Provider-based stigma is defined as the negative attitudes, beliefs, and behaviors of mental health providers toward clients they serve. Often unintentional and unknowingly conveyed, this phenomenon has been indicated in previous research (e.g. Lauber, Nordt, Braunschweig, & Rössler, 2006; Nordt, Rössler, & Lauber, 2006; Hugo, 2001; Schulze, 2007). Other instruments crafted to measure provider stigma have utilized theory in their development, without incorporating the voice of the client (e.g. Wilkins & Abell, 2010; Kennedy, Abell, & Mennicke 2014). To better address the social injustice posed by provider stigma, the profession requires a valid and reliable measure, guided by theory, which also reflects the client and family experience. This study attempts to do so, referencing the five themes of the experience-based model (Charles, 2013) to guide item development. These themes include: blame & shame; disinterest, annoyance, and/or irritation; degradation & dehumanization; poor prognosis/fostering dependence; coercion/lack of ‘real’ choice. The measure’s item pool was generated following Nunnally and Bernstein’s (1994) domain sampling method, in reflection of the experience-based model, and reviewed by a series of focus groups. The electronically hosted survey was distributed to a purposive sample of mental health service providers employed at Virginia’s public mental health agencies. Using a final sample of N = 220, factor analysis indicated a four factor solution, accounting for 32.454% of the items’ variance. Refinement resulted in a scale of 20-items demonstrating adequate internal consistency, measured by Cronbach’s alpha = 0.817. The four factors of the Mental Health Provider Self-Assessment of Stigma Scale (MHPSASS) were labeled: Irritation & Impatience (eight items); Choice & Capacity (five items); Adherence & Dependence (four items); Devalue & Depersonalize (three items). Hypothesized relationships were found between provider self-rating of burnout and MHPSASS score (Pearson’s r = 0.235, p = 0.001) as well as social desirability level and MHPSASS score (r = -0.169, p = 0.015), supporting the MHPSASS’ construct validity. As a measure of provider-based stigma, the MHPSASS displays adequate reliability and validity. Future studies are indicated, including replication. Limitations include agency response rate, unknowable individual level-response rate, social desirability, and the potentially burdensome length of the survey package.

Negative attitudes and stigma associated with mental illness have a profound impact on individuals who experience them. Researchers have defined stigma as the attribution of a deviant characteristic to members of a particular group. Persons with severe and persistent mental illness (SPMI) face many difficulties that impact their full participation in social life. Although attitudinal reactions to individuals with SPMI have improved considerably over the last few decades, there are still areas for improvement. Limited research has been conducted to evaluate attitudes and stigma associated with individuals with SPMI among human service professionals-in-training (HSPs). For this study HSPs were defined as individuals entering into social service, mental health, and substance abuse professions. Further, there have only been a few published studies in attitude research that utilized randomized vignettes portraying individuals with two different mental health diagnoses. Data collection occurred in counselor education and similar programs at many universities. A total of 79 participants (20 males and 58 females) took part in this study. Recruitment efforts reached HSPs at 27 universities throughout the contiguous United States. For this study, participants were asked to respond to self-report surveys and to one of two written vignettes to quantify their attitudes toward the individuals depicted in them. The two vignettes described an individual with a mental illness and differed in the diagnosis attributed to the individual: schizophrenia spectrum disorder in one vignette and generalized anxiety disorder in the other vignette. Results indicated that although there were slight mean differences between the two groups of participants, the differences were not statically significant, t (77) = 0.63, p =53. The Attribution Questionnaire-27 (AQ-27; Corrigan, 2012) gathered overall attitudes towards mental illness. The Mental Health Provider Stigma Inventory (MHPSI; Kennedy, Abell, & Mennicke, 2014) was used to collect data on attitudes, behaviors, and social pressure impacting stigma towards individuals who have SPMI. Data collected with these two scales yielded evidence to indicate that participants held stigmatizing attitudes towards individuals with SPMI. Data gathered suggested that graduate students in rehabilitation counselor education programs expressed fewer stigmatizing attitudes than students from other programs. This result was seen across both measures. Data were collected on frequency of contact with persons with mental illness to evaluate the association between contact frequency and knowledge of mental illness and negative attitudes. Demographic data gathered included gender, age, professional training, and number of years of work experience in a counseling-related role. Further, a hierarchical multiple regression was used to determine which order of predictors were statistically significant to the outcome measure. Prior literature suggest that prior contact and familiarity scores playing a more important role in predicting the outcome variable (AQ-27) then the demographic information. The first model was statistically significant F(6,72) =3.64, p= .003 and explained 23% of the variance in the dependent variable (AQ-27 total scores). After the input of these demographic factors the second step included LOF and SADP- PCF-R scores. After entry of the second step the overall variance was 28%. The second model was statically significant F(8,70) = 3.39 p = 002 and explained an additional 4% variance in the model. In the final adjusted model, four out of the seven predictor variables were statistically significant. A small pilot study consisting of rehabilitation counseling professionals was used to develop the methodologies for this study. The primary limitation of the primary study was the sample size. Further details of the methodology used and limitations of this particular study will be described in subsequent chapters. Implications of this study and suggested future research are proposed.

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