Stigma experienced and/or conveyed by family members of individuals with mental health conditions may impact on their health and wellbeing, and on the quality of care and health outcomes of people with lived experience of mental illness. However, most of the research on stigma and mental illness has been on public attitudes and behaviors of patients rather than what is expressed by or experienced within families. We aimed to identify scales that assess stigma in the context of family life, and to evaluate their psychometric properties. A literature search across Web of Science, PsycINFO, Medline, Scopus, and ProQuest Social Science (up to August 2025) yielded 14 eligible studies, reported via PRISMA. None of the 14 scales directly or solely assesses family-context stigma, but includes dimensions of self or public stigma, especially related to schizophrenia, possibly neglecting other forms of severe mental illness (SMI). In addition, existing tools often overlook the full range of family relationships and diverse caregiving experiences. There is a need for measures that more adequately and comprehensively capture the often complex and nuanced experience of mental illness stigma within families.

Abstract Background Currently, individuals with lived experience of mental illness face significant barriers in accessing mental health services, including persistent stigma, insufficient support resources, and limited accessibility of traditional service models. In recent years, digital mental health interventions have developed rapidly. Among them, Artificial Intelligence (AI) avatars, characterized by their high accessibility, interactive anthropomorphism, and emotional responsiveness, offer new possibilities for bridging existing service gaps. However, existing research has predominantly focused on efficacy verification, leaving a lack of in-depth exploration into the specific psychological and social mechanisms through which they exert therapeutic effects in this population. Therefore, this study aims to empirically and systematically analyze the potential therapeutic pathways and mechanisms of action of AI avatars in providing mental health support to this group. Methods The study recruited 96 participants who self-reported lived experience of mental illness and current moderate psychological distress. They were randomly assigned to Group A (n = 48) and Group B (n = 48). Group A engaged in structured dialogue support via an interactive interface with an AI avatar trained on principles of empathy and cognitive-behavioral therapy, for 20 minutes twice a week over a period of 6 weeks. Group B received standardized mental health education text materials of equal frequency and duration. Assessments were conducted before and at the end of the intervention using the Kessler Psychological Distress Scale (K10), the University of California, Los Angeles Loneliness Scale (UCLA-LS), and a self-developed Working Alliance Inventory (measuring the sense of connection with the avatar). Repeated-measures analysis of variance was used to test the intervention effects, and path analysis was employed to preliminarily explore the mediating role of the working alliance. Results Repeated-measures ANOVA showed a significant group (A vs. B) × time (pre- vs. post-intervention) interaction for K10 scores (F (1, 94) =21.37, p<.001, η2 = 0.19) and loneliness scores (F (1, 94) =18.52, p<.001, η2 = 0.16). Group A demonstrated a significant reduction in K10 scores (mean difference = −5.82, p<.001) and loneliness (mean difference = −4.15, p<.001) after the intervention, whereas no significant changes were observed in Group B. Path analysis indicated that the working alliance formed with the AI avatar significantly mediated the alleviation of psychological distress (indirect effect β = −0.31, p=.002). Discussion The study confirms that structured interaction with an AI avatar can effectively reduce psychological distress and loneliness in individuals with lived experience of mental illness, and that the therapeutic effect is partially achieved through the establishment of a positive working alliance. This suggests that the therapeutic mechanism of AI avatars may stem from providing a safe, accessible, and non-judgmental interactive space, operating through pathways of emotional resonance and cognitive restructuring. The findings provide mechanistic evidence for developing digital therapeutic tools targeting mental health vulnerable groups. Future research should focus on the long-term maintenance of effects, the impact of the avatar's level of anthropomorphism, and further exploration of its differential pathways of action across various subgroups. Funding No. KT2510097.

