Program may reduce health care providers’ biases against people with mental illness, study shows

A recent study by investigators at Des Moines University and the National Alliance on Mental Illness (NAMI) shows that NAMI’s Provider Education Program can improve the way medical students perceive and treat patients with severe mental illness, or SMI, helping reduce the stigma these individuals face in health care.

A pilot offering of the NAMI program was made possible at DMU beginning in 2018 through a grant from the Mid-Iowa Health Foundation. The recent study was funded by an ongoing annual grant from the Iowa Department of Public Health with support of the Iowa Governor’s Office.

Lead author of the study is Jeritt Tucker, Ph.D., a former assistant professor in the department of behavioral medicine at DMU. Additional authors are Andrew Seidman, who was a Ph.D. student in counseling psychology at Iowa State University and a graduate assistant on the study; current DMU faculty Julia Van Liew, Ph.D., assistant professor of behavioral medicine, and Lisa Streyffeler, Ph.D., chair of behavioral medicine; Teri Brister, Ph.D., LPC, national director of research and quality assurance at NAMI; and Alexis Hanson and Sydney Smith, both fourth-year students in the University’s doctor of osteopathic medicine program.

“Although there have been significant advances in the treatment of mental illness, patients presenting with SMI continue to face complex barriers in receiving competent care for both psychiatric and general medical conditions,” the authors state in an article about the study, published in Academic Psychiatry in July. “It is critical to continue finding ways to increase providers’ emotional competence, beliefs, and behavior toward patients with SMI early in their medical education.”

The study evaluated the attitudes, beliefs and behavior of 41 third-year DMU osteopathic medical students who completed the 15-hour NAMI program and, as a control group, 80 students who didn’t. The program was offered as an elective course and was described to students as an opportunity to improve skills related to caring for patients with severe mental illness.

The course is now required of all third-year DMU osteopathic medical students.

All students who participated in the NAMI program and those who served as the control group had earlier completed rotations in psychiatry as well as family medicine, general internal medicine, pediatrics, general surgery, obstetrics/gynecology, emergency medicine, and medical and surgical subspecialties. Both sets of students completed an initial questionnaire assessing demographic information, personality traits, attitudes, beliefs, and behaviors toward patients with SMI. They then repeated the questionnaires one week after the program concluded and again three months later.

Students who participated in the NAMI curriculum reported increased positive attitudes (less anxiety, lower desire for social distance), improved beliefs (interest in psychiatric patients, views of the cause and origin of illness), and improved behavioral intentions during acute psychiatric emergencies and in routine physical care. A majority of these findings were sustained three months after students completed the program, suggesting both initial potency and promising potential for more longstanding impact.

Designed for groups of eight to 24 participants, the NAMI Provider Education Program is led by a team of three trained facilitators: a person living well in recovery from SMI, a family member of someone with SMI and a health care provider with personal or family experience with SMI. The curriculum emphasizes facilitators sharing personal, familial and clinical experiences with SMI and recovery and includes a mix of didactic presentations, small-group discussions, clinical scenarios and experiential exercises.

The authors say the program is effective in improving students’ attitudes, beliefs and behaviors because of its length, depth and “contact-based” approach, in which participants have the opportunity to interact on an equal basis with individuals living well in recovery from a mental illness.

The authors acknowledged that students who chose to participate in the NAMI program were more likely to “endorse a history of help-seeking and had higher levels of trait openness,” although they controlled for these factors in their analyses. They also noted that the study was conducted at a single institution with a modest sample size. Still, the authors say, a structured, contact-based approach such as the NAMI Provider Education Program is “promising.”

“This study was the springboard for embedding the NAMI Provider Education Program into our doctor of osteopathic medicine curriculum. Given the benefits of the program, we have been able to add it as a regular requirement for all students completing their third year in the D.O. program,” Streyffeler says. “We have also been able to collaborate with NAMI to tailor the program specifically for medical students, and we are currently studying the effectiveness of this enhanced curriculum and are excited about the results.” 

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