Stigma and mental health treatment

MENTAL disorders are now recognised to be incredibly common in our community. With one in five people experiencing some form of a mental disorder every year, and 45% affected during a lifetime, mental health conditions impact heavily on community capacity and disrupt the lives of people in every location and situation.

Fortunately, in recent decades the perception of mental illness itself has catapulted from an ignored and shameful condition to one acknowledged to be commonplace, treatable and generally compatible with living a normal life. This acknowledgement that mental illness can frequently be successfully treated has been core to its rehabilitation in the public eye.

I wonder if much of the historic stigma and hysteria which influenced the treatment of unwell people was related to despair. If people fear what they do not understand, then the combination of what they do not understand and what cannot be effectively treated must have been particularly horrifying.

Today, psychiatrists are pleased to say this is not the case. In the past 30 years, interventions including psychological therapies and medications have greatly improved, especially for conditions of high prevalence. The popularity of techniques such as mindfulness demonstrate this greater awareness and interest in mental health interventions, even as psychiatrists continue to seek improved treatment tools.

Yet negative depictions of the other tools of mental health care are routine.

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Side-effects of chemotherapy medications are well known but it is not commonly suggested that people suffering from cancer should not take the medications prescribed by their specialist. Instead, after a discussion with your doctor, it is implicitly understood that for someone with a serious or chronic condition, the benefits of a medication outweigh the negatives. And there are significant campaigns by doctors, consumer groups and not-for-profits which support efforts to add better chemotherapy drugs to the Pharmaceutical Benefits Scheme, to increase medical trials of new drugs and encourage research into medications showing potential.

As a psychiatrist, I yearn for the day crowds of people support my patient being able to access better treatments. Instead we discuss new treatments in quiet whispers.

Thousands of Australians currently take antipsychotics and antidepressants, which while effective are not as effective as we would like, and carry significant risks of side-effects, for example related to diabetes and ischaemic heart disease.

Yet new drugs are treated with suspicion if not outright hostility. There is no campaign to address this.

I recognise, as do my colleagues, that the community’s distrust of some mental health treatments is informed by a history which does not reflect the ethos of patient care and integrity that it should have. However, it seems we are now hamstrung in our efforts to improve the care, and consequently the lives, of our patients, by the compromising of increased discussion of mental health care with the use of disparaging and inaccurate depiction of medical interventions, hospitalisation and the intentions of clinicians.

A recent example was a story on the highly regarded ABC TV program 7.30 which discussed contemporary electroconvulsive treatment (also known as ECT) using graphic and disturbing footage from the 1960s.

ECT is always a sensitive topic and not surprisingly so, but media sentiment seems to be permanently anchored to the depiction of it as an unnecessary and horrifying intervention as shown in the movie One flew over the cuckoo’s nest (1975), which is set in 1963. There are not many areas of medicine I suspect that would be comfortable with the standards of 1963 treatment being applied to patients today.

This is not an isolated case. Other well-known depictions of ECT, including Shine (1996) and Requiem for a dream (2000), carry the same biases.

On a more positive note, a recent episode of SBS TV’s Insight about ECT, and the ABC’s powerful Changing minds documentary, show that an even-handed discussion of psychiatric treatments like ECT and the role of hospitalisation is possible, especially when it includes the voices of real-life consumers and carers.

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This is necessary as ECT remains a highly effective treatment for people with severe and intractable depression, a condition which has a very high risk of suicide, and few if any quick-acting interventions.

I make these comments because we know media coverage can alarm and deter our patients who are already suffering the effects of challenging health conditions, and who do not deserve to be scared by out-of-date and inaccurate depictions of legitimate contemporary treatments.

I think of the recent furore about a “wellness blogger” who falsely claimed to have recovered from cancer and gave poor advice encouraging inadequate care. She was rightly condemned for her lack of compassion and judgement for patients.

Do people with mental illness deserve anything less?

Serious mental illnesses experienced by patients such as the ones we see every week are complex and difficult to treat. But not treating them effectively has far worse implications. Australians deserve both the best treatments that modern medicine can deliver, and the opportunity to discuss these treatments in an impartial and respectful environment. I encourage the media and the community to join with us to try even harder to provide this.

Professor Malcolm Hopwood is President of the Royal Australian and New Zealand College of Psychiatrists