Implementation of a new tool to address mental illness-related structural stigma in healthcare: Findings from an emergency department setting

Background: Mental illness-related stigma in healthcare settings remains a key issue for health quality. While considerable attention has been paid to addressing stigma at interpersonal and individual levels, there is increasing acknowledgment that stigma is also a structural problem. Structural stigma refers to the inequitable de-prioritization, devaluation and ‘othering’ of mental health and substance use (MHSU), as compared to physical health. Structural stigma creates and perpetuates health inequalities and poorer standards of care for people with MHSU disorders. This is especially evident in the emergency department (ED) setting, which are experiencing increasing presentations related to MHSU. Study Objectives: This nursing-led study aimed to address the following questions: 1) What impact do structural changes have on patient experiences over time? 2) What is the difference between patient experiences when visiting the ED for a physical health concern compared to a mental health concern? 3) To what extent is the Stigma Cultures in Healthcare Scale considered a useful tool for quality improvement in the ED? Presentation Objectives: The objectives of this research presentation are: 1) To demonstrate how MHSU-related structural stigma is a quality-of-care issue; 2) To discuss the development and implementation of a measure to assess MHSU-related structural stigma from the perspective of patients in an emergency department; and 3) To provide results including changes in patient experiences as quality improvements were made in this ED. Methods: This nursing-led study aimed to address the following questions: 1) What impact do structural changes have on patient experiences over time? 2) What is the difference between patient experiences when visiting the ED for a physical health concern compared to a mental health concern? 3) To what extent is the Stigma Cultures in Healthcare Scale considered a useful tool for quality improvement in the ED? Results: Analysis revealed significant differences in experiences of structural stigma across the three respondent groups. Patients seeking care for both MH/PH concerns reported the poorest experiences of care, followed by patients seeking care for MH concerns only. Findings also showed that the physical space dedicated to MH patients was experienced as particularly stigmatizing. Levels of stigma experienced by those seeking care for MH significantly decreased following structural-level quality improvements in the ED. Implications and lessons learned: Our findings support the presence of MHSU-related structural stigma in the ED setting. Changes to the ED culture and environment, such as renovating the layout, improving the model of care, and providing staff education, have potential to improve quality care and reduce stigma experienced by MH patients.