Sarah Clement

Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were...

Direct social contact interventions are known to reduce mental health stigma. Filmed social contact may be equally effective and have practical and cost advantages. To compare the effectiveness of a DVD, a live intervention and a lecture control, in reducing stigma, testing the hypotheses that: (a) DVD and live interventions will be equally effecti...

To develop and measure consensus about which type of message should be included in population-level campaigns to reduce mental health-related stigma. A panel of 32 experts attending an international conference on mental health stigma participated in a consensus development exercise. A modified nominal group technique was used incorporating two voti...

Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database. The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Seconda...

This study aimed to assess change in the quality of reporting of schizophrenia in UK national daily newspapers, comparing 1996 with 2005. Five newspapers were searched using the PROQUEST database for articles published in 1996 or 2005 which contained the term 'schizo...'. 1196 articles were identified and rated against indicators of poor quality re...

Whilst encounters in psychology are typically experienced relationally, qualitative dyadic research in psychology is relatively rare. This study used qualitative dyadic research to understand psychological therapy assessments, exploring how experiences are actively created through situated, relational encounters. Seven dyads participated in qualita...

Objective To synthesize the qualitative literature on adults’ experiences of psychological therapy assessments. The review was led by people with experience of undergoing assessments, with high levels of client involvement throughout. Search strategy A comprehensive search of electronic databases was undertaken, with additional search strategies e...

Objectives To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work. Design Realist review. Setting Primary, secondary and tertiary care. Results A systematic search identified 1448 studies, of which 22 met the inclu...

People with serious mental illness experience discrimination across many different contexts. Mental illness-related discrimination has, however, been an underresearched area until the last decade. This study aims is to expand understanding of the relationship between discrimination and well-being. Cross-sectional data on stigma, experiences of disc...

Purpose The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK. Design/methodology/approach The app...

Background Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel can...

Background: Continuity of care (COC) is central to the organization and delivery of mental health services. Traditional definitions have excluded service users, and this lack of involvement has been linked to poor conceptual clarity surrounding the term. Consequently, very little is known about the differences and similarities in the conceptualiza...

Background: Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings. Aims: To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and...

Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we s...

Suicide is a major global public health issue. Mental illness is a risk factor for suicide, but as many individuals with a diagnosed mental health problem do not experience suicidal ideation or attempt suicide, other individual and societal factors must be considered. Mental illness-related discrimination is one potential risk factor. Using mixed m...

Background Decisions about whether to disclose mental health problems to employers are complex, with potential personal, employment and legal implications. Decision aids are evidence based tools, designed to help individuals make specific choices between treatment options. We previously developed a decision aid-Conceal Or ReveAL (CORAL)-to assist s...

Objective: This study aimed to test the hypothesis that mental health–related discrimination experienced by adults receiving care from community mental health teams is associated with low engagement with services and to explore the pathways between these two variables. Methods: In this cross-sectional study, 202 adults registered with inner-city c...

This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health c...

Objective: This study assessed participants' experienced discrimination and their causal attributions, particularly to mental illness or race-ethnicity. Methods: In a cross-sectional study, 202 service users with severe mental illnesses were interviewed to assess their reported experiences of discrimination. The Major Experiences of Discriminati...

Aims: This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England. Methods: We use data fro...

Background The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the le...

People with mental illness face the dilemma whether or not to disclose their condition. We examined stigma variables and their relationship with comfort disclosing. Comfort with disclosure, well-being, symptoms and aspects of experiencing and reacting to stigma were assessed among 202 individuals with mental illness. Controlling for symptoms, great...

Aims. To explore the role of psychiatric admission, diagnosis and reported unfair treatment in the relationship between ethnicity and mistrust of mental health services. Methods. The Mental Illness-Related Investigations on Discrimination (MIRIAD) study was a cross-sectional study of 202 individuals using secondary mental health services in South...

