W La Revue canadienne de psychiatrie, vol 55, no 7, juillet 2010 440Objective: Stigma has been conceptualized as comprised of 3 constructs: knowledge (ignorance), attitudes (prejudice), and behaviour (discrimination). We are not aware of a psychometrically tested instrument to assess knowledge about mental health problems among the general public. Our paper presents the results of the development stage and the psychometric properties of the Mental Health Knowledge Schedule (MAKS), an instrument to assess stigma-related mental health knowledge among the general public. Methods:We describe the development of the MAKS in addition to 3 studies that were carried out to evaluate the psychometric properties of the MAKS. Adults aged 25 to 45 years in socioeconomic groups: B, C1, and C2 completed the instrument via face-to-face interview (n = 92) and online (n = 403). Results:Internal reliability and test-retest reliability is moderate to substantial. Validity is supported by extensive review by experts (including service users and international experts in stigma research). Conclusion:The lack of a valid outcome measure to assess knowledge is a shortcoming of evaluations of stigma interventions and programs. The MAKS was found to be a brief and feasible instrument for assessing and tracking stigma-related mental health knowledge. This instrument should be used in conjunction with other attitude-and behaviour-related measures.Can J Psychiatry. 2010;55(7):440-448. Clinical Implications· Improving public knowledge about mental health can produce a positive impact on stigma, facilitate help seeking, and contribute to a greater proportion of people with mental illness receiving treatment in future. · To our knowledge, the MAKS is the first psychometrically tested instrument to assess mental health-related knowledge at the population level and can be used for longitudinal studies of changing population levels of mental health-related knowledge. · The MAKS is a brief and feasible method for assessing and tracking stigma-related mental health knowledge and can facilitate evaluation of large-scale antistigma interventions, and will allow for better understanding in the future of how knowledge, attitudes, and behaviour interrelate. Limitations· Although online assessment should reduce social desirability, we cannot be certain to what extent social desirability affects participant response. · The MAKS alone is not sufficient for assessing reductions in discrimination or success of an antistigma intervention and should be used in conjunction with attitude-and behaviour-related measures. · Future research is still needed to examine how improvements in these areas of mental health knowledge translate into changes in stigmatizing behaviours.

Background. Although stigma in relation to mental health has been defined as including components of knowledge, attitudes and behaviour, no psychometrically tested instrument to assess behavioural discrimination at the population level has been developed. This paper presents details of the development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS), an instrument based on the Star Social Distance Scale, to assess reported (past and current) and intended (future) behavioural discrimination among the general public against people with mental health problems.Methods. Three studies were carried out to evaluate psychometric properties of the RIBS (Study 1, n = 92; Study 2, n = 37; Study 3, n = 403). Adults aged 25-45 in socio-economic groups: B, C1 and C2 (middle-income groups) took part in development and testing of the RIBS. Results.Internal consistency and test-retest reliability is moderate/substantial. Strong consensus validity was found, as rated by service users/consumers and international experts in stigma research.Conclusions. Use of a behavioural outcome may be important to evaluate the effectiveness of interventions intended to reduce stigma and/or discrimination related to mental illness. The RIBS was found to be a brief, feasible and psychometrically robust measure for assessing mental health-related reported and intended behavioural discrimination.

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Although the intervention produced short-term advantage there was little evidence for its persistent effect, suggesting a need for greater integration of ongoing measures to reduce stigma into the medical curriculum.

These findings provide promising results on improvements in press reporting of mental illness during the TTC programme in 2009-2011, and a basis for guidance to newspaper journalists and editors on reporting mental illness.