Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students.

BACKGROUND: Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students' perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes. METHODS: Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis. RESULTS: In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to 'how best to support students to prevent negative attitudes from forming' was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum. CONCLUSIONS: The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes.

An initiative to improve mental health practice in primary care in Caribbean countries.

Objectives: The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods: We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results: A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. Conclusions: The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

An initiative to improve mental health practice in primary care in Caribbean countries

[ABSTRACT]. Objectives. The aim of this initiative was to assess whether a novel training program – Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills – could improve primary health care providers’ confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do- Study-Act rapid cycle for learning improvement. Methods. We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers’ confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results. A total of 81 participants completed the program. The program improved primary care providers’ confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers’ stigmatization of people with mental health disorders. Conclusions. The program’s quality improvement model achieved its goals in enhancing health care provid- ers’ confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

[RESUMEN]. Objetivos. La finalidad de esta iniciativa fue determinar si un nuevo programa de capacitación, titulado Under- standing Stigma and Strengthening Cognitive Behavioral Interpersonal Skills (Comprender la estigmatización y fortalecer las competencias interpersonales cognitivas y conductuales), podría mejorar la confianza de los prestadores de atención primaria de salud en la calidad de la atención de salud mental que proporcionan en los países del Caribe, mediante el uso del ciclo rápido Planificación-Realización-Estudio-Acción para la mejora del aprendizaje. Métodos. Realizamos un estudio de observación prospectivo sobre el impacto de este programa de capac- itación. La formación se perfeccionó a lo largo de tres ciclos: en primer lugar, se evaluó la pertinencia del programa para la mejora de las prácticas en el Caribe; en segundo lugar, se llevó a cabo una capacitación piloto de 15 prestadores locales para adaptar el programa a la cultura y el contexto; en tercer lugar, en el otoño del 2021 se puso en marcha el curso con 96 prestadores de atención primaria. Los resultados anteri- ores y posteriores al programa se evaluaron mediante encuestas que incluían la confianza de los prestadores en la calidad de la atención de salud mental que proporcionaban, los cambios aparecidos en los prestadores en cuanto a la estigmatización, y su uso y conocimiento de las herramientas. En este artículo se describe una evaluación de los resultados del ciclo 3, correspondiente a la puesta en marcha oficial. Resultados. Un total de 81 participantes completaron el programa. El programa mejoró la confianza de los prestadores de atención primaria en la calidad de la atención de salud mental que proporcionaban a las per- sonas que presentaban trastornos de la salud mental y redujo la estigmatización de las personas con este tipo de trastornos por parte de los prestadores de la atención. Conclusiones. El modelo de mejora de la calidad del programa logró sus objetivos en cuanto a mejorar la confianza de los prestadores de atención de salud en la calidad de la atención de salud mental que propor- cionan en los países del Caribe; el programa aporta herramientas eficaces para sustentar esta tarea y ayudó a empoderar e involucrar a las personas usuarias.

[RESUMO]. Objetivos. O objetivo da iniciativa foi avaliar se um novo programa de capacitação, Compreensão do estigma e fortalecimento das competências cognitivas e comportamentais interpessoais, seria capaz de aumentar a confiança dos profissionais de atenção primária à saúde na qualidade da atenção à saúde mental que ofere- cem a pacientes no Caribe, utilizando o ciclo rápido Plan-Do-Study-Act (planejar, fazer, avaliar e agir) para melhorar o aprendizado. Métodos. Este foi um estudo observacional prospectivo sobre o impacto desse programa de capacitação. A capacitação foi aperfeiçoada ao longo de três ciclos. Inicialmente, avaliou-se a relevância do programa para o aprimoramento da prática no Caribe. A seguir, foi realizada uma capacitação-piloto de 15 profissionais locais para adaptar o programa à cultura e ao contexto. No terceiro ciclo, realizado no outono de 2021, o curso foi lançado, com a participação de 96 profissionais de atenção primária. Os resultados antes e depois do programa foram avaliados por meio de questionários, que incluíam a confiança dos provedores na qualidade da atenção à saúde mental oferecida, mudanças no estigma entre os profissionais e a utilização das ferramentas e o conforto dos profissionais em usá-las. Este documento apresenta a avaliação dos resul- tados do ciclo 3, o lançamento oficial do curso. Resultados. Oitenta e um participantes completaram o programa. O programa melhorou a confiança dos profissionais de atenção primária na qualidade dos cuidados de saúde mental que ofereciam às pessoas com experiência vivida relacionada a problemas de saúde mental. Além disso, reduziu a estigmatização das pessoas com problemas de saúde mental pelos profissionais de saúde. Conclusão. O modelo de melhoria da qualidade do programa atingiu suas metas de aumentar a confiança dos prestadores de serviços de saúde na qualidade dos serviços de saúde mental que prestavam no Caribe; o programa fornece ferramentas efetivas de apoio ao trabalho e ajudou a empoderar e envolver os clientes.

Increasing resiliency and reducing mental illness stigma in post-secondary students: A meta-analytic evaluation of the inquiring mind program.

Objective: Worsening student mental health, along with more complex mental illness presentation and increased access to campus mental health services, has led to a mental health "crisis" on campuses. One way to address student mental health needs may be through mental health programs which have been found to increase resiliency and help-seeking, and reduce stigma. Participants: The effectiveness of The Inquiring Mind (TIM), a mental health promotion and mental illness stigma reduction program, was examined in 810 students from 16 Canadian post-secondary institutions. Methods and Results: Using a meta-analytic approach, TIM improved resiliency and decreased stigmatizing attitudes from pre to post, with medium effect sizes (d > .50). Analyses with those that completed the follow-up (about one-third of the sample) showed that effects were mostly retained at three months. Other outcomes also point to the program's effectiveness. Conclusion: TIM appears to be an effective program for post-secondary students. However, additional research, including randomized control trials, is needed to address study limitations.

An initiative to improve mental health practice in primary care in Caribbean countries / Una iniciativa para mejorar la práctica de la salud mental en la atención primaria en los países del Caribe / Uma iniciativa para melhorar a atenção primária em saúde mental nos países caribenhos

ABSTRACT Objectives. The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods. We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results. A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. Conclusions. The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

RESUMEN Objetivos. La finalidad de esta iniciativa fue determinar si un nuevo programa de capacitación, titulado Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills (Comprender la estigmatización y fortalecer las competencias interpersonales cognitivas y conductuales), podría mejorar la confianza de los prestadores de atención primaria de salud en la calidad de la atención de salud mental que proporcionan en los países del Caribe, mediante el uso del ciclo rápido Planificación-Realización-Estudio-Acción para la mejora del aprendizaje. Métodos. Realizamos un estudio de observación prospectivo sobre el impacto de este programa de capacitación. La formación se perfeccionó a lo largo de tres ciclos: en primer lugar, se evaluó la pertinencia del programa para la mejora de las prácticas en el Caribe; en segundo lugar, se llevó a cabo una capacitación piloto de 15 prestadores locales para adaptar el programa a la cultura y el contexto; en tercer lugar, en el otoño del 2021 se puso en marcha el curso con 96 prestadores de atención primaria. Los resultados anteriores y posteriores al programa se evaluaron mediante encuestas que incluían la confianza de los prestadores en la calidad de la atención de salud mental que proporcionaban, los cambios aparecidos en los prestadores en cuanto a la estigmatización, y su uso y conocimiento de las herramientas. En este artículo se describe una evaluación de los resultados del ciclo 3, correspondiente a la puesta en marcha oficial. Resultados. Un total de 81 participantes completaron el programa. El programa mejoró la confianza de los prestadores de atención primaria en la calidad de la atención de salud mental que proporcionaban a las personas que presentaban trastornos de la salud mental y redujo la estigmatización de las personas con este tipo de trastornos por parte de los prestadores de la atención. Conclusiones. El modelo de mejora de la calidad del programa logró sus objetivos en cuanto a mejorar la confianza de los prestadores de atención de salud en la calidad de la atención de salud mental que proporcionan en los países del Caribe; el programa aporta herramientas eficaces para sustentar esta tarea y ayudó a empoderar e involucrar a las personas usuarias.

