Qualitative Research- Critical Appraisal

A Qualitative Study; experiences of stigma by people with

Mental Health Problems.

Student’s name
Institution’s affiliation
 Abstract:
In the current study/ article there was a clear statement of the aims and
objective of the research. The study was to examine experiences of people
with mental health problems recruited through a local mental charity about
stigma.

Introduction
Stigma experienced by service users accessing health care services is
prevalent within mental health services; research conducted by various
expects in health prevalent department have identified the experiences people
with mental health problems go through. Following this link up, I have
identified interest in this area since I feel compelled to understand and reflect
on the experiences of people with mental needs and to examine ways to
improve my practice in the service that I currently manage.
By Looking the at the qualitative research article, examining and learning
about the experiences people with mental health have, with stigma. Using Pico
I asked what are the experiences of stigma by people with mental health
problems?

PICO TABLE
P(Patient/ problem ) According to the research, people living
with mental disability face a lot of
discrimination and stigmatization from the
society.
I (intervention/indicator) In a sample of 30 persons, 25 felt easy when
near a mental disadvantaged person. This
shows the level of discrimination and
stigmatization that our society has imposed
to mentally disabled persons. The
stereotype that, mental disabled persons are
dangerous seems to be the driving force to
this increased perception.
C (comparison) A statistical analysis of consisting of a fixed
sample size that people preferred being
around other patients compared to mental
disabled patients.
O (outcome) The increased fear and stigmatization of
society has led to people living with mental
disability to alienate themselves and feel left
out in most societal activities.
Stigma itself has been described as a secondary illness (Finsen,
1996).Previous research bodies have looked at different areas, the impact of
public attitudes towards people with mental health problems and internalized
stigma on service users (Clement,et al,2015). In this assignment I used an
article from pub med library that entails a fundamental analysis study of
people’s perception to mental disable persons. Some of the key words that
presented themselves included; stigmatization, societal perception, mental
disable persons, Resilience. The choice of this article was based on its content
and writers who had experienced knowledge in the field of medication. The title
was “A qualitative study: experiences of stigma by people with mental health
problems”.
The research is important and relevant because there is a need to develop
strategies to enable individuals with mental health problems cope with
stigma. 44% of people in England may experience a mental health problem in
their life time. Health & Social Care information Centre 2015.
Approximately 9 out of 10 people with mental health problems report of
experience of stigma (Cocker et al, 2016) and mental health stigma continues
to be a major issue that needs addressing.The studies, looks at service user
experiences and views of stigma associated with mental health.

Methodology:
Research has looked at public & internalized stigma; there is limited research
about the subjective experiences of mental health stigma by participants
through characteristics (Bonnington & Rose, 2014).The current study look at
internalized stigma of experiences of people with mental health problems
within a non-statutory treatment seeking population.
As part of the research, it was important to have participants who were not in
contact or accessing mainstream services and or have limited contact with
mental health professionals.
It was noted that while participants may have used statutory / non statutory
services, they may choose or decide to have non statutory support as non-
stigmatizing support from their colleagues can be facilitated by charities who
are good at providing support and hence limit the focus on diagnosis and
mental health labels. For many with mental health this could be a favorable
option because of past experiences of mental health stigma.
CASP Checklist- Qualitative Research

1.Was there a Yes The goal of the research was to find out the
clear statement experience of stigma by people with mental health
of the aims of the problems.
research The research is important to identify stigma
experienced by people with mental health
problems.
The research is relevant to improve professional
practice within Health care and for people with
mental health needs experience to be shared.
Yes The researchers were able to interpret
2. Is a Qualitative experiences of research participants in the study.
Methodology There were two focus groups of 13 people with
Appropriate? mental problems researchers interviewed
participants, each participants experience was,
shared among their group. .
Qualitative research was appropriate for the study.
The researchers used Themasis analysis two main
themes and five sub-themes. The sample sizes and
classical unification of data was done as per the set
analysis standards. The two universal
methodology formats i.e. qualitative and
quantitative have been uniformly used. The
presentation of the data in the research was well
acquitted giving the basis of the research question
verifiable and scientifically moldable.
3. Was the Yes All 5 researchers reviewed themes numerous
Research design times before agreeing to the final themes. The
appropriate to researchers justified the design, was of good
address the aims quality, was rigorous and had an impact. This sets
of the research? the research design above per since it handle the
research questions amicably and in a right way
looking at both sides of the issue. I.e. research title.
4. Was the Yes Participants were age 18 or older. Recruitment
recruitment was made based on age gender, demographics and
Strategy self-reported mental Health Diagnosis to have
appropriate to different reports on experiences Richie, Lewis&
the aims of the Elam 2003.
research? Participants were all English speaking, had self-
reported experience of stigma related to their
mental health issue and not currently an acute
 episode.
Thirteen people with mental health problems were
recruited to two focus groups.
There was inclusive and exclusive criteria,
Participants were people with mental health
problems without currently experiencing a
psychotic episode. Exclusive criteria.
Participants that met the criteria were recruited
through local mental health charity to share
experience of stigma. On the aspect of age, the
recruitment process was in order and as per the
expected standards. Engaging people who are
directly involved with the research topic also
brings more credibility in the research. The
recruitment strategy is therefore awesome and
appropriate.
Yes The setting for data collection was justified.
5. Was the data “Commitment and rigorous aspect were
collected in a way demonstrated by the experience shown while
that addressed running the focus group, there was accurate
the research reporting of participant opinions and attention to
Issue? detail, was given during the research and analysis.
Different coders were used to accommodate for
different interpretation of data. Codes & themes
were checked as data -driven to ensure rigor. The
researchers were transparent and coherence were
followed by researchers.
It was systematic, researchers provided detailed
account of recruiting, data collection and data
analysis.
Impact and importance (P.223) were
demonstrated by the data obtained from
participants about their views on mental health
stigma.
The researchers made the methods explicit.
Researchers used topics guides covering six areas
relating to stigma.
The focus groups were facilitated just under two
hours, 108 .51secs and 115.83mins, the groups
were recorded, transcribed verbatim by first
Author Krueger, RA. & Casey M.A (2009). However,
not all the data collected was aimed at meeting the
research questions which to me a deviation in
terms of time and resources seems. Generally the
data set and data collection procedure was
 awesome and above per, hence the justifiable
results deduced by the articles.
6. Has the Yes
relationship The researchers clearly identified their role.
between Experienced researchers who had experience of
researcher and working with people with the local mental health
participants been community conducted the focus groups.
adequately Psychology students assisted with data collection
considered? and analysis and identified and managed
participant distress.
The researchers were from different age groups,
different professional backgrounds, social wo rk
clinical and academic psychology, & nursing. The
different professional background of the
researcher was good; it ensured a broad
perspective and balanced analysis and
interpretations.
This helped to remove professional bias. There
were two main themes; 1 hierarchy of label with 2
sub themes and 2 developing resilience with 3
subthemes.

7. Have ethical Yes Ethical standards were met.

Issues been taken Researchers had ethical approval by the
into universities ethic committee advised was given by
consideration? the mental health service user group on
management of participant distress & study
materials. One of the volunteers trained to
provide emotional support to participants.
Recruitment posters were given to local mental
health charity groups and organizations, eligible
participants who were informed of research
provided consent attended 1 of the focus groups.
Focus group 1 and focus group 2 a month after.
Researchers were sensitive (Yardley, 2000, p.220)
showing ethical participant care.
8. Was the Data Yes Data was analyzed for validity and reliability.
Analysis Thematic analysis was used for the data.
Sufficiently The methodology was appropriate; the design
Rigorous? used was thematic analysis to investigate the
experience of stigma for people with mental
health problems.
Co- authors listened to each audio recording / read
transcriptions. The researchers used coding and
had 737 codes. The codes were condensed to 94
 broad codes, the 94 broad codes were reduced to
two main themes & five sub-themes.
This was done to ensure reliability and to make
sure the research was rigorous and of good
quality.
9. Is there a clear Yes The finding of the research are exceptionally
statement of admirable as they bring together the main ideology in
findings? terms of the topic questions and ambitions. The goal
of the research is well established and maintained to
point. The preservations are well handled and proven
point blank not just theoretically but also through
scientific data. There is a clear statement of findings
which touches on the main questions of the research.
10. How valuable Valuable The findings could help health care professionals
is the research? Research and the public understand the stigma people with
mental health problems experience and to help to
improve professional practice, service delivery and
more importantly improve positive outcomes for
service users as a whole.

Researchers tried to make the studies to be natural to mimic real life. Local
community venues were selected to have diverse views.
 Results:
The researchers highlighted participants views of the impact and effect of the
hierarchy of labels on themselves as individuals with mental health problems
their families and friends and institutional stigma.
Participants talked about the impact their mental health when family
members were reluctant to allow their relative disclose their mental health
problems. Family members experience shame, self-blame and fear public
reactions after their relative disclosed mental health problem.
Participants also talked about denial relatives had in accepting their family
member had mental health problem. Participants also expressed family
member expectation, stereotypes and disassociation increasing social
isolation for them.
People with mental health felt they were negative consequences for having a
label, people with schizophrenia said they experienced the most stigma from
friends and family and institutional stigma. They also felt that health
professionals were not understanding and expressed negative comments
when expressed the desire to work in mental health. The GP told the
participant they would not be able to work within mental health because they
had mental problem. This could be the health care professional lack of
understanding and also still seeing the individual in the “sick role”. Hence also
demonstrating the power in-balance of health care professionals and people
with mental health problems. The whole research process was adequately
above bar and scientifically acknowledgeable as different research phenomena’s
were well carried out starting from the data collection modes to the methodology
analysis of the data. The results achieved in the research are acknowledgeable
and reliable since they followed a clear scientific procedure and have been
conducted by professionals in these particular field of professions.

Discussion:
Stigma Is prevalent for people with mental health problems and this is
experienced all the time.
However ways in which people experience stigma, it could be detrimental for
individuals their friends and family, institutions and have an implication on
how service providers, organizations and statutory services formulate policy
and procedures and service delivery on a whole.
Stigma is a possession of a negative characteristic which discredits and
segregates an individual from society Goffman (1963) .
Social identity theory perspective, this involves categorizing and stigmatizing
individuals in an in-group and out group (Tafjel & Turnet 1979).
People with mental health experience public stigma, stereotypes, prejudice
and discrimination based of hierarchy of mental health labels or diagnosis.
There are gradations of stigma; higher levels of prejudice have been
experienced by people with schizophrenia. 18-71% with Schizophrenia
experience stigma, 65-71% substance misuse than those with depression 14-
33% or anxiety disorder of which 26% experience stigma. The public also
assume people with mental health problems are unpredictable, violent and
dangerous (Angermyer & Dietrich, 2006).
Participants in the research also reported similar experiences and felt that
friend and families, intuitions, professionals responded differently based on
their diagnosis. Report on how ambulance staff responded were negative and
also disability assessors were not sensitive, demonstrating that people were
not empathetic. When people had a mental health problem as suppose to a
physical condition.

The biological approach assumes there is a physiological cause which says is

the abnormality in brain structure and or functioning Andersen (1985) which
is in contrast to other studies.
Also studies showed that biogenetic etiology of schizophrenia may increase
the desire for people without mental health problems to discriminate and
distance themselves (Angermeyer, 2014).
Furthermore this could also reduce empathy and encourage stigmatizing
views amongst health care professionals for people with mental health
problems (Schulze, 2007).
The current research shows that people with mental health experience
individual stigma, stigma from friends and family and institutional stigma.
Hence an increase in internalized stigma experienced by people with mental
health problems.
Other research have also shown that people with mental health problems are
at risk of social Isolation, inadequate health care, poor employment
opportunity and inadequate housing (Corringan &Watson 2002).
Each individual copes with mental health stigma differently, some can
recognize that they are able to be an instrument of change or decide to be
passive. The impact of stigma could reduce quality of life not only for people
with mental health but also for their friend s and family (Birtel at el 2017
Modified Labelling Theory offers an explanation about the negative effects
stigma may have on people with mental problems (Link et al, 1989).
Studies indicate that attitudes towards mental health & Labels are learnt
through socialization and idea of diagnosis or label caused people with mental
health problems to accept and apply negative views, & stereotypes to
themselves, i.e. Internalized stigma. (Corringham & Watson 2002).
Furthermore severity of mental health problem and feeling of hopelessness,
low self-esteem, discouragement and engagement with health care
professionals were associated with internalized Stigma (Livingston & Boyd
2010).
Also studies demonstrated that internalized Stigma may prevent people with
mental health needs from seeking help because of shame and embarrassment
(Clement et al, 2015).
Studies have shown the efficacy that cognitive behavioral therapy is an
effective intervention to reduce the impact of internalized stigma.
Morrison et al 2003 & also randomized control trials and disclosure
workshops (Corringham et al, 2015) highlighted the efficacy of CBT in
reducing the internalized stigma among people with mental health needs.
Some qualitative studies have looked at mental health stigma, illustrating that
education and disclosure of mental health problems reduced public stigma
(Jenson & Walkins 2007).
Studies have also demonstrated that Peer support can help to avoid public
stigma.
Previous studies and current study have also showed that those experiencing
psychosis or have had psychosis felt shame, fear, anxiety, hopelessness and
anger because of stigma (Burke, et al, 2016).

