Measuring How Mental Health Professionals See Service Users’ Rights

A new scale has been developed and validated to examine beliefs held by mental health professionals towards service users’ rights.


A new study, published in the International Journal of Environmental Research and Public Health, set out to develop and validate a scale that examines the beliefs and attitudes of mental health professionals toward service users’ rights. The scale, developed by researchers with lived experiences of mental health problems, is in response to an increased interest in service user experiences and a global push toward autonomy and freedom of choice in mental health services.

“Given the extent of the consequences of stigma and coercion towards mental health service users, it is essential to raise awareness among mental health professionals in order to foster non-stigmatizing and empowering attitudes through frameworks such as Recovery and Citizenship. In the context of planning and implementation of these training and awareness activities, there is a need to evaluate the impact this has on the beliefs and attitudes of professionals through standardized measures,” the researchers Francisco José Eiroa-Orosa and Laura Limiñana-Bravo from the University of Barcelona and Yale Program for Recovery and Community Health write.

Photo Credit: andres musta, CC BY-ND 2.0

There has been a growing push toward the inclusion of service users’ input in the mental health field. Recent studies have explored service users’ views of diagnostic criteriainpatient experiences, and common theoretical orientations, such as CBT. Many service users still report stigmatizing attitudes from mental health professionals.

“Receiving a mental health diagnosis is still considered as a predisposing factor that can lead to the experience of stigma from both the social environment and mental health professionals,” write the authors. “Over the last decades, in parallel to the rise of the Rehabilitation and Recovery movements, professionals have become more conscious of the need to offer non-discriminant care based on users’ rights.”

The authors of the current study aimed to increased current mental health professionals’ awareness of bias toward service users’ rights. While other measures exist, all are designed to be used by individual mental health professionals on specific mental health conditions. No scale is available, which is appropriate for use with a wide range of professionals working in various settings. Therefore, authors set out toward the “development of a flexible instrument to measure the beliefs and attitudes related to service users’ rights among all types of mental health professionals.”

The initial 44 questions in the survey were developed by researchers who previously had experiences as mental health service users. Experts reviewed these questions on stigma awareness and community mental health, including board members of the Catalan Federation of First-Person Mental Health Organizations, all of who have lived experiences of mental health problems. Additionally, questions were reviewed by focus groups, which included mental health professionals, service users, and relatives of service users.

After careful consideration and analysis, 25 items remained, which correspond to four domains: system criticism/justifying beliefs, freedom/coercion, empowerment/paternalism, and tolerance/discrimination. The scale, called the Beliefs and Attitudes towards Mental Health Service Users’ Rights Scale (BAMHS), was initially validated in with a Spanish speaking population using a diverse range of mental health professionals such as psychologists, psychiatrists, mental health nurses, and occupational therapist. The scale was validated in several settings, including inpatient, outpatient, and rehabilitation facilities.

“According to our results, the BAMHS may be a useful tool to assess the impact of awareness and training activities on professionals’ beliefs and attitudes towards service users’ rights. This new scale offers flexibility and assumes no prior awareness or knowledge, making it especially suitable for its use in areas where user-led and progressive professional movements are carrying out activities with professionals without previous recovery knowledge or awareness of user rights violations.”

The final version of the scale, which includes 25 self-report Likert-style questions ranging from 1=Totally Disagree to 4=Totally Agree give the assessor a final score that can be conceptualized on a range of respect or violation of user’s right. Questions assess a variety of professional beliefs related to individual’s abilities to take charge of their lives after receiving a mental health diagnosis, thoughts toward involuntary hospitalization, mechanical restraints, and respect for service users’ autonomy and widespread prejudices toward mental health service users.

The BAMHS is a brief scale which has been tested in diverse contexts and suitable to a wide range of professionals. Increased use of the scale could provide mental health professionals with a clearer understanding of potential biases toward service user’s rights. The scale is available via the open-access article here.

The authors conclude:

“We believe that our instrument brings a new perspective to the measurement of beliefs and attitudes of mental health professionals in the context of the new era opened by the Convention on the Rights of Persons with Disabilities.”



Eiroa-Orosa, F. J., & Limiñana-Bravo, L. (2019). An instrument to measure mental health professionals’ beliefs and attitudes towards service users’ rights. International journal of environmental research and public health16(2), 244. (Link)

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Jessica Janze
MIA Research News Team: Jessica Janze is a doctoral student in the Counseling and School Psychology program at the University of Massachusetts Boston. She has a master’s degree in counseling psychology and has worked primarily with children impacted by psychological trauma. Jessica’s research interests include the impact of mindfulness in early education, emotional regulation, and the role contemplative practices play in mental health.


