Kontakt X:X | DOI: 10.32725/kont.2026.014

Mental health stigma across healthcare levels: a mixed methods case studySocial Sciences in Health - Original article

Vesna Zupančič ORCID...^{1, 2, *}, Karmen Erjavec ORCID...²

¹ Ministry of Health, Ljubljana, Slovenia

² University of Novo Mesto, Faculty of Health Sciences, Novo Mesto, Slovenia

Introduction: Stigma among healthcare professionals remains a major barrier to accessible, high-quality mental health care. This study explores attitudes of Slovenian healthcare workers across different care levels toward people with mental disorders.

Methods: Using a mixed methods design, the study combines a survey of 223 professionals, the Opinion of Mental Illness Scale, and qualitative data from three focus groups and 20 interviews.

Results: Primary and tertiary care workers report fewer social restrictions and greater openness to integration than those in secondary care. Primary care workers showed the strongest willingness to include individuals with mental disorders in everyday life, though systemic constraints limit these efforts. Secondary care workers act more cautiously in crises, while tertiary professionals tend toward emotional distancing. Despite progress, stigma continues to impede equitable care. Discussion and Conclusion: Differences in attitudes toward marginalized groups (e.g., older adults, LGBTQ+, migrants) are not statistically significant, indicating a relatively uniform treatment approach. Across all care levels, there is a lack of continuous, reflective anti stigma education. Targeted cross level interventions - incorporating lived experience, reflective dialogue, and long-term curricula - are essential. Mixed methods designs help uncover underlying stigma dynamics and support responsive, evidence based strategies for change.

Keywords: Equity; Health care professionals; Marginalized or vulnerable groups; Mental health; Quality of health care; Stigma and discrimination

Grants and funding:

The data were collected as part of the research project CRP 2023: Mental Health Care - Gaps between mental health needs and comprehensive, integrated, and continuous care for different groups of marginalized adults (V3-2311), funded by the Slovenian Research and Innovation Agency (ARIS) and the Ministry of Health.

Conflicts of interest:

The authors have no conflict of interest to declare.

Received: November 7, 2025; Revised: January 19, 2026; Accepted: March 2, 2026; Prepublished online: March 9, 2026