Objective: To study the reliability, validity and acceptability of the mental illness: clinicians attitudes scale ( MICA) Chinese vision among community mental health staff. Method: Eighty community mental health staff from 8 regions in Guangzhou were investigated by MICA Chinese vision twice one week apart; and also by reports and intent behavior...

INTRODUCTION: A significant gap between the number of individuals who need mental health care and the ones who actually have access to it has been consistently demonstrated in studies conducted in different countries. Recognizing the barriers to care and their contributions to delaying or preventing access to mental health services is a key step to...

The anticipation of mental health-related discrimination is common amongst people with mental health problems and can have serious adverse effects. This study aimed to develop and validate a measure assessing the extent to which people with mental health problems anticipate that they will personally experience discrimination across a range of conte...

Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request 'reasonable adjustments'. There have been no intervention studies to support decision-making about disclosure to an employer. To determine whether...

OBJECTIVE Although nonattendance at initial appointments in mental health services is a substantial problem, the phenomenon is poorly understood. This review synthesized findings of randomized controlled trials (RCTs) of interventions to increase initial appointment attendance and determined whether theories or models contributed to intervention de...

Mental health-related stigma is widespread and has major adverse effects on the lives of people with mental health problems. Its two major components are discrimination (being treated unfairly) and prejudice (stigmatising attitudes). Anti-stigma initiatives often include mass media interventions, and such interventions can be expensive. It is impor...

Background Experienced discrimination refers to an individual’s perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in th...

Mental illness is associated with unfair treatment in a number of areas of life. There is currently no psychometrically validated measure that has been developed to specifically focus on such experienced discrimination. This study aimed to finalise the Discrimination and Stigma Scale (DISC) and establish its psychometric properties. DISC was furthe...

There are currently no published scales to assess the attitudes of students and professionals across a wide range of healthcare disciplines towards people with mental illness. Secondary analysis from a randomised controlled trial (RCT) of anti-stigma interventions was carried out to test the reliability, validity and acceptability of the Mental Ill...

Background The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to...

Despite the importance of continuity of care [COC] in contemporary mental health service provision, COC lacks a clearly agreed definition. Furthermore, whilst there is broad agreement that definitions should include service users' experiences, little is known about this. This paper aims to explore a new construct of service user-defined COC and its...

Many people with mental illness do not seek or delay seeking care. This study aimed to develop, and provide an initial validation of, a comprehensive measure for assessing barriers to access to mental health care including a 'treatment stigma' subscale, and to present preliminary evidence about the prevalence of barriers experienced by adults curre...

Stigma and discrimination present an important barrier to finding and keeping work for individuals with a mental health problem. This paper reviews evidence on: 1) employment-related disclosure beliefs and behaviours of people with a mental health problem; 2) factors associated with the disclosure of a mental health problem in the employment settin...

Table S2. Studies assessing employers hiring beliefs, behaviours and associated factors.

Mental health-related stigma is widespread and has major adverse effects on the lives of people with mental health problems. Its two major components are discrimination (being treated unfairly) and prejudice (stigmatising attitudes). Anti-stigma initiatives often include mass media interventions, and such interventions can be expensive. It is impor...

Many people with schizophrenia face stigmatisation. Several methods have been produced to simulate the auditory and visual hallucinations experienced by people with schizophrenia in order to increase empathy and understanding about the condition. However, there has been no review of such methods. This systematic review aims to determine whether and...

Background The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims To assess the relationship between user characteristics and established components of continui...

Background Service users with non-psychotic disorders are rarely studied. How continuity of care functions for this group is unknown. Aims To compare users of community mental health teams with non-psychotic disorders to those with psychotic disorders in terms of demographic and illness characteristics, continuity of care and clinical and social f...

Hackett & Betz (1981) proposed that Bandura's (1977) theory of self-efficacy can provide a useful conceptual framework in which to view the occupational preferences of women. They suggested that, largely due to socialization experiences, women have low self-efficacy expectations in relation to traditionally male occupations, and that this may contr...

