Useful strategies for reducing mental health stigma in healthcare settings: a Delphi study
Article Sidebar
Main Article Content
Abstract
Healthcare settings’ stigma towards mental health problems is a public health phenomenon that is attracting increasing research interest. Our aim was to identify useful strategies for reducing stigma towards mental disorders in healthcare settings. A qualitative study was carried out to reach an inter judge agreement among experts on these strategies, with a n = 23 experts in mental health stigma and clinical practice from Argentine and Spain. Consensus was reached on useful strategies for mental health stigma reduction in health and social contexts. Training in communication skills and empathy is the most useful strategy reported, followed by multidisciplinary work and supervision of clinical practices. It is advisable to promote the implementation of communication and empathy strategies during the education and training of health and social professionals to reduce stigma.
Downloads
Publication Facts
Reviewer profiles N/A
Author statements
- Editor & editorial board
- profiles
- Academic society
- Psychology, Society & Education
- Publisher
- UCOPress. Universidad de Córdoba
To learn about these publication facts, click 
PF is maintained by the Public Knowledge Project
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal retains the economic copyright of contributions that are accepted for publication. This means that it acquires the exclusive use of the document to be edited, disseminated, preserved, etc. in any support and for the time stipulated by the local legislation that regulates the performance of the publication.
Psychology, Society & Education is published under CC BY-NC-SA 4.0
References
Agres, M. (2016). Narrativas en primera persona: ¿Qué es lo nuevo para un profesional de la salud mental? [First person narratives: Is there anything new in them for a mental health professional?]. Vertex, XXVII(128), 274-279.
Agrest, M., Mascayano, F., Ardila-Gómez, S. E., Abeldaño, A., Fernandez, R., Geffner, N., Leiderman, E. A., Susser, E. S., Valencia, E., Yang, L. H., Zalazar, V., & Lipovetzky, G. (2015). Mental illness stigma research in Argentina. BJPsych International, 12(4), 86-88. https://doi.org/10.1192/s2056474000000623 DOI: https://doi.org/10.1192/S2056474000000623
Akins, R. B., Tolson, H., & Cole, B. R. (2005). Stability of response characteristics of a Delphi panel: Application of bootstrap data expansion. BMC Medical Research Methodology, 5, Article 37. https://doi.org/10.1186/1471-2288-5-37 DOI: https://doi.org/10.1186/1471-2288-5-37
Amsalem, D., Gothelf, D., Dorman, A., Goren, Y., Tene, O., Shelef, A., Horowitz, I., Dunsky, L. L., Rogev, E., Klein, E. H., Mekori-Domachevsky, E., Fischel, T., Levkovitz, Y., Martin, A., & Gross, R. (2020). Reducing stigma toward psychiatry among medical students: A multicenter controlled trial. The Primary Care Companion for CNS Disorders, 22(2), Article 19m02527. https://doi.org/10.4088/PCC.19m02527 DOI: https://doi.org/10.4088/PCC.19m02527
Carrara, B. S., Ventura, C. A. A., Bobbili, S. J., Jacobina, O. M. P., Khenti, A., & Mendes, A. C. (2019). Stigma in health professionals towards people with mental illness: An integrative review. Archives of Psychiatric Nursing, 33(4), 311-318. https://doi.org/10.1016/j.apnu.2019.01.006 DOI: https://doi.org/10.1016/j.apnu.2019.01.006
Chair Against Stigma UCM-Grupo 5 (2020). Good Practice Guide Against Stigma (2nd ed.). Reproexpres Ediciones.
Chin, S. H., & Balon, R. (2006). Attitudes and perceptions toward depression and schizophrenia among residents in different medical specialties. Academic Psychiatry: the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 30(3), 262-263. https://doi.org/10.1176/appi.ap.30.3.262 DOI: https://doi.org/10.1176/appi.ap.30.3.262
Clarke, D., Usick, R., Sanderson, A., Giles-Smith, L., & Baker, J. (2014). Emergency department staff attitudes towards mental health consumers: A literature review and thematic content analysis. International Journal of Mental Health Nursing, 23(3), 273-284. https://doi.org/10.1111/inm.12040 DOI: https://doi.org/10.1111/inm.12040
Corrigan, P. W., Mittal, D., Reaves, C. M., Haynes, T. F., Han, X., Morris, S., & Sullivan, G. (2014). Mental health stigma and primary health care decisions. Psychiatry Research, 218(1-2), 35-38. https://doi.org/10.1016/j.psychres.2014.04.028 DOI: https://doi.org/10.1016/j.psychres.2014.04.028
Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907-922. https://doi.org/10.1016/j.cpr.2010.06.004 DOI: https://doi.org/10.1016/j.cpr.2010.06.004
Cova, F., Monreal, V., & Grandón, P. (2024). Estigma en el nivel secundario de atención en salud mental hacia personas con diagnóstico psiquiátrico. Psykhe.
