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Sapphire research programme

Sapphire research programme

 Research programme on mental health-related stigma and discrimination.

SAPPHIRE was a five year research programme on mental health-related stigma and discrimination.

It focused mainly on three areas:

  • Access to mental healthcare
  • How physical health care is provided
  • Employment

Our programme of research studies led to the production of: best available evidence on population education regarding stigma and discrimination; legal requirements on disclosing psychiatric history; a decision-aid on job applications; DVDs for training courses; and four standardised scales to assess the impact of discrimination and associated financial costs.

Here you will find summaries of independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1053). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The Sapphire team also acknowledges the support of the Mental Health Research Network which assisted with a number of the SAPPHIRE studies.

Why was the research carried out?

Stigma and discrimination have been described by many people with mental illness as more disabling than the illness itself. Our research concurs with this experience, and shows that stigma and discrimination faced by people with mental illness is frequent and often severe, adversely affecting health outcomes by impairing: (i) help seeking and access to healthcare, (ii) the provision of physical and mental healthcare, and (iii) participation in employment, which for many is a critical aspect of recovery from mental illness.

How was the research undertaken?

The research comprised an inter-related portfolio of methodological studies; analytical studies; intervention studies and knowledge transfer actions.

Sapphire projects

Methodological studies: This work developed four standardised outcome measures relating to stigma and discrimination. We undertook further validation of the Discrimination and Stigma Scale (DISC) to assess experiences of discrimination and created a new measure, the Questionnaire on Anticipated Discrimination (QUAD) scale. We also established the psychometric properties of the scale of clinicians’ attitudes to people with mental illness (MICA) to assess views of health and social care staff about providing mental and physical healthcare to people with mental illness, and created a new scale to measure the financial costs associated with stigma and discrimination (CODA).

Analytical studies: We conducted analytical studies to better understand the nature of stigma and discrimination. A knowledge synthesis comprising of a Cochrane systematic review of mass media anti-stigma interventions (CREDO) and a consensus study on messages for anti-stigma campaigns (MOSAIC) was undertaken. The MIRIAD study compared discrimination in different diagnostic groups and by ethnicity, gender and age, and examined how this related to mental health help-seeking. A further analytical study (SPHERE) investigated care in Emergency Departments and developed understanding about diagnostic over-shadowing (the misattribution of physical illness to mental illness).

Intervention studies: The CORAL study continues the development and initial testing of a decision aid on disclosure of mental health status in job seeking, and examines the decisions of employers in relation to such disclosure. The Perspectives study compares live and filmed service user training materials to increase mental health awareness in a sample of nursing students, as forms of active ‘social contact’.

Knowledge transfer components: This included publication of findings to specialist and non-specialist audiences, production of a training material and dissimination of results at national and international conferences and using social media.

Where did it happen?

The research was primarily based at the Institute of Psychiatry and in the South London and Maudsley NHS Foundation Trust. Specific projects were in collaboration with other organisations detailed in the project sections.

Who was involved?

The Principal Investigator was Professor Graham Thornicroft, who worked with the SAPPHIRE research team and collaborators.

What was the timescale?

The Programme began in 2008 and ended in February 2014.

Find out more:

The information provided here and the papers and documents it has links to will provide a good overview of our work in the Sapphire programme. If you have any further queries please contact:

Professor Graham Thornicroft

Sapphire Summit

It was held on the 4th July 2013 as part of our knowledge transfer.


> News: IoP hosts major summit to challenge stigma and discrimination in mental health

> Programme of the summit

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