RESUMO Objetivos. O objetivo da iniciativa foi avaliar se um novo programa de capacitação, Compreensão do estigma e fortalecimento das competências cognitivas e comportamentais interpessoais, seria capaz de aumentar a confiança dos profissionais de atenção primária à saúde na qualidade da atenção à saúde mental que oferecem a pacientes no Caribe, utilizando o ciclo rápido Plan-Do-Study-Act (planejar, fazer, avaliar e agir) para melhorar o aprendizado. Métodos. Este foi um estudo observacional prospectivo sobre o impacto desse programa de capacitação. A capacitação foi aperfeiçoada ao longo de três ciclos. Inicialmente, avaliou-se a relevância do programa para o aprimoramento da prática no Caribe. A seguir, foi realizada uma capacitação-piloto de 15 profissionais locais para adaptar o programa à cultura e ao contexto. No terceiro ciclo, realizado no outono de 2021, o curso foi lançado, com a participação de 96 profissionais de atenção primária. Os resultados antes e depois do programa foram avaliados por meio de questionários, que incluíam a confiança dos provedores na qualidade da atenção à saúde mental oferecida, mudanças no estigma entre os profissionais e a utilização das ferramentas e o conforto dos profissionais em usá-las. Este documento apresenta a avaliação dos resultados do ciclo 3, o lançamento oficial do curso. Resultados. Oitenta e um participantes completaram o programa. O programa melhorou a confiança dos profissionais de atenção primária na qualidade dos cuidados de saúde mental que ofereciam às pessoas com experiência vivida relacionada a problemas de saúde mental. Além disso, reduziu a estigmatização das pessoas com problemas de saúde mental pelos profissionais de saúde. Conclusão. O modelo de melhoria da qualidade do programa atingiu suas metas de aumentar a confiança dos prestadores de serviços de saúde na qualidade dos serviços de saúde mental que prestavam no Caribe; o programa fornece ferramentas efetivas de apoio ao trabalho e ajudou a empoderar e envolver os clientes.

Measuring the Influence of Curricular Content and Personal Stories on Substance Use Stigma.

BACKGROUND: Understanding of the lived experience is an important educational strategy for improving attitudes toward stigmatized patient groups. This study evaluated the influence of a personal story intervention on nursing students' attitudes toward people who use opioids and measured attitudinal change from students' regular mental health and addictions curriculum. METHOD: This study used a single-group longitudinal design. Stigma outcomes were measured using the Opening Minds Provider Attitudes Toward Opioid Use Scale. Mean scores were analyzed for four time periods: control, social contact intervention, curricular component, and 3-month follow-up. Qualitative feedback also was collected. RESULTS: Stigma scores improved significantly from pre- to postsocial contact intervention. No differences were observed for curricular content, control period, or follow-up. Qualitative findings suggest the personal story was associated with positive student-reported attitudes. CONCLUSION: Integrating personal story interventions with traditional curriculum elements is a promising educational approach for improving perceptions and behaviors of nursing students toward people who use drugs. [J Nurs Educ. 2022;61(5):264-267.].

Measuring Stigma Towards People with Opioid Use Problems: Exploratory and Confirmatory Factor Analysis of the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS).

Many countries are experiencing an ongoing opioid crisis characterized by high rates of opioid use problems, overdose, poisoning, and death. Stigma has been identified as a central problem for seeking and receiving quality services from health providers and first respondents. The Mental Health Commission of Canada developed a scale that could be used to measure stigma in this population, as no such scale currently exists. This paper provides the results of psychometric testing of this new scale, known as the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS), using exploratory (EFA) and confirmatory (CFA) factor analysis. EFA findings showed a 15 item 2-factor solution, with subscales of 'attitudes' (6 items) and 'behaviours/motivation to help' (9 items). The confirmatory factor analysis provided some preliminary confirmation of the factor structure suggested by the exploratory analyses, but further research with larger samples is needed to fully confirm the factor structure. Overall, results support the use of the 15-item scale with health professionals and first responders, with factors used for descriptive value rather than as calculated subscales until further research can be completed.

Individuals to Systems: Methodological and Conceptual Considerations for Addressing Mental Illness Stigma Holistically.

Mental illness stigma is a complex public health issue that creates barriers for clients needing access to quality mental health services. Most research focuses on interpersonal stigma with emerging research examining intrapersonal and structural stigma in the healthcare setting. This commentary focuses on how to address the gaps in the existing research to elicit greater organizational/structural change in healthcare systems and positive health outcomes. It describes key components of a 5-year multiphase study that aims to explore and address multiple levels of stigma holistically among stakeholders including physicians, nurses, protective services staff, and patients/families in an emergency department setting. Unique to this study is the inclusion of a patient research partner who will be positioned as a co-designer throughout the project. The goal of this study will be to explore, address, understand, and evaluate interventions that mitigate stigma in healthcare at both the individual and structural/organizational levels.

Attitudes of health professionals towards people with substance use disorders in Brazil, controlling for the effects of social desirability.

