The effectiveness of mental health-related theoretical education and clinical placement in mental health settings in changing the attitudes of health care students towards mental illness: A systematic review.

Abstract

People with mental illness are subject to stigma, which is the process of stereotyping, prejudice and discrimination. Patients' experience of discrimination from the health care community may be a barrier to help-seeking in mental illness. Mental health-related theoretical education and clinical placement in mental health settings during student years may reduce stigmatising attitudes towards mental illness. The objective of the review was to synthesize the best available evidence regarding the effectiveness of mental health-related theoretical education and clinical placement in mental health settings in changing the attitudes of health care students towards mental illness. A three-step search strategy was utilized to find studies published in English from 2001 to 2010 (inclusive). An initial search of Medline and CINAHL was undertaken to identify keywords. Secondly, the keywords were used to search CINAHL, Medline, Scopus, PsycINFO (via OVID), ScienceDirect, Web of Science, Mednar, Proquest and TRIP. Thirdly, reference lists of the articles identified in the second stage were searched for other relevant studies. The final decision to include studies was made through the consensus of two independent reviewers. Articles were assessed by two independent reviewers for methodological validity using critical appraisal instruments adapted from the "Critical Review Form - Quantitative Studies" by Law et al. and JBI-MAStARI. Disagreements that arose between reviewers were resolved through discussion with a third reviewer. In total, 55 full text articles were retrieved from an initial 1957 search results. Twenty-six studies were found to have met all the inclusion criteria and were subjected to critical appraisal. Twenty-two were selected for inclusion and four were excluded. Of the 22 included studies, one was a randomised controlled trial, five were non-randomised controlled trials and 16 were before and after studies. Specific details about the study methods, interventions, participants, instruments used, and outcomes of significance to the review were extracted using a table developed by the reviewers. Statistical pooling was not appropriate due to the variety of instruments used to measure outcomes, thus the results of included articles were synthesized in narrative summary. Both mental health-related theoretical education and clinical placement in mental health settings are effective in changing the attitudes of health care students towards mental illness. Theoretical education in the form of videos, lectures, presentations delivered by people with mental illness and coursework are effective stigma reduction interventions. Clinical placement is more effective when combined with theoretical education. However, the effect of educational interventions may be transient. Videos, lectures, presentations delivered by people with mental illness should form the basis of anti-stigma interventions. Educational interventions should be offered regularly to promote lasting change in attitudes. Mental health coursework and clinical placement must remain part of the corecurricula in health care courses. There is a need to investigate the effectiveness of educational interventions using RCTs and longitudinal designs. Interventions which can produce more lasting change could be developed. More research can be done to investigate effects of interventions in other student groups and with regards to specific mental illnesses. Lastly, a "gold standard" for measuring attitudes needs to be developed.