Following these sentiments, which are clearly brought out in the research, it
is dully that the research has met the minimum requirement and different
segments of the research proof this. The methodology and data analytic
aspects in the research have been the outstanding merits for qualifying the
research as a standard type. The research has gone further in recommending
different ideologies that could be looked at in the future and given a scope of
prediction in terms of the subject factor in the research. With these things, one
can dully claim that the research is well conducted and has scientifically met
the appraisal points.

Conclusion:
The present qualitative research article reported the negative impact stigma
has on people as people experience social isolation, avoidance of disclosure of
mental health problems which could worsen mental health problems.
Mental stigma continues and remain as an issue that needs to be tackled not
just within health care professions but in society as a whole. The article has
followed dully ways and meets the set standard of a scientific thrilled paper.
There is close intersection of issues starting from methodology status all the
way to recommendation status. The uprising attitude of the authors qualifies
to be discerned and replicated in other studies since it meets the set standards
through academicals caliber and research modules.
 References

Andreasen, N. C. (1985). The broken brain (Vol. 1272). Harper Collins.

Angermeyer, M. C., & Dietrich, S. (2006). Public beliefs about and attitudes towards people with
mental illness: a review of population studies. Acta Psychiatrica Scandinavica, 113(3),
163-179.
Angermeyer, M. C., Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic
explanations and public acceptance of mental illness: Systematic review of population
studies. The British Journal of Psychiatry, 199, 367– 372.
https://doi.org/10.1192/bjp.bp.110.085563
Birtel, M. D., Haddock, G., Bamber, G., Huggett, C., Williams, S., & Awenat, Y. F. (2017).
Impact of stigma by association in mental health: Carers' challenges in health care
interactions and the need for support. Manuscript under review.
Bonnington, O., & Rose, D. (2014). Exploring stigmatization among people diagnosed with
either bipolar disorder or borderline personality disorder: A critical realist analysis.
Social Science and Medicine, 123, 7– 17.
https://doi.org/10.1016/j.socscimed.2014.10.048
Bos, A. E. R., Kanner, D., Muris, P., Janssen, B., & Mayer, B. (2009). Mental illness stigma and
disclosure: Consequences of coming out of the closet. Issues in Mental Health Nursing,
30, 509– 513. https://doi.org/10.1080/01612840802601382
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in
Psychology, 3, 77– 101. https://doi.org/10.1191/1478088706qp063oa
Burke, E., Wood, L., Zabel, E., Clark, A., & Morrison, A. (2016). Experiences of stigma in
Psychosis: A qualitative analysis of service users’ perspectives. Psychosis, 8( 2), 130–
142. https://doi.org/10.1080/17522439.2015.1115541
Clement, S., Schauman, O., Hraham, T., Maggioni, F., Evans‐Lacko, S., Bezborodovs, N., &
 Thornicroft, G. (2015). What is the impact of mental health‐related stigma on help‐
seeking? A systematic review of quantitative and qualitative studies Psychological
Medicine, 45, 11– 27. https://doi.org/10.1017/S0033291714000129
Corker, E., Hamilton, S., Robinson, E., Cotney, J., Pinfold, V., Rose, D., & Henderson, C.
(2016). Viewpoint survey of mental health service users’ experiences of discrimination in
England 2008–2014. Acta Psychiatrica Scandinavica, 134, 6– 13.
https://doi.org/10.1111/acps.12610
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with
mental illness. World Psychiatry, 1( 1), 16– 20.
Corrigan, P. W., Larson, J. E., Michaels, P. J., Buchholz, B. A., Del Rossi, R., Fontecchio, M. J.,
& Rüsch, N. (2015). Diminishing the self‐stigma of mental illness by coming out proud.
Psychiatry Research, 229, 148– 154. https://doi.org/10.1016/j.psychres.2015.07.053
Corrigan, P. W., Markowitz, F. E., & Watson, A. C. (2004). Structural levels of mental illness
stigma and discrimination. Schizophrenia Bulletin, 30( 3), 481– 491.