Background/Objectives: The need for a psychometrically validated measure of experienced discrimination was identified during a narrative review of survey measures of perceived, experienced and self stigma. To meet this need, DISC-12 underwent further developmental work and the psychometric properties of the final version were tested. Methods: The D...

SAPPHIRE is a five-year programme of research which seeks to increase understanding about mental health-related stigma and discrimination (www.sapphire.iop.kcl.ac.uk). It focuses particularly on the impact of stigma and discrimination on physical and mental health and on social inclusion. The projects selected for presentation cover physical health...

Background/Objectives: Social contact is known to reduce stigma and social contact-based interventions are being increasingly used in anti-stigma programmes in mental health. Recorded interventions, such as audiovisual DVDs, may act as an indirect form of social contact and may have practical and cost advantages, but little is known about their eff...

Background/Objectives: Many people with schizophrenia face stigmatisation in various social settings. Several different types of interventions have been developed to reduce stigma of schizophrenia such as protest, education, filmed contact, and personal contact. In the physical disability field there is a long history of using simulations that allo...

People with mental illness face stigma and discrimination in a variety of settings which can have an economic impact. The aim of this paper was to identify literature on the economic impact of mental illness stigma. A systematic review of the literature identified 30 papers from 27 studies by searching electronic databases and hand searching refere...

Description of each study located. Further information on each of the 57 papers included in this review.

There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measu...

Background: Patient-centred outcome measures are rarely used in primary care mental health settings. Aim:To determine reliability and change sensitivity for a new patient-generated measure, "PSYCHLOPS" Psychological Outcome Profiles, comparing those parameters with a conventional outcome measure. Setting:Patients attending clinical psychology servi...

To evaluate the published literature on the effects of complex (multi-faceted) interventions intended to improve the health-related outcomes of individuals with limited literacy or numeracy. We undertook a systematic review of randomized and quasi-randomized controlled trials with a narrative synthesis. The search strategy included searching eight...

This paper describes a measure of continuity of care, establishes its reliability and tests it in a field trial sample for evidence of its validity. In contrast to others, this measure has been generated from the perspectives of service users. As continuity of care is a concern particularly for those with severe mental illness, we have confined our...

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interven...

Community-based care for mental disorders places considerable burden on families and carers. Measuring their experiences has become a priority, but there is no consensus on appropriate instruments. We aimed to review instruments carers consider relevant to their needs and assess evidence for their use. A literature search was conducted for outcome...

The study aimed to determine the conceptual basis of measures of the patient-professional relationship used in routine mental health services research by reviewing their face, content and construct validity. A comprehensive literature search identified measures of the relationship used in mental health services research. The conceptual basis of eac...

1117 low risk women, who had been randomly allocated to either the traditional schedule of 13 antenatal visits or a reduced schedule of six to seven visits, were followed up 2–7 years after their delivery. Follow up was by means of a postal questionnaire (assessing the mother-child relationship, maternal psychological wellbeing, health service use,...

To assess the acceptability to women of antenatal transvaginal ultrasound scans; to compare the characteristics of women who accept the offer of a transvaginal scan with those who decline; to establish the prevalence of any psychological morbidity associated with the scan. The study was a cross-sectional questionnaire survey. Women were recruited f...

General practice websites are an emerging phenomenon, but there have been few critical evaluations of their content. Previously developed rating instruments to assess medical websites have been criticized for failing to report their reliability and validity. The purpose of this study was to develop a rating instrument for assessing UK general pract...

The simultaneous launch of orlistat and sildenafil in 1998 provoked much media attention, particularly around the role of lifestyle drugs and their potential costs if controls were not established. Fears were also expressed that primary care would be overwhelmed by demand, and little information was available about the attitude of GPs to their new...

