International Journal of Mental Health Systems最新文献

{"title":"Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders' and TB health workers.","authors":"T Mainga,&nbsp;M Gondwe,&nbsp;R C Stewart,&nbsp;I Mactaggart,&nbsp;K Shanaube,&nbsp;H Ayles,&nbsp;V Bond","doi":"10.1186/s13033-022-00542-x","DOIUrl":"https://doi.org/10.1186/s13033-022-00542-x","url":null,"abstract":"<p><strong>Background: </strong>In recent years, there has been increased recognition of the need to integrate mental health services into routine tuberculosis (TB) care. For successful integration, policymakers need to first understand the practices of TB health workers in the management of mental health conditions, including depression, anxiety, and psychological distress, and use this to decide how best mental health services could be delivered in tandem with TB services. In this qualitative study we aimed to understand how TB health workers and other stakeholders viewed mental health conditions linked to TB and how they screened and treated these in their patients.</p><p><strong>Methods: </strong>The study draws on qualitative data collected in 2018 as part of the Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for active TB trial (TREATS), conducted in eight urban communities in Zambia. Data were collected through 17 focus group discussions with local health committee members (n = 96) and TB stakeholders (n = 57) present in the communities. Further in-depth interviews were held with key TB health workers (n = 9). Thematic analysis was conducted.</p><p><strong>Results: </strong>TB stakeholders and health workers had an inadequate understanding of mental health and commonly described mental health conditions among TB patients by using stigmatizing terminology and overtones, for example \"madness\", which often implied a characterological flaw rather an actual illness. Psychological distress was also described as \"overthinking\", which participants attributed to psychosocial stressors, and was not perceived as a condition that would benefit from mental health intervention. There were no standard screening and treatment options for mental health conditions in TB patients and most TB health workers had no mental health training. TB Stakeholders and health workers understood the negative implications of mental health conditions on TB treatment adherence and overall wellbeing for TB patients.</p><p><strong>Conclusions: </strong>TB stakeholders and health workers in Zambia have a complex conceptualisation of mental health and illness, that does not support the mental health needs of TB patients. The integration of mental health training in TB services could be beneficial and shift negative attitudes about mental health. Further, TB patients should be screened for mental health conditions and offered treatment. Trial registration number NCT03739736-Registered on the 14th of November 2018- Retrospectively registered- https://clinicaltrials.gov/ct2/results?cond=&term=NCT03739736&cntry=&state=&city=&dist.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"34"},"PeriodicalIF":3.6,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10721378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study.","authors":"Sisay Abayneh,&nbsp;Heidi Lempp,&nbsp;Brandon A Kohrt,&nbsp;Atalay Alem,&nbsp;Charlotte Hanlon","doi":"10.1186/s13033-022-00545-8","DOIUrl":"https://doi.org/10.1186/s13033-022-00545-8","url":null,"abstract":"<p><strong>Background: </strong>Little is known about actual involvement or how to achieve service user and caregiver in mental health systems strengthening in low-and middle-income countries. This study describes the processes and explores involvement experiences of participants in a pilot study of a new model of service user involvement in mental health system strengthening in a rural district in southern Ethiopia.</p><p><strong>Methods: </strong>We applied a case study design using participatory action research (PAR). The PAR process comprised of three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, reflective notes, participatory observation of sessions, and in-depth interviews with 12 RPG members. We analyzed the process data descriptively. Thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study.</p><p><strong>Results: </strong>The stakeholder groups identified their top research priorities, developed an intervention and action plan and made a public presentation of preliminary findings. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. Four themes were developed about experiences of involvement in PAR: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions.</p><p><strong>Conclusions: </strong>This case study demonstrated the feasibility and acceptability of implementing a complex model of service-user involvement in mental health system strengthening in a resource constrained setting. More needs to be done to embed service-user involvement into routines of the primary healthcare system, alongside sustained support and strengthening multi-stakeholder collaboration at multiple levels.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"33"},"PeriodicalIF":3.6,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9765260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why did China's mental health law have a limited effect on decreasing rates of involuntary hospitalization?","authors":"Yarong Ma,&nbsp;Jie Zhang,&nbsp;Robert Rosenheck,&nbsp;Hongbo He","doi":"10.1186/s13033-022-00543-w","DOIUrl":"https://doi.org/10.1186/s13033-022-00543-w","url":null,"abstract":"<p><strong>Background: </strong>China's Mental Health Law (MHL) implemented in 2013 required increased consideration of the rights of people with mental illness and was expected to lead to a reduction in involuntary hospitalization (IH). This study aimed to examine the rates and correlates of IH in a large psychiatric hospital in Guangzhou from 2014 to 2017 after the implementation of MHL and a structured assessment of the need for IH.</p><p><strong>Methods: </strong>Unduplicated electronic medical records concerning all inpatients admitted to the hospital with a primary psychiatric diagnose were examined. Diagnostic, sociodemographic and socioeconomic data were used to identify correlates of IH using bivariate chi-square tests followed by logistic regression analysis.</p><p><strong>Results: </strong>Of 10, 818 hospitalized patients, there was a significant but small increase, from 71.6 to 74.9% in rates of IH in the years after a structured assessment of need for IH was implemented. Logistic regression analysis showed IH was positively associated with being younger, having a local residence, and a diagnosis of bipolar disorder, schizophrenia spectrum disorders or a substance abuse disorder as compared to those diagnosed with major depressive disorder.