In partnership with Atlas Research, the Manchester Health Department, NH Community Behavioral Health Association, the National Alliance on Mental Illness NH, and Dartmouth Medical School, MHCGM has developed a Stigma Assessment & Reduction Initiative, whose aims include identifying and eradicating internal Health Care Professional stigmas and spreading results and trainings to the greater community.
The initiative is comprised of five major components: (1)MCHGM has contracted stigma expert Gretchen Grappone to conduct a detailed stigma assessment of agency personnel and practices; (2)ensuing data will be compiled, interpreted, and discussed via a community stigma awareness forum; (3)data driven trainings for MHCGM staff and Community Mental Health Center management will be completed, (4)followed by a post-training stigma reassessment; (5)all findings and material will be presented to the community. Our goal is to reduce barriers to treatment from inside out.
We recognize that stigma surrounding mental illness and substance abuse is a major public health problem and so have designed a program to alter exacerbating behaviors. We know that people with mental illness are less likely to have primary care physicians, causing their reliance on emergency rooms. Perhaps less known are studies indicating that the higher the level of stigma endorsed by health care professionals the less the likelihood their patients will be referred to specialists. Researchers theorize “diagnostic overshadowing” prohibits people with mental illness from receiving crucial treatments. Given NIMH estimates that 40% of adults living with schizophrenia and 51% of persons living with severe bipolar disorder receive no treatment, health care professional stigma could be an obstacle to treatment for 3.5 million people. By confronting provider stigma, MHCGM’s program reduces barriers and increases access to evidence-based mental health services.
While statistics citing the frequency of “diagnostic overshading” are not readily available, personal narratives are, especially for those with mental illness. Too often health care provider stigma leads to inequalities in treatment, under-diagnoses or no diagnoses of co-existing physical illness. Further, over reliance on ERs by those facing mental illness increases the likelihood they will encounter staff not trained to handle psychiatric conditions. With specific health risk factors particular to those battling mental illness, it is imperative that clinicial and non-clinicial staff summon their complete cognitive skill set in support of all clients.
The internal Stigma Assessment & Reduction Initiative works to do just that: locate and reduce health professional stigma from the ground up, improving the overall quality of behavioral health care. Focused, on-going trainings highlighting personal stigma awareness and reduction strategies ensure quality treatment.
Annually, SMI costs Americans $193.2 billion in lost earnings (NAMI) and the U.S. spends more than $15 billion to incarcerate individuals with serious psychiatric disorders (DOJ). Businesses, too, pay a price for ignoring stigma surrounding mental illness. In a 2007 survey of HR managers, 8 in 10 respondents said they felt employees suffering from mental illness might refrain from seeking treatment due to “shame and stigma.” 47% of employees with 5 or more symptoms of psychological difficulties did not tell their immediate superior, and 43% of employees with symptoms of major depressive disorder said they had received no mental health treatment in the previous 12 months. Treatment, however, saves money: at 24 months following treatment, the intervention improved productivity by 8.2% at an estimated annual savings of $1,982 per full time equivalent. Reducing stigma prompts people to seek treatment sooner, resulting in better outcomes, reducing associated costs.
No health care setting in New Hampshire has embraced the task of self-assessing and addressing internal stigmas related to mental illness and substance use disorders. In fact, more often than not health care professional stigma is viewed as “other” by providers, something that exists outside the walls of health related institutions, hence the proliferation of statistics citing it as a significant barrier to treatment. The MHCGM, however, actively espouses a culture of meta-cognitive self-evaluation, which informs practices and policies on every level.
Given MHCGM's long-standing relationships with stakeholders and resources in the community, as well as its size and visiability—359 employees operating over 30 programs; 11,000 clients served each year, including 800 seniors and 2,000 children and adolescents—they are well positioned to lead comparable health care agencies via their Stigma Assessment & Reduction Initiative.
While MHCGM is a 55-year-old private non-profit system of comprehensive mental health services, and so enjoys a network of regional partnerships, the Stigma Assessment & Reduction Initiative is designed to be emulated in varying health care settings. Using emerging evidence-based practices to address structural stigma, the initiative utilizes promising strategies to lessen stigma in adults: 1) contact with a person successfully managing a mental illness and 2) targeted training by educators who are both credible and known to the community. Studies show that behavioral change is best achieved by relying on sustained anti-stigma programs, as opposed to intermittent campaigns, and by increasing knowledge of effectiveness through meta-cognitive evaluation. This project and subsequent educational material is map for health care providers to implement similar strategies. MHCGM has invited leaders of community health care agencies to attend trainings in hopes the initiative will spread.
Various organizations have committed their support to MHCGM’s initiative: The Manchester Health Department, for example, whose large facilities are necessary to conduct trainings. The NH Community Behavioral Health Association, which represent 9 of the 10 NH Bureau of Behavioral Health designated Community Mental Health Centers, has endorsed the opportunity for those CMHCs to nominate a representative to attend all trainings. MHCGM’s partnership with Dartmouth Medical School serves as curricular/pedagogical resource. In addition, Dartmouth is considering offering college credit for attendees of the trainings. The National Alliance on Mental Illness New Hampshire (NAMI NH), too, has offered needed statewide exposure, material and informational support, which is crucial to sustaining this effort. In the future, MHCGM will pursue local hospitals and area Public Schools to ensure that stigma awareness become the new normal.
MHCGM’s Stigma Assessment & Reduction Initiative is completely duplicable, transferrable, and adaptable by other institutions/organizations of similar and differing competencies. All resulting didactic materials are amendable to reflect agency focus and target population demographics. Training time tables reflect a suggested structure and are easily malleable, and stigma expert/educator Gretchen Grappone has committed to replicating similar trainings wherever and whenever necessary. Further MHCGM will provide a report on its stigma assessment and reduction program that will include implementation strategies for other health care organizations. All initiative related material and consultation support is available upon request.
To measure the effect of trainings and before & after training self-assessments, MHCGM will compile and discuss resulting data, studying trends, which will be the subject of our quality improvement plan meetings. We also track client surveys measuring self-stigma and perceived stigmas within MHCGM.
Further we will expect to expand the use of the Opening Minds Scale for Health Care Providers (OMS-HC) within the community, educating partners on its functionality, using our data sets as model. With MCHGM support, we will encourage providers to track data themselves in hopes of creating an environment where levels of stigma is included in quality assurance information collected in all health care providers settings. Lastly, we will encourage the use of stigma and self-stigma assessment scales in public schools.