Community Ment Health J (2017) 53:257–265
DOI 10.1007/s10597-016-0016-4
ORIGInAL PApER
Decreasing the Stigma of Mental Illness Through a Student-Nurse
Mentoring Program: A Qualitative Study
J. Konadu Fokuo1 · Virginia Goldrick2 · Jeanette Rossetti3 · Carol Wahlstrom3 ·
Carla Kocurek1 · Jonathon Larson1 · Patrick Corrigan1
Received: 2 May 2015 / Accepted: 19 May 2016 / Published online: 1 June 2016
© Springer Science+Business Media New York 2016
Abstract  Stigma is defined as endorsing prejudicial atti-
tudes about mental illness leading to discriminatory behav-
iors. It undermines the quality of medical care received
by people with mental illness. Research suggests contact
based interventions are effective in reducing stigma and
increasing positive attitudes towards people with mental ill-
ness. This paper describes the development of a consumer
led student-nurse mentoring program as part of nursing
student education. People with lived mental health experi-
ence would mentor student nurses regarding the harmful
effects of stigma and the beneficial outcomes of affirming
J. Konadu Fokuo
jfokuo@hawk.iit.edu
Virginia Goldrick
virginia.goldrick@illinois.gov
Jeanette Rossetti
rossetti@niu.edu
Carol Wahlstrom
cwahlstrom@niu.edu
Carla Kocurek
ckundert@hawk.iit.edu
Jonathon Larson
larsonjon@iit.edu
Patrick Corrigan
corrigan@iit.edu
1 Pinfold et al. 2005) and health related trainees (Aggarwal
Illinois Institute of Technology, 3424 S. State Street,
Chicago, IL 60616, USA
2 Happell 2009; Kassam et al. 2011) are among the most stig-
Office of Consumer Affairs, Illinois Division of Mental
Health, Chicago Read Mental Center, 4200 N Oak Park Ave,
Chicago, IL 60634, USA
3
Northern Illinois University, 1240 Normal Rd., Dekalb,
IL 60115, USA
attitudes. Seventy members of stakeholder groups (people
with lived mental health experience and student nurses)
participated in focus groups. Qualitative analyses revealed
themes across stakeholder groups regarding: perceived
mental health stigma from nurses, ways to reduce stigma,
target message for the mentorship program, characteristics
of mentors and logistics in developing such a program
within the student nurse curricula.
Keywords  Discrimination · Mental illness · Nursing
students · Contact based program · Stigma
Stigma prevents many people with mental illness from
achieving life goals in areas as vocation, independent liv-
ing, relationships, and health (Arboleda-Flórez and Sarto-
rius 2008). Stigma has been defined as endorsing prejudicial
attitudes about mental illness leading to discriminatory
behaviors. Unfortunately health care providers often
endorse these attitudes (Jones et al. 2008; Thornicroft et
al. 2007) undermining their quality of service (Druss et al.
2000a, b; Koroukian et al. 2012; Sullivan et al. 2006). One
vignette study showed health care providers who endorsed
stigmatizing attitudes about people with mental illness were
less likely to believe patients in a vignette would adhere to
prescriptions and hence less likely to refer them to a spe-
cialists or refill medications (Corrigan et al. 2014). In fact,
research suggests medical providers (Holzinger et al. 2003;
2012; Aker et al. 2007; Economou et al. 2012; Gough and
matizing of professionals.
Research done on erasing the public stigma of men-
tal illness distinguishes two kinds of strategies: education
(contrasting the myths of mental illness from the facts)
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and contact (interactions with people telling their stories of
recovery). Two independent meta-analyses of the strategies
found education and contact both yield positive benefits
(Corrigan et al. 2012; Griffiths et al. 2014). The meta-anal-
ysis by Corrigan et al. (2012) showed contact had signifi-
cantly greater effects than education alone, in fact, almost
twice the effect of education. Reducing stigma is not suffi-
cient in these efforts; programs also need to promote affirm-
ing attitudes like recovery and self-determination (Corrigan
et al. 2013). Personal goals are pursued and realized only
through support based on a recovery-oriented system
(Davidson et al. 2005).
Mixed methods research has begun to identify active
ingredients of effective contact-based programs (Corri-
gan et al. 2013, 2014). Two are especially important here:
targeted and continuous. Advocates argue that targeting
younger people might be a way to forestall stigma by pre-
venting stigmatizing attitudes and behaviors from being
learned in the first place. Hence, students in the professions
are logical targets for contact programs. Moreover, targeting
suggests messages represent the specific beliefs and behav-
iors of the group. This means understanding the stigma that
undermines services as well as the affirming attitudes and
behaviors that help promote recovery and self-determina-
tion. Nursing students developing a sense of professional
identity and direction are an important audience for efforts
to change stigma (Sercu et al. 2015; Ross and Goldner
2009). Research has attempted to change stigma among
nursing students using education (Sadow et al. 2002) and
contact (Sadow and Ryder 2008; Papish et al. 2013). How-
ever, these studies were mostly of convenience and lacked
effective stigma change models for student nurses.
Consistent with earlier research (Corrigan et al. 2013,
2014), we believed a student-nurse mentoring program
would be effective to tackle stigma and promote affirming
attitudes. People with lived experience would mentor student
nurses regarding the harmful effects of stigma and benefi-
cial outcomes to affirming attitudes. Mentoring is especially
innovative because it provides an alternative to the tradi-
tional relationship where a nurse helps a consumer. This
paper reviews qualitative research meant to identify compo-
nents of this kind of mentoring program. In particular, targets
of the message, characteristics of the mentor, and logistics of
the program are sought through focus groups with key stake-
holders: people with lived experience and nursing students.
Methods
This work was done as community based participatory
research (CBPR); CBPR is an approach to science that
believes research on groups is more valid when professional
researchers partner with stakeholders of that group (Kidd
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Community Ment Health J (2017) 53:257–265
and Kral 2005; Lewin 1946; Minkler and Wallerstein 2008).
Hence, we assembled a CBPR team of two groups: people
with lived experience with mental illness (n = 2) and nurses.
The nurse group was further divided into current providers
(n = 2) and nursing students (n = 2). Combining nurses and
people with lived experience as peers made for an especially
dynamic group. As partners, stakeholders and researchers
have ongoing, shared leadership roles in all elements of
design and implementation: defining research questions and
subsequent hypotheses, developing interventions meant to
reflect hypotheses, describing measures and designs that will
test interventions, conducting statistical analyses to make
sense of data collected per design, and interpreting findings
leading to recommendations with public health significance.
Stakeholders who are members of the CBPR team have
especially noticeable roles “going into” and “coming out”
of discrete research projects. At start-up—going into a proj-
ect—stakeholders have special insight that forms the key
research questions and corresponding hypotheses. This
ground work is central to subsequent design and measure-
ment decisions. The end of a project—coming out—is when
information from research is used to impact the public health
arena. At the start-up phase of the project, the CBPR team
was charged with collecting qualitative data. The CBPR
team had two tasks addressing the goals of this study. First,
they developed the interview guide that framed focus group
activities. After consensual discussion, the interview guide
queried the following areas.
●● Perceptions about nurse-consumer relationships;
●● Nature of stigma and discrimination between groups;
●● Strategies for decreasing stigma and promoting
affirmation;
●● Potential for mentoring program; and
●● Logistics of the program.
Next, the CBPR team broadly defined populations to be
recruited for focus groups as well as strategies to accomplish
recruitment. Time and place for group meetings were deter-
mined as well as flyers to advertise for focus group partici-
pants. The authors have no conflicts of interest to disclose
and certify responsibility for the content of this manuscript.
All activities for this project were reviewed and approved
by Institutional Review Boards at the Illinois Institute of
Technology and Northern Illinois University.
