Papers by Patrick Michaels
Journal of Mental Health, 2020
Background: Evidence supports the contribution of various stigma-related constructs to help-seeki... more Background: Evidence supports the contribution of various stigma-related constructs to help-seeking. These constructs have yet to be tested in a single model among college students, a group highly affected by mental illness. Aims: Using data from 153 college students, this study examines factors contributing to help seeking for mental illness. Method: Using path analysis, the current study evaluated a model of the relationship between level of familiarity, personal stigma, desired social distance, label avoidance, attitudes towards treatment seeking and intentions to seek treatment. Results: Findings support a model of help-seeking describing the relationship between familiarity with mental illness, personal stigma, social distance, label avoidance, attitudes and intentions to seek treatment. Conclusions: Findings suggest label avoidance, attitudes towards treatment seeking and intentions to seek treatment might be augmented through interventions aimed at increasing college students' levels of familiarity, or intimate contact, with individuals with mental illness. Additional implications for practice and further research are addressed.
Journal of Nervous and Mental Disease, Mar 1, 2016
Coming out with mental illness may be an effective strategy for reducing self-stigma. This study ... more Coming out with mental illness may be an effective strategy for reducing self-stigma. This study examined predictors and consequences of coming out. Participants (N=106) with severe mental illness who reported being out (n=79) or not out (n=27) endorsed benefits of being out (BBO) and reasons for staying in (RSI). Predictors from baseline measures were self-stigma, insight, and psychiatric diagnosis. Three outcome measures-basic psychological needs, care engagement, and depression-were also completed at baseline and one-month follow-up. Among participants already out, BBO and RSI were significantly and independently associated with self-stigma, insight, and lifetime affective diagnoses. In terms of consequences, BBO was associated with cross-sectional and one-month measures of engagement for those already out, but not for closeted participants. Among closeted participants, BBO was associated with baseline and one-month measures of basic psychological needs. Implications for strategies meant to promote disclosure in order to decrease self-stigma are considered.
Journal of Adolescent Health, 2016
Psychology, Society, & Education
People with mental illness frequently confront public stigma and may experience self-stigma. This... more People with mental illness frequently confront public stigma and may experience self-stigma. This review discusses the concepts of mental illness stigma and its consequences for those with mental illness. After a conceptual overview of stigma prominent consequences pertaining to public stigma (i.e., employment, health care quality) and self-stigma (i.e., self-confidence, quality of life, "why try" effect) are reviewed. We discuss the three main public stigma change strategies -protest, education, and contact -as well as current selfstigma change strategies (e.g., psychoeducation, cognitive-behavioral therapy). We conclude by noting that anti-stigma initiatives with more tailored content for specific groups (e.g., police officers vs. general public) may diminish the negative consequences of mental illness stigma by providing more concrete ways to help stigmatized people.
Psychiatry Research, 2015
This randomized controlled trial examined the impact of the Coming Out Proud (COP) program on sel... more This randomized controlled trial examined the impact of the Coming Out Proud (COP) program on self-stigma, stigma stress, and depression. Research participants who experienced mental health challenges were randomly assigned to a three session COP program (n=51) or a waitlist control (n=75). Outcome measures that assessed the progressively harmful stages of self-stigma, stigma stress appraisals, and depression were administered at pre-test, post-test, and one-month follow-up. People completing COP showed significant improvement at post-test and follow-up in the more harmful aspects of self-stigma compared to the control group. COP participants also showed improvements in stigma stress appraisals. Women participating in COP showed significant post-test and follow-up reductions in depression after COP compared to the control group. Men did not show this effect. Future research should determine whether these benefits also enhance attitudes related to recovery, empowerment, and self-determination.
Psychiatry Research, 2012
The internalization of public stigma by persons with serious mental illnesses may lead to self-st... more The internalization of public stigma by persons with serious mental illnesses may lead to self-stigma, which harms self-esteem, self-efficacy, and empowerment. Previous research has evaluated a hierarchical model that distinguishes among stereotype awareness, agreement, application to self, and harm to self with the 40-item Self-Stigma of Mental Illness Scale (SSMIS). This study addressed SSMIS critiques (too long, contains offensive items that discourages test completion) by strategically omitting half of the original scale's items. Here we report reliability and validity of the 20-item short form (SSMIS-SF) based on data from three previous studies. Retained items were rated less offensive by a sample of consumers. Results indicated adequate internal consistencies for each subscale. Repeated measures ANOVAs showed subscale means progressively diminished from awareness to harm. In support of its validity, the harm subscale was found to be inversely and significantly related to self-esteem, self-efficacy, empowerment, and hope. After controlling for level of depression, these relationships remained significant with the exception of the relation between empowerment and harm SSMIS-SF subscale. Future research with the SSMIS-SF should evaluate its sensitivity to change and its stability through test-rest reliability.
