Background
Methods
Design
Participants
Code | Organization | Job |
---|---|---|
P1
| Tehran University of Medical Sciences | Professor/Psychiatrist |
P2
| Support Forum of Schizophrenia Patients (AHEBA) | Chief/Psychiatrist |
P3
| Recovered patient | Author and social activist |
P4
| Islamic Development Organization | Consulting expert |
P5
| Tehran Municipality Health Office | Expert office |
P6
| Office of Social Pathology Prevention of Welfare Organization | Expert office/Psychiatrist |
P7
| Association of Clinical Psychology | Chief |
P8
| Family member of psychiatric patient | Board member of the Support Forum of Schizophrenia Patients (AHEBA) NGO |
P9
| University of Social Welfare and Rehabilitation Sciences | Professor/Psychiatrist |
P10
| Islamic Republic of Iran Broadcasting (IRIB) | TV Channel head/Psychiatrist |
P11
| Iranian Health Education & Promotion Association | Chief |
P12
| Office of Social Pathology Prevention of Welfare Organization | Expert office/General physician |
P13
| Armed Forces Medical Services Insurance Organization | Chief/ General physician |
P14
| Health Insurance of the Ministry of Welfare, Cooperation, Labor and Social Affairs | Expert office/ General physician |
Data collection and analysis
Part A | 1) What do you know about stigma reduction in areas of mental health? | |
2) Do you have any information about the stigma reduction programs in the field of mental health? | ||
If yes, please explain how (In the world/in Iran). | ||
3) Are these programs effective in your view? | ||
4) What is the potential benefit/detriment of these stigma reduction programs for you and your organization? | ||
5) Which of the following options shows your view about the actions taken in Iran and/or in your organization on the issue of stigma reduction? | ||
a) I strongly support it. | b) I somewhat support it. | |
c) I do not support, but I do not oppose it. | d) I somewhat disagree with what has been done. | |
e) I strongly disagree with what has been done. | f) Certain work has been done. | |
Part B (For those who answered “a”, “b” or “c” to question 5) | 6) Which of the following three aspects do you support for stigma reduction in mental patients (Multiple-choice selection is possible)? | |
a) Personnel, operational, and educational supports | ||
b) Logistic and equipment supports | ||
c) Funding required supports | ||
d) Others (with description): | ||
7. For those who are supporting programs for stigma reduction… | ||
a) When do you offer this support? | ||
b) Do you show you creativity or wait for others to do it? | ||
c) Do you think the financial or human resources in the country (and/or your organization) are available to support stigma reduction programs? | ||
d) In your opinion, which resources can be prepared quickly for stigma reduction? | ||
e) Is it a public support? Will it include all segments of the society or a particular group (Explain if necessary)? | ||
f) In what circumstances do you express your support? | ||
g) Will you collaborate with another person or organization for performing these actions? | ||
h) Under what circumstances will you not support? | ||
Part C (For those who answered “e” or “f” to question 5) | 8) With which of the involved aspects in stigma reduction do you disagree (Multiple-choice selection is possible)? | |
a) Personnel, operational, and educational supports | ||
b) Logistic and equipment supports | ||
c) Funding required supports | ||
d) Others (with description): | ||
9. For those who disagree with you … | ||
a) In what circumstances do you show your opposition? | ||
b) Do you have creativity in showing your disagreement or wait for others to do it? | ||
c) Do you have any other useful alternative programs? | ||
d) What resources are available for this replacement? | ||
e) Is it a public program? | ||
f) In what circumstances do you join to the stigma reduction programs of MoHME? | ||
g) Under what circumstances do you take action to support the stigma reduction programs? | ||
10) What organization or group do you think supports stigma reduction? | ||
11) What are the benefits of stigma reduction for these supporters? | ||
12) Which one of these supporters is actively initiative in stigma reduction? | ||
13) What organization or group do you think disagrees with stigma reduction? | ||
14) What are the benefits of their disagreement with stigma reduction? | ||
Part D: Media | 15) Is the media effective in the stigma reduction of mental health problems? | |
16) What effective action can the media do in the field of mental health? |
Rigor
Results
Themes | Sub themes |
---|---|
Emphasis on education and changing attitudes | Education and changing the attitudes of health care providers |
Public education | |
Utilizing the potential of Islamic clergymen | |
Changing the culture | Establishing cultural committees, launching campaigns, and determining a support ambassador |
The role of media | |
The role of books and educational materials | |
Holding festivals | |
The role of popular individuals | |
Introducing recovered patients | |
Creating a common language | |
Promoting supportive services | Budget and insurance coverage |
Necessity to devise appropriate tariffs for mental health services | |
Consideration of the social rights of patients | |
Role of various organizations and institutions | Ministry of Health and Medical Education |
Municipality | |
Islamic Development Organization | |
Other organizations | |
Integrated reform of structures and policies | Establishing committee and secretariat |
Delimiting the disciplines and preventing the involvement of non-experts | |
Integration of psychiatric wards in the general hospitals | |
Emphasis on having systematic and massive programs | |
Evidence-based actions | Research actions |
Using successful projects as a pattern |
Emphasis on education and changing attitudes
Education and changing the attitudes of healthcare providers
“I’ve seen that pharmacists or pharmacy technicians scare the patients and ask them to stop taking their medications.… So we have to educate this group of people as well.” (P3WN, SSI)
“For overcoming stigma, specialists and even experienced physicians and psychiatrists should be retrained.” (P5FGD2)
Public education
“I want to focus on this issue that when we face with a mental disorder in our families, everyone gets confused. I wish we were aware previously through the media or at least get information through textbooks or compulsory courses at universities.” (P8FGD1, SSI)
“Social awareness is at the top of all solutions. It can be started from very childhood or be included in the textbooks by the Ministry of Education”. (P8FGD2)
Utilizing the potential of Islamic missionaries
“One day the prophet of Islam [Mohammad (pbuh)] saw a kid throwing stones at a mentally ill patient. He stopped that kid and said: “He is a patient, we are not allowed to throw stones at these patients or mock them”. (P4WN)
Changing the culture
Establishing cultural committees, launching campaigns, and determining a cultural ambassador
“Unfortunately, some conceptions about mental patients have been established among the people. For example, we hear that some people say “he/she is faint-hearted, weak, or aimless.” (P7FGD1)
The role of media
“Media is like a university. It can either generate or reduce the stigma. It can increase the psychological knowledge of people through multiple programs.” (P1SSI)
“Building culture for movie producers and directors is a time consuming process. We cannot expect them to execute all psychological instructions immediately.” (P10FGD2)
The role of books and educational materials
“Writing appropriate books is a suitable solution in reducing stigma. It can help to re-introduce mentally ill patients to the society and show that they are like normal people in many ways. Thus mental disorders will be taken like many other diseases”. (P8FGD2)
“We can use social networks to promote the awareness of society by explaining the symptoms of disorders.” (P8FGD2)
Holding festivals
The role of popular individuals
“Well-known mentally ill patients should be introduced to the public. Like the great Iranian poet who was diagnosed with bipolar disorder.” (P3FGD1)
Introducing recovered patients
“We know many treated patients already suffering from mental disorders for years who are now successful and well-known. Sometimes, they are not willing to be recognized, but we have to introduce them to others.” (P7FGD1)
Creating a common literature
“We have to change associations or create appropriate words to them; otherwise, we will face with difficulties. Eventually, remodeling a building has many problems in comparison with building a new one!” (P10FGD2)
Promoting supportive services
Budget and insurance coverage
“They have to allocate sufficient budget. For example, artists are full of good ideas but obviously they need money! Making movies, producing a CD, and writing a book are costly. It is a good idea to give a CD to patients and their families, but this also needs budget!” (P8FGD1)
“Psychiatric patients, especially schizophrenic ones should be considered as special patients to be able to use insurance subsidies.” (P8FGD2)
Necessity of defining appropriate tariffs for mental health services
“We have to consider a special position for psychiatrists and clinical psychologists. We need experts to allocate tariffs for them.” (P1FGD2, SSI)
Consideration of the social rights for patients
“Promoting the quality of life and providing facilities for mental patients enhance their dignity in the society. These actions represent that mental patients have similar rights like the normal people. … Subsequently, the society would have a more positive attitude toward them.” (P11WN)
The role of various organizations and institutions
Ministry of Health and Medical Education
“Certainly, the MoHME cannot be alone. It is necessary that other organizations be in accordance with its policies.” (P1FGD1)
Municipality
“We communicate with all citizens. Indeed, our target population is not a special group; we can utilize the potential of health centers to educate people. … We can broadcast educational messages through the subways monitors. Also we can cooperate to produce different educational materials.” (P5FGD2)
Islamic Development Organization (IDO)
“Clergymen in different cities are prepared to do advertising in the field of stigma reduction in mental issues if they have a clear-cut programmed comprehensive plan.” (P4WN)
Other organizations
“There are very few NGOs active in mental disorder issues, or do not have enough power. We must empower them.” (P2FGD1, SSI)
Integrated reform of structures and policies
Establishing committee and secretariat
“We need establishing a committee for data collection about this phenomenon; then we do not need big decisions.” (P9FGD1)
Setting professional boundaries and preventing the involvement of non-experts
“There are no clear boundaries between therapeutic structures in Iran. … It means that we couldn’t define boundaries. The organizations should define delimitations so that non-experts are not allowed to interfere in the diagnosis or treatment process. It rarely happens in medicine that non-expert of a special field interferes in the treatment course of a heart disease or cancer, but in the field of mental disorders, such intervention of non-experts is very common.” (P1FGD2)
Integration of psychiatric wards in general hospitals
“Six years ago, we have to set up psychosomatic and psychiatric wards in general hospitals. In this way, patients will refer more easily, and also stigma will be reduced”. (P1FGD2)
Emphasis on having systematic and comprehensive programs
“We have to make proper policies, and other organizations and institutions should comply with it. We should not be separated and dispersed”. (P5FGD2)”
Evidence-based actions
Research actions
“We hope to find a clear statistical language to provide solutions to the related organizations through research-based methods”. (P9FGD2)