Results
Focus groups were convened with 70 individuals (51 peo-
ple with lived experience and 19 student nurses). Each
group was comprised of 6 to 10 participants and lasted
from 60 to 90 min. A scribe attended groups and took copi-
ous notes including verbatim quotes. Focus groups were
Community Ment Health J (2017) 53:257–265
Table 1  Perceptions of nurse-
consumer interactions from
people with lived experiences,
practicing nurses, and nursing
students
homogeneous, made up solely of people with lived expe-
rience or student nurses. Race demographics within the
people with lived experience focus group showed 81.6 %
of participants endorsing African American as either their
sole self-identified race or in combination with another race;
259
People with lived experience Nursing students
Positive with nurses in general Nurses in general
  Promotes relationships   Interactions
    Supportive     Need better communication skills
    Able to relate to me     Less stigmatizing language
  Promotes recovery     Better appreciation of holistic approaches
    Empowering   Attitudes
    Hopeful     Disrespectful
  Fosters good practice     Judgmental
    Able to explain medications     Overgeneralizes
    Helps adhere to prescriptions More senior nurses
    Bridge to doctors   Interactions
Negative with nurses in general     Need better communication skills
  Undermines relationships     Less stigmatizing language
    Poor communication skills     Stop offensive language
    Poor etiquette     Lack warmth and sensitivity
    Judgmental   Attitudes
    Scared     Jaded
    Unwilling to relate     Judgmental
  Dismissive Psychiatric nurses
    Authoritarian   Less stigmatizing language
    Patronizing   Specialized training
  Rude   More experience with this population
    Ill-tempered
    Stigmatizing
  Wrong goals
    Pill pusher
    Stifles personal growth
    Symptom focused
With psychiatric nurses
  Promotes interactions
    Compassionate
    Patient
    Personable
  Professionally skilled
    Attentive to wellness
    Intuitive to mental illness
    Helpful with activities of daily living
    Able to de-escalate situations
With student nurses
  Positive
    Willing to listen
    More interactive
    Better understanding and empathy
    More hopeful
    Less burned out
  Negative
    Scared and stigmatizing
    Lack knowledge
    Patronizing
    Judgmental less burned out
  Neutral
    Quiet
    Aloof
    Hands off
    Level of expertise unclear
    Ask a lot of questions
60.8 % were female. The student nurses were a bit more eth-
nically diverse (52.6 % European American; 42.1 % Asian
American); 94.7 % were female.
Overall themes were gleaned from transcripts of focus
groups using a grounded theory approach to qualitative
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Table 2  Strategies that will diminish stigma to enhance nurse-con- self-determination as they struggle with mental health chal-
sumer relationships lenges. Third, positive exchanges reflect good practice;
People with lived experience Nursing students “they [nurses] can help you when the doctor doesn’t have
time.” Effective nurses are able to: explain medication, help
Values focus Individual-focused
  Compassion   Direct interactions the person “adhere” to prescriptions, and essentially act as a
  Empathy with consumers bridge to the doctor.
  Counter prejudice   Build real People with lived experience also identified four themes
  Empowerment relationships reflecting negative interactions with nurses in general
  Recovery   Sensitive skills
Teach relationship-building skills   Students experience including qualities that undermine relationships. First, some
  Active listening symptoms in con- nurses have poor communication skills and can even be
  Therapeutic communication trolled environment rude. “They [nurses] ‘talk-down’ to you when they know
Teach professional skills Profession-focused you have a mental illness.” Poor communication skills were
  Medication management   Promote advocacy
  Mental health system navigation among nurses also manifested by some nurses as being dismissive. “Some
Diversity   Promote patient- nurses won’t listen to you [the consumer] unless they are
  Individual differences centered care talking to you about meds.” Second, the nurse-mental health
  Cultural uniqueness   Provide ethical care consumer relationship can be demeaning. Nurse attitudes
Timing   Complete psychiatry
  During student training rotations were also perceived by people with lived experience as vac-
  Continuing education illating between being authoritarian, “always telling you
what you should do or how you should feel”, or medically
patronizing, seemingly reducing all medical experiences to
analysis (Strauss and Corbin 1998). Open coding by inde- mental health related. For example one participant recounted
pendent raters yielded more than 70 discrete themes sug- an incident where she went to the emergency room due to
gesting saturation was approached after eight focus groups. abdominal pain, “the nurses once they knew what medica-
A summary of themes and concepts was then provided to tion I take, kept telling me the pain was all in my head. But
the CBPR team for feedback. The CBPR team contrasted it was my appendix.” Third, their rudeness can appear as
themes by stakeholder group: people with lived experi- being ill-tempered, especially when they seem to be under
ence, practicing nurses, and nursing students. Information time pressures. “They yell at you all the time in the emer-
in Tables 1, 2 and 3 represents responses grouped into three gency room; like it’s your fault you’re sick and they have to
categories that correspond with the goals of the study: per- work!” Finally, some nurses guide towards goals that differ
ceived interactions between consumers and nurses includ- from that of the consumer. “They are pill pushers, always
ing (1) feedback on stigmatizing and affirming attitudes that talking about meds. I told one nurse my meds were mak-
underlie these interactions, (2) general direction for replac- ing me dizzy, she shut me down and told me to keep taking
ing stigmatizing interactions with affirming exchanges, and them if I want to get better. So I just stopped taking the meds
(3) specific recommendations about content and logistics of altogether.” Being symptom and medication-focused stifles
a mentor program for nursing students. personal growth.
