Development of an intervention to reduce self-stigma in outpatient mental health service users in Chile.
BACKGROUND
Latin America is characterized by a high prevalence of public stigma toward those with mental illness, and significant selfstigma among labeled individuals, leading to social exclusion, low treatment adherence, and diminished quality of life. However, there is no published evidence of an intervention designed to address stigma in the region. In light of this, a psychosocial intervention to reduce self-stigma among users with severe mental illness was developed and tested through an RCT in two regions of Chile.


OBJECTIVE
To describe the development of the psychosocial intervention, assess its feasibility and acceptability, and evaluate its preliminary impact.


METHODS
An intervention was designed and is being tested, with 80 users with severe mental illness attending two community mental health outpatient centers. To prepare the intervention, pertinent literature was reviewed, and experts and mental health services users were consulted. Feasibility and acceptability were assessed, and impact was analyzed, based on follow-up qualitative reports by the participants.


RESULTS
The recovery-oriented, ten-session group intervention incorporates the Tree of Life narrative approach, along with other narrative practices, to promote a positive identity change in users, and constructivist psychoeducation, based on case studies and group discussions, to gather tools to confront self-stigma. The intervention was feasible to implement and well evaluated by participants, family members, and center professionals. Participants reported increased self-confidence, and the active use of anti-stigma strategies developed during the workshop.


CONCLUSIONS
This group intervention promises an effective means to reduce stigma of mental illness within Chile and other Latin American countries and feasibility to scale up within mental health services.
School of Public Health, Faculty of Medicine, Universidad de Chile. Santiago, Chile.
Sara
S
Schilling
School of Public Health, Faculty of Medicine, Universidad de Chile. Santiago, Chile.
Juan Antonio
JA
Bustamante
School of Psychology, Faculty of Medicine, Universidad de Valparaíso. Valparaíso, Chile.
Andres
A
Sala
School of Occupational Therapy, Faculty of Rehabilitation Sciences, Universidad Andrés Bello. Santiago, Chile.
Claudio
C
Acevedo
School of Public Health, Faculty of Medicine, Universidad de Chile. Santiago, Chile.
Eric
E
Tapia
School of Public Health, Faculty of Medicine, Universidad de Chile. Santiago, Chile.
Ruben
R
Alvarado
Departments of Public Health and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile.
Jaime C
JC
Sapag
Department of Epidemiology, Mailman School of Public Health, Columbia University. New York, USA.
Lawrence Hsin
LH
Yang
School of Social Work, Columbia University. New York, USA.
Ellen
E
Lukens
School of Public Health, Faculty of Medicine, Universidad de Chile. Santiago, Chile.
Franco
F
Mascayano
School of Nursing, Faculty of Nursing, Universidad Andrés Bello. Viña del Mar, Chile.
Patricia
P
Cid
School of Psychology, Faculty of Medicine, Universidad de Valparaíso. Valparaíso, Chile.
Thamara
T
Tapia
D000293:Adolescent; D000328:Adult; D002677:Chile; D003155:Community Mental Health Centers; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control / Q000523:psychology*; D008605:Mental Health Services; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D012649:Self Concept; D057545:Social Stigma; D013240:Stereotyping; D016896:Treatment Outcome; D055815:Young Adult