Stigma resistance at the personal, peer, and public levels: A new conceptual model.

Abstract

Objective: Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Methods: Twenty-four individuals with SMI who were either peer-service-providers (those with lived experience providing services; N = 14) or consumers of mental health services (N = 10) engaged in semi-structured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Results: Stigma resistance is an ongoing, active process that involves using one's experiences, knowledge, and sets of skills at the 1) personal, 2) peer, and 3) public levels. Stigma resistance at the personal level involves a) not believing stigma or catching and challenging stigmatizing thoughts, b) empowering oneself by learning about mental health and recovery, c) maintaining one's recovery and proving stigma wrong, and d) developing a meaningful identity apart from mental illness. Stigma resistance at the peer level involves using one's experiences to help others fight stigma and at the public level, resistance involved a) education, b) challenging stigma, c) disclosing one's lived experience, and d) advocacy work. Discussion: Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Stigma resistance is an ongoing, active process of using one's experiences, skills, and knowledge to develop a positive identity.Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services.

The Stigma Resistance Scale: A multi-sample validation of a new instrument to assess mental illness stigma resistance

“…In particular, public stigma beliefs, which do not necessarily assess stigma directed toward the self, are reflected in two of the five ISMIS subscale items (e.g., "I feel comfortable being seen in public with an obviously mentally ill person" and "People with mental illness make important contributions to society"). Thus, content assessed by the stigma resistance subscale of the ISMIS may overlap partially with content covered by the new measure, but we suggest it does not map as well onto domains reported as key by people with lived experience (Firmin et al, 2017).…”

“…A pool of 54 items was generated from qualitative interviews with 24 individuals doing well in their recovery, including peer-providers (n = 14). Items reflected the theoretical model developed from these analyses (Firmin et al, 2017) and frequently used direct wording used by participants. Items were pilot tested in Amazon's MTurk survey platform with individuals who identified as having lived experience with mental illness.…”

“…Similarly-worded items or items that assessed similar domains were compared and the better performing items within a broad domain were retained. Items were selected to fit the theoretical model previously identified (Firmin et al, 2017). EFAs were run using principal components with viramax rotation to determine the potential number of factors using scree plot loadings, with Eigenvalues greater than 1 considered (Jolliffe, 2002).…”

“…Moreover, stigma resistance involves the application of diverse experiences across multiple levels. A qualitative investigation of stigma resistance from the perspective of people with lived experience pointed to stigma resistance being an active, ongoing process of using one's skills, knowledge, and experiences to fight stigma at the personal, peer, and public levels (Firmin, et al, 2017).…”

“…Moreover, the extant measures may not fully reflect the construct of stigma resistance. Past theoretical work by Thotis (2011) and recent work establishing a model of stigma resistance grounded in the perspectives of people engaged in this process (Firmin et al, 2017) both conceptualize stigma resistance as a multi-faceted process, not fully captured by either of these subscales. Thus, we sought to develop and validate a new measure of stigma resistance.…”