Challenge Stigma Research Articles

The future of mental health care: peer-to-peer support and social media.

People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group. In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing. People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks. Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.

Acceptability of HIV Pre-Exposure Prophylaxis (PrEP) and Implementation Challenges Among Men Who Have Sex with Men in India: A Qualitative Investigation.

This qualitative study explored the acceptability of HIV pre-exposure prophylaxis (PrEP) among MSM in India, and identified facilitators and barriers to future PrEP uptake. In 2014, we conducted 10 focus groups (n=61) among a purposive sample of diverse MSM recruited through community-based organizations in Chennai and Mumbai, and 10 key informant interviews with community leaders and health care providers. Participants' mean age was 26.1 years (SD 4.8); 62% completed secondary education, and 42% engaged in sex work. No focus group participants had heard of PrEP, but once explained, most reported they would likely use it. PrEP was alternately perceived as a 'back-up plan', a condom substitute, or a burden with concurrent condom use. Facilitators were potential for covert use, sex without condoms, and anxiety-less sex. Potential barriers emerged around stigma associated with PrEP use, fear of disclosures to one's family, wife, or male steady partner, and being labeled as HIV-positive or promiscuous by peers. Preferences emerged for intermittent rather than daily PrEP use, injectable PrEP, and free or subsidized access through community organizations or government hospitals. Key informants expressed additional concerns about risk compensation, non-adherence, and impact on ART availability for treatment. Demonstration projects are needed in India to support PrEP implementation tailored for at-risk MSM. Educational interventions for MSM should address concerns about PrEP effectiveness, side effects, and mitigate risk compensation. Community engagement may facilitate broad acceptability and challenge stigma around PrEP use. Importantly, provision of free or subsidized PrEP is necessary to making implementation feasible among low socioeconomic status MSM in India.

Therapeutic communities and the local community: isolation or integration?

Purpose – The purpose of this paper is to test the feasibility of utilising an Asset-Based Community Development (ABCD) model in the context of an Alcohol and Other Drug Therapeutic Community, and to use this as a way of assessing how TCs can contribute to the local communities in which they are sited. Design/methodology/approach – This is a qualitative action research project, based on an evolving model in which key stakeholders from participating sites were instrumental in shaping processes and activities, that is a partnership between a research centre, Turning Point in Melbourne, Australia and two Recovery Services operated by the Salvation Army Australia Eastern Territory (TSA). One of these is the Dooralong Transformation Centre on the Central Coast of New South Wales and the other, Fairhaven, is in the Gold Coast hinterland of Queensland, Australia. The project was designed to create “rehabilitation without walls” by building bridges between the treatment centres and the communities they are based in, and improving participation in local community life. This was done through a series of structured workshops that mapped community asset networks and planned further community engagement activities. Findings – Both of the TCs already had strong connections in their local areas including but not restricted to involvement with the mutual aid fellowships. Staff, residents and ex-residents still in contact with the service were strongly committed to community engagement and were able to identify a wide range of connections in the community and to build these around existing Salvation Army connections and networks. Research limitations/implications – This is a pilot study with limited research findings and no assessment of the generalisability of this method to other settings or TCs. Practical implications – Both TCs are able to act as “community resources” through which residents and ex-residents are able to give back to their local communities and develop the social and community capital that can prepare them for reintegration and can positively contribute to the experience of living in the local community. Social implications – This paper has significant ramifications for how TCs engage with their local communities both as a mechanism for supporting resident re-entry and also to challenge stigma and discrimination. Originality/value – The paper and project extend the idea of ABCD to a Reciprocal Community Development model in which TCs can act as active participants in their lived communities and by doing so can create a “therapeutic landscape for recovery”.

How Uncover Ostomy challenges ostomy stigma, and encourages others to do the same

People who undergo ostomy surgery are often worried about being stigmatized. Ostomates explain that they appreciate contact with others who can relate to their experiences and are concerned with where to get advice and support about their ostomies. Internet communities are one outlet to challenge stigma and find support, and the web site Uncover Ostomy is one such community. The web site is the work of Jessica Grossman, a college student who challenges ostomy stigma through provocative photos. Through the associated Facebook fan page, users upload their own photos uncovering their ostomies. This project examined uploaded photos to see how people challenge stigma using new media technology. Additionally, the project examined comments left by Facebook users to understand how the ostomy community reacted to these photos. Implications of such spaces for users to challenge a stigmatizing condition are discussed.

