Assessment of Mental Health Stigma in Mental Health Care Workers

This paper presents and discusses the assessment of mental health stigma in mental health care workers in an inpatient psychiatric hospital. Mental health conditions are prevalent throughout the United States with "one in 5 adults experiencing a mental health condition every year" (NAMI, 2017a, para. 4). Stigma within mental health care workers can affect patient treatment outcomes; therefore, it is important to know whether or not mental health stigma exists in health care workers (Stuber, Rocha, Christian, & Link, 2014). This is especially true for those who work in a hospital dedicated to helping those with mental illness. Based upon the results of an extensive literature search, it was found that there is limited data on mental health stigma within the mental health care workforce in the United States and no data for the state of Utah. This paper records the results and interpretations of the pilot study into mental health stigma in mental health care workers. Various interventions have been utilized to address the issue of mental health stigma; however, it remains a problem. Lewin's change theory is suggested in this project to help maintain a longer lasting effect on the issue of mental health stigma. The objectives of this project were to 1) assess nurse managers' perspectives on mental health stigma using qualitative means, 2) assess the stakeholders' (psychiatric technicians, social workers, registered nurses, physicians, and nurse practitioners) levels of mental health stigma utilizing a validated instrument (Opening Minds Stigma Scale for Health Care Providers, OMS-HC, Image A), and 3) present the data to stakeholders in order to explore potential interventions aimed at reducing mental health stigma. Both questionnaire results and qualitative results received in staff meetings indicated the presence of mental health stigma in the mental health care workers working in an inpatient psychiatric hospital. Differences were noted between professions; however, they were not statistically significant. Further research and interventions will need to occur in the future to better address the presence of stigma in mental health care workers.

Running Head: ASSESSMENT OF MENTAL HEALTH STIGMA Assessment of Mental Health Stigma in Mental Health Care Workers Lillian Farris, RN, BSN Project Chair: Larry Garrett, PhD, MPH, BSN Content Expert: Andrew Szeto, PhD College of Nursing University of Utah 1 ASSESSMENT OF MENTAL HEALTH STIGMA 2 Abstract This paper presents and discusses the assessment of mental health stigma in mental health care workers in an inpatient psychiatric hospital. Mental health conditions are prevalent throughout the United States with "one in 5 adults experiencing a mental health condition every year" (NAMI, 2017a, para. 4). Stigma within mental health care workers can affect patient treatment outcomes; therefore, it is important to know whether or not mental health stigma exists in health care workers (Stuber, Rocha, Christian, & Link, 2014). This is especially true for those who work in a hospital dedicated to helping those with mental illness. Based upon the results of an extensive literature search, it was found that there is limited data on mental health stigma within the mental health care workforce in the United States and no data for the state of Utah. This paper records the results and interpretations of the pilot study into mental health stigma in mental health care workers. Various interventions have been utilized to address the issue of mental health stigma; however, it remains a problem. Lewin's change theory is suggested in this project to help maintain a longer lasting effect on the issue of mental health stigma. The objectives of this project were to 1) assess nurse managers' perspectives on mental health stigma using qualitative means, 2) assess the stakeholders' (psychiatric technicians, social workers, registered nurses, physicians, and nurse practitioners) levels of mental health stigma utilizing a validated instrument (Opening Minds Stigma Scale for Health Care Providers, OMSHC, Image A), and 3) present the data to stakeholders in order to explore potential interventions aimed at reducing mental health stigma. Both questionnaire results and qualitative results received in staff meetings indicated the presence of mental health stigma in the mental health care workers working in an inpatient ASSESSMENT OF MENTAL HEALTH STIGMA psychiatric hospital. Differences were noted between professions; however, they were not statistically significant. Further research and interventions will need to occur in the future to better address the presence of stigma in mental health care workers. Keywords: mental health stigma, mental health care workers 3 ASSESSMENT OF MENTAL HEALTH STIGMA 4 Introduction Problem Description: Nature and significance of the local problem Mental health conditions are experienced globally by a large number of patients with "one in 5 adults experience[ing] a mental health condition every