De-Stigmatization for Individuals with Severe Mental Illness and Substance Use Disorder: A Multi-Method Approach to the Development of the Biondo REACH Training Program for Healthcare Students

Abstract Despite the development of de-stigmatization training programs, individuals with severe mental illness (SMI) and/or substance use disorder (SUD) continue to face profound levels of stigmatization from their healthcare providers (HCPs). Stigmatizing behaviors exhibited by HCPs exacerbate dehumanizing and devaluing experiences and inhibit people with SMI and SUD from seeking services. Moreover, recipients of stigmatization from HCPs experience poorer physical and mental health outcomes, self-esteem, and self-efficacy, and overall quality of life. Although some de-stigmatization trainings have shown to be useful in reducing stigmatizing beliefs, there is a need to address the primary concerns expressed both by healthcare students and individuals with SMI and/or SUD. We employed a multi-methods study to: (1) understand the lived experience of individuals with SMI and/or SUD and their interactions with HCP, (2) examine self-reported perceptions of healthcare students’ stigmatizing beliefs towards individuals with SMI and/or SUD, and (3) develop preliminary goals towards creating a collaborative training program co-taught with people with lived experience (PWLE) of SMI and/or SUD. We collected quantitative data from healthcare students at an urban university using the Attribution Questionnaire and lived experiential qualitative data from individuals with SMI and/or SUD through focus groups. Results showed that healthcare students primarily exhibit pitying and helping stigmatizing behaviors, while PWLE feel dehumanized, devalued, and excluded from their treatment. Our training program—Rehumanization, Empathy, Attunement, and Compassion in Healthcare (Biondo REACH)—will be developed and co-taught by PWLE, focusing on the identified gaps in healthcare services between PWLE and HCP.