Are you aware that knowledge of your patient’s mental health status may influence the type or quality of care you provide?
In its 2014 report titled Mental Health Stigma in the Military, RAND Corporation addressed interrelated forms of stigma that could prevent service members from seeking mental health treatment:
- Individual stigma (e.g., loss of self-esteem and self-efficacy)
- Institutional stigma (e.g., governmental policies and existing systems)
- Public stigma (e.g., peers, families, health care providers, and the community)
Public stigma includes negative attitudes and beliefs about persons with mental health disorders or their treatment, as well as behaviors that can ensue from these assumptions. These behaviors may be prejudicial and discriminatory even though they are likely largely unintentional. This blog focuses on how public stigma can influence the decision-making of health care providers, ways that health care providers might unwittingly contribute to patients’ experiences of mental health stigma, and finally, steps providers can take to help reduce stigma.
Sometimes health professionals are unaware that their behaviors may contribute to stigma and ultimately influence clinical interaction or patients’ treatment-seeking behaviors. Research has shown that health care practitioners, including psychiatrists and family physicians, were more likely to hold negative beliefs about people with mental health disorders when compared to the general public. This may be attributed to providers encountering a high volume of patients who struggle with acceptance of their mental health diagnosis or managing their mental health symptoms.
These beliefs may translate to a tendency to exclude patients with mental health diagnoses from treatment decisions or to provide less treatment information. Additionally, when patients perceived stigma from providers, they reported trusting providers less and experiencing more self-stigma and overall less satisfaction. Although typically unintentional, stigmatizing attitudes and behaviors may present a major barrier to care and recovery; if patients sense unwelcoming behavior from their health care provider, this can impact their interaction and communication with the provider.
Lastly, stigma may occur in the form of diagnostic overshadowing – the inadequate or delayed treatment of people with mental health disorders due to misattribution of their physical symptoms to their mental health status. In this scenario, mere knowledge of a patient’s mental health status, past history of mental health symptoms, or treatment may serve as a distraction for health care providers. This knowledge can color a provider’s judgment or prevent them from considering the full range of hypotheses, potentially resulting in misdiagnosing non-mental health-related concerns patients may have.
So, how can we reduce potential stigma from health care providers?
Mental health education-based approaches have shown varying degree of success. Anti-stigma programs have produced some evidence of positive change among participating health care providers. A great example of one such program is the Real Warriors Campaign (RWC). It provides information, tools and resources for health care providers to share with service members, veterans and their families while they seek care.
Below are some general practices that may help to reduce stigma when interacting with your patients:
- Identify stereotypes active in the military community (e.g., the perception that mental health symptoms/diagnosis are signs of weakness), and look for opportunities to counter some of these stereotypes during patient interactions. For example, health care providers might make a point of commenting on the courage it takes to show up for treatment to counter beliefs that individuals with mental health concerns are not strong.
- Identify “gut” reactions as potential indicators of implicit bias, and consider how these reactions may influence treatment delivery and management.
- Take an “in-your-boots” approach and consider the situation from the service member’s/patient’s perspective. Reminding yourself that patients may be uncomfortable speaking openly about mental health might soften the way you speak to them about their problems and create a more comfortable clinical environment.
- Avoid assuming that you understand what’s going on with a patient based solely on the mental health diagnoses in the medical record. Take the time to listen and get to know them before jumping to conclusions, and don’t assume you have all the answers based on a patient’s history.
- Increase your general knowledge about the experiences of people with mental health disorders. For example, volunteer involvement, watching documentaries, or reading memoirs focused on mental health may be instrumental in challenging your assumptions and creating empathy for people with mental health disorders.
- Lastly, ask yourself: what diagnoses would I have considered if I were unaware of the patient’s mental health diagnosis? For medical providers, what tests would I have run given a patient’s symptoms?
Dr. Omobola Mudasiru is a health care analyst at Deployment Health Clinical Center. She has a Master of Science in environmental health and a Doctorate in Public Health focusing on infectious diseases, health literacy and access to health care among key demographics.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Deployment Health Clinical Center or Department of Defense.