Contact-based Interventions Research Articles

\u201cI Didn\u2019t Know What They Wanted From Me\u201d\u2013the Perspective of Individuals with Mental Disorders on Police Interventions

Encounters between individuals with a mental disorder and police forces can be harmful and dangerous for both parties involved. Previous research explored mostly police officers’ subjective experience of these encounters and focused on their recommendations. The present study takes the perspective of individuals with a mental disorder and investigates their subjective experience of dealing with the police. Thirteen semi-structural interviews were conducted with individuals with a history of mental health problems who have had encounters with the police and experienced contact-based anti-stigmatization interventions as consultants. Interviews revolved around the subjective experience of these police encounters. Questionnaires were used to inquire about context factors, individuals’ perceptions of police officers, and their sense of security during these encounters. Furthermore, individuals were asked to rate police officers’ ability to recognize signs and symptoms of ill mental health and give recommendations in regard to adequate communication strategies, interventions, and police training. The results indicate that encounters were experienced predominantly as positive and non-threatening. Participants emphasized the importance of communication strategies with a focus on empathy and respect. Keeping personal space and satisfying basic needs was recommended. Contact-based anti-stigmatization interventions were regarded as an effective approach to reduce stigma. Empathy and respect are perceived as key strategies for police officers when dealing with individuals with a mental disorder. To promote these strategies, trialogical anti-stigmatization interventions and crisis intervention training, including communication skills and face-to-face contact, are promising approaches.

Reducing depression-related stigma and increasing treatment seeking among adolescents: randomized controlled trial of a brief video intervention.

Confronting stigma early in life could enhance receptivity to seeking treatment. We evaluated the efficacy of social contact interventions to reduce stigma toward depression and to enhance treatment-seeking intentions among adolescents. We hypothesized that the brief video-based interventions would be more effective than their matched controls. Using crowdsourcing, we recruited and randomly assigned 1,183 participants aged 14-18 to one of four video-based stimuli on a 4:4:1:1 ratio: (a) adolescent girl with depression; (b) adolescent boy with depression; (c) same girl, without depression; or (d) same boy, without depression. In each of the ~100-second-long videos, two simulated patients (SPs) depicted empowered presenters sharing their personal stories. In the depression conditions, SPs described how social support from family, friends, and professionals helped them overcome their symptoms and recover. We found a significant effect for the Depression Stigma Scale (DSS) between active and control groups (F = 27.4, p < .001). We found a significant increase in treatment-seeking intentions, as measured by the General Help-Seeking Questionnaire (GHSQ; p < .001). Secondary analyses revealed that racial (but not gender) congruence between protagonists and participants resulted in greater stigma reduction and treatment seeking, as compared to racially incongruent pairings (t = 2.9, p = .004). A brief video-based intervention effectively reduced stigma toward depression and increased treatment seeking among adolescents. Favorable changes were greater when race (but not gender) was congruent between protagonists and participants. Future studies should explore how to optimize brief contact-based interventions according to adolescents' race and ethnicity and how to scale such interventions to novel online platforms of dissemination.

Building Social Cohesion Through Intergroup Contact: Evaluation of a Large-Scale Intervention to Improve Intergroup Relations Among Adolescents

Past research has found intergroup contact to be a promising intervention to reduce prejudice and has identified adolescence as the developmental period during which intergroup contact is most effective. Few studies, however, have tested whether contact-based interventions can be scaled up to improve intergroup relations at a large scale. The present research evaluated whether and when the National Citizen Service, a large-scale contact-based intervention reaching one in six 15- to 17-year-olds in England and Northern Ireland, builds social cohesion among adolescents from different ethnic backgrounds. In a diverse sample of adolescents (N = 2099; Mage = 16.37, age range: 15–17 years; 58% female), this study used a pretest–posttest design with a double pretest to assess the intervention’s effectiveness. Controlling for test–retest effects, this study found evidence that the intervention decreased intergroup anxiety and increased outgroup perspective-taking—but not that it affected intergroup attitudes, intergroup trust, or perceptions of relative (dis-)advantage. These (small) effects were greater for adolescents who had experienced less positive contact before participating and who talked more about group differences while participating. These findings suggest that the intervention might not immediately improve intergroup relations—but that it has the potential to prepare adolescents, especially those with less positive contact experiences before the intervention, for more positive intergroup interactions in the future.

Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong.

