Although diverse strategies to reduce police involvement in mental health crisis response are emerging, people with serious mental illnesses and/or those experiencing a mental health crisis routinely encounter police. Officers need training to safely and effectively interact in these situations. The Crisis Intervention Team (CIT) model is a collaborative approach that includes a 40-h training of officers who self-select to become CIT officers. Despite widespread adoption across thousands of U.S. communities, no randomized, controlled trial (RCT) has assessed CIT training's effectiveness. Our objective is to determine the effectiveness of CIT training on officers' demonstrated skills and behaviors in three outcome areas: (1) verbal and non-verbal crisis de-escalation skills (the primary outcome), (2) officers' use of four domains of procedural justice, and (3) disposition-related decision-making. Hypothesized mediators and moderators will also be assessed.

A total of approximately 240 officers from seven or eight U.S. sites will engage in video-recorded standardized scenarios at baseline, with half being randomized to receive CIT training within the following 3 weeks. Officers will then be reassessed at 3 and 6 months after the CIT training week. Trained raters, blinded to site, treatment arm, and timepoint, will evaluate the primary outcome. Survey-based data will capture officer characteristics and hypothesized mediators and moderators.

This study employs innovative methods, including standardized scenarios with professional actors portraying psychosis with agitation, depression with suicidality, and mania with refusal to leave, to measure officers' skills and behaviors.

The multi-site RCT will yield generalizable, high-impact findings to inform policy and practice, addressing critical gaps in research on CIT training.

The community attitudes towards mental illness scale (CAMI) is widely used to measure authoritarianism, benevolence, social restrictiveness, and community mental health attitudes held by general populations and medical professionals. This study compares the fit of published alternative factor structures of the CAMI to a general population English-speaking sample and examines what mental illnesses individuals think about when responding. Using data from 749 US MTurk participants, confirmatory factor analysis supported a modified version of Morris' (2012) structure - fear/exclusion, social control, and goodwill - χ2(183) = 1094.44, p < 0.001, RMSEA = 0.08, CFI = 0.90, SRMR = 0.06. Most participants (73.6%) considered specific mental illnesses, with bipolar disorder, depression, and schizophrenia most common. Some found challenges defining mental illness. Comparing structures of a widely cited tool and identifying what respondents think about while completing the scale assists the many researchers using the CAMI. This clarifies our understanding of community stigma and improves our capacity to reduce it.

Nursing students' negative perceptions of and reduced interest in individuals experiencing mental health challenges could lead to problems such as deteriorating quality of mental health nursing and lack of competent, qualified mental health nurses. Promoting changes and developments in mental health nursing education for greater effectiveness is pivotal. This study aimed to develop, introduce and validate a blended learning service user involvement programme for mental health nursing education-the first of its kind in South Korea. This study is reported according to TREND guidelines. The experimental group's scores for attitudes and empathy with individuals experiencing mental health challenges increased significantly after taking the 6-week service user involvement class. The experimental group achieved higher scores for knowledge of mental health nursing, satisfaction, and confidence in performance than the control group, which attended a traditional-style class. However, no significant difference was found between groups in changes in attitudes towards and empathy with individuals experiencing mental health challenges. The service user involvement class could improve some students' knowledge of mental health nursing and confidence, but providing the course in a single semester is not sufficient to improve students' attitudes towards and empathy with individuals experiencing mental health challenges. Therefore, an appropriate approach to more systematic long-term planning should be developed, and public perception should be improved. Additionally, long-term studies should evaluate the sustainability and progression of changes in attitudes and empathy over time. We recommend developing mental health nursing education programmes with diverse designs and structures.

Mental illness stigma continues to be pervasive and problematic in society. Researchers have attempted to better understand this stigma through investigations into demographic factors that may predict stigma, focusing on factors such as age, ethnicity and education.

We investigated demographic factors in the context of Aotearoa New Zealand, with a particular focus on Māori, the Indigenous people of Aotearoa. We used data from the Health Promotion Agency, which collected representative samples from Aotearoa across three survey waves (total n = 3518). Assessment instruments were the Mental Health Knowledge Scale (MAKS), the Reported and Intended Behaviour Scale (RIBS) and the Community Mental Health Ideology subscale of the Community Attitudes towards the Mentally Ill (CAMI). Using linear mixed-effects model we controlled for several demographic variables (e.g. age, biological sex, education and socioeconomic status) and additional variables (e.g. having a psychological condition and whether participants knew someone with mental illness) across three models for each measure.

The results revealed that mental illness stigma was lower among both Māori and European participants. Additional variables and their associations with mental illness stigma are also discussed.

Overall, this study illustrates mental illness stigma as lower among Indigenous people in Aotearoa, which prompts further research into ethnicity and mental illness stigma as well as non-Western understandings of mental illness.

Nursing students often experience anxiety, stress, and fear during a clinical rotation in a mental health setting due to stressors and biases toward the setting as well as lack experience in caring for patients with mental health conditions. One in four people worldwide suffers from a mental disorder; therefore, it is critical that nurses feel confident interacting with these patients to provide equitable care. Undergraduate training is a critical period for changing students' attitudes toward this population. This study's goal was twofold. First, we offered students' exposure to common behaviors and symptoms displayed by a patient with mental illness through an engaging and immersive virtual reality simulation experience before taking care of patients in a clinical setting. Second, we aimed to determine if a virtual reality simulation will change students' attitude and stigma, favorably, toward patients with mental health conditions. We used a mixed-method comparative analysis to collect information and identify themes on undergraduate students' attitudes and stigma toward patients with mental health conditions. Our findings demonstrate that virtual reality simulations enhance awareness and sensitivity to the situations of others (empathy) while improving their communication skills. The use of virtual reality in a baccalaureate curriculum deepens the understanding of health equity in behavioral health for nursing students.

One in five adults in the United States suffers from mental illness. Negative social influences in the Hmong community stigmatize those who have mental health challenges and mental health outcomes are impacted by poor mental health literacy. Language barriers, conflicting traditional beliefs, and Western concepts of health contribute to low mental health literacy and willingness to seek professional mental health services among the Hmong.

The aim of this project was to successfully implement Mental Health First Aid (MHFA) to a group of 30 or more Hmong adult church leaders in a faith-based setting.

