Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: a qualitative investigation

ABSTRACT

The present study aimed to describe associations between various types of mental health stigma and help-seeking behaviors among ethnically diverse clients with posttraumatic stress disorder (PTSD) served by an urban community health clinic. The present study draws qualitative data from a parent National Institute of Mental Health Study that aims to identify barriers and facilitators of implementing Cognitive Processing Therapy (CPT) for PTSD. A total of 24 participants from the initial phase of the trial were included in the present study. Mental health stigma emerged as one notable barrier to seeking mental health treatment, as participants described how experiences of environment-level stigma, internalized (self-)stigma and perceived (felt) stigma from their family, friends and previous healthcare providers influenced their decisions to seek care. Despite these barriers to help seeking, many clients also reported that positive interactions with informal and formal support systems, and encouragement from study therapists, helped to combat mental health stigma and facilitate decisions to participate in an implementation trial for CPT. Findings suggest that providers in community health settings may need to attend directly to stigma at the initiation of mental health treatment.

KEYWORDS:

• Stigma
• mental health
• literacy
• trauma
• community

Acknowledgements

The authors wish to express sincere gratitude to the project's research assistants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Sarah E. Valentine, PhD is a Research and Clinical Fellow at the Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Department of Psychiatry, Massachusetts General Hospital, and Clinical fellow in Psychology at Harvard Medical School.

Louise Dixon is a clinical research coordinator at Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Department of Psychiatry, Massachusetts General Hospital.

Christina P. C. Borba, PhD, MPH is Director of Research for The Chester M. Pierce, MD Division of Global Psychiatry at the Massachusetts General Hospital (MGH). She is an Assistant in Psychology (Psychiatry) at Harvard Medical School and an Assistant in Research at MGH.

Derri L. Shtasel, MD, MPH is the Director of the Division of Public and Community Psychiatry at Massachusetts General Hospital and the Executive Director of the Kraft Family National Center for Leadership and Training in Community Health.

Luana Marques, PhD is the Director of the Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments. She is Assistant Professor in the Department of Psychiatry at Massachusetts General Hospital/Harvard Medical School.

Additional information

Funding

This study was funded by a grant through the National Institute of Mental Health (NIMH) (NIMH K23 MH096029-01A1) awarded to Dr. Luana Marques. Dr. Christina P. C. Borba's time was supported by a grant through NIMH (K01MH100428).