Background & Purpose: Research on understanding the stigma of mental illness has resulted in the identification of sub-types, the most common of which is public stigma defined as the negative attitudes of the general public toward individuals living with mental illnesses (Hayward & Bright; Rüsch, Angermeyer, & Corrigan, 2005). That the public generally holds these attitudes and beliefs is well-documented (Corrigan, Mueser, Bond, Drake, & Solomon, 2008; Rusch et al., 2005; Wahl, 1999). What is surprising is that some researchers have identified similar attitudes and beliefs held by mental health providers (Lauber, Anthony, Ajdacic-Gross, Rossler, 2004; Lauber, Nordt, Braunschweig, & Rossler, 2006; Nordt, Rossler, & Lauber, 2006). There is evidence of a less discussed stigma subtype: provider stigma which can be defined as the negative attitudes, beliefs, and behaviors that mental health providers possess and enact toward clients they serve. The social justice implications of provider stigma are profound, yet any effort to address it must begin with an in-depth exploration of the concept and experience of provider stigma. Only with an adequate understanding of provider stigma can we hope to create reliable and valid measures and ultimately develop interventions to foster its alleviation. This presentation describes an ethnographic content analysis (ECA) of client and family member-authored literature around the concept of provider stigma specifically. The outcome of this analysis is a conceptual model of five themes related to the lived experience of provider stigma from the consumer perspective. The hope is these will be used by researchers to develop measures of, and interventions for, the phenomenon.
Methods: A purposive sample of client and family-authored books was generated through a search of Amazon.com's best-sellers, with included books meeting pre-established criteria. Data collection and analysis were guided by Altheide's (1987) work on ECA, consisting of “reflexive movement between concept development, sampling, data collection, data coding, data analysis, and interpretation” (p.68). Each book's narrative text deemed relevant to the study was unitized and coded into emergent themes. The categories were reviewed, linked, and recoded using a combination of induction and deduction. Trustworthiness and dependability of the findings were strengthened through the use of constant comparison, including multiple pieces of literature, and external audit.
Results: The following themes were identified as relating to client and family member's experience of provider stigma: 1. Blame and shame 2. Provider disinterest, annoyance, and/or irritation 3. Degradation and dehumanization 4. Poor prognosis/fostering dependence 5. Restraint, coercion, and forced medication
Conclusion & Implications: The identified themes of client and family experience of provider stigma, listed above, form the conceptual model of provider stigma. The conceptual model's creation has implications for social work research, namely that it may be useful in guiding future inquiry on provider stigma, specifically the concept's operationalization and intervention design. In addition, the conceptual model may be useful to social work practice, as professionals in mental health services may be sensitized to the potentially stigmatizing nature of their attitudes and behaviors.