A pretest posttest project design was used. The project implementation process was guided by the Plan-Do-Study-Act (PDSA) model and took place from June 2023 to August 2023. Participants were recruited from three local Detroit Hmong churches. Indicator measures included the Mental Health Literacy Scale (MHLS) and Community Attitudes toward Mental Illness (CAMI) Scale before and immediately after training. One final survey was administered at 6 weeks post MHFA training to measure information retention, stigma, and utilization of MHFA skills.

Results reflect the existing body of literature regarding MHFA and the positive impacts on mental health literacy, confidence level, mental health awareness, and decreasing stigma.

MHFA continues to demonstrate successful implementation across many settings and populations, especially for this project among Hmong adult church leaders. More research is needed to expand on mental health and the Hmong.

Mentally ill offenders face stigma, being perceived as both dangerous and unpredictable. This leads to social discrimination, which causes devaluation, distancing, and unequal treatment towards them. Critical and dismissive attitudes of healthcare professionals and police toward these patients undermine their care, treatment, and prospects for rehabilitation. This study investigated the attitudes and stereotypes of health professionals and police officers who frequently interact with mentally ill offenders. Participants completed three scales: Attitudes Toward Mentally Ill Offenders (ATMIO), Community Attitudes Toward the Mentally Ill (CAMI), and Familiarity Level Scale. The sample included 523 professionals, 283 health professionals, 139 mental health professionals, and 101 police officers, with an average age of 41.4 years and 40.3% having over 20 years of experience. Results showed that all groups displayed negative attitudes toward mentally ill offenders, with little variation between them. This highlights the need for professionals to recognize their biases when caring for this population.

(1) Background: Research on mental health literacy (MHL) and attitudes toward mental health problems (ATMHP) among non-medical college students in Nepal is limited. This study examined the relationship between MHL and ATMHP, considering demographic variables and familiarity with mental health issues; (2) Methods: We conducted a cross-sectional survey with 385 college students from Chitwan and Kathmandu, Nepal, using opportunity sampling. Descriptive and inferential statistics examined demographic differences, while Pearson's correlation assessed relationships among latent variables; (3) Results: No relationship was found between MHL and ATMHP (r = -0.01, p = 0.92). Females had greater awareness of stereotypes (p = 0.025, g = 0.24). Hotel management students showed better self-help strategies (p = 0.036, d = 0.46). Public college students scored higher in self-help strategies than government (p = 0.036, d = -0.32) and private college students (p = 0.02, d = -0.32). Non-employed students outperformed employed ones in self-help strategies (p = 0.002, g = -0.46). Other demographic factors showed no significant relationships; (4) Conclusions: MHL and ATMHP were unrelated, indicating that increasing MHL alone may not improve attitudes. Multidimensional interventions combining education and experiential learning are needed. Certain demographic factors influenced stereotypes and self-help strategies, while others showed no significant impact.

Mental-health-related stigma prevents youth from seeking help for mental health problems. Limited studies in low- and middle-income countries assess the effect of arts-based education in reducing such stigma among youth, thereby leaving a gap in evidence-based, age- and culturally-appropriate interventions.

To evaluate the impact, feasibility, and acceptability of CREATORS, an arts-based educational program on reducing mental-health-related stigma among youth in India.

We conducted a mixed-methods, pre-post control group study among college-going adolescents in Hyderabad, India. At baseline and post-intervention (after six weeks), we examined differences in intended behavior towards people with mental health problems.

Our study involved 432 participants across three study groups: participants creating art on the theme of mental-health-related stigma over six weeks (n = 123), a student audience viewing 2-h arts show by participants (n = 244), and a control group (n = 65). Between baseline and post-test, participants creating art showed significantly lower stigma towards people with mental health problems compared to members of the control group (coefficient = 1.55, 95%CI 0.06-3.04, p = 0.041). Participants found the intervention useful and enjoyable (>95%; n = 773 across six weeks). Participants identified that collaborative creation of art made the subject of mental health interesting and relatable.

Participating in an arts-based educational program was associated with significantly lower mental-health-related stigma among youth compared to a control group in the short term. High acceptability of the program demonstrates the utility of arts-based education to address mental-health-related stigma. With community partners and artists as facilitators, our program may support mental health specialists in mental health promotion.

Between 2008 and 2019, we reported positive change relating to mental health stigma and discrimination among the adult population of England, supporting the effectiveness of the Time to Change campaign.

Using data from the Attitudes to Mental Illness survey (2008/2009 to 2023), we investigated the extent to which positive changes in stigma were sustained by 2023, 2 years after the programme's end in 2021.

We used regression analyses to evaluate trends in outcomes. Measures were of stigma-related knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes toward the Mentally Ill scale (CAMI)) and desire for social distance (Reported and Intended Behaviour Scale (RIBS)). We also examined willingness to interact with people based on vignettes of depression and schizophrenia, and attitudes toward workplace discrimination, using data from the British Social Attitudes Survey for comparison.

CAMI scores improved between 2008 and 2023 (s.d. 0.24, 95% CI 0.16-0.31), but decreased since 2019 (P = 0.015). After improvements between 2009 and 2019, 2023 MAKS and RIBS scores no longer differed from 2009 scores, indicating decreases in stigma-related knowledge (MAKS scores declined 7.8%; P < 0.001) and willingness to interact (RIBS scores declined by 10.2%; P < 0.001) since 2019. Conversely, comparison with British Social Attitudes Survey data indicated that willingness to interact with people with depression and schizophrenia increased gradually between 2007, 2015 and 2023, and attitudes to workplace discrimination also improved.

The lasting positive changes reflect support for non-discrimination and willingness to interact with someone after a sense of familiarity is evoked. Besides the end of Time to Change, interpretations for declines in other outcomes include the COVID-19 pandemic and economic stress.

Patient-centred care must consider service consumers' needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain.

The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students.

a one-group pre-postintervention design with no control group was conducted.

A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings.

A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction.

The educational 9-month intervention was effective in reducing students' stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities.

