Honest Open Proud for Psychotic and Bipolar Disorder in Norway

Because people with mental illness experience both public and personal stigma, which is related to lower levels of recovery and wellbeing, it is common to struggle with decisions regarding potential disclosure of mental health difficulties or diagnoses. There are pros and cons with both disclosure and secrecy. Disclosure can lead to social support, followed by improved mental health and reduced public stigma, but also stigmatization and social exclusion. Secrecy can prevent stigmatization but may also lead to social isolation and thus poorer mental health and increased public stigma. Therefore, people with mental illness need help to make strategic decisions about whether, and if so, to whom, when and how they wish to disclose their mental health problems. As contact with other people with mental health difficulties is crucial to anti-stigma interventions, people with mental illness could benefit from meeting peers, especially as role models. This suggests that peer facilitators could be an important feature in a program aiming to help people with mental illness handle stigma and challenges related to disclosure. The Honest Open Proud (HOP) program was developed for this purpose. Because people with psychotic and bipolar disorders experience particularly high levels of both public and personal stigma, which negatively impacts their recovery rates, they may be especially in need of the HOP program.

The investigators aim to evaluate whether a Norwegian adaptation of the HOP group program, which is facilitated by peers, is feasible and acceptable for people with psychotic and bipolar disorders in an outpatient setting. Moreover, whether it helps them handle stigma and disclosure related decisions.

The investigators propose a pilot randomized controlled trial, comparing an intervention group receiving a 6-week Norwegian adaptation of the HOP program to a waiting list control group. Both groups receive treatment as usual. The main research question is whether this intervention is feasible and acceptable. However, efficacy measures tapping change in stigma and disclosure distress, as well as recovery and wellbeing, from before to after the intervention, were included. The aim is to find what effect sizes can be expected in future larger studies in Norway, rather than to find significant differences in effect sizes.

• Disclosure Distress (Rüsch et al., 2014a) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• Warwick and Edinburgh Wellbeing Scale (WEMWBS) (Tennant et al 2007) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• Satisfaction with life (Lehman, 1988) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• The Questionnaire about the Process of Recovery - 15 (QPR-15) (Niel et al 2007) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• Internalised Stigma of Mental Illness Inventory (ISMI-10) (Boyd, Otilingam, & Deforge, 2014) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• Patient Health Questionnaire-4 (PHQ-9) (Kroenke et al 2009) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]
• Generalized Anxiety disorder (GAD-7) (Spitzer et al, 2006) [Time frame: Change from T0 to T2 (assessed at T0 = week 0; T2 = week 6)]