People with lived experience expanded on interactions
Consumer and Nurse Interactions by providing a list of qualities that suggest good exchange
with psychiatric nurses: compassion and patience. “Some
Table  1 summarizes responses about nurse-consumer nurses can be very nice and helpful. They’ll ask you how
exchanges by group. This is important information because you’re doing, if anything has changed in your life, and only
it suggests the “dos” and “don’ts” that might form the con- then ask about the meds.” Nurses who are professionally
tent of the mentoring program. People with lived experience trained in effective communication skills also promote
summarized impressions of nurses in general, psychiatric quality interactions. Nurses who are “intuitive about mental
nurses, and nursing students. Three positive themes emerged illness” and who promote wellness, by talking to consum-
about interactions with nurses in general. First, people with ers about “diet and exercise,” are important. Helping with
lived experiences identified qualities that promote relation- activities of daily living and being able to de-escalate situa-
ships: “When a nurse takes the time to listen to you—really tions were also acknowledged.
listen to you—most times it’s better than whatever medicine Finally, people with lived experience noted positive qual-
they are trying to force you to take.” Second, exchanges ities of nursing students that enhance a consumer’s perspec-
need to promote recovery and be hopeful; “it doesn’t help tive of them. Nursing students were valued when they were
when all they [nurses] do is talk about how sick you are. more interactive with consumers, wanting to listen to them.
They should talk about you getting better.” Recovery-based Nursing students were viewed as more hopeful because
exchanges are empowering, and encourage a person’s they may be less burned out. Positive perspectives were

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Table 3  Content and logistics of a nursing-student consumer mentor program

People with lived experience Nursing students
Content Content
  Compassion   Expectations of nurses
  Communication skills   Teach about disorders: symptoms,
  Learn: “I am a person.” Understand mental illness in relation to other contexts: rage, gender, etc course, recovery
  Teach recovery   Explain effective treatments
Activities Activities
  Shadow activities of daily living   Shadow activities of daily living
Logistics   Experiencing stigma with mentors
  When (time, frequency, and length) Logistics
    Frequency: Responses varied from weekly to monthly or to be decided by mentor/student   When (time, frequency, and length)
    Duration: Responses varied from 6 weeks to a year or to be decided by mentor/student     Frequency: Responses varied from 1 to
  Where 3 times weekly to every 2 weeks or to
    On versus off ward be decided by mentor/student
    Off ward?     Duration: entire rotation, three times
      Office, school, clinic per rotation, 8 weeks, or to be
      Casual but public (Starbucks) decided by mentor/student
      Mentor’s home   Where
      To be decided by mentor/student     On versus off ward
  Group and boundaries     Off ward?
    Size varies from one-on-one pairing to one mentor and multiple students to small group with       Office, school, clinic
multiple mentors       Casual but public (Starbucks)
    Mentors vary over the course of program       Phone
    Determine limits to relationship       To be decided by mentor/student
    Define confidentiality   Group and boundaries
    Require mutual respect     Size varies from one-on-one pairing to
Other structural concerns one mentor and multiple students to
  Insights about students small group with multiple mentors
  Overview of their training Other structural concerns
  Supervise mentor pairs   First meeting as group of all students
  Matching system: mentors and students with ice breaker
  Grade students (and mentors?)   Try to match mentor and students
  Pay mentors   Mentors and students should not change
Characteristics of mentors over course of program
  Recovery status   Matching system: mentors and students
    Need to be stable   Grade students (and mentors?)
