Title: Improving Mental Health Outcomes by Reducing Stigma and Discrimination
Funder: Department of Health (England)

Abstract: 5.1 Aims and objectives To strengthen the evidence base to improve outcomes for people with mental illness by reducing stigma and discrimination, through research on: (i) help-seeking and access to mental healthcare; (ii) provision of physical healthcare; (iii) outcomes related to occupation and work. Achieved by: (i) methodological development of standardised, outcome measures; (ii) analytical studies to assess discrimination; (iii) evaluative studies of training tools; and (iv) knowledge transfer activities to disseminate results. 5.2 Background Stigma and discrimination have been described by many people with mental illness as more disabling than the primary condition. Research shows that stigma and discrimination faced by people with mental illness is frequent, often severe and contributes to poorer health outcomes, and is a significant factor in the reluctance of people with mental illness to seek treatment and care. In relation to health outcomes three specific elements are impaired: (i) help seeking and access to healthcare, (ii) the provision of physical and mental healthcare, and (iii) low rates of participation in employment which hinder recovery from mental illness. As the empirical base of research on stigma is mostly limited to attitude surveys, there is a lack of evidence of effective interventions. A further knowledge gap concerns disadvantaged groups, such as black mentally ill people, which will be addressed in this programme. We have led or collaborated with numerous related research projects on intervention, analytical and methodological studies. This programme will therefore build on and accelerate this work to lead to more effective interventions. 5.3 Research plans We propose an inter-related portfolio of elements within this programme: 4 methodological studies; 5 analytical studies, 3 intervention studies; and 4 knowledge transfer actions. Methodological studies: development of the Discrimination and Stigma Scale (DISC) to assess experiences of discrimination and create the Questionnaire on Anticipated Discrimination (QUAD) scale to assess such self-inflicted forms of social exclusion. We shall also further develop the scale of clinicians’ attitudes to people with mental illness (MICA) to assess views of medical and social care staff about providing mental and physical healthcare to people with mental illness, and create a new scale to measure the financial costs associated with stigma and discrimination. Analytical studies: to better understand the nature of stigma and discrimination include knowledge synthesis on population interventions to reduce stigma; comparison of discrimination in different diagnostic groups and ethnicity; developing a model of the financial costs associated with stigma and their measurement; and pilot study on diagnostic over-shadowing. Intervention studies: on diagnosis disclosure in job seeking and decisions of employers in relation to disclosure of psychiatric history will be conducted. We shall also compare live and recorded service user training materials to reduce stigma, as forms of active ‘social contact’. Knowledge transfer components: include publication of findings to specialist and non-specialist mental health audiences, production of a training pack aimed at health and social care; and dissemination of results at national and international conferences and on the mental healthcare and stigma websites. 5.4 Research team The research team of this programme consists of expertise from health economics, psychiatry, social science, service users, and systematic reviews. We have a strong track record of research on stigma and discrimination. 5.5 Research environment The South London & Maudsley NHS Trust and Institute of Psychiatry (including the Health Service Research Department) have a long-standing partnership in undertaking research to establish the best care for people with mental illness and have succeeded in attracting substantial external funding (£33.9m in 2005/06). 5.6 Anticipated outputs, outcomes and impact At the national level, the key outputs include publication of best available evidence on population education; legal requirements on disclosing psychiatric history; a decision-aid workbook on job applications; and DVDs for training courses. At the local level, standardised scales will be produced, and at the individual level, we shall use these scales to assess the impact of discrimination and associated financial costs. 5.7 Public involvements in the proposed research Members of the public/ service users will be involved in three ways: (i) ongoing consultation with relevant stakeholders; (ii) members of the public with relevant direct experience of stigma (including carers) will be represented on the Programme Steering Group and collaborate in all aspects of the research; (iii) dr Rose of the Service User Research Enterprise (SURE) is a Co-applicant, and some parts of the Programme will be user led.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH