“Courtesy stigma”: associative stigma experienced by Indonesian mental health nurses working in a psychiatric setting: a qualitative study

BACKGROUND: Mental health is crucial for emotional and personal well-being, healthy relationships, and effective community contribution. The stigma associated with mental illness often diminishes the therapeutic alliances between those with mental illness and healthcare practitioners. Courtesy stigma refers to the social disapproval people encounter due to their association with individuals from a stigmatized group. This study aimed to explore the associative stigma experienced by psychiatric nurses working with individuals with mental illnesses in an Indonesian psychiatric setting. METHODS: This is a qualitative descriptive approach. We recruited 25 nurses from a psychiatric hospital in Makassar, Indonesia. We conducted semi-structured interviews, and the data were analyzed using a thematic analysis approach. RESULTS: We identified four themes: 1) perspectives of working in a psychiatric hospital; 2) barriers to working in the psychiatric hospital; 3) elements of courtesy stigma; and 4) the reasons for courtesy stigma. CONCLUSIONS: This study found that nurses working in mental health hospitals experienced stigma by association with patients with mental illness. Public education and the expansion of community mental healthcare are essential measures to reduce the effects of associative stigma. Further research is necessary to identify the factors contributing to the preponderance of associations among mental health nurses employed in Indonesian mental health settings.