Self-stigma exerts a range of adversities for persons with severe mental illness (SMI), however, little is known about the association between peer contact, social support and self-stigma. This study aimed to explore the mediating role of social support on the relationship between peer contact and self-stigma among persons with SMI in Hong Kong. A total of 159 persons with SMI (schizophrenia and mood disorder) in community service centres participated in the study through completing a survey on self-stigma, social functioning, social support, perception of peer contact and mass media. Logistic regression was utilised to explore the influencing factors of self-stigma among the participants. The results showed that 81.1% of participants reported moderate to severe levels of self-stigma. Self-stigma was significantly associated with diverse factors (e.g. social functioning). Importantly, positive peer contact was significantly associated with lower self-stigma of persons with SMI. Social support acted as a mediator between peer contact and self-stigma. The results of this study suggest that contact-based interventions, such as enhancing positive peer-to-peer contact, should be conducted for reducing self-stigma among persons with SMI.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review.

Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors. A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure. A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations. Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

Commentary on "Effect of Contact-Based Interventions on Stigma and Discrimination".

Commentary on "Effect of Contact-Based Interventions on Stigma and Discrimination".

Effect of Contact-Based Interventions on Stigma and Discrimination: A Critical Examination of the Evidence.

Contact-based interventions are commonly regarded as best practice in stigma reduction. In this Open Forum, the author used the findings from eight systematic reviews to critically evaluate the quality of the evidence for the effectiveness of such interventions. He found that trials of contact-based interventions lacked methodological rigor, reporting was biased toward positive results, the trials were subject to demand characteristics, no dose effects were observed, effects did not last, and no evidence supported behavior change. Standards for future trials are proposed and implications for reducing stigma and discrimination are discussed.

The Effect of Contact-Based Interventions on the Attitudes and Behaviors of Nursing Students towards People with Mental Illness: A Literature Review

Background: Student nurses and other healthcare students are the future mental health professionals and have the potential for changing the future of mental healthcare. Therefore, their negative attitudes and behaviors should be screened and corrected by effective anti-stigma interventions. Otherwise, they would likely withhold some health services and practice coercive treatments once planning care to people with mental illness. However, little is known on effective approaches to correct these negative attitudes and behaviors, despite the previous reviews that have shown that contact-based interventions have demonstrated positive attitudinal and behavioral changes for nursing students towards people with mental illness. Aim: The aim of this literature review was to compile the available research evidence on contact-based interventions that have targeted the attitudes and behaviors of nursing students towards people with mental illness. Methods: The relevant literature was extracted by searching electronic databases (MEDLINE, PsycINFO, and CINAHL) and by hand checking reference lists of past similar reviews. Results: Eleven studies were retrieved and included in this review. The included studies in this review either have employed social contact interventions, video-based social contact interventions, or both types for the aim of combining or comparing. Furthermore, the included studies either have targeted the attitudes of nursing students towards people with mental illness (including prejudice), or a combination of attitudinal and behavioral outcomes (including behavioral intentions and social distance). No studies have targeted behavioral outcomes solely. Conclusions: From the available literature, the current authors cannot draw conclusions on the most effective type, form, or ingredients of contact-based interventions among nursing students, as previous literature has large variations. No consistency was found in the previous studies regarding the types or contents of effective contact-based interventions. The compiled evidence in this review, has suggested that contact-based interventions (both social contact and video-based social contact) have been effective in changing the attitudes and behaviors of nursing students favorably, similarly to what previous reviews have found.

Teaching tolerance or acting tolerant? Evaluating skills- and contact-based prejudice reduction interventions among Palestinian-Israeli and Jewish-Israeli youth

Although contact-based interventions are the cornerstone of prejudice reduction, in high-conflict environments, incendiary contact with outgroups can instead exacerbate negative attitudes. Supplementing contact interventions with social-cognitive/emotional approaches may, instead, help facilitate positive contact. This study evaluated the effectiveness of two prejudice reduction interventions among 148 Palestinian-Israeli and 154 Jewish-Israeli 5th grade students (Mage.years = 10.55, SD = 0.26) in a high conflict area. Schools in Jaffa, Israel were assigned to a social-cognitive/emotional skills-based intervention, a skills- and contact-based intervention (i.e., skills, skills+contact), or the control group—all delivered as part of the curriculum. Prejudice was assessed through participants' judgments of and justifications about hypothetical scenarios of intergroup exclusion in peer and home contexts at pre-test, post-test, and 6-month follow-up. Repeated measures ANOVAs showed various main effects including gender, ethnicity, and context in which the exclusion occurred (peer/home). Significant higher level interactions with group by time demonstrated the positive influence of both treatment groups on prejudice reduction. The skills and skills+contact groups became more rejecting while the control group became more accepting of exclusion across time. Additionally, the skills and skills+contact groups increased in moral and empathic reasoning over time, whereas the control group increased in social conventional and stereotyped prejudiced reasoning. These findings illustrate the effectiveness of in-school social-cognitive/emotional skills and combined skills+contact approaches in reducing the prejudiced attitudes of Palestinian- and Jewish-Israeli pre-adolescents, especially in areas with protracted conflict.

