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Analytical studies

Mental Illness-Related Investigations on Discrimination: The MIRIAD Study

Foundation studies 

Two foundation studies have been conducted for the healthcare seeking arm of the main MIRIAD study:

  • The first is a systematic review on the impact of stigma on help-seeking. One hundred and fourty four relevant studies have been identified and synthesised. A paper has been submitted and has had revisions invited by Psychological Medicine.
  • The second is the development of the BACE scale, a 30-item measure to assess both barriers to accessing mental healthcare generally and those specifically linked to stigma and discrimination. The development and psychometric properties of the BACE has been published (Clement et al 2012). The Bace was shown to have acceptable psychometric properties and was used in the main MIRIAD study. The BACE scale is now available for use Main study 


This study aims to increase understanding about the nature and effects of discrimination and stigma experienced by people with mental health problems. Aims: The study will answer four main research questions: 

  1. To what extent do people anticipate and experience mental illness-based discrimination, and is this affected by their diagnosis, age, gender, social background and ethnicity?
  2. What impact do stigma and discrimination have on healthcare seeking and use of services?
  3. What are peoples' experiences of multiple discrimination (discrimination based on mental illness and on membership to another social group that is treated unfairly)?
  4. What are the economic costs of mental illness-based discrimination?  


Two hundred people who use community mental health services and have a diagnosis of a schizophrenia-related disorder, bipolar disorder or depression took part in this study. Black ethnicity was a focus as Black people are at particular risk of experiencing aversive pathways to mental health care. Consequently the sample was restricted to those from Black and White ethnic groups. Participants were interviewed over two settings. Additional data was collected from clinical records, and from the participant's main mental health professional. 

Progress to date and future plans:

We recruited and interviewed 202 people. We have submitted six papers on the MIRIAD findings to date. 


This video shows the findings of the MIRIAD study, titled Discrimination Firsthand.


Research by our team, such as the Perspectives study and Credo study has shown that hearing firsthand experiences can help to reduce stigma. Documenting experienced discrimination is also a vital foundation for discovering how best to approach changing society to put an end to mental health discrimination. In SAPPHIRE’s MIRIAD study we used our DISC scale to ask mental health service users about their experiences of discrimination (‘being treated unfairly’).

The video highlights how we present findings from our thematic analysis of the examples they gave for the main life areas where they reported discrimination. These are shown in the form of fictional statements and scenes.

> Download a copy of the fictional statements used in the video 


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