year" (NAMI, 2017a, para. 4). Moreover, there is a problem in health care with mental health stigma which influences patients' treatment and outcomes (Stuber, Rocha, Christian, & Link, 2014). "The opinion of psychiatrists as the most significant figures in their environment may be crucial in shaping the social image of the mentally ill and success in the process of recovery" (Kochanski & Cechnicki, 2017, p. 39). Mental health stigma can alter the way a patient is treated by a provider because the stigma can influence that provider to make decisions or treat a patient differently than the actual needs of the patient indicate (Stuber, Rocha, Christian, & Link, 2014). Mental health stigma can also create a barrier to access to care. Patients express a hesitancy to go to providers who they feel stigmatize them (Corrigan, Druss, & Perlick, 2014). "Stigma impacts care seeking at personal, provider, and system levels" (Corrigan, Druss, & Perlick, 2014, p. 43). Mental illness stigma, or mental health stigma, is rarely studied in health care workers, let alone in mental health care workers, which leaves a gap in current research that is needed. An extensive literature review on this subject shows that there is currently little to no information on mental health stigma in mental health care workers in the state of Utah, so it is difficult to determine the level of significance locally. Stuber, Rocha, Christian, and Link (2014) researched this topic in Washington state, but no other information was found. Literature search criteria included the following phrases, both combined and individually, on CINAHL and PubMed: mental health, mental illness, stigma, mental health stigma, mental illness stigma, ASSESSMENT OF MENTAL HEALTH STIGMA 5 mental healthcare workers, psychiatric workers, Utah. Additionally, these phrases were searched on Google in the case that the information was more obscure. Mental health stigma in mental health care workers is a problem because it causes a bias in those providing care to mental health patients, and it can limit a patient's access to mental health care. The reviewed literature on mental health stigma revealed one article that focused on mental health care providers (social workers) and stigma in the United States (Covarrubias & Han, 2011). This focus is present outside of the United States, but within the United States there remains very little assessment or research on the subject. Information about how to address the problem of stigma was evident in the search; however, there was limited information specifically about mental health stigma in mental health care workers (Ungar, Knaak, & Szeto, 2016). This is why an assessment of mental health stigma in mental health care workers in Utah is necessary to begin the research on this subject. Mental health stigma is defined by Link and Phelan as being composed of four parts: labeling, stereotyping, separating, and status loss or discrimination (2001). People can react emotionally to these components of stigma. This emotional reaction first begins when someone characterizes another person as different from themselves in some way; it turns into stereotyping when this difference is given a label (Modgill, et al., 2014). Following labeling, people then differentiate between mainstream or "normal," and the labeled group or "abnormal". This creates an atmosphere where the labeled group is rejected through lowering their social status or through discrimination (Modgill, et al., 2014). Ultimately this is what the process of stigma appears to be. ASSESSMENT OF MENTAL HEALTH STIGMA 6 Available Knowledge Mental health stigma occurs when a person treats another person with mental illness in a different way based on their mental health condition (NAMI, 2017b). This stigma is present not only in the general public, but amongst professional health care providers as well (Kochanski & Cechnicki, 2017). In a Polish study of psychiatrists, it was shown that psychiatrists had almost the same amount of mental health stigma as the general public (Kochanski & Cechnicki, 2017). This demonstrates that despite education and exposure to patients with mental illness, stigma against patients is still present in health care professionals (Sickel, Seacat, & Nabors, 2014). Although stigma has been acknowledged as a problem, attempts to reduce its effect have been relatively unsuccessful on a large scale and result in many patients suffering from discrimination (Gaebel, et al., 2015). Access to mental health care is limited. In 2016, there were fewer options for mental health care in the Affordable Care Act marketplace than for primary care (Zhu, Zhang, & Polsky, 2017). For example, only 42.7% of eligible physicians were participating in mental health care options, while 58.4% of physicians were participating in primary care (Zhu, Zhang, & Polsky, 2017). Given this limited access to mental health care for those with insurance, one can imagine how difficult access to this care is for those without insurance. Mental health stigma adds to this problem by creating an