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From October 1, 2019 to March 19, 2020, the Mental Health Commission of Canada’s (MHCC’s) structural stigma research team explored the idea of developing an audit tool for mental health and substance use (MHSU). * The research group used a human-centred design for its process of inquiry and the development of mental illness stigma interventions.3 This methodology aligns with existing health-care quality improvement methods (related to human factors), root cause analysis, and process mapping. Concurrent with the late stages of this project, Canada’s chief public health officer released her 2019 annual report, entitled Addressing Stigma: Towards a More Inclusive Health System. Serendipitously, this comprehensive document outlines the stigma pathways to health outcomes model† and describes the process and impact of stigma at various levels, including intrapersonal, interpersonal, institutional, and societal. We believe our work aligns well with this report, since it provides us with another organizing model for the various rapid prototypes and interventions that were stimulated by our networking activities. Our specific work on mental health and substance use may further advance the report’s intentions: to design and develop interventions and “action solutions” to improve health outcomePurpose
Our initial strategy evolved by reframing and contextualizing stigma within the health-care system’s quality-of-care framework, specifically under the “E” pillar of equity. Establishing stigma as a quality-of care problem within existing monitoring and delivery processes requires new ways of thinking and the creation of a quality audit tool.
The research group set out to conduct a range of networking activities to identify promising partners for the design, development, and implementation of a structural stigma audit tool. The process involved inquiring,
networking, and developing relationships with potential partners, key system influencers, and decision makers. We contacted 13 agencies across a small sampling of the health regulatory and performance measurement field, locally, provincially, nationally, and (more selectively) internationally. With Nivatha Moothathamby having made the appropriate arrangements, Thomas Ungar interviewed each agency in
person or by tele- or web conference. Stephanie Knaak also attended two of the meetings. Due to availability problems and a time zone difference, we collected information from one contact by email.‡Methodology
Key Findings
No agency is using or knows of any specific tool or measure to target structural stigma or mental health equity, although some groups have a mandate to develop and track quality in mental health care.
Others have been developing mental health quality indicators that are somewhat related. These indicators may be grouped as follows:
procedures for three diagnoses.
has recently been calling for the same.
o relative time since last new build or renovation of physical space for MHSU treatment (often in the oldest, most decaying part of a hospital and among the last to be renovated)
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