Variation In Provider Attitudes And Treatment Recommendations For Individuals With Schizophrenia And Additional Marginalized Identities: A Mixed-Method Study

Objective: This study evaluated correlates of mental health stigma among treatment providers, including whether provider attitudes, conceptualizations, and treatment recommendations regarding serious mental illness (SMI) may differ depending on client demographic characteristics. Methods: Atotal of 246 providers (medical students, psychology trainees, and licensed clinical psychologists) and 98 community members completed an online survey including measures of mental illness stigma and questions regarding a vignette of a person presenting to an emergency department (ER) with primary complaints of pain and a historical schizophrenia diagnosis. The vignette demographics were randomly varied using 2 x 2 x 2 factorial design including race (Black/White), housing status (housed/homeless), and criminal justice history (arrest/no arrest). Results: Providers endorsed mental health stigma at varying levels compared with the community sample, with medical students demonstrating the highest stigma. Prior experience working with psychiatric populations was associated with lower stigma. Providers were more likely to conceptualize homeless ER presentations as potentially due to a lack of resources or substance dependence and were less likely to conceptualize ER presentations with arrest histories as pain related. Homeless vignettes were more likely to be referred for social services and vignettes with arrest histories were less likely to be referred for follow-up pain services. Conclusions and Implications for Practice: Findings suggest that individuals with SMI and additional marginalized identities likely experience exacerbated stigma within treatment settings, and this may also influence treatment decision-making. There is a need to consider intersectionality in future research and interventions for decreasing mental health stigma in healthcare settings.