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Mental health stigma at primary health care centres in Lebanon: qualitative study.
Abi Hana, Racha; Arnous, Maguy; Heim, Eva; Aeschlimann, Anaïs; Koschorke, Mirja; Hamadeh, Randa S; Thornicroft, Graham; Kohrt, Brandon A; Sijbrandij, Marit; Cuijpers, Pim; El-Chammay, Rabih.
Affiliation
  • Abi Hana R; Ministry of Public Health, National Mental Health Programme, Beirut, Lebanon. rasha_abihana@hotmail.com.
  • Arnous M; Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands. rasha_abihana@hotmail.com.
  • Heim E; Ministry of Public Health, National Mental Health Programme, Beirut, Lebanon.
  • Aeschlimann A; Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
  • Koschorke M; Department of Psychology, University of Zurich, Zurich, Switzerland.
  • Hamadeh RS; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England.
  • Thornicroft G; Primary Healthcare Department at Ministry of Public Health, Beirut, Lebanon.
  • Kohrt BA; Global Health Team of Experts (GHTE), Beirut, Lebanon.
  • Sijbrandij M; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England.
  • Cuijpers P; Department of Psychiatry and Behavioral Sciences, Division of Global Mental Health George Washington University, Washington, DC, USA.
  • El-Chammay R; Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
Int J Ment Health Syst ; 16(1): 23, 2022 May 07.
Article in En | MEDLINE | ID: mdl-35525972
BACKGROUND: Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. METHODS: Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. RESULTS: The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. CONCLUSION: This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Qualitative_research Language: En Journal: Int J Ment Health Syst Year: 2022 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Qualitative_research Language: En Journal: Int J Ment Health Syst Year: 2022 Document type: Article Affiliation country: Country of publication: