BACKGROUND: We aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma. METHODS: We analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias. RESULTS: The 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 (B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes (B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems. CONCLUSIONS: Mental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.

Care Policy and Evaluation Centre London School of Economics London United Kingdom

Department of Psychiatry Faculty of Medicine in Pilsen Charles University Prague Czechia

Department of Public Mental Health National Institute of Mental Health Klecany Czechia

EpiCentre Department of Psychiatry University of Cambridge Cambridge United Kingdom

Health Service and Population Research Department Institute of Psychiatry Psychology and Neuroscience King's College London London United Kingdom

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Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, et al.A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4:634–42. PubMed

Evans-Lacko S, Courtin E, Fiorillo A, Knapp M, Luciano M, Park AL, et al.The state of the art in European research on reducing social exclusion and stigma related to mental health: a systematic mapping of the literature. Eur Psychiatry. 2014;29:381–9. PubMed

Schomerus G, Matschinger H, Kenzin D, Breier P, Angermeyer MC. Public attitudes towards mental patients: a comparison between Novosibirsk, Bratislava and German cities. Eur Psychiatry. 2006;21:436–41. PubMed

Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, et al.Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord. 2013;150:320–9. PubMed

Winkler P, Csemy L, Janouskova M, Mlada K, Motlova LB, Evans-Lacko S.Reported and intended behaviour towards those with mental health problems in the Czech Republic and England. Eur Psychiatry. 2015;30:801–6. PubMed

Winkler P, Mladá K, Janoušková M, Weissová A, Tušková E, Csémy L, et al.Attitudes towards the people with mental illness: comparison between Czech medical doctors and general population. Soc Psychiatry Psychiatr Epidemiol. 2016;51:1265–73. PubMed

Letovancová K, Kovalčíková N, Dobríková P.Attitude of society towards people with mental illness: the result of national survey of the Slovak population. Int J Soc Psychiatry. 2017;63:255–60. PubMed

Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, Group IS. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009;373:408–15. PubMed

Corker EA, Beldie A, Brain C, Jakovljevic M, Jarema M, Karamustafalioglu O, et al.Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: the FEDORA project. Int J Soc Psychiatry. 2015;61:438–45. PubMed

Krajewski C, Burazeri G, Brand H.Self-stigma, perceived discrimination and empowerment among people with a mental illness in six countries: Pan European stigma study. Psychiatry Res. 2013;210:1136–46. PubMed

Aliev A-A, Roberts T, Magzumova S, Panteleeva L, Yeshimbetova S, Krupchanka D, et al.Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia. Soc Psychiatry Psychiatr Epidemiol. 2021;56:1329–40. PubMed

Höschl C, Winkler P, Peěč O.The state of psychiatry in the Czech Republic. Int Rev Psychiatry. 2012;24:278–85. PubMed

Pec O. Mental health reforms in the Czech Republic. BJPsych International. 2019;16:4–6. PubMed PMC

Winkler P, Mladá K, Krupchanka D, Agius M, Ray MK, Höschl C.Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012. Schizophr Res. 2016;175:180–5. PubMed

Winkler P, Koeser L, Kondrátová L, Broulíková HM, Páv M, Kališová L, et al.Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry. 2018;5:1023–31. PubMed

Winkler P, Broulíková HM, Kondrátová L, Knapp M, Arteel P, Boyer P, et al.Value of schizophrenia treatment II: decision modelling for developing early detection and early intervention services in the Czech Republic. Eur Psychiatry. 2018;53:116–22. PubMed

Winkler P, Kondrátová L, Kagstrom A, Kučera M, Palánová T, Salomonová M, et al.Adherence to the convention on the rights of people with disabilities in Czech psychiatric hospitals: a nationwide evaluation study. Health Hum Rights. 2020;22:21. PubMed PMC

Janoušková M, Formánek T, Bražinová A, Mílek P, Alexová A, Winkler P, et al.Attitudes towards people with mental illness and low interest in psychiatry among medical students in central and eastern Europe. Psychiatry Q. 2020;92:407–18. PubMed

Alexová A, Kågström A, Winkler P, Kondrátová L, Janoušková M.Correlates of internalized stigma levels in people with psychosis in the Czech Republic. Int J Soc Psychiatry. 2019;65:347–53. PubMed

Krupchanka D, Chrtková D, Vítková M, Munzel D, Čihařová M, Růžičková T, et al.Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic. Soc Sci Med. 2018;212:129–35. PubMed

MHCZ. Strategy of mental health care reform. Prague, Czech Republic: Ministry of Health; 2013.

Saxena S, Thornicroft G, Knapp M, Whiteford H.Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370:878–89. PubMed

Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al.The Lancet Commission on global mental health and sustainable development. Lancet. 2018;392:1553–98. PubMed

Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophr Bull. 1981;7:225–40. PubMed

Rüsch N, Evans-Lacko SE, Henderson C, Flach C, Thornicroft G.Knowledge and attitudes as predictors of intentions to seek help for and disclose a mental illness. Psychiatr Serv. 2011;62:675–8. PubMed

Evans-Lacko S, Henderson C, Thornicroft G. Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009–2012. Br J Psychiatry. 2013;55:s51–7. PubMed

Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al.Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci. 2011;20:263–71. PubMed

Holmes EP, Corrigan PW, Williams P, Canar J, Kubiak MA. Changing attitudes about schizophrenia. Schizophr Bull. 1999;25:447–56. PubMed

Evans-Lacko S, Corker E, Williams P, Henderson C, Thornicroft G.Effect of the time to change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003–13: an analysis of survey data. Lancet Psychiatry. 2014;1:121–8. PubMed

Hansson L, Stjernswärd S, Svensson B.Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009–2014: an evaluation of a national antistigma programme. Acta Psychiatr Scand. 2016;134:71–9. PubMed

Bratbo J, Vedelsby AK. ONE OF US: the national campaign for anti-stigma in Denmark. In: The stigma of mental illness-end of the story?. Cham: Springer; 2017, p. 317–38.

Campos L, Dias P, Duarte A, Veiga E, Dias CC, Palha F. Is it possible to “find space for mental health” in young people? Effectiveness of a school-based mental health literacy promotion program. Int J Environ Res Public Health. 2018;15:1426. PubMed PMC

Jorm AF, Jorm AF, Christensen H, Griffiths KM, Jorm AF, Christensen H, et al.The impact of beyondblue: the national depression initiative on the Australian public’s recognition of depression and beliefs about treatments. Aust N Z J Psychiatry. 2005;39:248–54. PubMed

Thornicroft C, Wyllie A, Thornicroft G, Mehta N. Impact of the “like minds, like mine” anti-stigma and discrimination campaign in New Zealand on anticipated and experienced discrimination. Aust N Z J Psychiatry. 2014;48:360–70. PubMed

Reavley NJ, Jorm AF. Stigmatising attitudes towards people with mental disorders: changes in Australia over 8 years. Psychiatry Res. 2012;197:302–6. PubMed

Stuart H, Chen SP, Christie R, Dobson K, Kirsh B, Knaak S, Koller M, Krupa T, Lauria-Horner B, Luong D, Modgill G.Opening minds in Canada: targeting change. Can J Psychiatr. 2014;59(1_suppl):13–8. PubMed PMC

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Methods and tools to assess implementation of mental health policies and plans: A systematic review