Acta Psychiatrica Scandinavica, 2009
The British Journal of Psychiatry, 2009
It has been claimed 1 that stigma is a major barrier to mental health service use and explains, a... more It has been claimed 1 that stigma is a major barrier to mental health service use and explains, among other factors such as accessibility and quality of services, why many people choose not to participate in treatment. However, empirical support for this assertion is scarce. We therefore examined the impact of self-stigma and stigma-related cognitions on service use. In this context, perceived stigma refers to the level of stigma people with mental illness observe in society (e.g. 'The public thinks people with mental illness are stupid'); self-stigma implies internalisation of public stigma, resulting in low self-esteem (e.g. 'I have a mental illness and therefore I am stupid').
Social work in public health, 2014
People of color with serious mental illnesses experience high rates of morbidity and mortality. P... more People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.
The Journal of Nervous and Mental Disease, 2013
The media are often identified as partially responsible for increasing the stigma of mental illne... more The media are often identified as partially responsible for increasing the stigma of mental illness through their negatively focused representations. For many years, training programs have educated journalists on how to report on mental illness to reduce stigma. This purpose of this study was to evaluate the benefits of reading a positive, neutral or a negative journalism article that discusses mental illness. Consenting adult participants were randomly assigned to read one of three published articles about recovery from mental illness, a dysfunctional public mental health system, or dental hygiene. The participants completed measures immediately before and after the intervention; the measures administered evaluated stigmatizing and affirming attitudes toward people with mental illness. Public stigma was assessed using the nine-item Attribution Questionnaire and the Stigma Through Knowledge Test (STKT). The STKT is a measure of mental illness stigma less susceptible to the impact of social desirability. Affirming attitudes represent public perceptions about recovery, empowerment, and self-determination, indicated as important to accepting and including people with psychiatric disabilities into society. Significant differences were observed between the articles on recovery and dysfunctional public mental health system, as well as the control condition, on the measures of stigma and affirming attitudes. The recovery article reduced stigma and increased affirming attitudes, whereas the dysfunctional public mental health system article increased stigma and decreased affirming attitudes. Not all journalistic stories have positive effects on attitudes about mental illness.
Community Mental Health Journal, 2014
This study assessed the Anti-Stigma Project workshop, a contact/education intervention developed ... more This study assessed the Anti-Stigma Project workshop, a contact/education intervention developed by On Our Own of Maryland, Inc. and the Maryland Mental Hygiene Administration. Two separate randomized controlled trials administered pre-and post-test questionnaire assessments. One included people with mental illness (N = 127) and a second included mental health providers (N = 131). Post-intervention, people with mental illness were more aware of stigma, had lower levels of prejudice, and increased belief in recovery. Providers were more aware of stigma, had lower levels of prejudice, and increased concurrence in self-determination of people with mental illness. Increasing providers' stigma awareness and recognition can promote higher quality service delivery. Increasing stigma awareness and recognition for people with mental illness can foster confidence in overcoming psychiatric disabilities. Using a participatory action research team, our protocol included extant and newly developed stigma change tools. Organizations seeking to conduct effective evaluation studies should consider collaborative processes including the expertise of affected constituents.
Psychiatric Rehabilitation Journal, 2013
Objective: A major public health priority has been to eliminate stigma's egregious effects on lif... more Objective: A major public health priority has been to eliminate stigma's egregious effects on life opportunities for people with mental illnesses. Research shows contact-based antistigma programs are among the most effective. Such findings call for clarity to define the components of consumer-directed antistigma programs. This article represents community-based participatory research (CBPR) and the first step of a mixed methods design to describe the active ingredients comprising these kinds of programs. Method: CBPR investigators developed an interview guide and subsequently facilitated four focus groups to identify key components. Participants included antistigma experts with lived experience. Using grounded theory, two independent raters identified 641 discrete themes. Two additional coders then sorted themes into constructs representing key ingredients of contact-based programs. Coders agreed upon 198 constructs and then grouped them into a hierarchical model of key ingredients in consumerdirected stigma change. Results: Five criteria represent indicators of successful consumer-directed programs: (a) program design-factors necessary for trained presenters to facilitate programs; (b) targeting-tailored presentation congruent with target's goal; (c) staffing-facilitators and leadership are diverse people with lived experience; (d) messaging-presentation discusses struggles and recovery from mental health challenges; and (e) follow-up and evaluation-assessment of sustained audience change. Conclusions and Implications for Practice: This study identified key ingredients of consumerdirected antistigma programs. Part two of the mixed methods design, a quantitative cross-validation study, will yield a sound fidelity measure.