Pictures of health

Julie Sheen helped set up a campaign at her university to promote student mental health, challenge stigma and encourage those under stress to seek help earlier. To raise awareness, she produced a highly praised film montage that can be seen on YouTube.

Resisting and challenging stigma in Uganda: the role of support groups of people living with HIV

IntroductionGlobal scale up of antiretroviral therapy is changing the context of HIV-related stigma. However, stigma remains an ongoing concern in many countries. Groups of people living with HIV can contribute to the reduction of stigma. However, the pathways through which they do so are not well understood.MethodsThis paper utilizes data from a qualitative study exploring the impact of networked groups of people living with HIV in Jinja and Mbale districts of Uganda. Participants were people living with HIV (n=40), members of their households (n=10) and their health service providers (n=15). Data were collected via interviews and focus group discussions in 2010, and analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ anti-stigma activities.ResultsStudy participants reported that HIV stigma in their communities had declined as a result of the collective activities of groups of people living with HIV. However, they believed that stigma remained an ongoing challenge. Gender, family relationships, social and economic factors emerged as important drivers of stigma. Challenging stigma collectively transcended individual experiences and united people living with HIV in a process of social renegotiation to achieve change. Groups of people living with HIV provided peer support and improved the confidence of their members, which ultimately reduced self-stigma and improved their ability to deal with external stigma when it was encountered.ConclusionsAntiretroviral therapy and group-based approaches in the delivery of HIV services are opening up new avenues for the collective participation of people living with HIV to challenge HIV stigma and act as agents of social change. Interventions for reducing HIV stigma should be expanded beyond those that aim to increase the resilience and coping mechanisms of individuals, to those that build the capacity of groups to collectively cope with and challenge HIV stigma. Such interventions should be gender sensitive and should respond to contextual social, economic and structural factors that drive stigma.

The role of community conversations in facilitating local HIV competence: case study from rural Zimbabwe.

BackgroundThis paper examines the potential for community conversations to strengthen positive responses to HIV in resource-poor environments. Community conversations are an intervention method through which local people work with a facilitator to collectively identify local strengths and challenges and brainstorm potential strategies for solving local problems.MethodsWe conducted 18 community conversations (with six groups at three points in time) with a total of 77 participants in rural Zimbabwe (20% HIV positive). Participants were invited to reflect on how they were responding to the challenges of HIV, both as individuals and in community groups, and to think of ways to better support openness about HIV, kindness towards people living with HIV and greater community uptake of HIV prevention and treatment.ResultsCommunity conversations contributed to local HIV competence through (1) enabling participants to brainstorm concrete action plans for responding to HIV, (2) providing a forum to develop a sense of common purpose in relation to implementing these, (3) encouraging and challenging participants to overcome fear, denial and passivity, (4) providing an opportunity for participants to move from seeing themselves as passive recipients of information to active problem solvers, and (5) reducing silence and stigma surrounding HIV.ConclusionsOur discussion cautions that community conversations, while holding great potential to help communities recognize their potential strengths and capacities for responding more effectively to HIV, are not a magic bullet. Poverty, poor harvests and political instability frustrated and limited many participants’ efforts to put their plans into action. On the other hand, support from outside the community, in this case the increasing availability of antiretroviral treatment, played a vital role in enabling communities to challenge stigma and envision new, more positive, ways of responding to the epidemic.

Influence of Time to Change's social marketing interventions on stigma in England 2009-2011

England's Time To Change (TTC) social marketing campaign emphasised social contact between people with and without mental health problems to reduce stigma and discrimination. We aimed to assess the effectiveness of the mass media component and also that of the mass social contact events. Online interviews were performed before and after each burst of mass media social marketing to evaluate changes in knowledge, attitudes and behaviour and associations between campaign awareness and outcomes. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health and intended behaviour towards people with mental health problems. Prompted campaign awareness was 38-64%. A longitudinal improvement was noted for one intended behaviour item but not for knowledge or attitudes. Campaign awareness was positively associated with greater knowledge (β = 0.80, 95% CI 0.52-1.08) and more favourable attitudes (commonality OR 1.37, 95% CI 1.10-1.70; dangerousness OR 1.41, 95% CI 1.22-1.63) and intended behaviour (β = 0.75, 95% CI 0.53-0.96). Social contact at events demonstrated a positive impact (M = 2.68) v. no contact (M = 2.42) on perceived attitude change; t(211) = 3.30, P = 0.001. Contact quality predicted more positive attitude change (r = 0.33, P<0.01) and greater confidence to challenge stigma (r = 0.38, P<0.01). The favourable short-term consequences of the social marketing campaign suggest that social contact can be used by anti-stigma programmes to reduce stigma.