  1. It is directed toward the problem itself. We are going to ask a psychiatrist to fix stigma? Ask a physician?
    We already know from experience and articles that not only bias exists within the medical community, but abuses exist, shoddy disrespectful care exists.
    One is never “recovered” as far as psychiatry arms reach. The record itself stays forever, it is NEVER removed.
    The fact remains is despite no criminal offense, we/they are treated worse than criminals.
    This is a UN issue.
    We are begging for crumbs with these attempts.
    The only thing we should be asking the UN/governments for is the removal of the DSM and it’s garbage. And the removal of the ability to record private conversations between psychiatry and client.

    Is my heart condition ever used in court? Yet sadness/distress/ can be used in court. It is a crime to have anxiety.

    Sorry this attempt is exactly what psychiatry likes, but kudos to those who think the system can be more loving.
    Actually no one is asking for love, or kindness from them. I will not ask them to be treated as if I have autonomy. No one has the right to bless me with autonomy.

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      • Bradford,
        The beauty of it is.
        Even if you go to another shrink and he says “I can’t diagnose you with anything”.
        The one you got 20 years ago counts, the one with no diagnosis does not negate the label. Gotta love science.
        Can any physical ailment be used in court against you? None. Any psychiatric label can destroy any and all credibility you have, even proper medical care.
        THAT exposes psychiatry exactly for what it is. It is very alarming that our leaders of countries are intimidated by psychiatry.
        I guess it’s akin to farming. (pharming people)
        We cannot get rid of drugs, treatment unless we get rid of the psych bible. The labels/diagnosis are our whole problem. When it comes to personal problems that people see a shrink for, they should not even be allowed to record it.
        I mean, how great that a person innocently goes into an office with problems that they are trying to work out, and find themselves in the wrong door. It’s like a gate to hell. If the truth was on the door, “Dr Hell”, with pictures of patients strapped, injected, torn apart families, cops, people homeless, in front of judges, etc etc, most people would not step into that pathetic place. Educate the kids. On forums where kids are, on gaming sites. On forums where kids talk about their problems.

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  2. On the face of it, this sounds like a good thing. Let’s find out exactly what “they” think of “us”. But I wonder how many people would approve of this is we rephrased it to “Measuring How White People View Black People’s Rights” or “Measuring How Americans View Middle Easterners Rights” or “Measuring How Israelis View Palestinians’ Rights”. Or how about “Measuring How Endocrinologists View Diabetics’ Rights” which is absurd and illustrates how some groups are seen to have rights and others not so much. It quickly becomes apparent that the opinions of dominant groups over subordinate groups is largely irrelevant. And we all should know that appeal to expertise is a logical fallacy. We all deserve human rights as detailed by the UN, full stop.

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      • Psychiatry is chalk full of euphemisms and oxymorons.

        Examples of oxymorons:

        “Integrate” means isolate or segregate
        “Diagnose” means perform degradation ceremony
        “Serve” means rule
        “Insight” means breaking point
        “Hospitalization” means imprisonment for no legal reason
        “Assisted outpatient treatment” means pharmacological torture
        “Mental health” means gas lighting

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  3. Lol, as I often do, I revisit articles that I already read and commented on.

    I realize that in this article, the title itself speaks volumes and so one needs to read no further.
    The title itself tells the basic truth. Why in the world, in what society would we even have to phrase this as a question? It should not have to be phrased to users nor the “tyranny” (as Rachel phrased it appropriately)
    The average “intelligent” (whatever that means) should see that IF there is a practice that sees people as “sick”, why would there be any “rights” issues?
    Would there be ANY rationality to taking rights away from “sick” people?
    You take rights away from criminals and that is the end of that tune.

    Screw psychiatry. People that read such articles often do not see the irony.
    The most unreasonable shrink can see the lies he lives. Whatever behooves a person to live in this kind of position and practice their game, is beyond apprehension.
    To me it is no wonder that the word “insight” became one of psychiatry’s favorite words. Deep down in their unconscious they perhaps crave something. It is almost like an anger towards the mainstream of society.

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    • Psychiatry’s primary function for any but “soft diagnoses” is punitive. Whether you commit any crime or not they’ll treat you like a criminal and punish you for existing.

      We already have a legal system to deal with people who actually commit crimes.

      Tom Cruise has gone on record against psychiatry. (No, I don’t want him for a celebrity spokesperson!) Funny how he never has connected the Pre-Crime Unit in The Minority Report with Psychiatry.

      Only instead of predicting real crimes and preventing them, these would be Pre-Crime Police get violent criminals released for “good insight” and “meds compliance” like Eric Harris, Devin Kelley and countless others. As well as locking up peaceful, law-abiding citizens indefinitely. Because they MIGHT commit crimes someday you see. Due process be hanged.

      We already have a police force and psychics with better track records than shrinks.

