Microsoft Word – Final Paper- FIQWS.docx
Discrimination of Mental Health in the Medical Field
During Canada’s Mental Health week, the Centre for Addiction and Mental Health (CAMH) launched a public advocacy campaign, called “Mental Health is Health.” According to their website, the campaign was aimed to break the stigma against mental health. They implemented advertisements that “…Torontonians would be able to see on billboards and bus shelters across the city, but there’s also a television commercial and three videos from former NHL goaltender Corey Hirsch, three-time cancer survivor Rabi Qureshi, sharing their stories of their battle with a mental illness.” By utilizing well-known people with high standing and patients with personal experience, the campaign is effective in spreading their message. The stigma and discrimination of mental health patients in the medical field is sadly still prevalent, influencing many people to spread awareness through different genres and sources such as CAMH’s campaign, personal narratives, Tiktok videos, and research papers.
One of CAMH’s advertisement is a commercial video, in which a young female patient briefly describes her condition as “an anxiety disorder.” Since the video has a brief duration of thirty seconds, it increases the chance of an engaged audience and especially the younger population who tend to have shorter attention spans. As the female patient describes her symptoms such as “migraines, numbness, weight loss,” there are also short clips of her wheezing and hyperventilating that last shorter than a second and occur suddenly. In the latter half of the video, there is also a beeping noise of a hospital machine. In addition to this, the dark blue filter of the video also adds to the cold and unsettling feeling, which allows the audience to comprehend what it feels like to be a mental illness patient. She refers to her mental health disorder and that “it deserves to be treated like any other illness. But it’s not.” The video ends with the patient hopelessly looking outside the window as the campaign’s main message “illness is illness. mental health is health” is displayed. The commercial is available on YouTube, a popular and public platform that reaches out to a wide range of audience. The video also includes a hashtag, #MentalHealthIsHealth, which enables the algorithm to recommend the video to an audience with a specific interest in mental health. Not to mention, the title of the video, “I Can’t Breathe” also captures the attention of more people by the title’s distinctiveness. Discrimination against mental health patients is an extremely detrimental characteristic of society and should not be as widespread as it is today. Through advocacy campaigns, such as CAMH’s Mental Health is Health, this issue of mental health and the risks that results from how it is perceived in health care is becoming a common topic. More articles, like Juliann Garey’s NY Times article “When Doctors Discriminate” and other research papers have also been addressing this issue.
In her opinion-based article, “When Doctors Discriminate,” Juliann Garey describes her personal experiences where her needs are not met and adequate healthcare is not provided, as the YouTube video claims. One shocking occurrence was when the ENT doctor felt “uncomfortable” treating her ear infection, after being informed of her bipolar disorder. This left her with permanent hearing loss. Through her personal narrative, she demonstrates the severity of this mental health crisis in the medical field and how it affected her personally. Garey’s experience is just one example of what many patients with mental health disorders face under the presence of health care professionals. This stigma of mental health is instilled in many of us, as we tend to associate mental health patients as being unstable or “drug-seeking.” (2) This dangerous perspective is also instilled in many health care professionals and trainees, which brings up the importance of educating about this issue of mental health discrimination in the practice of medicine. If these measures are not taken, this ultimately puts patients with mental disorders in greater risk of deteriorating health and can “…die 25 years earlier than those without one.” (2) Thus, this also pressures mental health patients to keep their condition to themselves, avoid daily health checkups, and further damage their health. Garey, who resonates with this and prefers to keep her mental health condition to herself, explains that “It wipes clean the rest of my resume, my education, my accomplishments, reduces me to a diagnosis.” (2) This fear of revealing her mental health condition arises from the stigma, as it is seen as something to be ashamed of, a hindrance, or a disability. People with a mental health history, like “schizophrenia” or “depression” and other illnesses, are labeled as deranged or troubled, thus affecting their personal lives. It makes it harder for them to get out in the real world, socialize, find a job, make friends, and in general just live like patients without mental illnesses. The argument that Garey conveys in her article correlates back to YouTube campaign video, as it provides her own narratives of how often patients with mental illnesses are dismissed and provided inadequate healthcare.
