Schedule

Melissa DuPont-Reyes, Columbia University

Anti-stigma efforts that communicate the diathesis-stress model—the interactive neurobiological-psychosocial component causes of mental illness—has increased reception to treatment. Yet violent/dangerous stereotypes have increased too. These efforts have predominantly diffused in English-language media. We causally examined the effects of diathesis-stress model communication on stigma by examining diverse language/cultural media among Latinx populations.

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Anti-stigma efforts that communicate the diathesis-stress model; mixed-methods; Latinx populations and/or Spanish-language and English-language media; U.S.-based research.

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To examine diathesis-stress communication across diverse language/cultural media among Latinx populations, we obtained multiple samples of data. (1) A two-week composite sample of primetime Spanish-language and English-language television (N=22 programs) was randomly drawn from 09/07/22-09/27/22 in the New York City metro area. (2) A comprehensive, bilingual list of mental health awareness hashtags was developed to download 28,268 Spanish and 205,774 English tweets from the Twitter Academic API from 09/19/22-10/10/22. (3) A quota US-based Latinx sample ages 13-86 (N=2058) self-completed assessments (α=.72-.94) in 2021 ascertaining: frequency of Spanish/Latinx and English media use and mental health content scanning/seeking; beliefs about mental illness neurobiological-psychosocial causes—genetics, brain chemistry, environment, stress; treatment—improves with treatment or on its own; stigma—violent/dangerous, bad character, unwilling to socialize; and help-seeking to healthcare providers or family/friends. Analyses of television data included intercoder reliability and descriptive/bivariate analyses; Twitter data included machine learning sentiment and structural topic analyses; and survey data included structural equation modeling.

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Compared to Spanish-media, English-media exhibited significantly more diathesis-stress codes in television and Twitter data (p<0.01). In survey data, English-media use was positively associated with neurobiological-psychosocial causal beliefs while Spanish/Latinx-media use was negatively associated (p<0.01). Thus, analyses suggest greater diathesis-stress information in English- versus Spanish/Latinx-media. However, diathesis-stress information in English-media was also found to be positively associated with stigma: English- versus Spanish-media samples contained significantly more stigma codes (p<0.01); and neurobiological-psychosocial causal beliefs were positively associated with increasing mental illness social rejection beliefs (p<0.01) that reduced help-seeking to healthcare professionals and family/friends (p<0.05).

Luca Pingani, University of Modena and Reggio Emilia; Giulia Ferrazzi, University of Modena and Reggio Emilia; Francesco Borgazzi, University of Modena and Reggio Emilia; Roberto Ferretti, University of Modena and Reggio Emilia; University of Modena and Reggio Emilia

This study explores the representation of mental health in two prominent Italian newspapers, "Corriere della Sera" and "La Repubblica," spanning from 2006 to 2021. The aim is to quantify articles containing mental health-related terms, assess their focus on mental health issues, detect stigmatizing content, analyze temporal trends and find possible predictors of stigmatizing articles.

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Newspapers.

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The search utilized electronic archives, with evaluators categorizing articles as mental health-related (rMH) or not (nrMH), further classifying rMH as stigmatizing, non-stigmatizing, neutral, or mixed.

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Out of 1988 articles meeting inclusion criteria (nrMH: 1511; rMH: 451): the percentage of rMH articles varies from 17,79% in 2006 to 72,84% in 2021 and there is a statistically significant difference in the distribution of articles (rMH/nrMH) over the six years considered (Χ2=16,52; df=5; p=0,005). The study highlights variations in stigmatization across years. In 2009, stigmatizing articles peaked at 19.78%, while none were identified in 2018. Statistical analysis indicates a significant shift in the characterization of rMH articles (Stigmatizing/Non-stigmatizing/Neutral/Mixed) over time (Χ2=65.50; df=15; p<0.001), revealing an increasing trend in non-stigmatizing articles. Additionally, logistic regression identifies two potential predictors of stigmatizing articles: the number of words in the title and the type of addressed mental health disorder.

Elise Carrotte, Melbourne School of Psychological Sciences, The University of Melbourne; Chris Groot, Melbourne School of Psychological Sciences, The University of Melbourne; Michelle Blanchard, Melbourne School of Psychological Sciences, The University of Melbourne; Fincina Hopgood, Melbourne School of Psychological Sciences, The University of Melbourne; School of Humanities, Arts, and Social Sciences, University of New England; Melbourne School of Psychological Sciences, The University of Melbourne

On the Same Wavelength' is a storytelling initiative aiming to reduce public stigma affecting Australians living with complex mental health issues such as schizophrenia, bipolar disorder, and PTSD.

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This is a six episode, co-designed podcast series featuring narratives from people with lived experience. Each episode focuses on a SANE Peer Ambassador, who shares their lived experience and the personal impacts of stigma and discrimination across a particular life domain, and their hopes for the future. The podcast combines elements of educational, contact and protest-based interventions.

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The podcast was evaluated through a mixed methods study including a randomised controlled trial and qualitative interviews. University students (N = 163) were randomised to listen to three episodes of On the Same Wavelength or a control podcast. The study indicated modest, short-term reductions in prejudicial attitudes, increases in state empathy, and high acceptability among listeners.

Ashley F. Railey, Oklahoma State University; Alison Greene, Indiana University Bloomington; Courtney Olcott, Oregon State University; Kristina Hunter-Mullis, Indiana University Bloomington; , Indiana University Bloomington; Charmin Gabbard, Connection Cafe

The program targeted public stigma (the desire for social distance and causal attributions) as they relate to recovery and managing substance use disorder in a rural county in the United States (Fayette County, Indiana). The target audiences included close associates and family of people who use drugs, healthcare professionals, and law enforcement.

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The communication campaign combined social contact components. The design and implementation process applied a community-based prevention marketing framework to integrate social marketing principles and theoretical guidance from intergroup contact theory into the community-based project. The process triangulated expertise between academic, community, and marketing sectors to translate evidence from the representative Person-to-Person Health Study (2018-2020) of 2,050 Indiana residents, 225 from Fayette County and from a community work group (n=5) into a one-time, 6-month marketing plan with two components: social media (Facebook) and social contact at the Café (in-person networking (n=3), social events (n=6)).

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Awareness of the Café and harm reduction activities in Fayette County, information seeking on harm reduction, positive feedback to campaign products, and attending in-person events were the primary outcomes. Implementation fidelity—adherence on content and frequency—to the marketing plan was also assessed. The social media (80 percent adherence) and social contact (30 percent adherence) components were implemented according to the marketing plan. Awareness and positive feedback increased over the course of the campaign. On average, 40 percent of total visits to the Café website came from the campaign.

Rosemary Gathara, Basic Needs; Judy Kariuki, Basic Needs Basic Rights Kenya; BNBR Champion, Basic Needs Basic Rights Kenya; Erla Magnusdottir, CBM UK; Sue Baker, Changing Minds Globally

‘Speak Up’ was a five-year mental health anti stigma project delivered in Nairobi, Kenya led by Kenyan Mental Health NGO Basic Needs Basic Rights Kenya (BNBR) working in partnership with international NGO CBM UK. The project originally started as one of five global anti-stigma pilots in the Time to Change Global programme (2018-2020)

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The ‘aim was to tackle youth mental health stigma, and one of the project targets was to improve media reporting and social media discussion of mental health. We know that the media (in many forms) can either perpetrate mental health stigma or be a positive force in combating it and, as such BNBR Champions had identified the media as a key audience to target when the project plans were developed.

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BNBR developed a strategic partnership with the Media Council of Kenya (responsible for setting media standards and ensuring compliance with those standards).

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BNBR also commissioned P&L Consulting to conduct a baseline analysis of media coverage in Kenya (February 2020 – 2021) in order to assess the extent of positive and negative mental health reporting and identify emerging trends within news media reports and social media discussions. The baseline findings were then used to inform the SpeakUp Campaign’s positioning strategy. In June 2023 a follow-up media monitoring study was conducted to determine any shifts or improvements over the 24months since the baseline study. Moreover, it aimed to evaluate any impact BNBR's recent anti-stigma initiatives might have had on media discourse since the publication of the baseline report.

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The Speak Up project anti-sigma activities included a social marketing campaign, social contact events, training for Caregivers and Community Health Promoters, and training and support for over 60 lived experience Champions. Champions were involved throughout the design and delivery of the project and became active campaign advocates publishing their stories via their own social media accounts and working with the media to improve their coverage.

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Another key aspect of the project was focused on a partnership with the Media Council of Kenya aimed at improving media coverage and social media discourse of the topic.

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The work with the Media Council entailed training workshops with Journalists, Editors and Social Media Influencers where a select number (51) were sensitized on mental health and best practices in mental health reporting including use of language and how to interview people with lived experience of mental health issues.

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Media reporting guidelines and a mental health reporting curriculum were also developed by partners and BNBR Champions.

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To determine any shifts or improvements in the reporting of mental health-related topics and subsequent discussions on social media, BNBR commissioned P&L Consulting, an independent research and communications firm, to conduct a monitoring study.

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P&L conducted a systematic monitoring and analysis of a diverse array of media outlets (print, electronic, online) and social media platforms throughout the specified period. A randomised selection of 542 Kenyan news articles pertaining to mental health were selected after a keyword search – these were published or broadcast by media outlets with substantial readership and viewing figures. The articles were then analysed in more detail.

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Social media discourse on mental health was tracked and analysed by P&L Consulting using social media listening tools that tracked common phrases that were used by Kenyans when making reference to mental health related issues. These same terms were used for the keyword searches to track media articles on mental health.

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20 Kenya-based journalists completed an online questionnaire designed to assess their understanding and opinions in relation to mental health and their coverage of the issue. Respondents included seven health reporters, four business reporters, five crime reporters and four lifestyle reporters.

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This approach allowed for a comprehensive assessment of media coverage and online discourse pertaining to mental health.

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§ Significant increase in positive mental health coverage and a significant decrease in negative media coverage. Between February 2020 and February 2021, 15 percent of the news stories were positive, 52 percent were negative while 33 percent were neutral. Between June 2021 and June 2023, 50 percent of the stories were positive, 21 percent were negative while 29 percent were neutral.

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§ Share of voice increased significantly. The volume of news coverage related to mental illness exhibited an upward trend over time with a significant increase from 4% of all media coverage relating to mental health in 2020/2021 to 12% in 2023. On social media platforms, a marked upswing in hashtags related to mental health was evident, with "depression”, "addiction”, “suicide”, "help”, and "recovery" experiencing a surge in usage.

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§ Impact of BNBR's mental health initiatives: The report acknowledges the significant impact of Basic Needs Basic Rights Kenya's (BNBR) strategic initiatives on the evolving mental health discourse. It found that out of the 542 news stories reviewed, 104 were generated as a direct result of BNBR’s initiatives.

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The full media monitoring reports can be accessed through the links below:

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Baseline Report: 2020 – 2021: https://basicneedskenya.org/wp-content/uploads/2021/11/Basic-Needs-Kenya-Media-Monitoring-Report-2020_21.pdf

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Endline report: 2021 – 2023: https://basicneedskenya.org/wp-content/uploads/2023/11/BNBR-Media-Monitoring-Report-June-2021-June-2023.pdf

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Conclusions

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§ Partnerships with media bodies secure more ownership (ideally taking a co-ownership approach) that in turn supports more engagement and impact of any training and resources for Editors and Journalists and compliments the sustainability of work to improve media reporting of mental health issues.

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§ People with lived experience who are trained and supported as mental health anti-stigma Champions should be involved from the outset in the co-design and delivery of training for Editors and Journalists. This is not just the correct approach but it can also help transform how media professionals view people with lived experience if they experience people actively delivering and facilitating the training (potentially this could also be described as a form of social contact).

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§ Taking this approach would mirror recommendations 6 and 8 of The Lancet Commission on ending stigma and discrimination in mental health that relates to media organisations and people with lived experience.

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-Recommendation 6: all national and international media organisations (traditional and new media) should be called upon to issue policy statements and action plans (based on the findings of this Lancet Commission) on how they promote mental health and contribute to reduction of stigma and discrimination in mental health.

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-Recommendation 8: funded programmes to support people with lived experience should be provided in the following three categories: mutual help or peer support networks; integration of PWLE as providers of health and social services provision (e.g., peer support workers); and service users receive support with disclosure decisions.

Carol Liang, Deputy CEO, Mind HK; Odile Thiang, Lead Clinical Advisor, Anti-stigma

Improved perceptions, reduced negative attitudes, improved awareness of stigma and mental health

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At Mind HK, we have trained 100 ambassadors (and are training more) to share stories about their mental health recovery journeys. We have also created platforms for them to share their mental health stories widely, and subsequently evaluated them to showcase the impact of their stories on events. We believe storytelling is key to reducing stigma and raising awareness.

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We have conducted research using a mixed method approach to show significant changes in pre-post evaluations for individuals who attend events or watch media featuring stories shared by our lived experienced ambassadors.

Ella Zoe Tsang, Storytaler; Amanda C. M. Li, Storytaler; Winnie W. S. Mak, Storytaler

The project's primary focus is on three key target groups: the general public, individuals with lived experiences of mental health challenges, and caregivers. By targeting these groups, the project aims to address stigma reduction from multiple perspectives, fostering a holistic approach to mental health education and destigmatization.

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In Hong Kong, there is a lack of training programs focusing on empowering and enabling individuals with mental health challenges to become agents of social change in their communities through multifarious modalities including videos, talks, workshops, and events. Many people with lived experience and caregivers are enthusiastic about using their experiences to support others and create a more mentally healthy society. However, they may not have access to systematic training and learning opportunities to enhance their knowledge and skills and support their well-being when engaging in stigma reduction work.

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By providing appropriate training, these individuals can effectively and sustainably generate positive changes. Our training program aims to fill this gap by empowering individuals with mental health challenges and caregivers in Hong Kong, and it is the first of its kind in Hong Kong. The training will be delivered through both online and offline platforms, increasing accessibility to the materials, and enabling more individuals to acquire relevant knowledge and skills.

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This project aims at enhancing the impact of individuals with mental health challenges and caregivers by providing them with the necessary skills and knowledge to effectively address stigma associated with mental illness. Through comprehensive training, participants will gain expertise in public education and social change strategies, enabling them to raise awareness about mental health, reduce stigma, and foster community engagement in mental health discussions. The project's overarching goal is to create an empowering environment where individuals and communities are equipped to actively participate in public education, destigmatization efforts, and contribute to sustainable improvements in individual and community mental health.

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Stigmatized experiences directly hinder the process of mental health recovery and have a negative impact on the well-being of people with lived experience (Mak et al., 2017; Chan & Mak, 2012; Yu, Mak & Chio, 2021; Yu et al., 2021). Moreover, stigma does not only affect people with lived experience it also impacts their caregivers. A study published in 2022 showed that affiliate stigma is prevalent among family caregivers of individuals with mental illness in Hong Kong (Li et al., 2022). Addressing public stigma and

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affiliate stigma is crucial for promoting diversity and inclusion in our society, and proactive efforts are needed to tackle this issue. Stigma reduction is considered essential in this regard.

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Currently, most stigma reduction campaigns in Hong Kong are led by professionals, with people having mental health challenges primarily seen as recipients rather than active agents in mental health initiatives. In contrast, countries like the UK, USA, and Australia have seen the flourishing of co-production and peer-led initiatives, exemplified by organizations like Rethink Mental Health. A systematic review demonstrated that peer-led initiatives can reduce self-stigma and the pressure of stigma, thereby enhancing recovery and empowerment among individuals with mental health challenges. The findings further indicated that such initiatives increase self-efficacy and willingness to seek professional help (Sun et al., 2022).

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Based on our experience of working with individuals with mental health challenges over the past eight years, we have observed a lack of skills and knowledge necessary for facilitating broader change in society. People who want to be self-advocate need to be equipped with skills on sharing their personal stories, communication skills to effectively explain the concept of stigma to the public, peer support skills to protect themselves from potential setbacks. Also, they need to be equipped with the knowledge and leadership skills to organize and deliver stigma reduction initiatives within the community.

Guadalupe Morales Cano, Universidad Jaume, I Valencia, Spain, Fundación Mundo Bipolar

health professionals, mental health sector, policy makers, general public.

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Meaningful involvement of persons with live experience. Nothing about us, without us.

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I am a journalist, I worked for 15 years on a Spanish TV channel. My work was appreciated, but when they found out I had a psychiatric diagnosis, they fired me. I was devastated. Shortly after I entered the world of mental health. My main purpose has been to fight stigma and discrimination.

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Following the teachings and as commissioner of The Lancet Report to ending stigma and discrimination, I have seen for myself how contact and working with other sectors is the best way to end stigma.

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Working in the direction of having a significant and meaningful involvement, “nothing about us, without us”, is my vision.

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In this sense, I consider that training for peers, and these for professionals, is a very powerful weapon. In research, all our courses are evaluated. They have been selected as good practice by the European Commission.

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I will present the results of the Global Consultation to Persons with Lived Experience and Family/Carers. Transforming Mental Health Care: Insights Implementing Alternatives to Coercion. WPA Working Group on Partnerships from the WPA WG Consultation on with Service Users and Carers. In its conclusions stigma appears as one of the main reasons of impediment to recovery.

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Likewise, giving testimony and my experiences in different national and international forums and media can have a great impact. I was the first person with a mental health problem to be a speaker at the EU Parliament, there a spoke against stigma and how it had affected my life.

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Finally, being a representative of the collective in first person, whether at a local, regional, national, European or global level, makes a difference.

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A change of mindset is required, first of all health-related sectors, then of political sectors, and finally at the general public.

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I have represented PWLE in my government for 10 years, also before the EU programs on mental health, and before the WHO. I would like to highlight the excellent way WPA has involved me in their activities and working groups. It is really a good practice, which serves as an example.

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Training selected Good Practice by the European Commission. Research published

Nathalie Oexle, Ulm University; Matthias Luehr, Ulm University; Nicolas Ruesch, Ulm University

Public suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) is harmful for suicide prevention, for example by increasing emotional distress among persons at risk for suicide and reducing help-seeking and disclosure. However, interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalization (i.e. liberal attitudes towards suicide) and therefore increase suicide risk. Despite great relevance, whether and how public suicide stigma can be reduced without negative side effects remains unknown. We aimed to test the efficacy of four brief online-interventions in reducing public suicide stigma as well as investigate their impact on other outcomes relevant for suicide prevention among members of the general population.

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Public suicide stigma

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We conducted a web-based online RCT among 3.897 members of the German general population recruited via an established online research panel. Participants were randomized into six groups, receiving one of four interventions (education text-based, education video-based, contact text-based, contact video-based) or control group content. Data were collected directly before and after intervention participation as well as about two weeks later. We used linear mixed modelling to test the efficacy of contact- and education-based text and video interventions in reducing public suicide stigma as well as their impact on suicide normalization.

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We found hardly any significant time x group interactions, which means that there were no significant differences between participants exposed to the interventions and those exposed to the control condition with regard to changes in suicide stigma and suicide normalization. Significant reductions in suicide stigma pre/post were observed among all participants, including controls, suggesting social desirability bias. Our findings also show low acceptability of presented intervention content indicated by low watching/reading times, particularly among older men with high suicide stigma scores at baseline. Implications for future research and intervention development to reduce public suicide stigma will be discussed.

Limor Smith, MSW, MS, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES Center), Graduate College of Social Work, University of Houston; Dr. Robin E. Gearing, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES Center), Graduate College of Social Work, University of Houston; Dr. Kathryne B. Brewer, Department of Social Work, University of New Hampshire; Dr. L. Christian Carr, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES Center), Graduate College of Social Work, University of Houston; Jewish Family Service, DannyClarkHTX@hotmail.com; Andrew Robinson, MSW, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES Center), Graduate College of Social Work, University of Houston; Dr. David Roe, Department of Community Mental Health, University of Haifa, Israel

Introduction: Historically, there have been strong prohibitions against suicide within the Jewish faith, including publicly discriminating against individuals who die by suicide. Taking one’s life is antithetical to Jewish culture, where life is sacred and regarded as belonging to God, not humanity. It is important to determine how the experience of being Jewish in the U.S. translates into suicide stigma. This study randomly assigned participants to one of six vignettes that were varied by gender (female, male) and age (18, 25, 83 years old) assessing public stigma toward a suicidal individual. Public stigma was assessed in U.S. Jewish communities with a measure that separately examined dimensions of public stigma (e.g., relationship anxiety, hygiene, recovery).

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Research Questions: (1) Is there a direct effect of gender and/or age of the vignette person

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experiencing suicidal ideation on respondent suicide stigma? (2) Does suicide-stigma differ based on participants’ sociodemographics (e.g., experienced discrimination, help-seeking)?

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(3) Is there an interaction between gender and age of the vignette person with respondent suicide stigma?

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public stigma; cross sectional; United States Jewish communities; Houston, Texas

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Method: In a Jewish community, we used a randomized vignette survey design on Qualtrics that was administered in person via computer tablets. The sample was comprised of 242 Jewish individuals [MA = 48.55 (16.18); Gender (Male = 30.54%; Female = 69.46%)]. The measures included (a) the Mental Illness Stigma Scale (MISS; Day et al., 2007); (b) the Everyday Discrimination Scale (EDS; Forman et al., 1997); and (c) the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF; Fischer & Farina, 1985). The basic analytic approach was analysis of covariance (ANCOVA) and confirmatory factor analysis (CFA) was used to check the model fit of all measures.

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Results: For males, lower relationship anxiety stigma, that is, less participant unease and fear about having a relationship with a suicidal person, was found among suicidal persons who were 15-year-olds compared to 25- and 73-year-olds. Further, participants were more likely to endorse relationship anxiety stigma when they reported more everyday experiences of discrimination and/or more negative attitudes toward seeking professional psychological help. Two interaction effects were found, vignette person gender moderated: (a) the effect of attitudes toward help seeking on hygiene stigma; and (b) the effect of vignette person age on hygiene stigma. Hygiene stigma reflects beliefs about the appearance and physical self-care of a suicidal person.

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Implications: Suicide stigma differs across the life cycle and across genders in the Jewish community. Findings highlight the need to consider age and gender when tailoring stigma and suicide awareness campaigns. The relationship between increased everyday experiences of discrimination and greater relationship anxiety stigma warrants future research. When the current environment is more discriminatory against a demographic group, such as antisemitism toward the Jewish community, it may be relevant to examine whether stigma toward mental health is affected.

Robin E. Gearing, University of Houston; Doris Akyere Boateng, University of Ghana; Rabiu Kwaku Boakye Asante, University of Ghana; Kathryne B. Brewer, University of New Hampshire; University of Texas at Arlington; Sondra Fogel, University of South Florida; Shahnaz Savani, University of Houston/Downtown; L. Christian Carr; Andrew Robinson, University of Houston; Susan Robbins, University of Houston, University of Houston

In Ghana, the limited research suggests that suicide is an act that is highly stigmatized. Until July 2023, suicidal behavior in Ghana was considered a crime subjecting individuals attempting suicide to arrest, prosecution and criminal penalties. Currently, Ghana lacks a national suicide prevention strategy. This study contributes to a deeper understanding of the complex interplay between individual and societal/community perspectives on suicide that may ultimately inform effective strategies for suicide prevention, intervention and support. Research questions were: 1) What is the relationship between personal responsibility and suicide stigma; 2) What is the relationship between etiology of suicidal ideation and suicide stigma; and 3) Does gender moderate the relationship between either personal responsibility or etiology and suicide stigma?

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Cross-sectional convenience study of adults across two cities in Ghana (Accra and Tamale), The online Qualtrics survey (in English, Dagbani or Twi languages) was administered via tablets and comprised of sociodemographic questions, standardized measures (e.g., mental health, religiosity, stigma), and an experimental vignette methodology (varied by age and gender) to examine suicidal attitudes, perceptions, and beliefs.

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Beyond standard descriptive statistics, the statistical analysis (Stata 17, R version 4.2.2) included a canonical correlation analysis (CCA) to examine the proportion of variance in stigma scores that could be explained by beliefs about personal responsibility for, and causes of, suicidal ideation.

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The majority of the sample were male (53.3%), lived in Accra (51.76%), were unemployed (51.76%), college educated (56.35%), with a mean age of 33.19 years. The analysis found statistically significant explanatory variates explained about 20% of response variance for males and 18% for females. Our findings reveal a complex landscape of attitudes towards suicide in Ghana, which aligns with some global trends but also shows unique regional characteristics. This research examined the relationship between people's beliefs about the causes/etiology and personal responsibility of suicidal ideation and the resultant stigma. Findings underscores that these perceptions are not only multi-faceted but also gender-specific. Addressing mental health/suicide stigma requires a nuanced and multifaceted approach that acknowledges the roles of sociodemographic factors, cultural beliefs, and attribution regarding the origin of suicidal ideation. These findings support community-based stigma reduction efforts to help develop a comprehensive approach to bring about greater empathy, inclusivity, and support for individuals living with suicide ideation and mental illness.

Robin E. Gearing, University of Houston; Micki Washburn, University of Texas at Arlington; Kathryne B. Brewer, University of New Hampshire; Luis R. Torres-Hostos, The University of Texas Rio Grande Valley; Universidad Nacional Autonoma de Mexico Escuela; Natalia Giraldo-Santiago, Massachusetts General Hospital; Miao Yu, University of Texas at Arlington; Alberto Cabrera, University of Houston; Adelaide Garcia Andres, Universidad Autónoma de Nuevo León

Suicide continues to be a significant public health concern impacting all cultural and ethnic groups across the world. Little research examines and compares stigma toward suicide in Mexican and Mexican-American populations, including effect of immigration on beliefs and attitudes toward suicide. This study investigated the following questions: 1) What are the public stigma beliefs toward those experiencing suicidal ideation in Mexican-Americans, compared to respondents s from Mexico; 2) Does age and gender of the suicidal individual affect expressions of public stigma; and 3) Does public stigma differ by country of origin for Latinos residing in the US?

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Utilizing data from two community-based samples (n=451): one from Mexican-Americans in Houston (n=248), and a second focusing on residents in Mexico City (n=203). Participants were given one of six vignettes depicting a person experiencing suicidal ideation which were randomize by gender (male/female) and age (15-, 38-, 73-years) of the person experiencing suicidal thoughts.

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Utilizing data from two community-based samples (n=451): one from Mexican-Americans in Houston (n=248), and a second focusing on residents in Mexico City (n=203). The study examined the influence of respondent characteristics (age/gender/country of origin) on suicide related stigma using MANOVA and multiple regression. Data analysis was conducted using SPSS 27.0 and Mplus 8.9.

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Our findings found that location predicted the significant difference in public community stigma: respondents who are from the US scored lower in community stigma towards vignette subject. In examining the associations between suicide-related stigma and characteristics of respondents in Mexico City, the regression models explained 7.1%, 10.3%, and 5.7% of the variance in personal-level, community-level, and future potential stigma, respectively. In the USA, regression models for personal-level stigma, the second generation and third generation of immigration scored higher than the first generation of immigration. These findings underscore that suicide perceptions and beliefs are nuanced and differ across generations, location and participants knowledge and exposure to individuals with mental health concerns. Addressing suicide stigma requires a nuanced and community-specific approach that acknowledges the roles of sociodemographic factors, local beliefs, and knowledge of and exposure to suicide. These findings support the need to specificity in targeting community-based stigma reduction efforts within Latino/Hispanic communities.

Sara Abu Touq, Ire Adelakun, Laura Boifort, Skyler Enriquez, Luisa Ortega, Brendan Salisbury

Rasa Geniene, Vilnius University (Faculty of Philosophy, Institute of Sociology and Social Work; Center for Disability Studies); Kornelija Krutulytė, Vilnius University (Faculty of Law; Center for Disability Studies)

The research aims to deconstruct the capacity limitation system and offer alternative methods for the balance of the system and the development of services that ensure the legal capacity of individuals.

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Limitation of legal capacity - one of the most experienced stigmas among persons with mental and/or intellectual disabilities. Based on the framework of U. Bronfenbrenner's ecological systems theory, persons with disabilities are stigmatized according to their abilities at the macro level (laws, society's attitude, norms), at the exo level (from which the norms of the macro system are concrete manifestations), at the meso level (when specialists from different sectors interact with each other interaction decides the person's position) at the micro level (where decisions are made by the person's guardian). Disability rights activists often equate a limitation of legal capacity with juridical death. The issue of incapacity is intertwined in three main systems (social security, health care, justice), which, from the idea, should organize and provide services that meet the individual needs, but on the contrary - the system works in such a way that there are no alternatives that would restore or prevent the limitation of legal capacity.

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Purpose of the presentation: Introduce the balance of social security, health care and justice sectors in the capacity (non)restriction system (both revealing structural obstacles and opportunities for system improvement). Study objective: The balance of different sectors in ensuring the legal capacity of persons with disabilities. Study design: The research uses an innovative methodological approach, which proportionally includes representatives of different related sectors in the study of the capacity system, which can help to identify both the main obstacles and alternatives to the capacity limitation system. Participants: professionals from different fields (20 interviews).

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The results of the study showed that a strong system imbalance prevails in the system of (non)restriction of capacity - the medical and legal sectors have the highest weight, social security has the lowest. The results of the study also revealed that the system of (non)restriction of capacity is still dominated by a strong medical model of disability assessment. When assessing a person's ability to make decisions independently, the attention is paid to assess what the person cannot do, but what the person could do if he received appropriate help is not assessed at all. However, what a person could do if he received the appropriate help and services is completely underestimated. Also, the research revealed that there are no institutions that represent (defend) the interests of a person with a disability, which means that those who are interested in limiting a person's capacity can initiate it without any additional obstacles.

Melissa Ceuterick, Ghent University, Belgium

Sociological literature on health-related stigma contains remarkably few theoretical reflections on stigma related to medication use.

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This is a combination of personal- perceived public stigma, specifically related to medication

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To address this gap, a grounded theory of medication stigma is introduced, based on an analysis of 30 in-depth interviews with long-term users of benzodiazepine receptor agonists (BZRAs). The grounded theory approach was informed by sensitizing concepts from sociological literature on health related stigma.

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The proposed theoretical conceptualisation contains three different layers of medication stigma, which I will then further explore building on Scambler’s critical conceptualisation of health-related stigma, the shame-blame complex. The first layer of medication stigma is related to the metonymical role of medication. As a symbol of the underlying condition (here anxiety and insomnia), which in itself is often stigmatised, medication potentially reveals an ontological deficit, one is to be ashamed of. The second layer of medication stigma emerges from the contested pharmaceuticalisation of these underlying problems. The choice for medication is diverging from the societal health imperative and hegemonic norms around healthicisation. Opting for the metaphorical ‘easy way’, is therefore seen as something to be blamed for (in critical theory called a moral deficit). Furthermore the perception of this norm is further grafted on ageist stereotypes. To fully grasp the mechanisms of medication stigma it is necessary to understand how particular properties of medication fuel negative labelling. Hence, the third layer of medication stigma is built around negative labels about the assumed inherent properties of the medication. In the case of BZRA this contains stereotypes about the psychotropic effects resulting in a presumed changed ‘self’ and moralising ideas about addiction resulting from the dependence forming properties. From a critical theoretical perspective, the third layer thus merges a supposed moral and ontological deficit. Finally, I reflect on possible unintended outcomes of this multilayered stigmatisation.

Florence Sum Yu Ho, The Chinese University of Hong Kong; Emily Wing Yi Lau, The Chinese University of Hong Kong

This study explores the application of Buddhist-derived psychological constructs towards advocating social justice.

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Through developing a short term direct cultivation of equanimity, self-compassion and mindfulness respectively, this study aims to differentiate and compare effects of the 3 constructs in cultivating compassion and reducing stigma towards socially minoritized groups. It is hypothesized that Equanimity, a stable and balanced state of mind towards all experiences, can not only encourage compassion but contributes to reducing bias.

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Reviewing the current research field on stigma and advocacy, while Buddhist concepts of interconnectedness were explored in relation to stigma reduction, equanimity for instance were mainly used as an outcome measure for meditation practices, seldom for direct cultivation and application in real-life contexts. This study serves as a proof of concept for the use of Buddhist-derived psychological constructs in de-stigmatization attempts, eventually fostering advocacy-driven motivation or action.

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Target population: Socially minoritized groups - groups of individuals subordinated by the society as distinguishable by physical or cultural differences who normally hold less power in the society. For example, those with mental illness diagnosis or physical disabilities, ethnic minorities, or sexual minorities.

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Participants were recruited through a university’s mass mail and convenient sampling. The final sample consists of 194 participants, mean age 22.4 (SD= 5.798), 60.8% female, 57.2% has no daily encounter with social minorities, 82% with no knowledge of Buddhist doctrine and 74% with no mindfulness experience. Participants were randomized into equanimity condition (N=50), self-compassion condition (N= 47), mindfulness condition (N=50) and controlled condition (N=47) respectively. The experiment consisted of a 22-minute video which includes a 7-minute animated didactic part on respective Buddhist constructs, and a 14-minute audio-guided experiential part.

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Responses were collected at 3 timepoints: immediately before and after the experiment, and after one-week for follow-up. Measures include the two-factor Equanimity Scale (Juneau et al., 2020) ;The 21-items State Mindfulness Scale (Tanay & Bernstein, 2013) ;The 20-item Sussex-Oxford Compassion for the Self Scale (SOCS-S; Gu et. al, 2019); The 20-item Sussex-Oxford Compassion for Others Scale (SOCS-O; Gu et. al, 2019) ; The 13-items Social Distancing Scale (Mak et al., 2014); and a 6-items self-created scale, based on the Collective Action scale (Chan & Mak, 2021) to measure advocacy behaviors.

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Repeated measures ANOVAs (n=194) found that separate inductions of equanimity, self-compassion and mindfulness all significantly increased compassion to others. However, only inductions of equanimity and mindfulness led to a significant decrease in social distance, with equanimity group carrying greater effect size. No significant effect was found in increasing advocacy actions for social minorities. Results suggested the application of direct cultivation of equanimity towards reducing bias, while increase in self-compassion or compassion does not contribute towards reducing bias.

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In exploration of the relationships between equanimity, mindfulness and self-compassion, all experimental groups significantly increased self-compassion and state mindfulness. Even-mindedness, one of the subscales of equanimity, was cultivated from the induction of equanimity and self-compassion respectively. However, no significant time by group interaction effect was found for hedonic independence, another subscale of equanimity.

Lely Safrina, University of Groningen, Universitas Syiah Kuala; Nudzran Yusya, 4Department of Psychology, Universitas Syiah Kuala, Indonesia; Gerdina H. M. Pijnenborg, 2Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands 3Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands; T.K..Bouman, 1Department of Clinical Psychology and Experimental Psychopathology, The Netherlands

In the primary healthcare system of Indonesia, represented by Puskesmas, clinical psychologists play a crucial role in addressing mental health issues. However, they often confront stigma related to mental health in the course of their work. This qualitative study delves into clinical psychologists' experiences, exploring how they perceive and navigate this stigma while fulfilling their roles

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clinical psychologists, Indonesia

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This research employed a qualitative study design to explore the self-perception of clinical psychologists regarding their roles in the Indonesian healthcare system in Yogyakarta with stigma associated with mental health in Puskesmas. Data were collected through five focus group discussions (FGDs) between December 2022 and March 2023. All clinical psychologists working in Puskesmas (community health centers) across Yogyakarta were invited to participate in the study. To be eligible, participants must have at least one year of professional experience working in Puskesmas. A total of 45 clinical psychologists participated in the FGDs, representing a diverse group of professionals from various Puskesmas in Yogyakarta. Local facilitators with expertise in qualitative research methods and familiarity with the local context were engaged to facilitate the FGDs. Thematic analysis was used to analyze the data collected from the FGDs.

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1. Perception of Stigma: Initial findings reveal that clinical psychologists often encounter societal and institutional stigma related to mental health in their professional roles. They perceive that mental health issues are frequently stigmatized in society, which affects how service users approach and engage with psychological services.

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2. Navigating Structural Stigma: Clinical psychologists encounter structural and policy-based stigma within the Puskesmas system, such as limited resources for mental health and insufficient support for mental health initiatives. These structural barriers impact their ability to provide adequate care.

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3. Impact on Clinical Practice: Stigma influences how clinical psychologists interact with their clients. They report the need to address and counteract stigma as a part of their practice, working to create safe and non-judgmental spaces for service users. Additionally, stigma affects the willingness of individuals to seek psychological services.

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4. Advocacy and Change: Many clinical psychologists expressed a commitment to advocating for change in policies and public perceptions surrounding mental health stigma. They believe raising awareness and promoting mental health education is essential to reducing stigma.

Kristin Kosyluk, University of South Florida; Erin Gallagher, This Is My Brave

The targets of the This Is My Brave intervention are public stigma, desired social distance [proxy of discrimination], perceived difference [driver of stigma], self-stigma/empowerment, and label avoidance/attitudes toward treatment-seeking.

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This Is My Brave (TIMB; https://thisismybrave.org/) is a national non-profit anti-stigma organization grounded in the principles of contact-based stigma change and peer support. TIMB issues casting calls within communities for individuals with lived experience of mental illness and/or addiction to come forward and share their stories of their challenges with mental illness/addiction, as well as their recovery journey and message of hope, through any means of creative expression (i.e., monologue, poetry, song, stand-up comedy). TIMB storytellers (cast members) go through a process of several months working with the production team and their cast mates to fine-tune their performance, supporting one another on their journey to show day and taking the Brave stage. A TIMB cast is typically comprised of 8 - 10 storytellers. TIMB requires Brave Production Teams to capture TIMB shows using professional videography. These videos are housed on the TIMB YouTube Channel (https://www.youtube.com/@ThisIsMyBrave). TIMB's videos have been used in various ways to extend the reach of this program beyond the theater.

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Dr. Kristin Kosyluk, Director of the STigma Action Research (STAR) Lab at the University of South Florida (Tampa, Florida, USA), has served as This Is My Brave's (TIMB's) evaluation partner for the past eight years, conducting multiple studies to evaluate the impact of the program on stigma reduction targets. This work has demonstrated that TIMB is effective in reducing stigma, improving beliefs about recovery and empowerment, and improving willingness to seek treatment among the audience members of a Brave show (Kosyluk et al., 2018). Additionally, TIMB videos have been shown to reduce perceived differences and desired social distance among viewers (Kosyluk et al., 2021). Dr. Kosyluk has also gathered data over the past several years from TIMB cast members. These data suggest that cast members experience an increase in empowerment (power-powerlessness and righteous anger subscales of the Empowerment Scale).

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TIMB has also produced numerous targeted versions of their shows aimed at addressing stigma among and toward specific groups, including:

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- This Is My Brave College Edition

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- This Is My Brave High School Edition

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- This Is My Brave National Teen Show

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- This Is My Brave- Stories from the Black Community

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- This Is My Brave- Stories from the APIDA Community

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- This Is My Brave- Stories from the Veteran Community

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- This Is My Brave- Stories from the College Athlete Community

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Dr. Kosyluk's STAR Lab Team and colleagues evaluated the Stories from the Black Community shows (Conner, Kosyluk, et al., 2023), finding that these shows produced significant declines in stigma, discrimination, and perceived difference, and increases in beneficial attitudes towards treatment-seeking and anti-racism among audience members. Additionally, audience members who identified as Black Indigenous People of Color (BIPOC) experienced significantly greater improvements in beneficial attitudes toward treatment-seeking compared to non-BIPOC audience members, demonstrating the importance and value of these targeted shows. STAR Lab has also evaluated the Asian, Pacific Islander, and Desi American (APIDA) Community show, with similar findings to the Black Community show, though not finding differences in effects between APIDA and non-APIDA audience members.

Amanda C. M. Li, Storytaler; Winnie W. S. Mak, The Chinese University of Hong Kong & Storytaler; Calian Wong, The Chinese University of Hong Kong

Stigma against people with mental illness is a significant concern worldwide. Research has been conducted to identify effective strategies to reducing stigma that leads to numerous adverse outcomes. Two of the most promising approaches for reducing stigma are education and contact. However, these interventions are typically conducted face-to-face, which presents challenges due to real-world constraints such as time costs for storytellers, pragmatic constraints, and limited contact to attendees. Additionally, few studies have explored psychological moderators of stigma reduction efforts which may shed light on which approach is suitable for which type of persons. Therefore, the purpose of this study is to investigate the impact of online psychoeducation and online contact, specifically through sharing recovery stories, on reducing stigma. The study also aims to identify possible psychological attributes that may moderate the effectiveness of these interventions.

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This study focused on addressing public stigma at the individual level. To assess the effectiveness of utilizing online education and contact through recovery stories in reducing stigma, longitudinal data were collected. The study took place in Hong Kong.

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277 participants (67.51% female; mean age=22.38, SD=4.15) were recruited for this study. Participants were randomized into three groups: control group, education group, and story group. They were asked to complete a questionnaire at three different time points: before the intervention, immediately after the intervention, and one month after the intervention.

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In the control group, participants read posts about interesting facts related to Hong Kong. In the education group, participants read posts containing factual information about mental health. In the story group, participants read posts that incorporated mental health information into a story written by individuals in recovery of mental illness.

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These interventions lasted for one month, during which participants were exposed to a post every three days in three separate Facebook groups. The following outcomes were measured: mental health literacy, attitudes towards people with mental illness and help-seeking, stigma against people with mental illness, social distance. Compassion, non-attachment, and interconnectedness were measured as possible moderators. Linear mixed models were conducted to analyse the data.

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Results showed that online education was effective in increasing mental health literacy, reducing stigmatizing attitudes towards people with mental illness, and enhancing help-seeking attitudes. Online contact was also found to be effective in increasing mental health literacy, reducing stigmatizing attitudes towards people with mental illness, and strengthening personal advocacy for people with mental illness.

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Compassion, nonattachment, and interconnectedness were found to be significant moderators. Specifically, compassion moderated the reduction of public stigma, nonattachment moderated the promotion of a more positive attitude towards people with mental illness, and interconnectedness moderated both outcomes in the online contact group.

Gordon Johnston, See Me

Scotland’s Mental Health and Wellbeing Strategy, published in November 2023, has a vision of a country “free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.”

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The Lancet Commission on ending stigma and discrimination in mental health (Thornicroft et al, 2022) https://doi.org/10.1016/S0140-6736(22)01470-2 describes people with lived experience as “the key change agents for stigma reduction”.

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Across the mental health policy landscape in Scotland, lived experience engagement has become an integral part of all new developments. This includes the work of See Me, Scotland's national programme to end mental health stigma and discrimination, which builds lived experience into all its programs.

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Many other developments have been based on the lived experience of Scots, including our new Mental Health and Wellbeing Strategy, our Self Harm Strategy and Suicide Prevention Strategy.

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A range of initiatives enable this engagement to take place on an ongoing, not one off, basis. Work to implement the Suicide Prevention Strategy is informed by a Lived and Living Experience Advisory Group and a Youth Advisory Group. Voices of eXperience (VOX) is government funded as a national collective advocacy organisation. A new Diverse Experiences Advisory Panel (DEAP) has been formed to enable engagement with those from communities traditionally excluded, or unlikely to engage, in policy making. And a fundamental review of all mental health law, the Scott Review, had a leadership team that included two people with lived experience as vice chairs of the review.

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We have moved over several years from little or token lived experience involvement to a position where discussion starts from how to involve rather than whether to involve. This major policy shift will have a positive impact on efforts to tackle mental health stigma.

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In this presentation, you will hear from voices of lived experience who have worked across See Me initiatives. Through these first-hand accounts, we will explore what involvement has looked like, and what it has meant to people with lived experience of mental ill-health in Scotland.

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This is an ongoing shift in approach across many different programmes and initiatives. The position isn’t perfect, but considerable progress can be demonstrated.

Ben C. L. Yu, The Hong Kong Polytechnic University; Winnie W. S. Mak, The Chinese University of Hong Kong; Floria H. N. Chio, Trent University

A total of 157 Hong Kong college students (70% women, Mean age = 20.31) were recruited in Study 1 while 128 Hong Kong college students (62.5% women, Mean age = 24.35) were recruited in Study 2.

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Objective of Study

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The perceived separation of the socially dominant group from people with mental illness has been theorized to be one of the main components of stigmatization. Therefore, building a connection between the dominant group in the general population and people with mental illness could contribute to stigma reduction. Interconnectedness, derived from Buddhist psychology, emphasizes an individual’s understanding that all events or phenomena in the world arise due to various causes and conditions; thus, no one and nothing exists in isolation. With an understanding of interconnectedness, members of socially dominant groups will know how closely connected they are with people with mental illness and, therefore, have less stigma and a greater intention to advocate for this group of people. The author will introduce how interconnectedness could be a potential candidate in the reduction of public stigma on mental illness, supported by the findings of two experimental studies.

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Method

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In Study 1, participants were randomly assigned to three conditions, including the interconnectedness condition, compassion condition, and active control conditions. Participants in each condition underwent a 20-minute exercise that manipulated the respective constructs. Study 2 aimed to compare the effect of interconnectedness with different types of explanations of the recovery of people with schizophrenia, including biogenetic explanation, psychosocial explanation, and sociocultural explanation on public stigma reduction. People were randomly assigned to four conditions, which include bio-psychosocial explanation condition, bio-psychosocial-sociocultural condition, bio-psychosocial-sociocultural-interconnectedness condition, and bio-psychosocial-sociocultural-interconnectedness condition. Participants in both studies were asked to complete pre-experimental, post-experimental, and 2-week follow-up assessments.

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Results of Study 1 in the interconnectedness condition showed reduced social distance from people with mental illness at the post-experimental assessment. Compassion was also supported to be a significant mediator in the association between interconnectedness and the intention to advocate for people with mental illness. The results of Study 2 showed that participants in the condition with interconnectedness induced reported that they felt more responsible for the recovery process of people with schizophrenia, which predicted lower social distance and higher intention to advocate for this group of people at the 2-week follow-up assessment. The two studies provided causal evidence supporting the potential of interconnectedness in stigma reduction for people with mental illness.

Rosemary Gathara, Ms Judy Kariuki, BNBR Kenya; BNBR Champion; Marta Sanchez, Obertament; Sue Baker, Obertament Champion, Changing Minds Globally/CBM UK; Erla Magnusdottir, CBM UK

In both the Basic Needs Basic Rights (BNBR) Kenya’s ‘Speak Up’ anti-stigma project and the Catalonian ‘Obertament’ anti-stigma programme one of the main targets was to improve public knowledge, attitudes, and intended behaviour related to mental health (measured using the MAKS, CAMI, RIBS tools in Kenya and the CAMI and RIBS tools in Catalonia). Another related target was to build the confidence and skills of local people with lived experience of mental health problems to tackle stigma (and in Kenya to claim their rights and in Catalonia to reduce self-stigma). They would then deliver ‘social contact’ conversations amongst other activities. In Kenya there was a priority focus on young people aged 18-35.

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In total 110 people with lived experience were trained and supported as Champions in Catalonia over a period of five years (2018-2023) whilst in Nairobi County and surrounding areas in Kenya 62 people with lived experience were trained and supported as Champions over five years (2018-2023).

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In both Kenya and Catalonia local people with lived experience were recruited to become anti-stigma Champions who were provided with training and on-going support from the project leads as well as peer support from other Champions.

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Champions were central to the anti-stigma projects that took a co-productive approach to ensure Champions co-designed and delivered key aspects of the projects including training for Editors, Journalists, Care givers and Community Health Promoters, planning and delivering social contact events, and the development and delivery of training for new cohorts of Champions in Nairobi.

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In Catalonia training for Champions aimed to empower, create social bonds, and develop tools and skills to participate in actions to fight stigma through sharing testimonies. Training included three initial sessions to provide knowledge to help identify stigmatising behaviours and how to respond to them, three sessions from the Honest Open Proud training (devised and originally delivered by the Illinois Institute of Technology Professor Patrick Corrigan), and media training providing tools to share mental health stories safely and effectively with the media.

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In Nairobi BNBR Kenya’s initial training for the first 20 Champions, delivered in English and Swahili in 2019, was based on the Champion Training Modules developed by the Time to Change programme in England and then adapted by local partners in Africa and India as part of the Time to Change Global programme (TTCG) that ran from 2018 to 2020. A series of training modules were focused on increasing knowledge and confidence to challenge mental health stigma and discrimination in communities with the main method being social contact activities, but this developed into the further anti stigma work with new audiences.

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The Champion training modules covered an introduction to mental health stigma and discrimination, the role of a Champion, social contact, opening and closing conversations, levels of disclosure, managing challenging situations, taking care of yourself and others. Media training was also provided.

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23 Catalonia Champions were surveyed in 2023 before and then after completing the training using the Internalized Stigma of Mental Illness Scale (ISMI) with questions focused on the respondent’s identity and experience as someone with a mental illness. The impact analysis was positive, reducing the mean of the ISMI scale from 2.14 to 1.83 significantly (T-student test 0.00 <0.05). A further survey of 80 Champions in 2023 (who had been active for several years) found that: 88% said their self-stigma had improved, 87% felt able to have open conversations on mental health, 74% said there were more capable of identifying situations of discrimination towards them, and 87% said they felt more able to help people around them.

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In Nairobi an independent evaluation at the end of the TTCG programme in March 2020 involved analysis of Champions’ levels of confidence (to tackle mental health stigma) and empowerment since ‘since becoming a Champion in the Time to Change Global programme’ using a five-point Likert scale. 87 Champions from the locations of the five pilots were surveyed including 13 people from Nairobi (6 female and 7 male). The findings from Kenyan Champions were that: 100% had improved belief in themselves, 92% felt more confident to speak about their mental health problem to the general public, 100% felt more confident to tackle stigma and discrimination, 100% felt more confident to stand up to someone that is treating them unfairly whilst 100% said they felt more confident to stand up to someone that is treating some else unfairly.

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Quote from BNBR Kenya Champion: “How to package your story. There is a topic that I really loved that we learned, how to share your story safely, because at first, we would share our stories but some of the questions you were asked would trigger you and you wouldn’t know how to answer but through the training at least we were told to share what you are confident answering and if not, you don’t have to answer it”

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Quote from Obertament Champion: “Now I'm raising things/comments/actions that are stigmatizing in my group of friends. I've stopped pretending "nothing's going on” and shut up for fear of losing friendships. I have gained self-confidence”

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Whilst the training models and evaluation tools used in Catalonia and Kenya differed, there were similarities is some of the content of the training and in the positive impacts reported by Champions involved in the projects.

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Conclusions:

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Whilst the training models and evaluation tools used in Catalonia and Kenya differed, there were similarities is some of the content of the training and in the positive impacts reported by Champions involved in the projects.

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Further research and qualitative evidence from Champions from both projects show longer term benefits; follow-up assessment of empowerment and attitudes amongst Catalonian Champions revealed that the positive effects from the training were maintained over time, and many unexpected outcomes have been reported amongst Nairobi Champions as part of the end of the project evaluation in 2023. The findings report many longer-term impacts on Champions’ lives that included setting up social media accounts to share their stories and challenge stigma, establishing MH organisations to provide services/training/communication support, advocating for mental health and addressing stigma as part of national, regional and global networks and gaining employment in this field. For example, Edwin Mburu (trained in 2019 as Champion) who now works for the Global MH Peer Network and Daphne Wanjiru who is using her lived experience as she starts training to become a counsellor.

Eglė Šumskienė, Vilnius University; Violeta Gevorgianiene, Vilnius University

Obective of the study is to reveal the experiences of mothers with intellectual and psychosocial disabilities whose children have been removed, placing a spotlight on the pervasive stigma and the deeply rooted oppressive societal, institutional, and personal circumstances.

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Institutional decisions to separate children from their mothers with intellectual and psychosocial disabilities are primarily shaped by the pervasive public stigma. Public discourse legitimizes intervention in the private and family lives of individuals with disabilities, leading to restrictions on the sexual and reproductive rights. Moreover, institutional stigma is a contributing factor, as professionals frequently adopt a controlling stance, fueled by a lack of trust in the abilities of these mothers to care for their children.

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Conducted between 2018 and 2022, twelve in-depth qualitative, semi-structured interviews with mothers having intellectual or psychosocial disabilities form the core of this research.

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The main categories emerged from the research data and shed light on the narratives of mothers with intellectual and psychosocial disabilities who experienced child removal: a) origins: labelled as "deviant" from the beginning, b) the quest for acceptance and attachment, c) the child portrayed as an "incident," both a source of pride and a burden, d) the absence of social affirmation, e) the judgment of removal – swift and irrevocable, and f) feeling abandoned by loved ones, society, and ultimately left childless.

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The interviews revealed, even if support was offered to women, often it did not come within the timeframe that it was really needed. Having been abandoned during their own childhood, the women later encountered challenges that they couldn’t resolve alone. The support offered often came too late and could not fill the void of love, care, and basic survival skills, which were gaps from their own childhood. This support was not the remedy for healing; it was merely a pill to relieve the symptoms. Their stories challenge societal power structures by highlighting the resistance of institutional frameworks to embrace diverse maternal roles. In societies advocating for diversity and inclusion, there remains a gap, preventing the acknowledgment of various "motherhoods" that extend beyond the conventional roles depicted on the forefront.

Sven Speerforck, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Germany; Vanessa Jürgensen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Germany; Mirjam Göbel, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Germany; Nicholas Meyer, nstitute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

The perception of what constitutes mental illness is influenced by various social and medical developments. Prevalence-induced concept change is a phenomenon where decreasing the prevalence of a category leads people to expand their judgment of that concept. In this study, we tested whether changing the prevalence of statements describing mental illness results in a change in the concept of mental illness.

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General population, cross-sectional assessement

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Based on a population survey (n = 1031), we created a validated set of 273 brief statements depicting either clear symptoms of mental illness, clear examples of healthy behaviour, or ambiguous situations. We presented a subset of statements to 138 students, asking them to judge whether each statement represented mental illness, or not. After 96 statements, we reduced the prevalence of clearly mentally ill statements in one group, while the proportion of statements denoting clear mental illness remained the same in the other group.

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In the group where the proportion of clearly mentally ill statements was reduced during the experiment, a concept change of mental illness evolved: participants were more likely to identify a statement as denoting a mental illness. The results indicate that the perceived prevalence of symptoms of mental illness is important for conceptualizing mental illness and that decreasing prevalence broadens the concept of mental illness. These findings add a novel perspective to current debates around diagnostic thresholds, the treatment-prevalence paradox, the medicalization of emotions, and the focus of anti-stigma campaigns.

Camille Wets, Hedera, Department of Sociology, Ghent University (Belgium); Dr. Melissa Ceuterick, Hedera, Department of Sociology, Ghent University (Belgium); Prof. Dr. Piet Bracke, Hedera, Department of Sociology, Ghent University (Belgium)

Depression is a prominent mental health concern in Belgium, affecting nearly one in ten Belgians (9.4%). It is particularly important to address depression among people with a migration background within the Belgian population. Studies across Europe have found higher prevalence rates of mental health problems such as depression and similar findings have been observed in Belgium. Notwithstanding the evidence suggesting a higher prevalence of depression among people with a migration background, recent studies indicate that these patients face additional challenges in accessing adequate medical care and are underrepresented in mental health services. Research has demonstrated that people with a migration background may face obstacles when seeking mental health care, including structural, cultural and linguistic barriers.

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However, recent studies have shed light on the possible impact of health care providers on disparities in mental health care utilisation. In this way, researchers have come to assume that general practitioners (further referred to as GPs) may contribute to ethnic disparities in mental health care use by inadvertently relying on stereotypes when evaluating and referring depressed patients with a migration background. This can lead to divergent treatment and referral outcomes when compared to native patients. While research on this possible provider bias among European GPs is limited, findings by Ceuterick and colleagues (2020) and Delaruelle and colleagues (2022) suggest evidence of a provider bias among Belgian GPs. These results underscore the crucial role that Belgian GPs can play in reducing ethnic disparities in mental health care use. Given their central role as gatekeepers in the Belgian primary health care system, GPs have the power to apply (unconscious) stereotypes when assessing and referring patients with a migration background. Ultimately, this can lead to (unintentional) stigmatisation of these patients and GPs can (unintentionally) contribute to disparities in mental health care due to the stigmatisation of patients with a migration background.

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Consequently, this study aims to examine the stigmatisation of patients with a migration background suffering from depression in the accounts of Belgian GPs.

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The main stigma target of our study is that of patients with a migration background suffering from depression in medical encounters with Belgian GPs.

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Nineteen in-depth interviews and four focus groups with Dutch-speaking GPs were conducted. Employing Link and Phelan’s (2001) theoretical framework of stigma, a critical discourse analysis will be performed in order to explore the potential stigmatisation of these patients. Our study emphasizes the significance of Link and Phelan’s (2001) conceptualisation of stigma, highlighting the essential role of power to the social production of stigma. Given the expert and gatekeeping role of GPs, we anticipate that this aspect will play a central role in our findings. Additionally, the four interrelated components of stigma (‘labelling differences’, ‘stereotyping differences’, ‘separating “us” from “them”’ and ‘status loss and discrimination’) will guide both the discourse analysis of the in-depth interviews and focus groups and the interpretation of our final findings.

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We believe this study can contribute to the field of research on stigmatisation and ethnic disparities in mental health care in an innovative way. The ultimate goal is to formulate constructive recommendations based on the obtained results to support general practice, in order to prevent unconscious stereotyping and stigmatisation of patients with a migration background suffering from depression. Consequently, we aim to remove barriers to access to high-quality mental health care for these patients in the Belgian health care setting.

Therese L. Todd, New York University School of Law

The present study sought to measure explicit and implicit bias toward people with mental illness among the general public and police officers to understand how attitudes toward mental illness vary among these populations within the United States.

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Population

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Participants

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Participants from the general public (n = 303) were recruited via Prolific, a crowdsourcing online platform that is specifically designed for social science research (Palan & Schitter, 2018). General public participants were compensated $7.25. All participants had to be 18 or older and live in the United States. The general public were approximately half male and female and primarily White (76%). 34% had a Bachelor's degree and the most common income range was $25,000 - $49,999 (30%).

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Police officers in the US (n = 198) were recruited from Police1 (a policing blog), personal contacts, and email recruitment through police department leadership and administration. Officers were primarily male (76%), White (89%), highly educated (57% Bachelor’s degree), most (79%) made over $100,000 per year, and most (75%) had received Crisis Intervention Team (CIT) or mental health training. Officers were compensated $20 for their time.

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Procedure & Measures

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Through a Qualtrics online study, all participants completed a series of self-report questionnaires, a memory recall task, two implicit association tests, and demographic questions. For explicit bias, participants completed the Social Distance Scale, Dangerousness Scale, Attitudes toward Mental Illness Scale, and only police officers completed the Mental Health Attitude Survey for Police. For implicit bias, officers completed two IATs assessing the association between badness and mental illness and dangerousness and mental illness. To expand the operationalization of implicit bias, I also administered the Mental Illness Microaggressions Scale – Perpetrator Version, and developed a free recall memory task, in which the ratio of positive to negative facts remembered from a video about a PMI’s life story served as a measure of implicit bias. All measures were randomized.

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The results demonstrate that among the total sample generally attitudes toward mental illness were fairly moderate and, in all cases except for the IATs, attitudes were more positive leaning. It is noteworthy that the only variables to reveal negatively skewed attitudes toward PMIs were the IATs. Other variables whose total sample means were near the midpoint were the MIMS-P Patronization Subscale, MIMS-P Fear of Mental Illness Subscale, and Dangerousness Scale. Given that dangerousness of PMIs is the most pervasive stigma of mental illness, it makes sense that the MIMS-P Fear of Mental Illness Subscale and Dangerousness Scale would be relatively more elevated than the rest.

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I ran multivariate linear regressions for each measure of bias controlling for demographics. In most instances, bias was not significantly different between the general public and police officers. However, sample type was a significant predictor of four bias measures: the Dangerousness IAT (B = .18, t(473) = 3.06, p = .002), Social Distance Scale (B = 1.72, t(476) = 2.70, p = .007), AMIS Total Scale (B = 2.33, t(475) = 3.58, p < .001), and AMIS Recovery & Outcomes Scale (B = 1.53, t(475) = 3.80, p < .001). Across all measures, officers demonstrated significantly more negative bias toward persons with mental illness than the general public.

Therese L. Todd, New York University School of Law

Police responses to persons with mental illness (PMIs) compared to those without appear to be more likely to result in negative outcomes, underscoring the importance of understanding these interactions and the factors that may influence them (Crocker et al., 2009; Kesic et al., 2013; Rossler & Terrill, 2017). Research has examined how attitudes may impact behavior, yet little research has examined officer attitudes toward PMIs, and no study has examined implicit bias toward PMIs among police officers or how police culture may impact outcomes in mental health crises. Some research has found that implicit attitudes may be more influential in decision-making than explicit attitudes (Banaji & Greenwald, 2013; Greenwald et al., 2009). Research on police culture has demonstrated that when officers perceive a positive, procedurally just climate, they are more likely to engage in positive policing practices (Myhill & Bradford, 2013; Bradford et al., 2014). No studies have assessed police culture related to mental health crises. The present study sought to assess the role of explicit and implicit bias toward mental illness, as well as police culture, on officer decision-making related to PMIs. I hypothesized: 1) implicit bias, over and above explicit bias, toward PMIs would be a significant predictor of less helpful and more restrictive outcomes; and 2) police culture will moderate the relationship between implicit bias and officer decisions, such that lower perceptions of police culture and higher implicit bias will result in the endorsement of less helpful and more restrictive resolutions.

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Population and structural

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Participants

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Participants were police officers in the US (n = 198) recruited from Police1 (a policing blog), personal contacts, and email recruitment through police department leadership and administration. Officers were primarily male (76%), White (89%), highly educated (57% Bachelor’s degree), most (79%) made over $100,000 per year, and most (75%) had received Crisis Intervention Team (CIT) or mental health training. Officers were compensated $20 for their time.

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Procedure & Measures

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Through a Qualtrics online study, police officers completed a series of self-report questionnaires, a memory recall task, two implicit association tests, a police culture measure, demographic questions, and responded to decision-making questions about a written vignette of mental health crisis. For explicit bias, officers completed the Social Distance Scale, Dangerousness Scale, Attitudes toward Mental Illness Scale, and Mental Health Attitude Survey for Police. For implicit bias, officers completed two IATs assessing the association between badness and mental illness and dangerousness and mental illness. To expand the operationalization of implicit bias, I also administered the Mental Illness Microaggressions Scale – Perpetrator Version, and developed a free recall memory task, in which the ratio of positive to negative facts remembered from a video about a PMI’s life story served as a measure of implicit bias. Officers also completed a measure of procedurally just organizational climate related to perceptions of their supervisors, other officers, and department policies. All measures were randomized. Then, police officers read a written vignette describing a mental health crisis and indicated the level of force they would most likely use and how likely they would be arrest, transport the person to services, and take no formal action in the encounter.

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Analytic Strategy

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To assess the relationship between bias and decision-making, I conducted hierarchical multivariate regressions with each outcome as the dependent variables (use of force, arrest, mental health transport, and no action). Each regression included four steps in the model: demographic characteristics, explicit bias variables, implicit bias variables, and police culture variables. To assess how police culture moderated the relationship between bias and officer decision-making, I replicated these analyses and included a fifth step in the model of interaction terms between implicit bias and police culture.

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Importantly, I found that all officers would not use force above a verbal warning and 82% of officers reported they would be very unlikely or unlikely to arrest the PMI described in the vignette. I now describe the significant results of the multivariate analyses. Overall, the models predicting officer decision-making accounted for 23% (no action) to 32% (mental health transport) of the variance. In general, implicit bias explained a larger percent of variance across models than explicit bias. Although bias did not consistently predict officer decision-making, it was a significant predictor in some instances. Results demonstrate officers who desired greater social distance from PMIs were less likely to transport them to mental health services (B = 0.07), yet interestingly those who endorsed higher levels of microaggressions against PMIs were more likely to transport them to services (B = -0.06). Further, officers with more negative attitudes toward mental illness were less likely to take action in a mental health crisis (B = -0.07). Finally, officer-related procedurally just organizational climate moderated the relationship between bias and officer decision-making such that those with the lowest officer-related culture, and highest levels of implicit bias toward PMIs, were least likely to transport a PMI to services (B = -0.06) or take action in a mental health crisis (B = 0.13).

Alicia Lucksted, University of Maryland School of Medicine; Phil Yanos, Psychology Department, John Jay College Of Criminal Justice; Joseph S. DeLuca, Department of Psychological and Brain Sciences, Fairfield University; Uzma Ambareen, Medical Director & Consulting Psychiatrist, The Recovery House, Karachi Pakistan

Internalized stigma is shaped by both common principles of oppression and unique personal and social identities and circumstances combining in dynamic ways. Resources and interventions to support people’s resistance to the risks and harms of internalized stigma must fully embrace both to be effective. This symposium will offer three brief presentations of ways panelists are approaching this synergy to create interventions and will invite attendees to discuss their ideas as well

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Our panel will offer information on three novel anti-stigma efforts centered on resilience against internalized stigma and intersectional identities. The approach of the first (Yanos & DeLuca) is based on narrative therapy, the approach of the second (Ambareen) is incorporating psychoeducation and cognitive restructuring strategies forged in north america into a Pakistan cultural context, and the third (Lucksted) focuses on self-compassion and reframing stigmatized health conditions. As directed, the title and a brief abstract of each of our three papers/presentations is below.

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(1) Title: Adaptation of Narrative Enhancement and Cognitive Therapy for Youth Dealing with Intersectional Stigma

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Phil Yanos, PhD, Professor, Psychology Department. John Jay College Of Criminal Justice, City University of New York.

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& Joseph S. DeLuca, PhD, Assistant Professor, Department of Psychological and Brain Sciences, Fairfield University

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Short Abstract: Youth is a time when identity is still being formed, and internalization of stigma related to mental illness and other marginalized identities (related to race, ethnicity, and sexual identity) may have a powerful impact. This presentation discusses the process of adapting an existing psychosocial intervention targeting self-stigma- Narrative Enhancement and Cognitive Therapy (NECT)- for youth who have recently experienced a first episode of psychosis and how it can be used to address intersectional stigma.

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Do you already have a paper in progress related to this talk? Yes.

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DeLuca, J. S., & Yanos, P. T. (2023). Targeting Internalized Stigma in First-Episode Psychosis Services: Treatment Strategies from an Intersectional Perspective. Journal of Health Service Psychology, 49, 97-106.

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(2) Title: Developing Hum Bolenge / End the Silence, a self-stigma resilience group for psychiatric rehabilitation clients in Karachi Pakistan.

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Uzma Ambareen, MD, Medical Director & Consulting Psychiatrist, The Recovery House, Karachi Pakistan

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Short Abstract: Over the past three years, a team at The Recovery House in Karachi, Pakistan, the only recovery-focused psychosocial rehabilitation program in the city, has worked to create a group program to help clients question internalized and societal stigma and “find their voice” in personally and culturally concordant ways. Incorporating elements of three different US and European based internalized stigma interventions, the program is now in action, led by a Peer-facilitator (TRH client alumni) and a non-Peer staff member. This brief presentation will summarize its development and focus on what participants are saying about the impact of the group for them personally in their family, city, and social/cultural environments.

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Do you already have a paper in progress / published related to this talk? No

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(3) Title: Self-Concepts and Self-Judgements in Navigating Societal and Internalized Stigma regarding Substance Use, HIV, and Intersecting Social Identities (U.S.)

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Alicia Lucksted, PhD, Associate Professor, Department of Psychiatry, University of Maryland School of Medicine

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Short Abstract: While developing two distinct but related psychosocial interventions regarding self-stigma, we interviewed over 40 people living with problematic substance use, HIV, and other stigmatized conditions and life situations. Self-concepts and self-judgements are prominent in their descriptions of navigating these conditions, reflecting internalized stigmatizing messages from intimates and broader social influences. This brief presentation will highlight these stories -and- the self-help and intervention elements that interviewees describe as important in coping with and reducing them.

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Do you already have a paper in progress related to this talk? In progress but not published

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As novel anti-stigma efforts, all three are at early stages of evidence -- having been used in a few iterations or pilot situations with observational data regarding impact.

Lea Mayer, University of Ulm, Germany; Stefanie Johler, University of Ulm, Germany

Negative attitudes about people who experience suicidality and their relatives (i.e. suicide stigma) remain a pervasive challenge, often leading to significant consequences for affected individuals. As general practitioners are often the primary contact with the health care system for individuals experiencing suicidality, they play a pivotal role in the early detection and treatment of suicidality and therefore in suicide prevention. Fear of suicide stigma among general practitioners can lead to a restricted help-seeking behavior of suicidal people due to shame and fear of resentment. This stigmatization can impede successful treatment which, in turn, can increase suicide risk.

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To fight suicide stigma among general practitioners, we developed and evaluated a suicide-specific module, which was implemented within the E-Learning program BASE. BASE aims to empower general practitioners in dealing with psychosocial problems among their patients, including suicidality, child abuse, emotional relationships and sexuality as well as workplace-related challenges.

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public suicide stigma among general practitioners/structural stigma against people experiencing suicidality in primary care

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We developed BASE based on a qualitative needs assessment, which was conducted between August and November 2021. Fifteen general practitioners participated in a qualitative interview, as part of which they were questioned about their experiences and perceived barriers to identify and manage suicidality among their patients. Based on obtained results and considering previous literature, both educational and contact-based intervention components were implemented within BASE, and their effectiveness in reducing suicide stigma were evaluated among 124 general practitioners in a pre-post evaluation study.

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Results from the needs assessment indicated challenges with identifying, assessing and managing suicidality among general practitioners. Preliminary analyses of collected pre-post data revealed significant reductions in suicide stigma.

James Dennis, University of Oxford, UK, and Oxford Health NHS Foundation Trust; Julia Kelly, Oxford Health NHS Foundation Trust; Matthew T. D. Knight, University of Oxford, UK, and Oxford Health NHS Foundation Trust

This service improvement project investigated barriers to, and facilitators of, effective Positive Behaviour Support (PBS) practice through asking frontline nurses and healthcare assistants about their experiences of supporting patients in a secure intellectual disability service. Literature suggests that effective PBS implementation is limited by locally-specific operational and cultural factors, including stigmatised attitudes towards individuals with an Intellectual disability.

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Structural, policy, individual level stigma. cross section qualitative design looking at healthcare provision within the UK.

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Data from six semi-structured interviews with staff were analysed using Interpretative Phenomenological Analysis (IPA),

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The qualitative analysis resulted in three superordinate themes: 1. Following Your Heart; 2. It’s Really Tough – You Have to be Strong; and 3. Just out of Reach – the Small Things That Make a Big Difference. Theme one highlighted how participants experienced close emotional ties to particular patients which could be protective against stigma, but may also limit opportunities for colleagues to establish similar relationships. Theme two described how participants responded to challenges in their roles and navigated team divides regarding the ‘right’ way to respond to behaviours that challenge and competing restrictive versus positive risk-taking ideologies. Theme three captured participants’ wishes for more time for targeted patient wellbeing initiatives and to establish a common PBS approach, emphasising the role of language. Resulting recommendations for the service included: recognising and providing support for the emotional efforts of staff; increasing confidence in PBS-orientated staff by generating meaningful outcome evidence that dissuades colleagues from using alternative practices; and providing targeted training, making creative use of existing interest and skill in PBS within the team.

Franziska Marek, Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany

The death of a close person by suicide presents unique emotional, psychological, and social challenges for suicide loss survivors (SLS). These challenges stem from the sudden and shocking nature of the loss and the multifaceted impact of the stigma surrounding suicide bereavement. Stigmatizing perceptions include notions of negligence and moral failure attributed to SLS and the internalization of such beliefs (i.e., self-stigma), creating barriers to accessing adequate social support for SLS. Social support is an important determinant of adaptive coping, protecting against adverse health outcomes associated with bereavement. This study focuses on the interplay between stigma and social support in suicide bereavement. Our research aims to unravel how stigma and social support interact and influence bereavement experiences and mental health of SLS. We further explore specific characteristics of social experiences that either perpetuate or alleviate perceived stigma as well as facilitate or hinder supportive care among this population.

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This cross-sectional, mixed-methods study, conducted in Germany in 2022/2023, examines the dynamics of self-stigma, perceived public stigma and social support among SLS. It addresses a significant research gap and aims to deepen our understanding of the bereavement experiences of SLS and the social mechanisms that influence them. This knowledge is crucial for developing targeted interventions to reduce stigma and increase social support in suicide bereavement.

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Participants were recruited through social media and suicide bereavement support organizations. Qualitative data was collected through problem-centered, guideline-based online individual interviews with a diverse sample of 18 SLS to explore SLS’ stigma and support experiences. Transcripts were analyzed using qualitative content analysis. Additionally, an anonymous online survey was conducted among 550 SLS. Linear regression analysis will be employed to explore associations between self-stigma, perceived public stigma, perceived loss-related social support, loss-related distress, and mental health outcomes among SLS. The study implementation and data analysis were advised by an expert advisory board consisting of SLS and experts in the field of postvention and suicide bereavement.

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Findings from the qualitative analysis reveal that communication patterns, particularly shortly after the loss, are instrumental in shaping perceptions of stigma and social support. We found that proactive compassion and communal grief expressions play a significant role in fostering supportive and destigmatizing environments. Conversely, avoidant communication and the absence of social reciprocity are linked to increased perceptions of stigma. Intra-familial dynamics characterized by open reflection about feelings of guilt as well as self-education on topics related to mental illness and suicidality emerge as critical in countering self-stigma. Quantitative data analysis is currently ongoing and will provide insights into the associations between perceived public stigma, self-stigma, perceived social support, grief-related distress, and mental health outcomes among SLS.

David Conley, PhD, MSW, University of North Carolina Wilmington

This study examined state-level, mental health-related legislation in order to expose forms of structural stigma as well as identify patterns related to bill outcomes.

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The type of stigma being investigated was structural stigma, to include mental health-related legislation in state legislatures across the United States.

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Quantitative content analysis was conducted on a stratified random sample of mental health-related bills. Specifically, textual data in bills were converted to frequencies that were used in binary logistic regression analyses.

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The study found that structural stigma was present in the language and potential effect of mental health-related bills. Further, political party of the sponsor(s), party majority status, and structurally stigmatic language were all associated with bill passage. Finally, party majority status and structurally stigmatic language predicted bill passage.

Lowri Jones, Time to Change Wales; Dr Bridey Rudd, Mental Health Foundation (Scotland); Nick Jedrzejewski, See Me Scotland

As this campaign is still in development (to be launched in March 2024) we are yet to set the specific metrics and targets. The aim of this campaign is to build on challenging public attitudes around mental ill health and influence the future intended behaviour towards those who are suffering. The campaign focuses on shame, recognised in the literature as an emotional correlate of self-stigma (Shulze et al., 2020).

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If it’s okay to not be okay is a new campaign jointly developed by the UK-Anti Stigma Alliance which is made up of the mental health anti-stigma programmes in the four nations of the UK: See Me in Scotland, Time to Change Wales, Mind in England and Inspire in Northern Ireland.

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A desire to run a joint marketing campaign has been long in the making and during one of our residential meetings last year, a decision was taken to go ahead with it, pooling resource across the four nations to make it happen. Cross-national anti-stigma campaigns are rare, and we are not aware of one that has been delivered by GASA members across four national contexts. Accordingly, there are real lessons for the GASA network to be learnt around delivering campaigns cross-nationally.

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We explored a number of thematic areas which could form the basis of the campaign. Research in each of our four nations shows that shame came through strongly in how people with long term, complex mental illness perceive themselves - and how society perceives them. We agreed to collaborate on a joint campaign across the nations using the theme of shame as the key focal point. We define shame as “a sense of embarrassment or negative reaction some people feel, or are made to feel, when opening up to a mental health problem”. We wanted to develop something memorable and bold, moving away from the softer messaging which we have collectively deployed previously e.g. Time to Talk Day campaigns. We wanted a campaign which would talk to those experiencing serious and/or long-term mental illness as not enough is being done in this territory. We tested the need for a campaign through focus groups hosted in each nation involving experts by experience to consider whether there is scope for such campaign concurring that there is a real need.

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Campaign Objectives

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The overall aim of the campaign is to raise awareness of the negative impact of shame to improve attitudes across society. The key objectives were agreed as follows:

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a) Increase the understanding of general public of how mental health shame impacts people’s lives

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b) Improve confidence to speak about mental illness – both of people with experience of poor mental health and those around them

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c) Change perceptions towards people living with mental health problems (with a focus on complex and serious mental health problems)

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d) Explore own behaviour and challenging your own displays of shame, self-stigma, prejudices and beliefs.

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Audiences

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a) Primary audience – people with experience of poor mental health

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Those who experience severe, enduring and complex mental illness (bipolar, schizophrenia, personality disorder) – though the campaign will speak to all. Shame comes through strongly in how they perceive themselves, and withdrawing from opportunities many of us take for granted.

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b) Secondary audience – friends and family

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Those whose behaviour (i.e. negative words and actions) creates or perpetuates shame. Much of self-stigma is a result of the action of others. We therefore want to see people change the way they act and react towards mental illness, to stop those who are struggling from feeling unfair shame.

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Campaign Creative

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If It's Okay To Not Be Okay challenges the well-used phrase ‘It’s ok to not be ok’, from the perspective of those who live with mental health issues every day. For many it is still not ok to not be ok when living with certain diagnoses. The campaign development and creative outputs centrally feature the authentic voices of those living with mental illness. Verbatim content from eight experts by experience is central to the campaign. People with lived experience are featured talking about why it doesn’t feel ok to have a mental health problem or illness and how shame is still prohibitive and life-limiting across many life areas. The development of this creative content offers lessons to other campaigns around how to adapt campaign creative messages, language, and framing to different national contexts.

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This campaign will launch in March 2024 across all 4 nations of the UK where a full evaluation of the reach and impact will be measured and analysed. The data will be available to present at the conference if we are successful with this submission.

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We will also be able to present our reflections on the process and learnings around a 4-nation campaign, including creative development and national tailoring.

Floria H. N. Chio, Department of Psychology, Trent University

Despite the increasing recognition of the importance of mental health among university students, self-stigma related to help-seeking remains a significant barrier. This study seeks to investigate the role of self-compassion in help-seeking self-stigma and help-seeking intentions among university students. Understanding the interplay between these variables is crucial for developing targeted interventions to promote mental health and reduce stigma. Moreover, by comparing healthcare and non-healthcare students, the study aims to explore potential variations in help-seeking self-stigma and intentions within these distinct groups, providing valuable insights for tailored support strategies.

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The present study examined help-seeking stigma, which refers to individuals' negative beliefs, attitudes, or perceptions about themselves when seeking help for mental health issues. Employing a cross-sectional design, this study explores the association between self-compassion and help-seeking stigma and how these factors are linked to help-seeking intentions among university students. The study also investigates differences in help-seeking self-stigma and intentions between healthcare and non-healthcare students in Hong Kong.

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Hong Kong university students were recruited, and participants completed measures of self-compassion, help-seeking intention, and help-seeking stigma through an online survey.

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Healthcare students showed significantly lower levels of help-seeking stigma and higher levels of help-seeking intention than non-healthcare students. Additionally, results indicated that self-compassion was associated with higher levels of help-seeking intention through lower levels of help-seeking stigma.

Sheharyar Hussain, John Jay College of Criminal Justice - CUNY Graduate Center; Philip Yanos, John Jay College of Criminal Justice

Pakistani American community represents the second largest ethnic minority group (after Asian Indians) within the larger South Asian group, comprising about 10 percent of all South Asians living in the U.S. In spite of anecdotal evidence that mental health stigma is prevalent within the community, few studies have investigated the experiences of community members dealing with mental health challenges, as well as the stigma they experience within their families and in the larger community. Furthermore, the current literature on South Asian experiences in the U.S. has primarily centered on Asian Indian experiences. The objective of this study is to: (1) understand how Pakistani Americans experience mental health stigma in their families and in the larger community, and (2) address the knowledge gap in the literature by studying the experiences of Pakistani Americans whose narratives have been missing from the current literature.

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This study targets multiple forms of stigma including internalized stigma, anticipated stigma, and community stigma in the Pakistani American population living in the U.S. We recruited adults (ages 18 and up) who identified as Pakistani and currently resided in the United States.

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The present study used a qualitative approach (in-depth individual interviews) with nine Pakistani American participants to explore mental health stigma and help-seeking in the community. All of the interviews were done via distance technology (i.e., Zoom), recorded for transcription purposes, and transcribed by a professional transcription service. Recruitment is still ongoing, and we hope to complete twenty in-depth interviews by April 2024.

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Preliminary results revealed that community stigma and anticipated stigma were the most commonly endorsed themes among Pakistani Americans, followed by internalized stigma. Furthermore, findings also revealed that participants experienced microaggressions and/or overt experiences of discriminations due to their mental health concerns. Additionally, the study also identified some barriers to mental health treatment including systemic barriers (e.g., insurance coverage, financial costs, therapists’ lack of cultural competence, not knowing where to find a therapist) and cultural barriers (e.g., faith healers and family’s disapproval of mental health services).

Denise Burnette, Virginia Commonwealth University

To explore how stigma associated with cognitive impairment affects help-seeking for the condition among older adults in India.

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Cultural stigma; Cross-sectional study, Mumbai, India

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Focus groups and in-depth interviews with 20 triads comprising a person aged 60+ who screened positive for MCI, their identified primary caregiver and their primary care physician or psychiatrist and / or traditional healer

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I sampled from NGO-sponsored memory camps in the community and used maximum variation sampling to achieve diversity on key attributes. Interviews were translated from Hindi or Marathi and I used Framework Analysis to analyze the data in Atlas.ti.

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Knowledge and awareness of cognitive impairment and treatment resources were low and all three groups of participants emphasized the role of stigma in reluctance to seek. Physicians attributed the condition to disease-induced pathology and lay persons blamed brain malfunction due to normal aging. Predominant attitudes were that this condition is not a disease, is not serious and/or is not treatable, and that it evokes debilitating stigma toward and among impaired persons, their families and their health care providers.

Karina Stjernegaard, Zealand Region, Denmark (PsykInfo) & University of Southern Denmark

We set out to explore how current mental health professionals, who have lived experiences of being mental health service users themselves, are influenced by these experiences in their daily practices.

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The stigma target in this study is the mental health professionals with lived experiences of being mental health service users themselves, but also how these experiences do not hinder these mental health professionals from stigmatizing current mental health service users.

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The study is a constructivist grounded theory study. Data consists of interviews and diary notes from 14 mental health professionals (psychiatrists, nurses, occupational therapists, pedagogues, and health care workers) working within the Danish mental health system (wards, outpatient units, and housing).

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Stigmatization is experienced, feared, or performed on three levels by the mental health professionals:

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1) Experienced stigmatization: The mental health professionals describe experiences of stigmatization from colleagues and management when they disclose past experiences of being a mental health service users. These experiences include management banning them from sharing their experiences with current service users (stigmatization influencing interactions with service users) and getting job advertisements sent anonymously by colleagues wanting them to get another job (stigmatization influencing the social working environment).

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2) Fear of stigmatization: The mental health professionals have a fear of experiencing stigmatization from colleagues and management, which prevents them from sharing their lived experiences of being service users. The mental health professionals fear that disclosure will influence their future job opportunities and that they will no longer be perceived as capable and professional (fear of stigmatization influencing collaboration with colleagues and management) because some of their daily choices are based on their own negative lived experiences as service users - they do not want current service users to experience what they experienced as service users e.g. being objectified and wrongly assessed.

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3) Fear of and performing stigmatization: The mental health professionals have a fear of not being perceived as professionals by the current mental health service users, and that the service users will perceive them as fragile (fear of stigmatization influencing interactions with service users). Moreover, the mental health professionals worry that sharing their lived experiences will turn focus away from the service user, and on themselves, which they find problematic. In addition, some of the mental health professionals stigmatize certain service user groups themselves e.g. not sharing their experiences with service users with a specific diagnosis (performing stigmatization of current service users).

Xinyi Zhao, Peking University

To investigate the mental illness stigma and its correlates among psychiatrists in China.

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Chinese psychiatrists’ mental illness stigma.

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An online questionnaire survey was conducted among registered psychiatrists in 2022. A total of 2,442 participants were included. Mental illness stigma was measured by the Perceived Devaluation-Discrimination (PDD) scale, with higher scores indicating higher levels of stigma. Linear regression analysis was conducted to identify the influential factors of mental illness stigma.

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The scores of the PDD scale, the Perceived Devaluation subscale, and the Perceived Discrimination subscale were all higher than the mid-point (i.e. 3). Participants with higher professional titles(p<0.001), younger age (p<0.01, p<0.001, p<0.05), lower income satisfaction (p<0.001, p<0.01, p<0.001), and lower job satisfaction (p<0.001) had higher scores in the PDD scale and its two subscales (α=0.05). Participants with a violent attack in the past year reported higher scores (p<0.01, p<0.001) in the PDD scale and the Perceived Devaluation subscale(α=0.05). Women reported lower scores (p<0.05) in the Perceived Devaluation subscale than men(α=0.05).

Luca Pingani, University of Modena and Reggio Emilia; Alessia Bessi, University of Modena and Reggio Emilia; Mattia Marchi, University of Modena and Reggio Emilia; Gian Maria Galeazzi, University of Modena and Reggio Emilia

This study seeks to investigate if the involvement of fifth-year medical school students in the Integrated Course in Psychiatry within the curriculum leads to enhanced understanding of mental health, improved attitudes towards individuals facing mental health distress, and intended behavior and/or contact with those experiencing mental health issues. Additionally, the study aims to identify potential predictors linked to changes over time in the three mentioned variables (knowledge, attitudes, and behaviors).

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Fifth-year medical school students.

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Public stigma.

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All participating students were requested to complete a socio-demographic questionnaire and the Italian versions of three psychometric instruments: Mental Health Knowledge Schedule (MAKS-I), Community Attitudes to Mental Illness (CAMI-I), and the Reported and Intended Behavior Scale (RIBS-I). Each student was assigned a code that will be used to match the questionnaires when re-administered at 3 months and 6 months.

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The results demonstrated an improvement in attitudes and behaviors towards people with mental distress. However, knowledge regarding mental health has decreased. Furthermore, it emerged that following people on social media who talk about mental health challenges is associated with an increase in attitude over time, while having experienced mental health challenges increases the level of intended behavior and/or contact with individuals experiencing mental health issues.

Dr Bridey Rudd, Mental Health Foundation; See Me Scotland; Dr Patty Lozano-Casal, See Me; Vicky Moynihan, See Me; Keith Russell, NHS Scotland; Mental Health Nurse Leads Scotland; Karen Ozden, NHS Scotland; Katie Borland, See Me Scotland; Jo Finlay, Mental Health Foundation

Scotland is facing a critical shortage of mental health nurses. The past decade has brought a sharp UK-wide fall in the number of mental health nurses and for the past two years, Scottish universities have been unable to fill places on mental health nursing courses. Recent survey results show that more than 50% of people leaving nursing have done so before they planned to (Nursing & Midwifery Council, 2022). Reasons for leaving the profession commonly related to mental health and stigma and discrimination.

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One possible factor in this is stigma by association. International studies have identified a high prevalence of stigma by association among mental health professionals and trainees (up to 75%), with impacts including job dissatisfaction, low resilience, professional burnout, unwillingness among students to specialise in mental health, and a desire among current staff to work in other sectors of health (Njaka et al., 2023).

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This presentation outlines a collaborative study in Scotland exploring the nature and scale of associated stigma experienced by the mental health nursing workforce in Scotland.

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Using a cross-sectional design, this study examines experiences of stigma by association by current and former qualified and pre-qualified mental health nurses across Scotland. Wider stigma and discrimination is also explored, with questions covering intersectional and self-stigma.

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The study takes a mixed-methods approach, incorporating the Clinician Associated Stigma Survey (Yanos et al., 2017) within a larger survey of scale and open-text questions. Questions cover demographics (including lived experience of mental health problems), experiences of stigma and discrimination within participants’ work or educational settings, and the impact of these on participants’ behaviour. Further questions focus on participants’ wider experiences of stigma related to their own mental health and other intersectional aspects of their identity.

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Follow-up focus groups and interviews with survey respondents and participants from groups under-represented by the survey explore survey findings in more depth.

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This presentation will outline preliminary findings from this study, including the prevalence and severity of experiences of stigma by association within the mental health nursing workforce in Scotland. We will examine how this study contributes to the international evidence, and discuss what the study tells us about how to address stigma within the mental health workforce.

Joseph S. DeLuca, Ph.D., Fairfield University; Julie Berrett-Abebe, PhD, LICSW, Fairfield University; Michelle Pagnotta, LPC (MA), NCC, Fairfield University; Margaret McNamara McClure, Ph.D., Fairfield University

The objectives of this study were to (1) understand the cross-sectional correlates of psychosis stigma among interdisciplinary mental health trainees in the United States (US) and (2) evaluate the initial effectiveness of an early-stage psychosis clinical training and stigma reduction program for this group. Psychosis remains one of the most stigmatized mental health conditions worldwide, and stigma toward psychosis has been on the rise in the US (e.g., Pescosolido et al., 2019). Clinical training and stigma reduction programming for mental health trainees is especially needed, since this group often does not receive specialized training in this area (e.g., Fiorillo et al., 2013; Kline et al., 2019) and may harbor stigma toward individuals with psychosis (e.g., O'Connor & Yanos, 2023). Better understanding baseline correlates of psychosis stigma and mechanisms of change can guide future programming.

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Mental illness stigma (specifically psychosis-related public/provider stigma) among interdisciplinary mental health trainees in the US. Cross-sectional and longitudinal data reported.

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A mixed-methods approach was used, with a pre-test (N = 33) and immediate-post-test (N = 37). Matched participant data were analyzed (N = 21) for a sample of primarily white (81%), female (67%) graduate students (76%), aged 18-34 (81%). There was a relatively even distribution of trainees from psychology, social work, counseling, psychiatric nursing, and marriage/family therapy. Primary outcome variables related to stigma included: intended social distancing (13-item measure) and negative stereotyping (two items on dangerousness and positive recovery beliefs). Various socio-demographic variables were also collected, as well as a question about personal psychosis contact (e.g., friend, family, self) and satisfaction with the program. Clinical knowledge was evaluated via an open-ended prompt. Following the pre-test and before an immediate post-test, participants were audience members for a ~75-minute in-person presentation on interdisciplinary healthcare and psychosis that included evidence-based stigma reduction components (e.g., social contact videos and education).

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At the pre-test, intended social distancing and dangerousness beliefs were in the moderate range; however, recovery beliefs were high (i.e., belief that someone with psychosis could recover with treatment). Intended social distancing and dangerousness beliefs were significantly correlated at pre-test (r = .61, p = .004). Approximately 30% of the sample reported personal psychosis contact, and participants with prior psychosis contact (v. no contact) reported significantly lower dangerousness beliefs at baseline, t(15) = 2.40, p = .030. Socio-demographics (race, gender, discipline/program, age) were not significantly correlated with stigma. Regarding prospective change, paired-samples t-tests revealed significant stigma reductions from pre- to immediate post-test with moderate to large effect sizes: intended social distancing (p <.001), dangerousness beliefs (p = .002), and recovery beliefs (p = .020). Specifically, participants were on average: 20% more comfortable being close to someone with psychosis (intended social distancing) after the training, 31% less likely to endorse dangerousness beliefs, and 15% more likely to endorse recovery beliefs. In terms of feasibility and acceptability, satisfaction with the program was high overall (M = 9.2/10.0, SD=1.3; >95% agreed the training was useful and could be incorporated into their clinical work). Last, one-third of participants reported limited psychosis knowledge at pre-test, with preliminary qualitative analyses suggesting improvements in psychosis knowledge at post-test.

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Overall, a brief interdisciplinary training program focused on reducing stigma and increasing clinical knowledge demonstrated acceptability, feasibility, and initial effectiveness. At the baseline, dangerousness beliefs and intended social distancing were significantly correlated in the expected direction, and trainees with personal contact reported lower stigma. After the program, trainees reported being more comfortable around someone with psychosis and endorsed fewer negative stereotypes. Notably, recovery beliefs were already high among trainees at the baseline but still improved over time. Longitudinal data collection is ongoing (i.e., 6-week and 18-week follow-ups) and will be analyzed before the conference.

Stephanie Knaak, Mental Health Commission of Canada & University of Calgary; Heather Stuart, Queen's University; Srah Sass, University of Calgary; Uyen Ta, Mental Health Commission of Canada; University of Calgary, jasmi@ucalgary.ca; Jacqueline Smith, University of Calgary, jacqueline.smith1@ucalgary.ca

Stigma remains a major barrier to care and recovery for people with substance use and/or mental health problems in the healthcare sector, despite the accumulation of an increasingly robust body of evidence about key ingredients and effective interventions and approaches for stigma reduction – including the central importance of social contact and meaningful involvement of people with lived experience of mental health and substance use disorders (PWLE). One possible reason for this is the tendency to favour educational and training-type interventions and short-term implementation strategies to address stigmatization, as opposed to focussing more explicitly on the structural nature of stigma in these settings.

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Structural stigma, as defined by Hatzenbuehler (2016), refers to societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized. A focus on structural stigma seeks to understand and address the ongoing systemic de-prioritization, devaluation, and ‘othering’ of mental health and substance use health -- as compared to physical health --within our healthcare delivery, governance, knowledge building, and training systems (Ungar & Knaak, 2024). It also seeks to understand how the healthcare experiences of people with mental health and substance use concerns are shaped by expressions of structural stigma shapes, an area where little research currently exists.

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The objective of this research is three-fold: 1. To frame mental health and substance use-related quality of care issues as expressions of structural stigma; 2 To describe the development, testing, and suggested uses for two new scales that have been designed to capture experiences of structural stigma from the perspectives of patients themselves; and 3. To provide results from the first wave of implementation of these measures in one Emergency Department setting in Canada.

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We are focussed on structural (institutional/policy-level) stigma within healthcare settings, from the perspectives and experiences of healthcare consumers.

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Scale development & testing: qualitative focus groups with PWLE and review of existing scales to generate items; review and input from PWLE to refine items; exploratory and confirmatory factor analysis using national survey data (n=2476).

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Implementation study: Longitudinal design, with a focus on Wave 1 (baseline assessment, prior to any quality improvement interventions). Population of interest: patients who accessed Emergency Room care at one Canadian hospital. Recruitment: postcard distribution in hospitals and community agencies, as well as direct recruitment by research associate in hospital. Measures: participants completed the Stigma Cultures in Healthcare Scale (SCHS), and the Structural Stigma in Mental Healthcare Scale. Additional qualitative responses were collected for eight questions. Analysis: ANOVA analyses were undertaken to assess differences in structural stigma experiences for patients seeking mental health care only, physical health care only, or mental health and physical health concerns. Qualitative responses were coded for major themes across groups.

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Analyses for the Stigma Cultures in Healthcare Scale provided support for a 23-item unidimensional scale that could be used in any healthcare setting to assess the presence of a stigma culture.

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Analyses for the Structural Stigma in Mental Healthcare Scale revealed two strong factors—a 12-item factor pertaining to aspects of coercive care (named the Coercive Care Stigma Scale), and an 8-item factor pertaining to aspects of Person-Centred Care (named the Person-Centred Care Stigma Scale).

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Analysis for the Wave 1 implementation of these scales in an Emergency Department setting revealed significant differences in experiences of structural stigma across the three respondent groups. Patients seeking care for both mental health and physical health concerns reported the poorest experiences of care, followed by patient seeking care for mental health concerns only. Findings also showed that the physical space dedicated to mental health patients was experienced as particularly stigmatizing.

Alicia Lucksted, University of Maryland, USA; Shannon Gwinn Mitchell, Friends Research Institute, Baltimore Maryland USA; Zoe Smith, Friends Research Institute, Baltimore Maryland USA

This novel program is designed for people in treatment for problematic substance use, including medication treatments. The "target" is equipping them with strategies, skills, information, and self-reflection to reduce their internalization of the stigmatizing messages and behaviors they are exposed to and to increase their resilience and resistance.

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The program's approach combines (1) principles from Corrigan's social cognition model of mental health stigma, especially re stereotype (il)legitimacy" and group identification, (2) cognitive behavioral therapy principles including metacognition and counter-messaging, and (3) identity theory approaches, especially avoiding/resisting pathologized identity engulfment and self-compassion (Neff et al).

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We developed the 4 session program in collaboration with people with living experience of the target conditions and have completed two small clinical pilots to create a stable manualized program. No RCTs have been completed.

Christopher Tupy, Dachverband IDEE Austria; Lisa Kainzbauer, HPE Vienna; Tobias Schiffler, Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna

People experiencing mental illness (PMI) are affected by blatant inequalities in somatic healthcare due to socio-economic disadvantages such as social isolation, poverty, or stigmatization. This leads to inadequate and delayed treatment and severely impairs their health, with life expectancy up to 20 years below average. The COMITMENT project is dedicated to investigating the multifaceted barriers and facilitators that PMI encounter when seeking somatic healthcare. This study not only seeks to highlight the disparities in healthcare access this often-neglected population faces but also aims to propose viable solutions to mitigate these challenges.

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A pivotal aspect of this research is the exploration of various forms of stigma. The study scrutinizes structural and policy-based stigma, examining how entrenched biases within healthcare systems and policies detrimentally impact PMIs' healthcare access. Furthermore, it delves into the cross-sectional aspects of stigma, assessing how it intersects with other socio-economic factors like poverty and social isolation, thereby exacerbating healthcare disparities.

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COMITMENT utilizes a qualitative and participatory methodology, orchestrated by a 'trialogic' steering group. This unique composition includes a person with lived experience of mental illness, a family member/caregiver of PMI, and a nursing practitioner experienced in psychosocial care. The research team conducted two comprehensive co-creation workshops, bringing together PMI, their support networks including family and friends, and professionals from both somatic and psychosocial healthcare fields. These workshops fostered open dialogues, allowing for a deep understanding of the challenges PMI face in accessing physical healthcare. Data collection was conducted through comprehensive participant observation and direct input from workshop participants, followed by a thematic analysis to discern underlying patterns and themes.

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The preliminary findings of the study are multifaceted, encompassing six core themes: (1) Accessibility and Facility Design, (2) Resources and Bureaucracy, (3) Raising Awareness Among Healthcare Professionals, (4) Social Awareness, (5) Structural Diversity of Services, and (6) Networking. Our findings include the necessity for healthcare facilities to be more welcoming and adaptable to the needs of PMI. This includes considerations like facilitating easier navigation within the facilities and personalizing healthcare experiences, as well as making healthcare access smoother and more efficient for this population. A significant insight from the study is the crucial role of awareness and training among healthcare professionals. It highlights the importance of integrating real-life experiences of PMI into healthcare education to foster empathy and understanding. Additionally, the study points out the need for increasing social awareness about mental health, suggesting that integration of mental health education at various levels can significantly reduce stigma and misconceptions. The study also calls for a diversification in the structure of healthcare services. This includes creating a centralized resource for health services information and developing outreach programs that cater to PMI in more accessible ways. Networking emerges as another vital area, with the study suggesting the need for better communication channels and events that promote information exchange on mental health topics.

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The identified challenges and strategies in this study provide tangible steps towards enhancing somatic care for PMI, while findings highlight the necessity of a comprehensive approach that simultaneously addresses multiple aspects of healthcare. COMITMENT could form the basis for social, systemic and political change to reduce inequalities in healthcare and improve the quality of life of this marginalized population.

Dr. Sara Hickmann, Bring Change 2 Mind, Los Angeles Kings, Los Angeles Kings

Elite athletes/High performing individuals

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Normalizing mental health check ups similar to physical check ups

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“Studies show that only about 11% of people get treatment for anxiety disorders in the first year they’re having symptoms, and many suffer for longer than that before their anxiety ever comes up in a medical setting,” says Dr. Mangione, chief of the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA.

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At some point in their lives, approximately 26% of men and 40% of women experience an anxiety disorder, Dr. Mangione notes. She explains that generalized anxiety is marked by fear and worry at a level that impedes one’s ability to function.

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Although the task force’s review of the evidence to support asymptomatic anxiety screening began before the onset of COVID-19, Dr. Mangione points out that the social isolation, fear of becoming sick and upending of lives during the pandemic are all risk factors for anxiety, depression and other mental health problems.

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“If ever there were a time when we should be making sure people don’t have untreated or undiagnosed anxiety, this is it, because as a population we’ve been very stressed with what’s been going on the last few years,” Dr. Mangione says.

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The task force’s recommendation to screen asymptomatic adults ages 19-64 for anxiety disorders in primary care settings comes on the heels of the guideline it issued last year to screen asymptomatic children ages 8-18. The task force has previously recommended screening asymptomatic adults for depression.

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Of the 250 professional athletes screened over a 2 year period, less than 1% of them faked good and responded in a guarded manner. The other 99% used the opportunity to reflect on their mental health status, respond to the screening items and engage in dialogue. Between 5-15% of them followed up with therapy appointments or took other steps towards addressing their health.

Marieke Pijnenborg, University of Groningen; laura steenhuis, university of groningen; akke ariesen, University of Groningen; Susanne Spoelman, cosis; Windesheim; j.t, van Busschbach, Windersheim

Already in early phases of psychotic disorders, individuals demonstrate difficulties with social participation. They often stop working, studying, participating in leisure activities and lose contact with peers. DSMN is a sport-based intervention, that aims to impact factors that underlie poor social participation: self-stigma, physical inactivity, negative symptoms, and low self-esteem.

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self-stigma in first episode psychosis in mental health care and community

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We performed a qualitative study (n=13) to gain more insight in the subjective needs and barriers of potential participants. Subsequently, a feasibility study (n=3) was conducted with the preliminary DSMN protocol. Based on these outcomes, the final version of the DSMN intervention was developed.

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Barriers for sports were e.g. lack of time, negative symptoms, self-stigma, low self-esteem and negative perceptions of other patients in case of sports in groups, while e.g. a trusted environment, safety and sporting with peers were facilitators. The feasibility study showed that people appreciated individual goals, a skilled trainer, group interventions and an open conversation about stigma with an expert by experience. Based on these outcomes, the final version of the DSMN intervention was developed. The final protocol of DSMN consists of a minimum of 22 sessions in a 22 to 26 week time-frame, consisting of three phases: individual psychomotor therapy (focusing on goal setting and regaining trust in one’s own physical capabilities), a group intervention combining psychomotor therapy and sport (focusing on social connectedness) and finally sporting in the local community (focused on social (re)integration). The intervention is tailored to individual needs and goals.The results of both the needs and barriers and feasibility study, the outline of the final intervention and the design of a multiple baseline single-case design study to evaluate the intervention, will be discussed.

K. Amanda Maranzan, Lakehead University, Canada; Jana Hörger, Department of Psychiatry II, Ulm University & BKH Günzburg, Germany; Nathalie Oexle, Department of Psychiatry II, Ulm University & BKH Günzburg, Germany; Kristin Kosyluk, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA; Christian Helms, Center for Psychotraumatology, Military Hospital Berlin, Germany

Honest, Open, Proud (HOP) is a peer-led group program to support participants with mental illness with their decision whether to disclose their condition to others. Disclosure decisions are personal and often complex, depending on the environment and one’s personal vulnerability to public stigma. HOP’s efficacy on stigma stress (the perception that stigma-related harm exceeds one’s coping resources) and on self-stigma has been shown in a first meta-analysis based on five randomized-controlled trials (RCTs; Rüsch & Kösters 2021). However, its efficacy across different target populations (adolescents, college students, soldiers, suicide attempt survivors) and cultures is not well understood. This symposium will present new evidence on HOP based on recent RCTs (to be completed by June 2024) from different countries and different target groups.

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Self-stigma, stigma stress

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This symposiums brings together researchers from North America and Europe that conducted altogether five RCTs to evaluate effects of HOP on self-stigma, stigma stress and other outcomes such as recovery, depressive symptoms and attitudes to help-seeking. The RCTs evaluated HOP for adolescents in Germany (Jana Hörger), for college students in Canada (K. Amanda Maranzan & G. Dabas), for active soldiers of the German military (Christian Helms & Gerd Willmund), for suicide attempt survivors in the US (Nathalie Oexle & Lindsay Sheehan) as well as for college students in the US (Kristin Kosyluk).

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The presenters will report data on HOP’s efficacy to reduce stigma stress and self-stigma as well as to affect other outcomes such as depressive symptoms, recovery and attitudes to help-seeking. They will also discuss the role of possible moderators of program efficacy such as age, gender and diagnosis and mode of delivery (face-to-face, online as in K.A. Maranzan’s study, or using chatbot technology as in new work by K. Kosyluk). Finally, issues of program implementation (reach, fidelity, sustainability) will be considered across the different settings.

Dr Bridey Rudd, See Me, and The Mental Health Foundation; Wendy Halliday, See Me; Jo Finlay, Mental Health Foundation; Simon Hunter, Glasgow Caledonian University

Stigma towards those living with mental illness occurs globally and endures across many areas of life. The Scottish Mental Illness Stigma Study (SMISS) sought to explore experiences of stigma and discrimination amongst people living with mental illness in Scotland in the first national survey of its kind in Europe.

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Adults in Scotland who identified as having experienced stigma as a result of living with severe, complex and/or enduring mental illness were invited to take part in a survey exploring participant’s experiences and anticipation of stigma and discrimination across 14 life areas, and the impact of these on their behaviour. Questions spanned public, structural and self-stigma.

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SMISS was inspired by the Australian National Stigma Report Card (reference report). With permission from the Australian research team, their original Our Turn to Speak survey was used as a template for the development of the survey for a Scottish population. Survey development and subsequent qualitative research was guided by an advisory group comprising people with lived experience and representatives from project and wider strategic partners.

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The survey comprised three sections of questions covering: demographics (including questions relating to diagnosis based on a hybrid version of ICD-10 and 11 criteria), attitudes towards mental health and questions about stigma and discrimination related to specific life areas.

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The survey ran between November 2021 and March 2022 and received 346 eligible responses. Qualitative research was undertaken with 70 participants to add depth to survey findings, and to gather additional evidence from groups underrepresented in the survey (men, people aged over 65, and people from more diverse minority ethnic backgrounds).

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Survey data revealed the devastating impact that mental health stigma and discrimination have on people across every life area explored in the survey. Key findings showed that stigma and discrimination can lead to difficulty accessing or engaging with critical services and can impede people’s ability to sustain positive relationships, maintain meaningful employment and take part in community groups and volunteering.

Wendy Halliday, See Me

Scotland’s Mental Health and Wellbeing Strategy , published in November 2023, has a vision of a country “free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.”

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See Me’s five year strategy “With Fairness in Mind” sets out medium term outcomes to support reduction in stigma and discrimination in in Scotland

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Despite long term investment in action on mental health stigma, the Scottish Mental Illness Stigma Study (SMISS) highlighted the negative and pervasive impact of stigma and discrimination, emphasising that stigma and discrimination can lead to difficulty accessing or engaging with critical services; impede people’s ability to sustain positive relationships, and maintain meaningful employment.

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There is growing appreciation of the need to take a system wide approach to address the social injustice and inequality experienced as a result of stigma and discrimination.

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If selected this session would build on the joint plenary session proposed by colleagues in Australia, Canada and See Me. It would look more specifically about the ways See Me has used the data from the Scottish Mental Illness Stigma Study to influence policy and practice change in Scotland.

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See Me, Scotland’s national programme to end mental health stigma and discrimination has focused attention on influencing commitment and sustained action, across the system, to address mental health stigma and discrimination

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• Created With Fairness in Mind, a 5 year strategy for See Me (strategic and aspirational) setting out that addressing stigma requires system wide change - appreciation that the agenda is greater than what See Me will be able to achieve without collaboration

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• Focused on engagement with the Policy team(s), sponsor branch, suicide prevention, strategic policy unit, The Minister, elected members, professional advisors etc.

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• Contributed to strategic national partnerships including the Scottish Mental Health partnership to embed a focus on addressing stigma and discrimination as part of responses and strategic submissions to government

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• Described and reinforced the foundational nature of stigma and the continuing need to address it

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• Facilitated and supported lived experience testimony and leadership to emphasise the associated challenges but also to lead/ guide solutions to transformation

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• Delivered the Scottish Mental Illness Stigma Study, this has been impactful in profiling the pervasive and unjust nature of stigma affecting people living with complex and enduring mental illness – requiring change at public, structural and individual levels

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• Undertook data/ evidence reviews and re-ran polls and Feels FM – to draw data relating to particular groups within the population and increased attention on understanding and addressing the stigma affecting diverse and marginalised communities

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Current position:

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• The strategic team in Scottish Government are more convinced of the need to increase attention and action towards ending stigma and discrimination - particularly in respect of how it impacts people with experience of mental illness and people from minoritised communities who continue to experience intersectional stigma and face multiple barriers.

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• There is now an identified policy sponsor for the anti-stigma commitments in the strategy, working alongside See Me they will influence action for change in policy and across government portfolios

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• The Scottish Mental Illness Stigma Study (SMISS) has generated renewed interest (and commitment) from national and local partners including:

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o Increased engagement of people with lived experience in policy and practice developments

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o National organisations (public, private and third sector) making explicit strategic commitments to end stigma and to reduce inequalities created by stigma and discrimination.

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o Increased engagement of national networks

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o Increased interest for joint working at local level

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• The Mental Health and Wellbeing Strategy makes multiple statements about the need to understand and address stigma and discrimination – in the vision, as a strategic outcome and peppered throughout the document. Addressing stigma is also a key priority in both the suicide prevention and self harm strategies and action plans.

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To go further in achieving our outcomes, and to influence the sustained, systemic change needed it will be beneficial to maximise the strategic opportunity we have now. See Me is well placed to provide leadership, facilitation and expertise to drive forward national strategic action. Initially this will be done in three phases

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Phase 1: Influencing implantation of the strategy and supporting documentation, advising on how best to integrate actions across the Mental Health and Wellbeing Strategy delivery plan, the workforce plan etc. as they are forming.

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Phase 2: Formation of a Short life Expert Group to establish the priority actions to be taken forward within the context of the strategy and supporting documentation guided by:

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• Undertaking a situational analysis through self-assessing our combined activity and approach to addressing stigma in Scotland; benchmarking current activity (including See Me’s) against Australia’s Draft National Stigma Reduction Plan

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• Prioritising actions, that are evidence based and speak directly to the Mental Health Strategy outcomes

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• Advising on the set up and arrangements for a strategic partnership to provide coordinated leadership to address the issues raised, fill gaps and progress actions.

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• Support transformational change, mobilise action, collaboration, coordination, and ensure collaborative accountability

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Phase 3: Formation of a National Delivery Collaborative to support joint planning and delivery of the priority actions. The collaborative will influence and support change at different levels across the system, in line with the priorities identified by the expert group, share practice and learning.

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The session will examine the steps taken by See Me to secure ongoing national, strategic commitment to ending mental health stigma and discrimination. It will highlight the benefit of the using the data collected from the Scottish Mental Illness Study (and other key data) in influencing stigma at multiple levels

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Addressing stigma is a continuous journey and we are able to share our learning and experience of taking a ‘knowledge into action’ approach, sharing the impact that we have been able to capture so far.

Ioannis Bakolis, Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; Elaine Brohnan, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; Nicolas Rüsch, Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany; Petra Gronholm, Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; Sara Evans-Lacko; Personal Social Services Research Unit, London School of Economics and Political Science, London, UK

Building on the International Study of Discrimination and Stigma Outcomes (INDIGO) network research, the objective of our programme of research was to develop a cross-culturally adapted short version of the Discrimination and Stigma Scale (DISC) within the INDIGO partnership.

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The INDIGO (International Study of Discrimination and Stigma Outcomes) Partnership Programme is an international research programme which aims to develop and test new methods to reduce mental health related stigma in five countries around the world. The Partnership developed from the INDIGO Network activities is designed to address the evidence gaps through culturally adapted, multi-level anti-stigma interventions with the use of locally validated scales.The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with mental health conditions. However, the length of the DISC may represent a disadvantage especially in country settings with limited human capacity and infrastructure.

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Data from 1087 participants with major depressive disorder and 732 patients with schizophrenia were collected as part of two research network studies across 35 countries - Anti Stigma Programme European Network (ASPEN) and International Study of Discrimination and Stigma (INDIGO). We used a Meta Exploratory Factor Analysis (meta-EFA) and a Multiple Causes Multiple Indicators (MIMIC) Model to reduce the number of items in the DISC scale. The psychometric properties (scaling assumptions, validity, reliability) of DISCUS were replicated in a sample of 1195 people with a wide range of mental health conditions from 21 sites in 15 countries/territories, across six global regions. We further tested the implementation and assess the psychometric properties of DISCUS to evaluate these anti-stigma interventions (e.g. feasibility, acceptability) in the Indigo Partnership.

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meta-EFA and MIMIC model reduced twenty-one items to eleven items. Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnostic groups for the 11-item DISCUS. Convergent validity was confirmed in the total sample and within all regions [Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings globally and could be part of a suite of evaluation measures for anti-stigma programmes

Petr Winkler, National Institute of Mental Health, Czechia; Benjamin Kunc, NIMH CZ; Zoe Guerrero, NIMH CZ; Karolina Mlada, NIMH CZ

We aimed to compare levels of mental health related stigma among the Czech general adult population before and after the Covid-19 pandemic. Further, we aimed to compare levels of recognition of own mental health problems, among those members of the general population who screened positively for mental disorders as assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.).

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Population stigma; repeated national cross-sectional studies with de facto identical methods; Czech adult non-institutionalized population

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We conducted a comprehensive analysis of multiple almost identically designed cross-sectional surveys carried out on representative samples of the non-institutionalized adult population in Czechia in 2017, 2019, and 2022. Mental health problems were assessed using M.I.N.I. in 2017 and 2022, while SELF-I gauged self-recognition in 2017 and 2022. Mental health-related stigma was evaluated using RIBS and CAMI in 2019 and 2022.

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Attitudes towards individuals with mental health problems exhibited no improvement; however, reported and intended behaviours, i.e. proxies of social distance, changed for a better. Also, self-recognition of mental health problems improved for those screening positive for depression, anxiety, and suicide risk, but not for alcohol use disorders.

Ashley Seybold, Shatterproof; Megan Bolton, Indiana University - Irsay Institute; Asha Carroll, Shatterproof; Rachael Cooper, Shatterproof

Evidence shows that health communication campaigns, especially those rooted in the collective impact (CI) framework, are a promising strategy for addressing public health issues, including public stigma. Shatterproof, a non-profit organization dedicated to reversing the addiction crisis, has combined a CI framework and health communication campaign to address the public stigma of addiction through its Unshame campaign.

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Unshame relies on CI, including grassroots community engagement, and a continuous improvement, evidence-based decision-making process integrating existing empirical literature and vetted survey measures to reduce addiction stigma among the general public. The campaign consists of the following components: (1) an integrated media strategy driven by organic, paid, and influencer-generated social media content; (2) a research-driven, contact-based strategy to source and curate video testimonials from people across the state and community-based organizations (CBOs); and (3) engagement with stakeholders and advocates in CBOs across the state.

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Year 1 evaluations in two ongoing states demonstrate success at increasing knowledge of addiction (e.g., campaign-exposed individuals are significantly (p<0.01) more likely to associate OUD with a chronic medical condition compared to unexposed individuals), improving attitudes toward those living with addiction (e.g. campaign-exposed individuals are more likely to associate with someone with OUD, having significantly (p<0.05) lower public stigma, including less desire to social distance, compared to campaign-unexposed individuals), and developing competencies to support loved ones and community members with addiction (e.g., campaign- exposed individuals are significantly (p<0.01) more likely to know where to obtain and how to administer naloxone as well as know how to find quality treatment for OUD compared to unexposed individuals). With a reach of over 10% of the population, these public-facing social media campaigns have the potential to continually spread throughout the state and, in time, the nation.

Alicia Lucksted, University of Maryland School of Medicine; Uzma Ambareen, Medical Director & Consulting Psychiatrist, The Recovery House, Karachi Pakistan

In Pakistan, efforts to reduce the stigmatization of mental health concerns and psychiatric treatments are usually limited to the voices of some medical practitioners and fewer religious leaders, while others in both roles endorse stigmatizing messages. People with lived experience have little public voice and the potential costs of someone speaking out are high for the individual, their family, and even extended family and their community. As one of few recovery-oriented psychosocial rehabilitation agencies in Pakistan, The Recovery House (TRH, Karachi) is seeking to build a foundation of lived experience self-respect and voice working alongside its clients. One initiative has been creation of Hum Bolenge / End the Silence, a group program for TRH clients (and soon, alumni). Its targets for stigma reduction are the societally imposed, internalized, and anticipated stigma messages pervasive for TRH clients and their families. Hum Bolenge offers people living the experience of mental health conditions a supportive, empowering, private group and space in which to consider accurate information about stigma, their own views and values, and how the two relate, toward narrating their own stories and creating their own voices.

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Hum Bolenge was created over several years, by a team of TRH staff, leadership from its parent organization Caravan of Life Trust, numerous recent former clients, consultation from client family members, and assistance from outside advisors with experience creating, delivering, and evaluating person-level internalized and anticipated stigma interventions. Through a thoughtful methodical process, we combined elements of three existing psycho-educational and therapeutic stigma interventions (a) Narrative Enhancement and Cognitive Therapy for Stigma by Yanos and colleagues, (b) Healthy Out and Proud, by Corrigan and colleagues, and (c) Ending Self Stigma, Lucksted & Drapalski and colleagues) with (d) deep experiential and clinic expertise from TRH clients and staff.

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As a result, Hum Bolenge is based on principles of psychoeducation, empowerment, cultural embeddedness, narrative, cognitive behavioral therapy, and resilience. It is a multi-session group program, co-led by a person with lived experience of mental health concerns and a current psychiatric rehabilitation practitioner. It approaches stigma from attendee’s personal experience, inviting them to consider and apply the various points, strategies, and exercises as they see fit and to discuss this process as the group moves through the program sessions. The program’s name comes from the forced silence and secrecy that stigma often imposes on people, and points to our hope that it will help each person find their voice and use it in ways small and large that fit for them.

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Hum Bolenge is also part of an evolving anti-stigma ecosystem at TRH which includes client self help and fellowship opportunities, increasing anti-stigma social media and public education, and more stigma content in existing family education and support. People who take part in Hum Bolenge will have a variety of diverse opportunities to take roles in and to help shape this ecosystem, including leadership, but this is not required of anyone.

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We have individual level feedback and testimonials from the three rounds of clients who have participated in it. We will be creating fuller evaluation in the future, moving into formal research. But no formal studies have been completed yet.

Dr Anna Ross, Centre for Mental Health, University of Melbourne; A/Prof Amy Morgan, Centre for Mental Health, The University of Melbourne; A/Prof Alex Wake, School of Media and Communication, RMIT University; Prof Anthony Jorm, Centre for Mental Health, The University of Melbourne; Centre for Mental Health, The University of Melbourne, nreavley@unimelb.edu.au; Amy Morgan, Centre for Mental Health, The University of Melbourne; Alex Wake, School of Media and Communication, RMIT University; Anthony Jorm, Centre for Mental Health, The University of Melbourne; Nicola Reavley, Centre for Mental Health, The University of Melbourne

Despite its rare occurrence, complex mental illness is commonly linked to violence and crime in the news media. There is sufficient evidence that exposure to the media can influence attitudes and behaviours towards people with mental illness. To reduce harmful effects of news reporting, this research aimed to 1) Develop best practice guidelines, and 2) Pilot trial an education intervention for media reporting on mental illness and crime.

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This research targets Australian media professionals and journalism students, aiming to reduce stigma in the news media and the general population.

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Best practice was determined using the Delphi expert consensus method, where experts rated statements according to importance for inclusion in the guidelines. Experts represented three groups: people with lived experience of severe mental illness, media professionals, and mental health professionals. The content of the guidelines informed an education intervention, which was delivered to journalism students and evaluated at baseline and 3-weeks follow-up.

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Seventy-seven statements were endorsed into the guidelines. These expand on existing media guidance by elaborating on accurate portrayals and appropriate language, mental health literacy for journalists, and reporting relevant risk factors. The education intervention significantly improved journalism students’ knowledge of the guidelines, reporting behaviours, and reduced stigmatising attitudes at 3 weeks follow-up. Developing and implementing best practice guidelines for media reporting on mental illness and crime has significant potential to reduce stigma and discrimination towards people with mental illness on a large-scale community level through wider implementation. Ultimately, improving media reporting will reduce the adverse impacts of stigma on people living with complex mental illness, playing a significant role in improving social inclusion and recovery.

Dr Anna Ross, Centre for Mental Health, The University of Melbourne; A/Prof Amy Morgan, Centre for Mental Health, The University of Melbourne; Prof Nicola Reavley, Centre for Mental Health, The University of Melbourne; Anne Deveson Research Centre, SANE; A/Prof Amy Morgan, Centre for Mental Health, The University of Melbourne; Prof Nicola Reavley, Centre for Mental Health, The University of Melbourne, Anne Deveson Research Centre, SANE

SANE’s StigmaWatch program promotes responsible reporting of mental illness and suicide in the Australian media. It aims to reduce stigma and other harms stemming from problematic media portrayals of suicide and mental illness by holding the media accountable for portrayals that are not aligned with the Mindframe guidelines. This world-first program encourages members of the public to report media coverage that potentially breaches these guidelines. Constructive feedback is provided to journalists and media outlets for revising the media item to ensure it is consistent with Mindframe guidance. In collaboration with SANE, we conducted the first evaluation of the StigmaWatch program to determine its impact on modifying problematic or potentially harmful media coverage.