Psychiatric referral rates vary widely between different general practices. To increase our understanding of this variation, we conducted a one-year prospective observational study of outpatient psychiatric referrals made by all general practices (622 referrals from 29 practices) within the catchment area of one inner-city psychiatric service. Cont...

This chapter gives an overview of research relating to psychological aspects of caesarean section. It focuses on four main questions: *What are the psychological effects of caesarean section on the mother, her partner and her relationship with her infant? *What factors (obstetric, psychological, attitudinal, and health care-related) make women more...

The purpose of this study was to examine the effect of psychotherapeutic interventions in primary care upon antidepressant prescribing and consultation rates. Seventy-five patients were identified who had received a psychotherapeutic intervention from a practice-based therapist. Just over half (16 out of 30, i.e. 53%) of those who had received a ps...

We describe a conceptual framework that we have developed for evaluating primary care research networks. The framework includes objectives, process indicators, and outcome indicators. We propose the framework as a provisional model that we hope will promote further research and debate.

To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal cli...

To assess the acceptability and safety of a minor illness service led by practice nurses in general practice. Multicentre, randomised controlled trial. 5 general practices in south east London and Kent representing semi-rural, suburban, and urban settings. 1815 patients requesting and offered same day appointments by receptionists. Patients were as...

The aim of the present study was to assess whether the psychosocial and behavioral changes that occur during and after pregnancy influence long-term weight gain. The study examined 74 mothers enrolled in the Antenatal Care (ANC) Project (a randomized controlled trial of antenatal care based in South London), all of whom had volunteered to take part...

To assess the relative importance of heritable characteristics and lifestyle in the development of "maternal obesity" after pregnancy. South east London, in the homes of mothers who had delivered their babies at either Guy's, Lewisham or St Thomas's hospitals. Seventy four mothers of low antenatal risk who had been enrolled in the Antenatal Care (A...

This study describes the development of an intrapartum intervention score used to quantify the degree of intervention in childbirth. Existing measures do not cover the wide range of current interventions, and are not empirically based. A sample of 1,714 postnatal women rated 20 interventions on an 11-point scale according to ‘how much of a medical...

EDITOR—Torgerson and Sibbald discuss the difficulties of assessing the relative merits of treatments when patients have strong preferences for one of the alternatives.1 In these circumstances, however, patients should not be expected to participate in randomised comparisons, and neither should the professionals caring for them. It is important to c...

This article considers alternative ways of providing antenatal services, and discusses how well these alternatives might meet women's psychological needs in pregnancy. These alternatives include individualized or flexible antenatal visit schedules, drop-in clinics, telephone advice, targeted care, antenatal groups and home visits. The alternatives...

In Britain, and much of the developed world, most births take place in hospital, usually with only the birthing woman, her partner and healthcare professionals present. It is therefore rare for women to witness childbirth before they themselves give birth. Women do, however, witness birth indirectly, through the eye of a television camera.

to ascertain: (i) which demographic, obstetric, maternity care, practical and attitudinal variables, and which variables relating to social support and life problems predict satisfaction with traditional antenatal visit schedules; and (ii) which of these variables predict satisfaction with reduced antenatal visit schedules. a secondary analysis of...

To compare the clinical and psychological effectiveness of the traditional British antenatal visit schedule (traditional care) with a reduced schedule of visits (new style care) for low risk women, together with maternal and professional satisfaction with care. Randomised controlled trial. Places in south east London providing antenatal care for wo...

To ascertain the views of midwives, obstetricians and general practitioners (GPs) on possible changes in the provision of antenatal care, and to describe any differences in attitude between the three professional groups. survey using postal questionnaire. Three hospitals in south-east London. The questionnaire was sent to 251 midwives, 50 obstetric...

to examine existing research evidence to ascertain whether 'listening visits' in pregnancy, targeted at women with low emotional wellbeing, are likely to be effective in preventing postnatal depression and in improving other maternal psychological outcomes. the evidence currently available suggests that postnatal listening visits are effective in p...