Training community mental health staff in Guangzhou, China: evaluation of the effect of a new training model

English version České info

Background:
Increasing numbers of people with mental disorders receive services at primary care in China. The aims of this study are to evaluate impact of a new training course and supervision for community mental health staff to enhance their levels of mental health knowledge and to reduce their stigmatization toward people with mental illness.

Methods:
A total of 77 community mental health staff from eight regions in Guangzhou in China were recruited for the study.4 regions were randomly allocated to the new training model group, and 4 to the old training model group. Levels of mental health knowledge were measured by purpose-made assessment schedule and by the Mental Health Knowledge Schedule (MAKS). Stigma was evaluated by the Mental Illness: Clinicians’ Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS). Evaluation questionnaires were given at the beginning of course, at the end, and at 6 month and at 12 month follow-up.

Results:
After the training period, the 6-month, and the 12-month, knowledge scores of the intervention group were higher than the control group. At 6-month and 12-month follow-up, means scores of MAKS of the intervention group increased more than the control group (both p < 0.05) when age, sex, marriage status, title and time were controlled for. At 6-month follow-up, means scores of MICA of the intervention group decreased more than that of the control group (p < 0.01). At after-training, at 6-months, and at 12-months, mean scores of RIBS of the intervention group increased more than the control (p < 0.01, p < 0.001, p < 0.001) when age, sex, marriage status, title and time were controlled for.

Conclusions:
Compared with the traditional training course and supervision, the new course improved community mental health staff knowledge of mental disorders, improving their attitudes toward people with mental disorder, and increasing their willingness to have contact with people with mental disorder.

Keywords:
Training program; Mental health staff; Stigma; Knowledge

Autoři: Jie Li ^1*; Juan Li ²; Graham Thornicroft ³; Hui Yang ¹; Wen Chen ⁴; Yuanguang Huang ¹
Působiště autorů: Guangzhou Brain Hospital, Guangzhou Medical University, 36# Mingxin Road, Liwan, Guangzhou 510 70, China. ¹; Henan Provincial Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, 388# Jianshe Road, Muye, Xinxiang 45 00 , China. ²; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK. ³; Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Sun Yat-sen Center for Migrant Health Policy, 74#Zhongshan Road II, Yuexiu, Guangzhou 510080, China. ⁴
Vyšlo v časopise: BMC Psychiatry 2015, 15:263
Kategorie: Research Article

© 2015 Li et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-244X/15/263

Souhrn

Keywords:
Training program; Mental health staff; Stigma; Knowledge

Zdroje

1. WHO: Global burden of disease: 2004 update. WHO, Geneva; 2008.

2. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al.: Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.

Lancet 2013, 382(9904):1575-1586. PubMed Abstract | Publisher Full Text

3. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP: Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.

JAMA 2004, 291:2581-2590. PubMed Abstract | Publisher Full Text

4. WHO and Wonca: Integrating mental health into primary care: a global perspective. WHO and Wonca, Geneva; 2008.

5. Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, et al.: Global mental health 3: treatment and prevention of mental disorders in low-income and middle-income countries.

Lancet 2011, 370:991-1005. Publisher Full Text

6. Kakuma R, Minas H, van Ginneken N, Poz MRD, Desiraju K, Morris J, et al.: Global mental health 5: human resources for mental health care :current situation and strategies for action.

Lancet 2011, 378:1654-1663. PubMed Abstract | Publisher Full Text

7. Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M, et al.:Acceptability and feasibility of using non-specialist health works to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, South Africa, and Uganda.

Soc. Sci. Med 2014, 118:33-42. PubMed Abstract | Publisher Full Text

8. WHO: World health report 2001. Mental health: new understanding, new hope. WHO, Geneva, Switzerland; 2001.

9. Desjarlais R, Eisenberg L, Good B, Kleinman A: World mental health. problems and priorities in low income countries. Oxford University Press, Oxford, UK; 1995.

10. Lauber C, Nordt C, Braunschweig C, Rossler W: Do mental health professionals stigmatize their patients?

Acta Psychiatr Scand Suppl 2006, 429:51-59. PubMed Abstract | Publisher Full Text

11. Beales D: Continuing stigmatisation by psychiatrists.

Br J Psychiatry 2001, 178:475. PubMed Abstract | Publisher Full Text

12. Corker E: Stigma caused by psychiatrists.

Br J Psychiatry 2001, 178:379. PubMed Abstract | Publisher Full Text

13. Harangozo J, Reneses B, Brohan E, Sebes J, Csukly G, Lopez-Ibor J, et al.: Stigma and discrimination against people with schizophrenia related to medical services.

Int J Soc Psychiatry 2013, 60(4):359-366. PubMed Abstract | Publisher Full Text

14. Schulze B: Stigma and mental health professionals: a review of the evidence on an intricate relationship.

Int Rev Psychiatry 2007, 19(2):137-155. PubMed Abstract | Publisher Full Text

15. Li J, Huang XM, Guo YB, Yang CJ, Zhou WC: A study of the psychiatric training program for community psychiatric practitioners in Guangzhou.

