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Background: Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer screening uptake by people with mental illness in order to inform interventions to promote equal access.Methods: The interview study was conducted in both urban and rural settings. The study was informed by the Theoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants included 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and 11 professionals involved in cancer screening.Results: Themes emerging from the data that affected uptake included knowledge of screening programmes by both service users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery factors; service users' beliefs and concerns about cancer screening, and practical issues. These are relevant to different stages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are admitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner (GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer screening is often not considered during health promotion. Barriers including information processing problems, the extent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary between individuals. Screening professionals are motivated to help, but may lack time or training to manage mental health needs. Reactive measures are available, but service users must request help which they may find difficult.Conclusions: There are specific barriers to cancer screening uptake for mental health service users that prevent equality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels. Primary and secondary care staff and policy-makers should work together to develop an integrated approach to cancer screening in this population. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to test the hypothesis that mental health-related discrimination experienced by adults receiving care from community mental health teams is associated with low engagement with services and to explore the pathways between these two variables. Methods: In this cross-sectional study, 202 adults registered with inner-city community mental health teams in the United Kingdom completed interviews assessing their engagement with mental health services (service user-rated version of the Service Engagement Scale), discrimination that they experienced because of mental illness, and other variables. Structural equation modeling was conducted to examine the relationship of experienced discrimination and service engagement with potential mediating and moderating variables, such as anticipated discrimination (Questionnaire on Anticipated Discrimination}, internalized stigma (Internalized Stigma of Mental Illness Scale), stigma stress appraisal (stigma Stress Appraisal), mistrust in services, the therapeutic relationship (Scale to Assess Therapeutic Relationships),difficulty disclosing information about one's mental health, and social support. Analyses controlled for age. race-ethnicity, and symptomatology. Results: No evidence was found for a direct effect between experienced discrimination and service engagement. The total indirect effect of experienced discrimination on service engagement was statistically significant (coefficient=1.055, 95% confidence interval ∣CI∣=.312-2.074. p=.019). mainly via mistrust in mental health services and therapeutic relationships (coefficient=.804, 0.295-1.558. p=.019). A 1-unit increase in experienced discrimination via this pathway resulted in 804-unit of deterioration in service engagement. Conclusions: Findings indicate the importance of building and maintaining service users' trust in mental health services and in therapeutic relationships with professionals and countering the discrimination that may erode trust. [ABSTRACT FROM AUTHOR]

Objective: This study assessed participants' experienced discrimination and their causal attributions, particularly to mental illness or race-ethnicity. Methods: In a cross-sectional study, 202 service users with severe mental illnesses were interviewed to assess their reported experiences of discrimination. The Major Experiences of Discrimination Scale assessed major experiences of discrimination and their recency and frequency across 12 life domains and perceived reasons (attributions). The Everyday Experiences of Discrimination Scale assessed ten types of everyday discrimination and attributions for these experiences. Results: Most participants (88%) reported discrimination in at least one life domain, and 94% reported ever experiencing everyday discrimination. The most common areas of major discrimination were mental health care (44%), neighbors (42%), police (33%), employment (31%), and general medical care (31%). The most common attributions for major discrimination were mental illness (57%), race-ethnicity (24%), education or income (20%), or appearance (19%). Almost half (47%) attributed experiences of major discrimination to two or more causes. No differences were found between racial-ethnic groups in overall experienced discrimination or in main attributions to mental illness. However, compared with the mixed and white groups, participants in the black group were most likely to endorse raceethnicity as a main attribution (p<.001). Conclusions: Mental illnessrelated discrimination was found to be a common issue across racial-ethnic groups, and discrimination based on race-ethnicity was prevalent for the mixed and black groups. There is a need for antidiscrimination strategies that combine efforts to reduce the experience of discrimination attributed to mental illness and to race-ethnicity for racial-ethnic minority groups. [ABSTRACT FROM AUTHOR]

Purpose: People with mental illness face the dilemma whether or not to disclose their condition. We examined stigma variables and their relationship with comfort disclosing. Methods: Comfort with disclosure, well-being, symptoms and aspects of experiencing and reacting to stigma were assessed among 202 individuals with mental illness. Results: Controlling for symptoms, greater comfort disclosing one's mental illness was associated with lower anticipated discrimination and lower stigma stress; more comfort disclosing was related to greater well-being. Conclusions: Anticipated discrimination as an external threat and stigma-related stress as an internal process may reduce comfort with disclosure and could be targeted in interventions. [ABSTRACT FROM AUTHOR]

