We believe this study is important because is the first to specifically evaluate in our setting the phenomenon of stigma associated with mental illness in the State Security Forces and Corps. Our findings indicate that in Spanish Police, the label of mental illness was associated with greater desire to help, more feelings of pity and less consideration of responsibility for the situation. We also found increased feelings of anger and avoidance, a greater perception of danger, and desires for segregation and coercion to obtain medical treatment. In addition, we evaluated the possible influence of different illnesses (schizophrenia and depressive disorders) on police encounters. According to our results, the diagnosis of schizophrenia increased the perception of danger and the desire to segregate and coerce for medical treatment compared to depression.
Since Watson´s work  who studied the phenomenon of stigma in the American police with the modified- AQ questionnaire [15, 23], no previous study has applied this tool in the Police force which gives our research an added value. In general, our results are consistent with those of Watson , except for the anger dimension, where they did not find association. When comparing the scores for each factor according to whether the person had a mental illness or not, the differences were low (< 0.5 points) except for pity and coercion dimensions, where Watson et al. obtained lower scores than we did. These results could be due to the fact that we included in our study two types of illnesses with different expected associated stigma (schizophrenia and depression) . The differences in pity dimension may highlight the fact that the PO are increasingly aware of the phenomenon of stigmatization towards psychiatric patients. Other possible explanation is the cultural differences between continents as some studies suggest less stigma in the Spanish population . However, the desire for coercion for medical treatment may also indicate a deficit in knowledge about the recovery and treatment of people with mental illness.
The differences in stigma-related constructs according to whether a person was diagnosed with schizophrenia or depressive disorder may be explained by the fact that the stereotype of dangerousness is more ingrained in schizophrenia than in depression [27, 29]. However, for the avoidance factor, which is an indicator of social distance, we found no significant differences between the two diagnoses. Even though the officers showed more positive attitudes towards depressive disorders, avoidance behaviors are one of the elements most related to stigmatization. Therefore, according to our findings, we cannot conclude that a diagnosis of depression generates less stigma in the Police than schizophrenia, as studies in the general population suggest [6, 27, 30, 31]. Perhaps, the most positive finding to highlight in the comparative analysis between both disorders, is that the responsibility dimension did not revealed significant differences. This finding is likely related to officer´s knowledge that depressive disorders, like schizophrenia, are mental illnesses. One of the great scourges suffered by people with depression is that they may be considered weak and responsible for their situation because of the stereotypes at the general population that perpetuate this consideration [29, 32–35].
We also analyzed the differences between the questionnaire constructs according to the vignette role and the psychiatric diagnosis. The most relevant finding was that dangerousness, coercion and segregation factors were significantly different in all roles, being higher in psychiatric patients regardless of the diagnosis. The result on dangerousness suggests that this stereotype is intrinsically linked with the diagnosis of mental illness. Although the information provided about the type of mental illness and the vignette role may be different, the perception of dangerousness in the police context does not vary. These findings are consistent with those found in various police institutions around the world, where researchers argue that the most common police misconception is that all people with mental illness are dangerous [12, 15, 16, 18, 20, 36]. Unfortunately, the desire for segregation and coercion for treatment together with the perception of dangerousness, may PO to inadvertently escalate situations through approaching patients with threatening body language and speech and may evoke of unnecessary violence in police encounters .
Finally, we found relationship between different sociodemographic variables and the AQ factors when the hypothetical person had a psychiatric history. Our findings indicated that women showed more feelings of pity and desire to help people with mental illness than male PO. These results seem to support the conclusions of surveys of the general population that suggest that women had less stigmatizing attitudes towards mental illness than men . In the police context, however, this desire to help could be understood as an indicator that female PO accept their role of help of this population. On the other hand, younger PO maintain a greater perception of danger and desire for avoidance psychiatric patients than older PO. These findings are consistent with previous research that suggests that veteran PO have less stigmatizing attitudes . However, research in the general population concludes that older people have more stigmatizing attitudes . These differences may be due to the fact that younger PO in their early years in the Police force have a biased contact with psychiatric patients during periods of acute symptoms. These encounters in crisis situations can be generalized and form a misperception of danger, which can be nuanced over the years by having contact with these individuals in a wider range of situations. We also found that the length of service was positively correlated with the responsibility dimension and negatively correlated with avoidance. As previous studies have shown that training programs may reduce stigma [14, 39–41], we believe that the fact that veteran PO consider psychiatric patients more responsible for their situation is a consequence of a lack of knowledge since the range of labor seniority in our sample is very wide and consequently the training programs received as well.
Some limitations should be considered when interpreting our results. The vignettes did not include environmental variables that are usually present in daily law enforcement. Further studies should evaluate these results in other situations more representative of daily police practice. A second limitation we should consider is that we explore the phenomenon of stigma with a self-administered questionnaire. Although these questionnaires have proven to be practical, cost-effective, and low participant- burden, they have some limitations in terms of recall bias and social desirability . These unresolved issues should be better assessed in future studies.
The greatest strength of this research lies in the fact that it can provide valuable information to improve the protocols for law enforcement of the Spanish Police with psychiatric patients and to guide and update the training activities of the Police in this field. Recent studies carried out in police forces in other countries have shown that a specific training program on mental health helps to reduce stigmatizing attitudes, and increases understanding and support for people with a psychiatric diagnosis [14, 39–41].