How Chinese psychiatrists see and manage stigmatisation of psychiatric patients: a qualitative study in Hong Kong

Background: Health professionals including psychiatrists were reported to have stigmatising opinions on psychiatric patients. Their views may be affected by clinical, social and cultural factors.

Objective: This study explored the views of Chinese psychiatrists on stigmatisation of psychiatric patients.

Methods: Focus group discussions with psychiatrists were conducted in Hong Kong. Their views towards stigmatisation of psychiatric patients and strategies to reduce stigmatisation were discussed.

Findings: The psychiatrists perceived the clinical needs to classify the patients according to the diagnoses and they did not see it as stigmatisation. They believed that some mental illnesses are characterised with violence or deviance, and were not completely curable. Instead of trying to eliminate stigma, they managed in ways that took social expectations into consideration. They might offer a relative vague diagnostic label to save the 'face' of the patients and secure greater acceptance for the illness from the public. They tended to accept family members to make decisions on behalf of the patients. Reconciling public interest and patients' autonomy, they encouraged stable psychotic patients to live in the community but agreed to institutionalise those patients with violent behaviours.

Conclusion: While the psychiatrists argued that the diagnosis was not a form of stigma, they were sensitive enough and framed responses to patients in ways to minimise stigma. They tended to believe that stigma was inevitable given the nature of some psychotic disorders. Disguising the stigma appeared to be the common approach to deal with stigma in a Chinese context.

Clinical implications: The psychiatrists, especially those practicing in a Chinese context, may consider a wider perspective of community mental health rehabilitation which is not limited to social stability but also social life.