When Mental Health Care Is Stigmatizing: A Participative Study in Schizophrenia

• Published in: Psychiatric rehabilitation journal 2023-09, Vol.46 (3), p.232-242
• Main Authors: Valery, Kevin-Marc, Fournier, Thomas, Violeau, Louis, Guionnet, Sarah, Bonilla-Guerrero, Julien, Caria, Aude, Carrier, Antonin, Destaillats, Jean-Marc, Follenfant, Alice, Laberon, Sonia, Lalbin-Wander, Nadeja, Martinez, Eric, Quemper, Danielle, Staedel, Bérénice, Touroude, Roselyne, Vigneault, Luc, Prouteau, Antoinette
• Format: Article
• Language: English
• Subjects: Family Members; Female; Human; Humanities and Social Sciences; Male; Mental disorders; Mental Health; Mental health care; Mental Health Services; Psychology; Schizophrenia; Stigma
• ISSN: 1095-158X; 1559-3126; 1559-3126
• DOI: 10.1037/prj0000567

Objectives: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. Method: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. Results: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). Conclusions and Implications for Practice: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. Impact and Implications This study describes 15 concrete situations of stigma experienced in mental health services by users with a schizophrenia diagnosis and their relatives (e.g., discrediting somatic complaint, pessimism, stereotype of dangerousness, violent practices, infantilization, lack of collaboration, lack of social inclusion, lack of respect in intimacy, lack of information and explanations). In addition, this study focused on factors associated with less experienced stigma, such as recovery-oriented practices.