Mental health-related stigma in health care and mental health-care settings: response to journal article

There is a study in the Lancet Psychiatry this month that looks at the high incidence of “stigmatization” towards those with psychiatric labels by MENTAL HEALTH PROFESSIONALS. I respond below the excerpt with a piece based on my personal experience of such bigotry in the ranks of those charged to care for folks with diagnosis.

Mental health-related stigma in health care and mental health-care settings (available with free registration)

The questions they set out to answer are as follows:

psychStigma in a health-care context probably contributes to the disparity in life expectancy,20 compared with the general population, but before this can be tackled effectively, careful consideration of what stigma means in health care is needed. We used a theoretical framework and separated mental health services from other health services, because the effect of stigma might vary in these contexts. We then addressed the questions: do mental health professionals stigmatise people using their services; and do other health-care professionals stigmatise people with mental illness? If health professionals do stigmatise people with mental illness, what are the effects on quality of mental health care and physical health care? We then considered the evidence that stigma and discrimination in the health-care context can be decreased. To focus this Review on health professionals, we excluded the literature in which health-care students were the only study group. Neither did we address the question of the extent to which stigma is a barrier to health professionals seeking help for their own mental illness. (read the report on the study here)

It’s safe to assume they’ve missed out on a lot of the subtle ugly stuff those of us subject to such bigotry experience every time we enter the system. Still it’s good that it’s being considered and published in the Lancet.

I’ve written quite a lot on this topic and so I’m reposting an edited and shortened version of a piece I’ve shared before below.

Bridging Patient-Professional Divide

Depending on how I choose to identify myself with other professionals, I am treated radically different. Generally speaking, when I identify as a social worker, rather than the author of Beyond Meds, — which is identified commonly as a “patient” blog, — I am received with respect by mainstream and alternative professionals both. I am also engaged more deeply and with more interest. On the other hand, when I identify primarily as the author of the blog but also a mental health professional, I am more likely to be treated dismissively. Because those professionals who profess to share my interest in radically changing the system or using alternatives to psychiatry exhibit this bigotry quite often as well, it only reinforces how deeply entrenched these prejudices are across all sectors of society. Clearly what professionals across the board remember once it’s disclosed is that I was a user of psychiatry: a mentally ill person. I don’t consider myself as such anymore, but that doesn’t seem to matter even, quite often, among those professionals who profess not to believe in mental illness!

My online experience of identifying as patient vs. social worker, therefore, offers me a unique perspective. The majority of those in mental distress are subject to the care of mental health professionals who consider them inherently less than equal. This is not generally recognized because on a conscious level professionals are not aware of having these issues. But well-meaning and acting with prejudice are not mutually exclusive. People don’t see it in themselves. How might we change this? One way, of course, is to begin to courageously find and root out our own bigotries. All human beings have them.

I think that expanding the concept of peer counseling may help bridge the divide between clinician and patient. When we meet those we are helping from a place of vulnerability and equality, we can bring about healing. I noted that once I publicly acknowledged my frailty, my humanity, the healing relationship often became stronger with those I interact with. Some of the connections and healing relationships I’ve made via my work at Beyond Meds have been astonishingly deeper and more honest than any work I ever did as a social worker when I relegated significant parts of myself as off limits to my clients. Clinicians are taught to do this, of course.

Authenticity is often trained right out of mental health professionals and instead a vague and subtle superiority replaces it. I too was tainted and saw it in myself, as a professional, even as I saw it in my colleagues around me. I also experienced it as a patient/client, I was actively made ‘other’ by the people I saw professionally. These parts – that of the knowing superior vs the ignorant inferior – are in all of us too, regardless of training! I suggest those in mental health circles who have taken up the mantle of helper become acutely conscious of this so that they might minimize the harm it can cause in relationship with others.

We are all, every one of us, in this wonderful and mysterious thing called life. And all of us are struggling in various ways to make sense of it. Is there really such a difference between someone trained as a clinician and a client?  If those trained to help were also trained to remember that their role as helper was because they have much more in common with their patients/clients than not, then we will start to see a flattening of hierarchy. We all have incredible capacities and learn very particular things in our own individual idiosyncratic ways. Most of it is not learned in school or training regardless of level of education.

This begs the question: Is it possible that identifying with a client might actually be a good thing? This is surely exactly why “peer counselors” are effective. I would like to make the argument that as human beings we are, indeed, all peers. A peer is an equal. I understand the word is used in other ways. This is a challenge to consider a broader context. We are all on this planet trying to figure out what the heck we’re doing here…every last one of us. In that process we all suffer. And the reality is it’s a conundrum for every last one of us. We are all the same that way. The manifestations change but there is a universality in the nature of suffering that make a lot of mental health professionals very uncomfortable and the result is projection. Putting all that ugly stuff on the client “other.”

We might start by consider our shared humanity…even in our weaknesses and flaws.  In providing a safe container from that understanding we bond more deeply. The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties.  I believe that all our psyches contain a full spectrum of the content of the collective psyche within it…some people experience more or less of this or that, but we’ve all got it. Healing ourselves and others both require deep familiarity with all its parts. This is not understood particularly well among most mental health professionals.

Many mental health professionals not only know little about the deepest part of the psyche, they are terrified of it, adding another layer of obfuscation to the problem. When people in mental distress are terrified the last thing they need is to be met by a “healer” who is also terrified.

Ultimately what is at stake here is becoming conscious of the nature of our humanity. I am blessed to know many such people, lay and professional both, who are conscious of these issues. Still, it’s very hard for people lost in mental distress to find resources that include deeply healing professionals and so the people who need healing the most often do not find it. It starts with us going ever deeper into ourselves and lovingly, with compassion, helping others do the same.

More on this topic: 

About Monica Cassani

Author/Editor Beyond Meds: Everything Matters