Programs targeting mental illness stigma can improve knowledge and attitudes

Mehta N, Clement S, Marcus E, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review Br J Psychiatry. 2015;207(5):377-384.

Review question

What are some effective ways to reduce mental illness-based stigma? What is the impact of mental health anti-stigma programs in the long term? Are programs shown to be effective in reducing mental illness-based stigma in high-income countries also effective in low- and middle-income countries?

Background

Mental illness-based stigma is described as negative attitudes and stereotypes against people with mental illnesses, and can act as a barrier for those with illnesses in having a satisfying life. Research focused on ways to reduce mental illness-based stigma has steadily grown in recent years. However, many of the approaches used to reduce mental illness-based stigma are based on findings from high-income countries. No review has explored the effectiveness of anti-stigma programs in low- and middle-income countries (although that is where 85% of the world’s population lives), nor have any measured the success of these programs in the long-term.

How the review was done

The researchers completed a systematic review of 80 studies published between 1983 and 2013. Half of the studies had a low risk for bias, and the remaining studies had unclear or high risk of bias.

A total of 422, 653 participants were included in the studies. Excluded from this review were studies focused on people with dementia, substance misuse, or developmental disorders.

Key features of the studies were:

• Focused on measuring effectiveness of approaches to change mental health-related stigma (i.e prejudice, discrimination or public mental health awareness)
• Measured impacts of approaches on at least one of:

i) knowledge - increasing study participant knowledge towards mental illnesses

ii) attitudes - reducing prejudice or negative self-stigma against mental illnesses

iii) behaviour - reducing discrimination against mental illnesses or increasing stigma-coping for those with mental illness

• Minimum of 4 weeks of follow-up after completion of the anti-stigma intervention.

Examples of anti-stigma programs included motivational interviewing and mental health education workshops. Studies compared programs to control groups (i.e. people receiving usual treatment or best available treatment)

What the researchers found

Anti-stigma programs with at least 4 weeks of follow-up increased mental health knowledge by a moderate amount, and reduced stigma-related attitudes by a small amount. There was not enough data to determine whether anti-stigma interventions reduced negative behaviour against people with mental illness at 4 weeks or longer. None of the included studies measured the effects of anti-stigma programs in low-income countries, and only one study conducted in Chile (low-middle income country) found that programs reduced stigma-related attitudes. There is a need to study the impact of anti-stigma programs in low income countries.

Conclusion

Mental health anti-stigma programs show modest effectiveness in increasing mental illness knowledge and reducing mental illness-related stigmatization when follow up occurs 4 weeks or more after completion of the program.