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CAMH Stories Centre for Addiction
and Mental Health

Eroding stigma in community health centres

A first-of-its-kind control trial in Canada conducted by CAMH’s Office of Transformative Global Health has found that anti-stigma interventions in primary health care settings lead to lower levels of stigmatizing attitudes and behaviours towards people with mental health and substance use problems.


“Stigma is experienced in diffe
rent ways: personally, socially and systemically. In a health care setting, this might present as a client being provided insufficient information, being left out of the decision-making process or being patronized,” explains Emily Lentinello, Project Coordinator and Special Advisor, Office of Transformative Global Health.

To learn more about the ways stigma exists in health care settings and to test whether anti-stigma intervention improved this in primary care settings, the Office of Transformative Global Health conducted The Acceptance Project.

This project measured both stigmatizing attitudes among staff and stigmatizing experiences among clients in six Community Health Centres (CHCs) across the GTA.

Involving clients in the learning process

Primary care settings are typically the first point of contact for people struggling with a mental illness or substance use problem. For that reason, this project targeted CHCs specifically to assess what role stigma plays in accessing care from the first point of contact.

IMG_3.jpgProject staff and CHC Champions randomly select CHCs to determine which would receive the intervention and those that would not.

he Acceptance Project tested the effectiveness of an innovative five-pronged intervention to reduce stigma towards people with mental health and substance use problems among CHC staff. The team collected quantitative and qualitative data over the course of three years, with three CHCs receiving interventions; three acting as the control group.

The five elements of the intervention were:

  1. A Team of Champions: Recruited CHC staff as project leaders and promoted the initiative at their Centre;
  2. Contact-based Training: Sessions incorporated a person with lived experience and academic facilitators to educate all staff on various stigma-related topics such as cultural differences and intersecting stigmas;
  3. Raising Awareness Campaign: Developed and showcased media with anti-stigma messages (e.g. posters, logo, pens/buttons);
  4. Policy Analysis: CHC Policies and Procedures were analyzed to ensure language and content reflected anti-stigma principles and values;
  5. Recovery Art-based Program: A 10-week program that included both staff and client participants creating art together and sharing their work at an all-staff event.

Every element of the project included client input and active participation. The art-recovery program was particularly impactful. 

IMG_4.jpgRexdale Community Health Centre was one of the CHCs that especially enjoyed the recovery-based art program as part of The Acceptance Project’s anti-stigma intervention.​

“I think having this art program was a saving grace for a lot of us,” said one client participant. “To come here and feel safe knowing that we’re pushing ourselves out of our box, out of our comfort zone to learn with new people, materials and surroundings. It was scary, but I’m glad I did it. I’m a little bit proud of myself.”

A step in the right direction

Over the course of the three-year project, staff and clients from all six CHCs completed four rounds of stigma questionnaires, with a select number also completing in-depth interviews and focus groups.

The results are clear: intervention leads to lower levels of stigmatizing attitudes.

“This project heightened our awareness of the specific care and consideration that clients with mental health and substance use problems deserve when accessing our services,” said Liben Gebremikael, Executive Director, TAIBU CommunityHealth Centre. “And I would recommend this to other CHCs. We found the art program so effective that we’ve continued to facilitate this with our staff and clients."

“This project demonstrated some early success in our ability to effectively erode stigma in the primary care setting,” says Emily. “And although this is a good start, we are currently exploring the possibility of scaling up to other primary care services, and ideally, hospitals.”

The importance of reducing stigma at all levels cannot be overstated, and its elimination will surely result in better care for people with mental health and substance use problems.​​​​

Published on October 11, 2017

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