BACKGROUND: Nowadays, and thanks to the major transformations experienced by psychiatry, since a half century, we estimate that the perception of the persons with psychiatric disorders would have changed and that they would have acquired the statute of patient with whole share. AIM: To study social representation of psychiatric diseases in Tunisia. METHODS: Prospective study, based on the socio-anthropological fold of the study "Mental health in general population: images and realities", the social representations associated with "madness", "mental illness" and "depression" in a representative sample of 920 subjects. RESULTS: Gradual images for these 3 archetypes were found. In fact, the depression is perceived as a soft disorder, which is reactional to the difficulties of life. The behaviour related to depression not only is seen as the least dangerous, but also the closest to the normality. Therefore, the "depressive" remains relatively accepted and integrated within the society. On the contrary the image of the "insane" is printed by a pejorative connotation and is marked by dangerousness, unpredictability, and immorality. Besides, the origins of the madness seem enigmatic. The "insane" is, therefore, stigmatized and thrown back. His exclusion extends as well to the family, social and professional domains. CONCLUSION: The image of the mental illness seems some what blurred, taking place in the interface of madness, depression and neurological diseases.

[Peer support in a patient organization in psychiatry. Experience and practices]. / Le soutien par les pairs dans une maison des usagers en psychiatrie. Expérience et pratiques.

Mental health patient organizations have only recently found a place among mental health stakeholders. Their activities at an individual level are based on a range of activities involving peer support, including mutual help groups or MHGs (similar to consumer-run organizations). A qualitative study based on an ethnographic approach was conducted in a patient organization at the Centre Hospitalier Sainte-Anne, where volunteers working in patient organizations receive visitors. The study examines the experiences and practices of patient organization members acting as peer helpers in order to reflect on what patient organizations are able to contribute to people receiving psychiatric treatment. The results show that peer helpers in the patient organization or mutual help groups share the experience of recovery and promote peer support. These practices are in line with the demands of people with mental disorders expressed at different stages of their treatment. Four main components of the process of peer-support were identified. This study shows the specificity of this kind of practice in relation to the current range of resources in mental health.