Purpose Stigma and discrimination in the workplace are prevalent challenges faced by mental health professionals (MHPs) with lived experience of mental illness, affecting their well-being and job sustainability. Although self-disclosure of lived experience has the potential to reduce discrimination and stigmatization, fear of repercussions often deters professionals from sharing their experiences. This study aims to explore the role of self-disclosure in the workplace in relation to self-stigma, discrimination and self-esteem within MHPs. Design/methodology/approach Using a cross-sectional design, an online survey was conducted to assess self-disclosure, self-stigma, discrimination and self-esteem. A total of 124 MHPs were included and were categorized into five professional groups. Self-disclosure was operationalized as the extent to which individuals revealed their personal experience with mental health issues to colleagues through six questions. The relationship between self-disclosure and self-stigma (Internalized Stigma of Mental Illness-10), experienced discrimination (Stigma Scale-Discrimination subscale) and self-esteem (Rosenberg Self-esteem scale) was investigated using linear regression. Findings Self-disclosure was significantly positively associated with self-esteem but was not associated with self-stigma and discrimination. Exploratory analyses suggested that this positive association may be specific to professionals with a DSM classified mental illness, who also reported higher self-stigma and discrimination. Significant variations in disclosure, self-stigma and discrimination were observed between professional groups. Originality/value The study provides new quantitative evidence about self-disclosure among MHPs and challenges existing concerns about the risks of self-disclosure by showing its positive impact on self-esteem among MHPs. This underscores the importance of interventions that promote open dialogue to reduce stigma within professional settings. Future research should use longitudinal designs and explore additional factors influencing disclosure dynamics.

Sorry you are not part of us: A phenomenological study on lived experiences of mental illness in an adult population in Port Harcourt, Nigeria

This cross-sectional qualitative study investigates how Russian men with obsessive-compulsive disorder (OCD) experience and manage mental health stigma, focusing on differences between those with a clinical diagnosis and those who self-identify with the disorder. Through in-depth interviews with eleven participants, the research explores meaning-making, disclosure practices, coping strategies, and the impact of masculine norms on help-seeking. Findings reveal that self-identified men often leverage the OCD label for personal understanding and peer support, while clinically diagnosed men gain validation but encounter heightened stigma due to their formal status. Both groups employ selective disclosure and narrative reframing to navigate societal pressures. The study highlights the interplay between personal identity, social recognition, and institutional legitimacy, underscoring the need for gender-sensitive and culturally tailored mental health interventions in Russia. This work contributes to understanding mental health stigma negotiation in understudied populations and settings, offering insights into how diagnostic status, gender norms, and cultural-historical context shape lived experiences of mental illness.

ABSTRACTBackgroundDespite decades of quality improvement efforts in mental healthcare, patient preferences remain insufficiently integrated into care planning and system design. Although person‐centered care strives to align services with patients' most valued preferences, current tools for measuring those preferences often fall short. Embedding co‐design approaches—where patients and other stakeholders collaborate as equal partners in tool development—is essential to ensure that measurement instruments are both relevant and resonant with lived experience. This study aimed to develop a questionnaire that captures patient preferences in mental healthcare through a co‐design process that actively integrates lived experience, thereby enhancing face and content validity.MethodsThe development of the questionnaire followed four key phases: identification of domain, item generation, content validity, and pre‐testing of questions. A co‐design approach was integral to the entire process, with active collaboration with the co‐researcher or co‐designers at every phase.ResultsNine themes were identified in the literature, and two novel themes, “the person as a whole” and “meaningful community connections” emerged through co‐design and extend beyond prior studies. From 242 preliminary items, workshops refined the questionnaire to 58, and content validation further reduced it to 54 items with recommendations for clarity, simplicity, and anonymous responses. Pre‐testing of questions confirmed the questionnaire's usability and face validity.ConclusionsThis study demonstrates how traditional questionnaire development can be supported by co‐design to effectively develop a patient preference questionnaire that is both valid and meaningful within the Danish mental healthcare context. While limitations exist, particularly regarding group dynamics and representation, the process sets a strong foundation for future work.Patient or Public ContributionThis study was co‐designed in collaboration with individuals with lived experience of mental illness. A co‐researcher with lived experience was involved throughout several stages of the research process, including the design and facilitation of workshops, recruitment of participants, and interpretation of findings. Additional 15 co‐designers with lived experience were engaged in two workshops, contributing actively to the generation, refinement, and validation of questionnaire items. Their insights ensured that the tool reflects the values and preferences of those it aims to serve. Peer workers, clinicians, and researchers also supported the co‐design process, helping facilitate workshops and integrate experiential and academic perspectives.