Burnout is a primary psychosocial risk factor in the workplace. Mental health stigma, which includes negative cognitions, emotions, and behaviors, also undermines the performance of social healthcare professionals. This study aimed to explore the levels of burnout in a sample of community social healthcare workers as well as its relationships with variables such as stigma towards mental health problems, professional skills, and job characteristics. An online assessment was conducted with 184 social healthcare professionals (75.5% female, mean age = 40.82 years, SD = 9.9). Medium levels of burnout and stigma and high levels of professional skills were observed. Multiple linear regression analyses revealed that stigma towards mental health problems and professional skills predicted emotional exhaustion (R2 = 0.153, F(4, 179) = 9.245, p < 0.001), depersonalization (R2 = 0.213, F(3, 180) = 17.540, p < 0.001), and personal accomplishment (R2 = 0.289, F(5, 178) = 15.87, p < 0.001). These findings suggest that social healthcare systems could benefit from taking care of the mental health of their workers by addressing burnout, tackling negative attitudes towards mental health problems, and providing professional skills training. This would help to make social healthcare systems more inclusive and of higher quality, thereby reducing health costs.

Instruments to assess the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion are either missing or lack evaluation of their validity and reliability.

The aim of this study is to evaluate the validity and reliability of three instruments developed to fill this gap in the literature, the World Health Organization's QualityRights (WHO QR) Knowledge questionnaire, the WHO QR Attitudes questionnaire, and the WHO QR Practices questionnaire.

A sample of participants was recruited and completed an online survey. Content validity and face validity were assessed for the three questionnaires. Based on the characteristics of the questionnaires, different approaches were used to assess their construct validity (confirmatory factor analysis, known group validity, and convergent and divergent validity). Internal consistency was evaluated using Cronbach's alpha and test re-test reliability using Pearson's and Spearman's r coefficients.

The analyses conducted indicate that the three questionnaires are valid and reliable instruments to evaluate the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion.

This finding lends support to the use of these instruments both within mental health services and in the general population for a better understanding of current knowledge, attitudes, and practices related to a human rights-based approach to mental health in mental health services and the community.

Few studies have explored the associated factors of attitudes of nonpsychiatric nurses towards mental disorders. Therefore, this study is aimed to evaluate the attitudes of nonpsychiatric nurses towards mental disorders and especially explore the association between psychiatric clinical practice and these attitudes.

A total of 1324 nonpsychiatric nurses and students majoring in nursing were recruited through an online questionnaire from December 2021 to March 2022 in Sichuan Province, China. Demographic information, personal care experience, psychiatric nursing education and the Community Attitudes towards the Mentally Ill (CAMI) were collected. A higher score indicates a stigmatizing attitude in the authoritarianism and social restrictiveness (SR) subscales and a positive attitude in the benevolence and community mental health ideology (CMHI) subscales. Multivariate linear regression was employed to analyze associated factors of attitudes towards mental disorders, and hierarchical linear regression was used to analyze the association between psychiatric clinical practice and the attitudes towards mental disorders.

Under the control of confounders, high education level, long residence in urban and personal care experience were positively correlated with score of authoritarianism and SR (p < 0.05), and negatively correlated with score of benevolence (p < 0.05). Long residence in urban and personal care experience were negatively correlated with score of CMHI (p < 0.05). Hierarchical linear regression analysis showed that after adjusting for demographic information, psychiatric clinical practice was associated with lower score of benevolence (B = -0.09, 95%CI = -0.17 ~ -0.003, p = 0.043) and CMHI (B = -0.09, 95%CI = -0.17 ~ -0.01, p = 0.027), but the initial associations between psychiatric clinical practice and authoritarianism, SR disappeared.

High education level, long residence in urban, personal care experience and the psychiatric clinical practice were associated with the discrimination of nonpsychiatric nurses towards mental disorders. Further exploring practical strategies to optimize the psychiatric clinical practice experience of nonpsychiatric nurses could help improve their attitudes towards mental disorders.

Understanding and eliminating mental illness stigma is crucial for improving population mental health. In many settings, this stigma is gendered, from the perspectives of both the stigmatized and the stigmatizers. We aimed to find the differences in the level of stigma across different mental disorders while considering the gender of the study participants as well as the gender of the people depicted in the vignettes. This was a population-based, experimental vignette study conducted in Buyende District of Eastern Uganda in 2023. We created 8 vignettes describing both men and women with alcohol use disorder, major depressive disorder, generalized anxiety disorder, and schizophrenia consistent with DSM-5 criteria. Participants from 20 villages in rural Buyende District of Uganda (N=379) were first read a randomly selected vignette and administered a survey eliciting their attitudes (Personal Acceptance Scale [PAS] and Broad Acceptance Scale [BAS]) towards the person depicted in the vignette. We used analysis of variance (ANOVA) with Bonferroni-adjusted, empirical p-values to compare levels of acceptance across disorders and genders. Attitudes towards people with mental illness, as measured by the PAS, varied across different mental disorders (p=0.002). In pairwise mean comparisons, the greater acceptance of anxiety disorder vs. schizophrenia was statistically significant (Mean [SD] PAS: 2.91 [3.15] vs 1.62 [1.95], p=0.008). Secondary analyses examining differences in acceptance across gender combinations within mental disorders showed that PAS varied across gender combinations for depression (p=0.017), suggesting that acceptance is higher for women with depression than men with depression. In this population-based vignette study from rural Uganda, we found that people with schizophrenia were less accepted compared to people with anxiety disorders. We also found that there was greater acceptance of women with depression than men with depression. Anti-stigma initiatives may need to be targeted to specific disorders and genders.

(1) Background: Mental health problems are associated with negative connotations that may lead to discrimination and rejection of people diagnosed with mental disorders. The present study aimed to develop and validate a new scale (the Spanish Social Stigma Scale-S3) to assess the current level of social stigma in the general Spanish population. (2) Methods: The assessment tool was developed after reviewing the items of existing tools that represent the most appropriate indicators for the assessment of social stigma. A review was performed by volunteer subjects and by a group of experts in the field, based on the participation of 563 respondents to a survey. (3) Results: The confirmatory factor analysis revealed that the developed tool fits with the factors that determine the level of social stigma and shows good internal consistency (χ2SB = 412.0321, gl = 293, p < 0.01; BBNNFI = 0.922; CFI = 0.930; IFI = 0.931; RMSEA = 0.028 [0.022, 0.035]). (4) Conclusions: The S3 is useful for assessing knowledge, attitudes, and behavior towards people diagnosed with a mental disorder. This tool may be used for the identification and development of mechanisms necessary for the reduction of social stigma in the general population.

