Mental Health Providers' Perceived Quality of Care, Expectations for Recovery, and Stigma Towards Consumers

Background and Purpose: Mental health providers may endorse custodial attitudes or negative beliefs about those with mental illness. Provider stigma can negatively impact the effectiveness of services delivered, and create barriers for consumers to access and engage in care. This study examines the relationship among clinician-rated quality of care, clinician recovery orientation, and stigmatizing beliefs using a recently-developed measure of mental health provider stigma.

Methods: Cross-sectional data were collected from clinical staff at a community mental health center (n=57). Self-report measures were collected anonymously using an electronic survey instrument. Provider stigma was measured using Charles and Bentley's (2018) Mental Health Provider Self-Assessment of Stigma Scale (MHPSASS). Quality care and discordant care were measured using Luther and colleagues (2018) scales. Recovery orientation was measured using the Provider Expectations for Recovery Scale (Salyers, et al., 2013). Internal consistencies for each scale and Pearson correlations among scale scores were inspected. Hierarchical multiple regression was conducted to identify the relationship of quality care, discordant care, and expectations for recovery with provider-based stigma.

Results: Respondents identified mostly as white (70%), female (74%), and masters-level clinicians (58%). Professional affiliations were mostly social work (53%) and counselling/psychology (28%).  Internal consistencies were acceptable for quality care (α=.75), discordant care (α=.84), recovery orientation (α=.93), and the overall MHPSASS score (α=.84); MHPSASS sub-scales showed unacceptable internal consistency (α=.36 to .65) with the exception of the irritation/impatience sub-scale (α=.84). Stigma was correlated with quality care (r=-.37,p<.01) and discordant care (r=.52,p<.001), but uncorrelated with recovery orientation (r=-.01, p>.05). Correlations among quality and discordant care (r=-.24, p=.07) and quality care and recovery expectations (r=.23,p=.08) approached significance. In the first step of the regression model, only discordant care (.501, p<.001) contributed significantly (F(3,53)=8.97, p<.001, R²=.337). In the second step, an additional 10.28% of variance in stigma was explained by the interaction of recovery orientation with quality and discordant care (p<.05). The main effect for discordant care was partially attenuated (B=.386, p=.002), and the interaction of recovery orientation with quality care was significant (B = -.340, p=.004).

Conclusions and Implications: Preliminary data suggests good construct validity for the MHPSASS, as scores are inversely related to quality care and positively associated with discordant care. Internal consistencies for the proposed factors were poor, although this initial sample size was small and further psychometric work is required. That recovery orientation was uncorrelated with perceived stigma could be attributable to this sample having a relatively high recovery orientation.  The relationship of discordant care to stigmatizing beliefs or custodial attitudes is important: while provider stigma may be viewed as an individual deficit, the systems in which clinicians work—defined by the expectations at work, and the available services to offer—may contribute to stigmatizing attitudes, while the experience of providing a high quality, effective service may interact with recovery orientation to buffer against custodial attitudes.