Explicit and implicit stigma of mental illness in mental healthcare settings

Understanding the nature of stigma in clinical care settings is of principal importance for both patients and employees alike. This study explored explicit and implicit attitudes toward mental illness among psychiatric inpatient facility employees (N = 72) who work directly and regularly with the severely mentally ill. Implicit biases were measured via a version of the Implicit Association Test (IAT), and explicit biases toward mental illness were measured via the Perceived Dangerousness of Mental Patients scale (PDMP) and two questions that had participants rate their attitudes toward persons with mental illness and persons with physical illness via a Likert scale. Implicit bias against persons with mental illness was evident in the association of mental illness with dangerous, but was not evident in the association of mental illness with bad (though there was a trend in this instance also). Results also revealed significant group differences, as nurses, compared to mental health professionals, exhibited stronger implicit associations of mental illness with dangerous and mental illness with bad. This finding may be due to the nature of nurse-patient interactions, as nurses sometimes deal with more difficult and demanding circumstances than other mental health professionals (it is not believed that nurses are more intrinsically biased people). As expected, participants did not exhibit explicit biases against persons with mental illness. Counter to a priori hypotheses, correlations revealed no significant relationships between implicit stigma and measures of patient contact, a finding that may be explained by unmet conditions of the Contact Hypothesis. As expected, explicit and implicit attitudes were found to be unrelated to each other, suggesting they represent different constructs. Explicit measures were not interrelated, but implicit measures were significantly correlated with each other. The general presence of implicit stigma is testament to the prevailing negative social messages about mental illness. Society's pervasive stigmatizing of mental illness continues to make it a marginalized condition, and the problem is not resolved.