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The StigmaWatch program targets Australian journalists and media professionals, aiming to reduce stigma in media portrayals and ultimately the general population.

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Using data routinely collected through StigmaWatch from 2017 to 2021, this study explored the impact of StigmaWatch on confirmed breaches of media guidelines and the trends in media items being reported to StigmaWatch, including by type of illness, breach type, and publication.

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A total of 1,300 reports of harmful or stigmatizing media portrayals of suicide and mental illness were lodged to StigmaWatch between 2017 and 2021. Of these, 700 (53.8%) were confirmed to be unique breaches of the Mindframe guidelines, and almost half (44.3%) were modified following feedback from StigmaWatch. Most of the confirmed breaches that were reported to StigmaWatch were related to media portrayals of suicide (n = 491, 70.1%). For media portrayals of people with a mental illness (n = 191, 28.9%), portrayals of people with schizophrenia were the most commonly reported and confirmed breaches. The most commonly confirmed breaches of the Mindframe guidelines were as follows: mentioning suicide or self-harm method; using sensationalized language to describe suicide or mental illness; using the term “commit suicide”; and not including help-seeking information. These findings demonstrate the substantial impact of the StigmaWatch program, and have important implications for improving StigmaWatch practices and for future research.

Nicola Reavley, University of Melbourne; Amy Morgan, University of Melbourne; Angela Nicholas, University of Melbourne; Judith Wright, University of Melbourne; University of Melbourne, anross@unimelb.edu.au; Karen Block, University of Melbourne; Georgina Sutherland, University of Melbourne; Lisa Brophy, LaTrobe University; Catherine Minshall, LaTrobe University; Deborah Warr, Charles Sturt University; Claudia Marck, University of Melbourne; Kate Kelleher, Kate Kelleher Consulting; Justin Noel, Origin Communications.

The aim of this project was to conduct consultations with a wide range of stakeholders in order to develop recommendations for a national stigma reduction strategy.

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structural/policy based

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We conducted online video interviews and focus groups with 234 stakeholders, including people with lived experience (either their own or as a carer), advocates (who were often people with lived experience as consumers or carers), anti-stigma program providers, mental health peer support workers, health professionals, health professional students, people with ‘broad expertise’ (who held multiple roles relevant to the project) and those working to support people with mental illness in employment, education and social services settings.

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Key themes were: ensuring that people with lived experience are central to any strategy, including in leadership, co-design, delivery and evaluation roles and the need to provide opportunities and support for people with lived experience to share narratives that create empathy and challenge stigmatising attitudes, notably those relating to people being seen as entirely defined by their diagnosis, as dangerous or unpredictable, or as unable to recover and live full and meaningful lives.

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The most frequently nominated key intervention settings were health services, workplaces and the media. Many participants noted the need to target the general community; family and friends of people experiencing a mental illness; police and the justice system; policymakers and educational institutions. Participants noted the need to tailor activities for Aboriginal and Torres Strait Islander and culturally and linguistically diverse communities incorporating culturally appropriate understandings of mental health and engaging community leaders in design, delivery and evaluation.

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There was strong support for a national strategy to address stigma and discrimination towards people with complex mental illness. Participants also noted the need for a long-term approach as well as for ongoing evaluation of effectiveness.

Amy Morgan, University of Melbourne; Judith Wright, University of Melbourne; Andrew Mackinnon, University of Melbourne; Anthony Jorm, University of Melbourne;

Mental health related discrimination by friends, family members and intimate partners is especially common, particularly avoidance and dismissive reactions. In contrast, good quality initial support (ie. ‘mental health first aid’) may improve help-seeking and mental health outcomes, although there are few studies that have examined this. We aimed to develop a new measure to assess the quality of initial support from family and friends for a mental health problem, and test whether better quality help was related to better mental health outcomes.

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Public stigma (discrimination), longitudinal, adults from high income countries, Australia

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We recruited adults who had experienced a recent mental health problem or crisis and were helped by someone close to them. Participants completed a newly developed questionnaire based on mental health first aid guidelines, comprising 12 questions about actions the other person took to support them. The Mental Health Support Scale – Received contained both ‘recommended’ (e.g., Asked whether you had thoughts of harming yourself or others) and ‘non-recommended’ actions (e.g., Tried to cheer you up by telling you that things don't seem that bad). Participants were also asked questions related to their perceptions of the quality of the support and its impact on their mental health, help-seeking, and relationship with the person. Participants were re-assessed six months later to prospectively evaluate the impact of the support on mental health, quality-of-life, help-seeking, and self-stigma.

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1116 participants who had experienced a variety of mental health problems (77% depression) were recruited. Confirmatory factor analysis supported a two-factor solution: 9 items formed a highly reliable dimension representing recommended actions (omega=.81) while the 3 not recommended items loaded poorly on a second factor. Receiving higher quality support was associated with better perceived mental health (r=.38), improved relationship with the helper (r=.39) and seeking help from a doctor/GP (r=.44) or mental health professional (r=.49). This study provides initial evidence in support of the validity of the Mental Health Support Scale – Received. Results suggest that receiving support consistent with good mental health first aid is associated with better outcomes in recipients.

Anja Kare Vedelsby, ONE OF US, The Danish Health Authority; Giuseppe Øllgaard Parlatore, ONE OF US ambassador

Since it was launched in 2011, the overall target for the anti-stigma program ONE OF US is to promote inclusion and reduce discrimination related to mental illness. The integration of the program into the Danish Health Authority was implemented to create a foundation for a sustainable organisation that could secure the program in the long term. Another target was to integrate an anti-stigma approach in the Danish Health Authority in general - first of all in relation to mental health but also in relation to other stigmatised areas such as overweight, gender identity issues and addiction.

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ONE OF US is based on social contact with a large corps of ambassadors trained to share their lived experience of mental illness in many different contexts within the five target areas: service users and relatives; professionals in the health and social sectors; young people; the labour market; the public and the media. In 2021, the national level of ONE OF US was integrated into the Danish Health Authority where social contact continues to be the fundamental principle. The organisational change brought with it a new opportunity to represent lived experience internally in the Danish Health Authority in new projects, campaigns and working groups outside the ONE OF US program. So ONE OF US has become an internal resource at a policy level that promotes and facilitates access to lived experience representation in a way that makes it easy and is expected for policy makers and where the lived experience perspective is treated as equal.

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Through the years the efficacy of ONE OF US has been documented through a wide range of surveys and since the integration into the Danish Health Authority in 2021 ONE OF US ambassadors have represented a lived experience perspective in many different contexts in the authority's work beyond ONE OF US.

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At the conference two examples will be presented:

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1. Denmark's 10-year mental health action plan. Here ambassadors are involved at many different levels, including represented in the national council for the implementation of the plan. A part of the action plan is a national plan for suicide prevention and here stigma reduction is an explicit means to preventing suicide and emphasise the importance of hope for recovery. Personal stories of lived experience have also played an important role for the suicide prevention plan as well as other parts of the plan.

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2. When The Danish Health Authority was commissioned to do a project on perinatal depression stigma reduction was included as a target along with increased knowledge among professionals and new and expecting parents. Ambassadors shared their lived experience of perinatal depression throughout the project including in short videos targeted professionals and parents respectively. In a seminar for midwives and home visitors all respondents stated that it made them more aware of the significance of stigma and how they themselves could work in a stigma reducing manner (13% to a very high degree, 57% to a high degree, 23% to some degree and 8% to a lesser extent). A campaign targeted new and expectant parents also showed positive results. The 22% recalling the campaign in a post campaign survey had significantly more positive attitudes towards disclosing having a perinatal depression. The campaign collaboration with podcasts and influencers (all four influencers themselves had lived experience of perinatal depression) also performed very well with above average interaction creating a powerful platform where large numbers of people shared their own personal experience.

Louise Hornbøll, The Danish Health Authority; Pernille Petersen, ONE OF US Ambassador

On behalf on the Danish anti-stigma program ONE OF US based in the Danish Health Authority, The National Institute of Public Health will complete a national survey about stigma and discrimination among people with mental illness in Denmark.

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The objective is to study and describe the magnitude of experiences with stigma, discrimination, self-stigma and positive treatment (i.e. situations when treated more positively because of mental illness) among a representative sample of 5.000 people with mental illness in Denmark.

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The study will provide a rating of the degree to which discrimination has been experienced in various areas of life including e.g work, relationships, parenting, housing, leisure and health services.

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There will be a discussion which include former studies in Denmark with similar design.

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The study is based on the definition of stigma as an overarching term including three elements: (1) problems of knowledge (ignorance or misinformation); (2) problems of attitudes (prejudice); and (3) problems of behaviour (discrimination). The study focuses on the third aspect of stigma: problems of behaviour or discrimination.

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The study aims to contribute to the Danish anti-stigma program ONE OF US based in the Danish Health Authority, and identify levels of discrimination, who and in which areas people experience stigma the most. The results will be used to target anti-stigma work, and initiatives moving forward and will be included in the five target areas of the program: Service users and relatives, Young people, The labour market, Professionals in health and social services and The media and the public.

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The study will also allow the Danish Health Authority for tracking changes over time to follow the results of anti-stigma initiatives as a part of a ten year mental health action plan.

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The study is based on the definition of stigma as an overarching term including three elements: (1) problems of knowledge (ignorance or misinformation); (2) problems of attitudes (prejudice); and (3) problems of behaviour (discrimination). The study focuses on the third aspect of stigma: problems of behaviour or discrimination.

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The study aims to contribute to the Danish anti-stigma program ONE OF US based in the Danish Health Authority, and identify levels of discrimination, who and in which areas people experience stigma the most. The results will be used to target anti-stigma work, and initiatives moving forward and will be included in the five target areas of the program: Service users and relatives, Young people, The labour market, Professionals in health and social services and The media and the public.

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The study will also allow the Danish Health Authority for tracking changes over time to follow the results of anti-stigma initiatives as a part of a ten year mental health action plan.

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The data collection will proceed in march 2024, so at this moment we can’t describe any preliminary findings. We expect to be able to present findings e.g: 1. levels of discrimination, who and in which areas people experience stigma the most. 2. The development since 2015 especially in relation to self-stigma, which was reported by the majority of the respondents in 2015. 3. In the 2015 survey young people stood out as they reported a higher degree of experiences with stigma and self-stigma. In Denmark there has been a development on how the youth talk about mental health, and there is a societal notion that they are better at talking about mental health problems than the older generations. Will this development reflect the results or is it still a taboo among young people?

Jón Gunnar Bernburg, University of Iceland; Sigrún Ólafsdóttir, University of Iceland

Dating back to Goffman (1963), sociologists have attempted to understand stigma, and in particular the process of something or someone being stigmatized. Conceptions and responses to mental illness vary across time and context, yet the association between mental illness and stigmatizing responses is nearly universal. Due to the persistence of this association and its harmful effects on individuals, groups and societies, much effort has been put into stigma reducing activities within and across nations. A key finding from the Stigma in Global Context – Mental Health Study was that stigma was exceptionally low in Iceland, in comparison to 17 other countries across the globe. Building on this finding, we use new data from Iceland to evaluate the possibilities of reducing stigma even further in a society with a relatively low levels of stigma.

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Population stigma, comparison over-time

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Using nationally representative samples from 2006 and 2023, we ask: “Has social distance and stigma toward individual experiencing schizophrenia and depression changed over the 17-year period in Iceland?”.

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Our findings suggest that stigma toward depression has decreased significantly, indicating more normalization of a mental health problem that is often viewed as less serious. Conversely, stigma toward schizophrenia has not changed significantly and even increased slightly (but not significantly) over time. The findings have implications for policy and stigma reduction efforts by showing that even in a society with low levels of stigma, a reduction is possible, but more importantly they underscore the importance of paying attention to different types of mental health problems, as a reduction in stigma for one type does not automatically indicate a general reduction in stigma toward mental illness.

Glen E. Kreiner, University of Utah

We have targets in two categories - (1) levels of stigma and (2) populations affected. Regarding the levels of stigma, our Grand Challenge addresses all three: (a) structural, (b) social, and (c) self. Regarding populations, we overtly address all parts of the American population - geographic (e.g., rural, suburban, urban); race/ethnicity; age; religions; LGTBQ+; workplaces; etc.; we customize our campaigns toward these populations while still having an overarching unifying message.

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The Stop Stigma Together (SST) campaign uses a collective impact model to frame our Grand Challenge: to end the stigma surrounding mental illness and substance use disorder in the United States. The Huntsman Mental Health Institute at the University of Utah is the "backbone organization" that provides seed funding and coordination for SST. The initiative kicked off in April 2022 with a Design Studio, followed by a Design Summit in October 2022. During and after these meetings - attended by almost 200 national and regional leaders on mental health - we collaboratively created and refined our structures and processes to meet the needs of our partners as they work toward stigma elimination.

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We work with a diverse group of partners in the United States to leverage their ongoing efforts and spark new ones. Partners include major associations (e.g., American Psychiatric Association, American Psychological Association), not-for-profit organizations (e.g., National Alliance on Mental Illness, Kennedy Forum, Shatterproof, One Mind, Jed Foundation, Carter Center), federal government agencies (e.g., Substance Abuse Mental Health Services Administration, Department of Labor, National Institute on Drug Abuse), workplace advocates (e.g., Society for Human Resource Management, Health Action Alliance), and media entities (e.g. Pinterest, Paramount+, Entertainment Industry Council). Beyond these major national organizations, we also work with individuals and small- and medium-sized organizations throughout the U.S. in order to provide them access to a broader social network.

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We engage with our partners not only directly (one-on-one) but also through Communities of Practice led by Task Forces. Communities of Practice enable individuals, groups, and organizations who share a common passion within the anti-stigma movement to come together to share best practices, develop toolkits, lobby governments, and develop/disseminate knowledge. These Communities of Practice cover a wide swath of populations and contexts in which mental health stigma occurs, and currently include: workplaces, children/youth/family, faith communities, veterans, mass media, journalism, criminal justice system, policy, rural, and counties. As Stop Stigma Together grows, more Communities of Practice will be added based on partner interests and societal needs.

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We bring together these participating organizations through on-site conferences (such as our Annual Summit in Salt Lake City and a Child/Youth/Family Summit in New York City in October 2023). We also host webinars for partners and meetings of the above-mentioned Task Forces. We also disseminate a regular newsletter to keep partners apprised of our and their efforts.

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One of our key partners is the Ad Council, a highly influential not-for-profit that has pioneered social change in the United States for many decades. With the Ad Council, we have created a campaign called "Love, Your Mind" (https://loveyourmindtoday.org/), which comprises a series of public service announcements aired nationally, podcasts for targeted populations, local events, and other outreach.

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Hence, overall, Stop Stigma Together brings together a diverse array of organizations to channel our collective resources toward a unified yet customized goal set to eliminate mental health stigma.

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Given that the official launch of Stop Stigma Together was less than two years ago, we are in the relatively early stages of being able to demonstrate its efficacy. That said, we categorize these metrics efforts in two ways - internal and external. Our *internal* metrics track issues such as quantity and quality of partner organizations; we currently have over 300 participating organizations. We are currently gathering qualitative data from our key partners on how they see SST's successes and areas of improvement, and have received overwhelmingly positive feedback on SST's ability to (a) break down silos across organizations and populations, (b) bring together diverse communities into a shared vision, and (c) influence structural, social, and self stigma.

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Our *external* metrics focus on stigma in U.S. society and are divided into four categories:

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(1) A legal mapping study to document laws in all 50 States that either dismantle or reinforce mental health stigma; funding is currently being secured for this.

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(2) The General Social Survey (GSS), which is the 'gold standard' in sociology research in the United States; we have secured funding to restart the mental health stigma component of that survey; it will be deployed in Spring 2024.

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(3) A series of qualitative studies on people's 'lived experiences' with mental illness; each study would focus on a specific illness (e.g., ADHD, BPD, depression) or population (e.g., rural America, racial/ethnic minorities, LGTBQ+, youth); we are seeking funding for this project but have begun pilot studies on farmers and entrepreneurs.

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(4) Surveys on substance use disorder stigma; these studies are rolling out state-by-state in partnership with Shatterproof, a leading not-for-profit in the SUD stigma space.

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Finally, data from our Ad Council partnership show that our campaign is having both short-term (e.g., immediately after watching a PSA) and long-term (e.g., changing attitudes) effects on how people see mental health in the U.S. We can include examples from the campaign (and its strategy) in the presentation.

Wufang Zhang, Peking University Sixth Hospital, Peking University Institute of Mental Health, China; Xiaotong Zhang, Peking University Sixth Hospital, Peking University Institute of Mental Health, China; Ning Ma, Peking University Sixth Hospital, Peking University Institute of Mental Health, China

This qualitative study explored and clarified key attributes of mental health stigma in mainland China, as reflected by service users, family members and mental health professionals. The understanding of stigma achieved through this study could help identify challenges and opportunities to change policies to provide better service in this social and cultural context.

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Self-stigma, stigma by association, public stigma and structural stigma were described by service users, family members and mental health professionals. Interviews took place in Beijing, and policy documents in mainland China were reviewed and analysed.

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Semi-structured interviews were carried out to investigate perspectives of 26 participants including 14 service users, 3 family members and 9 mental health professionals (psychiatrists, primary care doctors, a nurse and a licensed social worker). Individual interviews were principally conducted face-to-face, while 6 interviews had to be conducted remotely via video calls on the social media application WeChat due to the COVID-19 pandemic and relevant restrictions. Interview transcripts were coded using NVivo software, and inductive thematic analysis was completed with pre-developed code summary template. Key attributes of mental health stigma were evaluated on the basis of thematic analysis. Publicly available policy documents were reviewed and critically analysed for strengths and limitations pertaining to mental health service provision with reference to the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS 2.2) and checklist for evaluating a mental health policy or plan. Combining this analysis with attributes of stigma, opportunities and challenges for policy change were identified.

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Self-stigma among service users and stigma by association among family members are manifested by the reluctance to seek mental health diagnoses and treatment, and the unwillingness to disclose mental health conditions. These manifestations are closely associated with poor knowledge and stigmatising misconceptions about mental disorders. For public stigma, beliefs in unpredictability and dangerousness are common. The public tends to differentiate disorders with serious symptoms, i.e. people with these disorders are irrational and violent, from other disorders such as depression that may not be considered as real medical illness. The former group is believed that they could not be completely cured, while the latter who are clear-thinking and self-controlled could better recover after receiving treatment or even don’t need treatment. The general public also thinks that mental disorders are resulted by individuals’ poor stress resistance and personality weaknesses. Stigmatising behavior mostly occurs in workplaces where environments are competitive. Employment discrimination indicates structural stigma that people with mental health conditions lack abilities to achieve occupational success and wealth. This intersects with gender-based stigma, specifically men are expected to pursue career and income but women focus on marriage and family. Considering stigma among service users and family members along with family culture in China, it is challenging to include involvement of service users and their families in mental health policy. Other main challenges exist in human resources, equity of access, financing and intersectoral collaboration, but organization of services, prevention and rehabilitation and advocacy could be opportunities to improve the quality of service.

Javeed Sukhera, Hartford Hospital; Mental Health Commission of Canada; Uyen Ta, Mental Health Commission of Canada

Mental health and substance use stigma includes prejudice and discrimination that harms patients and impairs equity. Despite some advances in anti-stigma training, existing approaches tend to focus on raising awareness of interpersonal forms of stigma such as stereotyping against patients with mental illness. Shifting the focus of anti-stigma training to target structural forms of stigma which are structurally embedded and perpetuated through policies and practices within healthcare may advance anti-stigma training towards sustainable improvements in knowledge, skills, and structural change. The Mental Health Commission of Canada designed, piloted, implemented, and evaluated a novel eLearning course on dismantling structural stigma.

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Learning objectives, instructional design strategies, and an eLearning course was developed based on a literature review, needs assessment, and a co-design process involving diverse partners, and a pilot testing phase. The course focused on knowledge building and personal reflection using a transformative learning framework. Learners engaged in reflection and evidence-informed approaches to build skills to identify and dismantle structural stigma in healthcare contexts.

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Participants included individuals who completed the publicly available course from April 1 to December 31, 2023 that were self-identified health system leaders and influencers, as well as healthcare professionals (n=303).

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84% percent of participants (n=254) completed the course also completed a pre and post evaluation. Ninety-eight percent agreed that the course met the stated learning objectives, was organized in a manner that helped them understand underlying concepts and would recommend the course to their colleagues. Ninety-eight percent felt the course raised their understanding and knowledge about the topic and gave them concrete actions and examples to dismantle structural stigma. Ninety-two percent felt the course was relevant to their work. Overall, participant response to the course was overwhelmingly positive.

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Overall, we found that our web-based interactive eLearning course designed to improve knowledge, skills, and attitudes about structural stigma while challenging, transforming, and enlightening learners’ beliefs and assumptions is an accessible tool with potential to produce sustained educational and practice-based outcomes and improve equity for individuals with mental health and substance use challenges.

Javeed Sukhera, Hartford Hospital; Mental Health Commission of Canada; Uyen Ta, Mental Health Commission of Canada; Stephanie Knaak, Mental Health Commission of Canada

Efforts to address mental illness stigma within the healthcare sector have not produced sufficient or sustained changes to delivery, quality, or models of care. One such reason is that many anti-stigma efforts tend to be targeted at interpersonal aspects of stigma, seeking to reduce prejudicial attitudes and improve discriminatory behaviors. Shifting attention to structural aspects of stigma may have unique potential to advance stigma reduction into the future. In this study, the authors conducted a realist case study of interventions to address structural stigma in healthcare organizations. The results from the study were used to inform a practical information guide for healthcare organizations.

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Structural mental health and substance use stigma in healthcare contexts. Including but not limited to policy, practice, and governance.

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In the context of broader work undertaken by the Mental Health Commission of Canada (MHCC) in structural stigma, the MHCC solicited applications from health organizations across Canada who had developed initiatives to address structural stigma in a healthcare context. The research team hoped to leverage what was learned from these real-world examples to inform key ingredients, features, strategies, and considerations and assist other organizations, departments, or work units who have an interest in combating and addressing structural stigma. Sixty-two submissions were received and six were selected as exemplars as part of a publicly available report of exemplar cases. Utilizing a realist multiple explanatory case study approach, authors reviewed data from all cases. After developing their initial program theory, the exemplar cases were analyzed for possible context-mechanism-outcome configurations.

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Results suggest that effective interventions required organizational readiness to disrupt existing power asymmetries, shared governance infrastructures, and an alignment of values despite historical mistrust between disparate partners. Mechanisms for change involved proactive management of resistance, disruptive innovation, co-designing processes, and embedding structural change into existing policy. Outcomes included sustainability, reduced coercion, and improved trust. Findings suggest that interventions to address structural stigma can produce sustained policy and practice change if organizations embrace power sharing and trust building while embedding change within policies and governance structures.

Lowri Wyn Jones, Time to Change Wales; Rachelle Bright, Time to Change Wales; Amanda Pearce, Time to Change Wales

This training module is an innovative approach to tackle mental health stigma and discrimination with health care staff as both an employer and service provider. By using digital stories of individuals with lived experience of mental ill-health as a focal point, we aimed to change attitudes and behaviour working towards creating a culture of compassion and respect.

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Time to Change Wales (TtCW) is the national campaign to end stigma and discrimination faced by people with mental ill-health. TtCW’s quantitative research commissioned in 2017, 2019 and 2021 consistently revealed that mental health stigma is experienced within healthcare settings showing an upward trend since 2019. As a response to this we partnered with a large Welsh health board (Swansea Bay) who employ 12,500 healthcare staff to create a unique training module which served to address these challenges.

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Our targets between 2022 and 2024 was to train 1,000 healthcare staff which we have now exceeded. The learning objectives for participants were:

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• To recognise that stigma is experienced within the healthcare service and how it translates into behaviour that directly impacts the patient.

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• To understand the longer term and knock-on effects of stigma experienced in services.

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• To be more able to recognise self-stigma and learn about the tools and approaches individuals can apply to encourage them to use mental health services when they self-stigmatise.

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• To understand what contribution healthcare staff can make individually to improve patient journeys.

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• To have the tools and confidence to speak up and to challenge stigma when witnessed.

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• To feel more confident in creating an open culture of dialogue when things don’t go too well.

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Time to Change Wales and Swansea Bay Health Board shared a common vision which was to work towards more compassionate cultures where staff and patients don’t experience mental health stigma. As far as we know this is the first time such an innovative approach between an anti-stigma campaign has worked on such a large scale with a health board in Wales. This training aimed to address a key aspect of wellbeing which was to create a culture of acceptance and openness, free of stigma and discrimination from a staff and patient perspective. It addressed and explored the social norms and environment around mental health within the health board as being foundational to promote and maintain good levels of wellbeing. The training provided a stark insight into what this looks like if this infrastructure’s not in place leading to feelings of anxiety, isolation and exclusion. The training positioned itself outside of conventional training comfort zones, it provoked and challenged what staff thought they knew about mental health and how our beliefs and innate prejudices inadvertently guide behaviours towards patients and each other.

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The training was anchored around the powerful digital stories commissioned by TtCW and featuring their volunteers' (Champions) talking candidly about their experiences of stigma within healthcare services. These impactful and compelling videos were for some difficult to digest but provided a unique opportunity for participants to put themselves into their shoes and empathise with how it might feel to be excluded, blamed, shamed and insignificant when accessing mental health support. This allowed participants the space to reflect on their own practice and experiences and truly understand the profound impact of the experiences on an individual’s life. The realisation by participants that their actions or behaviour may have unwittingly compounded the experiences of stigma and that the smallest changes can make the biggest difference. There was a palpable sense of compassion shown towards the individuals featured and a disbelief that this could happen within services in Wales. It gave permission for participants to open up, possibly for the first time and share their own lived experience of stigma and how it has impacted them or their loved ones.

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The training has had far-reaching impact, beyond what we had set out to achieve. We’ve trained over 1,000 healthcare staff and we received very positive feedback overall with 98% of participants who responded saying they’d recommend the training to their colleagues.

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In terms of evaluation we created a framework which would allow us to compare knowledge and awareness before and after the training to gauge the immediate impact of the intervention. Specifically, we can say that participants’ after-knowledge of the impact of stigma significantly improved after the training. 98% of participants said that their understanding of stigma and its impact was ‘good’ or ‘very good’ after attending the training, compared to 47% prior to attending. In terms of recognising signs of stigmatising behaviour, prior to the training the figure was 43% and after the training it was 90%. One participant commented that it provided them with “a reminder and enthusiasm to keep challenging prejudices and stereotypes at work. Also challenging myself, keeping myself in check and aware of my own prejudices that may develop.” By offering this training we have brought healthcare staff members together from different professions and grades into a “leveller” dialogue around stigma, something which wouldn’t have happened organically without the training. It provided a much-needed platform for staff to learn and grow from each other’s experiences, to give them permission to be vulnerable and step outside comfort zones.

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Following the success of this training which has been shortlisted for multiple awards, we have plans to roll out to more health boards and academic institutions in the near future.

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We plan to carry out more in-depth evaluation with the health board on the lasting impact of the training on staff and on the organisation as a whole and we anticipate this will be ready to share at the WPA conference in June.

Bhawana Subedi, Transcultural Psychosocial Organization (TPO) Nepal

To explore the perspectives of multiple levels in the health system on novel stigma intervention involving people with lived experiences in Nepal

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The interventions piloted were at three levels of cadres within the healthcare systems:

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1. Community level: Female Community Healthcare Volunteers (FCHVs) and local healthcare stakeholders (such as municipality leaders, and health coordinators) in a rural municipality in Nepal (Arjunchaupari Municipality) were targeted through multiple activities such as media campaign, stakeholder workshop, and government’s mental health training targeted for FCHVs where the stigma component was integrated. In these activities, People with Lived Experiences (PWLEs) were involved in narrating their recovery narratives using the photo voice method.

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2. Primary healthcare level: Primary healthcare providers from the rural municipality in Nepal (Arjunchaupari Municipality) were provided with 7-days of mhGAP style mental health training with integration of anti-stigma components such as PWLE recovery narratives using photovoice, aspiration figure narratives, and myth-busting exercises.

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3. Specialist level: Psychiatric residents/psychiatrists, Psychiatric nurses, and General Practitioners were provided with 2-days of training on identifying and addressing anticipated, experienced, and self-stigma of PWLEs they come into contact with. This included understanding different forms of stigma faced by PWLEs, interacting with PWLEs during their recovery and stigma narratives using photovoice, and role-playing.

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Qualitative interviews were conducted with all three cadres of mental healthcare workers. Thematic analysis was done where key themes were identified and coded using the dedoose software.

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The findings from the interventions accumulated from all three levels of cadres: Female Community Health Workers (FCHV), Primary healthcare providers, Mental Health Specialists

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1. Perceptions on stigma and mental health before training

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All three levels of cadres expressed they had very limited knowledge of mental health and related stigmas. In addition, they shared that they never really emphasized the stigma aspects of mental health. To explain further, FCHVs expressed that they perceived mental health problems as stigmatizing problems and often used derogatory terms such as "lunatic" or "insane" when referring to people with mental health problems and also perceived mental health as an incurable condition.

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2. Perceptions on the involvement of People with Lived Experiences (PWLEs) in training

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The service providers have highlighted the positive impact of PWLEs involvement on them. They shared the involvement of PWLE was effective and it has helped in reducing their stigma perspective and also brought confidence in them to treat the mental health patients and explained the easiness of MH problem diagnosis and treatment. Moreover, mental health specialists mentioned the involvement of PWLE made them enlighten on the patient's perspective. They shared that PWLE involvement has been eye-opening in terms of how their service-providing culture has had flaws all those years. They noted the narration of the patient's story through the photo voice method was insightful.

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3. Perceptions on benefits of training/stigma intervention

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All three levels of personnel have mentioned that they had a transformative shift in their perception of mental health after the training. They shared they had realized how the mental health stigma and stigmatizing behaviors were deeply rooted within themselves. Stakeholders also shed information on how the day workshop made them understand and learn about mental health problems. Primary health care providers expressed the training had motivated them to diagnose and treat mental health patients through primary health facilities. Besides that, Mental health specialists said the antistigma campaign and PWLEs involvement was an enlightening perspective on mental health-related stigma for them which has resulted in alterations in their workplace dynamics, specifically to reduce the mental health-related stigma.

