Conceptualizing Professional Stigma Toward Forensic Mental Health Service Users: Results of a Qualitative Inquiry

Abstract

Forensic service users may face double stigma due to severe mental illness and a history of criminal offending. Professional stigma, involving stigmatizing attitudes and behaviors among mental healthcare professionals, can impede treatment and rehabilitation. Research on professional stigma, particularly toward forensic service users, is scarce. We explore relevant concepts of professional stigma using a Delphi consensus study and focus group. The Delphi study involved 98 experts across five panels (academics publishing about stigma or forensic mental healthcare, forensic and community mental healthcare professionals, and forensic service users), who evaluated the relevance of 85 stigma-related items on a 7-point Likert-scale. Consensus was reached on 26 items, including stereotypes, prejudices, and discrimination, reflecting dangerousness, fear, recovery potential, and restrictions. The focus group, involving seven forensic service users, yielded experiences with professional stigma, including recovery pessimism, perceived dangerousness, devaluation through offenses, dismissive reactions, differential treatment, intrusive behavior, and restrictions. Our findings highlight the complexity of conceptualizing professional stigma and provide a foundation for developing an instrument to assess it. Future research will evaluate the psychometric properties of this instrument, which is essential for identifying and addressing stigma in forensic and community mental healthcare, ultimately improving care and rehabilitation outcomes for forensic service users.