Abstract: Mental illness is associated with unfair treatment in a number of areas of life. There is currently no psychometrically validated measure that has been developed to specifically focus on such experienced discrimination. This study aimed to finalise the Discrimination and Stigma Scale (DISC) and establish its psychometric properties. The DISC was further developed using (1) service user and interviewer focus groups; (2) reading ease testing; and (3) cognitive debriefing interviews. The revised scale then underwent psychometric testing to establish the following properties: reliability; validity; precision; acceptability; and feasibility. The final 22-item DISC demonstrated good psychometric properties (n=86) including inter-rater reliability (weighted kappa range: 0.62–0.95), internal consistency (α=0.78) and test–retest reliability (n=46) (weighted kappa range: 0.56–0.89). Feasibility, validity and acceptability were also established. In conclusion, the 22-item DISC is recommended for use in measuring experienced stigma and discrimination. Additional work to develop a measure of anticipated stigma is recommended. [Copyright &y& Elsevier]

Background: Experienced discrimination refers to an individual's perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in this area have not gone beyond prevalence, therefore little is known about the nature of experienced discrimination in relation to parenthood, and how is it constituted. This study aims to generate a typology of community psychiatric service users' reports of mental illness-based discrimination in relation to becoming or being a parent. A secondary aim is to assess the prevalence of these types of experienced discrimination. Methods: In a telephone survey 2026 community psychiatric service users in ten UK Mental Health service provider organisations (Trusts) were asked about discrimination experienced in the previous 12 months using the Discrimination and Stigma Scale (DISC). The sample were asked if, due to their mental health problem, they had been treated unfairly in starting a family, or in their role as a parent, and gave examples of this. Prevalence is reported and the examples of experienced discrimination in relation to parenthood were analysed using the framework method of qualitative analysis. Results: Three hundred and four participants (73% female) reported experienced discrimination, with prevalences of 22.5% and 28.3% for starting a family and for the parenting role respectively. Participants gave 89 examples of discrimination about starting a family and 228 about parenting, and these occurred in social and professional contexts. Ten themes were identified. These related to being seen as an unfit parent; people not being understanding; being stopped from having children; not being allowed to see their children; not getting the support needed; children being affected; children avoiding their parents; children's difficulties being blamed on the parent's mental health problem; not being listened to; and being undermined as a parent. Conclusions: This research highlights the need for: greater support for parents with mental illness, those wishing to have children, and those who lose access or custody; services to better meet the needs of children with a mentally ill parent; training about discrimination for professionals; and parenting issues to be included in anti-stigma programmes. [ABSTRACT FROM AUTHOR]

Abstract: There are currently no published scales to assess the attitudes of students and professionals across a wide range of healthcare disciplines towards people with mental illness. Secondary analysis from a randomised controlled trial (RCT) of anti-stigma interventions was carried out to test the reliability, validity and acceptability of the Mental Illness: Clinicians'' Attitudes (MICA) v4 scale, a modification of the MICA v2 scale in a sample of 191 nursing students. The MICA v4 was found to have good internal consistency (α=0.72) and item-total correlations. Principal component analysis produced a five-factor structure and the scale had acceptable convergent validity. A group of students and professionals within the healthcare discipline (n=5) reported that the MICA v4 had good face validity and suggested its use with students and professionals working in non-mental health settings. The scale had low rates of missing data, good readability and took less than 4min to complete. The MICA v4 scale was found to be a reliable, valid and acceptable measure of foundation year nursing students'' attitudes towards mental illness. It has the potential for use with students and qualified staff across a range of healthcare professions and is available for use from the authors. [Copyright &y& Elsevier]

The article discusses a study which assessed the relationship between user characteristics and established components of continuity of care for psychotic patients, and the impact of continuity on clinical and social functioning. Participants in the study include 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points. It was found that improvement in quality of life was associated with better Experience & Relationship continuity score.

The article discusses a study which compared users of community mental health teams with non-psychotic disorders to those with psychotic disorders in terms of demographic and illness characteristics, continuity of care and clinical and social functioning. The study followed up service users with non-psychotic disorders for one year and compared to 180 service users with psychotic disorders. It was found that service users with non-psychotic disorders experienced more care transitions.