Criminal Justice Professionals' Attitudes Toward Mental Illness and Substance Use.

Despite the high prevalence of behavioral health disorders in justice settings and prior research on the importance of attitudes in successful treatment outcomes for behavioral health populations, few studies have examined criminal justice professionals' attitudes toward mental illness and substance use. We conducted a state-wide survey of 610 criminal justice professionals using items adapted from the Drug and Drug Problems Perceptions Questionnaire (Albery et al. 2003) to examine attitudes toward mental illness and substance use as a function of criminal justice position and personal contact. For attitudes toward both mental illness and substance use, defense attorneys and community corrections officers reported more positive attitudes relative to jail correctional staff and prosecutors. For attitudes toward substance use, personal contact moderated the effect of position on attitudes. Findings underscore the importance of targeted training and other contact-based interventions to improve criminal justice professionals' attitudes toward behavioral health populations.

School-based Interventions for Improving Disability Awareness and Attitudes Towards Disability of Students Without Disabilities: A Meta-analysis

This article presents the results of a meta-analysis of the effects of school-based interventions for improving disability awareness and attitudes towards disability of students without disabilities in Kindergarten through secondary school grades in the Republic of Korea (South Korea). A total of 20 studies published between 2001 and 2017 were included, covering a sample of 2679 students without disabilities. The overall effect was statistically significant and large (d = 1.335). Specifically, subgroup analyses showed that the effects were large for contact-based interventions, use of materials, role-playing, and human rights interventions in that order. The school-based interventions were significantly more effective in improving attitudes towards disability than disability awareness. The intervention effects did not significantly differ by school levels. Results of meta-regression analyses showed that the number of sessions had significantly more impact than instructional time per session. Limitations, recommendations for future studies, and practical implications are discussed.

Understanding Mental Illness Stigma Toward Persons With Multiple Stigmatized Conditions: Implications of Intersectionality Theory.

People with mental illness are often members of multiple stigmatized social groups. Therefore, experienced disadvantage might not be determined solely by mental illness stigma. Nevertheless, most available research does not consider the effects and implications of membership in multiple stigmatized social groups among people with mental illness. Reflecting on intersectionality theory, the authors discuss two intersectional effects determining disadvantage among people with mental illness who are members of multiple stigmatized social groups, namely double disadvantage and prominence. To be effective, interventions to reduce disadvantage experienced by people with mental illness need to be flexible and targeted rather than universal in order to address the implications of intersectionality. Whereas education-based approaches usually assume homogeneity and use universal strategies, contact-based interventions consider diversity among people with mental illness.

Labelling of mental illness in apaediatric emergency department and its implications for stigma reduction education.

IntroductionStigmatizing attitudes and behaviours towards patients with mental illness have negative consequences on their health. Despite research regarding educational and social contact-based interventions to reduce stigma, there are limitations to the success of these interventions for individuals with deeply held stigmatizing beliefs. Our study sought to better understand the process of implicit mental illness stigma in the setting of a paediatric emergency department to inform the design of future educational interventions.MethodsWe conducted a qualitative exploration of mental illness stigma with interviews including physician, nurse, service user, caregiver and administrative staff participants (n = 24). We utilized the implicit association test as a discussion prompt to explore stigma outside of conscious awareness. We conducted our study utilizing constructivist grounded theory methodology, including purposeful theoretical sampling and constant comparative analysis.ResultsOur study found that the confluence of socio-cultural, cognitive and emotional forces results in labelling of patients with mental illness as time-consuming, unpredictable and/or unfixable. These labels lead to unintentional avoidance behaviours from staff which are perceived as prejudicial and discriminatory by patients and caregivers. Participants emphasized education as the most useful intervention to reduce stigma, suggesting that educational interventions should focus on patient-provider relationships to foster humanizing labels for individuals with mental illness and by promoting provider empathy and engagement.DiscussionOur results suggest that educational interventions that target negative attributions, consider socio-cultural contexts and facilitate positive emotions in healthcare providers may be useful. Our findings may inform further research and interventions to reduce stereotypes towards marginalized groups in healthcare settings.

Reducing the stigma of mental illness.