Shandong Arch of Psychiatry 2005, 18(1):12-13.

16. Thornicroft G, Tansella M: Better mental health care. Cambridge University Press, Cambridge; 2009.

17. WHO: mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. WHO, Geneva; 2008.

18. Shu L, Si TM: Guideline for schizophrenia. Peking University Medical Press, Beijing; 2007.

19. Shen QJ, Liu TB, Zhang HY: Guideline for bipolar disorder. Peking University Medical Press, Beijing; 2007.

20. Liu TQ, Hao W, Yu X: Psychiatric learning guidance and problem sets. People’s Medical Publishing House, Beijing; 2011.

21. Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, et al.:Filmed v. live social contact interventions to reduce stigma: randomized controlled trial.

Br J Psychiatry 2012, 201(1):57-64. PubMed Abstract | Publisher Full Text

22. Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G: Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness.

Acta Psychiatr Scand 2010, 122(2):153-161. PubMed Abstract | Publisher Full Text

23. Gabbidon J, Clement S, van Nieuwenhuizen A, Kassam A, Brohan E, Norman I, et al.:Mental illness: Clinicians’ Attitudes (MICA) Scale –psychometric properties of a version for healthcare students and professionals.

Psychiatry Res 2013, 206:81-87. PubMed Abstract | Publisher Full Text

24. Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al.: Development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS): a stigma-related behaviour measure.

Epidemiol Psychiatr Sci 2011, 20(3):263-271. PubMed Abstract | Publisher Full Text

25. Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, et al.:Development and psychometric properties of the mental health knowledge schedule.

Can J of Psychiatry 2010, 55(7):440-448.

26. Evans-Lacko S, Henderson C, Thornicroft G: Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009–2012.

Br J Psychiatry 2013, 202:s51-s57. Publisher Full Text

27. Li J, Li J, Thornicroft G, Huang YG: Levels of stigma among community mental health staff in Guangzhou.

China. BMC Psychiatry 2014, 14:231. PubMed Abstract | BioMed Central Full Text

28. Li J, Li J, Huang YG, Thornicroft G: Mental health training program for community mental health staff in Guangzhou, China: effects on knowledge of mental illness and stigma.

Int J Ment Health Syst 2014, 8:49. PubMed Abstract | BioMed Central Full Text

29. Li J, Li J, Gabbidon J, Clement S, Ma ZY, Guo YB, et al.: Reliability and validity of the Chinese vision of mental illness: the clinicians’ attitudes scale among community mental health staff.

J Clin Psychiatry 2014, 24:227-229.

30. Jenkins R, Kiima D, Njenga F, Okonji M, Kingora J, Kathuku D, et al.: Integration of mental health into primary care in Kenya.

World Psychiatry 2010, 9(2):118-120. PubMed Abstract | Publisher Full Text

31. Sadik S, Abdulrahman S, Bradley M, Jenkins R: Integrating mental health into primary health care in Iraq.

Ment Health Fam Med 2011, 8(1):39-49. PubMed Abstract | Publisher Full Text

32. Saxena S, Thornicrof G, Knapp M, Whiteford H: Global Mental Health 2: Resources for mental health: scarcity, inequity, and inefficiency.

Lancet 2007, 370:878-889. PubMed Abstract | Publisher Full Text

33. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al.: Global Mental Health 1: No health without mental health.

Lancet 2007, 370:859-877. PubMed Abstract | Publisher Full Text

34. WHO: mhGAP. Mental Health Gap Action Programme: Scaling up care for mental, neurological, and substance use disorders. WHO, Geneva; 2008.

35. Beldie A, Boer J, Brain C, Constant E, Figueira M, Filipcic I, et al.: Fighting stigma of mental illness in midsize European countries.

Soc Psychiatry Psychiatr Epidemiol 2012, 47(Suppl 1):1-38. PubMed Abstract |Publisher Full Text

36. Sartorius N: Fighting stigma: theory and practice.

World Psychiatry 2002, 1:26-27. PubMed Abstract | Publisher Full Text

37. Sartorius N: Stigma and mental health.

Lancet 2007, 370:810-811. PubMed Abstract | Publisher Full Text

38. Cheon BK, Chiao JY: Cultural variation in implicit mental illness stigma.

J Cross Cult Psychol 2012, 14:1058-1062. Publisher Full Text

39. Yang LH: Application of mental illness stigma theory to Chinese societies: synthesis and new directions.

Singapore Med J 2007, 48(11):977-985. PubMed Abstract | Publisher Full Text

40. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M: Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey.

Lancet 2009, 373(9661):408-415. PubMed Abstract | Publisher Full Text

41. Lasalvia A, Zoppei S, van BT, Bonetto C, Cristofalo D, Wahlbeck K, et al.: Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey.

Lancet 2013, 381(9860):55-62. PubMed Abstract | Publisher Full Text