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ForwardMGB AMC Morbidity & Mortality Series: November 10, 2026- Stigma
Stigma is a pervasive, modifiable driver of poor outcomes across serious mental illness and substance use disorders, operating at the individual, interpersonal, and structural levels. As McGinty and Barry describe, stigma is persistent and rooted in the belief that mental illness and addiction reflect a personal choice or moral failing, and rates of stigmatizing attitudes are high not only in the general public but within the health care professions themselves (McGinty and Barry, New England Journal of Medicine, 2020). This stigma is not only a matter of attitudes but also of outcomes: anticipated and internalized stigma can prevent a person from seeking help or engaging with treatment and lifesaving services such as harm reduction, while structural stigma contributes to underinvestment in high-quality treatment infrastructure and suboptimal care. Addressing stigma is not a secondary concern but a core determinant of whether patients reach, enter, and remain in effective care.
Stigma delays help-seeking and prolongs untreated illness. The barrier is most evident in the early days of interfacing with care. In the first systematic review of help-seeking in psychosis, synthesizing 19 studies and 9,686 participants, Skrobinska and colleagues found that people with psychosis consistently report stigma, poor mental health literacy, and lack of family support as key barriers to seeking help (Skrobinska et al., Psychology and Psychotherapy, 2024). Because a longer duration of untreated psychosis is associated with poorer healthcare outcomes and increased risk of relapse, these stigma-related delays translate directly into worse prognosis. The review's recommendation—assertive, culturally sensitive engagement targeted toward those with poor mental health literacy and limited social support—reframes stigma reduction as an active clinical strategy for shortening the path to treatment rather than a passive hope.
Stigma also undermines engagement and adherence once patients are in care. Even after treatment begins, personal stigma continues to negatively impact outcomes. In meta-analyses of personal stigma in psychosis drawing on 216 records, Eliasson and colleagues found that personal stigma was inversely related to medication adherence and positively associated with the number of hospitalizations, as well as with worse symptoms and diminished wellbeing (Eliasson et al., Clinical Psychology Review, 2021). Internalized stigma thus forms a self-reinforcing cycle: shame and anticipated discrimination discourage disclosure and adherence, which precipitates relapse and rehospitalization, which in turn deepens stigma. For this M&M conference and CME learning goals, these converging findings establish a clear teaching point—screening for and actively addressing stigma, strengthening mental health literacy, and engaging the family and support network are evidence-based levers for improving engagement, adherence, and ultimately survival across mental illness and substance use disorders.
Target Audience
This program is intended primarily for Psychiatrists; other allied staff, such as Psychologists, Physicians from other specialties, Nurses, Physician Assistants, Nurse Practitioners, and Social Workers, are welcome to attend.
Learning Objectives
Upon completion of the activity, participants will be able to:
-Describe the individual (internalized), interpersonal (anticipated), and structural levels of stigma toward mental illness and substance use, and understand how each acts as a barrier to help-seeking, treatment engagement, and harm-reduction services
-Analyze the relationship between personal stigma and clinical outcomes in psychosis, such as lower medication adherence and higher hospitalization rates, and learn to apply this evidence to risk assessment and treatment planning
-Identify practical strategies at the individual, team, and system levels to reduce stigma-related barriers to care
Presenters:
Claire Triller, MD has no financial disclosures to report
Course summary
- 1.00 AMA PRA Category 1 Credit™
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of IHP and Massachusetts General Hospital. IHP is accredited by the ACCME to provide continuing medical education for physicians.
IHP designates this Enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- 1.00 Nursing Contact Hours
Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.
This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1.00 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.
- 1.00 Social Workers
As a Jointly Accredited Organization, the MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.00 clock hours for continuing education credits.
- 1.00 Participation
This course allows other providers to claim a Participation Certificate upon successful completion of this course.
Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.
- 1.00 Psychologists CE Credit
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.00 CE credit.
Presenters:
Claire Triller, MD has no financial disclosures to report.
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Target Audience
This program is intended for: Psychiatrists, Physicians
This program is intended primarily for Psychiatrists, other allied staff such as Psychologists, Physicians from other specialties, Nurses, Physician Assistants, Nurse Practitioners, and Social Workers, are welcome to attend. Participants can receive up to 1.0 CE.
Accreditation
In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
1.0 Physicians
MGH Institute of Health Professions designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
1.0 Nursing
MGH Institute of Health Professions designates this activity for 1.0 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.
1.0 Psychologists
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.0 CE credit.
1.0 Social Workers
As a Jointly Accredited Organization, MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.0 clock hours for continuing education credits.
1.0 IPCE Credit
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credits for learning and change.
* This activity designed to meet the criteria for risk management study in Massachusetts.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of IHP and Massachusetts General Hospital. IHP is accredited by the ACCME to provide continuing medical education for physicians.
IHP designates this Enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- 1.00 Nursing Contact Hours
Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.
This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1.00 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.
- 1.00 Social Workers
As a Jointly Accredited Organization, the MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.00 clock hours for continuing education credits.
- 1.00 Participation
This course allows other providers to claim a Participation Certificate upon successful completion of this course.
Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.
- 1.00 Psychologists CE Credit
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.00 CE credit.
Accreditation
In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
1.0 Physicians
MGH Institute of Health Professions designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
1.0 Physician Associates/Assistants
AAPA Credit Designation Statement – Live
MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
AAPA Credit Designation Statement – Enduring Materials
MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until {Expiration Date). PAs should only claim credit commensurate with the extent of their participation.
1.0 Nursing
MGH Institute of Health Professions designates this activity for 1.0 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.
1.0 Pharmacists
This activity provides 1.0 contact hours of continuing education credit.
NOTE FOR PHARMACISTS: Upon closing of the electronic evaluation, IHP will upload the pharmacy-related continuing education information to the CPE Monitor within 60 days. Per ACPE rules, IHP does not have access nor the ability to upload credits requested after the evaluation closes. It is the responsibility of the pharmacist or pharmacy technician to provide the correct information [NABP ePID and DOB (in MMDD format)] in order to receive credit for participating in a CE activity.
1.0 Psychologists:
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.0 CE credit.
1.0 Social Workers
As a Jointly Accredited Organization, MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.0 clock hours for continuing education credits.
1.0 IPCE Credit
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.