I want to touch the sky: how an enterprise challenges stigma for sex‐workers

PurposeThe purpose of this paper is to demonstrate how a “just” enterprise can challenge stigma deeply embedded in culture and in the process develop and prevent a whole new generation of women, in this case the daughters and grand‐daughters of sex‐workers, from being stigmatized.Design/methodology/approachDrawing on fieldwork interviews this paper, through appreciative inquiry analyses and most significant change questioning, examines the development of an Indian based enterprise called Freeset, a company employing women leaving sex work, and examines its history and its possible future trajectory. Freeset challenges the stigma of these Indian sex‐workers, including that perpetuated through patriarchy, by offering alternative work which displays respect for their abilities and dreams and up‐skills them to function as leaders in their communities.FindingsWhile stigma erodes social status by discounting and discrediting persons considered outside the norm, it is possible to challenge that process and change the life trajectory of its victims.Research limitations/implicationsHearing and highlighting the voice of the stigmatized is vital in clarifying a holistic view of stigma and its impact on society.Practical implicationsThere are significant insights into how values based enterprises might establish their ethos in cultures that discount those values the enterprise upholds.Originality/valueFew enterprises focused on producing social change outcomes develop sustainable business practices that challenge the economic root causes of stigma. Freeset provides new insights into managing diversity issues in a South Asian context to achieve that goal.

Challenging stereotypes and legitimating fat: An analysis of obese people’s views on news media reporting guidelines and promoting body diversity

This article contributes to scholarship on the cultural politics of obesity by providing insights into how people considered ‘obese’ think news media reporting should be improved and their views on ideas such as reporting guidelines and promoting body diversity. A thematic analysis of interview data identified the following themes: ‘Challenging stereotypes’, ‘The limits of news’, ‘Individual responsibility’ and ‘Legitimating fat’. These themes capture the divergence in views and reflect differences in how people construct obesity and conceive the influences of media on audiences. Situated in the context of the contested science and news frames surrounding obesity, the analysis also engages with wider debates about the potentially unintended consequences of seeking to challenge stigma. We conclude that media and policy discourses need to reflect a diversity of ways of framing obesity if the views of obese people are to be included.

Public Health Approaches to Palliative Care: The Role of the Hospice Social Worker Working with Children Experiencing Bereavement

In Western societies, death, dying and palliative care are surrounded by confusion and ignorance, with specialist palliative care only available to the lucky few ( Kellehear, 2007). A public health approach to palliative care has been recognised for the contribution it can make to meaningful end-of-life care. Such approaches have gained increased literature and policy focus and practice examples exist worldwide. In the UK, end-of-life care policy documents have highlighted the significance of a public health approach. They identify action to challenge stigma associated with death and dying to enable positive end-of-life care experiences. This paper discusses contemporary thinking around death and dying and how this relates to public health approaches to palliative care. It outlines the social work role in end-of-life care and discusses the significance of a public health approach drawing on practice experience as a hospice social worker involved in the facilitation of a children's bereavement service. It argues that social work has a significant role in the development of public health approaches to palliative care.

Challenging stereotypes and changing attitudes: Improving quality of care for people with hepatitis C through Positive Speakers programs

Positive Speakers programs consist of people who are trained to speak publicly about their illness. The focus of these programs, especially with stigmatised illnesses such as hepatitis C (HCV), is to inform others of the speakers' experiences, thereby humanising the illness and reducing ignorance associated with the disease. This qualitative research aimed to understand the perceived impact of Positive Speakers programs on changing audience members' attitudes towards people with HCV. Interviews were conducted with nine Positive Speakers and 16 of their audience members to assess the way in which these sessions were perceived by both speakers and the audience to challenge stereotypes and stigma associated with HCV and promote positive attitude change amongst the audience. Data were analysed using Intergroup Contact Theory to frame the analysis with a focus on whether the program met the optimal conditions to promote attitude change. Findings suggest that there are a number of vital components to this Positive Speakers program which ensures that the program meets the requirements for successful and equitable intergroup contact. This Positive Speakers program thereby helps to deconstruct stereotypes about people with HCV, while simultaneously increasing positive attitudes among audience members with the ultimate aim of improving quality of health care and treatment for people with HCV.

