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 different 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.
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.
project measured both stigmatizing attitudes among staff and stigmatizing
experiences among clients in six Community Health Centres (CHCs) across the
clients in the learning process
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.
Project staff and CHC Champions randomly select CHCs to determine which would
receive the intervention and those that would not.
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.
five elements of the intervention were:
- A Team of Champions: Recruited CHC staff as
project leaders and promoted the initiative at their Centre;
- 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;
- Raising Awareness Campaign: Developed and
showcased media with anti-stigma messages (e.g. posters, logo, pens/buttons);
- Policy Analysis: CHC Policies and
Procedures were analyzed to ensure language and content reflected anti-stigma
principles and values;
- 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.
element of the project included client input and active participation. The
art-recovery program was particularly impactful.
Community Health Centre was one of the CHCs that especially
enjoyed the recovery-based art program as part of The Acceptance Project’s
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.”
step in the right direction
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.
results are clear: intervention leads to lower levels of stigmatizing
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
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.”
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