https://doi.org/10.1093/oxfordjournals.schbul.a007096
Corrigan, P. W., Morris, S., Larson, J., Rafacz, J., Wassel, A., Michaels, P., & Rush, N. (2010).
Self‐stigma and coming out about one's mental illness. Journal of Community
Psychology, 38( 3), 259– 275. https://doi.org/10.1002/jcop.20363
Finzen, A. (1996). Der Verwaltungsrat ist schizophren. Die Krankheit und das Stigma [The
Board of Directors is schizophrenic. The disease and the stigma]. Bonn, Germany:
Psychiatrie‐Verlag.
Goffman, E. (1963). Stigma. London, UK: Penguin.
Hayward, P., Wong, G., Bright, J. A., & Lam, D. (2002). Stigma and self‐esteem in manic
depression: An exploratory study. Journal of Affective Disorders, 69( 1–3), 61– 67.
https://doi.org/10.1016/S0165-0327(00)00380-3
Health & Social Care Information Centre. (2015, December 16). Health Survey for England,
2014: Chapter 2: Mental health problems. Retrieved from
http://content.digital.nhs.uk/catalogue/PUB19295
Jensen, L. W., & Wadkins, T. A. (2007). Mental health success stories: Finding paths to
recovery. Issues in Mental Health Nursing, 28( 4), 325– 340.
https://doi.org/10.1080/01612840701244086
Knifton, L. (2012). Understanding and addressing the stigma of mental illness with ethnic
minority communities. Health Sociology Review, 21( 3), 287– 298.
https://doi.org/10.5172/hesr.2012.21.3.287
Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research.
London, UK: Sage.
Lebowitz, M. S., & Ahn, W. (2014). Effects of biological explanations for mental disorders on
clinicians’ empathy. PNAS, 111, 17786– 17790.
https://doi.org/10.1073/pnas.1414058111
Link, B. G., Struening, E., Cullen, F. T., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified
labeling theory approach to mental‐disorders – An empirical‐assessment. American
Sociological Review, 54( 3), 400– 423. https://doi.org/10.2307/2095613
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for
people living with mental illness: A systematic review and meta‐analysis. Social Science
& Medicine, 71, 2150– 2161. https://doi.org/10.1016/j.socscimed.2010.09.030
Morrison, A. P., Birchwood, M., Pyle, M., Flach, C., Steward, S. L. K., Byrne, R., & French, P.
(2013). Impact of cognitive therapy on internalized stigma in people with at‐risk mental
states. The British Journal of Psychiatry, 203, 140– 145.
https://doi.org/10.1192/bjp.bp.112.123703
Ritchie, J., Lewis, J., & Elam, G. (2003). Designing and selecting samples. In J. Ritchie & J.
Lewis (Eds.), Qualitative research practice. London, UK: Sage.
Schulze, B. (2007). Stigma and mental health professionals: A review of the evidence on an
intricate relationship. International Review of Psychiatry, 19( 2), 137– 155.
https://doi.org/10.1080/09540260701278929
Tajfel, H., & Turner, J. (1979). An integrative theory of intergroup conflict. In W. Austin & S.
Worchel (eds.) The social psychology of intergroup relations (pp. 33– 48). Belmont, CA:
Brooks/Cole.
Vass, V., Morrison, A. P., Law, H., Dudley, J., Taylor, P., Bennett, K. M., & Bentall, R. P.
(2015). How stigma impacts on people with psychosis: The mediating effect of self‐
esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry
Research, 230, 487– 495. https://doi.org/10.1016/j.psychres.2015.09.042
Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self‐stigma associated with
 seeking psychological help. Journal of Counseling Psychology, 53( 3), 325– 337.
https://doi.org/10.1037/0022-0167.53.3.325
Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007). Self‐stigma in people with mental
illness. Schizophrenia Bulletin, 33, 1312– 1318. https://doi.org/10.1093/schbul/sbl076
Whitley, R., & Campbell, R. D. (2014). Stigma, agency and recovery amongst people with
severe mental illness. Social Science & Medicine, 107, 1– 8.
https://doi.org/10.1016/j.socscimed.2014.02.010
Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15, 215–
228. https://doi.org/10.1080/08870440008400302
Appendix: 1

The Article; Link

A qualitative study: experiences of stigma by people with mental health problems -

Huggett - 2018 - Psychology and Psychotherapy: Theory, Research and Practice -
Wiley Online Library

https://onlinelibrary.wiley.com/doi/full/10.1111/papt.12167