Honest, Open, Proud (HOP)! Acceptability and feasibility of the French version of a programme to reduce self-stigma of mental illness

Objectives. - This pilot study aims to assess the feasibility and acceptability of a short program about disclosure of mental illness for people with psychiatric disorders. Materials and methods. - The participants with a diagnosis of a severe psychiatric disorder were recruited in three psychosocial institutions in French-speaking Switzerland to attend 4 one-hour group sessions of the program Honest, Open, Proud. The sessions were led by a peer practitioner and a psychiatric nurse, using the program guide and the exercise manual shared with the participants. These documents were developed by the team of Patrick Corrigan and are available online. Session 1 invites the participants to consider the advantages and disadvantages of disclosing a mental illness. The costs and benefits are also put into perspective according to different contexts and the potential short- and longterm consequences. Session 2 presents different ways to disclose, from social avoidance to openly spreading one's experience. Session 3 allows participants to learn how to tell their own story. One month after session 3, participants attend a recall session to review their intentions to disclose or not after attending the program and if they have done so, talk about this experience. Self-stigma was measured with the Internalized Stigma of Mental Illness scale, comprising five dimensions; alienation, stereotype adherence, perceived discrimination, social withdrawal and resistance to stigmatization. Acceptability of the program for participants was measured by a 11-item self-reported questionnaire, open questions, attendance rate and drop out. Feasibility was assessed through its operational (training, accessibility, human resources), economics and legal (translation rights ethical considerations) dimensions. Results. - The results are based on data from a sample of 31 participants, aged 43 on average (SD 11.85) with a disease duration of 12.3 years (SD 8.77). The participation rate for HOP sessions was at 93.5%. Most of participants (23/29) attended all sessions, five participants attended three sessions and two participants attended two sessions. Most of participants (84%) appreciated the facilitation by a mental health peer practitioner and having the opportunity to talk about something they could not address elsewhere (73%). For 92% of them, elements of HOP could be applied in their daily lives and all are unanimous when recommending HOP to other people with psychiatric disorders. The HOP program is designed to be facilitated by peer practitioners, yet in Switzerland, their number and integration into care settings is still limited. The program has been feasible with a peer-practitioner only, in three institutions. The program is available freely for peer-practitioners and without cost for the participants and was adapted to the cultural context and was led in four sessions. It was accepted by the ethical committee for human being research and the original authors gave the right to translate it into French. Participants ask for a longer intervention with more practical exercises. In pretest, the average self-stigmatization score for the sample was 2.10 (SD 0.40), with a theoretical maximum of 4. The sub-dimension alienation shows an average score (2.32, SD 0.58) higher than the others. sub-dimensions, and adherence to the stereotype the lowest average score (1.87, SD 0.38). In post-test, the total self-stigma score decreased by 0.16, an average of 1.94 (SD 0.41). All the means of the sub-dimension scores also decreased, most importantly for the alienation (0.267). Internalized Stigma of Mental Illness scale total score was significantly improved at post-test (t(22) = 2.08, P = 0.049). Conclusions. - This pilot study shows that the HOP program is acceptable and feasible for people with mental health disorders and achievable in psychosocial institutions. The results at the self-stigma scale show a reduction of self-stigma total score. (C) 2020 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This pilot study demonstrates that the HOP program is acceptable and feasible for individuals with mental health disorders, and can be implemented in psychosocial institutions. The results from the self-stigma scale indicate a decrease in total self-stigma score.