The effectiveness of mental health disorder stigma-reducing interventions in the healthcare setting: An integrative review

Abstract

Individuals with mental health disorders frequently seek medical treatment in health care settings other than a mental health facility. However, mental health disorder stigmatization is prevalent in the healthcare setting across the globe. Stigmatizing attitudes remain widespread among healthcare professionals who are responsible for delivering patient-centered, quality care. Stigma in the healthcare setting can undermine effective diagnosis, therapy, and optimum health outcomes. Addressing stigma is critical to delivering quality health care in both developed and developing countries. Therefore, it is important to deliver successful anti-stigma education, along with practical strategies, to reduce the stigma of mental health disorders among healthcare professionals. An integrative review was conducted to identify the effectiveness of various interventions used in 10 different countries globally to reduce the stigma of mental health disorders in the healthcare setting.

Introduction

Mental health disorders (MHDs) are on the rise resulting in a widespread epidemic affecting millions of individuals in the United States (NAMI, 2019). Multiple studies have shown that people with MHDs have increased morbidity and mortality compared to the general population (Nordentoft et al., 2013; Wahlbeck et al., 2011). The World Health Organization estimated that in 2020, about 1.53 million individuals died from suicide, which is one death every 20 s (WHO, 2020). A significant percentage of these individuals suffer from chronic MHDs (Bachmann, 2018; WHO, 2020). This unabated epidemic, which continues to increase, is hitting healthcare organizations exceptionally hard. For the purpose of this integrative review, the phrase ‘healthcare professionals’ refers to those with existing healthcare degrees and those pursuing a career in health care.

The prevalence of MHDs is increasing rapidly in the United States. One in 25 Americans live with a MHD, such as schizophrenia, bipolar disorder, or major depression disorder (CDC, 2018; NAMI, 2019). In 2018, one in five Americans aged 18 or older, or an estimated 47.6 million adults, were diagnosed with a MHD (NAMI, 2019; SAMHSA, 2016). It is predicted that more than 50% of peoples in the United States will be diagnosed with a MHD at some point of their lives (CDC, 2018). Recent data indicates a substantial spike of patients presenting to healthcare settings for the chief complain of MHDs (Tucci et al., 2015), and the healthcare setting is often the initial point of contact for individuals suffering from MHDs (Khenti et al., 2019). In addition, uninsured individuals with MHDs choose the emergency department for treatment knowing that, by law, they cannot be rejected based on their insurance status (Joint Commission, 2015). However, despite this increase and a need for treatment, stigmatization of MHD patients by health care professionals (HCPs) have become a public health crisis (Knaak et al., 2017).

A recent study by Del Olmo-Romero et al. (2019), reports individuals who use mental-health services expressed feeling demeaned and discriminated by HCPs. Stigma towards patients with MHDs undermines the quality of patient-centered care (Schmitt et al., 2014) and adds to a disparity in life expectancy (Henderson et al., 2014). Stigmatization experienced by individuals also causes concealment of symptoms, which can lead to further rage, anxiety, verbal outbursts, and increased suicidal ideation. This stigmatization creates a reluctance in the patient, which increases the likelihood that they may avoid seeking social and/or medical support (Chaudoir & Fisher, 2010). In response to these issues, measures are being taken locally and internationally to decrease the stigma and prejudice faced by individuals who are diagnosed with a MHD.