Ulla Lindgren, PsykInfo/Center for Involvement of Relatives, Mental Health Services, Region of Southern Denmark; Giuseppe Parlatore, ONE OF US, PsykInfo, Mental Health Services, Region of Southern Denmark; Liselene Pedersen, PsykInfo, Mental Health Services, Region of Southern Denmark; Jeanne Holm Ovesen, Center for Involvement of Relatives, Mental Health Services, Region of Southern Denmark & Institute of Regional Health Research, University of Southern Denmark; Emilie Nørholm Henriksen, Center for Involvement of Relatives, Mental Health Services, Region of Southern Denmark & Institute of Regional Health Research, University of Southern Denmark; Rikke Amalie Agergaard Jensen, Center for Involvement of Relatives, Mental Health Services, Region of Southern Denmark & Institute of Regional Health Research, University of Southern Denmark

The nationwide program "ONE OF US" in Denmark has a long history of valuing and amplifying the voices of individuals with lived experiences of mental illness. Nationally, the program is organized as part of the Danish Health Authority, and regionally, it is organized in one of the five PsykInfo’s (Psychiatric Information Centre) that are part of each of Denmark’s five regions. This presentation centers on three specific regional activities within the program, focusing on the PsykInfo in the Region of Southern Denmark.

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The stigma reduction target of the first activity is embedded in the medical education, the other two activities reach into health care provider training. Together, the activities inform students and health care professionals about the realities of the stigmatized conditions and challenge negative stereotypes.

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The three activities share a common thread – a reliance on social contact. This strategic approach emphasizes the power of personal connections, transcending textbooks and classrooms to foster authentic interactions between individuals with lived experiences and those on the front lines of healthcare. By grounding stigma reduction efforts in real, human stories, the activities aims to challenge preconceptions, reshape perspectives, and contribute to a more compassionate and inclusive healthcare landscape.

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Activity 1: In a collaboration between the medical study program at the University of Southern Denmark and PsykInfo, ambassadors (individuals with lived experiences of mental illness) from ONE OF US are paired with medical students participating in the Human First (Mennesker Først) seminar (6 ECTS points). In this seminar, students visit the ambassadors in their homes to engage in conversations covering (1) the individuals’ life situations, (2) their personal encounters with mental illness, and (3) their interactions with mental healthcare services. Following each meeting, students compose reflective papers. Throughout the seminar, students also convene in smaller groups with consultants from PsykInfo who facilitate supervision and guide them in reflective practices. The seminar curriculum draws from narrative medicine, health psychology, and professional ethics. Approximately 80 students have been engaged in this activity during 2023. We present qualitative data on the students’ experiences and impact of the activities.

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Activity 2: Within the mental health services of the Region of Southern Denmark, the onboarding process for all new employees includes a comprehensive one-day seminar. This seminar is designed to introduce new employees to key individuals within the organization and foster dialogue and reflection on aspects such as patient-centeredness and personal recovery. Representatives from the management, the Human Resources (HR) department, the Clinical IT department, the Quality and Improvement department, and an ambassador from ONE OF US deliver presentations during this seminar. The one-day seminar is evaluated, and we present qualitative and quantitative data collected in 2023 on the healthcare professionals’ experiences, including the impact of personal stories from the ambassadors.

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Activity 3: Individuals with severe mental illness are more likely to have multiple physical health conditions than the general population. This is particularly true for young people with severe mental illness. Those aged 15 to 34 years are 5 times more likely to have 3 or more physical health conditions. At the same time, their lives are 15 to 20 years shorter than for the general population. These inequalities have been attributed to a combination of factors, including systemic issues, such as the separation of mental health services from other medical services and healthcare provider issues such as lack of knowledge about- and stigma associated with mental illness. In this initiative, an ambassador from ONE OF US collaborates with a consultant from PsykInfo to engage healthcare professionals in the somatic field in meaningful conversations. These interactions aim to provide professionals with personal perspectives on the experiences of individuals navigating both severe mental illness as well as physical illness. As of 2023, this activity has successfully reached 750 professionals. In the future, we will expand this program to reach other professionals, such as police officers and prison guards. The goal is to broaden the impact of our initiative, fostering a deeper understanding and awareness of the challenges faced by individuals managing severe mental illness and physical health conditions across various sectors.

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Past studies have indicated that interventions based on social contact are particularly effective for achieving short-term changes in knowledge and attitudes. Although data on this specific aspect were not collected, we have collected quantitative information on reach of the activities as well as quantitative and qualitative data pertaining to the personal experiences and impact of the activities.

Maria Schröder-Best, Philipps University Marburg, Germany

The primary objective of the study is to investigate the prevalence and impact of self-stigmatization among individuals within the forensic mental health system. The study aims to fill a gap in existing literature by exploring the nuanced experiences of this population and understanding the interplay between societal attitudes and the self-reference of the participants.

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The stigma target in the research pertains to individuals within the forensic mental health system, addressing a gap in current literature that predominantly focuses on stigmatization within the general psychiatric context. The study adopts a cross-sectional and mixed method approach, examining the prevalence and impact of self-stigmatization on this specific population. Moreover, the investigation considers both individual and systemic dimensions of stigma, shedding light on the interplay between societal attitudes and the structural aspects within the forensic mental health system.

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The study used a mixed-methods approach with the aim to contribute to a more holistic interpretation of the complex and multifaceted phenomenon of self-stigmatization in this unique population.

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A quantitative approach was employed utilizing well-established psychological inventories to assess various dimensions of the participants' experiences. The survey instrument incorporated established measures such as the Self-Stigma of Mental Illness Scale (SSMI), Stigma Experience Scale (SES), Discrimination in Mental Health System (DMS), Psychosocial treatment compliance (PTCS), among others.

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Complementing the quantitative phase, qualitative data were gathered through in-depth narrative interviews. Participants were encouraged to share their personal experiences, perceptions, and coping mechanisms related to stigmatization. The narrative interviews provided a rich context to understand the lived experiences of individuals within the forensic mental health system, allowing for a nuanced exploration of the psychosocial factors that contribute to self-stigmatization.

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This presentation delves into the phenomenon of self-stigmatization within the context of forensic care. The study focuses on individuals within the forensic system who grapple with both mental health challenges and legal involvement. Drawing inspiration from Corrigan et al.'s (2006) model, the research investigates the aspects of awareness and agreement of stigmas as well as their application to one's own person, and how they affect one's sense of self-worth.

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To date, data has been gathered from a cohort of individuals (n=60), employing f.e. the Stigma of Self-Mental Illness scale (SSMI), the Discrimination in Mental Health System Questionnaire (DMS) or the Stigma Experience Scale (SES). By the time of the conference, data from an anticipated 90 to 100 participants will be analyzed. Participants engaged in both quantitative questionnaires and in-depth (narrative) interviews exploring their experiences with stigma.

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At this stage, the first interesting findings are emerging. For example:

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Preliminary findings reveal high levels of awareness among participants regarding societal stigmatization, with a majority acknowledging negative prejudices - both within the qualitative and quantitative data. This seems particularly interesting, as this group of people, in particular (around 60% of people in the German Forensic Mental Health System are diagnosed with Schizophrenia), is denied an appropriate assessment of reality by society.

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Both the quantitative and qualitative data show that the group of people themselves does not share the prejudices and judges other patients critically but realistically.

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A noteworthy aspect of our research pertains to the extent of self-stigmatization. Contrary to theoretical assumptions, quantitative data suggests that individuals within the forensic system may not internalize social attributions. However, qualitative insights, particularly from in-depth, narrative interviews, provide a rich understanding of coping mechanisms, such as developing a "thick skin" or creating a metaphorical "high wall" to counteract the impact of societal judgments.

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Further exploration reveals the negotiation of stigmas related to criminality versus mental illness. Preliminary results suggest that individuals navigate criminal stigmas more adaptively than those associated with mental health, indicating potential implications for self-concealment, defense mechanisms, and internalization.

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This presentation promises to offer a comprehensive analysis of self-stigmatization among individuals in forensic care, incorporating both quantitative and qualitative perspectives. The implications of these findings on mental health interventions and societal perceptions will be discussed.

Tianming Zhang, Shanghai University

The objective of this study is to comprehensively canvass the subjective experience of internalized stigma from the perspective of people with severe mental illness.

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Internalized stigma, cross-sectional study, people with severe mental illness, a rural community in China

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Narratives of 16 people with schizophrenia obtained using the method of photo-elicitation interviewing from a project entitled Community In-Alliance for Recovery: Challenging Stigma of Mental Illness in Rural China (CIFR) were extracted for this study. A directed content analysis approach was adopted for analyzing the qualitative data.

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The main source of stigma identified in the narratives pertains to perceived discrimination from several aspects of the social system, such as family, workplace, and community. In addition, participants endorsed negative public stereotypes and formed adverse self-image. The findings of this study also showed that participants adopted negative behavior responses to their stigmatized status, including social withdrawal, passive and selective disclosure of mental illness, and label avoidance.

Beth Hobern, Melbourne School of Psychological Sciences, The University of Melbourne; Imogen Rehm, Institute of Health and Sport, Victoria University, Melbourne; Michelle Blanchard, Melbourne School of Psychological Sciences, The University of Melbourne; Christopher Groot, Melbourne School of Psychological Sciences, The University of Melbourne

Schizophrenia and substance use disorders (SUD) are highly stigmatised conditions that frequently co-occur. However, little is known about stigma towards people living with co-occurring schizophrenia and SUD (SZSUD). This presentation will discuss the findings of three iterative mixed-methods studies examining stigma from the perspective of people living with SZSUD and the public. By exploring stigma from both perspectives, these studies aim to comprehensively investigate if and how multiple stigmatised identities in the form of SZSUD are related to stigma in interpersonal relationships for Australians living with these conditions.

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Studies 1 (N = 90) and 2 (N = 50) examined stigma from the perspective of Australians living with schizophrenia, SUD, and SZSUD. This included internalised, perceived, experienced, and anticipated stigma and discrimination in relationships with friends, family, intimate partners, and carers.

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Study 3 examined public stigma in the form of stereotyped cognitions, prejudicial emotions, and discriminatory behavioural responses to characters described as living with schizophrenia, SUD (alcohol or amphetamine), or SZSUD (N = 469).

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These studies were conducted as part of the National Stigma Report Card (NSRC), a partnership project between the Melbourne School of Psychological Sciences and SANE Australia, with funding support from the Paul Ramsay Foundation. The studies utilise and build upon the data from the first NSRC survey, Our Turn to Speak (OTTS). Data was collected through interviews and online surveys.

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Australians living with SZSUD expressed high levels of agreement with internalised, perceived, experienced, and anticipated stigma in relationships. One-way ANOVAs found that people living with SZSUD reported significantly higher agreement with experienced stigma in relationships with friends and family compared to people living with SUD alone. However, a different pattern of responses was observed for public stigma. Here, the highest levels of stigma were expressed in response to people living with SUD, followed by those with SZSUD and SZ, respectively. Additional quantitative and qualitative results will be discussed, along with the implications of this research and recommendations for future directions.

Carmen Simonsen, Department of Psychology, University of Oslo; Gina Åsbø, Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Kristin F Wold, Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Torill Ueland, Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Ingrid Melle, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Internalised stigma is common in people with psychotic disorders and is related to lower levels of recovery and wellbeing. However, we know less about long-term development of internalised stigma in people with first-episode psychosis (FEP). Therefore, a FEP 10-year follow-up study investigated the rate of internalised stigma in the total sample and between schizophrenia spectrum disorders (SZ) and psychotic bipolar spectrum disorders (BD), and how it relates to positive outcomes.

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Internalised stigma - first-episode psychosis - longitudinal study - in Norway.

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Methods: At 10-year follow-up in the Norwegian TOP study, participants with FEP (n=122) were re-assessed with structured clinical-interviews. Self-rating measures were used for internalised stigma (Internalized Stigma of Mental Illness Inventory (high-stigma: mean-score >2.5)), emotional wellbeing (Life-Satisfaction Scale (score ≥5) and Temporal Experience of Pleasure Scale (total-score ≥72)), and personal recovery (Questionnaire about the Process of Recovery-15-item scale (total-score ≥45)). Clinician rated measures were used for clinical recovery (symptom-remission and adequate functioning (minimum one-year)).

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Results: Overall, 20.2% of people with FEP presented high internalised stigma at 10-year follow-up, with higher rates in participants with SZ (25.4%) than BD (9.1%). The majority of participants with high internalised stigma did not experience emotional wellbeing, personal recovery or clinical recovery.

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Conclusions: A minority still experience high internalised stigma 10-years after start of treatment for a psychotic disorder, although rates are higher for people with SZ than BD. As high internalised stigma co-occurs with lack of positive outcomes, internalised stigma could be an important treatment target to improve chances for long-term recovery and a good life for a subgroup of people with psychotic disorders.

Dorottya Őri, Semmelweis University, Budapest, Hungary; Peter Szocsics, Semmelweis University, Budapest, Hungary; Tamás Molnár, Győr, Hungary, Petz Aladar Hospital; Lucie Bankovska Motlova, Charles University, Prague, Czech Republic; Psychiatric Clinic of Minsk City, Minsk, Belarus, olgakazakovamd@gmail.com; Sabrina Mörkl, Medical University of Graz; Michael Wallies, Therapie auf Augenhoehe; Mohamed Abdulhakim, Vrije Universiteit Brussel; Sylvie Boivin, EPSM Étienne Gourmelen; Kristina Bruna, Psychiatric Hospital Gintermuiza; Carolina Cabacos, Faculty of Medicine of University of Coimbra; Elvira Anna Carbone, University Magna Graecia of Catanzaro; Elona Dashi, University Hospital Center “Mother Theresa”; Giovanni Grech, Mount Carmel Hospital; Stjepan Greguras, University Hospital Centre Zagreb; Iva Ivanovic, Clinical Centre of Montenegro; Kaloyan Guevara, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism; Selay Kakar, Erasmus University; Konstantinos Kotsis, University of Ioannina; Ida Maria Ingeholm Klinkby, Capital Region of Denmark; Jovana Maslak, Institute for Mental Health; Shevonne Matheiken, Pennine Care NHS Foundation Trust; Ana Mirković, Children's Hospital Ljubljana; Nikita Nechepurenko, The Serbsky State Scientific Center for Social and Forensic Psychiatry; Angelis Panayi, Freelancer; Ana Telma Pereira, Faculty of Medicine of University of Coimbra; Edith Pomarol-Clotet, FIDMAG Research Foundation; Shaeraine Raaj, South Meath Mental Health Service; Polona Rus-Prelog, University Psychiatric Clinic Ljubljana; Joan Soler-Vidal, FIDMAG Research Foundation; Robertas Strumila, Vilnius University; Florian Schuster, Klinikum rechts der Isar der Technischen Universität München; Helena Kisand, University of Tartu; Ann Reim, University of Tartu; Gumru Ahmadova, City Hospital N15; Matus Vircik, Psychiatric Hospital Michalovce; Helin Yilmaz Kafali, Işık University; Natalia Grinko, Ukrainian Catholic University; Sándor Rózsa, Károli Gáspár University of the Reformed Church

A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma and psychosocial and professional factors.

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Provider stigma, cross-sectonal, trainees and specialists in child and adolescent and general adult psychiatry, online survey accross Europe

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The self-reported, anonymous, online survey was used, and the Opening Minds Stigma Scale for Health Care Providers was the main outcome measure. The survey was translated into the local language of each participating country. Participants were practising specialists and trainees in general adult or child and adolescent psychiatry.

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A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries the less stigmatising attitudes were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = −0.92, p = 0.019), receiving medical treatment for a mental illness (d = −0.88), as well as having a friend or a family member similarly affected (d = −0.68)), being surrounded by colleagues who are less stigmatising (d = −0.98), providing psychotherapy to patients (d = −1.14), and being open to (d = −1.69) and having a possibility to participate in (d = −0.94) case discussion, supervision, or Balint groups.

Shevonne Matheiken, Cambridgeshire and Peterborough NHS foundation Trust

To measure stigmatising attitudes of psychiatrists and factors that co-related with lower scores

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Stigma and attitudes of psychiatrists towards patients, cross-sectional, UK

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Quantitative online survey after ethics approval, Opening minds stigma scale for HCP

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169 responses, 3 groups had statistically significant lower stigma scores : psychiatrists with lived experience of mental illness, those who received/involved in psychotherapy and those whose patients received stigmatising attitudes from other clinicians.

Ananta Dave, Black Country Integrated Care Board, UK

Reducing/preventing doctors' suicides

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Courageous compassionate leadership right from medical school, role modelling vulnerability, early help seeking, and prioritising self care. Developing tailored services for doctors including rehabilitation while staying in employment when possible. Training psychiatrists in occupational psychiatry so that there is a pool of doctors trained in treating mental illness among doctors and medical students. Sensitive support for bereaved colleagues and families when a doctor dies by suicide. Sharing stories of hope and recovery to reduce stigma. Mental health of the medical profession to be seen as a pubic health issue .

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Findings from Dr Ananta Dave's (soon to be published) Churchill fellowship will be discussed in the talk.

Katrina Scior, Kings College London; Julie Evans, University College London; Anna Hildebrand, University College London; Harriet Mills, University College London; Henry Clements, University College London

Assess the feasibility and acceptability of HOP-MHP, delivered as guided self-help intervention, with optional peer support forum

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stigma among mental health care providers

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Pilot RCT of the guided HOP-MHP self-help intervention. Acceptability assessed through survey and interviews with subsample. Feasibility assessed through retention rates.

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The intervention was found to be acceptable, with mental health providers welcoming the opportunity to consider sharing their difficulties and engage with peers. Feasibility data indicate that the guided self-help format needs rethinking.

Norman Sartorius

Amy Ronaldson, King's College London; Professor Claire Henderson, King's College London

We investigated the extent to which the positive longitudinal changes reported from 2008 to 2019 using the Attitudes to Mental Illness Survey were sustained by 2023, two years after the end of the Time to Change social marketing campaign in England.

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The adult population living in England, in particular those aged 25-45.

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We used data from the Attitudes to Mental Illness survey - a survey of a nationally representative quota sample of adults from England and evaluated long-term trends (2008/2009 to 2023) in outcomes using regression analyses. Outcomes included measures of attitudes towards mental illness (Changes in Attitudes to Mental Illness scale (CAMI)), mental health-related knowledge (Mental Health Knowledge Schedule (MAKS)), and desire for social distance (Reported and Intended Behaviour Scale (RIBS)). We also examined willingness to interact with people with depression and schizophrenia specifically, as well as attitudes towards workplace discrimination against people with these conditions using data from the British Social Attitudes Survey (BSAS) 2015 for comparison.

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Reported in standard deviation units (95% confidence intervals (CI)), attitudes towards mental illness significantly improved between 2008 and 2023 (SD=0.24, 95% CI=0.16 to 0.31), but following an increase of 9.9% between 2008-19, scores decreased significantly by 3.3% (p=0.015). Although MAKS and RIBS scores showed consistent improvement from 2009 to 2019, 2023 scores on these scales no longer differed from scores in 2009, indicating a significant decrease in mental health-related knowledge (MAKS scores declined 7.8% since 2019, p<0.001) and desire for social distance (RIBS scores declined by 10.2% since 2019, p<0.001). However, comparison with BSAS data from 2015 indicated that in 2023 respondents were more willing to interact with people with both depression (β=-2.69, p<0.001) and schizophrenia (β=-2.70, p<0.001). Moreover, people in 2023 were more likely to agree that people with depression and schizophrenia are just as likely to be promoted in the workplace, and to disagree that their medical history should make a difference. This change was most pronounced for schizophrenia (OR=2.52, 95% CI=2.02 to 3.14).

Christopher Tupy, Dachverband IDEE Österreich; Alexandra Puhm, Austrian National Public Health Institute; Julian Strizek, Austrian National Public Health Institute; Monika Nowotny

Austria’s anti-stigma efforts at federal level aim to reduce four main levels of stigma: structural, cultural, personal, and self-stigmatization. Compared to other national strategies, it is characterized by a strong emphasis on structural discrimination (e.g. legislation and policies) and cultural meanings (e.g. in the media and in arts and culture) that legitimate discrimination against people living with mental illness. The goal is to combine a broad range of actions addressing all different levels of stigma in different settings to make good use of synergies and achieve the highest possible impact. Efforts cover different areas of action, i.e. health and social affairs, work / labour, education, media, empowerment and self-representation of PWLE, civil society engagement and advocacy, arts and culture, science and monitoring. Anti-stigma aims and targets include awareness raising (with specific foci on selected target groups such as health and social care workers, children and adolescents, teachers, and managerial staff), non-discriminatory structural/legal frameworks, overall equality for PWLE and many more.

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The recommendations stress the need for a whole-of-society approach. Similar like health promotion needs a mental-health-in-all-policies approach, stigma-reduction needs concerted action across all areas of society. The National Action Plan on Disability 2022–2030 to implement the UN Convention on the Rights of Persons with Disabilities (UNCRPD) is another guiding document for Austria’s efforts. Starting in 2020, recommendations were set up by a nationwide expert committee, consisting of public officials from different fields of federal administration (a.o. health, social affairs, labour, education, arts and culture), scholars from different fields of research, PWLE, caring relatives and psychosocial care practitioners, disability rights experts, communication experts and media representatives. Recommendations are based on Austrian and international good / best practice examples, and evidence for similar interventions. All recommendations were developed in a participatory manner with the equal involvement of PWLE, caring relatives of people with mental illness and psychosocial care practitioners (= trialogical approach). Recommendations for two of the four stigma levels (self-stigmatization and personal stigmatization) have been published as interim reports. Publication of recommendations on the two remaining levels (structural and cultural stigmatization) is planned for 2024. Furthermore, a multi-strategic catalogue of prioritized recommendations shall be defined in the course of this year. The intended audience are (mainly) political decision makers.

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For the time being, evidence is available only for some selected national initiatives. Austria’s multi-strategic approach to destigmatization is guided and supported by seminal international research outcomes, e.g. the report by the Lancet commission on ending stigma and discrimination in mental health. This is especially true with regards to the multi-level approach we follow or the idea that educational activities should be offered in combination with contact based activities. The strengthening and refinement stigma monitoring will make part of our future efforts. The Study “Monitoring Public Stigma Austria 1998–2018 (MOPUSTIA18)” provides baseline data for the time before Austria’s anti-stigma programs efforts at federal level took off. The efficacy of the current efforts may be measured against these results in the future.

Virginia Rubaine, British Virgin Islands Health Services Authority (BVIHSA); Anna Neilson-Williams, Bermuda Hospitals Board; Karen Grant-Simmons, Bermuda Hospitals Board; Sue Baker, Changing Minds Globally/Implemental

Two pilot anti-stigma projects were established with local partners in two UK Overseas Territories (the British Virgin Islands and Bermuda) as part of a programme funded by the UK Government to build local capacity to address mental health stigma.

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The pilot project aims were to: Research the extent, impact and drivers of mental health stigma to inform implementation, to train local people with lived experience to safely and effectively share their stories at social contact events, and research and deliver social marketing campaigns to improve public attitudes.

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The methodology for the anti-stigma pilots in the BVI and Bermuda was based on an evidence-based anti-stigma programme (Time to Change ) implemented in England and then adapted to local contents and cultures by mental health teams from the BVIHSA, the Bermuda Hospitals Board and Bermuda Ministry of Health.

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The core elements of the Time to Change methodology that were adapted by partners:

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• Foundational Research. A survey of local people with mental health problems (‘Stigma Shout’) to measure the extent and impact of stigma on day-to-day activities and ‘audience insight’ focus groups with local populations to provide greater insight into the prevailing beliefs, social norms and understanding of mental health to shape the campaign and selection of target audiences, media channels, and locations for social contact events

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• Lived Experience Champions/Ambassadors. Recruiting, training, and supporting local people with mental health experiences who would be willing to share this with the public at social contact events and potentially as part of campaigns

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• Social Contact Events – the most globally evidence-based anti-stigma methodology that involves planning public-facing events where Champions/Ambassadors have two-way conversations that involve disclosure of their mental health experiences (that is safe and effective) to drive changes in public attitudes

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• Social Marketing Campaigns – using insight research to design and implement marketing campaigns to change public knowledge, attitudes, and behaviour related to mental health. This includes creating concepts, messaging and content and delivering it through paid, owned and earned channels.

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Foundational research: 41 people in the BVI and 74 people in Bermuda with mental health problems completed an adapted stigma survey (‘Stigma Shout’ which was first used in England in 2006/07). 43.9% (BVI) and 43% (Bermuda) of respondents reported that stigma had stopped them doing things. The findings in the BVI and Bermuda also reflect similar findings from the original Stigma Shout survey undertaken in England where families, wider families, friends and the community were identified as causing the most stigma and discrimination.

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Focus groups with segments of the local population were organised and facilitated by the mental health teams in the BVI with 44 people and in Bermuda with 87 people using a discussion guide adapted from Time to Change. The guide was used to elicit responses from focus group participants that would provide insight into their understanding and knowledge of mental health, prevailing myths and facts, and intended future behaviour. Questions also assessed participants awareness of previous mental health campaigns and strategies that might increase their understanding and empathy.

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The Bermuda research was used to inform the development of a campaign and the drafting of a White paper in 2023 and the BVI research findings were used to inform the development of a social marketing campaign called ‘Mindful’.

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The ‘Mindful’ campaign in the BVI has achieved impressive levels of reach and engagement. The campaign was mostly delivered through paid social media with Facebook, Instagram and LinkedIn utilized. Between 1st August and 15th December 2023 there were approximately 193,000 impressions (an ‘impression’ refers to each unique time any content from the account, or the account itself, is displayed on an individual’s screen during their browsing).

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On average the audience engaged with the content 13.17% of the time (whether by liking, commenting, reacting to, sharing, or saving the posts) resulting in some sort of active engagement with the material 25,000 times over the campaign period. This level of reach and engagement has been impressive in a population of approximately 31,000 people. Further analysis of the performance of social media adverts shows that the best performing content featured the Champions.

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Caption: Photos of Champions in the BVI during training (left) and speaking at a public event.

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Caption: Facebook post on 17th October 2023 as part of the Mindful campaign featuring Champion Tashima Barzey that secured 16,449 impressions, 351 reactions and a 25% engagement rate.

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The core methods were adaptable to BVI and Bermuda contexts but differences were noted in the numbers who felt able to speak publicly as Champions. There are seven active trained Champions in the BVI but, despite 85 people being approached and five people completing the initial training in Bermuda, there are currently no active Champions.

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Conclusions: Stigma was shown to be present in both the BVI and Bermuda. It was feasible to adapt the core methods of Time to Change to new contexts of very small island communities, however there were significant differences in the numbers of people who felt able to share their lived experience as trained Champions in Bermuda compared to the BVI. Different approaches to having lived experience Champions are currently being explored in Bermuda which might provide further useful learning.

Karin Wagner, New York State Office of Mental Health

The goal of the plan is to reduce stigmatizing beliefs, attitudes and behaviors and to increase help-seeking behaviors in the state of New York as measured by referral and service volume for MH services.

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Interventions have included local regional interventions and statewide interventions. Local community agencies have educational messages holding community events, experiential interventions, the sharing of lived-experience testimonies and also statewide educational interventions within certain larger groups such as messaging and guidance to the state’s large Behavioral Health providers (to increase their awareness and encourage action) and the mental health workforce. Specific findings regarding the landscape analysis and needs assessment and descriptions of completed and planned activities will be provided.

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This work will review a variety of stigma reduction interventions across the state. Several of them have demonstrated reduction in stigmatizing beliefs, and attitudes through a pre- post- evaluation design. The initial baseline surveys have been analyzed and shown a relationship between stigma levels and ability to engage in shared decision making.

Lynn E. Fiellin, play2PREVENT Lab, Center for Technology & Behavioral Health, Dartmouth College; Lily Hoerner, play2PREVENT Lab; Tyra Boomer, play2PREVENT Lab at the Center for Technology & Behavioral Health, Dartmouth College; Heather M. Francis, Indiana University; Bernice Pescosolido, Indiana University

Reduce stigma related to mental health and seeking mental health support in adolescents through a novel videogame intervention

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Social stigma in youth populations

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This study was conducted utilizing semi-structured focus groups with adolescents across the US focused on self-reported current mental health concerns, stigma, and social life challenges. Demographically diverse groups were prioritized, with each group targeting specific demographics (e.g., Black, Asian, Latino, and mixed gender). Focus groups were conducted via Zoom, audio recorded, transcribed, and coded using NVivo 14. Inductive qualitative analysis was utilized to identify codes and themes that emerged from these data.

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Eleven focus groups, each with 4-8 study participants, were conducted, yielding a total of 53 participants across five U.S. states. Major themes identified were access to mental health resources, stereotypes around stigmatized groups, and the impact of social media. Students shared that mental health stigma was severely impacted by social media use. Students who were regularly exposed to assemblies and conversations around mental health were more likely to use available resources, while students with less exposure highlighted less utilization of similar resources. Students also shared their social experiences with mental health and stigma, revealing there were stereotypes present and that this often contributed to the social dynamics around mental health in their schools.

Sara Evans-Lacko, Care Policy and Evaluation Centre, London School of Economics and Political Science; Cristiane Paula,, Mackenzie University; Carola Ziebold,, UNIFESP; Wagner Ribeiro, Care Policy and Evaluation Centre, London School of Economics and Political Science

Overall, this study investigates the factors facilitating or impeding access to care and support, with a particular focus on the role of caregivers and understanding the role of stigma in initial help-seeking and ongoing support. Firstly, we delineate the spectrum of formal and informal mental health care accessed by Brazilian youth. Secondly, we explore caregiver and youth factors influencing engagement with these services, particularly emphasising the role of caregiver stigma. Lastly, we distinguish between the barriers faced in initially accessing support with the perceived barriers among those using some services or support.

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This study focuses on help-seeking stigma among caregives of Brazilian youth.

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Analysis of 1,400 caregiver interviews from a high-risk cohort of young people (aged 10–19) in Brazil assessed the relationship between mental health care utilisation and caregiver characteristics. Cohort data collected information on young people’s formal/informal mental health care use, and associated barriers and facilitators to care. Detailed data were also collected on youth mental health and its impact on functioning; and caregiver characteristics— education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization.

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Persistence and greater impact of youth mental health conditions were associated with a

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higher likelihood of care, more clearly for formal care. When controlling for these factors, however, caregiver stigma emerged as a critical barrier to formal mental health care access, particularly for initial access to care.