Controlling the spread of COVID-19 requires individuals to adopt preventive behaviours, but conspiracy beliefs about its origin are spreading. The aim of this paper is to better comprehend the strength of conspiracy beliefs versus objective COVID-19 information to predict people's adherence to protective behaviours (getting vaccinated, being tracked through APPs, and keeping social distance from infected people). Study 1 shows that COVID-19 implicit theories detected in the Pre-study were activated as independent factors that constitute people's interpretations of the virus origin. These beliefs were related to a lesser intention to engage in preventive behaviours and a higher level of mistrust in institutional information, although some beliefs generate positive expectations about COVID-19 consequences. In Study 2, conducted with a different sample, official COVID-19 information was included as an independent variable, but this new variable did not further explain results. Lastly, Study 3 consisting of both previous samples confirmed that conspiracy beliefs had a direct effect on a lesser willingness to engage in preventive actions, a higher mistrust, and positive expectations about COVID-19 consequences. We conclude that objective COVID-19 information did not buffer the effect of conspiracy beliefs; they interfere with actions to prevent it by taking institutions as scapegoats or complicit with secret powers.

As well as affecting physical health, COVID-19 can impact mental health. Despite this, Israelis may not be getting needed mental health care because of culture-related barriers such as stigma and lack of knowledge about mental health and appropriate care. This is especially likely among vulnerable populations, such as Ethiopian immigrants, yet the topic has been understudied. This study aimed to examine to what extent COVID-19-related mental health stressors and issues are found among Ethiopian-Israelis and the extent of stigma and mental health literacy among Ethiopian-Israelis during the COVID-19 period. It also examined differences between the 1.5th and 2nd generations and potential interventions to improve their mental health. Online surveys were filled out by a convenience sample of 225 Ethiopian-Israelis recruited from a variety of sources in the fall of 2020. Over 40% expressed greater mental distress since COVID-19 started. Stigma and lack of mental health-related knowledge were found among many in this population, serving as potentially important barriers to getting appropriate mental health care. For example, only 52% disagreed with the statement that people with mental illness should not be given any responsibility and only 66% felt confident they could identify having a mental health problem requiring treatment. Variations were found by types of stressors, stigma, and lack of knowledge, as well as by immigration generation, for at least some measures. COVID-19 can negatively impact mental health and appropriate mental health care utilization, especially for a racial/ethnic minority group of immigrants such as Ethiopian-Israelis. Interventions are needed, such as increased education about mental health from a variety of sources, which can help decrease stigma and improve mental health care utilization among this group, especially when appropriately tailored.

This paper presents the study protocol for a feasibility study of a manualised mental health awareness and stigma reduction intervention for Black faith communities, as part of the Outcomes and Needs of Traditional Religious And Complementary practitioners (ON TRAC) project. The primary objective is to assess the feasibility and acceptability of the intervention and the secondary objectives include assessment of the feasibility of: recruiting participants to take part in the intervention, delivering the intervention, and conducting qualitative assessments, and use of the selected scales. The findings from this study will be used to inform the development of a subsequent trial which will focus on exploring the potential impact of the intervention on stigma-related knowledge, attitudes, and behaviour.

The study uses a mixed-methods approach. A total of 80 participants from four Black Majority Churches in South London will be recruited. Randomisation of the participants will be at an individual level to either the intervention group (who will participate in the 10 week Mental Health Awareness Course intervention) or to the waiting list control group (who will receive the same intervention, 8 weeks after the intervention group). Outcomes for both arms will be collected at baseline, postintervention, and at 4 week follow-up. In addition, focus group discussions will be conducted with participants in the intervention group, a week following the end of the 10 week session course, to investigate the feasibility and acceptability of the mental health awareness course.

The results of this research will be disseminated at local, national, and international levels.

ISRCTN12253092.

The prevalence of mental disorders in adolescents has a considerable impact on daily life, restricting tasks and diminishing overall quality of life while potentially leading to stigmatization. This study aims to measure the impact of a mental health literacy intervention program, called "Bicho de 7 Cabeças" project, in b-learning format, on the increase of knowledge and the decrease of stigma in young people from Póvoa de Varzim, in Portugal. A quasi-experimental study was conducted, from November 2022 to May 2023, involving an experimental group ("Bicho de 7 Cabeças" protocol) and an active control group (informational brochures), utilizing a pre-test/post-test design. Mental Health Literacy Measure-MHLM, Mental Health Promoting Knowledge Scale-MHPK-10, Mental Illness Knowledge Schedule-MAKS, Reported and Intended Behaviour Scale-RIBS, and Community Attitudes toward People with Mental Illness-CAMI were used. A total of 504 young students from the 9th grade enroll in this study, with a mean age around 14 years old. There is a significant difference between stigma (p <.001) and knowledge (p <.001) scores at baseline and follow-up. The results of this study shows that interventions aimed at young people for the promotion of mental health literacy and stigma reduction are needed and more initiatives should be implemented in schools to address these problems.

Social exclusion towards schizophrenia can occur as a response to symptom presentations and/or diagnostic knowledge. The present study examined stigma towards schizophrenia as a function of diagnostic awareness, positive symptoms, and negative symptoms.

559 participants were presented with one of eight vignettes depicting an individual in a social situation based on a 2 (label: present, absent) x 2 (positive symptoms: present, absent) x 2 (negative symptoms: present, absent) design. Participants then completed various measures of social exclusion and stigmatizing attitudes.

A significant three-way interaction between positive symptoms, negative symptoms, and a diagnostic label was found for stigmatizing attitudes such that knowledge of diagnosis was associated with less stigma when symptoms were present but resulted in more stigma when symptoms were absent. A significant interaction between diagnostic label and negative symptoms was found on social distance such that knowledge of diagnosis increased desire for social distance when negative symptoms were present.

Diagnostic awareness increases stigmatizing attitudes and social distance when symptoms are not present. However, when contextualized with the presence of symptoms, diagnostic awareness may reduce exclusion by providing an explanation for those symptoms. Determining when and to whom to disclose one's diagnosis may be helpful to improve social functioning in schizophrenia.

With the number of people with dementia dramatically increasing over time and dementia becoming a major health concern worldwide, scales have been developed to assess the stigma socially attached to this neurodegenerative disorder. There are, however, almost no available methods and assessment constructs for person-centered translation of dementia public stigma scales.

To develop such a method and such an assessment construct by translating the Dementia Public Stigma Scale (DPSS) into standard written Chinese.

