Addressing mental illness stigma in German higher education: study protocol for a mixed-methods evaluation of a psychosocial setting-based intervention.

INTRODUCTION: Mental illness stigma is associated with a range of negative consequences, such as reduced help-seeking for mental health problems. Since stigma affects individual, social, and structural aspects, multilevel interventions such as the Canadian programme The Working Mind have been proven to be the most effective. Given the solid evidence base for The Working Mind, it is our aim to implement and evaluate culturally adapted versions of the programme in German higher education, targeting students, employees and managers. METHODS AND ANALYSIS: We will evaluate the programme with regard to its effect on mental illness stigma, openness to mental health problems, willingness to seek help, and positive mental health outcomes. Further, we will investigate the programme's effectiveness dependent on gender and personal values, various mechanisms of change, and factors facilitating and hindering implementation. The study uses a sequential explanatory mixed-methods evaluation design (QUAN → qual) that consists of three steps: (1) quasi-experimental online survey with programme participants, (2) focus groups with programme participants, and (3) qualitative interviews with programme stakeholders. The quantitative data collected in step 1 will be analysed using 2×3 analysis of variances and a parallel multiple mediation analysis. The results will inform the qualitative data to be collected in steps 2 and 3, which will be analysed using qualitative content analysis. ETHICS AND DISSEMINATION: The study was approved by the local Ethics Committee (Ethics Committee of University Medicine Greifswald; BB 098/23). Participants have to provide written consent before taking part in a focus group or interview. As for the online survey, participants have to give their consent by agreeing to an online data protection form before they can start completing the survey. We will publish central results and the anonymised data in an Open Access Journal. Further, the statistical code will be included as a supplement to the paper(s) documenting the results of the study. TRIAL REGISTRATION NUMBER: DRKS00033523.

Examining the experiences of student peer support workers delivering care within post-secondary institutions.

Objective: Despite experiencing exacerbation of mental health issues, post-secondary students may not seek help due to perceived stigma, overreliance on the self, or preference for nonprofessional supports - including peer support. This study aimed to understand peer support workers' (PSWs) perspectives regarding providing support for mental health concerns in post-secondary institutions. Methods: 41 PSWs were recruited from two post-secondary institutions. 17 semi-structured interviews and three focus groups were conducted. Themes were identified using a qualitative descriptive approach. Results: Three themes emerged: (1) diverse presentations and approaches to operationalizing peer support for mental health issues on campus exist; (2) peer support has core ingredients; (3) reasons why students access peer support extend beyond mental health crisis. Conclusions: An inclusive peer support approach to mental health is needed for post-secondary students. Considerations for implementation hinge on providing standardized, foundational training to prepare PSWs for the complex mental health issues that present across services.

Social perceptions and the stigmatization towards fifteen mental illnesses in France: a preliminary study on the role of vital force and burden.

Introduction: This study examined social perceptions and rejection towards fifteen mental illnesses, as well as a preliminary test of the SUBAR model, that hypothesized perceptions of both vital forces and burden would be negatively and positively related to social rejection, respectively. Methods: Using an online survey with participants from France (n = 952), social rejection was assessed using a feeling thermometer and a social distance scale, while social perceptions were measured using visual analog scales. Results: A stigma map for these different disorders is drawn up, revealing the social perceptions and levels of stigmatization specific to certain mental illnesses. Controlling for relevant social perceptions (i.e., danger, warmth, competence), we found that perception of burden was positively and significantly associated to social distance and negative feeling for 73% and 67% of mental illnesses, respectively. The perception of vital force was negatively and significantly related to social distance and negative feeling for 87% and 20% of mental illnesses, respectively. The change in R2 between model 1 (i.e. perception of danger, warmth, competence) and model 2 (i.e. model 1 + perceptions of vital force and burden) significantly improved in 100% of cases for social distance and 67% of cases for negative feeling. Conclusion: These preliminary data provide support for the SUBAR model and call for further investigations to better understand the social rejection of people with mental illnesses.

Developing recommendations to improve identification, prevention, and response to suicide thoughts and behaviours among post-secondary students: A mixed methods study.