As Garey’s narrative exemplifies the message conveyed in the YouTube video, Sophie Reilly also reveals how she is failed by the healthcare system because she is a patient with multiple mental illnesses. Her popular media article is called “ ‘I deserve more than to be thought of as crazy’: a journey through mental illness.” Published by The Guardian, a well-known British daily newspaper, the article is available to the public. This enables for more viewers to come across this article and learn about Reilly’s experience and the issue. In her article, Reilly shares how she felt when diagnosed with psychosis, as it was “the most terrifying thing in the world.” (3) Reilly reinforces that patient with mental illnesses “deserve anything but to be thought of as merely ‘crazy or “mental” or “loopy” or “schizo” or “a screw loose” and never trusted, or taken seriously, as everyone’s too scared of us, or thinks we’re just broken, or they plain don’t give a shit.” She describes how she feels she is perceived by others when her mental illness is revealed, using words like “mental” and “screw loose.” (3) This change in other people’s perception provides a parallel to Garey’s decision to keep her mental illness to herself. In her article, Reilly’s use of casual tone and curse words draws the attention of younger readers, along with the older generation who read the newspaper daily. The first-person perspective and descriptive language used to describe her experiences and herself as a person outside of her mental diagnoses, create a vivid image for the audience to grasp her main message. Reilly states her achievements such as being a “qualified English teacher,” yet also described her desperate state of suffering and surviving mental illnesses like “old beggars.” (3) With this specific diction, she clearly establishes how patients with mental illnesses can be described with two completely opposite words and should not be confined to only one, which is usually the title of being unstable. Reilly ends her article with a strong and similar message as CAHM’s campaign video by saying “We are people, not diagnoses.” (3) Once again, she reminds the audience that patients with mental issues need to be seen and given equal treatment as a regular patient and nothing less.
In addition to the personal narratives that allow readers to understand the hidden feelings of patients who struggle with mental health, there are also research papers and data that validate the YouTube video’s message. In the campaign’s advertisement video, the patient’s last words are “But it’s not,” referring to the failure of her call to draw medical attention to patients with mental illnesses. It leaves a sense of hopelessness and discouragement. However, this issue of mental health discrimination in the medical field is progressively growing open for discussion, as seen in the medical article, “Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions.” In the article, the severity of the health crisis of mental health stigma is clearly shown as “A survey conducted by the Canadian Psychiatric Association found that 79% reported first-hand experiences of discrimination towards a patient and 53% observed other medical providers, discriminating against a patient from psychiatry…” (4) The provided data makes the audience question why these numbers are so large and start paying attention to this issue. To fully understand this crisis, we must question where this crisis stems from. The answer is the stigma, or also known as the negative perception of mental health. The research paper also explains that “…stigmatization occurs on multiple levels throughout the healthcare sector, including structural (eg, investment of resources, quality of care standards, organizational culture), interpersonal (eg, patient–provider interactions, discriminatory behaviours, negative attitudes), and intraindividual (e.g., self-stigma, patient reluctance to seek care, provider reluctance to disclose a mental illness and/or seek care.)” (4) Stigma can be built into many different relationships, including a doctor-patient relationship or even a self-to-self relationship. This explains why the stigma of mental health is so dangerous and widespread in the field of medicine. The increasing acknowledgment of this serious mental health stigma also allows people to realize that as long the stigma of mental health continues to be fostered into the healthcare system, there will not only be discrimination against mental patients, but also medical professionals with mental illnesses themselves. The research article, “Reducing Mental Health Stigma in Medical Students and Doctors Towards Their Peers With Mental Health Difficulties: A Protocol” acknowledges this behavior of medical students and professionals “…with mental health difficulties continue to suffer in silence despite the availability of effective treatment.” (5) Because of the negative outlook on the topic of mental health and on anyone who has a history with mental health disorders, it is kept a secret. Even medical practitioners, who know better than to leave a diagnosis untreated, resort to keeping their condition to themselves. This can be extremely harmful to the individual, but also the patients that they provide care for. As a medical professional, one must be in the right state of providing care for others who seek help. If mental health goes untreated, just like a physical health disorder, it can deteriorate even more. After a study was conducted at Harvard University, the research article states that “…the overall pooled prevalence of depression or depressive symptoms in participants included in their study was 28.8% – greater than in the general population (Mata et al. 2015).” (5) This statistic establishes the fact that medical students and professionals are more prone to develop depression and other mental health issues. However, they are also more likely to refuse treatment or seek help. Sadly, this contributes to the higher suicide rate in physicians, compared to the general population. Garey and Reilly’s personal experiences and multiple research papers show that certain actions are needed to be taken to ensure that this mental health issue, as demonstrated in the YouTube video, is broken down.