</p><p><strong>Conclusions: </strong>IH did not decrease over the first four years after the implementation of China's MHL and a structured assessment in 2013 perhaps, reflecting the initiation of a systematic assessment of the need for IH and the relatively low number of psychiatric beds in this area.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"32"},"PeriodicalIF":3.6,"publicationDate":"2022-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of relaxation techniques 'as an active ingredient of psychological interventions' to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis.","authors":"Syed Usman Hamdani,&nbsp;Zill-E-Huma,&nbsp;Syeda Wajeeha Zafar,&nbsp;Nadia Suleman,&nbsp;Um-Ul-Baneen,&nbsp;Ahmed Waqas,&nbsp;Atif Rahman","doi":"10.1186/s13033-022-00541-y","DOIUrl":"10.1186/s13033-022-00541-y","url":null,"abstract":"<p><strong>Background: </strong>Adolescent depression and anxiety are among the leading contributors to health burden worldwide. 'Relaxation Techniques (RTs)' are a \"set of strategies to improve physiological response to stress\" and are frequently cited as an active ingredient of trans-diagnostic, psychosocial interventions for scaling-up care for preventing and treating these conditions in adolescents. However, there is a little evidence on the effectiveness of 'relaxation techniques' for this age group.</p><p><strong>Aim: </strong>As a part of the Wellcome Trust's Active Ingredients commission, we did a systematic review and meta-analysis to evaluate the effectiveness of RTs to reduce the symptoms of distress, anxiety and depression in young people, aged 14 to 24 years old, globally.</p><p><strong>Methods: </strong>We searched 10 academic databases to include 65 Randomized Controlled Trials (RCTs) of relaxation-based interventions for young people with the symptoms of anxiety and depression. Primary outcomes were reduction in symptoms of distress, anxiety and/or depression. We employed the Cochrane risk of bias tool and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines to assess certainty of outcomes pertaining to anxiety, depression and distress. Standardized mean difference was estimated using effect size.</p><p><strong>Results: </strong>The analysis of 65 RCTs with 8009 young people showed that RTs were highly effective in treating anxiety (pooled effect size of (Standardized Mean Difference-SMD) - 0.54 (95% CI - 0.69 to - 0.40); moderately effective in reducing distress (SMD = - 0.48, 95% CI - 0.71 to - 0.24) and had only a weak effect on improving depression in young people (SMD = - 0.28 (95% CI - 0.40% to - 0.15). Face-to-face delivered relaxation techniques yielded higher effect size (SMD = - 0.47, 95% CI - 0.64 to - 0.30) compared to online delivery (SMD = - 0.22, 95% CI - 0.48 to 0.04) for anxiety.</p><p><strong>Conclusion: </strong>Most of the included studies were from High Income Countries (HICs) and had a high risk of bias. Further high-quality studies with low risk of bias, especially from low resource settings are needed to evaluate the evidence for effectiveness of RTs as an active ingredient of psychological interventions to reduce the symptoms of distress, anxiety and depression in young people.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"31"},"PeriodicalIF":3.6,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10620725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions.","authors":"Eshetu Girma, Bezawit Ketema, Tesfahun Mulatu, Brandon A Kohrt, Syed Shabab Wahid, Eva Heim, Petra C Gronholm, Charlotte Hanlon, Graham Thornicroft","doi":"10.1186/s13033-022-00540-z","DOIUrl":"10.1186/s13033-022-00540-z","url":null,"abstract":"<p><strong>Background: </strong>People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.</p><p><strong>Methods: </strong>This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.</p><p><strong>Results: </strong>A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.</p><p><strong>Conclusion: </strong>There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"30"},"PeriodicalIF":3.6,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9219139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9401186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial.","authors":"Keng-Yen Huang,&nbsp;Janet Nakigudde,&nbsp;Elizabeth Nsamba Kisakye,&nbsp;Hafsa Sentongo,&nbsp;Tracy A Dennis-Tiwary,&nbsp;Yesim Tozan,&nbsp;Hyung Park,&nbsp;Laurie Miller Brotman","doi":"10.1186/s13033-022-00538-7","DOIUrl":"https://doi.org/10.1186/s13033-022-00538-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students' mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers' use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children's mental health issues as a potentially cost-effective strategy to promote chi","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"28"},"PeriodicalIF":3.6,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10503431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia","authors":"S. Wedajo, G. Degu, A. Deribew, Fentie Ambaw","doi":"10.1186/s13033-022-00536-9","DOIUrl":"https://doi.org/10.1186/s13033-022-00536-9","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46634573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of Timothy's Law on hospitalization among patients with mental health conditions in New York State","authors":"Mingfei Li, Victor S. Y. Lo, Piaomu Liu, Eric Smith","doi":"10.1186/s13033-022-00535-w","DOIUrl":"https://doi.org/10.1186/s13033-022-00535-w","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2022-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46255272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff","authors":"J. Ingram, Bronte Lyford, Amanda McAtamney, Sally Fitzpatrick","doi":"10.1186/s13033-022-00534-x","DOIUrl":"https://doi.org/10.1186/s13033-022-00534-x","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2022-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41913079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health stigma at primary health care centres in Lebanon: qualitative study.","authors":"Racha Abi Hana, Maguy Arnous, Eva Heim, Anaïs Aeschlimann, Mirja Koschorke, Randa S Hamadeh, Graham Thornicroft, Brandon A Kohrt, Marit Sijbrandij, Pim Cuijpers, Rabih El-Chammay","doi":"10.1186/s13033-022-00533-y","DOIUrl":"10.1186/s13033-022-00533-y","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"16 1","pages":"23"},"PeriodicalIF":3.1,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9749260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}