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Discrimination, Serious Mental Illness and Health Care Professionals

Mentioning health care professionals along with discrimination and mental illness is likely surprising for many. It certainly was to me when I first encountered a study called "Community Attitudes Towards People With Schizophrenia." Conducted in Alberta as part of the World Psychiatric Association's Global Campaign to Fight Stigma and Discrimination, the results, for the general population were encouraging. Researchers, Dr. Heather Stuart and Dr. Julio Arboleda-Flôrez, found "most respondents were relatively well informed and progressive in their reported understanding of schizophrenia and its treatment."

What was concerning was their finding that those who work with the mentally ill were expected to be more tolerant but they were not. The authors stated "these findings support the perceptions of those with schizophrenia that their most stigmatizing experiences occur within the mental health provider community, in which they have their most frequent contacts." (Page 5 of the study). That was published in 2001 and the situation has not improved.

In 2007, a study conducted by the Royal College of Psychiatrists in the UK concluded that "once the medical team knows a patient has psychiatric problem, they give them poorer quality of care." The report went on to say that "Doctors don't like dealing with patients with psychiatric problems. They view them as different and they spend less time with them. They don't offer the patient the same intensity of investigation as the non mentally-ill patient. It's prejudicial treatment."

In 2008, Mental Health America conducted a survey to examine overall healthcare in mental health settings when it was revealed that people with schizophrenia die at least 25 years earlier than the general population. This earlier death is, in large part, due to preventable medical conditions like diabetes, cardiovascular disease, and respiratory and infectious diseases. I believe that part of the reason that patients were suffering from preventable diseases was that the majority of psychiatrists said they did not have the time or the skill to provide overall care. They left some health issues to primary care physicians who they felt were better qualified. Obviously, somebody dropped the ball with some very serious consequences.

In a survey of all medical students at the University of Michigan in 2009 and reported in the Journal of the American Medical Association, researchers found that not only do medical students have a higher incidence of depression than the general population but they were highly stigmatizing toward those with depression. These medical students "attach a higher degree of stigma to having the mental illness." In a commentary, psychiatrist John Grohol said that these students "should be the most open-minded about these disorders" but they are not.

Not too long ago, I ran into a medical student who expressed surprise that anyone with schizophrenia could actually do well. I mentioned this to a psychiatrist on faculty of that medical school and suggested more education was needed about mental illness for the medical students. The response from the psychiatrist surprised me. She said that many of her psychiatric residents did not know any better either.

Dr. Carolyn Dobbins, a counsellor in Knoxville, Tennessee , mentions in her forthcoming book, What A Life Can Be: One Therapists Take on Schizoaffective Disorder, that it is not unusual to hear her colleagues say something like "You don't want that client; he has schizophrenia." And she mentions a neurologist examining someone with schizophrenia who storms out of the examination room muttering "Goddamn schizophrenics."

In light of these gloomy facts, it is encouraging to learn that the Mental Health Commission of Canada has partnered with the University of Calgary to evaluate a course designed to educate medical students and help reduce their prejudices about mental illness.

Called the Mind Course, it is a compulsory program for all second year medical students at the University of Calgary. The three week program involves lectures from practising psychiatrists, visits to psychiatric hospital units and guest lectures by those with mental illnesses.

Dr. Andriyka Papish, a fourth year psychiatric resident at the University of Calgary, decided to become a psychiatrist after taking this course. "Stigma is quite prevalent in the medical community", she said and is therefore anxious to see if the evaluation of this program demonstrates that it helps to reduce stigma by medical professionals.

Those with serious mental illnesses will never receive optimal care if society does not deal with discrimination against them. There really is no reason that so many with serious mental illnesses must have their lives ended so much earlier than the rest of us from preventable diseases or to receive second rate health care. Educating health care professionals will go a long way to improving their lives.

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