environment where people do not feel that they can seek mental health services even if they have access to them (Corrigan, Druss, & Perlick, 2014). An example of this is shown in emergency departments: psychiatric patients wait on average "3.2 times longer" than non-psychiatric patients (Nicks & Manthey, 2012, p. 1). This leads to a delay in care and sometimes more fatal consequences. In 2008, a psychiatric patient died in the waiting room of a psychiatric emergency department despite signs and symptoms of ASSESSMENT OF MENTAL HEALTH STIGMA 7 needing help (Interlandi, 2008). Due to the fact that it was a psychiatric emergency department, many staff members did not take her behavior seriously, attributing her symptoms to her mental illness (Interlandi, 2008). This ultimately resulted in her delay of care and her death (Interlandi, 2008). This was not uncommon at this location as many psychiatric patients reported having to wait 4-5 days before being seen (Dwyer, 2008). Mental health care can be a difficult occupation for many as evidenced by the employee burnout due to the high levels of stress and anxiety when dealing with acutely ill populations, specifically inpatient units (Tingle, 2017). Christodoulous-Fella, Middleton, Papathanassoglu, and Karinikola (2017) found that there is an association between work-related moral distress and secondary traumatic stress symptoms for nurses working with mental health patients. Many mental health nurses experience morally distressing situations on inpatient mental health units. These distressing situations increase the likelihood that they may suffer from secondary traumatic stress symptoms. This can lead to eventual burnout over time. As highlighted above, stigma is an issue not only in the general public, but also in mental health professionals. Mental health stigma is a significant contributing factor to the level and quality of care provided to the patient suffering from the mental illness. It is particularly important to assess mental health care workers, because the population that they work with are all suffering from one type of mental illness or another and because their work in high stress situations can lead to burnout. If mental health care workers have stigma against their patients, it can result in less than optimal treatment outcomes for their patients. Rationale There have been many attempts to reduce stigma; however, it still exists despite these efforts, such as implementing programs and interventions that work on a "multi-dimensional, ASSESSMENT OF MENTAL HEALTH STIGMA multi-level approach that address stigma holistically" (Ungar, Knaak, & Szeto, 2016, para. 31). The different "aspects of stigmatization include discriminatory behaviors and practices, diagnostic overshadowing, fragmentation and marginalization, and less timely and/or less adequate treatment for non-mental health medical concerns" (Ungar, Knaak, & Szeto, 2016, para. 3). Utilizing Lewin's change theory, also known as the 3-Step Model of Change, may help address mental health stigma in mental health care workers (Burnes, 2004). This theory focuses on the idea that there are three steps needed in order for change to occur: 1) unfreeze, 2) necessary change, and 3) refreeze (Burnes, 2004). The first step includes unfreezing the thoughts related to the process or item that is to be changed, the second step is discussing the results with stakeholders in order to make people realize this change is necessary and to their benefit, and the third step is refreezing that thought process (Burnes, 2004). Utilizing this conceptual framework may help to build a better buy in from stakeholders and in turn result in a lasting change. Specific Aims The purpose of this project is to assess the level of mental health stigma in mental health care workers. This is done to better understand and address stigma toward mental illness within a sample of mental health care workers (psychiatric technicians, social workers, registered nurses, physicians, and nurse practitioners), and to assess its potential to impact the quality of care they provide to patients. The objectives of this project were to 1) assess nurse managers' perspectives on mental health stigma using qualitative means, 2) assess the stakeholders' (psychiatric technicians, social workers, registered nurses, physicians, and nurse practitioners) levels of mental health stigma utilizing a validated instrument (Opening Minds Stigma Scale for Health Care Providers, OMS-HC, Image A), and 3) present the data to stakeholders in order to 8 ASSESSMENT OF MENTAL HEALTH STIGMA 9 explore potential interventions aimed at reducing mental health stigma. These aims support steps one and two of the Lewin's Change Theory. Methods Context The University of Neuropsychiatric Institute (UNI) is part of the University of Utah health care system (University of Utah, n.d.). UNI is home to both inpatient units and outpatient services catering to child, adolescent, and adult patients with mental health problems (University of Utah, n.d.). There are nine inpatient