Building an inclusive campus: A culturally responsive ACT approach for provider empowerment and stigma reduction in China

Mental illness stigma among healthcare providers is a primary barrier to the global shift towards community-based mental health care. University mental health service providers (MHSPs) have received limited attention in stigma reduction efforts. This mixed-methods study evaluated the acceptability of ACE-LYNX, an intervention integrating acceptance and commitment therapy (ACT) and group empowerment psychoeducation, and examined whether participation was associated with changes in stigma among Chinese university MHSPs. A sample of 409 MHSPs from six Chinese universities participated in the intervention. Stigmatizing attitudes were measured pre-intervention, post-intervention, and at the 3-month follow-up using the Community Attitudes Toward the Mentally Ill (CAMI) scale and were analyzed using generalized estimating equations. Acceptability was assessed using the Training Session Feedback Form. Nine focus groups (n = 69) explored participants' experiences and perceived impacts at follow-up using thematic analysis. The intervention demonstrated high acceptability (mean score ≥ 4.38/5.0) and was associated with significant reductions in social restrictiveness attitudes (p < .001). Authoritarianism and benevolence improved immediately after the intervention, whereas community mental health ideology showed no significant change. Qualitative findings identified three themes: potential mechanisms of change from cognitive defusion to embodied practice, barriers to sustained practice, and catalyzing future action as agents of change. These data signal that the ACE-LYNX intervention was highly acceptable, and provided preliminary evidence of reduced provider stigma. Culturally adapted ACT-based interventions may represent a promising pathway within global mental health task-sharing frameworks. Future efforts should combine training with supportive implementation ecosystems, including ongoing peer support and supervision.