ABSTRACT There is a global movement focusing on reducing the stigma of mental illness. One of the fundamental strategies is increasing contact with people with emotional problems by incorporating their lived experience into our research, teaching, and practice. These efforts have generally targeted consumers of mental health services, but some work strives to address stigma in mental health practitioners and faculty. More attention should be directed toward the importance of providers and faculty sharing their lived experience with each other. Self-disclosure in this arena can facilitate a sense of community, unity, collective work and responsibility, and authenticity. In addition, it can enhance the likelihood that practitioners with lived experience will seek treatment and accommodations, and care from colleagues if they need it. The intersections of self-disclosure, stigma, and lived and living experience are explored, with commentary by the author about her lived experience of mental illness.

Observations and perspectives of peer professionals involved in civil commitment rulings for individuals with mental illnesses in South Korea.

We aimed to extend the current social participation literature from the perspectives of individuals with a lived experience of mental illness. Our team conducted interviews with 12 participants, recruited via snowball sampling, living with schizophrenia or schizoaffective disorder. We used conventional qualitative analysis to identify two overarching themes of social participation: “doing” and “belonging.” Assessment tools that measure all facets of social participation should be used in therapy practice. Additionally, practitioners should be aware of potential risks associated with social participation. Limitations of this study include a small sample that consisted of individuals who were accessing mental health resources.

ABSTRACT Introduction Digital self‐help interventions for mental health can improve symptoms of common mental disorders such as depression and anxiety. However, such online interventions remain inaccessible to the majority of people in LMICs due to a lack of smartphone access, internet signal and/or affordability of data. However, radio persists as a key form of information and entertainment, and remains the most popular form of mass media in Africa. This study aimed to improve the accessibility of a well‐evidenced online self‐help intervention (WHO's Step‐by‐Step) by adapting it for delivery over radio. The objectives were to a) explore the feasibility of adapting the intervention to radio and b) evaluate impacts on mental health symptoms in adults with mild‐moderate depression and/or anxiety. Methods The Lumuno radio campaign was adapted from WHO's Step‐by‐Step intervention using formative research with mental health researchers, clinical professionals, community groups and people with lived experience of mental illness. The resulting radio campaign was broadcast daily, at high intensity, for 26 weeks. A mixed‐methods pilot study, including a pre‐post panel of 440 individuals recruited from Mazabuka town, Zambia, was used to evaluate the campaign's impact on depression and anxiety levels. Results Mean depression score (PHQ‐9) decreased by 19.7% (effect size −0.65, p < 0.001) and mean anxiety score (GAD‐7) dropped by 10.7% (effect size −0.22, p < 0.05). At endline, 41% and 54% respectively of those who had moderate to moderately severe depression, or moderate anxiety at baseline achieved a clinically significant reduction in symptoms. Conclusions This is the first study to indicate that a radio campaign promoting self‐help for depression and anxiety is feasible and may significantly improve mental health outcomes, however, a more rigorous trial is needed to confirm these promising pilot results. Radio may provide an accessible and cost‐effective platform for delivering mental health support in Zambia and, potentially, other LMIC contexts where radio listenership is high.

The value of people's unique lived experience of mental illness (including psychosis), professional treatment and recovery as a valid form of knowledge remains relatively unexplored and under-utilised by mental health professionals, policy makers and by those seeking help. Mutual peer support remains a largely untapped resource, often ignored and distanced from mainstream services. In this reflective perspective article, I share my own experiences as a service user, spouse, close relative and brother-in-law and also as someone who worked for many years in mutual peer support and in the area of recovery. I reflect on the findings of my doctoral narrative research which focused on the role played by Grow Mental Health, Ireland's largest network of mutual peer support groups, in recovery from a wide range of diagnoses. The main finding from this research suggested that recovery can be experienced as a re-enchantment with life and that mental illness can act as a gateway to mental health rather than be experienced as a form of (often life-long) disability. In the discussion I try and envisage what a recovery oriented mental health system might look like, and what changes would need to be introduced. Despite such a long personal history of dealing with mental illness and witnessing many different levels of recovery, I still have much to learn about mental illness and recovery. I also welcome many recent changes made within the system and indeed this special edition of the journal.