units, each with a number of core and float psychiatric technicians, nurses, social workers, and physicians. There are also several outpatient services ranging from addiction recovery intensive outpatient services to psychotherapy services within the surrounding community. When discussing the questionnaire and the subject with the nurse managers of all the units before the questionnaire was distributed, the environment was very receptive, and the nurse managers expressed an interest in discovering the outcome for their units. Mental health stigma is an important concept among mental health care workers; however, up until this point, there have not been any documented quality improvement assessments or projects focusing on this subject within UNI. Intervention There is no intervention for this paper; however, a validated scale was used to assess the mental health stigma in mental health care workers of a psychiatric inpatient hospital. The Opening Minds Stigma Scale for Health Care Providers was created and tested in Canada by the Mental Health Commission of Canada (MHCC) in an effort to reduce stigma (Mental Health Commission of Canada, 2017) and initially tested on 787 health care providers to specifically establish its validity (Modgill, et al., 2014). The MHCC found that many people believed that ASSESSMENT OF MENTAL HEALTH STIGMA 10 the stigma associated with their mental disorder was worse than the mental disorder itself (Mental Health Commission of Canada, 2017). This intervention utilizes a Likert scale to determine the participant's general level of stigma, with score ranging from 20 (least stigmatized) to 100 (most stigmatized) (Modgill, et al., 2014). This scale has three subscales: attitude, disclosure and help seeking, and social distance and is a 20-item Likert questionnaire (Modgill, et al., 2014). The OMS-HC assessment tool was distributed online via a link through a secure web application for building and distributing surveys and questionnaires (REDCap), which allowed participants to take the questionnaire anonymously. These data were collected in aggregate to assure confidentiality. An electronic form of consent was required for participation, but no identifying information was collected, and participation was voluntary. Participants were given their final score after they completed their questionnaire to illustrate their level of stigma. The entire collected data was then presented in aggregate to the stakeholders in person to help determine and assess the best intervention to help reduce stigma. Notes were taken and analyzed for content and general themes, and directions for future interventions were compiled. The first step in this process of change was providing the participants with a mental health stigma questionnaire to help them question their own idea of stigma; the second step was to share the data with participants to help show them that there is a need for changing views around mental health stigma in mental health care workers. The final step was to solidify, or refreeze, this idea that change needs to occur and that mental health stigma in mental health care providers is a subject that needs to be examined and addressed. ASSESSMENT OF MENTAL HEALTH STIGMA 11 Study of the Intervention The OMS-HC scale was chosen for this project because it was created to directly measure the mental health stigma of health care employees (Modgill, et al., 2014). This scale was tested in Canada on a total of 1,523 participants after its initial test on 787 health care providers and shown to be internally consistent, effective, and valid (Modgill, et al., 2014). Since this project focused on measuring and assessing mental health stigma in mental health care workers, this scale was found to be appropriate for this study. This was a new way of assessing mental health stigma in mental health care for the target hospital; therefore, the nurse managers and physicians of the hospital were consulted prior to the distribution of the questionnaire specifically about this project. This was done in order to inform them about the project and to assess their level of commitment to change if stigma was determined to be present. There were no other studies going on focusing on stigma at this time in the hospital that might have interfered with or affected the results that were collected. Measures The OMS-HC scale has also been shown to be moderately sensitive to change when it comes to anti-stigma interventions, which means utilizing it for future interventions would help determine interventions' effectiveness. Sensitivity was measured "using paired t-tests, effect size (Cohen's d), and standardized response means (SRM)" (Modgill, et al., 2014, para.2). Although the study testing this scale was quite large and showed positive results for its validity and effectiveness, further studies would solidify its standing. For future implementation, the cost and time would be minimal since the questionnaire can be replicated. This questionnaire was only active for two months; given more time, there would be