Winnie W. S. Mak, Department of Psychology, The Chinese University of Hong Kong; Ben C. L. Yu, The Hong Kong Polytechnic University; Rebecca Y. M. Cheung, University of Reading; Floria H. N. Chio, Trent University; The Chinese University of Hong Kong, 1155151985@link.cuhk.edu.hk; Winnie W. S. Mak, The Chinese University of Hong Kong; Ben C. L. Yu, The Hong Kong Polytechnic University; Rebecca Y. M. Cheung, University of Reading; Floria H. N. Chio, Trent University; Kriti Kakani, The Chinese University of Hong Kong

For many individuals across cultures, their attitudes and intention to seeking help for depression are often hinged on how much weight they put on preserving family face concern and their anticipated concern about the impact of help-seeking stigma on their family (interdependent stigma). With the proliferation of digital mental health services that can be accessed anytime, anywhere privately, the present four-culture study (Canada, England, Hong Kong, India) investigated how family face concern and interdependent stigma may affect help-seeking attitudes and intention for face-to-face psychological services compared to those for digital mental health services.

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Individuals with concerns of depression stigma and stigma of seeking professional help across Western and Eastern cultures.

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643 valid responses from university students from Canada (n=172), England (n=158), Hong Kong (n=155), and India (n=160) were collected. Based on the Patient Health Questionnaire (PHQ-9) composite score, 147 (22.8%), 211 (32.7%), 146 (22.6%), 92 (14.2%), 49 (7.6%) participants were categorized as having minimal, mild, moderate, moderately severe, and severe depression, respectively.

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Across four cultures, university students completed a cross-sectional questionnaire related to depressive symptoms, face concern, stigma, and help-seeking for depression on Qualtrics, an online questionnaire software. Upon completion, students received subject pool credits.

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A serial mediation model was used to examine the associations between family face concern, interdependent stigma, help-seeking attitudes, and intention for both face-to-face and digital mental health services. Results of path analysis found that participants’ family face concern was positively associated with interdependent stigma (β= .21, p <.001), which was negatively associated with attitudes towards face-to-face psychological services (β= -.24, p <.001) but were not significantly associated with digital mental health services, after controlling for depressive symptoms. Attitude towards seeking face-to-face mental health services was strongly and positively related to intention towards seeking face-to-face mental health services (β= .68, p <.001); and attitude towards seeking digital mental health services was strongly and positively related to intention towards seeking digital mental health services (β= .61, p <.001). Significant indirect effect of family face concern on face-to-face intention through interdependent stigma and face-to-face attitude was observed (β= -.04, 95% CI -.05 to -.02). In summary, help-seeking attitude for digital mental health services was not associated with cultural-based concerns for disgracing one’s family by help-seeking. Cross-culturally, digital mental health services may be an acceptable approach to treat depression compared with face-to-face mental health services.

Leonor Pereira da Costa, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University; Isabel Santos, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University; Sara Albuquerque, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University; Ana Carvalho, Lusófona University; Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University, ana.beato@ulusofona.pt; Isabel Santos, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University; Sara Albuquerque, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University; Ana Carvalho; Lusófona University; Ana Beato, Digital Human-Environment Interaction Lab- HEI-Lab, Lusófona University.

This study presents an empirical validation of an arts-based and psychoeducational program aimed at reducing mental health stigma among youth.

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Structural Stigma among Portuguese youth from 11 to 21 years old

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125 youths (M = 13.70; SD = 2,06) participated in the intervention that consisted of four complete days of artistic and expressive activities (i.e. theater, visual arts, music, and cinema) regarding topics of inclusion, diversity and mental health. We collected their levels of social stigma and related variables with four scales (Mental Health Knowledge Scale, Social Distance Scale, Intergroup Anxiety Scale, and the Attribution Questionnaire) across three times (baseline before the intervention, after de intervention and follow up after approximately three months). Data were analyzed using Mixed Effects Models analysis, considering time as fixed variable, age and previous psychological programs as fixed covariates and random intercepts for participants.

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Knowledge regarding mental health issues improved over time (b = 1.23, SE =

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0.39, t (205.91) = 3.17, p = .002), while social distance intentions (b = - 0.07, SE = 0.03, t

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(207.80) = - 2.27, p < .001), intergroup anxiety (b = − 1.019, SE = 0.39, t (210.41) = − 2.64, p = .009), and stigma (b = − 0.479, SE = 0.05, t (214.38) = − 9.31, p < .001) decreased over time. In general, interventions using art present a hopeful opportunity for promoting beneficial outcomes, especially among young individuals, breaking down social obstacles to seeking assistance and improving the availability of mental health support.

Amy L Johnson, Lehigh University

To use new methods of computational text analysis to investigate how the language and terminology we use to discuss mental health and illness is imbued with stereotypes about race, gender, and criminality.

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Cultural biases and stereotypes implicit in mental health language used by major American newspapers in the 21st century, with particular attention to stereotypes of criminality and how they intersect with race and gender identity.

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A computational method of text analysis, word embeddings, applied to full text data from five major American newspapers between 2000 and 2023, the New York Times, Wall Street Journal, Washington Post, Los Angeles Times, and Chicago Tribune (N = 395,886). Specifically, I assess a measure of semantic (meaning) similarity between the identities of black and white men and women, cultural concepts of illness and criminality, and an array of mental health terminology, from anxiety to psychosis.

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I show that the landscape of mental health is broadly racialized as black, challenging the notion of mental illness as a predominantly white phenomenon. Cultural ideas about mental illness are gendered such that women are medicalized and men are criminalized, yet certain terms blur the boundary between illness and criminality. I highlight how stereotypes embedded in mental health language perpetuate stigma around men’s mental health and justify social control with notable implications for black men. I conclude with recommendations for the mental health movement by advocating for more inclusive discussions around men’s mental health and revised person-centric language.

Micah R. Lattanner, PhD, Santa Clara University, Department of Public Health; Mark L. Hatzenbuehler, PhD, Harvard University, Department of Psychology; Sarah McKetta, MD, PhD, Harvard University, Department of Population Medicine; John E. Pachankis, PhD, Yale University, School of Public Health

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) populations are at increased risk of adverse mental, behavioral, and physical health outcomes compared with cisgender heterosexuals (Reisner et al., 2016; Zeeman et al., 2019). Structural stigma—defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and wellbeing of the stigmatized” (Hatzenbuehler & Link, 2014, p. 2)—has been proposed as one stigma-related exposure contributing to this disparity (Hatzenbuehler, 2016). The body of evidence linking structural stigma to adverse health outcomes among LGBTQ+ populations has grown substantially over the past two decades. In response, we conducted a comprehensive review of quantitative studies examining associations between LGBTQ+ structural stigma and health-related outcomes, resulting in the largest review of the literature to date (Hatzenbuehler et al., in press).

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The stigma target for the current project was structural stigma among LGBTQ+ populations.

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We searched PubMed and PsycInfo for peer-reviewed, English-language, quantitative studies that examined structural stigma and an outcome among LGBTQ+ people (n=182,668 studies identified, published up to Dec 31, 2022). To capture the multitude of health-related consequences of structural stigma (i.e., health outcomes and potential mechanisms), we did not restrict the search on the basis of study outcome. In order for studies to be eligible for inclusion, structural stigma had to be: 1) measured objectively (i.e., they did not rely on self-report of LGBTQ+ respondents); and 2) specific to LGBTQ+ status. Based on this criteria, 132 eligible studies were identified. We reviewed the references of the 132 eligible studies and identified an additional 20 eligible studies. We identified two additional studies after consultation with content experts. The final sample set included 157 eligible studies; 98 of these studies examined associations between structural stigma and a health outcome(s), whereas the remaining 59 studies examined associations between structural stigma and a potential mechanism(s).

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Of the 98 identified articles that used an objective measure of structural stigma and assessed a health outcome among LGBTQ+ individuals, outcomes included: 1) mental health (n=57 studies); 2) substance use (n=27 studies); 3) HIV/AIDS or STIs (n=20 studies); and 4) physical health (n=20 studies). Further, 75 studies examined moderators of the associations studied (e.g., sex, sexual orientation, structural stigma measure, age, race or ethnicity). Structural stigma was associated with an adverse health outcome either in the full LGBTQ+ sample or in at least one subgroup in 91% of studies, providing generally consistent evidence that structural stigma is associated with increased risk for poor health among LGBTQ+ individuals.

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Our review also identified 90 articles that documented positive associations between LGBTQ+ structural stigma and candidate mechanisms that could potentially mediate the association between structural stigma and LGBTQ+ health. Three classes of mechanisms have received the most attention: (1) individual or interpersonal stigma processes, (e.g., concealment, internalized stigma, and discrimination; n=46 studies); (2) health-care related factors (e.g., utilization, access, and avoidance; n=23 studies); and (3) general biopsychosocial mechanisms (e.g., social isolation and emotion dysregulation; n=19 studies).

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In order to advance the structural stigma and health literature, we propose the following future directions: 1) evaluating health outcomes that have received relatively less attention (e.g., specific physical health conditions); 2) expanding upon, and formally testing, candidate mechanisms proposed to indirectly explain the association between structural stigma and health; 3) measuring structural stigma at more proximal levels (e.g., organizations and institutions); 4) developing measures of structural stigma unique to each LGBTQ+ subgroup; and 5) evaluating the effects of intersecting forms of structural stigma.

Jodie Collins, University of Oxford, UK, and Oxford Health NHS Foundation Trust; Alastair Pipkin, Northamptonshire Healthcare NHS Foundation Trust, UK; Matthew Knight, University of Oxford, UK, and Oxford Health NHS Foundation Trust

Minimal research exists on gender non-conforming individuals’ experience of disclosing mental health difficulties to healthcare professionals working within Gender Identity Clinics (GICs). As such little is known about the potential impact of intersectional stigma within this context. This project aimed to understand the barriers and facilitators of mental health disclosure experienced by service-users at a GIC in the United Kingdom.

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individual / iatrogenic / structural. Cross sectional, within UK National Health Service Settings

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This was a qualitative study, in which six semi-structured interviews were completed and analysed using Interpretative Phenomenological Analysis.

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Four superordinate themes were interpreted from the data: 1. Facing and overcoming challenges in accessing Gender Care, 2. The journey to the true self: who have I been and who I am now? 3. The flow of power, and creating personal agency, and 4. The true lived experience of the Gender Clinic. The themes revealed multiple barriers in participants’ pursuit of gender-affirming healthcare. This included mental health difficulties whereby some participants feared the impact mental health disclosure would have on their access to treatment. This in turn lead to concealment which many believed facilitated their access to gender-affirming healthcare. Additionally, having a non-binary identity was experienced as a barrier. The themes also reflected participants’ views on self-identity, power and the GIC’s strengths/limitations. Many appeared to be on a journey navigating intersectionality; discovering, understanding, and accepting how different parts of themselves, such as being gender non-conforming and an individual with mental health difficulties, co-exist. Typically, participants saw themselves in a powerless position compared to healthcare professionals at the GIC, however many created power by taking control of how they engaged with and accessed the GIC.

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These findings are related to existing literature on disclosure whereby stigma associated with mental health prevented disclosure or led to concealment of one’s identity through fear of the potential consequences. Findings support previous research that identified a lack of knowledgeable clinicians and lack of holistic care as healthcare barriers, and extended this with questions as to whether healthcare professionals could indeed be ‘all-knowing’.

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Recommendations generated for service improvement included greater service-user involvement in the development of care-plans, and care pathways to ensure the service is meeting the needs of the population. Further, that the service develop clearer definitions of terminology to guide referral and treatment criteria, and increase accessibility to the GIC through person-centred approaches to individual’s communication, social and access needs.

Emily Ekl, Indiana University

Stigma is inherently relational as it is a process that unfolds in interaction and separates the ‘normal’ from the ‘deviant.’ Therefore, a full understanding of the stigmatization process requires consideration of characteristics of both the stigmatizer and the stigmatized. As one key characteristic in the stigmatization process, multiple lines of research have examined how gender shapes mental illness stigma. One line of research on the stigmatized shows that certain mental health conditions are gender-typed and that gendered expectations of mental illness moderate stigma. Another line of research shows that individuals are less stigmatizing towards others with the same gender, suggesting a potential interactive effect between gender of stigmatizer and gender of stigmatized. However, research has yet to fully integrate these lines of research together and test how gender variously shapes the stigmatization process. Therefore, I empirically test how these theories of gender and stigmatization come together to impact desire for social distance. I ask: How do men and women differently stigmatize persons with mental illness based on their gender and gendered nature of their disorder?

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The outcome measure is social distance, or the desire for proximity between oneself and the stigmatized person. This study uses cross-sectional survey data collected on a nationally (U.S.) representative sample and operationalizes social distance as measured by survey responses for desire for social distance across multiple contexts. Respondents were asked: “How willing would you be…” (a) to move next door to [Name]? (b) to spend an evening socializing with [Name]? (c) to make friends with [Name]? (d) to have [Name] start working closely with you on a job? (e) to have a group home for people like [Name] opened in your neighborhood? (f) to have [Name] marry into your family? Respondents could select: definitely willing (1), probably willing (2), probably unwilling (3), or definitely unwilling (4). For my analysis, I dichotomize these responses into unwilling (1) and willing (0).

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I use data from the 2018 General Social Survey Mental Health Module. This module presents a vignette about a person experiencing a mental illness. For this analysis, I focus on respondents who received the vignette of an individual experiencing major depression (a female-typical disorder) or alcohol dependence (a male-typical disorder). Following the vignette, respondents were asked a series of questions about the vignette character. I focus on the questions around desire for social distance as my outcome measure (discussed above).

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To examine the relational nature of gender, I employ logistic regression to predict desire for social distance. I use an interaction term between my primary dependent variables: respondents’ gender (male or female) and vignette characters’ gender (male or female). By running models separately for vignette mental health condition (depression or alcohol dependence), I am also able to examine how the gendered nature of each condition is associated with desire for social distance. All analyses are conducted in Stata 17 and use post-estimation of regression models to interpret interaction effects.

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Results show that female respondents have a lower desire for social distance from women with depression in terms of being a neighbor, socializing, or becoming a friend, particularly in relation to male respondents who receive a male vignette. This suggests that women may be overall less stigmatizing towards and more willing to interact with women with depression (i.e., a gender-typical disorder), whereas men desire greater social distance from men with depression (i.e., gender-atypical disorder).

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Results are less clear cut for vignette characters with alcohol dependence. Female respondents have higher desire for social distance from men with alcohol dependence in terms of being a neighbor or socializing. However, male respondents are less likely to endorse a man with alcohol dependence marrying into their family compared to a woman marrying into their family. This suggests that men and women desire more social distance from men with alcohol dependence (i.e., gender-typical disorder), but that this desired distance differs by context.

Petra Gronholm, King’s College London, United Kingdom; Nicole Votruba, Nuffield Department for women’s and reproductive health, University of Oxford; United Kingdom; Dristy Gurung, TPO Nepal, Nepal, & King’s College London, United Kingdom; Ameni Metsahel, Razi University Hospital La Manouba, Tunisia

The Indigo Partnership research programme is a multi‑country, multi‑site collaboration for anti‑stigma interventions in low‑ and middle‑income countries. This work is conducted in seven sites across five countries: China, Ethiopia, India, Nepal, and Tunisia. Specifically, the Indigo Partnership involves developing and pilot testing three anti‑stigma interventions at each research site, focused on stigma reduction at the community, primary care, and mental health specialist care levels. These interventions are discussed in further detail in this symposium.

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The interventions within the Indigo Partnership are based on the principles of reducing stigma and discrimination through social contact and the involvement of people with lived experience of mental health conditions within the intervention implementation. This is achieved through different means in the three interventions discussed during this symposium: Indigo Local, Indigo Primary, and Indigo READ. Another leading principle of this work is the cultural and contextual adaptation of these interventions at each research site.

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These pilot interventions were implemented on a proof-of-principle basis. Mixed-methods approaches were used to evaluate their feasibility and potential effectiveness. This symposium will present emerging findings of the efficacy of the Indigo Partnership anti-stigma interventions.

Nicole Votruba

Dristy Gurung

Ameni Metsahel

Philip Yanos, John Jay College of Criminal Justice, CUNY; David Roe, Ph.D., University of Haifa; Daniel Abrams, Abrams Utbildning AB; Julien Dubreucq, MD, Ph.D., University Hospital of Saint-Étienne, Department of Child and Adolescent Psychiatry, France & CNRS 5229 (Institute of Cognitive Neuroscience, University Lyon 1); Associate Professor of Psychiatry, University of Verona, Verona, Italy, antonio.lasalvia@univr.it; None

Narrative Enhancement and Cognitive Therapy is a group-based psychosocial intervention originally developed in 2007 that is geared toward helping people who have been psychiatrically labelled recover their sense of value and overcome the effects of self-stigma. NECT has been supported by findings from 3 independent randomized controlled trials and has been implemented in settings across Europe, North America and Asia. This panel will discuss the NECT-Global initiative to facilitate the implementation of NECT, and provide a snapshot of NECT’s implementation in 3 different settings: Sweden, Italy and France.

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Philip Yanos, PhD, Professor, Psychology Department. John Jay College Of Criminal Justice, City University of New York, and David Roe, PhD, Professor, Haifa University

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Title: Overview of the development of NECT and the NECT-Global initiative

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Short Abstract: This panel will review the initial development of NECT, prior research on its efficacy, and challenges for its adaptation.

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Daniel Abrams, Abrams Utblidning AB

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Title: Update on adaptation, dissemination and implementation of NECT in Sweden

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Short Abstract: Between 2016 and 2022 extensive efforts have been made to educate NECT-group leaders in Sweden. One of the regions that stand out in this respect is the County of Dalarna, where the aim has been to administer differentiated education to all staff in psychiatry, about 1000 persons. This project is not yet finished but will be during 2024.

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Antonio Lasalvia, MD, PhD, Associate Professor of Psychiatry, University of Verona, Verona, Italy

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Title: Adaptation and research on NECT in Italy

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Short Abstract: The translation and adaptation processes for the Italian version of the NECT initially involved two focus groups. One group comprised service users (family members and patients), while the other comprised mental health professionals with diverse backgrounds. These groups played a crucial role in discussing the draft of the translated manual, assessing its readability and comprehensibility, and contributing to its further refinement. Following this, the translated version was back-translated by a native speaking professional translator and reviewed by the authors of the original version. The intervention is set to undergo testing in a multi-site randomized trial involving individuals with both affective and non-affective psychosis. This trial will be conducted across several community mental health centers in the Veneto and Trentino-Alto Adige regions (northeast Italy) to evaluate its feasibility and effectiveness in routine clinical settings.

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Julien Dubreucq (MD, PhD); University Hospital of Saint-Étienne, Department of Child and Adolescent Psychiatry, France & CNRS 5229 (Institute of Cognitive Neuroscience, University Lyon 1)

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Title: Update on adaptation, dissemination and implementation of NECT in French-speaking countries

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Short Abstract: This talk will present the adaptation and dissemination of NECT in French-speaking countries (implementation in different settings and with diverse populations, e.g. adolescents with mental health problems or persons with borderline personality disorder) and some related research projects.

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NECT is a group-based intervention that includes sections on psychoeducation, cognitive behavioral techniques, and personal story-telling, or “narrative enhancement” exercises. NECT has been supported by research findings, including 3 independent randomized controlled trials.

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NECT has been supported by research findings, including 3 independent randomized controlled trials conducted in the US, Sweden and Taiwan.

Eli G. Godwin, Boston Children's Hospital; LB Moore, Boston Children's Hospital; Sabra L. Katz-Wise, Boston Children's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health

Determine how transgender youth and their siblings conceptualize, experience, manage, and resist anti-transgender stigma in its various forms and how this changes over time.

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Type of stigma: structural/policy and interpersonal; Sampling timeframe: longitudinal (5 waves, 2.5-3 years, 2016-2019); population: transgender youth ages 14-17 years (at baseline) and their siblings ages 14-24 years (at baseline); location: New England region (states of Maine, Massachusetts, New Hampshire, Vermont, Connecticut, Rhode Island) of the US

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We used reflexive thematic analysis (Braun and Clarke) and a template organizing approach (Crabtree and Miller) to conduct a secondary analysis of one-on-one, semi-structured interviews (N=88) with 10 transgender youth and their siblings (N=20). The participants completed at least four of five waves of a mixed-methods, longitudinal study of transgender youth and their families in the New England region of the US. Theoretical frameworks included Goffman's concept of courtesy stigma, Corrigan and Miller's concept of vicarious stigma as a component of courtesy stigma, the Health Stigma and Discrimination Framework, and Bronfenbrenner's Ecological Systems Theory.

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Four themes were generated: 1) exercising agency, 2) schemas for understanding stigma, 3) “passing,” and 4) awareness of their spatio-temporal and relational positionality. Transgender youth and their siblings were keenly aware of anti-transgender stigma within their extended families, schools, regions, and nation, including the shifting sociopolitical climate with respect to transgender youth in the US. They exercised agency to combat this stigma through various means (e.g., mutual aid, educational labor) as they sought to make sense of their stigma experiences using developmentally appropriate schemas (e.g., determining who to "come out" to based on political affiliations or region of origin). Both transgender youth and their siblings connected their concerns about enacted stigma to their perceptions of whether the transgender youth "passed"* as cisgender, and most connected such "passing" to the receipt of gender-affirming medical care. Finally, participants were aware not just of the extent of anti-transgender stigma in the US but also of how their own axes of privilege or marginalization (e.g., living in a liberal town/state, being racialized) made them/their sibling more or less susceptible to experiencing anti-transgender discrimination. Findings have implications for family counselors, education professionals, policy advocates, and others who support transgender youth and/or their family members.

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*This was the term used by transgender youth so we have retained it, though with quotes to acknowledge the negative connotation it can have for some transgender people.

Dr Pradeep Banandur, Professor and Head, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru; Dr Santosh Loganathan, Professor of Psychiatry, NIMHANS, Bengaluru; Dr Gautham Melur Sukumar, NIMHANS, Bengaluru; Dr Arvind Banavaram, NIMHANS, Bengaluru

The program Yuva Spandana (meaning responding to youth) is a model youth mental health promotion program implemented in Karnataka, a state in southern India. This is implemented by the Department of Youth Empowerment and Sports, Government of Karnataka with technical support from the Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India. The program is a youth-to-youth guidance and counselling services program implemented out of a district guidance center situated within every district stadium within Karnataka. The program provides guidance, counselling and referral services to "any youth (15-29 years) with any issue through these guidance center. This program is implemented since the past 10 years. Placement of guidance centre in the district stadium, focusing on any issue of youth and the program being managed by youth, are the interventions focused on stigma reduction.

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The program was developed through a process of stakeholder engagement and consensus building. Stakeholders included youth, their parents, teachers, government officials from department of youth along with experts. Program is implemented by trained lay youth counsellors utilizing an empowerment model. They are paid a honorarium of 5000 Indian Rupees per month (~60 USD per month). All activities of the program are documented utilizing a real-time digitized data management system specifically developed for the purpose. District and state level advisory committees are set-up to review the program on a quarterly and half-yearly basis respectively. These committees include youth stakeholders as prominent members.

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Till date, the program has reached around 8 million youth across the state of Karnataka. Approximately 40000 youth have received guidance and support services for their issues. Among the issues, nearly half of them (50.6%) present with education and academic issues, 22.7% of them present with health and lifestyle issues followed by self-development issues (15.2%), relationship issues (6.7%), safety (3.8%) and gender, sex and sexuality issues (1.1%). All these issues can develop into mental health problems among youth as adults which is being prevented earlier thereby ensuring primordial prevention of stigma in the long run.

Wenhua Lu, The City University of New York School of Medicine

Compared to other racial/ethnic groups, Asian American and Pacific Islander (AAPI) adolescents are at similar or higher risk for mental health (MH) problems, including depression and anxiety, but least likely to seek help. Stigma is a major barrier to MH help-seeking in adolescents. Yet, MH anti-stigma interventions for adolescents are rare, and existing programs are limited by 1) a focus on promoting knowledge which is often not well-received by youths and 2) shortage of culturally appropriate components for racial/ethnic minorities. This study proposes to culturally adapt the youth-led, club-based Bring Change to Mind (BC2M) anti-stigma intervention for AAPI high school students. The objectives of the study are to (1) clarify mechanisms by which culture can influence MH stigma in AAPI adolescents, (2) develop a tailored version of the BC2M for AAPI high school students, and (3) initially test the cultural appropriateness, acceptability, and efficacy of the program.

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The study is carried out in 3 phases. Phase 1 involved semi-structured focus groups with AAPI club members, leaders, and advisors to gather information regarding their experiences with BC2M and identify culturally unique factors that can influence MH stigma and help-seeking in AAPI adolescents. Phase 2 used this information to develop a culturally tailored MH anti-stigma program specifically for AAPI high school students, and the ecology validity model was used to endure the cultural validity of the program. Phase 3 will involve a pilot study with pre- and posttest design to evaluate the feasibility, acceptability, and appropriateness of the program.

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Phase 1 was completed in April 2023, in which we conducted focus groups with 13 AAPI club members, leaders, and advisors of BC2M and identified culturally unique factors that can influence MH stigma and help-seeking in AAPI adolescents, including race-related experiences, the model minority stereotype, academic stress, intergenerational cultural conflicts, and peer support. Based on these findings, in Phase 2, we developed a 2-month, 8-session anti-stigma program specifically for AAPI youths with activities such as peer discussion (e.g., facts and myths about MH in AAPI youths), experiential activities (e.g., initiating conversation with AAPI parents about MH), creative activities (e.g., the “Yes, But” strategy), contact-based opportunities (e.g., expert panel), and photovoice (e.g., to identify AAPI community assets for MH). Phase 2 was completed in January 2014. Phase 3 will be commenced in a high school with large proportion of AAPI students in New York City in February 2024 and end in June 2024.

Elizabeth Anderson, Indiana University; Bernice Pescosolido, Indiana University

We examine cross-national variation in the association between stigma, measured by social distance and treatment-based stigma, and respondents' open-ended suggestions for care.

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Cross-sectional and cross-national (including 17 nations in the Global North and Global South)

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With data from the Stigma in a Global Context-Mental Health Survey (SGC-MHS), we use measures of social distance and treatment-based stigma alongside respondents' open-ended suggestions for care. We group these suggestions into different patterns of care by estimating multiple group latent class models (LCM) and examined for differences by age, gender, and level of education using multinomial logistic regression models.

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Drawing data from a subset of the 17 countries in the Global North and Global South, the results reveal both diverse and similar patterns of care across countries and for individuals. More importantly, the association between culturally shaped recommendations for care with stigmatizing attitudes reveals critical differences relevant for research and policy.

Cathy Ghalib, University of Oxford, UK, and Oxford Health NHS Foundation Trust; Matthew T. D. Knight, University of Oxford, UK, and Oxford Health NHS Foundation Trust

There is evidence to suggest that adult individuals from ethnic minoritised groups are less likely to access mental health services and more likely to face mental health inequality. They are also more likely to experience self, social, and structural stigma. This thematic synthesis sought to explore qualitative data that considered the perceived barriers and facilitators to mental health help-seeking in adult ethnic minoritised groups.

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Structural, cross-sectional, within mental healthcare settings

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A thematic synthesis was conducted. Keywords related to 'mental health', 'ethnic minorities', 'barriers', and 'facilitators' were searched using electronic databases (PsychINFO, MEDLINE, PUBMED, CINAHL and Scopus). Papers were assessed using predefined eligibility criteria and were quality appraised using The Standard Quality Assessment Criteria for Evaluating Primary Research Papers.

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16 papers were included in the study. Screening of papers showed strong inter-rater reliability with a Cohen’s Kappa rating of .89.

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The thematic synthesis generated seven themes embedded into three broader constructs: 1. Stigma (medical label, family/friends and community/society), 2. Institutional challenges (immigration and communication), and 3. Concept of self (self-image and self-worth).

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The results suggested that even where individuals from ethnic minoritised groups wanted to seek support, the institution, policies and procedures could become barriers (e.g., regarding immigration status and fear of deportation). Barriers were seen to prevent individuals from accessing basic healthcare, further marginalising them in society. When individuals were willing to access mental health services, a level of cultural sensitivity, understanding of marginalisation, and acknowledgement of power from the outset were perceived as essential. Further, consideration of intersectionality was noted as fundamental regarding accessing services. It will be important for future research and clinical service provision to consider how multiple stigmatised identities may impact access to mental health help-seeking in minoritised groups to ensure increased, and much needed, equity of healthcare.

Wendy Halliday, See Me

Stark findings from See Me’s Scottish Mental Illness Stigma Study (SMISS) show that people experiencing mental illness continue to experience significant levels of stigma and discrimination when trying to access, or when in employment, leading ultimately to people withdrawing from employment related opportunities.

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This and wider international research and learning around mental health at work demonstrate that existing employment systems, processes and cultures lead to pervasive structural stigma, and little effort is made to address this and other types of mental health-related stigma including self-stigma, public stigma and stigma by association.

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Action to address mental health stigma and discrimination is central to the recently published Mental Health and Wellbeing Strategy and supporting action plan

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For some time See Me, Scotland’s national programme to end mental health stigma and discrimination, has been supporting employers to take action on stigma and discrimination as a core part of their approach to supporting mental health and inclusion within the workplace; consistent with more recent recommendations from the Lancet Report , See Me aims to provide evidence-based, practical advice and support for employers to help them create mentally healthy working environments, free from stigma and discrimination. Over the last 15 years See Me’s offer of support has evolved from a simple employer pledge, to tailored consultancy and support, and currently to a flexible, self-serviced digital approach, supported by limited consultancy.

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The current See Me in Work programme supports employers to address stigma and discrimination across seven organisational building blocks: senior leadership, safe and effective disclosure, mental health awareness and literacy, line management, reasonable adjustments, capacity building and ethos and culture.

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A review of See Me’s ‘workplace programme’ in August 2018 identified improvement areas aimed at increasing flexibility and self-management for employers, and addressing staff capacity and resource limitations to meet employers’ demand for support. The review led to the development of a ‘starter pack’ for employers, and the digitalisation of the See Me in Work offer via a new Workplace Portal.

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Since 2016 See Me has provided consultancy advice and support to over 200 employers operating in Scotland with over 170,000 employees. See Me continually adapts the approach based on lived experience data, See Me’s learning, evaluation and emerging evidence. A three year evaluation report from 2016 – 19 is available at https://www.seemescotland.org/media/9727/sm-workplace.pdf, along with annual monitoring and impact reports:

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• https://www.seemescotland.org/media/11305/mhf-scotland-see-me-evaluation-report-2020-2021.pdf

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• https://www.seemescotland.org/media/11069/see-me-impact-report-30-may.pdf

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In recent years, the Covid-19 pandemicprovided new challenges for employers and consequently, the See Me in Work programme. Some policies and practices adopted by workplaces during the pandemic have remained. The links between these ways of working and experiences of mental health stigma and discrimination have not yet been purposefully explored. In this presentation, we will share data and learning from See Me in Work and discuss how we are adapting the approach to address emerging challenges including engaging employers in this agenda; leadership buy in to mainstream action on stigma, accountability and resourcing.