Improving mental health literacy in adolescents is a global priority. The purpose of this study is to examine differences in students’ attitudes across five components of mental health literacy—supportability, severity, susceptibility, recoverability, and preventability—by comparing classes led by individuals with lived experience of mental illness and textbook-based classes led by teachers. This study focuses on high school students in Japan, where educational interventions in mental health literacy remain limited. This quasi-experimental study examined changes in mental health literacy among 150 Japanese high school students (aged ≥15) following two types of instruction: one for students who received lessons from individuals with lived experience of mental illness (lecturer-guided), and another by a teacher using textbook content (non-lecturer-guided). A 24-item questionnaire measuring five mental health literacy components—supportability, severity, susceptibility, recoverability, and preventability—was administered at three time points: pre-, post-, and 3-month follow-up. Valid responses from 117 students were analyzed using factor analysis and ANOVA. Five factors were extracted with acceptable internal consistency. The lecturer-guided group showed significant post-intervention improvements in severity, susceptibility, and recoverability (p < .001), with partial retention at follow-up. The non-lecturer-guided group also showed modest gains, particularly in susceptibility. However, no significant changes were observed in supportability or preventability in either group. Lessons led by individuals with lived experience of mental illness can improve student understanding of key aspects of mental health literacy, particularly the seriousness, personal relevance, and treatability of mental illness. However, support and prevention-related beliefs may require more comprehensive or repeated interventions. These findings support the integration of lived-experience lectures into mental health education and provide a multidimensional framework for evaluating educational outcomes.

Improving mental health literacy in adolescents is a global priority. The purpose of this study is to examine differences in students' attitudes across five components of mental health literacy-supportability, severity, susceptibility, recoverability, and preventability-by comparing classes led by individuals with lived experience of mental illness and textbook-based classes led by teachers. This study focuses on high school students in Japan, where educational interventions in mental health literacy remain limited. This quasi-experimental study examined changes in mental health literacy among 150 Japanese high school students (aged ≥15) following two types of instruction: one for students who received lessons from individuals with lived experience of mental illness (lecturer-guided), and another by a teacher using textbook content (non-lecturer-guided). A 24-item questionnaire measuring five mental health literacy components-supportability, severity, susceptibility, recoverability, and preventability-was administered at three time points: pre-, post-, and 3-month follow-up. Valid responses from 117 students were analyzed using factor analysis and ANOVA. Five factors were extracted with acceptable internal consistency. The lecturer-guided group showed significant post-intervention improvements in severity, susceptibility, and recoverability (p < .001), with partial retention at follow-up. The non-lecturer-guided group also showed modest gains, particularly in susceptibility. However, no significant changes were observed in supportability or preventability in either group. Lessons led by individuals with lived experience of mental illness can improve student understanding of key aspects of mental health literacy, particularly the seriousness, personal relevance, and treatability of mental illness. However, support and prevention-related beliefs may require more comprehensive or repeated interventions. These findings support the integration of lived-experience lectures into mental health education and provide a multidimensional framework for evaluating educational outcomes.

Mortality from respiratory diseases in individuals with severe mental illness: a large-scale systematic review and meta-analysis of pooled and specific diagnoses.

Ensuring mental well-being has become an important target for community wholeness. Despite our growing knowledge and scientific discovery, the core challenges such as mental health stigma remain a sad deterrent in progressive society. The work of advocacy began in the 1990s to encourage social integration and support mental health recovery. However, it is still unclear how such advocacy work would produce favorable outcome. Locally in Malaysia, a mental health advocacy event was conducted in a tertiary university hospital with collaborative efforts from mental health providers and multidisciplinary units of care. The highlights of the event were three public disclosure and sharing sessions; two by individuals with lived experience of mental illness and another by a psychiatric caregiver. The event ended with a showcase of patients’ various artworks done in the psychiatric rehabilitation unit. The impact of this advocacy work was experiential from the initial stage of planning to the delivery of content during the event, and thereafter as a catalyst to further improve in functional recovery. The therapeutic work and alliance were shared by different roles through guided reflection of the patients’ and caregiver’s journey in the content for sharing. The successful delivery of the advocacy event also foresees further empowerment of people with lived experience of psychiatric illness to step up as a critical role of voice to enhance community connections and encourage social integration. Furthermore, the importance and value of advocacy can be included in psychiatry training, clinical settings, self-help organizations, and peer-led communities in efforts to promote mental health recovery.

