Examining policy development, implementation, and evaluation through an anti-stigma lens to reduce structural stigma related to mental health conditions in healthcare settings

Abstract

Structural stigma, including policies and practices embedded in the healthcare system, perpetuates barriers that create and maintain inequitable outcomes for those with mental health conditions. This type of stigma negatively impacts recovery, treatment seeking, access to healthcare, and quality of healthcare for those with mental health conditions and is particularly evident within the emergency department setting. Research has suggested that policy is one way to address some of the root causes of structural stigma related to mental-health conditions and that policy changes can positively impact the lived reality for people with mental health conditions. Despite this call to examine policies through an anti-stigma lens, there exists a notable lack of tools or guidelines to do so. There is, however, a significant amount of research highlighting anti-stigma considerations in policy that can reduce inequitable treatment of those with lived and living experience of mental health conditions in the emergency department, and more broadly, healthcare settings. The current paper is a narrative review of these anti-stigma considerations organized by the phases of the policy cycle (i.e., development, implementation, and evaluation), that can inform a future tool that examines policies through an anti-stigma lens. Some key findings include engaging in meaningful co-creation, considering language, and examining the impact on quality of care within policy. The review also points to a set of overarching considerations that should be examined at all phases of the policy cycle (e.g., considerations of intersectionality and inclusion). Finally, the discussion focuses on considerations when implementing these recommendations.