Background: The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to an occupational health professional, or do not do so at all due to the anticipation of discrimination or a wish for privacy. However, non disclosure precludes the ability to request reasonable adjustments in the workplace or to make a claim of direct discrimination. Disclosure to employers is therefore a difficult decision. A recent pilot study by our group of the CORAL decision aid showed that it helped mental health service users clarify their needs and values regarding disclosure and led to reduction in decisional conflict. The present proof of concept trial aims to determine whether a full scale randomised controlled trial (RCT) is justifiable and feasible, and to optimise its design. Methods: In this single blind exploratory RCT in London, a total of 80 participants (inclusion criteria: age ?18 years, on the caseload of a specialist employment adviser working with people with mental illness; referred to the adviser either from primary care via Improving Access to Psychological Therapies or secondary mental health service; currently seeking or interested in either paid or voluntary employment, and a Decisional Conflict Scale score of 37.5 or greater and stage of decision score 1-5) will be recruited from vocational advice services. After completing a baseline assessment, participants will be randomly assigned to one of two conditions (1) Use of the CORAL Decision Aid (DA) in addition to treatment as usual or (2) Treatment as usual. Those allocated to the DA condition will be given it to read and complete, and the researcher will be present to record the time taken and any content that causes confusion. Intervention participants may keep the decision aid but are discouraged from showing it to other service users to avoid contamination. Follow up interviews will be conducted at 3 months. Primary outcomes are: (i) stage of decision making score; (ii) decisional conflict scores and (iii) employment related outcomes. Secondary analyses will identify predictors of disclosure and qualitative analysis will explore the impact of the intervention. Discussion: A reduction in decisional conflict regarding disclosure leading to more effective job seeking activity could have significant economic consequences for people with mental illness in terms of employment rates and productivity. [ABSTRACT FROM AUTHOR]

Abstract: Background/objectives: Many people with schizophrenia face stigmatisation. Several methods have been produced to simulate the auditory and visual hallucinations experienced by people with schizophrenia in order to increase empathy and understanding about the condition. However, there has been no review of such methods. This systematic review aims to determine whether and how simulated hallucinations are effective in reducing stigma, and if simulated hallucinations are safe and acceptable. Methods: Medline, Embase, PsycInfo, the Cochrane Library, CINAHL, and Worldcat Dissertations and Theses were searched from 1980 to September 2010. Reference checking, hand-searching, and contacting of experts in the field were also performed. A narrative synthesis of quantitative studies was conducted, and qualitative studies were synthesised using meta-ethnography. Results: Ten studies were included. Simulation tools varied in context, but consistently increased both empathy towards, and desire for social distance from, people with schizophrenia whilst findings for other attitudes were inconsistent. Participants reported physical, cognitive and emotional discomfort. Qualitative data suggest that these discomforts give participants an ‘insider''s perspective’ which produced empathy and respect. Simulated hallucinations sometimes produced concurrent negative affect, and physical and emotional distress, but were considered a highly acceptable learning tool. Discussion/conclusions: Simulated hallucinations have contradictory effects on stigma, increasing empathy but also the desire for social distance. They should therefore be used with caution. Further research is required to discover if there is a way of using simulated hallucination interventions that increases empathy without increasing the desire for social distance from people with mental illness. [Copyright &y& Elsevier]

The authors reflect on the prevalence of disability hate crime and targeted violence as a discriminative act against mentally disabled persons. They say that mentally disabled persons experience abuse and harassment in more than one locations and the perpetrators are commonly teenagers. They mention several laws recognising violence and hostility in discrimination and human rights perspective which includes the 1998 Human Rights Act, Criminal Justice Act 2003, and Disability Equality Duty.

Background: There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measures used, their characteristics and psychometric properties. Method: A narrative literature review of survey measures of mental illness stigma was conducted. The databases Medline, PsychInfo and the British Nursing Index were searched for the period 1990-2009. Results: 57 studies were included in the review. 14 survey measures of mental illness stigma were identified. Seven of the located measures addressed aspects of perceived stigma, 10 aspects of experienced stigma and 5 aspects of self-stigma. Of the identified studies, 79% used one of the measures of perceived stigma, 46% one of the measures of experienced stigma and 33% one of the measures of self-stigma. All measures presented some information on psychometric properties. Conclusions: The review was structured by considering perceived, experienced and self stigma as separate but related constructs. It provides a resource to aid researchers in selecting the measure of mental illness stigma which is most appropriate to their purpose. [ABSTRACT FROM AUTHOR]

Background: Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database.Aims: The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields.Method: The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions.Results: Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials.Conclusions: There is a relative dearth of research activity on bipolar disorder compared with schizophrenia. [ABSTRACT FROM AUTHOR]

Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma. [ABSTRACT FROM AUTHOR]