The Fight against Stigma: Multilevel Stigma Interventions in Schizophrenia Patients

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts. Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months. Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%. Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung. Significance for public health Schizophrenia is a chronic mental disorder that is closely related to stigmatization. Stigma and discrimination in patients with schizophrenia lead to poor medication adherence, leading to poor images and low self-esteem in patients. Also, stigma causes patients and families to be reluctant to seek medical treatment for their clinical conditions, so that stigma is closely related to the process of treating patients with schizophrenia. This study illustrates the effect of multilevel stigma interventions on decreasing stigmatization in people with schizophrenia. This study's results are expected to contribute to the provision of interventions to reduce stigmatization in schizophrenia patients throughout the scope of health care.