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  4. I think the best example of how mental health professionals view patients rights came from the Operations Manager who did a “formal investigation” of my complaint about the way I was ‘treated’ (ie kidnapped and tortured for 7 hours). She investigated the matter, uncovered the fact that I had a legitimate complaint, conspired with others to pervert the course of justice, distributed fraudulent documents to lawyers representing me, and on the face of evidence I have she was involved in a conspiracy to have me murdered in an Emergency Dept after telling me that she would “fuking destroy” me. Fortunately a Prof noticed what they were going to do to resolve there little problem and was waiting in the next booth at the Emergency Dept and interupted the unintentional negative outcome. Police were acually providing assistance to this Operations Manager to retrieve the documenst I still have demonstrating the criminal offences of kidnapping and torture, AND that they provided a fraudulent set of documents to my legal representatives. This of course may go some way to explaining why police can not find their copy of the Criminal Code and tell me that “it’s best they don’t know about that” when I explain that they have been providing material support to organised criminals who are killling people in our hospitals. Probably sounds insane, and it’s meant to, that stops you good people from actualy checking what i’m saying and as with the police, i’m sure you will all be shocked when, if the pile of bodies is ever exposed publically, (not that I expect it to be, my government finds it much cheaper to murder people in EDs than have their negligence, fraud and slander exposed).
    I have the documents, but the issue of peoples families being threatened by authorities seems to be poking good folk in the eye while these criminals are being enabled. I’m sure they will get around to performing their duty eventually, they did with the child raping priests (or are we still using the old term of “character flawed priests”?. Like our Minister for Health prefers the term “referral and detention” rather than the factual terms of “torture and kidnapping”? Despite having access to the truth), after nearly 40 years.

    What on earth are my medical records from an exclusive private clinic doing turning up in a public hospital anyway? I mean its patently obvious HOW they ended up there but given that these were court ordered sealed, …… oh wait further motivation for the unintended negative outcome huh? Handing out peoples private records from court documents might cause a few problems for the bread and butter of the clinic, legal – medico reports for the courts huh? Given that Australias richest businessman was a client, were they handing out his personal information? I’d have thought there were laws protecting that type of information. Real shame the police can’t find the Criminal Code (Which may be with the copy of the Privacy Act, try there Sargent) because if they did they might realise WHY they attempted to murder me.

    Bah, I get it. More money allowing criminals to do a bit of business, and i’m just rocking the boat.

    Rights? You don’t have any. A bit like friends when you need them. Lawyers take money from me to exploit their position and throw me under a bus because criminals requested that they do. Activists who wet their pants and the first sign of trouble. Doctors who turn blind eyes to “patients” being murdered by their colleagues. Politicians who are happy to stand by while citizens are subjected to known torture methods and call it ‘medicine’, and refer complaints to ineffective statutory bodies knowing nothing will be done. And citizens who allow them to enact carte blanche and zero accountability and live in fear that they might be next.

    I want my tax back for a start, your a bunch of frauds.

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    • I have made a comment above to the Police Sargent who tells me he can’t find the copy of the Criminal Code, and therefore a clear breach of Section 305A Inoxication by Deception is not a crime. Well, it is a crime but he just doesn’t want to take the documented proof of this “abhorrent and extremely dangerous” act (our Politicains words on spiking with date rape drugs not mine).

      I’v got further comment to make to this Sargent who appears to have accepted the word of someone who telephoned him and spoke the truth when they said they were a psychiatrist. But the good Police Sargent might want to cheeck whether the claim that I was their “patient” and therefore don’t take the evidence of serious criminal offences he has until they get the chance to “sort it out”. There’s a major problem for the administration of justice right there Sargent. You see, I wasn’t actually this psychiatrists “patient” at all. He was really worried that you would take the documents i had and you (or more likely one of your colleagues because I would question your ability to see beyond the excesses of your donut addiction) might notice that I had been the victim of some people conspiring to stupefy and commit an indictable offence, namely kidnapping.

      So I ask if you would perhaps listen to people who come into your station with proof of criminal offences that you actually take it from them and allow someone with a level of inteligence to sort these matters out to deal with it. Rather than you decide to provide material support for a criminal who requests that you do something for him because he is a doctor. Particularlywhen for example someone comes in from a night club and claims they have been ‘spiked’ with a date rape drug and have documents to prove that, don’t just take a call from the alleged rapist and send the victim away for them to be dealt with by mental health for their “hallucinations”, as was done with me. Look at what my lawyer called “the proof” before acting in the interests of criminals please.

      I know people will find it difficult to believe me regarding these matters, specially given the levels of slander and fraud I have been subjected to. But they don’t need to ask me, my daughter was with me when you turned me away. Oh damn, she and her children have been threatened, I forgot. The things these mental health professionals need to do to get their medical care to the community is just terrible, they simply need more powers to intervene when anyone stands n the path of their “good thing”.

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