Provider perspectives on mental health day service modernization

A postal survey and semi‐structured interviews were under taken with mental health day centre staff in two regions of England, investigating whether criticisms levelled at buildings‐based day services are justifiable. The majority of respondents agreed with recommendations outlined in From Segregation to Inclusion (National Institute for Mental Health in England/Care Services Improvement Par tnership, 2006), believing that mental health services should ideally be based in community locations. Respondents believed that this would help to challenge stigma, facilitate community integration, and provide service users with more oppor tunities. However, concerns were expressed as to the availability of mainstream facilities and whether this approach would be suitable for all service users. Suggestions on how day services could be improved included having access to reliable sources of funding, relaxing access criteria, and having greater service user involvement.

Creating Social Spaces to Tackle AIDS-Related Stigma: Reviewing the Role of Church Groups in Sub-Saharan Africa

An expanding body of literature explores the role of African church groups in facilitating or hindering the support of people living with AIDS and challenging or contributing to HIV/AIDS-related stigma. Treating church groups as social spaces in which HIV/AIDS-related stigma may potentially be challenged, we systematically review this literature, identifying five themes that highlight the complex and contradictory role of the church as a potential agent of health-enhancing social change. In many ways the church perpetuates HIV/AIDS-related stigma through (i) moralistic attitudes and (ii) its reinforcement of conservative gender ideologies. However some churches have managed move towards action that makes a more positive contribution to HIV/AIDS management through (iii) promoting various forms of social control for HIV prevention, (iv) contributing to the care and support of the AIDS-affected and (v) providing social spaces for challenging stigmatising ideas and practices. We conclude that church groups, including church leadership, can play a key role in facilitating or hindering the creation of supportive social spaces to challenge stigma. Much work remains to be done in developing deeper understandings of the multi-layered factors that enable some churches, but not others, to respond effectively to HIV/AIDS.

Challenging mental health-related stigma through social contact

Stigma is one of the greatest challenges facing people with mental illness today. In addition to the distress and feelings of rejection it causes, stigma can lead to housing and employment discrimination and can cause people to avoid seeking help for their illness due to shame and fear. Social contact—direct, personal contact between members of the general public and members of a stigmatized group—is one of the most promising strategies for reducing stigma and discrimination.1 Since the 1960s, research has investigated the use of social contact between members of the general public and people with mental illness to reduce stigma associated with mental illness. Recent research has incorporated more sophisticated randomized trials2 and meta-analysis methods1 to investigate specific components and mechanisms of social contact. The current literature, however, lacks naturalistic studies which apply the social contact theory at the population level. In this viewpoint, we discuss Time to Change 3 as an example of a way to facilitate research and application of the social contact theory in naturalistic settings at the population level and the necessary features which should be incorporated in order to optimize results. We argue that the development of novel and innovative ways of incorporating social contact in the field of public mental health will make a significant impact towards decreasing stigma and discrimination against those with mental illness. In January 2009, two mental health charities, MIND and Rethink, launched the largest ever programme in England to combat mental health stigma and discrimination,3 with the Institute of Psychiatry as the evaluation partner. A key aim of the Time to Change programme is to reduce stigma by facilitating social contact between members of the general public …

The Creation of “We Are Neighbours”: Participatory Research and Recovery

Community-based participatory research is an enabling and empowering practice that is based in principles that overlap with those of mental health recovery. Using a participatory approach, an advocacy group called the Dream Team, whose members have mental health issues and live in supportive housing, planned and conducted a study of the neighbourhood impact of two supportive housing buildings in Toronto. The study found that tenants do not harm neighbourhood property values and crime rates, and that they do make important contributions to the strength of their neighbourhoods. This article demonstrates the strength of a self-directed collective of individuals who are prepared to challenge stigma and discrimination, and documents their use of participatory action research as a proactive strategy to contribute their knowledge to discussions that shape the communities, services, and politics that involve them.