Health professionals are in a strategic position to help people with substance use disorders (SUDs) who seek health services for support or treatment. However, it is known that professionals' attitudes towards people who use alcohol and other drugs are marked by stigmatizing attitudes that create barriers to access quality treatment and make it difficult for the user to adhere to it. From this, the present study aimed to investigate the attitudes of 264 health professionals from specialised services and primary health care (PHC) in the Southeast region of Brazil, through Opening Minds Scale for Healthcare Providers (OMS-HC), taking into account the hypothesis of contact with the subject as a predictor of more positive attitudes. For this, a Multiple Hierarchical Regression was carried out to ascertain the contribution of the variables used in the explanatory model of attitudes. In addition, the measure of social desirability (SD), assessed by Brazilian Portuguese adaptation of Marlowe-Crowne Social Desirability Scale, was used as a control variable in the regression model to obtain a more robust and accurate model regarding the presence of biased responses, pervasive in studies on attitudes. In general, our findings showed that contact/familiarity with substance use, either through direct contact with users or through the respondent's own use, predicted more positive attitudes, with specialised service professionals expressing more positive attitudes than those working in PHC. Blaming the user for his/her condition presented itself as a predictor of more negative attitudes. Studies like this are of paramount importance for understanding the relationship established between professionals and service users and, therefore, for tailoring interventions and programs that aim to reduce stigmatizing attitudes and provide better access to health for people with SUDs. The importance of using the SD measure as a control variable in Regression is also emphasised, as an effective way to overcome to a common limitation in studies of attitudes.

Opioid Use Stigma: An Examination of Student Attitudes on Harm Reduction Strategies.

Understanding how the public views harm reduction strategies may help inform researchers on how to reduce related stigma and barriers to help-seeking. The current study explored whether stigma towards those who use opioids was affected by gender and type of harm reduction strategy used. Undergraduate students (N = 328) were randomly assigned to read one of six vignettes varying by gender and the type of harm reduction strategy: no harm reduction, opioid agonist therapy (OAT), or safe consumption sites (SCSs). Results demonstrated that participants were less stigmatizing towards the character who engaged in OAT compared to the character with no harm reduction. There was also a pattern demonstrating that SCSs may be perceived more negatively than OAT, although these differences only met conventional significance, not adjusted/corrected alphas. There were no significant effects for gender. Qualitative results revealed that participants held misconceptions about harm reduction. Implications and future directions are discussed.

Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework.

Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.

Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente.

This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.

Making the implicit explicit: A visual model for lowering the risk of implicit bias of mental/behavioural disorders on safety and quality of care.

Persons with mental illness and/or addictions have poorer health outcomes than the general population. Lower quality of healthcare has been identified as an important factor. A main contributor to lower quality of care for people with mental illnesses and/or addictions may be the cognitive implicit bias of mental versus physical care when assessing and categorizing a patient's clinical presentation. The objective of this article is to highlight how this implicit cognitive bias of mental versus physical care can result in human factor risks to quality of care. We provide three specific case examples of where these quality concerns arise. We also propose the use of a new visual tool to help educate and create awareness of this implicit-bias-based risk and quality care problem.

How a shared humanity model can improve provider well-being and client care: An evaluation of Fraser Health's Trauma and Resiliency Informed Practice (TRIP) training program.

Stress in the healthcare sector is an important concern, with worrying trends in provider burnout, secondary traumatic stress, and lower mental health. Importantly, provider stress is also connected to patient care, with recent research on Canada's opioid crisis finding that compassion satisfaction and burnout are linked to the perpetuation of negative attitudes and behaviours towards people with opioid use problems. In 2017, the Fraser Health Authority developed a training program for direct service providers designed to address this important connection-a mental health and resiliency program based in the principles of trauma-informed practice and care. This article reports the results of an evaluation of this program. Findings suggest that embedding resiliency and self-compassion within trauma-informed training programs is a promising approach for cultural change in healthcare practice. Leaders are encouraged to explore how such a model may be implementable for their own organizations and departments.

The Working Mind: A Meta-Analysis of a Workplace Mental Health and Stigma Reduction Program.

OBJECTIVES: This article describes a meta-analysis of The Working Mind, a program that was developed to address workplace mental health. The basic program addresses issues related to stigma in the workplace, the use of a mental health continuum model to evaluate signs and indicators of mental illness, and the development of coping skills. A manager version further addresses issues such as how to work with an employee who struggles with mental health issues, workplace accommodations, and overall management issues. METHODS: A total of 8 replications evaluated program effects on stigma, self-reported resilience, and coping abilities. RESULTS: The implementation of the program was associated with moderate reductions in stigma and increased self-reported resilience and coping abilities. These results were generally consistent across settings and showed nonsignificant differences when various potential moderators of the program were evaluated (e.g., employees versus managers, public versus private sector, gender, age). Qualitative comments collected at the end of the program suggested that many program participants found the program to be helpful and that the skills were being employed. CONCLUSIONS: Directions for future research, including the need for a randomized trial of The Working Mind, are discussed. Overall, the results suggest that the program is successful in its aims, but further inquiry is encouraged.

