Ward features affecting stigma experiences in contemporary psychiatric hospitals: a multilevel study

Background Various studies have revealed the existence and negative consequences of stigmatization of persons receiving professional mental health care. Less attention is generally paid to factors affecting these stigma experiences. The influence of the immediate treatment context, especially, is largely neglected. Objective In this article, a multilevel design is used to explore the link between characteristics of the treatment context and stigma experiences, controlling for client characteristics. Method Data of 366 clients from 42 wards in psychiatric hospitals are used to investigate the relationship of individualized treatment, group atmosphere and ward size to selfrejection. Results The results reveal significant differences in self-rejection between the wards. Furthermore, they show that individualized treatment in a ward is related to less self-rejection, but only if it does not worsen the group atmosphere. A positive group atmosphere seems to reduce self-rejection. Finally, clients of larger wards report more self-rejection. Conclusion The connection between ward characteristics and stigma experiences has important research and policy implications. It brings together the domains of stigma research and mental health services research, which have mostly been developed on a separate basis. In terms of policy, this kind of study could highlight factors in the immediate treatment that could be changed to reduce stigma experiences for clients of mental health services