Page 148 - GHES-3-1

Global Health Economics and
Sustainability
Reducing public stigma related to psychosis

in collectivistic cultures. Previous research supports The need to use existing research to enhance health
the effectiveness of family-based psychoeducational spending has been emphasized in recent literature (Idris
interventions for complex mental health conditions in et al., 2024). Leviton (2017) suggested that empirical
such societies. For example, Ran et al. (2015) found that studies on evidence-based public health interventions
systemic psychoeducation involving families of individuals should address common clinical challenges and provide
with psychosis in China was beneficial and its effects were practical knowledge for solving these issues. Research
maintained over a 14-year follow-up. This outcome has shows that public stigma associated with severe mental
not yet been replicated in individualistic Western societies. health conditions, such as psychosis, exacerbates social
In addition, recent research by Mankiewicz et al. (2021) isolation and economic inactivity among affected
has demonstrated the cross-cultural acceptability of FIp, individuals, hindering their ability to seek professional
including among Asian families. help and access health-care services, which in turn extends
the duration of untreated psychosis (Clement et al., 2015;
An unexpected finding of the present study was that Schomerus et al., 2019). As noted earlier, the global
personal responsibility for difficulties related to PMIH socioeconomic impact of this situation is substantial,
significantly increased after the intervention. According involving both direct health-care costs and indirect costs
to the responsibility model of attribution theory, if related to prolonged unemployment (Chong et al., 2016).
individuals are seen as responsible for their own difficulties This is true for both Western and Asian societies (Zhai,
and if these difficulties are perceived as controllable, they 2013), with mental health professionals in Asia identifying
may be held personally responsible, which can influence public stigma as a significant barrier to accessing and
negative emotional responses and discriminatory behavior engaging with health-care services for individuals with
(Corrigan et al., 2003; Hinshaw & Stier, 2008). Therefore, psychosis (Wen & Mankiewicz, 2024). Our study provides
psychoeducation was anticipated to reduce attributions of preliminary evidence supporting a structured, theory-
personal responsibility, leading to decreased prejudicial based, and evidence-informed intervention to address this
attitudes and discrimination. Although this finding widespread stigma. Such an approach can help individuals
appears to contradict established literature, a recent study seek help, access professional services, support their
by Johnson-Kwochka et al. (2021b) found a strong positive recovery, return to work, and contribute economically
association between higher responsibility attribution and to their community and society. The psychoeducational
increased willingness to help or interact. intervention, being brief and delivered digitally, is highly
Johnson-Kwochka et al. (2021b) suggested that cost-effective and can be easily distributed through
attributing personal responsibility to PMIH may not online platforms, social media, or mental health service
imply blame but rather indicate a belief that individuals websites. It is ideally suitable as part of larger systemic
have control over their recovery and can benefit from campaigns addressing this issue. This aligns with the
assistance. Our findings support this view, as they show digital global health-care model currently promoted by
a significant increase in participants’ willingness to help G20 (Ramaprasad et al., 2023).
and interact with individuals experiencing psychosis This study had several limitations. Although the
following psychoeducation. Considering the reduction in psychoeducational intervention included relevant
stigma observed on most subscales post-intervention, our information to counter general misconceptions about
results challenge the assumption that higher responsibility psychosis, it did not address specific societal myths and
attribution necessarily leads to more stigmatizing attitudes stigmas prevalent in Singapore, such as increased aggression
and behaviors. Furthermore, rather than reinforcing or self-harm tendencies, as highlighted by Mankiewicz
the disease paradigm of schizophrenia, which portrays & Kam (2024). Given that culture strongly influences
individuals as disabled and unable to recover (Mankiewicz, stereotypical views and prejudicial beliefs (Cheon & Chiao,
2013), our psychoeducational intervention was based on 2012), there is a need for culturally tailored interventions.
a cognitive behavioral model of psychosis, which views Future research should compare the effectiveness of
unhelpful delusional thoughts and safety behaviors as psychoeducational content that addresses general
controllable and subject to change (Mander & Kingdon, misconceptions with content customized for specific
2015). Therefore, the observed increase in perceived cultural contexts. In addition, we could not conclusively
controllability may represent a positive shift in how determine the effectiveness of psychoeducation as a
individuals with psychosis are viewed, from being seen as systemic intervention, as it was applied individually. As
severely ill and needing separation from society to being Mankiewicz and Tan (2024) have recently suggested,
capable of managing their well-being and having the exploring psychoeducation in community and health-care
potential for recovery (Mankiewicz, 2015). settings could provide insights into its effectiveness as a

Volume 3 Issue 1 (2025) 140 https://doi.org/10.36922/ghes.3363