We translated the DPSS following three major steps: (1) literal translation and mistranslation identification; (2) panel discussions of items with problematic translations; and (3) the final checking of the translated scale. Informed by the translation and adaptation process, we then developed a method for person-centered translation of dementia public stigma scales. Based on this method and our panel discussions, we finally proposed a tripartite assessment construct for quality evaluation of the translation of dementia public stigma scales.

Forward and backward translation did not work sufficiently in dementia public stigma scale translation. Mistranslations were induced by three major causes, including confusion caused by multiple Chinese meanings of the immediate Chinese direct translation, the lack of immediate Chinese direct translation because of varying positive/negative emotions attached to multiple translations, and the lack of culture-specific idioms in Chinese. Based on these factors, we proposed a tripartite dementia translation assessment construct. Following this assessment tool, we determined the best Chinese version that could further be tested for its psychometric properties among the public.

A method and an assessment construct for person-centered translation of dementia public stigma scales were developed. Such a method and such an assessment construct could be followed in the translation of dementia public stigma scales and the translation evaluation of such scales.

This research aimed to culturally adapt and validate the MIAS scale for Arabic-speaking individuals within the Saudi Arabian general population, with an emphasis on cultural, societal, and individual nuances.

An initial pilot testing with a small group ensured the scale's clarity. Subsequently, two cross-sectional studies involving 189 participants to assess structural validity of the Arabic MIAS scale, and 38 participants to assess the test-retest reliability. Descriptive statistics, Cronbach's α, Intraclass Correlation Coefficient (ICC), and Confirmatory Factor Analysis (CFA) were employed for data analysis.

The Arabic MIAS scale demonstrated good internal consistency and acceptable test-retest reliability (ICC α = 0.631). A three-factor model emerged (CFI = 0.890, TLI = 0.845, RMSEA = 0.094), including "Outcomes," "Negative Stereotypes," and "Recovery," closely mirroring the original study's structure. one item was excluded from the model since it didn't align with any of the three factors.

The study contributes a culturally adapted, validated, non-condition-specific tool to gauge public attitudes toward mental health stigma in an Arabic context. It highlights the need for culturally sensitive stigma research and interventions and underscores the importance of improving such tools for cross-cultural applicability and comparability.

Negative attitudes towards mental illness are known to exist among medical students in Nigeria. However, the effect of undergoing a rotation in psychiatry on their attitudes is uncertain.

It aimed to determine the effect of psychiatry posting during medical training on medical students' attitudes toward mental illness and examine the association of posting-related and demographic factors with their attitudes.

It is a prospective cohort study in which 187 medical students from three different universities were followed up during their psychiatry postings in two different posting sites. Questionnaires containing basic demography, posting-related variables, and the Community Attitude to Mental Illness (CAMI) scale were administered to all available students before and after the rotation in psychiatry. A paired t-test was applied to test the differences in the CAMI scores before and after posting, while ANOVA and hierarchical regression were utilized to determine the association of variables with the CAMI scores.

There were significant differences between the pre-and post-rotation CAMI scores in CAMI's social restrictiveness (SR) and community mental health ideology (CMHI) domains, indicating improved attitudes. Demographic factors had no significant influence on the students' attitudes, but the length of posting, university of the students, and posting sites had varying impacts.

Psychiatry rotation has a positive impact on students' attitudes toward mental illness in both posting sites, particularly in the domains of SR and CMHI. This underscores the importance of psychiatry training in medical education in changing the attitudes of future healthcare professionals.

The World Health Organization recommends person-centred and integrated care for mental health of people with Neglected Tropical Diseases. This study assesses the feasibility and acceptability of mental health care for people with NTDs, which integrated mental health care into primary health care services, in central Nigeria.

People affected by NTDs were screened for depression and anxiety, and those identified referred to the integrated service. Following their use of the service, Focus Group Discussions were held with service users and carers, and Key Informant Interviews with health service providers. Service providers were also interviewed on attitudes, before and after training with the WHO mhGAP Intervention Guide.

In general service users reported satisfaction with the services, which they found to be dignified and accessible. They expressed concern about affordability, and waiting times. Providers also felt the service was acceptable. System gaps were identified, for example in health information systems and supervision. Poor political will threatened sustainability. CAMI scores did not change with mhGAP training.

Locally designed services that support mental health of people with NTDs can be integrated into primary care. Weak basic infrastructure and lack of investment are barriers to sustainability and potential effectiveness.

L'Organisation mondiale de la santé recommande des soins centrés sur la personne et intégrés pour la santé mentale des personnes atteintes de maladies tropicales négligées. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui ont intégré les soins de santé mentale dans les services de soins de santé primaires, dans le centre du Nigeria. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui intègrent les soins de santé mentale dans les services de soins de santé primaires, au centre du Nigeria.

Les personnes atteintes de MTN ont fait l'objet d'un dépistage de la dépression et de l'anxiété, et celles qui ont été identifiées ont été orientées vers le service intégré. Après leur utilisation du service, des discussions de groupe ont été organisées avec les utilisateurs du service et les soignants, et des entretiens avec des informateurs clés avec des prestataires de services de santé. Les prestataires de services ont également été interrogés sur leurs attitudes, avant et après la formation au guide d'intervention mhGAP de l'OMS.

En général, les utilisateurs des services se sont déclarés satisfaits des services, qu'ils ont trouvés dignes et accessibles. Ils ont exprimé des inquiétudes quant à l'accessibilité financière et aux temps d'attente. Les prestataires ont également estimé que le service était acceptable. Des lacunes ont été identifiées dans le système, par exemple dans les systèmes d'information sanitaire et la supervision. Le manque de volonté politique a menacé la viabilité des services. Les scores CAMI restent inchangés suite à la formation au mhGAP.

Des services de santé mentale conçus localement pour venir en aide aux personnes atteintes de MTN peuvent être intégrés aux soins primaires. La qualité de l'infrastructure de base et le manque d'investissement sont les obstacles principaux à la durabilité et à l'efficacité potentielle de ces interventions.

La Organización Mundial de la Salud recomienda una atención centrada en la persona e integrada para la salud mental de las personas con Enfermedades Tropicales Desatendidas. Este estudio evalúa la viabilidad y aceptabilidad de la atención a la salud mental de las personas con ETD, que integra la atención a la salud mental en los servicios de atención primaria, en Nigeria central.

