Date Presented 04/12/21
Stigma is a barrier to health care access for people with mental illness; OTs work with these individuals in all treatment settings. This study explored how a Level II fieldwork setting affects students' attitudes toward mental illness. Mental health settings were related to positive attitudes; pediatric settings were related to stigmatizing attitudes. Integrating mental health into the broader OT curriculum or classroom and clinic, in any fieldwork setting, may positively affect students' attitudes.
Primary Author and Speaker: Christine A. Linkie
Contributing Authors: Abigail Herman, Mairead Gormley, Erica Di Meo, Jessica Leonard
PURPOSE: Stigmatizing attitudes and anticipated discrimination by healthcare providers have been identified as barriers to healthcare access for people with mental illness. Approximately 20% of adults and 49% of adolescents in the US experience mental health disorders (National Institute of Mental Health, 2019); occupational therapists may work with these individuals in any treatment setting. Academic coursework and fieldwork experience are two interconnected elements of occupational therapy (OT) education that help to shape students' attitudes. The research question for this study was ‘How do OT students’ attitudes towards people with mental illness vary based on Level II fieldwork exposure?’
DESIGN: This was a descriptive study that mainly used quantitative methods but also had a qualitative (phenomenological) component. Researchers identified OT program directors via the AOTA website and emailed them a description of the study and a link to an online survey; directors could then forward the email to their students. OT students who had completed at least one Level II fieldwork were eligible to participate. Participants (N = 102) were students from 36 occupational therapy assistant, master's level, and clinical doctorate programs across the US.
METHODS: The online survey consisted of a demographic questionnaire and 2 measures: Level of Familiarity scale (LOF; Corrigan, 2012) and Mental Illness: Clinician’s Attitudes scale (MICA; Thornicroft, 2013). The LOF measures familiarity with mental illness by assigning a numerical score based on the highest level of familiarity indicated by the respondent. The MICA uses items with a Likert-type scale to measure attitudes about mental illness. Pearson correlation was used to examine relationships between familiarity and attitude. Analysis of covariance (ANCOVA) was used to investigate relationships between fieldwork settings and attitude while controlling for mental illness familiarity. The survey included one open-ended question: ‘How did your experience in your Level II fieldwork setting affect your feelings and attitudes toward people with mental illness, if at all?’ Responses were analyzed using qualitative coding methods.
RESULTS: Mental health settings for Level II fieldwork were associated with significantly more positive attitudes towards mental illness [F(2,99) = 7.18, p = .009]; pediatric settings were related to significantly more stigmatizing attitudes [F(2,99) = 5.40, p = .022]. Physical disability settings were not related to attitudes [F(2,99) = 0.28, p = .600]. There was no correlation between students’ familiarity and attitudes (r(102) = .13, p = .210). Several themes emerged from qualitative analysis, including ‘seeing the person and not the diagnosis,’ ‘integration of mental health in all settings,’ and ‘negative responses’ reflecting students’ attitudes or those of their clinical instructors.
CONCLUSION: As hypothesized, Level II mental health placements were associated with more positive attitudes. The association between pediatric placements and more stigmatizing attitudes was a surprising finding. Students’ responses reflected the need for integration of mental health in academic and fieldwork experiences. Level II placements in mental health promote positive attitudes towards mental illness; however, many students do not do Level II mental health fieldwork, and fewer OTs work in mental health settings and can offer that opportunity.
IMPACT STATEMENT: Integrating mental health into the broader OT curriculum, including in fieldwork in any setting, may support OT students as future healthcare professionals who are welcoming and holistic, and help to address the stigma barrier that limits healthcare access for people with mental illness.
References
Bagatell, N., Lawrence, J., Schwartz, M., & Vuernick, W. (2013). Occupational therapy student experiences and transformations during fieldwork in mental health settings. Occupational Therapy in Mental Health, 29(2), 181-196. https://doi.org/10.1080/0164212x.2013.789292
Corrigan, P., Green, A., Lundin, R., Kubiak, M., & Penn, D. (2001). Familiarity with and social distance from people who have serious mental illness. Psychiatric Services, 52(7), 953-958. https://doi.org/10.1176/appi.ps.52.7.953
Thornicroft, G. (2011). Physical health disparities and mental illness: The scandal of premature mortality. The British Journal of Psychiatry, 199, 441–442. https://doi.org/10.1192/bjp.bp.111.092718
Boyle, M., Williams, B., Brown, T., Molloy, A., McKenna, L., Molloy, E., & Lewis, B. (2010). Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: A cross-sectional study. BMC Medical Education, 10(71), 1-8. https://doi.org/10.1186/1472-6920-10-71