Performing an Asylum: Tripping Through Time and La Pazzia

Performing an Asylum: Tripping Through Time and La Pazzia Kirsty Johnston (bio) O! Visitor to Toronto ‘La Belle’ standing by the city Hall, Walk due west ’long Queen street, ’till you come to a high stone wall; Within the walls is a palace, extending right and left, This dear visitor is the home, for people of sense bereft, There are illusions and delusions, around you by the score, But on this point, I’ll not say much, being sensitive and sore; This, you must remember, that patients here within, Are here, because we all were born into a world of sin . . . Now come inside the building, and enter into the halls, You will see many patients, whose sorrow for pity calls.1 The “high stone wall” noted by patient Graeme L. still marks the site of a Toronto mental health care facility. Although it is now called the Centre for Addiction and Mental Health, Queen Street Division, and the original asylum buildings first erected there in 1850 have been demolished and replaced by concrete buildings more formally akin to 1960s institutional modernism, the same stone walls continue to mark the site’s eastern and western borders. Within the walls the site has undergone many changes, each connected to shifting visions of the asylum, its role within the city, and the effective provision of mental health care. This essay considers two theatrical productions performed by the Workman Theatre Project (WTP), an integrated theatre company that involves people with mental illness experience and seeks to challenge stigma. Both Tripping Through Time (1993) and La Pazzia (1999) built upon the particular institutional space of the mental hospital and former asylum grounds to provide audiences with different reminders of the social history and contemporary resonance of asylum life. In Tripping Through Time, audience members were diagnosed randomly and individually, labeled as inpatients, and employed in patient’s work. La Pazzia positioned the audience as medical clinicians engaged in a psychiatric postmortem. Explicit references in each to the site’s asylum history and geography connected the diegetic space with the actual environment surrounding both audiences and performers. The two productions played with specific spatial and historical features of the institutional site to open discussion of how people diagnosed with mental illness have experienced the highly stigmatized institutional space over time. Whereas Tripping Through Time sought to build bridges to the broader community without, La Pazzia aimed to remind the medical professional community within of its responsibility to guard the dignity of patients. Tripping Through Time was produced as part of a larger public exploration of the asylum’s history, while La Pazzia was produced for the site’s clinicians and administrators as they marked the beginning of a new administration. The first drew newcomers into the space, received critical praise, and became one of the company’s most requested productions; the second attracted protest and challenged its audience to rethink divisions between on-site communities and their own [End Page 55] connections to past and present psychiatric practices. What shaped these different outcomes? How did each production use the institutional space to further the company’s aims? Since 1989, the walls noted by Graeme L. have also contained the WPT, a performing arts company with its own board and independent mandate that operates out of the institution’s Joseph L. Workman Auditorium. The company is dedicated to artistically training and integrating people who have received mental health services with professional theatre artists. Founded in 1989 by former psychiatric nurse Lisa Brown, the company has since created over 20 theatrical productions, each focused on bringing an aspect of mental illness experience to public attention, and each aimed at challenging stigma about such experiences. The company’s productions have toured locally across Ontario and Manitoba and internationally to Germany.2 It is important to note that the company is not involved in drama therapy or psychodrama; rather, it aims to foster artistic achievement by providing professional theatre training to its members. Company members, now numbering over 400, are defined as individuals with interests in the arts who have received mental health services at some point during their lives. Members are active at all levels of the company...

Challenging stigma around mental illness and promoting social inclusion using the performing arts

This article outlines the rationale, evidence base, method and qualitative evaluation of a project that uses the performing arts to challenge the stigma surrounding mental illness and promote social inclusion of people with mental health problems. The partnership project has run for three years with students of Reigate Sixth Form College and staff and users of voluntary and statutory mental health services in East Surrey. Collation of three years of evaluation data showed it as a successful approach to: positively influence students' attitudes, knowledge and empathy around mental health issues; and positively affect mental health service clients' mood and their feelings of achievement, confidence and inclusion. Key elements of the project's success and sustainability are summarised.

Understanding and Influencing the Stigma of Mental Illness

Life goals and the opportunities that define them are impaired by the stigma of mental illness. Three kinds of stigma may act as barriers to personal aspirations: public stigma, self-stigma, and label avoidance. Challenging mental illness stigm is essential in helping individuals accomplish recovery-related goals. Public stigma may be changed through protest, education, and contact. Self-stigma can be addressed by fostering group identity, changing the perceived legitimacy of stigma through cognitive rehabilitation, and making strategic decisions about disclosing one's mental health history. Stigma change for label avoidance is not as well understood but may include the education and contact approaches used for public stigma. Evidence-based approaches to stigma change need to be substantiated by rigorous investigations.

Second Trimester Abortions in India

Second Trimester Abortions in India