Las personas afectadas por ETD fueron examinadas para detectar depresión y ansiedad, y las identificadas fueron derivadas al servicio integrado. Tras su utilización del servicio, se celebraron debates de grupos focales con los usuarios y cuidadores del servicio, y entrevistas a informantes clave con los proveedores de servicios sanitarios. También se entrevistó a los proveedores de servicios sobre sus actitudes, antes y después de la formación con la Guía de Intervención mhGAP de la OMS.

En general, los usuarios se mostraron satisfechos con los servicios, que consideraron dignos y accesibles. Expresaron su preocupación por la asequibilidad y los tiempos de espera. Los proveedores también consideraron que el servicio era aceptable. Se detectaron deficiencias en el sistema, por ejemplo en los sistemas de información sanitaria y la supervisión. La escasa voluntad política amenazaba la sostenibilidad. Las puntuaciones CAMI no cambiaron con la formación mhGAP.

Los servicios diseñados localmente para apoyar la salud mental de las personas con ETD pueden integrarse en la atención primaria. La debilidad de la infraestructura básica y la falta de inversión son obstáculos para la sostenibilidad y la eficacia potencial.

Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.

According to the United Nations, access to medical care is a fundamental human right. However, there is widespread stigmatization of severe mental illnesses and this appears to seriously hamper the quality of healthcare in people with psychiatric co-morbidity. Thus, interventions that help reduce stigma among healthcare providers are urgently needed.

The objective of the current study was to investigate the effects of a psychiatric clerkship on stigmatizing attitudes toward mental disorders held by medical students.

Between 2018 and 2019, a total of 256 third- and fourth-year students from Marburg University Medical School (Germany) completed two surveys-one before and one after a 2 week clerkship program that was designed to prioritize direct interaction with the patients. For measuring stigma, the questionnaires contained questions about students' attitudes toward psychiatry (ATP), including the Opening Minds Scale for Healthcare Providers (OMS-HC), Community Attitudes Toward the Mentally Ill (CAMI), and measurements according to the Stereotype-Content Model (SCM). We conducted pre-vs.-post comparisons using the Wilcoxon signed rank test with continuity correction or paired t-test and employed the Spearman method for correlational analysis. We considered p < 0.05 significant and adjusted all p-values reported here using the Benjamini-Hochberg procedure to account for family-wise error.

After the clerkship, a significantly reduced stigma was found, as assessed with ATP (mean p < 0.001), OMS-HC (sum and subscale "attitudes" p < 0.001; subscale "disclosure" p = 0.002), and both SCM subscales (p < 0.001). Moreover, we observed significant associations between stigma expression (e.g., OMS-HC sum) and the willingness of students to choose psychiatric residency after finishing medical school (before clerkship: p < 0.001; ρ = -0.35; change after clerkship: p = 0.004; ρ = -0.2).

Our findings indicate that a psychiatric clerkship that involves students in direct interaction with patients may effectively reduce stigma. Therefore, we advocate the incorporation of components of direct interaction in medical education to combat stigma and unequal treatment, as this could improve outcomes in patients with severe mental illnesses.

Mental health stigma is a relevant phenomenon with implications for the people who suffer from it. Despite its importance, no studies have been carried out in Spain at national level with a representative sample of the population.

The aim of this research is to analyze the stigma associated with MHPs in a representative sample of the Spanish population for the first time.

A cross-sectional quantitative descriptive study was carried out with a representative sample of the population (N = 2746). Descriptive analyses and regressions are carried out on the different dimensions of stigma such as attitude, attribution and intention of social distance.

Medium levels of stigma are obtained in stigmatizing attitudes and attributions, and medium-low levels in the intention of social distance. The best predictors of stigma in its different dimensions are attitudes, attributions and intention of social distance themselves. Progressive political ideology is related to less stigma in all dimensions. Knowing someone with mental health problems and talking openly about it together with higher education are also relevant protectors. Mixed results are obtained regarding age, gender and help-seeking.

National programs and campaigns focused on attitudes, attributions and behavioral intentions are necessary to reduce the stigma still present in Spanish society.

Globally, stigma associated with mental, neurological and substance use (MNS) disorders is rampant and a barrier to good health and overall well-being of people with these conditions. Person-centred digital approaches such as participatory video may reduce stigma, but evidence on their effectiveness in Africa is absent.

To evaluate the effectiveness of participatory video in reducing mental health-related stigma in a resource-limited setting.

We evaluated the effectiveness of using participatory video and face-to-face interaction between people with MNS disorders and a target audience in lowering stigma among 420 people living in Kilifi, Kenya. Changes in knowledge, attitudes and behaviour (KAB) were measured by comparing baseline scores with scores immediately after watching the participatory videos and 4 months after the intervention. Sociodemographic correlates of stigma scores were examined using multivariable linear regression models.

Compared with baseline, KAB scores significantly improved at both time points, suggesting reduced stigma levels. At 4 months, the changes in scores were: knowledge (β = 0.20, 95% CI 0.16-0.25; P < 0.01), liberal attitude (β = 1.08, 95% CI 0.98-1.17; P < 0.01), sympathetic attitude (β = 0.52, 95% CI 0.42-0.62; P < 0.01), tolerant attitude (β = 0.72, 95% CI 0.61-0.83; P < 0.01) and behaviour (β = 0.37, 95% CI 0.31-0.43; P < 0.01). Sociodemographic variables were significantly correlated with KAB scores; the correlations were not consistent across the domains.

Participatory video is a feasible and effective strategy in improving knowledge, attitudes and intended behaviour in a resource-limited setting. Further studies are required to understand the mechanisms through which it lowers stigma and to examine long-term sustainability and the effectiveness of multicomponent interventions.

Building partnerships between mental health services and Black faith communities to co-produce culturally tailored interventions is an essential step towards improving access to services and reducing stigma among the Black population. Given that Black faith organisations are considered a primary source of emotional and psychological support they are well positioned as 'gatekeepers' for services, to overcome barriers to engagement and build trusting relationships with the Black community. The aim of this paper is to pilot a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK, and to make an initial assessment of feasibility, acceptability and outcomes.

This study employed a mixed methods pre-post-design, based upon the Medical Research Council Framework (MRC) for complex interventions, and the Implementation Science Research Development.

The qualitative assessments indicate that the intervention was found overall to be acceptable and feasible to the Black faith community population. This pilot study did not find statistically significant changes for the Mental Health Knowledge schedule (MAKS), Reported and Intended Behaviour Scale (RIBS), intended help-seeking or willingness to disclose (Attitudes to Mental Illness Survey) measures. However, the direction of all the non-significant changes in these measures suggests positive changes in mental health knowledge, a reduction in participants' desire for social distance, and greater willingness to disclose personal experiences of mental health problems. A statistically significant improvement in the Community Attitudes towards Mental Illness (CAMI) scale results indicated a lower level of stigmatising attitudes towards people with lived experience of mental health conditions (PWLE), and an increase in tolerance and support towards PWLE after the intervention. Significant improvement in the willingness to disclose measure suggests increased preparedness to seek help amongst participants, a lesser desire for social distance, and greater willingness to engage with PWLE after the intervention. Three key themes, including 9 subthemes were identified from the qualitative data analysis: (i) initial implementation and intention to adopt; (ii) perceived suitability and usefulness of intervention to address cultural issues relating to mental health in the Black community; and (iii) strengthening the capacity of faith leaders.

This ON TRAC pilot study shows that the intervention was feasible and acceptable, and that it has promising positive impacts and next requires larger scale evaluation. These results demonstrate that the intervention was a culturally acceptable way to potentially increase mental health awareness and reduce stigma in Black faith communities.

ISRCTN12253092.

Recent systematic review and meta-analysis of public attitudes have shown that despite improvements in mental health literacy, public attitudes and desire for social distance with mental illnesses have remained stable over time.

To assess the awareness and attitude of the rural community towards mental disorders using the CAMI scale.

This mixed method study was conducted under the ICMR-STS grant scheme after IEC approval. It included administration of a pre-tested questionnaire adapted from CAMI scale on 196 adults aged 18-60 years from an adopted village in the field practice area of medical college along with 8 in-depth interviews of key people in the same community. Thematic analysis was done for the qualitative part whereas for the quantitative part, Pearson's correlation coefficient, independent t-test, ANOVA and Kruskall-wallis test were used.

Age was positively correlated with the attitude of authoritarianism, social restrictiveness, CMHI and showed a negative correlation with attitude of benevolence. Females showed higher scores for authoritarianism and social restrictiveness. There was a statistically significant difference between APL and BPL groups for authoritarianism attitude towards the mentally ill (P value = 0.02) and CMHI (P value = 0.033). It was observed that with increase in the education levels there was a rise in the mean score of the values for the attitude of benevolence but the difference wasn't statistically significant (P > 0.05). Thematic analysis of the key informant interviews suggested various perceptions of the community regarding mental illness, available options for management, current practices of the community and what can be done further to improve facilities for mental health.

People in the community have a varied perspective to mental illnesses which has changed for the better over time but community still approaches quacks first which warrants the need for more awareness. For this, feasibility and effectiveness of increasing involvement of females from the community in health-related decisions can be explored further. We recommend further awareness generation in the younger generation with community-based research on perceptions of the community about mental health. This will provide more practical and feasible solutions to complement the national mental health program.

Existing TBI misconception measures are critiqued for failing to measure postinjury social experiences. This study developed a social subscale for the Common Misconceptions about TBI (CM-TBI) questionnaire for use in the general public.

Seven experts independently review items drawn from the literature. Shortlisted items were administered online to 158 adults (aged ≥18 years; 51% postschool educated; 60% no TBI experience), the CM-TBI, and a measure of construct validity (a published TBI-adaptation of the Community Attitudes Towards the Mentally Ill; CAMI-TBI). One week later, the new items were redeployed (n = 46).

Expert review and iterative correlations identified a 10-item social subscale (internal consistency, test-retest reliability, α's>.80). When added to the CM-TBI (ie. CM-TBI-II), the internal consistency was .71. The social subscale was significantly correlated with CAMI-TBI measures (p's <.05, r's > .3). There was no significant difference on the social subscale for education subgroups (school vs post-school, p = 0.056) or previous TBI experience; but there was a difference for the CM-TBI-II (post-school>school; Cohen's d = 7.83, large effect).

This study found strong preliminary psychometric support for a new social subscale, administered as the CM-TBI-II. This subscale shows promise as a measure of misconceptions about social functioning post-TBI. The CM-TBI-II could support evaluations of programs aiming to improve social engagement and community participation for people with TBI.

Determining the potential barriers responsible for delaying access to care, and elucidating pathways to early intervention should be a priority, especially in Arab countries where mental health resources are limited. To the best of our knowledge, no previous studies have examined the relationship between religiosity, stigma and help-seeking in an Arab Muslim cultural background. Hence, we propose in the present study to test the moderating role of stigma toward mental illness in the relationship between religiosity and help-seeking attitudes among Muslim community people living in different Arab countries.

The current survey is part of a large-scale multinational collaborative project (StIgma of Mental Problems in Arab CounTries [The IMPACT Project]). We carried-out a web-based cross-sectional, and multi-country study between June and November 2021. The final sample comprised 9782 Arab Muslim participants (mean age 29.67 ± 10.80 years, 77.1% females).

Bivariate analyses showed that less stigmatizing attitudes toward mental illness and higher religiosity levels were significantly associated with more favorable help-seeking attitudes. Moderation analyses revealed that the interaction religiosity by mental illness stigma was significantly associated with help-seeking attitudes (Beta = .005; p < .001); at low and moderate levels of stigma, higher religiosity was significantly associated with more favorable help-seeking attitudes.

Our findings preliminarily suggest that mental illness stigma is a modifiable individual factor that seems to strengthen the direct positive effect of religiosity on help-seeking attitudes. This provides potential insights on possible anti-stigma interventions that might help overcome reluctance to counseling in highly religious Arab Muslim communities.

Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.

The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far.

Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251).

In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research.

The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people's help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10-19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions.

Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.

The Community Attitudes to Mental Illness (CAMI) scale measures social stigma towards people with mental illness. Although it has been used worldwide, the psychometric properties of the CAMI have not been systematically reviewed. The main aim of this study was to systematically review the psychometric properties of the different versions of the CAMI more than 40 years after of its publication.

A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, and EMBASE from 1981 (year of publication) to 2023 (present). A double review was performed for eligibility, data extraction, and quality assessment.

