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An ongoing study led by a member of the Faculty of Nursing and researchers from the Department of Psychology and the Cumming School of Medicine aims to address the multiple levels of mental illness stigma existing within the health-care system, specifically within emergency room settings.

Working in conjunction with Foothills Hospital Emergency Services, Alberta Health Services (AHS) and the Calgary Health Foundation, the researchers are examining the issue through the Exploring Mental health Barriers in Emergency Rooms (EMBER) study.

“One in five Canadians will experience mental health-related issues in any given year. For many patients and families, an emergency department visit may reflect their first point of contact with the health-care system for a mental illness,” says Dr. Jacqueline Smith, BN’09, PhD’15, assistant professor in nursing and EMBER principal investigator.

While emergency departments are important for managing acute mental health crises such as suicidal ideation, many patients report feeling stigmatized, devalued and dismissed — experiences that create barriers to accessing services. 

A unique feature of the EMBER study is its inclusion of a patient-research partner, Emily Hilton. who is an active member of the research team and has lived through the experience of a mental illness. Including Hilton on the research team ensures the study properly represents the voices of patients and their families.

“I think that, especially in terms of things like being a part of the focus groups for the patient and family members, it provides almost like a permission to talk about mental health, because there is still a lot of stigma,” says Hilton. “In terms of talking about your experience, there is still this hierarchy that doctors know best and the health-care system is always going to work to do what's best for you. And, as much as we would all love to believe that's true, it's impossible when stigma is a part of the equation. 

“I think that I act as a face in the room that is not in a position of authority; a face in the room that is able to say, ‘Listen, I understand.’” 

Multi-stakeholder approach

In addition to the patient and family experience, the EMBER study will also explore staff members’ experiences of mental illness bias and discrimination, and the impact it can have on an employee’s ability to provide care and receive mental health-related care for themselves. 

The research team will also work collaboratively with AHS’s Policy Services team to examine mental health-related policies that may be connected to institutional stigma and practices that create barriers to access, help-seeking and the provision of mental health services. 

While there is an awareness of mental illness stigma within health-care systems, very few studies address more than one level of stigma and almost all studies focus on interpersonal stigma. “We want to extend those boundaries and explore stigma holistically on multiple levels (intrapersonal, interpersonal and institutional) in an Emergency Services setting, by utilizing multiple stakeholder participants,” says Smith.

The multi-stakeholder approach taken by the EMBER researchers makes it the first of its kind in Canada. The five-year study, funded by the Calgary Health Foundation, is already underway with recruitment of patients and families, emergency physicians and nurses, psychiatric physicians and nurses, and emergency protective services staff from Foothills Hospital Emergency.

The first two phases of the research will include a needs assessment that explores experiences, evaluates policies and identifies anti-stigma interventions that will be implemented and evaluated over several years. 

“Our goal is to enhance patient-provider interactions and policies related to access and quality care for patients and families seeking care for mental health-related concerns,” says Smith. 

Interested in participating?

For those interested in participating in this study, including patients and families who have visited Foothills Hospital Emergency Services for mental health-related concerns and staff from Foothills Hospital Emergency — including physicians and nurses, psychiatric physicians and nurses, and emergency protective services staff — contact the EMBER team directly at 403-441-3520 or EMBER.study@ucalgary.ca. Or click on one of the links below, provide your contact information, and the study team will reach out to you directly:

• (Physicians and nurses, psychiatric physicians and nurses, protective services staff) 
• (who have visited the FMC ER in the last five years, felt stigmatized due to a mental health concern, and are currently 18 years or older)