Abstract
Rationale: Patients with long-term mental health conditions often have complex physical, mental and social needs. They are high users of the acute general healthcare system, but can experience stigmatising attitudes and behaviours, and structural discrimination. We wished to improve understanding of stigmatisation in the acute healthcare setting, to target areas for future intervention. Objective: A synthesis of qualitative literature was undertaken in order to understand how patients with long-term mental health conditions are stigmatised, or otherwise, within the acute healthcare system. Method: A theory-driven framework approach was taken. Existing stigma theory was used to outline a framework for categorising stigmatising and non-stigmatising phenomena within the acute healthcare system. Results: A systematic literature
search of qualitative studies identified a sample of 51 studies that would inform the framework. Using data in these studies, a final theoretical 'best fit' framework was developed. In this framework there is an overarching pattern of labelling and stereotyping, plus five ways in which patients with mental health conditions are stigmatised in the acute healthcare system: through devaluation, social control, avoidance, rejection and failure to act. In addition, the framework outlines positive attitudes and behaviours - valuing, adjustment, responding, legitimising and positive action - which contrast with the stigmatisation patterns. Conclusions: The study offers a framework for identifying stigmatisation and positive treatment of those with mental health conditions in an acute health setting. This framework is of potential value in targeting areas for improved quality of care and may have utility beyond this setting and stigmatised group.
search of qualitative studies identified a sample of 51 studies that would inform the framework. Using data in these studies, a final theoretical 'best fit' framework was developed. In this framework there is an overarching pattern of labelling and stereotyping, plus five ways in which patients with mental health conditions are stigmatised in the acute healthcare system: through devaluation, social control, avoidance, rejection and failure to act. In addition, the framework outlines positive attitudes and behaviours - valuing, adjustment, responding, legitimising and positive action - which contrast with the stigmatisation patterns. Conclusions: The study offers a framework for identifying stigmatisation and positive treatment of those with mental health conditions in an acute health setting. This framework is of potential value in targeting areas for improved quality of care and may have utility beyond this setting and stigmatised group.
| Original language | English |
|---|---|
| Number of pages | 1 |
| Journal | Social Science & Medicine |
| Volume | 255 |
| Early online date | 28 Apr 2020 |
| DOIs | |
| Publication status | Published - Jun 2020 |
Keywords
- Acute healthcare
- Critical realist
- Discrimination
- Emergency care
- Mental health
- Qualitative synthesis
- Stigmatisation