Stigma Toward Psychosis in Urban Chile: Engaging "What Matters Most" to Resist Stigma Through Recovery-Oriented Services

• Published in: Psychiatric rehabilitation journal 2023-03, Vol.46 (1), p.65-73
• Main Authors: Becker, Timothy D., Blasco, Drew, Burrone, María Soledad, Dishy, Gabriella, Velasco, Paola, Reginatto, Gabriel, Mascayano, Franco, Wu, Maximillian S., Hu, Cindy, Bharadwaj, Simran, Khattar, Shivangi, Calderon, Liz, Filgueira, Cynthia, Alvarado, Rubén, Susser, Ezra S., Yang, Lawrence H.
• Format: Article
• Language: English
• Subjects: Chile; Culture (Anthropological); Female; First Episode (Disorders); Health disparities; Human; Humans; Male; Mental health care; Mental Health Services; Psychosis; Psychotic Disorders - therapy; Recovery (Disorders); Rehabilitation, Vocational; Social Stigma; Stigma; Urban Environments
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000546

Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. Methods: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. Conclusions and Implications for Practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. Impact and Implications Both traditional and capitalist values influence users of mental health services in urban Chile. Mental illness shapes stigma by interfering with widely valued goals of maintaining a good appearance, marriage and family formation, social connectedness, and independence. Mental health services have both positive and negative impacts on users' achievement of these goals. Future mental health services development can reduce stigma by aligning services with lived values.