Physicians, health thyself.
May 24th is Schizophrenia Awareness Day in Canada -- and the month of May is Mental Health month -- but a disturbing study just presented at the American Psychiatric Association (APA) meeting in San Francisco demonstrates just how prejudiced many health providers are towards those with serious mental illnesses.
And it is not simply stigma but prejudice, according to Dr Jeffrey Borenstien, the chief medical officer at the Brain and Behavior Research Foundation in Great Neck, New York, and chair of the Council on Communications of the American Psychiatric Association.
"We use the word stigma, but I would use a different word -- prejudice," he said at a press conference. "In our society, we don't allow prejudice anymore based on a variety of factors, but we still, to whatever degree, tolerate prejudice when it comes to people with psychiatric conditions, and that has to change."
Dr Borenstein was referring to the results of a study presented at the APA by Dr. Dinesh Mittal, a psychiatrist at the Central Arkansas Veterans Healthcare System and associate professor at the University of Arkansas, in Little Rock, and his colleagues.
What the researchers did was to create a mythical patient sent to four groups of health care professionals -- psychiatrists, general practitioners, mental health nurses and primary care nurses. The mythical patient was a 34-year-old man with hypertension, obesity, insomnia, and chronic back pain returning for a follow-up visit and seeking stronger medication for pain. He was a cafeteria worker, attended church, and enjoyed fishing and reading magazines but in one scenario he had a history of stable schizophrenia. In the second scenario, he had no indication of schizophrenia.
Unfortunately, the results did not come as a surprise to many of us who deal with the medical system and a relative with schizophrenia.
Overall, the health care professionals anticipated less adherence to medications in those with schizophrenia even though adherence rates between those with and without mental illness are similar. Those with schizophrenia were less likely to be referred to weight management programs than those without. The researchers pointed out that weight management programs are as successful with those with schizophrenia as those without. Again, those with schizophrenia were less likely to be referred to sleep clinics but pain clinic referrals were equal.
Those with schizophrenia were seen by the health professionals to have lower social functioning and lower competence to make treatment and financial decisions. The researchers expected that the mental health professionals would do better than the primary care workers but that was not the case. Both the psychiatrists and the primary care nurses had the lowest expectation that the schizophrenia patient would be able to understand educational material.
Dr. Borenstein stated:
"On average, people with severe psychiatric illnesses such as schizophrenia end up dying at a significantly earlier age than other people due to medical problems. So it's very important -- and that's why this study is an important study -- that we make sure that people with psychiatric conditions like schizophrenia receive the best possible medical care along with their psychiatric treatment."
It is sad and even reprehensible that those who are paid to care for the sickest of the mentally ill have such attitudes. The Mental Health Commission of Canada and the Canadian Medical Association do have programs to teach health providers which is a positive step. I suspect that more work needs to be done.