AbstractMental illness is an important issue within Australia and worldwide, with one in four people developing a mental illness in their lifetime. The stigma associated with mental illness is prevalent and can dramatically decrease the quality of life for people with mental illness, as well as restrict opportunity (e.g., employment and accommodation) and slow down recovery. One aspect that may contribute to stigma, and be helpful to consider for stigma reduction, is causal beliefs. Causal beliefs are factors that an individual believes cause or contribute to the development of mental illness, which commonly fall into three categories; biogenetic, psychological, and environmental. Previous research has established a link between causal beliefs (especially biogenetic) and stigma in the general public. This thesis examines the relationship between causal beliefs and stigma with mental health professionals and consumers. This thesis by published works makes an original contribution to this field by addressing the paucity of research that focuses on the perspectives of mental health professionals and consumers, and extends previous research by investigating the role causal beliefs play in the treatment process. The goal of this research program was to improve the quality of life for people with mental illness by increasing the understanding of how causal beliefs influence perceptions of mental illness and the treatment process. The research was created to achieve this by exploring the perspectives of mental health professionals and consumers with regards to their beliefs about the causes of mental illness and their experiences with how causal beliefs have been addressed in treatment.
This research used a mixed methods multiphasic design with findings from each phase of research informing the next. Six research papers report on the findings with each contributing to addressing the overall aims of the thesis. The first phase of research was a systematic review (paper one) in which 15 studies were identified that examined the relationship between biogenetic causal beliefs and mental illness stigma in mental health professionals and people with mental illness. The systematic review showed no support for a relationship between biogenetic causal beliefs and reduced stigma in mental health professionals or consumers, and in some circumstances biogenetic causal beliefs were associated with increased stigma. The second phase of research focused on mental health professionals and included both an online quantitative survey (paper two) and qualitative semi-structured interviews (papers three and four). The online survey was completed by 220 potential mental health professionals and investigated the relationships between causal beliefs, contact, and stigma. Paper two showed that potential mental health professionals endorsed biogenetic causal beliefs more strongly than other causal beliefs and that contact, psychological and environmental causal beliefs were significant predictors of social distance. Semi-structured interviews were conducted with 17 mental health professionals to examine their causal beliefs and the role that their causal beliefs play in perceptions of, and stigma towards, mental illness and the treatment process. Paper three revealed that mental health professionals endorse multiple causal beliefs simultaneously with most endorsing a combination of biogenetic, psychological, and environmental factors. Additionally, paper three showed that mental health professionals’ causal beliefs influenced their perception of consumers with both positive consequences (e.g., increasing empathy, and reducing blame) and negative consequence (e.g., increasing frustration and prognostic pessimism). Key findings from paper four indicated that mental health professionals’ causal beliefs influenced their approach to treatment and their decision about what interventions to provide as well as having an impact on other treatment variables such as empathy and therapeutic alliance.
The final phase of research was a qualitative examination of consumers’ causal beliefs and how these causal beliefs influenced perceptions of, and stigma towards, mental illness and the treatment process (papers five and six). Semi-structured interviews were conducted with 23 consumers. Thematic analysis was employed to identify main themes from the interview transcripts in both qualitative studies. Paper five showed that consumers endorsed multiple causal beliefs simultaneously with environmental factors being the most commonly reported main cause of consumers’ mental illness. Consumers’ causal beliefs influenced several factors important to treatment and recovery including the control and management of their illness, self-blame, feelings of responsibility, powerlessness, and perceptions towards themselves. Paper six showed that discussing causal beliefs in treatment was important to consumers, however, most consumers did not think that causal beliefs were addressed adequately in their treatment. Consumers’ causal beliefs were found to influence emotional responses such as self-blame, powerlessness, and acceptance which affect factors such as self-stigma, and prognosis. Additionally, consumers identified several associated benefits of discussing causal beliefs in treatment including, increased insight/personal understanding of their illness, symptom management and relapse prevention, and reducing self-blame.
This thesis contributes significantly to the understanding of mental health professionals’ and consumers’ causal beliefs, and the role that these beliefs play in perceptions of mental illness and the treatment processes. Results are considered in the context of previous research and theoretical frameworks, and the policy and clinical implications of findings are explored. This research demonstrates the importance of considering the causal beliefs of both mental health professionals and consumers in the treatment process to improve the effectiveness of treatment and services provided, and ultimately improve outcomes for consumers.
|Date of Award
|Tricia Brown (Supervisor) & Anita Mak (Supervisor)