Validation of the Mental Illness Stigma Scale for Mental Health Professionals

Background and Purpose: This paper describes the development of the Mental Illness Stigma Scale for Mental Health Professionals (MISS-MHP), designed to assess such professionals' stigmatizing attitudes and behaviors about persons with mental illness. Stigmatizing attitudes and behaviors result from labeling individual differences, linking the differences to negative stereotypes, separating “us” versus “them,” and discriminating against the individual. (Link & Phelan, 2001).

Leading researchers have demonstrated that mental illness stigma is prevalent among mental health professionals and called for more attention to this population. Clients who perceive stigma based on their mental illness report adverse consequences. The evidence of detrimental effects of stigma stirred national and worldwide attention as a barrier to mental health treatment. This measure is designed to improve understanding by assessing multiple stigma domains.

Methods: The MISS-MHP tracks Link and Phelan's conceptualization of stigma – labeling, stereotyping, separating, and discriminating. An expert panel of mental health professionals assessed face and content validity. The initial validation sample consisted of 239 students from a large public southeastern university. Social work, family and child sciences, psychology, mental health counseling, marriage and family therapy, and upper-level education classes were targeted for respondents who were familiar with psychopathology and on an academic trajectory towards mental health professions.

Results: Initial item pools were reduced based on preliminary analyses to strengthen psychometrics and produce a final measure minimizing respondent burden. Items were flagged for deletion if confirmatory factor analytic loadings were .6 or lower, cross-loadings existed, question wording was inappropriate, or if alpha-if-item-deleted scores indicated potential improvement. From the original 43 questions, 12 violated one or more of these criteria and were eliminated. Twenty-nine questions comprised the final measure. The global stratified alpha was .95

The final four subscale reliability estimates were strong: Labeling subscale alpha was .93 (SEM = .36), Stereotyping subscale alpha was .88 (SEM = .16), Separating subscale alpha was .85 (SEM = .25), and Discriminating subscale alpha was .80 (SEM = .21). All items continued to load strongly on their intended factors. The results of the structural equation modeling using MPlus Version 5 indicated a good model fit: χ2 = 600.584 (df = 354), CFI = .937, TLI = .927, RMSEA = .054, SRMR = .063.

The sample validity analysis included discriminant construct and convergent construct. Of the eight convergent construct indicators (two per subscale), seven were significant at the .01 level. The Level of Contact Report was significantly negatively correlated with the Labeling and Stereotyping subscales. The Opinions about Mental Illness Authoritarian Subscale was significantly positively correlated with the Separating and Discriminating Subscales.

Conclusions and Implications: These validation results suggest that the scale is a potentially useful tool for mental health professionals, educators, and researchers. As client perceptions of mental illness stigma are predictors of negative reactions, identifying and combating the phenomenon in those who help is of critical importance. Future research should validate the MISS-MHP with a practicing professional sample and work towards policy change.