    Recovery for a long time versus   Poster session at end
    Beginning of recovery process   Allow for student feedback (or mentors
  Lived experience and of program)
    Knowledge of mental health system   Manualize program
    Employed Characteristics of mentors
    No educational requirement   Lived experience
  Qualities     Be in recovery with serious mental
    Insightful illness
    Patient     Employed
    Mature and responsible   Qualities
    Honest     Insightful
    Willing to share story     Open to questions
  Skills     Willing to share story
    Good communication skills   Skills
    Good communication skills

countered by some concerns that undermine relationships.
Some nursing students seem scared of consumers, “they
always look scared in the psych ward!” Perhaps because
they [student nurses] believed stigmatizing beliefs about
mental illness. Students often lacked knowledge about men-
tal illness and treatment which, like nurses in general, led
them to be patronizing and judgmental. People with lived
experience also identified a “neutral” kind of relationship
with students. Within this “neutral” standing, nursing stu-
dents are perceived as quiet and aloof, not necessarily in a
negative way but shy, perhaps reflecting a lack of expertise.
Some nursing students ask a lot of questions while others
are more hands off.
Perspectives of people with lived experiences are
rounded out by those of student nurses (the right column
of Table  1). Students summarized their views in terms of

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nurses in general, more senior nurses (“older” nurses or
those practicing for “a while”), and peers. Perhaps because
of the nature of the questions, nursing students were mostly
critical in their responses. They identified several needs to
improve qualities of interactions between nurses in general
and consumers. Practicing nurses need to improve their
communication skills, especially being mindful of stigma-
tizing language. Student often mentioned older nurses call-
ing consumers “crazy, attention seeking, and annoying.”
Students thought better appreciation of holistic approaches
would smooth interactions. Students also identified attitudes
that undermine relationships: disrespect, overgeneraliza-
tion—“if a patient comes in with a history of mental illness,
a nurse will usually come tell you to be careful around that
patient because they might hurt you”—and judgmentalism.
Nursing students expressed similar concerns about senior
nurses. They believed more warmth and less stigmatizing
language was needed. They recommended replacing a sense
of being jaded and judgmental with a commitment to rela-
tionship. Students believed to improve the overall quality of
the nurse-consumer relationship would be to have special-
ized training and prior experience with people with serious
mental illness while in training.
Review of the quality of interactions led to questions
about why nursing students might pursue a career in psychi-
atric services. They identified several benefits of this voca-
tion. Pros included: less physically demanding; personal
desire to work with that population; slower pace; personal
experience; and greater use of essential “soft” skills (e.g.,
therapeutic communication). They also identified several
concerns, issues that might be the focus of the mentoring
program. They were concerned about burnout due to the
“overwhelming stress” that accompanies work in mental
health programs. They were concerned with perceptions
of psychiatric nursing not being “real” nursing; that it has
lesser status in the field. They wondered whether psychiatric
nursing requires skill sets that differ from the focus of their
training.
Replacing Stigmatizing Exchanges with Affirming
Interactions
Focus group participants were next asked ways to decrease
stigma in order to promote nurse-consumer relationships.
The goal here was to begin a list of broad strategies, some
which might be incorporated into the mentoring program.
Responses are sorted in Table  2 by stakeholder group.
People with lived experience were rich in their ideas; we
grouped them into five themes. Respondents thought anti-
stigma, pro-relationship programs should be (1) values
based, (2) teaching relationship skills, (3) teaching pro-
fessional skills, and (4) diverse. People with lived experi-
ence also said these kinds of program should (5) consider
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timing of these strategies. Important values include compas-
sion and empathy meant to counter prejudice and promote
recovery and empowerment. Relationship building skills
should include active listening and therapeutic communi-
cation while professional skills should include medication
management and navigation of the mental health system.
Diversity issues have a double meaning; first, as individu-
als we all differ from each other and should be recognized
as unique persons. Second, there are important subgroups
within our society which need to be considered within nurs-
ing education programs including people who differ in
terms of color, gender, sexual orientation, and SES. People
with lived experience wisely noted efforts should vary in
terms of timing. Stigma-busting and relationship promoting
programs are important during student training and continu-
ing education.
