Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers

Brandon A Kohrt, Elizabeth L Turner, Sauharda Rai, Anvita Bhardwaj, Kathleen J Sikkema, Adesewa Adelekun, Manoj Dhakal, Nagendra P Luitel, Crick Lund, Vikram Patel, Mark J D Jordans

Social Science & Medicine

Published on: 15 February 2020

Abstract: Initiatives for integration of mental health services into primary care are underway through the World Health Organization’s mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers’ stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of “what matters most.” RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a “what matters most” conceptual framework.

Keywords: Developing countries; Discrimination; Medical anthropology; Mental health; Patient participation; Primary health care; Social stigma; Teaching.

DOI: 10.1016/j.socscimed.2020.112852