Cruz-Ramírez, M. L, & Martínez C., Mayelín C. (2012). Perfeccionamiento de un instrumento para la selección de expertos en las investigaciones educativas. Revista Electrónica de Investigación Educativa, 14(2), 167-179.
De Villiers, M. R., De Villiers, P. J., & Kent, A. P. (2005). The Delphi technique in health sciences education research. Medical Teacher, 27(7), 639-643. https://doi.org/10.1080/13611260500069947 DOI: https://doi.org/10.1080/13611260500069947
Eiroa-Orosa, F. J., Lomascolo, M., & Tosas-Fernández, A. (2021). Efficacy of an intervention to reduce stigma beliefs and attitudes among primary care and mental health professionals: Two cluster randomised-controlled trials. International Journal of Environmental Research and Public Health, 18(3), Article 1214. https://doi.org/10.3390/ijerph18031214 DOI: https://doi.org/10.3390/ijerph18031214
Finn, R. H. (1970). A note on estimating the reliability of categorical data. Educational and Psychological Measurement, 30(1), 71-76. https://doi.org/10.1177/001316447003000106 DOI: https://doi.org/10.1177/001316447003000106
Fontesse, S., Rimez, X., & Maurage, P. (2021). Stigmatization and dehumanization perceptions towards psychiatric patients among nurses: A path-analysis approach. Archives of Psychiatric Nursing, 35(2), 153-161. https://doi.org/10.1016/j.apnu.2020.12.005 DOI: https://doi.org/10.1016/j.apnu.2020.12.005
Fox, A. B., Earnshaw, V. A., Taverna, E. C., & Vogt, D. (2018). Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma and Health, 3(4), 348-376. https://doi.org/10.1037/sah0000104 DOI: https://doi.org/10.1037/sah0000104
Gaebel, W., Zäske, H., Zielasek, J., Cleveland, H. R., Samjeske, K., Stuart, H., Arboleda-Florez, J., Akiyama, T., Baumann, A. E., Gureje, O., Jorge, M. R., Kastrup, M., Suzuki, Y., Tasman, A., Fidalgo, T. M., Jarema, M., Johnson, S. B., Kola, L., Krupchanka, D., Larach, V., … Sartorius, N. (2015). Stigmatization of psychiatrists and general practitioners: results of an international survey. European Archives of Psychiatry and Clinical Neuroscience, 265(3), 189-197. https://doi.org/10.1007/s00406-014-0530-8 DOI: https://doi.org/10.1007/s00406-014-0530-8
Geffner, N. I., & Agrest, M. (2021). Estudio sobre el estigma percibido y el estigma experimentado según los usuarios de servicios de salud mental en la ciudad de Buenos Aires: Su impacto en la recuperación. Revista Iberoamericana de Psicología, 14(2), 21-32. https://doi.org/10.33881/2027-1786.rip.14203 DOI: https://doi.org/10.33881/2027-1786.rip.14203
Geffner, N. I., Agrest, M., & Garber Epstein, P. (2021). Relato de la experiencia en Argentina de la adaptación de un programa estandarizado guiado por la recuperación en salud mental. Revista Iberoamericana de Psicología, 14(2), 57-68. https://doi.org/10.33881/2027-1786.rip.14206 DOI: https://doi.org/10.33881/2027-1786.rip.14206
Grandón F. P., Bustos N. C., Cova S. F., Saldivia B. S., Ramírez V. R., Vaccari J. P., Vielma A. A., & Turenne, E. (2021). Resultados del programa “Igual-Mente” de reducción de estigma en profesionales de atención primaria de salud hacia personas con diagnóstico de trastorno mental grave. Psykhe.
Heim, E., Henderson, C., Kohrt, B. A., Koschorke, M., Milenova, M., & Thornicroft, G. (2019). Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: A systematic review. Epidemiology and Psychiatric Sciences, 29, Article e28. https://doi.org/10.1017/S2045796019000167 DOI: https://doi.org/10.1017/S2045796019000167
Henderson, C., Noblett, J., Parke, H., Clement, S., Caffrey, A., Gale-Grant, O., Schulze, B., Druss, B., & Thornicroft, G. (2014). Mental health-related stigma in health care and mental health-care settings. The Lancet Psychiatry, 1(6), 467-482. https://doi.org/10.1016/S2215-0366(14)00023-6 DOI: https://doi.org/10.1016/S2215-0366(14)00023-6
Jorm, A. F. (2015). Using the Delphi expert consensus method in mental health research. The Australian and New Zealand Journal of Psychiatry, 49(10), 887-897. https://doi.org/10.1177/0004867415600891 DOI: https://doi.org/10.1177/0004867415600891
Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111-116. https://doi.org/10.1177/0840470416679413 DOI: https://doi.org/10.1177/0840470416679413
Knaak, S., Modgill, G., & Patten, S. B. (2014). Key ingredients of anti-stigma programs for health care providers: A data synthesis of evaluative studies. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 59(1), 19-26. https://doi.org/10.1177/070674371405901s06 DOI: https://doi.org/10.1177/070674371405901S06
Larkings, J. S., & Brown, P. M. (2018). Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review. International Journal of Mental Health Nursing, 27(3), 928-941. https://doi.org/10.1111/inm.12390 DOI: https://doi.org/10.1111/inm.12390
Lien, Y. Y., Lin, H. S., Lien, Y. J., Tsai, C. H., Wu, T. T., Li, H., & Tu, Y. K. (2021). Challenging mental illness stigma in healthcare professionals and students: A systematic review and network meta-analysis. Psychology & Health, 36(6), 669-684. https://doi.org/10.1080/08870446.2020.1828413 DOI: https://doi.org/10.1080/08870446.2020.1828413
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385. http://dx.doi.org/10.1146/annurev.soc.27.1.363 DOI: https://doi.org/10.1146/annurev.soc.27.1.363
Linstone, H. A., & Turoff, M. (2002). The Delphi method: techniques and applications. Addison-Wesley Pub. Co.
Manzanera, R., Lahera, G., Álvarez-Mon, M. Á., & Alvarez-Mon, M. (2018). Maintained effect of a training program on attitudes towards depression in family physicians. Family Practice, 35(1), 61-66. https://doi.org/10.1093/fampra/cmx071 DOI: https://doi.org/10.1093/fampra/cmx071
Mascayano, F., Lips-Castro, W., Mena-Poblete, C., & Manchego-Soza, C. (2015). Estigma hacia los trastornos mentales: características e intervenciones. Salud Mental, 38(1), 53-58. DOI: https://doi.org/10.17711/SM.0185-3325.2015.007
Mead, D., & Moseley, L. (2001). The use of the Delphi as a research approach. Nurse Researcher, 8(4), 4-23. https://doi.org/10.7748/nr2001.07.8.4.4.c6162 DOI: https://doi.org/10.7748/nr2001.07.8.4.4.c6162
Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., Lean, R. M., Mitchell, E. M. H., Nelson, R. E., Sapag, J. C., Siraprapasiri, T., Turan, J., & Wouters, E. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine, 17(1), Article 25. https://doi.org/10.1186/s12916-019-1256-2 DOI: https://doi.org/10.1186/s12916-019-1256-2
Pan American Health Organization (2022). Understanding and acting against mental health stigma in health contexts. Chair Against Stigma UCM-Grupo 5, Complutense University of Madrid.
Pettigrew, T. F., & Tropp, L. R. (2008). How does intergroup contact reduce prejudice? Meta-analytic tests of three mediators. European Journal of Social Psychology, 38(6), 922-934. https://doi.org/10.1002/ejsp.504 DOI: https://doi.org/10.1002/ejsp.504
Sarikoc, G., Ozcan, C. T., & Elcin, M. (2017). The impact of using standardized patients in psychiatric cases on the levels of motivation and perceived learning of the nursing students. Nurse Education Today, 51, 15-22. https://doi.org/10.1016/j.nedt.2017.01.001 DOI: https://doi.org/10.1016/j.nedt.2017.01.001
Solmi, M., Granziol, U., Danieli, A., Frasson, A., Meneghetti, L., Ferranti, R., Zordan, M., Salvetti, B., Conca, A., Salcuni, S., & Zaninotto, L. (2020). Predictors of stigma in a sample of mental health professionals: Network and moderator analysis on gender, years of experience, personality traits, and levels of burnout. European Psychiatry: the Journal of the Association of European Psychiatrists, 63(1), Article e4. https://doi.org/10.1192/j.eurpsy.2019.14 DOI: https://doi.org/10.1192/j.eurpsy.2019.14
Stone, E. M., Chen, L. N., Daumit, G. L., Linden, S., & McGinty, E. E. (2019). General medical clinicians’ attitudes toward people with serious mental illness: A scoping review. The Journal of Behavioral Health Services & Research, 46(4), 656-679. https://doi.org/10.1007/s11414-019-09652-w DOI: https://doi.org/10.1007/s11414-019-09652-w
Thornicroft, G., Sunkel, C., Alikhon Aliev, A., Baker, S., Brohan, E., El Chammay, R., Davies, K., Demissie, M., Duncan, J., Fekadu, W., Gronholm, P. C., Guerrero, Z., Gurung, D., Habtamu, K., Hanlon, C., Heim, E., Henderson, C., Hijazi, Z., Hoffman, C., Hosny, N., … Winkler, P. (2022). The Lancet Commission on ending stigma and discrimination in mental health. Lancet, 400(10361), 1438-1480. https://doi.org/10.1016/S0140-6736(22)01470-2 DOI: https://doi.org/10.1016/S0140-6736(22)01470-2
Zamorano, S., Sáez-Alonso, M., González-Sanguino, C., & Muñoz, M. (2023). Social stigma towards mental health problems in Spain: A systematic review. Clínica y Salud, 34(1), 23-34. https://doi.org/10.5093/clysa2023a5 DOI: https://doi.org/10.5093/clysa2023a5