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Discussion, Wednesday

On stigma, doctors and mental health

Continued from Page 1

Most doctors tell their patients that they are delusional and the voices need to be suppressed, not understood as having a deeper message. Time consuming?

Medication has become the accepted treatment since the 1960s. This means that any time spent with the patient is spent with a disproportionate percentage of the focus on the medication, not actually coaching the patient in how not to continue being a patient. If I were a mainstream psychiatrist today I would be bored silly.

Changing the practice of psychiatry to make it meaningful to the patient would make it much more meaningful to the psychiatrist. Perhaps their numbers would increase. Your comments on this are appreciated.

Heather Stuart: Thank you, Jung Frau, for your observations. I would take your argument even farther and suggest that our entire health and mental health care system must change to provide recovery-oriented supports and services for people with mental health problems and disorders. By recovery-oriented, I mean supports and services that are respectful and empowering for those who access them.

Toshio Ushiroguchi from Toronto: I think both patients and doctors experience a great deal of discrimination in the mental health sector mainly because a racist attitude exists towards patients suffering from ailments that affect their social behaviour.

Is it safe for a doctor to back someone a little strange? I think that there is cause for concern if a doctor is backing an offender, but often the mentally ill are branded criminals in court and the doctors that care for them become accomplices to some people as well.

Does the stigma change even more for doctors who work with the mentally ill and thus also become entangled in the legal system?

Heather Stuart: Toshio, you have put your finger on an important characteristic of stigma which is it's ability to affect not only the individual who has a mental heath problem, but all of those around them, including their family and friends, their mental health professionals, and their doctors. We think that people with mental disorders who are in the criminal justice system experience a double stigma which makes it even harder for them.

Marlene W from Hamilton: Kudos to Dr. Shah who has been incredibly candid about the ingrained systemic discrimination he faces from his own family and peers regarding his choice of medicine. I was taken aback when he was told 'But your so smart!' as a rationale to discourage him from going into psychiatry. That basically says to me that those with the worst grades in med school enter into psychiatry, aren't expected to excel and aren't expected to do much for their patients.

Have you found that to be true?

Heather Stuart: Marlene: Some of the most profoundly committed, compassionate, and wise people I have ever met have been those who have chosen a career path in mental health, and they have done this, like Dr. Shah, in spite of the stigma that surrounds this choice.

Having said that, we need to do much more to make mental health professions as an attractive career choice. Perhaps a way to do this is to start highlighting the important contributions made by mental health professionals through good news stories.

Secondly, we need to consider how we should change the way in which we train health professionals to ensure that they see mental health as rich and rewarding. Finally, we must ensure that mental health programs and professionals are appropriately funded as this will certainly underscore the point.

Christine Diemert, globeandmail.com: Prof. Stuart, I'm going to pull a portion of a comment from one of the people who commented on the article about stigma in the medical system and get you to respond.

This man spoke of his wife, who "works for CMHA as a crisis worker. She is a certified RNA that worked for years in the Psych ward of one of our local hospitals. She would confirm a lot that is in this article. It is not just the psychiatrists, but all people who work with the mentally ill, including RNs, RNAs, Social Workers, Psychologists, as well as the supporting agencies and the patient's families. The stigma is huge, even among the professionals.

"During cut backs in Ontario, and lay offs, the hospitals reassigned nurses to the Psych department who had ZERO training in psychiatry! That alone was incomprehensible."

My question is, in your research have you learned that when hospitals face cutbacks, the mental health services are the first to be cut?

Heather Stuart: With respect to funding, I think that all mental health services -- not only hospitals -- are seriously under funded and, yes, they are typically the first to be cut when budgets are tight, and the last to be funded when they are not. When new funding comes into mental health, it is difficult to protect and sustain it over the long run.

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In Breakdown, The Globe and Mail documents the enormous, unaddressed cost of mental illness to Canadian individuals, families and society. The series closes with a search for solutions.

 

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