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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO253

Measuring structural stigma from the patient perspective: findings on inequities in mental health care in an emergency department

MEASURING STRUCTURAL STIGMA FROM THE PATIENT PERSPECTIVE: FINDINGS ON MENTAL HEALTH CARE INEQUITY IN AN EMERGENCY DEPARTMENT

Structural stigma in the emergency department can be measured through patient reports, is highest among those presenting with both mental and physical health concerns, and decreases significantly following changes to the staffing model and staff training.

The study aimed to measure, from the patient perspective, whether patients presenting to the emergency department (ED) with mental health concerns systematically experienced differences in quality of care and whether structural changes reduced these differences. A mixed-methods approach was used at a hospital in Southern Alberta, Canada, with 710 surveys completed using a 31-question questionnaire between May 2023 and March 2026. The measurement instruments were the Stigma Cultures in Health Care Scale (SCHCS, 23 items) and the Structural Stigma in Mental Health Care Scale (SSMHCS, 7 coercive care items and 1 physical environment item), with additional qualitative responses collected for eight questions. The distribution of reasons for presentation was physical health only, 316 (45%); mental health only, 270 (38%); and both, 124 (17%). One-way analysis of variance (ANOVA) showed significant differences by reason for presentation across all measures (p<0.001). Mean SCHCS scores were 2.02 for physical health only, 2.27 for mental health only, and 2.51 for both; corresponding scores on the SSMHCS coercive care subscale were 1.77, 2.31, and 2.61, respectively, and scores on the “the space is calming” item were 2.49, 2.88, and 2.83. The highest levels of stigma were identified in the group with both mental and physical health concerns, while the highest levels of stigma related to the physical environment were found among patients with mental health concerns. Following changes to the staffing model and staff training, t-tests showed significant reductions in stigma levels (SCHCS from 2.40 to 2.18, p=0.016; SSMHCS coercive care from 2.56 to 2.12, p<0.001). Qualitative themes included inconsistent quality of care, a distressing physical environment, disregard for patient rights, restricted family support, long waiting times, exclusion from treatment planning, and a disconnect between mental and physical health care. In conclusion, structural stigma is a measurable and modifiable phenomenon that varies across groups; patient-reported data can be used to identify structural inequities and monitor the impact of institutional interventions.

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