Objective: This study aimed to generate recommendations regarding how to identify, prevent and respond to suicide thoughts and behaviors among post-secondary students. Methods: A convergent mixed-methods design with Nominal Groups Technique (NGT) was used. Post-secondary and high-school students and their caregivers generated and ranked recommendations. A Codebook Thematic Analysis approach guided analysis of the NGT-discussions and extended understanding of recommendations. Results: 88 individuals participated in 21 panels. Five key recommendations were identified: (1) increase student and staff education regarding suicide identification, prevention, and awareness of existing supports; (2) enhance rapid access to supports for those experiencing a crisis; (3) improve institutional academic supports for students following crisis; (4) reduce stigma; (5) improve communication regarding on-campus suicide. Common themes included perceived impact of attitudes, institutional barriers, and peer-support on suicide thoughts and behaviors. Conclusions: These recommendations can inform the development of student-centred interventions for improving mental health supports.

Increasing resiliency and reducing mental illness stigma in post-secondary students: A meta-analytic evaluation of the inquiring mind program.

Objective: Worsening student mental health, along with more complex mental illness presentation and increased access to campus mental health services, has led to a mental health "crisis" on campuses. One way to address student mental health needs may be through mental health programs which have been found to increase resiliency and help-seeking, and reduce stigma. Participants: The effectiveness of The Inquiring Mind (TIM), a mental health promotion and mental illness stigma reduction program, was examined in 810 students from 16 Canadian post-secondary institutions. Methods and Results: Using a meta-analytic approach, TIM improved resiliency and decreased stigmatizing attitudes from pre to post, with medium effect sizes (d > .50). Analyses with those that completed the follow-up (about one-third of the sample) showed that effects were mostly retained at three months. Other outcomes also point to the program's effectiveness. Conclusion: TIM appears to be an effective program for post-secondary students. However, additional research, including randomized control trials, is needed to address study limitations.

The Influence of Media on the Stigma of Suicide when a Postsecondary Student Dies by Suicide.

This study investigated whether media articles from a postsecondary institution could influence students' stigma toward suicide after a student dies by suicide. Undergraduate participants (N = 425) read a fictitious scenario about a student suicide and were randomly assigned to a control article (no mention of the suicide) or one of three intervention articles that acknowledged the suicide and included a discussion with a psychologist, a friend of the decedent, or a suicide survivor. The stigma toward suicide survivors, particularly stereotypes, was significantly less after the three intervention articles compared to the control. No differences were found between the intervention articles or regarding the stigma toward suicide decedents. Reduced stigma toward survivors indicates that acknowledging a suicide, when possible, should be considered.

Exploring Mental Health and Well-Being Among University Faculty Members: A Qualitative Study.

The current exploratory qualitative study describes how environmental factors, social interactions, personal experiences, and stigma affect mental health and help-seeking. In-depth, semi-structured interviews were conducted with nine university faculty members who self-identified as having mental illness-related concerns. Using Bronfenbrenner's ecological systems framework and thematic analysis, four domains were determined: (1) macrosystem (i.e., influences of academic culture); (2) mesosystem (i.e., influences of faculty leadership and interpersonal dynamics); (3) microsystem (i.e., influences of individual mental health experiences); and (4) exosystem (i.e., influences of stigma across structural, interpersonal, and intrapersonal levels). These domains included barriers to and facilitators of mental health and help-seeking. Findings suggest that competitiveness and individualism may perpetuate stereotypes that mental illnesses are inherent weaknesses, and that seeking help is a barrier to academic success. Recommendations for future research are provided. [Journal of Psychosocial Nursing and Mental Health Services, 60(11), 17-25.].

Individuals to Systems: Methodological and Conceptual Considerations for Addressing Mental Illness Stigma Holistically.

Mental illness stigma is a complex public health issue that creates barriers for clients needing access to quality mental health services. Most research focuses on interpersonal stigma with emerging research examining intrapersonal and structural stigma in the healthcare setting. This commentary focuses on how to address the gaps in the existing research to elicit greater organizational/structural change in healthcare systems and positive health outcomes. It describes key components of a 5-year multiphase study that aims to explore and address multiple levels of stigma holistically among stakeholders including physicians, nurses, protective services staff, and patients/families in an emergency department setting. Unique to this study is the inclusion of a patient research partner who will be positioned as a co-designer throughout the project. The goal of this study will be to explore, address, understand, and evaluate interventions that mitigate stigma in healthcare at both the individual and structural/organizational levels.

Opioid Use Stigma: An Examination of Student Attitudes on Harm Reduction Strategies.

