Psychiatrists Urged to Fight Stigma Linked to Mental Illness

Caroline Cassels

October 20, 2011

October 20, 2011 (Vancouver, British Columbia) — When it comes to discrimination and stigmatization of the mentally ill, psychiatrists are being urged to look within and put their own house in order.

A new position paper, released here at the Canadian Psychiatric Association (CPA) 61st Annual Conference by the association, aims to reduce stigmatization of and discrimination against the mentally ill by mental health professionals, including psychiatrists.

"Psychiatrists are not immune from harbouring and acting on their own stigmatizing attitude toward people with mental illness and their profession. This is understandable given that psychiatrists are members of a society where such views are pervasive and present from our earliest socialization and that our medical training has been replete with such stigma," the authors of the paper, led by Susan Abbey, MD, director, Program in Medical Psychiatry, University Health Network, and professor, Department of Psychiatry, University of Toronto, Ontario, Canada, write.

In fact, they note, psychiatrists may have even more negative attitudes about mental illness than the general public, possibly because they have cared, or are caring, for patients with severe and treatment-resistant mental illness.

Dr. Manon Charbonneau

"Physicians are a reflection of their society when it comes to stigmatizing attitudes but it's devastating when patients who need help encounter such attitudes. That's why CPA chose to focus its efforts on tackling this issue in the house of medicine. As physicians and psychiatrists it's our responsibility," Manon Charbonneau, MD, chair of the Stigma and Discrimination Working Group, said in a statement.

The position paper suggests a 3-pronged approach to reducing stigma: protest, educate, and contact. It calls on all psychiatrists to lead by example and to protest stigma and discrimination when they encounter it, use education to counteract it, and promote direct contact with people who have lived with mental illness.

"We need to protest discrimination at every level from the small injustices we witness in daily practice in our clinics and hospitals in our clinics and hospital, in our medical schools up to the federal and provincial level," Dr. Abbey said in a release.

In 2008, the CPA's Stigma-Discrimination Working Group conducted a survey of its members asking about first-hand experiences of discrimination. Based on 394 responses out of a possible 1083, 79% of respondents reported discrimination toward a patient, 65% reported discrimination toward a mental healthcare provider, 53% reported discrimination against psychiatry as a profession, and 53% observed other medical providers discriminating against a psychiatric patient. At 89%, the survey found that the highest rate of stigma and discrimination was toward people with mental illness presenting to the emergency department.

Furthermore, despite accounting for 15% of Canada's disease burden, in 2003 to 2004, mental healthcare received only 6% of total health funding.

"It's relatively easy to spot discrimination, but it's harder to identify stigmatizing attitudes. Often people don't even realize they have these attitudes," said Dr. Charbonneau.

The position paper proposes several educational initiatives including making stigma and discrimination part of the formal medical school curricula and continuing physician education. Furthermore, the authors highlight a need to collaborate with other medical organizations to address discrimination against psychiatric patients where they seek care, including the emergency department, inpatient medical and surgical wards, walk-in clinics, and their family physician's office.

"Tackling stigma and discrimination towards people with mental illness is the key to better mental healthcare. Canadian society and Canada's physician community efforts are in their infancy, and much work remains to be done, but it can be done," said Dr. Charbonneau.

Dr. Abbey reports she is on the advisory board of Eli Lilly Canada Inc, Lundbeck Canada Inc, and Pfizer Canada Inc. She also reports receiving research funding from Lundbeck Canada Inc. Dr. Charbonneau has disclosed no relevant financial relationships.

Canadian Psychiatric Association (CPA) 61st Annual Conference: Stigma and Discrimination. Released October 13, 2011.

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