more data to help clarify the level ASSESSMENT OF MENTAL HEALTH STIGMA 12 of stigma in this target population. In order to determine completeness of the data, all fields of the questionnaire were required to be filled in before submission. Analysis Since there is no intervention due to the assessment nature of this project, only descriptive statistics are presented. REDCap provided the results once the questionnaire was completed. These results are displayed in the tables below. Conventional content analysis was used for this study due to the limitation of research and data on the subject of mental health care providers having stigma toward their patients. This assessment was determined utilizing a questionnaire with a Likert scale. The Likert scale responses were paired with a number and calculated a total at the end of the questionnaire to show level of mental health stigma. The mean and standard deviation of this final number score was given for each profession and for the overall total (Sullivan & Artino, 2013). Data was assessed by utilizing REDCap to determine the percentage of participants who selected strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree for each question in the OMS-HC scale. Feedback was obtained at multiple stakeholders' meetings, notes were taken, and data was compiled concerning stakeholders' responses on possible future interventions. Ethical Considerations The University of Utah Institutional Review Board determined this study to be exempt from human subjects review. Ethical considerations of viewpoints of participants becoming public were addressed via the consent form prior to the questionnaire. No participant was required to do this questionnaire and all actions were taken to provide anonymity. ASSESSMENT OF MENTAL HEALTH STIGMA 13 Results Questionnaire Results One hundred and eighty-five questionnaires were collected; four of these were incomplete, resulting in 181 questionnaires for analysis. One hundred and eighty-one health care workers from the inpatient psychiatric hospital completed the questionnaire: • 102 (56.3%) psychiatric technicians; • 56 (30.9%) registered nurses; • 13 (7.1%) physicians; • 10 (5.5%) social workers. • No data collected for APRNs. There were 157 (86.7%) participants who responded that they have observed mental illness stigma affect the care and treatment of patients. The scoring potential ranged from 20 to 69 with the higher score representing more stigma. The mean score for all who participated was 38.3 with a standard deviation of 8.4 and a range from 20 to 69. The mean score and standard deviation for each profession is listed below (see Table B). The incomplete questionnaires (n=4) were excluded from the analysis. The results above (see Table B) are from a one-way ANOVA (Analysis of Variance) that was run in SPSS 4.0. This helped to determine if there was any significant difference between the groups statistically, and since the finding was 0.567, this indicates that the differences were not statistically significant. There is no current determination whether this will be clinically significant. The mean score for each question is provided to show the general trend of the answers to the questionnaire. ASSESSMENT OF MENTAL HEALTH STIGMA 14 The questions and the mean score for each of these is listed below (see Table A). A higher mean score equals more stigma overall and a lower mean score equals less stigma overall for that particular question. This helps to determine which questions added the most stigma to participants' final scores. This gives us insight into the particular problems that surround the mental health stigma in this particular setting. Qualitative Feedback The results were shared in person via presentation in two staff meetings and distributed electronically to other participants. Feedback results on interventions included adding a presentation and education to the annual training in the hospital, educating staff members on the diagnostic criteria from the DSM 5 for each diagnosis to clarify what is bias and what is not, and anonymously allowing people to share stories that would normalize mental health issues. Discussion Summary The results of this pilot study strongly suggest mental health stigma exists in mental health care workers in an inpatient psychiatric hospital. Strengths of this project include the use of the OMS-HC scale, content expert review, and being the first analysis of mental health stigma in mental health care workers in Utah. Interpretation Officially, there is no statistical significance between the different professions when it comes to mental health stigma. However, given only the mean score, one can see that the level of stigma from those who have the most stigma to those who have the least is represented as: Physicians, Psych Techs, Social Workers, and then Registered Nurses (see Table B). The differences were minimal, as the statistical data shows, but there was a slight difference, which ASSESSMENT OF MENTAL HEALTH STIGMA 15 needs to be considered. The questions concerning divulging