Student nurses’ distinguished anti-stigma approaches into
those that are individual (nurse)-focused and profession-ori-
ented. Those focused on individual nursing skills include
direct interactions with consumers to improve sensitivity
skills that build “real” relationships. Interestingly, students
wondered whether experiencing symptoms in controlled
environments might also decrease stigma: “To help with
empathy maybe we can try the 3D simulations on rotation or
something so that we have an idea of what people are expe-
riencing.” Student nurses also made several stigma-busting
suggestions that are profession-focused. Efforts should pro-
mote person-centered care that includes fundamental ethical
concerns. All student nurses should be required to complete
psychiatry rotations. Student nurses should be encouraged
to adopt advocacy roles.
Mentoring Student Nurses
We proposed replacing stigma with affirming attitudes
among student nurses through program where they are men-
tored by people with lived experience. Generally, the two
stakeholder groups endorsed the idea of mentors with lived
experience for student nurses, though practicing nurses
tempered the excitement wondering whether it might be
too lofty a goal. The three stakeholder groups were rich in
responses focus and are summarized in terms of five consid-
erations: content, activities, logistics, other structural con-
cerns, and characteristics of mentors; Table  3 summarizes
these responses.
Content and Activities
The mentor curriculum was divided into content—concep-
tual ideas that need to be addressed—and activities, get-
up-out-of-the-chair approaches to learning the core of the
program. People with lived experience believed compas-
sion should be central to content. Student nurses need to
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learn that people with mental illness are people, and that
recovery is the rule not the exception to their illness. Mental
illness varies by diversity issues so students need to under-
stand how gender, ethnicity, and other factors impact a per-
son’s choices. Fundamental to this are basic communication
skills, especially how to listen to the person with lived expe-
rience. Student nurses said content of the program should
teach students about symptoms and recovery, grounding the
discussion in effective treatments. Students also thought it
important to make sure expectations of peers reflected the
hope of recovery. People with lived experience and student
nurses agreed shadowing exercises would be important,
especially regarding the “ordinary” such as activities of
daily living. They also thought it useful to actually experi-
ence stigma with their mentors: “The student should go to
an activity or a place the mentor feels judged by their mental
illness and allow the student the opportunity to experience
the stigma.”
Logistics
Stakeholders provided specific recommendations regarding
when, where, and the form of the interactions. Recommen-
dations for meetings varied in frequency from once or twice
weekly to monthly. Duration of the program varied from 6
weeks to an entire clinical rotation. Some students and peo-
ple with lived experience thought frequency and duration
might be a decision made by the student-mentor pair. Stake-
holders varied whether the program should be conducted on
or off the ward, though most people thought off ward would
be best. Most respondents thought meetings should be con-
ducted in some kind of casual place: e.g., Starbucks or the
common area of the nursing school.
Respondents made several recommendations about rela-
tionships and boundaries. Recommendations regarding
mentor-student ratio varied, with some believing one men-
tor to one student might be best. Others thought multiple
students for one mentor might provide some value, giving
nursing students a chance to learn from each other. S ome
thought mentor pairs would be less stressful for individual
mentors. People with lived experience thought mentors
might be mixed up with students pairing during the course
of the program, exposing nurses to different people and their
stories. They also thought boundaries between nursing stu-
dents and mentors need to be clearly delineated, that expec-
tations regarding content and activities paralleled program
curriculum. This includes discussion and agreement regard-
ing confidentiality of issues that emerge during the program.
Other Structural Concerns
Everyone said nursing students should be graded for their
effort; some respondents thought mentors should receive
263
some form of evaluation too. People with lived experi-
ence thought someone should be supervising the mentor-
nursing student pairs during the course of the program.
They believed mentors should have some insights about the
student(s) with whom they are paired: perhaps some infor-
mation about nursing students’ background prior to meet-
ings. People with lived experience also encouraged some
kind of matching system where mentors and students were
picked in ways that complement each other. People with
lived experience thought mentors should be paid for their
work.
Student nurses believed matching mentor and students
might be wise. They also thought the pair should not
change over the course of the program; same mentor(s)
and student(s) throughout. Students believed a meeting of
all mentors and students would be a nice way to start the
program, providing ice breakers as well as making the mis-
sion of the program clear. Students also wondered whether
a group of the whole might be an effective way to end the
project too, perhaps with students doing poster sessions
regarding their learned experience with their mentors.
