A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore

Abstract

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers’ and policy advisors’ perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

Barriers and enablers to access and utilization of mental health care services across Southeast Asia: A preliminary scoping review

“…All included studies were published between 2018 and 2022, and all but three used qualitative research methodology. One study used a phenomenological approach (Tristiana et al, 2018) and eight studies used semi‐structured interviews (Gunasekaran et al, 2022; Hall et al, 2019; Nguyen et al, 2019; Parry et al, 2020; Putri et al, 2021; Subramaniam et al, 2021; Trang et al, 2021; Zay Hta et al, 2021). Of the remaining three studies, two were cross‐sectional studies (Charlson et al, 2019; Van et al, 2021) and one was a prospective cohort study (Trang et al, 2021).…”

“…Poor health literacy, especially a lack of understanding about mental health, was reported in six studies (Hall et al, 2019;Nguyen et al, 2019;Parry et al, 2020;Putri et al, 2021;Subramaniam et al, 2021;Trang et al, 2021;Zay Hta et al, 2021). Hall et al (2019) and Zay Hta et al ( 2021) reported that the lack of available information contributed to the poor knowledge held by the SEA population, while Subramaniam et al (2021) identified that mental health education was a low priority in schools and workplaces. Three studies (Gunasekaran et al, 2022;Putri et al, 2021;Subramaniam et al, 2021) identified poor health literacy likely leading to further stigma, resulting in ongoing barriers to accessing mental health care.…”

“…T A B L E 2 Characteristics of the included studies. (Charlson et al, 2019;Gunasekaran et al, 2022;Hall et al, 2019;Nguyen et al, 2019;Subramaniam et al, 2021;Trang et al, 2021;Tristiana et al, 2018;Zay Hta et al, 2021) whereby the self-stigma or internal resistance felt by people with mental illnesses limited their ability to access mental healthcare services.…”

“…A contributing factor to the stigma was poor health literacy. Subramaniam et al (2021) reported that poor health literacy may result in certain beliefs that people with mental health conditions are violent, lazy, or that their illness may originate from supernatural causes. Addressing the stigma can be a powerful enabler.…”

“…The findings from this review provide important implications for structures (system redesign, resource allocation, and educational imperatives), processes (clinical practice changes and modes of care), and outcomes (adequate data collection and measurement) for mental health care in SEA.4.1 |The multifaceted nature of stigma and its impact on accessing mental health care Stigma as a barrier can manifest across a diversity of a person's experiences and actions. BothGunasekaran et al (2022) andSubramaniam et al (2021) divided stigma into sub-themes, which were structured differently with similarities in their messages. Both studies highlighted that stigma could arise from within oneself-encompassing negative thoughts and stereotypes, from others-fear of discrimination from family, community, and professionals, and from a systemic causefunding, health professionals, improper care.…”