A total of 15 studies enrolling 10,841 participants were included. The most frequently reported factor structure comprises 3 or 4 factors. Overall, the internal consistency seems adequate for the global scale (α ≥ 0.80), except for CAMI-10 (α = 0.69). Internal consistency of the subscales are not supported, with authoritarianism being the weakest factor (α = 0.27 to 0.68). The stability over time of the total scale has been assessed in the CAMI-40, CAMI-BR, and CAMI-10 (r ≥ 0.39). Few studies have assessed the temporal stability of the CAMI subscales. Most of the correlations with potentially related measures are significant and in the expected direction.

The 3 and 4 factor structure are the most widely reported in the different versions of the CAMI. Even though reliability and construct validity are acceptable, further item refinement by international consensus seems warranted more than 40 years after the original publication.

PROSPERO identification number: CRD42018098956.

The prevalence of mental disorders and substance use among prisoners is high. Convicted prisoners of 'good behaviour' can be part of a peer support system in prisons.

To evaluate the feasibility of a peer support programme for prisoners with common mental disorders and substance use in prison.

The study used a mixed method research design, with a quasi-experimental approach (single group pre-post without control). It was conducted in two phases: Phase I. Thirty-five peers/convicted prisoners were recruited through advertisements on the prisoners' community radio station. Volunteers with good behaviour reports were given training over 5 days to recognise mental and substance use disorders and provide basic peer support in prison; their attitudes and knowledge were tested before and after the training.

Feasibility of the peer support programme was tested by (i) recording the number of cases identified and referred, (ii) pre- and post-evaluation of well-being, coping, and symptom severity of those supported and (iii) evaluating qualitatively the experience of the peer supporters and service users.

Thirty-five peer supporters identified 49 cases over 3 months. These cases showed significant improvement in well-being (Z -1.962; p < 0.050) and reduction in symptom severity (Z -1.913; 0.056). There was a significant improvement in the peers supporters' self-esteem from pre- to post-training (t -3.31; p < 0.002), improvement in their benevolence (t -4.37; p < 0.001) and a significant reduction in their negative attitudes to mental illness (Z -3.518; p < 0.001). A thematic model of peer support encompassed self-experienced benefits for the peer supporter, wider recognition of peer supporters in the prison, challenges to this kind of support, experience of training and visions for future work.

The peer support programme was experienced positively by the peer-supporters and supported. Common mental disorders, substance use and suicidality were recognised and appropriately referred. A full-scale evaluation of this promising programme is warranted.

There are, to date, limited and inconsistent findings concerning the relationship between insight and psychotic symptoms, despite some evidence in favor of the clinical and therapeutic relevance of the insight construct. We aimed to add to the pool of the available data in this area, by examining the correlations between the severity of insight and positive psychotic symptoms (delusions and auditory hallucinations), while accounting for self-stigma and attitudes towards medication, in a sample of long-stay inpatients with schizophrenia.

A cross-sectional study was conducted at the Psychiatric Hospital of the Cross, between July and October 2021. A total of 82 patients diagnosed with schizophrenia (aged 55.55 ± 10.21 years, 54.9% males) were enrolled. The semi-structured psychotic symptom rating scales, the Birchwood Insight Scale, the Belief About Medicine Questionnaire, and the Internalized Stigma of Mental Illness were used.

The mean duration of illness in years was 30.15 ± 11.73, and the mean duration of hospitalization in years was 17.56 ± 9.24. Sixteen out of the 82 patients (19.5%) were considered as having poor insight. Bivariate analyses showed that higher chlorpromazine equivalent dose was significantly associated with more delusions, whereas higher insight was significantly associated with lower delusions. Multivariable analyses revealed that Higher chlorpromazine equivalent dose (Beta = 0.004) was significantly associated with more delusions, whereas higher insight (Beta = - 0.89) was significantly associated with less delusions. No significant associations were found between insight, self-stigma and hallucinations.

Our results imply that more impaired insight is associated with greater severity of delusions, above and beyond the effects of self-stigma and medication doses. These findings are valuable to aid clinicians and researchers improve their understanding of the relationship insight-psychotic symptoms, and could help personalize prevention and early intervention strategies in schizophrenia.

The prevalence of mental health problems has rapidly increased over time. The extent to which this captures changes in self-reporting due to decreasing stigma is unclear. We explore this by comparing time trends in mental health and stigma-related indicators across English regions.

We produced annual estimates of self-reported mental disorders (SRMDs) across waves of the Health Survey for England (2009-18, n = 78,226) and three stigma-related indicators (knowledge, attitudes, and intended behaviour) across waves of the Attitudes Towards Mental Illness survey (2009-19, n = 17,287). Differences in trends were tested across nine Government Office Regions using linear models, adjusting for age, sex, ethnicity, marital status, and social class.

In 2009, SRMDs did not vary by region (p = 0.916), whereas stigma-related indicators did (p < 0.001), with London having the highest level of stigma and the North East having lowest level of stigma. Between 2009 and 2018, the prevalence of SRMDs increased from 4.3 to 9.1%. SRMDs increased and stigma-related indicators improved at different rates across regions over time (SRMDs p = 0.024; stigma-related indicators p < 0.001). London reported the lowest increase in SRMDs (+ 0.3 percentage point per year) yet among the largest improvements in attitudes and intended behaviour across regions.

Improvements in attitudes towards mental illness did not mirror changes in self-reported mental health problems across English regions over the past decade. The findings do not support the argument that changes in public stigma, at least when defined at this regional scale, have been driving the increase in self-reported mental health indicators in recent years.

Mental health policies and plans (MHPPs) are important policy instruments and powerful tools to facilitate development of mental health systems and services across the world. We aimed to map and analyse methods and tools used to assess the extent, process and impact of implementing MHPPs. We systematically searched peer-reviewed and grey literature across seven scientific databases. We extracted and analysed the data on a) the characteristics of included studies (e.g., policy areas, region of origin, income setting) and b) the methodology and evaluation tools applied to assess the extent and process of implementation. We included 48 studies in the analyses. Twenty-six of these studies employed only qualitative methods (e.g., semi-structured interviews, focus group discussions, desk review, stakeholder consultations); 12 studies used quantitative methods (e.g., trend analysis, survey) and 10 used mixed-methods approaches. Generally, methods and tools used for assessment were described poorly with less than half of the studies providing partial or full details about them. Only three studies provided assessment of full policies. There is a lack of rigorous research to assess implementation MHPPs. Assessments of the implementation of entire MHPPs are almost non-existent. Strategies to assess the implementation of MHPPs should be an integral part of MHPPs.