Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Note

Mental healthcare services support: the social role

of medical educator involved in the

destigmatization process to generate inclusion

Fabio Galli1, Karl J. New1, Marco Grech2

1University of South Wales, United Kingdom

2University of Malta, Msida, Malta

Abstract

Introduction: The stigmatization of mental healthcare services and users is a barrier to the

achievement of mental wellness present on a global level. 800000 suicides are estimated each

year, 25 suicide attempts for every suicide (ratio of 25:1), and in 2017 estimated a prevalence >

10% of people suffering from mental disorder or substance abuse (global data). The

stigmatization is a multifactorial phenomenon and process that involves different factors, which

overall cause health, social and economic damage. Slowing down and reducing access to mental

health and well-being pathways due to their influence in the community, also affect social

relationships and self-determination.

Purpose: to identify and describe the process, causes, and factors of stigmatization. Propose

destigmatization activities led by the medical educator.

Methodology: The manuscript develops a proposal focused on the destigmatization process of

mental health/wellbeing services and users, through the guidance of the medical educator as a

figure of connection between different professions (interdisciplinary and multidisciplinary), and

between different stakeholders.

Conclusion: each identifies factor described, can be involved in the destigmatization process to

generate inclusion, through different social interventions led by the role of the medical educator,

with the aim of supporting access to patient support processes and quality of life in communities,

generating inclusion through destigmatization.

Keywords

Medical Education, Mental health, Destigmatisation, Ethics, Includability

Address for correspondence:

Fabio Galli, Postal Address: M.Sc Medical Education Graduate, University of South

Wales, E-mail: fbogalli86@gmail.com

This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International

License (CC BY-NC 4.0).

©Copyright: Galli, 2023

Publisher: Sciendo (De Gruyter)

DOI: https://doi.org/10.56508/mhgcj.v6i1.163

Submitted for publication: 14

May 2023

Revised: 30 June 2023

Accepted for publication: 12

July 2023

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Introduction

The medical educator

The medical educator is mainly defined as the

multidisciplinary and multifunctional professional

who deals with the transformation and innovation

of the healthcare sector, mainly in the academic

area and in healthcare facilities, and the training

of learners in the healthcare areas (Bartle, 2014).

This professional figure, constantly evolving in

terms of knowledge, skills, and abilities, can carry

out activities related to the needs of society and

the community by interfacing in the areas of

healthcare, social-care, and social-works (Hean et

al., 2006). They support the strategies of teaching

and learning, leadership, communication, and

public-patient involvement (Samuel, 2021),

carrying out activities strictly connected to the

professionals who deal with mental healthcare.

One of the challenges that the medical educator

has to face in the universities, in health facilities,

and more generally in the community, is the

process of destigmatization of mental healthcare

services and patients (Rush et al., 2005) to

generate and improve inclusion, that is definable

as the capacity of a systems (health, school,

social, community) to be inclusive.

Table 1:

terminologies and definitions (adapted from Rush et al., 2005; Diener et al., 2003; WHO, 2004; Scully C., 2014;

Bodeker et al., 2020)

Definitions

Mental Healthcare

Services dedicated to mental disorders/illness and well-being.

Mental Health

State of emotional and social well-being.

Mental

Illness/Disorders

Condition of change in behaviours, emotions, thinking.

Mental Wellbeing

Combination of relational functions, feelings, emotions.

Mental Wellness

Condition of good mental health.

Includability

It is a term composed of inclusion and ability; it defines the capacity of a system

(community, workplace, university, services) to be inclusive.

Global Data

Globally, 800000 deaths from suicide are

recorded every year, with a suicide rate of 9.8 /

100000 in 2009, down compared to 1990 with a

rate of 13.6 / 100000 (Yip et al., 2021). The

number of suicide attempts turns out to be related

to suicides in a ratio of 20-25:1 (WHO, 2021).

More than 26 million patients are estimated to be

diagnosed with severe mental disorders

(Wainberg et al., 2017; GBD 2019 Mental

Disorders Collaborators). The peak of self-harm,

and mental and substance use disorders is

observed for the age group 20-24 years (Patel et

al., 2018). In 2017, it was estimated that 792

million people were affected by mental health

disorders, corresponding to 10.7% of the global

population (Ritchie et al., 2018; Nochaiwong et al.,

2021) and in total the social economic cost of poor

productivity caused by poor mental wellbeing is

projected to be $ 6 trillion by 2030 (The Lancet

Global Health, 2020).