Implementation, Uptake, and Culture Change: Results of a Key Informant Study of a Workplace Mental Health Training Program in Police Organizations in Canada.

BACKGROUND: Organizational characteristics and attributes are critical issues to consider when implementing and evaluating workplace training. This study was a qualitative examination of the organizational context as it pertained to the implementation of a workplace mental health program called Road to Mental Readiness (R2MR) in police organizations in Canada. METHODS: We conducted a qualitative key informant study in 9 different policing organizations in Canada. RESULTS: The central theme of "successful cultural uptake" emerged as key to R2MR's implementation and the ability to facilitate broader culture change. Successful cultural uptake was enabled by several contextual factors, including organizational readiness, strong leadership support, ensuring good group dynamics, credibility of the trainers, implementing widely and thoroughly, and implementing R2MR as one piece of a larger puzzle. Successful cultural uptake was also described as enabling R2MR's impact for broader cultural change within the organization. This enablement occurred through enhanced dialogue about mental health and the introduction of a common language, a supportive workplace culture, increased help seeking, and organizational momentum for additional mental health programming and policy initiatives. CONCLUSION: Successful uptake of R2MR has the potential to lead to promote change within policing organizations. The model derived from our research may function as a tool or roadmap to help guide other organizations in the process of or planning to implement R2MR or a similar intervention.

The Road to Mental Readiness for First Responders: A Meta-Analysis of Program Outcomes.

OBJECTIVES: First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program. METHODS: The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites. RESULTS: A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants' perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up. CONCLUSIONS: Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others.

On the Very, Very Frontlines of Mental Health Care.

The role and training needs of client-facing administrative staff in mental health settings is an underidentified topic in the literature. Although interactions between the medical office staff and clients are not typically defined as therapeutic, patients nevertheless often view client-facing staff as an extension of their physician or care team. These interactions can be both meaningful and important to the overall care experience and should be conceptualized and understood as a legitimate part of the larger healing environment. To this end, the authors propose that a more fulsome understanding is needed of the experiences and impact of administrative staff's role in the larger clinical encounter from the perspectives of both clients and staff. The authors also identify a number of unmet training and support needs for client-facing administrative staff.

Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals' management of depression.

BACKGROUND: Depression affects over 400 million people globally. The majority are seen in primary care. Barriers in providing adequate care are not solely related to physicians' knowledge/skills deficits, but also time constraints, lack of confidence/avoidance, which need to be addressed in mental health-care redesign. We hypothesized that family physician (FP) training in the Adult Mental Health Practice Support Program (AMHPSP) would lead to greater improvements in patient depressive symptom ratings (a priori primary outcome) compared to treatment as usual. METHODS: From October 2013 to May 2015, in a controlled trial 77 FP practices were stratified on the total number of physicians/practice as well as urban/rural setting, and randomized to the British Columbia AMHPSP⎯a multi-component contact-based training to enhance FPs' comfort/skills in treating mild-moderate depression (intervention), or no training (control) by an investigator not operationally involved in the trial. FPs with a valid license to practice in NS were eligible. FPs from both groups were asked to identify 3-4 consecutive patients > 18 years old, diagnosis of depression, Patient Health Questionnaire (PHQ-9) score ≥ 10, able to read English, intact cognitive functioning. EXCLUSION CRITERIA: antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent/emergent medical/psychiatric condition. Patients were assigned to the same arm as their physician. Thirty-six practices recruited patients (intervention n = 23; control n = 13). The study was prematurely terminated at 6 months of enrollment start-date due to concomitant primary health-care transformation by health-system leaders which resulted in increased in-office demands, and recruitment failure. We used the PHQ-9 to assess between-group differences at baseline, 1, 2, 3, and 6 months follow-up. Outcome collectors and assessors were blind to group assignment. RESULTS: One hundred-and-twenty-nine patients (intervention n = 72; control n = 57) were analysed. A significant improvement in depression scores among intervention group patients emerged between 3 and 6 months, time by treatment interaction, likelihood ratio test (LR) chi2(3) = 7.96, p = .047. CONCLUSIONS: This novel skill-based program shows promise in translating increased FP comfort and skills managing depressed patients into improved patient clinical outcomes⎯even in absence of mental health specialists availability. TRIAL REGISTRATION: #NCT01975948 .