title: Labelling of mental illness in a paediatric emergency department and its implications for stigma reduction education.
abstract: BACKGROUND
  Stigmatizing attitudes and behaviours towards patients with mental illness have negative consequences on their health. Despite research regarding educational and social contact-based interventions to reduce stigma, there are limitations to the success of these interventions for individuals with deeply held stigmatizing beliefs. Our study sought to better understand the process of implicit mental illness stigma in the setting of a paediatric emergency department to inform the design of future educational interventions.
  
  
  METHODS
  We conducted a qualitative exploration of mental illness stigma with interviews including physician, nurse, service user, caregiver and administrative staff participants (n = 24). We utilized the implicit association test as a discussion prompt to explore stigma outside of conscious awareness. We conducted our study utilizing constructivist grounded theory methodology, including purposeful theoretical sampling and constant comparative analysis.
  
  
  RESULTS
  Our study found that the confluence of socio-cultural, cognitive and emotional forces results in labelling of patients with mental illness as time-consuming, unpredictable and/or unfixable. These labels lead to unintentional avoidance behaviours from staff which are perceived as prejudicial and discriminatory by patients and caregivers. Participants emphasized education as the most useful intervention to reduce stigma, suggesting that educational interventions should focus on patient-provider relationships to foster humanizing labels for individuals with mental illness and by promoting provider empathy and engagement.
  
  
  CONCLUSIONS
  Our results suggest that educational interventions that target negative attributions, consider socio-cultural contexts and facilitate positive emotions in healthcare providers may be useful. Our findings may inform further research and interventions to reduce stereotypes towards marginalized groups in healthcare settings.
authors.affiliation: Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. jsukhera@uwo.ca.
authors.forename: Javeed
authors.identifier: http://orcid.org/0000-0001-8146-4947
authors.initials: J
authors.lastname: Sukhera
authors.affiliation: Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Kristina
authors.initials: K
authors.lastname: Miller
authors.affiliation: Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Milne
authors.affiliation: Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Scerbo
authors.affiliation: Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Rodrick
authors.initials: R
authors.lastname: Lim
authors.affiliation: Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Alicia
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Watling
keywords: Education; Equity; Labelling; Stigma