"FareAssieme" is a recovery-oriented community psychiatry model that has been implemented by the Mental Health Service of Trento since 1999. The approach is grounded in the active involvement of users and family members, with particular emphasis on experiential knowledge - the insights derived from lived experience of mental illness and recovery - as a resource for improving the quality of care and rehabilitation processes. At its core, the model involves the structured integration of Peer Support Experts (ESPs, Esperti in Supporto tra Pari), individuals with personal or familial experience of psychological distress who have attained a stable life balance and developed effective coping strategies. ESPs are embedded across all domains of the mental health service (SSM), including community teams, crisis services (territorial and hospital-based), residential settings, and front-office activities. Their role is to support others in their recovery journeys through narrative sharing and emotional proximity. ESPs have contributed to enhanced user engagement, improved service climate, and increased trust in providers. They have proven particularly effective in engaging individuals initially resistant to treatment, thereby facilitating stronger therapeutic alliances. The model also fostered the creation of the Participatory Planning Group (GPP), a deliberative body comprising users, families, ESPs, and professionals, which has developed several Operational Guidelines to standardize and disseminate shared practices within the SSM. "FareAssieme" stands as a validated model of participatory, recovery-oriented psychiatry. It highlights the transformative value of experiential knowledge within mental health services and makes a meaningful contribution to anti-stigma efforts and the co-construction of inclusive care pathways.

This case study explores the multifaceted roles of a nurse with lived experience of mental illness in facilitating peer support for mental health recovery in China. Drawing on qualitative interviews with the nurse, four service users, and four family caregivers, as well as non-participant observations, the study highlights how the nurse enacted four interrelated roles: wounded healer, educator, coordinator, and advocate. Through shared narratives and empathetic engagement, the nurse fostered emotional resonance and challenged internalized stigma among participants. Her integration of family caregivers and mobilization of external resources further strengthened the recovery environment. The study applies the “wounded healer” framework to examine three stages of role transformation—trauma recognition, pain transformation, and transcendence—within a culturally collectivist setting. Findings suggest that even a single nurse with lived experience can play a transformative role in recovery-oriented care, promoting both individual healing and broader social inclusion. By highlighting the therapeutic potential of integrating experiential knowledge into nursing practice, this study offers practical insights for expanding peer support models in under-resourced mental health systems. It also provides culturally relevant implications for the training and inclusion of nurses with lived experience in recovery-oriented mental health care in China and beyond.

Social contact strategy or social contact based anti-stigma intervention, where a person with lived experience (PWLE) of mental illness shares his/her lived experiences with the target group, has been found to be effective in reducing stigma and discrimination. A culturally appropriate social contact based anti-stigma intervention training module would be helpful in training PWLE. Since there is no culturally appropriate training module available in India, there is a need to develop a training module for PWLE of mental illness to deliver a social contact based anti-stigma intervention. Thus, the proposed mixed-methods study aims to develop and test the efficacy of a training module for PWLE of mental illness, using social contact strategy to reduce stigma and discrimination towards people with mental illness amongst undergraduate students. The proposed study will be carried out in three phases; Phase-I: formative work will be conducted using an explorative research design. After a formative and extensive literature review, the culturally appropriate training module will be developed and subsequently reviewed and validated by mental health experts and service users. Phase-II: PWLE of mental illness will be trained using the developed manual adopting a case series design. Phase-III: To test the efficacy of the training, a quasi-experimental research design will be used, in which the target group’s knowledge, attitudes and behaviour towards mental illness will be assessed pre- and post and at three-month follow-up. Socio-demographic data will be analysed using descriptive statistics. Qualitative data (Phase-I and Phase-III) will be analysed through thematic analysis. Based on normality distribution, a parametric test like RMANOVA or an equivalent non parametric test will be adopted during phase III for efficacy testing. In addition, the outcomes amongst the PWLE, i.e., self-stigma and self-esteem, will be assessed and use of the training module will be analysed using thematic analysis.