One way that action can be taken to spread the message of the YouTube campaign video is through social media. While YouTube can be categorized under social media, more modern and accessible social apps are starting to attract more of the younger generations. Dr. Jake Goodman uses these newer social media apps to his advantage, as seen in one of his viral TikTok videos. In the brief 30 second clip, Dr. Goodman reveals that he is a psychiatrist and a mental health patient. His first statement is captioned, “I’m a doctor in training, and most doctors would advise me NOT to post this.” (6) This first statement is clever as it hooks the audience and makes them curious to know why he is sharing something that would usually not be shared. Tiktok is one of the more popular apps that has recently gotten the attention of many young adults and older generations. The app enables editing and features such as filters, stickers, and music that can be used to attract more viewers, which are all utilized by Dr. Goodman. However, TikTok has also created a casual atmosphere to upload raw videos that aren’t as produced and fabricated like the campaign video and other YouTube videos. This allows viewers to empathize and connect with the content and the creator. In his own words, his purpose is to “break the stigma” and to be “proud of it.” (6) He communicates this message by including hashtags, like “#mentalheath” and “doctor” in his caption of the TikTok video. This attracts other health professionals to join him in breaking the toxic stigma in the medical field. This Tiktok video also correlates to a statement that the research paper states which is “challenging mental health stigma can help to break down the barriers to mental health services for people who urgently need them.” Doctors like Dr. Goodman, who realize the flaws of the current healthcare system that are also criticized in the YouTube campaign video, provides examples of how to successfully address and reduce this health crisis of mental health stigma. By providing personal narratives in his Tiktok video, Dr. Goodman also encourages other medical professionals to share theirs and how they implement changes in their practice. The comments of his Tiktok demonstrate the effectiveness of his video’s purpose. Some examples of these comments are “Thank you for normalizing this topic” and “As a physician, I can tell you how much this message matters in our community…” Being able to accept that he is both a psychiatrist and mental illness patient, Dr. Goodman is also able to use it to understand his patients better, instead of harming his patients if he had neglected his own mental health.
While there are various articles, sources of media, and videos that raise awareness of the discrimination that occurs to mental health patients, there seems to be a lack of research done on the effectiveness of interventions intended to alleviate this issue. However, the ScienceDirect narrative review, “Evidence for effective interventions to reduce mental-health-related stigma and discrimination” addresses the importance of including these “effective interventions intended to reduce mental-illness-related stigma or discrimination” in the conversation of mental health discrimination. (7) Interventions such as diverse social contact and education were implemented for different groups of people like students, health care staff, and the public. The review paper reported the findings that “mental health education or information interventions seemed to be the most effective type of intervention with regards to outcomes at 4 or more week’s follow-up, although education or information combined with direct or indirect contact, also performed well…” (7) By having research done on the influence of certain types of mediations, health care professionals are better able to know what creates changes and what does not.
In conjunction to this, Garey’s article “When Doctors Discriminate” also provides other potential interventions like “… policy recommendations, including designating patients with serious mental illnesses as a high-priority population; coordinating and integrating mental and physical health care for such people; education for health care workers and patients; and a quality-improvement process that supports increased access to physical health care and ensures appropriate prevention, screening and treatment services.” (2) The article explains the importance of having these changes instilled into our society and daily lives, as it would make a real difference. While the 30 second advertisement successfully spreads awareness of the importance of mental health, it does not offer a specific call to action or possible interventions that could help this issue of discrimination against mental health. Therefore, it is crucial that education facilities and students take initiative to educate themselves about the issue themselves. An example of this “is the narrative medicine program at Columbia University Medical Center, which starts with the premise that there is a disconnect between health care and patients and that health care workers need to start listening to what their patients are telling them, and not just looking at what’s written on their charts.” Along with this, “several major medical schools now have programs in the medical humanities, an emerging field that draws on diverse disciplines including the visual arts, humanities, music and science to make medical students think differently about their patients.” These narrative medicine courses have been shown to be extremely crucial and effective as reflected in my own experience in this course. Being introduced to the discrimination against mental health patients in a field meant for helping everyone and realizing the importance of raising awareness of this issue has been the main motivation for this research paper. This narrative medicine program proves to be successful in its efforts to eliminate such treatment against patients with mental illness and discrimination in the healthcare field, and finally begin a new generation of healthcare professionals where mental health is seen no different than physical health. If these campaigns and advertisements, discussions and research, and interventions like humanities and science courses are all properly implemented, the YouTube advertisement won’t have to be a reality for many patients.
Citations-
- CAMH. (2018, May 7). I Can’t Breathe – Mental Health Is Health Campaign|CAMH [Video]. YouTube. https://www.youtube.com/watch?v=jBS7v-v5oMo
- Garey, J. (2013, August 10). When doctors discriminate. The New York Times. https://www.nytimes.com/2013/08/11/opinion/sunday/when-doctors-discriminate.html.
- Guardian News and Media. (2017, November 9). ‘I deserve more than to be thought of as crazy’: A journey through mental illness. The Guardian. https://www.theguardian.com/healthcare-network/2017/nov/09/deserve-more-crazy- woman-journey-mental-illness.
- Knaak, S., Mantler, E., & Szeto, A. (2017, March). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347358/.
- Hankir, A., Fletcher-Rogers, J., Ogunmuyiwa, J., Carrick., FR., Zaman, R. (n.d.). Reducing mental health stigma in medical students and doctors towards their peers with mental health difficulties: A Protocol. Psychiatria Danubina. https://pubmed.ncbi.nlm.nih.gov/32890375/.
- Goodman, Jake. [@jakegoodmanmd]. (2021, December 12). I’ve had this in my drafts for weeks. It’s time to post it. Break the stigma. #doctor #mentalhealth [Video]. Tiktok. https://vm.tiktok.com/ZM8vscs6m/
- Thornicroft, G., Mehta, et al. (2015, September 22). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00298-6/fulltext
