“Making People Aware and Taking the Stigma Away”: Alleviating Stigma and Discrimination through Trialogue

Abstract

Mental health stigma and discrimination is a major societal issue. Participatory approaches such as Open Dialogue may be effective in bringing about changes in such stigma and discrimination. Trialogue is an extension of such approaches to three or more sets of stakeholders in mental health systems. The current study explores stakeholders’ evolving discourse concerning mental health stigma and discrimination over time through this approach and whether this approach may alleviate mental health stigma and discrimination. Through a prospective qualitative research design, individuals from seven participating communities throughout Ireland took part in interviews (n=42), focus groups (n=28) or Open Dialogue discussions (n=86) across three cycles of research. Thematic content relating to stigma/discrimination of individuals with mental health issues was purposefully analysed at each cycle using thematic analysis. The findings document the prevalence of avoidant approaches towards individuals with mental illness and their families in Irish society, resulting in negative effects of stigma and discrimination such as lowered levels of self-esteem, lower help-seeking behaviours, difficult interpersonal relations and fewer employment/educational opportunities. Trialogue Meetings evolved into a forum where myths surrounding mental illness were dispelled and more humane views of service users and service providers were established among relevant stakeholders and their social networks. The findings indicate that Trialogue Meetings may go some way to tackling stigma and discrimination through positive social contact, dialogue and education for relevant stakeholders in mental health systems. The findings also elucidate a culture of concealment of mental health issues in Ireland, leading to subsequent stigma and discrimination.