TY - JOUR
T1 - Mental health stigma at primary health care centres in Lebanon
T2 - qualitative study
AU - Abi Hana, Racha
AU - Arnous, Maguy
AU - Heim, Eva
AU - Aeschlimann, Anaïs
AU - Koschorke, Mirja
AU - Hamadeh, Randa S.
AU - Thornicroft, Graham
AU - Kohrt, Brandon A.
AU - Sijbrandij, Marit
AU - Cuijpers, Pim
AU - El-Chammay, Rabih
N1 - Funding Information:
In the Lebanon site, we would like to acknowledge the PHC department at the MoPH and PHC coordinators, particularly Imad Haddad, Rima Chayya and Lara Mhanna. We would like to thank the directors of the primary care centres and focal persons who facilitated the process at their centres, the primary care providers, service users that supported the study with their time and efforts. We would also like to thank MDM for funding this research project and the staff at MDM who were supporting this study, notably Marie Dermayan and Ahmad Metwalli. In addition, we would like to thank the NMHP team who were involved in implementing this study throughout all its phases; especially Perrine Posbic, Nour Kik, Jiana Tabbara, Sandra Maradian, Jinane Abi Ramia, Amjad Malaeb and Samyah Awada. Finally, we would like to acknowledge Joy Saade for her input in coding the second round of interviews and Sacha Moufarrej for her support in language editing and English proofreading. It is to be noted that the content of this article only reflects the authors’ interpretations.
Funding Information:
In the Lebanon site, we would like to acknowledge the PHC department at the MoPH and PHC coordinators, particularly Imad Haddad, Rima Chayya and Lara Mhanna. We would like to thank the directors of the primary care centres and focal persons who facilitated the process at their centres, the primary care providers, service users that supported the study with their time and efforts. We would also like to thank MDM for funding this research project and the staff at MDM who were supporting this study, notably Marie Dermayan and Ahmad Metwalli. In addition, we would like to thank the NMHP team who were involved in implementing this study throughout all its phases; especially Perrine Posbic, Nour Kik, Jiana Tabbara, Sandra Maradian, Jinane Abi Ramia, Amjad Malaeb and Samyah Awada. Finally, we would like to acknowledge Joy Saade for her input in coding the second round of interviews and Sacha Moufarrej for her support in language editing and English proofreading. It is to be noted that the content of this article only reflects the authors’ interpretations.
Funding Information:
Funding was provided by Médecins du Monde to support one research assistant in Lebanon. BAK has received funding from the US National Institute of Mental Health (R01MH120649). GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust, and by the NIHR Asset Global Health Unit Award. GT also receives support from the National Institute of Mental Health under award number R01MH100470 (Cobalt study). GT is supported by the UK Medical Research Council through the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. No funding agency was involved in the design, analysis, or decision to publish.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.
KW - Mental health Stigma
KW - Primary health care (PHC)
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85129741861&partnerID=8YFLogxK
U2 - 10.1186/s13033-022-00533-y
DO - 10.1186/s13033-022-00533-y
M3 - Article
AN - SCOPUS:85129741861
SN - 1752-4458
VL - 16
JO - International Journal of Mental Health Systems
JF - International Journal of Mental Health Systems
IS - 1
M1 - 23
ER -