Psychiatric Services, 2012
Public stigma and discrimination have pernicious effects on the lives of people with serious ment... more Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses. Given a plethora of research on changing the stigma of mental illness, this article reports on a meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness. The investigators heeded published guidelines for systematic literature reviews in health care. This comprehensive and systematic review included articles in languages other than English, dissertations, and population studies. The search included all articles from the inception of the databases until October 2010. Search terms fell into three categories: stigma, mental illness (such as schizophrenia and depression), and change program (including contact and education). The search yielded 72 articles and reports meeting the inclusion criteria of relevance to changing public stigma and sufficient data and statistics to complete analyses. Studies represented 38,364 research participants from 14 countries. Effect sizes were computed for all studies and for each treatment condition within studies. Comparisons between effect sizes were conducted with a weighted one-way analysis of variance. Overall, both education and contact had positive effects on reducing stigma for adults and adolescents with a mental illness. However, contact was better than education at reducing stigma for adults. For adolescents, the opposite pattern was found: education was more effective. Overall, face-to-face contact was more effective than contact by video. Future research is needed to identify moderators of the effects of both education and contact.
Psychiatric Rehabilitation Journal, 2014
Contact-based antistigma programs seemingly have a larger and more sustained impact than educatio... more Contact-based antistigma programs seemingly have a larger and more sustained impact than educational strategies. Previous qualitative research of advocates with lived experiences yielded 32 key ingredients of contact-based programs comprising 5 categories. This study sought an independent sample's feedback of the 32 ingredients. One hundred advocates with lived experience of mental health conditions who have led, coordinated, and/or delivered antistigma presentations completed an online survey to rank importance of key ingredients. Analysis of rank distributions showed most important ingredients in program categories: (a) design: face-to-face presentations, audience discussion; (b) target: specific group identified (e.g., employers), assessment completed with targets to derive stigma change goals relevant to needs; (c) staff: presenters are people with lived experience; (d) message: message includes on the-way-up stories; and (e) evaluation/follow-up: post-presentation follow-up actions discussed with targets. Future research hopes to yield a fidelity measure for contact-based programs.
Journal of Mental Health, 2013
For persons with mental illness, stigma diminishes employment and independent living opportunitie... more For persons with mental illness, stigma diminishes employment and independent living opportunities as well as participation in psychiatric care. Public stigma interventions have sought to ameliorate these consequences. Evaluation of anti-stigma programs' impact is typically accomplished with self-report questionnaires. However, cultural mores encourage endorsement of answers that are socially preferred rather than one's true belief. This problem, social desirability, has been circumvented through development of faux knowledge tests (KTs) (i.e., Error-Choice Tests); written to assess prejudice. Our KT uses error-choice test methodology to assess stigmatizing attitudes. Test content was derived from review of typical KTs for façade reinforcement. Answer endorsement suggests bias or stigma; such determinations were based on the empirical literature. KT psychometrics were examined in samples of college students, community members and mental health providers and consumers. Test-retest reliability ranged from fair (0.50) to good (0.70). Construct validity analyses of public stigma indicated a positive relationship with the Attribution Questionnaire and inverse relationships with Self-Determination and Empowerment Scales. No significant relationships were observed with self-stigma measures (recovery, empowerment). This psychometric evaluation study suggests that a self-administered questionnaire may circumvent social desirability and have merit as a stigma measurement tool.
Psychiatry Research, 2014
Decreasing the stigma of mental illness is not sufficient. Rather promoting important ideas, such... more Decreasing the stigma of mental illness is not sufficient. Rather promoting important ideas, such as recovery, empowerment, and self-determination, is important to increase social inclusion, or more broadly, affirming attitudes. The goal of this article is to evaluate the psychometrics of a battery of measures that assess both stigmatizing and affirming attitudes toward people with mental illnesses. The aforementioned battery was used in four separate RCTs on stigma change with different samples: college students, adults, health care providers, and mental health service providers. Test-retest indices were satisfactory for all samples except for the Empowerment Scale score for the mental health providers. Attribution Questionnaire-9 (AQ-9) scores were significantly and inversely associated with the three affirming attitude scale scores for eight of twelve correlations, with five of these meeting the Bonferroni Criterion. Research on social attitudes and structures needs to incorporate assessment of affirming perspectives about a group and effective anti-stigma programs need to promote social inclusion and affirming attitudes.
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Papers by Patrick Michaels