the participants' mental health to their colleagues and whether or not they would be more inclined to utilize treatment for mental health if it was not associated with their workplace (questions 10 and 11 of the OMS-HC scale) had the highest mean score of 3.0 and 3.5, respectively. These scores indicate that most stigma within these mental health care workers has to do with coworkers and peers, and how they are viewed, which is similar to the findings found in Washington (Stuber, Rocha, Christian, & Link, 2014). The Washington research indicated that "health professionals desired social distance" from peers who appeared to have mental illness, specifically schizophrenia, and suspected they were "likely to do something violent to others" (para. 22). Compared with the research done in Canada, the average OMS-HC scale score of the Utah research was lower overall. This may indicate that there is less mental health stigma in mental health care workers in Utah, but more research would need to be done in order to establish that. There was less mental health stigma than originally expected. This could have been due to the negative association between having mental health stigma and being a mental health care worker. An alternative explanation is that individuals were able to change their answers after their results had been posted. This may have resulted in an artificial lowering of the overall average score. There were not a lot of financial costs in relation to this study. However, mental health stigma and the question of how to intervene cannot be ignored or denied now that there are results indicating its presence. Limitations People being able to change their scores once they saw the what their original answers added up to was one of the largest limitations of this pilot study. This would need to be changed in the future to help clarify the data so that it was more accurate. Participants were requested not ASSESSMENT OF MENTAL HEALTH STIGMA 16 to change their scores once they got to the bottom of the questionnaire in an attempt to minimize this. Considering that this was done in only one inpatient psychiatric hospital, it may not have the same potential to work for outpatient clinics or ambulatory care hospitals. Limitations to the research for this study include the limited information on specific instances of mental health stigma affecting specific patient treatment outcomes. No literature was found relating mental health stigma directly with a particular treatment outcome. However, based upon multiple examples of mental health stigma and negative patient outcomes, some of which were discussed here, it does appear that mental health stigma is a significant factor contributing to the treatment of patients. Conclusions This research had a great impact on the mental health care workers; by asking them these questions, they encountered a lot of thoughtful insight into possible mental health stigma. It has affected not only the workers, but the system as well, by pointing out that this mental health stigma exists within the hospital. Mental health stigma in mental health care workers has not been investigated before in Utah. This research will be sustained through further investigation with other Doctor of Nursing Practice students moving forward. This type of research has the potential to spread to other psychiatric hospitals, units, and clinics. The next steps are to start implementing interventions to determine which are the most effective by performing a OMS-HC scale questionnaire after the intervention is completed. Multiple suggestions for interventions were provided during feedback, including an educational PowerPoint presentation at the annual skills fair, attempting to normalize mental health problems by relating anonymous stories to workers, and providing education on DSM 5 criteria in order to reduce mental health stigma based on clinical exposure ASSESSMENT OF MENTAL HEALTH STIGMA to difficult situations. Although progress has been made by performing this pilot study on mental health stigma in mental health care workers, more research will need to be utilized in order to get a full picture of this subject. 17 ASSESSMENT OF MENTAL HEALTH STIGMA Acknowledgements The following people are acknowledged for their important contribution in this research: Larry Garrett for his dedication as a faculty advisor, Andrew Szeto for his contribution as a content specialist, Tami Melville as the director of the Psychiatric Mental Health Doctor of Nursing Practice program, Pamela Hardin as the director of graduate programs, and Anne Hutton as an additional content specialist. 