RESEARCH WEEKLY: Stigma and the Importance of Peer Support During First-Episode Psychosis
By Morré Taylor
Editor’s note: May is Mental Health Awareness month and it is more important than ever to raise awareness about severe mental illness. Each Research Weekly published this month is chosen with this in mind.
Most young adults’ first-episode psychosis (FEP) coincides with a critical transitional period into the workforce, however, the onset of severe mental illness during this important time can hinder one's ability to participate in educational and occupational opportunities. This struggle to participate in the workforce may result in disability, unemployment and poverty. According to a 2021 research study published in Psychiatric Rehabilitation Journal, this disruption of educational and employment activities is caused in part by the self-stigma that is often generated in response to a psychosis diagnosis. The authors of this study infer that the internalization of stigma from family, mental health professionals and society can negatively influence a person with FEP’s navigation of their illness and their career-related aspirations.
Study details
In this study, the authors explored the work and school-related experiences of young adults with FEP who had participated in Coordinated Specialty Care (CSC) programs throughout the state of Oregon. Ten young adults between the ages of 21 and 28 were recruited from the Early Assessment and Support Alliance’s Young Adult Leadership Council. These participants completed two rounds of semi-structured interviews. The first interview collected data related to demographic information (race, economic status etc.) and career-related goals. The second interview, which took place 2-4 weeks after the first, aimed to clarify and expand upon data collected from the first interview.
Results
When asked about key moments that affected their pathway to employment and education, 50% of participants discussed barriers brought on by their first psychiatric treatment experience, including being treated in a stigmatizing way by treatment providers and the negative experience of being labeled with their diagnosis because of the negative perceptions associated with severe mental illness in society. The authors suggest that these experiences initiated self-stigma in the participants, contributing to their struggles to enter the workforce. Sixty percent of participants also discussed difficulties being in a work or school-related setting due to feelings of self-stigma. Participants’ feelings of self-stigma after receiving their diagnosis were perceived as an obstacle to obtaining educational or occupational success as many participants described themselves as lacking confidence in social situations and feeling isolated.
Several participants, however, discussed how connecting with other young adults with psychosis in their CSC programs helped alleviate their self-stigma and how seeing peers who were working toward the educational and occupational goals they had set for themselves prior to their diagnosis inspired them to do the same. Peer support and connection to vocational activities through their CSC programs proved crucial for helping young adults with psychosis navigate their career-related endeavors and conquer self-stigma.
Implications
These findings indicate that negative experiences with early psychiatric treatment and diagnostic labeling can cause self-stigma in young adults, disrupting their educational and occupational goals. This self-stigma, however, can be combatted by support from peers who are further along in their employment endeavors. According to the authors, this finding on peer support and the power of peer interactions in reducing self-stigma should encourage the development of peer-based programs for people with who are in the early stages of FEP and struggle with self-identity, self-confidence and self-stigma.
Because peer support is also essential for helping people experiencing FEP adhere to their career-related goals, the authors argue that these findings should be used to guide CSC and Supported Employment and Education (SES) interventions. These programs could consider strategies that encourage peer connections, such as informal mentoring. Lastly, this research calls attention to psychiatric stigma in hospital and treatment settings, which negatively impacts the self-identity, self-esteem and overall wellbeing of people experiencing FEP, thus emphasizing the need for efforts that reduce stigmatizing beliefs among healthcare professionals.
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