Table 2:

Mental disorders prevalence. (Adapted from Søvold et al., 2021; GBD 2019 Mental Disorders

Collaborators; Nochaiwong et al., 2021)

36.5 26.9 28 24.1

37 40 37

Stress Anxiety Depression PTSD /PTSS

Mental disorders

(prevalence, %)

Global Healthcare Workers

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

The Issue

Stigmatization: stereotype, prejudice, and

discrimination

Stigmatization (Ahmedani, 2011) is described

as a multifactorial process, towards a single

subject or a group, towards which different actions

are carried out such as the classification of

physical traits, the creation of a stereotype, the

action of separating us-them, the downgrade of

personal status, discrimination, and the

dependence of the stigmatizing action on what is

considered the centre of power or society,

community, and inherent socio-economic and

socio-political factors (Andersen et al., 2022). It is

possible to define the stigmatization of a single

subject and of a group, as the set of idealizations

and actions that cause a distorted identification

with respect to the reality of the single subject or

of the group, within the community. In its

complexity, stigmatization is different from the

concept of stereotype which can be defined as the

oversimplification of the image or idealization of a

particular subject or group (Pickering, 2015), from

the prejudice definable as the wrong judgment of

devaluation based on biases (Abrams, 2009), and

discrimination defined as unequal treatment and

isolation based on gender, sexual orientation,

religion, ideals, disabilities, pathologies, or other

personal characteristics (Bhugra, 2016) which can

be present both to individuals and to groups.

Stigmatization can be considered social,

professional, and self, and can be identified at a

macro level and micro level (Holder et al., 2020).

Table 3:

comparison between social stigmatization and self-stigmatisation (adapted from Corrigan, P. et al., 2012)

Stigmatization

Stereotype

Prejudice

Discrimination

Social

Negative perceptions with no

evidence.

Agreement with perceptions.

Behaviourally in reaction to

prejudices caused by stereotypes.

Self

Negative perception of oneself.

Agreement with perceptions.

Behaviourally in reaction to

prejudices caused by stereotypes.

An analysis can be carried out considering the

self-inflicted stigmatization or self-stigmatization,

which induces patients who use mental health

services to a condition of self-isolation, self-

stereotyping, creating the perception of

themselves as subjects external to the social,

socio-economic, and community context, and

increasing the feeling of shame and blame against

stigmatization (Corrigan, P. et al., 2012). Self-

stigmatization has a fundamental role in the

search for the correct support to reach the optimal

condition of mental wellness, influencing the

methods of research, relationship, motivation, as it

is jointly responsible for the slowdown of the

diagnostic process, and for adverse conditions for

the patient. Social, cultural, socioeconomic factors

are involved in the complexity of self-

stigmatization that influence the precocity in the

search for adequate support, in the continuity of

support, self-esteem, and complete inclusion, thus

influencing the satisfaction of needs (Lannin et al.,

2022; Mcleod, 2018)

Approach

The manuscript develops a theoretical

proposal focused on the destigmatization process

of mental health/wellbeing services and users,

through the guidance of the medical educator as a

figure of connection between different professions

(interdisciplinary and multidisciplinary), and

between different stakeholders.

Conclusions

The proposed mental healthcare

destigmatization and includability strategy places

the role of the medical educator in relationship

with different stakeholders such as universities,

schools, social and community bodies, society,

communication bodies, and with different

professional figures such as healthcare workers,

administrators, patients, family members,

volunteers, and other figures who may be involved

in the destigmatization process. The actions

described have been selected to trigger and guide

the destigmatization and inclusive processes for

each of the levels in which stigmatization is

identified (macro-level and micro-level) and for

each of the different stigmatization factors (social,

professional, and self-stigmatization) that are

mainly involved in causing of stigmatization and

exclusion, proposing a pluralistic guidance

intervention in the involvement of the community,

and leaded in multidisciplinary activities.

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Conflict of interest

The authors declare that they have no conflicts

of interest.

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