18 ASSESSMENT OF MENTAL HEALTH STIGMA 19 References Burnes, B. (2004). Kurt Lewin and the planned approach to change: A re-appraisal. Journal of Management Studies, 41: 977-1002. doi:10.1111/j.1467-6486.2004.00463.x Christodoulou-Felia, M., Middleton, N., Papathanassoglou, E.D.E., & Karanikola, M.N.K. (2017). Exploration of the associations between nurses' moral distress and secondary traumatic stress syndrome: Implications for patient safety in mental health services. Biomed Research International,1-19. doi:10.1155/2017/1908712. Corrigan, P.W., Druss, B.J., & Perlick, D.A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70. Covarrubias, I., & Hn, M. (2011). Mental health stigma and serious mental illness among MSW students: Social contact and attitudes. Social Work, 56(4), 317-325. doi: sw/56.4.317 Dwyer, J. (2008). After a death seen on tape, change is promised. New York Times. Retrieved from http://www.nytimes.com/2008/07/12/nyregion/12about.html. Gaebel, W., Zäske, H., Zielasek, J., Cleveland, H., Samjeske, K., Stuart, H., ..., & Fidalgo, T.M. (2015). Stigmatization of psychiatrists and general practitioners: Results of an international survey. European Archives of Psychiatry and Clinical Neuroscience, 265 (3), 189-197. doi:10.1007/s00406-014-0530-8 Interlandi, J. (2008). The woman who died in the hospital waiting room. Retrieved from http://www.newsweek.com/woman-who-died-hospital-waiting-room-92661. Kassam, A., Papish, A., Modgill, G., & Patten, S. (2012). The development and psychometric ASSESSMENT OF MENTAL HEALTH STIGMA 20 properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for health care providers (OMS-HC). BioMed Central Psychiatry, 12(62). Retrieved from https://doi.org/10.1186/1471-244X-12-62 Kochanski, A., & Cechnicki, A. (2017). The attitudes of Polish psychiatrists toward people suffering from mental illnesses. Psychiatria Polska, 51(1), 29-44. https://doi.org/10.12740/PP/62400. Link, B.G., & Phelan, J.C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385. 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Advances in Mental Health, 12(3), 202-215. ASSESSMENT OF MENTAL HEALTH STIGMA 21 Stuber, J. P., Rocha, A., Christian, A., & Link, B. G. (2014). Conceptions of mental illness: Attitudes of mental health professionals and the general public. Psychiatric Services (Washington, D.C.), 65(4), 490-497. http://doi.org/10.1176/appi.ps.201300136 Sullivan, G.M., & Artino, A.R. (2013). Analyzing and interpreting data from Likert-type scales. Journal of Graduate Medical Education, 5(4), 541-542. Tingle, J. (2017). Time to act to improve mental health care services. British Journal of Nursing, 26(16), 946-947. Ungar, T., Knaak, S., & Szeto, A. (2016). Theoretical and practical considerations for combating mental illness stigma in health care. Community Mental Health Journal, 52(3), 262-271. doi:10.1007/s10597-015-9910-4 University of Utah. (n.d.). University Neuropsychiatric Institute. Retrieved from https://healthcare.utah.edu/uni/. Zhu, J.M., Zhang, Y., Polsky, D.E. (2017). Networks in ACA marketplaces are narrower for mental health care than for primary care. Health Affairs, 2(9). ASSESSMENT OF MENTAL HEALTH STIGMA 22 Table A OMS-HC Questions 1. 2. 3. 4. 5. If a colleague with whom I work told me they had a managed mental illness, I would be just as willing to work with him/her. Employers should hire a person with a managed mental illness if he/she is the best person for the job. I would still go to a physician if I knew that the physician had been treated for a mental illness. If I had a mental illness, I would tell my friends. Mean Score 1.3 1.3 1.8 2.3 1.6 6. It is the responsibility of health care providers to inspire hope in people with mental illness. People with mental illness seldom pose a risk to the public. 7. I would not mind if a person with a mental illness lived next door to me. 1.7 8. I am more comfortable helping a person who has a physical illness than I am helping a person who has a mental illness. If a person with a mental illness complains of physical symptoms (e.g., nausea, back pain or headache), I would likely attribute this to their mental illness. If I were under treatment for a mental illness I would not disclose this to any of my colleagues. I would be more inclined to seek help for a mental illness if my treating healthcare provider was not associated with my workplace. I would see myself as weak if I had a mental illness and could not fix it myself. I would be reluctant to seek help if I had a mental illness. 1.9 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 2.4 2.1 3.0 3.5 2.0 2.0 Despite my professional beliefs, I have negative reactions towards people who 1.5 have mental illness. 1.5 There is little I can do to help people with mental illness. More than half of people with mental illness don't try hard enough to get better. The best treatment for mental illness is medication. 1.8 I would not want a person with a mental illness, even if it were appropriately managed, to work with children. 1.8 2.2 ASSESSMENT OF MENTAL HEALTH STIGMA 19. 20. 23 Healthcare providers do not need to be advocates for people with mental illness. I struggle to feel compassion for a person with mental illness. 1.3 1.3 Table B Overall N (%) M± SD 181 38.27 ± 0.63 Profession p1 0.567 Physicians 13 (7.1%) 39.00 ± 5.64 Registered Nurses 56 (30.9%) 36.98 ± 8.00 Social Workers 10 (5.5%) 38.27 ± 8.41 Psychiatric Technicians 102 (56.3%) 38.92 ± 9.03 ASSESSMENT OF MENTAL HEALTH STIGMA Image A 24