Understanding how the public views harm reduction strategies may help inform researchers on how to reduce related stigma and barriers to help-seeking. The current study explored whether stigma towards those who use opioids was affected by gender and type of harm reduction strategy used. Undergraduate students (N = 328) were randomly assigned to read one of six vignettes varying by gender and the type of harm reduction strategy: no harm reduction, opioid agonist therapy (OAT), or safe consumption sites (SCSs). Results demonstrated that participants were less stigmatizing towards the character who engaged in OAT compared to the character with no harm reduction. There was also a pattern demonstrating that SCSs may be perceived more negatively than OAT, although these differences only met conventional significance, not adjusted/corrected alphas. There were no significant effects for gender. Qualitative results revealed that participants held misconceptions about harm reduction. Implications and future directions are discussed.

Where's the party? A mixed method study investigating characteristics, motivations, and harms of attending off-campus (over on-campus) parties.

ObjectiveWe examined the characteristics, motivations, and harms associated with celebrating events at off-campus parties (OCPs), including a particularly harmful off-campus block party compared to on-campus parties (CPs). Participants and Method: Survey with a representative sample of 491 students in Canada. Three focus groups with a total of 14 students who have attended the OCBP and one focus group with community members affected by the OCBP (n = 10). Results: 14.3% of students attended OCPs. OCPs were significantly more likely to be associated with harms. Focus groups revealed that students attend the OCBP as it is cheaper to consume alcohol compared to CPs. Improved music was the most common solution to improve CP. Community members identified 16 potential solutions to mitigate the harms and prevent the OCBP. Conclusion: Reducing costs and improving the experience may increase likelihood of students attending CPs and minimize harms of OCPs.

Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample.

This study aimed to broaden previous investigations of correlates of lifetime cannabis use and problematic cannabis use among post-secondary students by examining the novel and contemporary issues of medicinal use and deep inhalation practices. The sample included 2212 undergraduate and graduate post-secondary students from Alberta, Canada, who completed the University of Calgary's Campus Experience with Cannabis Survey (average age 23.2, SD = 5.2). Nine variables were entered into the binary logistic regression to examine their differentiation of lifetime users from non-users. A multiple regression model was completed with past six-month users (n = 697), where the continuous dependent variable was cannabis use severity as measured by total scores on the Cannabis Use Disorder Identification Test-Revised. Twenty independent variables were entered simultaneously. Varsity athlete status, family mental illness, severity of alcohol use, greater support for legalization and lower perceived risk associated with regular cannabis use, differentiated lifetime users from non-users. Higher rates of religiosity and living with parents or relatives were associated with lower-lifetime rates. Male gender, earlier age of first cannabis use, cannabis use motives (including coping, enhancement and expansion), past six-month medicinal use and increased frequency of deep inhalation during consumption, were found to be significant correlates of severity. Different factors seem to predict lifetime cannabis use versus severity, and these differences may help inform the development and delivery of prevention efforts. Given that medicinal use and male gender were the largest correlates of severity, populations representing these groups may benefit most from targeted education and prevention.

Workplace Antistigma Programs at the Mental Health Commission of Canada: Part 1. Processes and Projects.

The Opening Minds Initiative of the Mental Health Commission of Canada has taken a novel approach to reducing the stigma of mental illness by targeting specific sectors. This first article describes Opening Minds' research and programming initiatives in the workplace target group. This article describes the context of mental illness stigma in Canada and the development of the Opening Minds initiative of the Mental Health Commission of Canada, with a specific focus on the workplace sector. We outline the steps that were taken to develop an evidence-based approach to stigma reduction in the workplace, including reviews of the state of the art in this workplace antistigma programming, as well as the development of tools and measures to assess mental illness stigma in the workplace. Finally, 2 specific program examples (e.g., Road to Mental Readiness and The Working Mind) are used to highlight some of the procedural and logistical learnings for implementing antistigma and mental health initiatives within the workplace. In a second related article, we further examine the Opening Minds workplace initiative, with a discussion of the lessons learned from the implementation and evaluation of antistigma programming in the workplace.

The Working Mind: A Meta-Analysis of a Workplace Mental Health and Stigma Reduction Program.

OBJECTIVES: This article describes a meta-analysis of The Working Mind, a program that was developed to address workplace mental health. The basic program addresses issues related to stigma in the workplace, the use of a mental health continuum model to evaluate signs and indicators of mental illness, and the development of coping skills. A manager version further addresses issues such as how to work with an employee who struggles with mental health issues, workplace accommodations, and overall management issues. METHODS: A total of 8 replications evaluated program effects on stigma, self-reported resilience, and coping abilities. RESULTS: The implementation of the program was associated with moderate reductions in stigma and increased self-reported resilience and coping abilities. These results were generally consistent across settings and showed nonsignificant differences when various potential moderators of the program were evaluated (e.g., employees versus managers, public versus private sector, gender, age). Qualitative comments collected at the end of the program suggested that many program participants found the program to be helpful and that the skills were being employed. CONCLUSIONS: Directions for future research, including the need for a randomized trial of The Working Mind, are discussed. Overall, the results suggest that the program is successful in its aims, but further inquiry is encouraged.

Implementation, Uptake, and Culture Change: Results of a Key Informant Study of a Workplace Mental Health Training Program in Police Organizations in Canada.

BACKGROUND: Organizational characteristics and attributes are critical issues to consider when implementing and evaluating workplace training. This study was a qualitative examination of the organizational context as it pertained to the implementation of a workplace mental health program called Road to Mental Readiness (R2MR) in police organizations in Canada. METHODS: We conducted a qualitative key informant study in 9 different policing organizations in Canada. RESULTS: The central theme of "successful cultural uptake" emerged as key to R2MR's implementation and the ability to facilitate broader culture change. Successful cultural uptake was enabled by several contextual factors, including organizational readiness, strong leadership support, ensuring good group dynamics, credibility of the trainers, implementing widely and thoroughly, and implementing R2MR as one piece of a larger puzzle. Successful cultural uptake was also described as enabling R2MR's impact for broader cultural change within the organization. This enablement occurred through enhanced dialogue about mental health and the introduction of a common language, a supportive workplace culture, increased help seeking, and organizational momentum for additional mental health programming and policy initiatives. CONCLUSION: Successful uptake of R2MR has the potential to lead to promote change within policing organizations. The model derived from our research may function as a tool or roadmap to help guide other organizations in the process of or planning to implement R2MR or a similar intervention.

Workplace Antistigma Programs at the Mental Health Commission of Canada: Part 2. Lessons Learned.

The Opening Minds Initiative of the Mental Health Commission of Canada has worked with many workplaces to implement and evaluate mental illness stigma reduction programs. This article describes the lessons learned from Opening Minds' research and programming initiatives in the workplace target group and details some of the most valuable learnings from collaborating with workplace partners. These insights range from issues such as the recruitment of potential partners to the implementation of evaluation in the workplace. The lessons learned described here are not intended as the optimal ways of developing partnerships or conducting research in a workplace setting but are intended to highlight some of our experiences in implementing antistigma programming. These experiences are provided so that those who are in the same situation can draw from our learnings to make their efforts more efficient. To conclude, we discuss some of our thoughts in which the implementation of workplace mental illness stigma reduction programming should work towards in the future.

The Road to Mental Readiness for First Responders: A Meta-Analysis of Program Outcomes.

OBJECTIVES: First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program. METHODS: The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites. RESULTS: A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants' perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up. CONCLUSIONS: Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others.

Cannabis Use for Medicinal Purposes among Canadian University Students.

OBJECTIVE: The study sought to describe a Canadian sample of university students' medicinal use of cannabis, including prevalence of cannabis use disorder (CUD) and replacement of traditional treatments with cannabis. METHOD: A random sample of 4000 university students was asked to complete a cross-sectional web-based survey. The survey was completed by 2212 (average age 23.2 years, SD = 5.2 years), representing a 55.3% response rate. To be eligible, students had to be enrolled in a class on campus and were 18 years or older. RESULT: Half (52%) of respondents used cannabis at least once in their lifetime, with ∼11% reporting medicinal cannabis use. Recreational motives to use cannabis were common among medicinal users (85%), several (38%) replaced traditional medication with cannabis, and more than a third received authorization by a health care provider. Of the medicinal users, 13.6% met the criteria for CUD. Common ailments for medicinal cannabis use were anxiety, sleep problems, depression, and pain. When mental health-related categories are combined, 78.2% of medicinal users used for at least 1 mental health condition. CONCLUSIONS: Medicinal cannabis use occurs among university students. None of the ailments listed by medicinal users meet the Canadian Family Physicians prescribing guidelines, and most are not among those viewed by the National Academies of Science, Engineering, and Medicine as having strong evidence for therapeutic value. The results raise concerns for health care providers who are authorizing or counselling patients' considering medicinal cannabis.

A longitudinal assessment of the road to mental readiness training among municipal police.

Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed.

Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions.

Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.