Mentor Characteristics
Respondents provided feedback on mentors in three areas:
lived experience, qualities, and skills. Everyone agreed
that the mentor should be in recovery, though where in the
process could vary between people who have overcome
their illness versus those new to recovery but hopeful and
personally achieving. Some respondents believed mentors
might be gainfully employed, though no educational crite-
ria should be used in selecting people. Good mentors have
several qualities. They should be willing to share their story
honestly, being insightful in the process. Good mentors are
patient, mature, and open to questions. Good communica-
tion skills are important.
Discussion
Stigma undermines the relationships some nurses have with
consumers of mental health services. Results of this study
showed some commonalities on this assertion across stake-
holder groups. Some nurses seem to be afraid of people with
mental illness, leading them to be dismissive, patronizing
and authoritarian. Stakeholders also identified qualities that
promote relationships. Supportive demeanor rooted in good
communication skills is fundamental. Embracing values of
recovery and wellness are essential. The good nurse, so said
many participants with lived experience, is compassionate,
patient, and personable. Stakeholders provided a variety of
solutions to overcome stigma and booster nurse-consumer
interactions. Listening skills and pro-recovery attitudes
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were prominent. Admittedly, the goal of this project was to
examine the form and putative impact of a nursing student
mentoring program. Hence, the lion’s share of feedback on
erasing stigma and promoting affirming attitudes focused on
this kind of mentoring program. Comments were both deep
and broad.
Program content should reflect the recurring theme of
good communication skills, pro-recovery vision, and com-
passion. Activities should be hands on and mostly in a place
that promotes “everydayness” such as casual public places
like Starbucks. The focus should be on activities of daily
living as much as on symptoms. Opinions about frequency
varied though there seemed to be some consensus to once
or twice weekly during a semester (which, by the way, fits
nicely into a university format). The mentoring program
should be rooted in the overall nursing curriculum, requiring
grades. Perhaps a start-up activity of the whole as well as a
final poster session would strategically cement the program.
A nursing faculty member should be assigned responsibility
and supervise the program; her or his tasks should be boosted
by a co-supervisor with lived experience. Characteristics of
good mentors including a history of lived experience that
has led to current recovery. Perhaps some matching system
could be developed to pair mentors and students. Ratio of
mentors and nurses—how many mentors should pair up with
how many students—will be influenced by considerations of
efficiency (how many nurses and mentors do we actually
have), group impact (might students learn from the experi-
ences of their peers) and mentor stress (might the program be
less demanding when mentors can rely on peers).
There are limits to the study. Absent from this report was
perspective of practicing nurses. We actually collected sur-
vey responses from four practicing nurses but decided not
to report them here partly because the sample was so small,
the method was different from focus groups, and psychiatric
nurses were not among them. Moreover, information from
nurse educators was not obtained. Future research needs to
obtain perspective of these groups.
The sample of student nurses and practicing nurses
lacked diversity in gender and ethnicity. Moreover, par-
ticipants were drawn from the Chicago area which limits
its generalizability to other areas of the country. Subse-
quent research with stakeholders from other areas might
add to the themes outlined in this paper. Finally, popular-
ity of themes is uncertain. Research participants noted, for
example, qualities of effective mentors. We were unable to
tell which of these qualities were viewed as most important
by the various stakeholder groups. A subsequent, quantita-
tive study with items reflecting these themes might provide
information about which of the various responses show con-
sensus within and across stakeholder groups. Moreover, a
sufficiently large sample will permit moderators to specific
judgments about program priorities.
13
Community Ment Health J (2017) 53:257–265
Information for the qualitative study is meant to inform
development of a consumer led anti-stigma mentoring pro-
gram. We believe the mentoring relationship will bolster
affirming attitudes and decrease stigmatizing beliefs within
nursing students. The addition of a mentoring relationship
creates a unique contact based intervention that can be used
across varying health related disciplines. As a next step, the
CBPR team crafted a program manual and workbook out-
lining the nature and logistics of interactions between men-
tors and student nurses. This was an iterative process with
the various stakeholder groups exchanging drafts as they
emerge. We are currently completing a pilot study examining
feasibility and impact of the program. Impact will include
measures of stigma, relationship, and affirming attitudes.
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