Kari Kristinsson, University of Iceland; Sigrun Olafsdottir, University of Iceland

We evaluate the interplay of a diagnosis of mental illness, gender, and race among the public in their willingness to interact with a hypothetical individual and the level of stigma associated with him or her.

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We are looking at Icelander´s evaluation using representative cross-sectional data.

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We use recent data from the Icelandic Stigma Study (2022) which is representative cross-sectional data on the Icelandic public.

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The results show that gender is an important factor in determining levels of stigma across the four conditions, specifically that the public is more likely to stigmatize men experiencing different types of mental illness, compared to women.

Dr Chris Groot, Melbourne School of Psychological Sciences, The University of Melbourne; Mental Ill-Health Stigma Researchers Australia Network (MISRA); Professor Heather Stuart, Distinguished Professor of Sociology, Indiana University; Founding Director, Indiana Consortium for Mental Health Services Research; Founding Director, Irsay Institute for the Sociomedical Sciences; Michael Pietrus, Opening Minds, Mental Health Commission of Canada; Professor Keith Dobson, University of Calgary; Victoria University, imogen.rehm@vu.edu.au; Professor Simon Hunter, Glasgow Caledonian University; Jo Finlay, United Kingdom Mental Health Foundation; Iwo Paszula, Glasgow Caledonian University; Dr Bridey Rudd, United Kingdom Mental Health Foundation; Wendy Halliday; See Me Scotland.

The complex issue of stigma and discrimination surrounding mental illness remains a global challenge. Accordingly, coordinated international responses may be particularly useful in addressing the problem. This panel discussion will provide an overview of a series of collaborative national studies conducted in Australia, Scotland, and Canada between 2019 and 2023. A central objective in this ongoing cooperative work has been advancing our international understanding of the complex ways in which individuals are affected by stigma and discrimination in the context of their diverse and multifaceted lives. Beyond the methods and findings of these studies, this panel discussion will describe lessons learned through the international team’s collaborative effort, and will draw out experiences, barriers and challenges, and factors leading to successful partnership.

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Several stigma mechanisms were targeted in these national cross-sectional studies, including but not limited to: internalisation of both public and structural stigma; experiences and anticipation of stigma, and their effects on withdrawal from life opportunities; personal and perceived public stigma; intersectional stigma; and positive experiences.

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This panel will discuss not only methods in each study but also, the common and unique methodological needs across countries, and the process of collaboration surrounding each of the three teams’ methodological approach. The development of the methodology will be described both chronologically and overall. Australia’s National Stigma Report Card project firstly developed and implemented the ‘Our Turn to Speak’ survey to index stigma in N = 1,912 Australians living with severe and complex mental or substance use disorder. This survey measured domains including but not limited to self-stigma; and experiences of stigma and discrimination, anticipation thereof, and withdrawal from opportunities, in 14 areas of life over the preceding 12 months. Next, ‘The Scottish Mental Illness Stigma Study’ built upon this work by adapting the Our Turn to Speak survey for their national context and surveyed N = 346 people living with mental illness across the country. Lastly, using selected items corresponding to the Australian and Scottish surveys and several other stigma measures, the Canadian team surveyed N = 4,029 participants, including n= 2,005 people living with a mental or substance use disorder and surveying 2,024 members of general public with no disorder.

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This panel presentation will compare and contrast the key findings across Australia, Scotland, and Canada. Stigma and discrimination in relationships with family and friends was found to be the chief area of concern for people living with mental illness across all three studies. The panel will discuss how this core finding has shaped current and ongoing work. Unique highlight findings from each country will also be presented.

Limor Smith, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES), Graduate College of Social Work, University of Houston; Dr. Robin E. Gearing, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES), Graduate College of Social Work, University of Houston; Dr. Kathryne B. Brewer, Department of Social Work, University of New Hampshire; Dr. L. Christian Carr, Center for Mental Health Research and Innovation in Treatment Engagement and Service (MH-RITES), Graduate College of Social Work, University of Houston

Introduction: This cross-sectional study assessed how public stigma toward people with mood disorders in United States (U.S.) Jewish communities differs based on a person’s type of mood disorder and gender, respondent characteristics, and respondent perceived public stigma. Jewish individuals in the U.S. (n = 243) completed a randomly assigned survey assessing public stigma after reading one of six vignettes about a person that varied by gender (female or male) and mood disorder symptomatology (major depressive disorder, bipolar disorder presenting with depression, and bipolar disorder presenting with mania).

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Significance: Within the U.S. Jewish community, research on public stigma toward mental illness has been mostly limited to general stigma toward mental illness and has focused on the Orthodox Jewish community. Previous research tends to examine religiosity and religious coping and stigma or help-seeking stigma, while studies on stigma specific to bipolar disorder could not be identified. This exploratory study examined how mood disorder type, gender of the person with a mood disorder, demographic characteristics of survey respondents, and their perceived public stigma would impact specific dimensions of public stigma (e.g., relationship disruption, hygiene, recovery, treatment efficacy).

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Public stigma toward people with mood disorders; cross-sectional; Jewish communities in United States; Houston, Texas

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Method: A Qualtrics electronic survey was used to assess participant demographics, mood disorder public stigma, and perceived public stigma of people with mental illness. Participant characteristics included that 52.67% reported a history of a mental health problem; MA = 49.19 (SD = 16.18); 60.8% female. Participants identified as 48% Reform, 24% Conservative, 21% Orthodox, and 7% non-religious Jews. The Mental Illness Stigma Scale (MISS; Day et al., 2007) was used to measure dimensions of public stigma toward mental illness. Perceived stigma, a covariate, was measured with the Devaluation of Consumers Scale (DC; Struening et al., 2001). Data were analyzed with EFA, MANOVA, ANOVA, and a test of simple slopes to assess an interaction effect.

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Results: Findings included (a) greater stigma toward lower recovery from bipolar disorder presenting with mania or depression as compared to major depressive disorder; (b) greater stigma toward more relationship disruption for bipolar disorder presenting with mania as compared to major depressive disorder; (c) stigma toward worse hygiene for major depressive disorder as compared to bipolar disorder presenting with mania or depression; (d) perceived stigma was positively associated with all dimensions of public stigma except recovery; and (e) an age by gender interaction revealed that younger and middle-aged male respondents reported greater treatment efficacy stigma, beliefs that treatment is not effective, compared to (1) female respondents regardless of age and (2) older males.

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Implications: This research has clinical and policy implications for tailoring stigma reduction campaigns and interventions to specific demographic groups within the Jewish community. Due to their lower treatment efficacy stigma, older males may serve as role models for treatment engagement among younger males in the community. Findings may inform future stigma reduction through the identification of distinct types of stigma people with mood disorders in U.S. Jewish communities may be experiencing.

Guangquan Shen, Indiana University; Bernice Pescosolido, Indiana University

The last twenty-five years has seen a major resurgence in empirical work, both qualitative and quantitative, on the stigma of mental illness. Predominant among researchers is a next-stage call to focus on intersectionality which aligns with policy, advocacy and programing directions moving toward tailoring anti-stigma efforts. However, intersectionality faces critical problems in analyses. Qualitative studies require in-depth penetration into intersectional communities, generally not allowing for marking whether findings are unique to or different from the more general communities of which they are a part. Quantitative studies allow for the possibility of that comparative view but often do not have sufficient numbers to interact complex configurations in the analysis. Here, we confront one of those limits by drawing on a large-scale stigma interview effort in China to explore how the long-standing unequal and potentially resurging situation for women as well as for the world-wide attention on the political and cultural prejudice and discrimination facing the Uyghur ethnic community shape the endorsement of stigma for depression and schizophrenia.

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This study targets social stigma against depression and schizophrenia in China. In particular, we analyze how social stigma further differs based on individuals’ gender and ethnicity.

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This study utilizes the Stigma in Global Context - Mental Health Study, China, 2011 (effective sample size = 3,524). Participants were randomly assigned with a vignette with three treatment conditions being manipulated: mental illness disorder type, gender, and ethnicity. Linear regression models were fitted to assess the relationship between vignette treatment conditions and social stigma. Interaction effects were examined to study how disorder type, gender, and ethnicity together impact social stigma toward mental illness.

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Drawing only from majority population respondents (Han Chinese), analyses reveal significant, direct and complex intersectional effects. Overall, disorder, ethnicity, and gender do not produce initial differences in stigma. However, considered together, results suggest that majority Han characters encounter greater social rejection from their own cultural counterparts when they have depression symptoms but lesser social rejection when they have schizophrenia symptoms compared to minority Uyghur characters. When considering gender differences within ethnicity groups, for male characters, no significant difference of disorder type in social distance is observed for both Han men and Uyghur men. In contrast, among female characters, Han women are more likely to be stigmatized when they display depression symptoms compared to schizophrenia, whereas an opposite effect is observed among Uyghur women. Controlling for standard factors such as attributions and contact, the female Han character with depression elicits the greatest social distance compared with other disorder, ethnic, and gender groups. The findings remain robust in the presence of controls, emphasizing the critical role of intersectionality in understanding and addressing mental illness stigma in China.

Lies Saelens, Ghent University; Piet Bracke, Ghent University; Melissa Ceuterick, Ghent University; Fanny D’hondt, Ghent University

Despite the high prevalence rates among adolescents, open discussions about mental health difficulties remain taboo, contributing to a hesitancy to seek both informal and formal treatment. Causal attributions are recognized as pivotal in shaping stigmatising attitudes and help-seeking behaviours, and often targeted in education-based anti-stigma interventions. However, existing literature has predominantly focused on adults, leaving a gap in research exploring this association among adolescents. Furthermore, while scholars indicated the existence of cultural variations in stigma, this remains largely unexplored, especially outside the United States. Hence, the current study aims twofold: firstly, to investigate the association between causal attributions and stigma among adolescents; and secondly, to explore potential cross-cultural variations in causal attributions and stigma and examine their relationships among both ethnic majority and minority adolescents.

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The current study focusses on public stigma by assessing individuals’ self-reported desire for social distance from peers with mental health difficulties (i.e., depression). Causal attributions encompass psychosocial, biogenetic, personal, supernatural, and lifestyle causes. We focus on school-aged adolescents in the last two years of secondary education (ages 16-18 years) in Flanders (Dutch-speaking part of Belgium).

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This study uses data from a cross-sectional research in which we developed and implemented this culturally sensitive stigma survey specifically tailored to adolescents of diverse ethnic/cultural backgrounds. The survey was based on findings from focus groups and existing surveys like the cross-national Stigma in a Global Context Mental Health Study and the National Stigma Study-Children. A total of 5035 adolescents from 38 secondary schools completed the questionnaire. Multilevel regression models were used to investigate the effect of causal attributions on the desire for social distance, with separate analyses for ethnic majority and minority adolescents.

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Our preliminary findings reveal intriguing differences in stigma patterns between ethnic minority and majority adolescents. Notably, ethnic minority adolescents demonstrated significantly less social distance from peers experiencing mental health difficulties compared to their majority counterparts. Moreover, variations in causal attributions were observed between the two groups, with biogenetic and psychosocial attributions more frequently held by ethnic majority students, and spiritual attributions more frequent among ethnic minority students. Concerning the relationship with stigma, the results indicate that psychosocial attributions are significantly associated with lower levels of social distance, while personal/moral attributions are linked to higher levels of social distance.

Brandy Smith, Indiana University; Guangquan Shen, Indiana University

From countries as diverse as China and the US, analyses of sociodemographic characteristics have been found to have relatively weak associations with stigma, as measured by social distance. However, a recent analysis of some of the same data from the Stigma in Global Context – Mental Health Study revealed a complex pattern of difference in stigma when gender (male, female), disorder (schizophrenia, depression) was considered together. Pushing this insight further, we examine whether this finding underlies a common but overlooked pattern of how social factors interact to shape the prejudice associated with mental illness. Using data from the US, where initially reported analyses did not find important, consistent or significant effects of these characteristics, we use graphical description and multiple regression analysis to explore the potential association of interactional on stigma for depression and schizophrenia.

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This is a cross-sectional study using data from the U.S. looking at social distance as a proxy for stigma.

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We use data from the Stigma in Global Context – Mental Health Study (SGC-MHS), US. The SGC-MHS, funded by the US National institutes of Health has representative data from adults in 17 countries. Using case vignettes meeting the DSM-IV edition criteria for schizophrenia and depression we do multiple regression analysis and graphical description to look at the interaction of gender and disorder type on stigma, as measured by social distance.

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We find that there is a significant pattern of difference in stigma dependent on gender (male, female) and disorder (schizophrenia, depression). Women with schizophrenia are associated with being more stigmatized than men with schizophrenia. However, men with depression have stronger associations with stigma than women with depression.

Margarita Alegría, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital; Departments of Medicine and Psychiatry, Harvard Medical School; Gabriela Livas-Stein, University of Texas, Austin; Michelle Cheng, Massachusetts General Hospital; Sheri Markle, Massachusetts General Hospital; Massachusetts General Hospital; Harvard Medical School

One persistent barrier to mental health services for minoritized and linguistic minority populations has been the stigma associated with receiving treatments. The evidence of the disparities in ethnic, racial, and linguistic minority populations needing mental health care but not disclosing their symptoms, accessing, or delaying care is commonly associated with the social stigma clients perceive it may convey to family, friends, employees, and even healthcare providers. The belief that divulging mental health problems or seeking mental health care devalues their social position, reduces their chances for employment, and distorts who they are, potentially being judged as dangerous, irrational, or weak, refrains many people of color in serious need from obtaining needed care. Yet, given the escalating rates of the unmet need for mental health care or delayed care for communities of color and linguistic minorities, few strategies have been tested to assess whether minoritized populations in the United States with social stigma are willing to become more activated to communicate and engage in their mental health care after undergoing a psychosocial education intervention. In this study, we evaluate whether Strong Minds, a psychosocial, educational intervention provided by community health workers, can increase the likelihood of English-, Spanish-, Mandarin-, or Cantonese-speaking adults becoming activated and/or using mental health care.

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Social stigma as assessed by the question “Sometimes people do not go to see a professional about their emotions, drugs, alcohol, or other health problems for various reasons. Does this reason apply to you?: You are concerned about what people would think if they found out you were in treatment.”

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This was a randomized control trial involving adults 18 years of age or older with moderate to severe depression or anxiety symptoms as defined by the CAT-MH. Recruitment occurred at primary care clinics or community-based organizations in Massachusetts and North Carolina, with most people not seeking mental health care. 1044 participants were randomly assigned in a 1:1 ratio to a psychoeducational intervention (n=524) or enhanced usual care (n=520), including referrals to social health determinants. The psychoeducational intervention included ten sessions called Strong Minds, adapted from cognitive behavioral therapy and care management for social determinants of health provided by a trained community health worker and supervised by a licensed clinician. Enhanced usual care participants received an NIH booklet on anxiety and depression, referrals to social determinants of health over a 6-month period by a care manager, and four calls to gauge that their mental health was not deteriorating. Participants were evaluated at baseline on whether stigma was a barrier to obtaining needed care, with the following question: “Sometimes people do not go to see a professional about their emotions, drugs, alcohol, or other health problems for various reasons. Does this reason apply to you?: You are concerned about what people would think if they found out you were in treatment.” Further, participants were assessed at 3-, 6-, and 12 months post-intervention to assess patient behavioral activation and mental health services use. Behavioral activation was measured using a modified version of the Patient Activation Scale (PAS), which included 9 items assessing patient activation during a medical encounter to treat mental health or substance use problems. Mental health services use was measured using affirmative responses about whether participants had a previous appointment with a primary care physician or mental health specialist to discuss mental health problems. We used assessments at 3-, 6-, and 12-months post-intervention to determine if, among participants with stigma at baseline, participants in the intervention group were more likely to become active in discussing mental health care and/or using mental health services prospectively compared to participants in the control group.

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At baseline, one of every three participants (34%) indicated they do not seek mental health care because they are concerned about what people would think if they found out they were in treatment. After adjustments by age and sex, there was variation in rates of reported stigma by language (p < 0.02) and race/ethnicity groups (p < 0.001). Specifically, Cantonese speakers had twice the odds of reporting that stigma was a barrier to obtaining mental health care compared to English speakers (Odd Ratio [OR] = 2.00; 95% Confidence Interval [CI] = 1.03 to 3.90; p = 0.04). Further, compared to non-Hispanic White participants, Asian or Pacific Islanders had 2.21 times the odds of not seeking mental health care because of stigma (95% CI = 1.26 to 3.89; p = 0.01). Among participants who reported stigma at baseline, the psychoeducational intervention was associated with higher patient activation 3- and 6-months post-intervention (Coefficient [b] = 7.92; 95% CI = 4.28 to 11.56; p < 0.001 and b = 5.06; 95% CI = 1.50 to 8.62; p = 0.005, respectively), and with increased odds of mental health service use 3-months post-intervention compared to the control condition (OR = 1.48; 95% CI = 1.01 to 2.16; p = 0.04).

Santosh Loganathan, Professor of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS) , Bengaluru, INDIA; Suvarna Agarwal, Research Associate, Project INDIGO, NIMHANS, Bengaluru, INDIA; Gurucharan B Mendon, PhD Scholar, NIMHANS, Bengaluru, INDIA; Anish V Cherian, Additional Professor of Psychiatric Social Work, NIMHANS, Bengaluru, INDIA; Professor of Public Mental Health Health Services and Population Research Department P029, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, claire.1.henderson@kcl.ac.uk; Uta Ouali, Professor of Psychiatry, Razi University Hospital TN, uta.ouali@gmail.com, Sir Professor Graham Thornicroft, graham.thornicroft@kcl.ac.uk, professor of community psychiatry centre for global mental health & centre for implementation science health service and population research department institute of psychiatry, psychology and neuroscience

Objectives of the intervention (READ-MH):

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● Recognizing and responding to stigma in routine clinical care

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● Identification and respond effectively to patient reports anticipated discrimination and self-stigma.

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● Limiting the extent of mental healthcare experience as stigmatizing to patients or service users or caregivers

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● Promotion and protection of human rights of the patient and address interpersonal discrimination at individual, family as well as service levels

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This study was conducted at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India as a part of the multi site intervention implementation in International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership Research Program. We shortlisted equal number of participants from diverse mental health professionals with varying experience for the final training program (n=20). The inclusion criteria comprised of professionals working in the institute as mental health care practitioners. The participants were shortlisted using purposive sampling. The participants were a mix of different mental health professionals from four different departments (clinical psychology, psychiatry, psychiatric social work, nursing, psychiatric rehabilitation services). The type of stigma targeted was Structural Stigma, Anticipated Stigma and Experienced Stigma.

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The study was an uncontrolled pre-post feasibility and preliminary effectiveness study using mixed methods. READ-MH was delivered to mental health professionals, working in mental health care after collecting baseline data, followed by collecting quantitative data post-training and then within 3 month post baseline collection. Qualitative data collection took place post-training followed by within 3months post baseline.

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Two scales were used. For assessing knowledge, a quiz based structured questionnaire on the content of training was used. Attitudes to addressing stigma and discrimination scale (ASTAD) was used to assess attitudes of mental health professionals while at work to measure stigma impact on service users.An objective-structured clinical examination (OSCE) was used for assessment of behavioral and communication skills. A fidelity checklist was used for recording delivery of implementation and active participation of participants during the sessions.

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Qualitative process data included feedback on intervention immediately post all sessions were completed through a Focus Group Discussion (FGD) and In depth interviews within 3 months of the intervention.

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The training program was divided over two days (one full day – 7 hrs and one half day – 3 hrs). The modules, content, methods of delivery and duration of READ-MH was followed as per the manual shared from Project INDIGO.

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The training program comprised of role plays, facilitated discussion based activities, interactive lectures, brainstorming, case vignettes using clinical case illustrations as well as experiences on site and a unique experience of testimony shared by Experts By Experience (EBE). EBE (n=2) were people who had recovered from mental illness. They gave a description of their illness and the personal recovery process, their experiences of stigma and discrimination when they took mental health services or in their community and how they coped as well as overcame stigma.

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Our hypothesis was that the interventions would improve the knowledge and attitudes on the two primary scales used. Nine psychiatrists, 4 psychologists, 5 psychiatric social workers and two nurses attended the training program.Quantitative data assessment was made using generalized linear mixed models. Descriptive statistics of outcome data as well as impact of training, outcome measure will be analyzed by comparing OSCE scores, ASTAD and knowledge quiz at pre, post and 3 month follow-up.

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The four main themes that emerged from focused group discussion (n=9) and individual interviews (n=4) of mental health professionals were as follows: (1) Journey of Involvement and Participant Insight/ Participation Pathway and Insights (2) Personal narratives of experts by experience (3) Embarking on stigma awareness (4) Attitudinal shift (instead of Altered attitudes) and behavioral adaptations towards Service users / Behavioral and Attitudinal Shift towards Service Users

Sara Evans-Lacko, Care Policy and Evaluation Centre, London School of Economics and Political Science; Francisca Vargas Lopes, Erasmus School of Health Policy and Management, Erasmus University Rotterdam; Brittany Morey, University of California, Irvine; Bruce Link, Univeristy of California, Riverside

This study investigates the interplay between mental health status and employment in the United States, against the backdrop of structural stigma that exacerbates employment disparities for individuals with mental health conditions. Despite a high desire to engage in paid employment, individuals facing mental health challenges encounter significant barriers in the workforce, contributing to marked disadvantages in employment opportunities and social inclusion. In this paper we describe how employment trends in the United States have changed between 2011 and 2018, for individuals with and without a diagnosis of depression. We further explore whether and to what extent these trends vary by state and over time, and whether this is related to implementation of equality rights legislation or accessibility of mental health care. Finally, we explore for which socio-demographic subgroups trends in disparities by mental health status varied the most.

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structural / policy -based

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We use data from the Behavioral Risk Factor Surveillance System (BRFSS), a repeated cross-sectional, telephone survey conducted monthly by the U.S. Centers for Disease Control and Prevention on representative samples from all U.S. states and territories. We combined BRFSS data for the years of 2011–2018 to create a panel of multiple cross-sectional samples. This data was enriched by linking state-level contextual information on policies supporting labour market participation of people with disabilities and mental health parity. Our main outcome of interest is the employment rate, and how it varied overtime by self-reported diagnosis of depression (yes /no). We graphically examine annual employment trends by depression diagnosis, overall and by state. We use ordinary least square models of employment rates as a function of time interacted with depression diagnosis to estimate the magnitude and statistical significance of the disparities, adjusting for state-level fixed effects, age and sex. We examine differences in trends by grouping states with similar implementation of Employment First policy and level of Parity Index (strength of state laws and regulations in addressing mental health parity). We do also study heterogeneous trends for subgroups defined by gender, age, race/ethnicity, education and income.

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Results: Employment rate in the US population increased from 77.9% in 2011 to 81.1% in 2018. The increase is seen in both individuals with and without mental health problems, although the levels of employment are considerably lower for the former group. When modelled linearly, the employment rate of individuals with depression increased 1.3 percentage points (pp) per year, about twice as much as for those without mental health problems. A faster increase for these groups led to a (small) reduction in disparities and was mostly seen in states with Employment first policies - particularly those implemented with a focus on cross-disability - as well as states with higher mental health parity. However, not all the population subgroups benefited the same: a reduction of employment disparities did not happen for individuals above 44 years old and those with low education and low income levels

Megan E. Bolton, Indiana University; Brea L. Perry, Indiana University; Heather M. Francis, Indiana University

The stigma of substance use disorder (SUD) can impede the employment opportunities of people with SUD, including reducing job retention for those currently employed and job acquisition for those seeking employment. Yet little is known about how discrimination of people with SUD varies across job opportunities and SUD characteristics. Using data from the 2021 Shatterproof Addiction Stigma Index (SASI) – one of the only national survey experiments to compare addiction stigma across substance dependencies – we assess the nature and magnitude of discrimination against coworkers, employers, and employees with SUD in the United States.

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We explore how addiction characteristics can affect workplace discrimination of people with common substance use disorders using a cross-sectional nationally representative online survey of U.S. adults, which was collected using Ipsos' KnoweldgePanel.

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Over 7,000 U.S. respondents were randomly assigned to a vignette describing a man with one of five substance dependencies (prescription pain medications, recreational pain medications, heroin, methamphetamine, alcohol) and one of two recovery statuses (active use, in recovery). Unique to the SASI is the inclusion of a workplace social distance scale measuring willingness to have the person with SUD as a coworker, hire as an employee, and have as a supervisor.

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Endorsement of workplace social distance did not vary by the employment status of respondents. However, desire for workplace social distance does vary by type of substance use and particularly for those with active substance use. That is, recovery from substance use is the strongest predictor of lower social distance, creating greater job market equality across types of substances. Additionally, active substance use is especially harmful for job seekers with methamphetamine addiction. These results suggest that the public stigma of substance use disorder has become embedded in the employment process – influencing prejudice and discrimination towards coworkers, job candidates, and supervisors – but not all substance dependencies are treated equally in the workplace.

Nicolas Rüsch, Ulm University, Germany; Melanie Gantner, Ulm University, Germany; Maria Gralla, Ulm University, Germany; Rebecca Erschens, Tübingen University, Germany; Tübingen University, Germany; Jörn von Wietersheim, Ulm University, Germany; Harald Gündel, Ulm University, Germany; Svenja Schlachter, Ulm University, Germany

There is a vicious cycle between unemployment and mental health: Whereas unemployment can negatively affect individuals’ mental health, poor mental health can be a risk factor for unemployment and failure to find re-employment. Furthermore, unemployed individuals with mental health issues can face a double stigma, that is, experiencing discrimination not only due to their mental health issues, but also due to their unemployment status. As a result, these individuals experience high levels of psychological distress, which can further impede chances of re-employment.

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It can happen that individuals with mental health issues internalize the experienced public stigma towards them, meaning that they apply negative stereotypes in the general public about individuals with mental health issues to themselves, a process referred to as self-stigma. As a result of self-stigma, individuals experience negative emotional reactions, particularly reduced levels of self-esteem and self-efficacy. Feeling demoralized, they do not pursue goal-related behavior, such as seeking re-employment or seeking help for their mental health. These far-reaching behavioral consequences of self-stigma have been labelled the “why try” effect. Accordingly, self-stigma could explain why unemployed individuals with mental health issues struggle to gain re-employment.

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Building on the “why try” effect, we propose that unemployed individuals who experience higher levels of self-stigma will have lower job-search self-efficacy. Furthermore, we aim to examine potential boundary conditions of this association, building on the transactional stress model. On the one hand, we propose that further stressors for unemployed individuals with mental health issues, such as symptoms of anxiety or length of lifetime unemployment, can exacerbate the negative association between self-stigma and job-search self-efficacy. On the other hand, we propose that resources of these individuals, particularly educational level and social inclusion, can mitigate the association.

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self-stigma, why try effect, intersectionality (mental illness and unemployment)

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The data is part of a wider interventional study, aiming to support unemployed, psychologically distressed individuals in improving their mental health and finding employment. This research project, funded by the German Federal Ministry of Work and Social Affairs, is conducted in Southern Germany in collaboration with six regional job centers. Recruitment of approximately 450 individuals who receive unemployment benefits and report a moderate to high level of psychological distress as well as motivation to find employment is currently ongoing. The boundary conditions of the “why try” effect will be examined with moderation analyses, testing the interaction effects between self-stigma and individuals’ stressors/resources (e.g., anxiety symptoms, educational level) on job-search self-efficacy. These analyses will be carried out using the study’s baseline data of both intervention and control group.

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Data collection is ongoing at the time of abstract submission and will be concluded in spring 2024. We will present first results at the conference.

K. Amanda Maranzan, Lakehead University; Lauren Reynolds, Lakehead University; Mila Popovic, Lakehead University; Stephanie Knaak, Mental Health Commission of Canada; Canadian Injured Workers Alliance, lkcooperbes@rogers.com; Lynn Shaw, University of Western Ontario; Chelsea Noel, Lakehead University; Minerva Porelle, Canadian Injured Workers Alliance; Valerie Gibbons, Lakehead University

For many people, work holds enormous social and financial significance, such as fostering one’s sense of self and identity, social status, and providing income. Stigma, often rooted in societal biases and misconceptions, can manifest in various forms, including those related to mental health, substance use, physical disabilities, gender, race, and other identity factors. The workplace, as a microcosm of society, is not immune to these challenges. This symposium focuses broadly on stigma and the workplace, including substance use stigma for workers in construction and other physically demanding jobs, and stigma towards individuals who sustain workplace injuries.

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Public stigma; self-stigma; structural stigma

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This symposium summarizes new projects and data focused on stigma and the workplace, including a podcast project, interviews with injured workers, and scoping review.

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(1) The Off the Clock Toolbox Talk podcast is a novel anti stigma innovation that increases awareness, knowledge and access to tools about pain, trauma, and substance use for men working in the trades, co-created with men with lived and living experience of a substance use disorder who work in the trades. Findings include number of episodes launched, episode themes, listener reach, and survey feedback results, including evidence of stigma reduction (Knaak).

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(2) Results from a series of semi-structured interviews with injured workers will be shared. Thus far, internalized stigma experiences have been described in the literature, but have not been a major focus of investigation. The presentation will report common themes among stigma experiences of those with lived experience, with the hope of shining light on the impacts of stigma and internalized stigma injured workers face (Reynolds & Maranzan).

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(3) Findings from a scoping review investigating how stigma is talked about, referenced, described, and discussed in the injured worker literature will be presented (N = 100 articles). Only 48% of articles discussing experiences of injured worker stigma use this specific term in their paper. Of those articles, only 11% used the term "stigma" consistently throughout the paper. Other terms used to describe stigma experiences included “experiences”, “barriers”, “attitudes” and “judgements”. Sometimes, researchers used terms that are more closely related to stigma, such as “discrimination” and “stereotypes”. The scoping review concludes that the literature describing the stigma experiences of injured workers uses heterogenous terms. (Popovic, Reynolds, Noel, Maranzan, Cooper, Porelle, Shaw)

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(4) Also presented will be a protocol and community engagement framework for a project focused on structural stigma towards injured workers in the workplace. The protocol includes recruitment and engagement of individuals with lived experience to center the project and outcomes on information needs (Maranzan, Cooper, Reynolds, Gibbons, Porelle, Shaw)