This paper presents a narrative review of anti-stigma programming using examples from different countries to understand and describe current best practices in the field. Results highlight the importance of targeting the behavioural outcomes of the stigmatization process (discrimination and social inequity), which is consistent with rights-based or social justice models that emphasize social and economic equity for people with disabilities (such as equitable access to services, education, work, etc.). They also call into question large public education approaches in favour of more targeted contact-based interventions. Finally, to add to the research base on best practices, anti-stigma programs are encouraged to create alliances with university researchers in order to critically evaluate their activities and build better, evidence informed practices.

Effects of contact with treatment users on mental illness stigma: Evidence from university roommate assignments

Mental illness stigma refers to negative stereotypes and prejudices about people with mental illness, and is a widespread phenomenon with damaging social, psychological, and economic consequences. Despite considerable policy attention, mental illness stigma does not appear to have declined significantly in recent years. Interpersonal contact with persons with mental illness has been identified as a promising approach to reducing mental illness stigma. This study investigates the effect of contact with mental health treatment users on stigma using an observational research design that is free of self-selection bias. The research design is based on the quasi-experiment in which university students are assigned to live together as roommates. Survey data were collected from first-year undergraduates at two large universities in the United States (N = 1605). Multivariable regressions were used to estimate the effect of assignment to a roommate with a history of mental health treatment on a brief measure of stigmatizing attitudes. Contact with a treatment user caused a modest increase in stigma (standardized effect size = 0.15, p = 0.03). This effect was present among students without a prior treatment history of their own, but not among those with a prior history. The findings indicate that naturalistic contact alone does not necessarily yield a reduction in mental illness stigma. This may help explain why stigma has not declined in societies such as the United States even as treatment use has risen substantially. The findings also highlight the importance of isolating the specific components, beyond contact per se, that are necessary to reduce stigma in contact-based interventions.

Recorded versus live social contact interventions to reduce stigma: randomised controlled trial

Background/Objectives: Social contact is known to reduce stigma and social contact-based interventions are being increasingly used in anti-stigma programmes in mental health. Recorded interventions, such as audiovisual DVDs, may act as an indirect form of social contact and may have practical and cost advantages, but little is known about their effectiveness. To compare the effectiveness of a DVD and a live mental health service user intervention and a lecture control, in reducing stigma. We hypothesised that: (i) there will be no difference between the DVD (indirect social contact with people affected by mental illness) and live (direct social contact) delivery modes; and (ii) the interventions with some form of social contact (DVD or live) will be more effective than a control with no social contact (lecture).

“Well it's like someone at the other end cares about you.” A qualitative study exploring the views of users and providers of care of contact-based interventions following self-harm

Objective We investigated the views of service users and staff regarding contact-based interventions (e.g., letters, telephone calls or crisis cards) following self-harm. Method Self-harm patients recently discharged from an emergency department were selected using purposive sampling ( n=11). Clinical staff from relevant service areas and voluntary staff took part in a focus group and individual interviews ( n=10). Interviews were transcribed and thematic analyses were conducted using methods of constant comparison to ensure that emergent themes remained grounded in the data. Results Most service users and staff participants identified the period of time directly after discharge as the time of greatest need. A contact-based intervention was viewed by service users as a gesture of caring, which counteracted feelings of loneliness. Delivery by mental health specialists was preferred, initially by phone, but letters were considered helpful later. The intervention should be both genuine in delivery and linked to current services. Potential barriers included means of accessing the service and threats to privacy. Conclusion The findings suggest that an appropriate design for an intervention might be the provision of an information leaflet, telephone calls (soon after discharge), then letters (offering continuity of contact). Aspects of value and concern expressed by service users should be helpful to clinicians and service providers.

Interventions for self-harm: are we measuring outcomes in the most appropriate way?

Kapur and colleagues provide a brief review of contact-based interventions for self-harm and note their continuing appeal, despite largely unconvincing trial results.[1][1] The question the authors should have posed is not ‘How might these interventions work?’ but ‘Why, when participants

Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm.

OBJECTIVE To engage a group of people with relevant lived experience in the development of a text-messaging intervention to reduce repetition of self-harm. BACKGROUND Contact-based interventions, such as follow-up letters, postcards and telephone calls, have shown potential to reduce repetition of self-harm in those who present at Accident and Emergency departments. Text messaging offers a low-cost alternative that has not been tested. We set out to develop a text-based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. METHOD We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. RESULTS Service users rejected both the idea of a generic, 'one size fits all' approach and that of 'audience segmentation', maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self-efficacy messages and store them in a personal message bank for withdrawal at times of crisis. CONCLUSIONS This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design.