IntroductionDespite expert recommendations to prioritise non-invasive and patient-centred approaches for behavioural crisis management, physical restraints are commonly used in the emergency department (ED). Patients describe the restraint process as coercive and dehumanising. The use of peer support workers, who are individuals with lived experience of mental illness and behavioural conditions, has shown positive patient outcomes when assisting individuals experiencing behavioural crises. However, there is limited evidence of the implementation of such an approach in the ED setting. The goal of this study is to evaluate if the implementation of a Peer support enhanced Agitation Crisis response Team (PACT) for behavioural crisis management in the ED is more effective than usual care to reduce restraint use and improve outcomes among patients presenting to the ED with behavioural crises.Methods and analysisWe will first conduct a stakeholder-informed needs assessment to codesign the protocol and then train staff and peers in PACT intervention readiness. Next, a stepped-wedge, cluster-randomised controlled trial will be conducted over 3 years at five ED sites across a healthcare system in the Northeast USA. The PACT intervention will integrate peer delivery of trauma-informed care within a structured, interprofessional, team-based response protocol for behavioural crisis management. The primary outcome is the rate of physical restraint and/or sedation use. The secondary outcome is the level of patient agitation during the ED visit. Analyses of primary and secondary outcomes will be conducted using generalised linear mixed models.Ethics and disseminationThis protocol has been approved by the Yale University Human Investigation Committee (protocol number 2000037554). The study is deemed minimal risk and has been granted a waiver of consent for trial participants. However, verbal consent will be obtained for a subset of patients receiving follow-up data collection. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations, or through direct mail notifications.Trial registration numberClinicaltrials.gov: NCT06556069.

IntroductionRecovery Colleges (RCs) are educational hubs offering free courses on mental health, well-being, and recovery through mutual and transformative learning. These co-learning spaces bring together individuals with diverse backgrounds—such as those with lived experience of mental illness, family members, and mental health practitioners—to collaboratively produce knowledge on mental health topics. Studies have shown RC participation leads to improvements in several psychosocial dimensions (e.g. mental health literacy, empowerment, well-being, reduced anxiety, stigma) and healthcare utilization. However, the methodological approach of averaging outcomes across all participants can mask important individual differences in experiences and outcomes, which is particularly significant given the heterogeneity of RC learners. In light of these limitations, this study aims to explore the heterogeneity of change among RC learners by identifying different trajectories of change and exploring their determinants.MethodsThe study adopts a quasi-experimental longitudinal design with repeated measures, utilizing data from 353 participants recruited from a French-language RC in Quebec, Canada. Data were collected at three time points: baseline (T0) prior to program participation, one-month post-program (T1), and three to four months post-program (T2). The study uses clustering techniques to identify distinct patterns of change across participants, focusing on key outcome measures such as well-being, anxiety, resilience, empowerment, and stigma.ResultsThe results identified three distinct clusters of change trajectories. The largest cluster (Cluster A) demonstrated moderate improvements in well-being, anxiety reduction, and slight increases in empowerment and resilience. Cluster B, characterized by participants with higher baseline well-being and lower stigma, showed improvements in empowerment and a slight reduction in stigma, often linked to participants with clinical backgrounds, such as healthcare practitioners. Cluster C, primarily composed of participants with clinical levels of anxiety and lower baseline empowerment, exhibited significant reductions in anxiety and increases in empowerment over time.DiscussionThis study contributes to a more nuanced understanding of the diverse outcomes associated with RC participation and highlights the importance of tailoring RC programs to meet the heterogeneous needs of learners. It also reinforces the role of empowerment as a central mechanism of change within the RC model, suggesting that empowerment fosters not only personal growth but also improved well-being and reduced stigma.