Multi-level mental health-related stigma interventions in healthcare systems through the involvement of people with lived experiences: Mixed-methods pilot findings from international study of discrimination and stigma outcomes (INDIGO) study in Nepal.

Authors

Bhawana Subedi, Kalpana Bhattarai, Brandon A Kohrt, Claire Henderson, Elaine Brohan, Graham Thornicroft, Ioannis Bakolis, Maya Semrau, Nicole Votruba, Petra C Gronholm, Uta Ouali, Dristy Gurung

Published in

PLOS mental health. Volume 3. Issue 9. Pages e0000638. Epub Sep 08, 2026.

Abstract

Mental health-related stigma is a barrier to access to mental health services. This mixed-methods pre-post pilot feasibility study aimed to adapt and pilot-test a multi-level anti-stigma intervention across three levels of the health system to assess its feasibility and potential to reduce mental health-related stigma in Nepal. Contact-based interventions integrating people with lived experience in mental health and stigma training packages were adapted and implemented, targeting female community health volunteers (n = 19), primary healthcare workers (n = 9), and psychiatrists and psychiatric nurses (n = 9). Stigma-related knowledge, attitudes, and competency were measured pre- and post-training with follow-up at 3 and 6 months. Qualitative interviews were conducted with 43 participants across levels. In INDIGO Local, knowledge score increased from 20.43 (95% CI: 20.0-20.9) at pre-training to 25.11 (95% CI: 23.83-26.17) at six months. In INDIGO Primary, the intended behavior increased from 16.67 (95% CI: 14.73-19.27) at pre-training to 18.88 (95% CI: 17.69-20.31) at post-training, while SDS mean score decreased from 39.26 to 20.62. The PCP's helpful behavior increased, and harmful behavior decreased. The knowledge and OSCE mean score in INDIGO READ-MH increased from 12.67 (95% CI: 10.36 -14.97) at baseline to 14.67 (95% CI: 13.28-16.05) at the post-training and from 2 (95% CI: 1.62-2.38) at pre-training to 9 (95% CI: 7.56-10.44) at post- training, respectively. The ASTAD subscale increased at three months, except for motivation and work satisfaction, which decreased at post-training. Qualitative data highlighted the positive attitudinal shift following the interventions, with strong emphasis on PWLE involvement. Overall, the providers perceived the training as feasible and appropriate within Nepal's health system. However, whilst they reported more positive perceptions towards persons with mental health conditions following the interventions, they also identified barriers to effective mental health care, such as insufficient availability of medicines, limited human resources, or separate counseling rooms.

PMID:
42709747
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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