The Role of Stigma in Predicting Attendance at Critical Incident Stress Debriefings

Emergency services personnel (ESPs) have been found to have increasing numbers of behavioral health conditions and suicidality due to the traumatic stress they endure in the line of duty. Despite widespread efforts to combat and reduce mental health stigma, rates remain elevated, and responders continue to suffer and lose their lives to suicide. Critical incident stress debriefings (CISDs) are one form of crisis intervention designed initially for ESPs to mitigate and normalize acute posttraumatic reactions while building unit cohesion. The purpose of this quantitative, cross-sectional study was to examine how the presence of stigma in ESPs (law enforcement officers, firefighters, EMS clinicians, 911 telecommunicators, and medicolegal death investigators) and the number of years spent in emergency services predict attendance at CISDs. This study was viewed through the theoretical lens of Richmond’s person-in-environment theory due to its holistic and inclusive foundation. The research question for this study was to examine to what extent stigma and years of service among ESPs could predict attendance at CISDs. Results of the study were not statistically significant, X2 (3, n = 171) = 1.594, p \u3e.001, meaning years of service, when coupled with stigma, could not predict attendance at CISDs. However, future research may consider gender as a variable to study, as over 60% of participants were females. Furthermore, ethnicity and age are recommendations for future research, as many variables may impact attendance when coupled with stigma. Various social change implications may arise from this study, such as researching new variables affecting stigma, as well as impacting crisis organizations\u27 research and interventions for ESPs in the United States

Beyond Options

Scholars and policymakers now debate reforms that would prevent a bankruptcy filing from being a moment that forces valuation of the firm, crystallization of claims against it, and elimination of junior stakeholders’ interest in future appreciation in firm value. These reforms have many names, ranging from Relative Priority to Redemption Option Value. Much of the debate centers on the extent to which reform would protect the non-bankruptcy options of junior stakeholders, or harm the non-bankruptcy options of senior lenders. We argue that this focus on options misplaced. Protecting options is neither necessary nor sufficient for advancing the goal of a well-functioning bankruptcy system. What is needed is a regime that cashes out the rights of junior stakeholders with minimal judicial involvement. To illustrate, we propose an “automatic bankruptcy procedure” that gives senior creditors an option to restructure the firm’s debt or sell its assets at any time after a contractual default. Under this procedure, restructuring occurs in bankruptcy, but sales do not. Sales are either subject to warrants (which give junior stakeholders a claim on future appreciation) or are subject to judicial appraisal (which forces senior lenders to compensate junior stakeholders if the sale price was too low). Our proposal can be seen as an effort to design a formalized restructuring procedure that borrows from traditional state law governing corporate-control transactions. We show that this procedure minimizes core problems of current law – fire sales that harm junior stakeholders, delay that harms senior lenders, and the uncertainties generated by judicial valuation, which are exploited by all parties

An Integrative Cognitive Model of Internalized Stigma in Psychosis

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level

Acute Inpatients’ Experiences of Stigma From Psychosis: A Qualitative Exploration.

Stigma is a common difficulty for those who experience psychosis as they are viewed as most dangerous, unpredictable, and least likely to recover. In particular, experiences of stigma are yet to be explored with inpatients admitted to psychiatric hospital. The aim of this study was to examine subjective experiences of stigma with acute psychiatric inpatients who experience psychosis. Twenty-five psychiatric inpatients with experiences of psychosis were interviewed using a semistructured interview measure to examine their subjective experiences of stigma. The interview schedule enquired about their experiences of stigma and discrimination and the personal impacts this has had. Thematic analysis was employed to analyze the qualitative data. The analysis identified 3 superordinate themes: ‘stigmatizing social environment and networks,’ ‘stigmatized person with psychosis,’ and ‘stigma interactions.’ These themes reflected experiences of stigma during the inpatient stay as well as in the community. A graphical representation of these themes and their interaction was developed. Stigma is a concern for acute psychiatric inpatients with psychosis. This concern should be explored in future research, and where appropriate addressed during admission to an acute psychiatric inpatient hospital

Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis

It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n = 200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions