Stigma still dogs mental illness

MEDICAL practitioners have an important role in destigmatising mental illness, says a GP with a special interest in mental health as newly published results from an Australian study find that stigmatisation remains highly prevalent and problematic.

GPs in particular could provide reassurance and education in the community that mental illness was just as much a part of life as physical illness, said Dr Caroline Johnson, a member of the Mental Health Council of Australia board and of the Royal Australian College of General Practitioners National Standing Committee — Quality Care.

Dr Johnson said that this week would present an ideal opportunity to raise discussion about mental illness, with World Mental Health Day to be held on 10 October.

The cross-sectional, questionnaire-based study, published in Family Practice, found that nearly 30% of patients would feel uncomfortable sharing a GP waiting room with a patient with schizophrenia and about 12% would be uncomfortable sharing it with a person with severe depression or severe anxiety. (1)

The researchers also found that of the 1134 respondents, less than 30% felt that general practice was an appropriate location for treatment of schizophrenia and only 48.8% thought it was suitable for treatment of severe depression or anxiety.

Lead author, Dr Parker Magin, of the discipline of general practice at the University of Newcastle, told MJA InSight that this finding was particularly worrying as caring for mentally ill patients was a core part of general practice.

However, Dr Magin said only 3.5% of respondents had reported ever having a disturbing or unsettling experience in the waiting room due to the mental illness of another patient.

“These feelings are more likely to be due to poorly controlled children in the waiting room, which is more an irritation than a concern”, he said.

Dr Johnson agreed, saying patients were more likely to complain about another patient coughing in the waiting room than about a mentally ill patient.

Dr Magin and Dr Johnson said the general practice waiting room was an ideal location to provide information and educational material to lessen the stigmatisation of mental illness.

Dr Johnson said that in her practice, in the Melbourne suburb of Surrey Hills, posters about many different conditions, including mental health, were posted around the waiting room.

She said in this way GPs could reiterate that mental illness should be treated in the same way as physical illness. Other ways for GPs to reiterate that mental illness was a part of general practice included training reception staff to recognise patients presenting with psychological stress.

However, she disputed the study findings that economic implications might cause concern for GPs and practices with a special interest in mental illness, as 10% of study respondents said they would change practices if that were the case.

“As mental health consultations take much longer, doctors who decide to do this are certainly not in it for the money”, Dr Johnson said.

Dr Magin said results published earlier this year from the same 2009 survey showed more than 15% of patients would change practices if their practice provided specialised care for opiate-addicted patients. (2)

However, he said the major difference in the results was that GPs could choose to prescribe opioid-substitution treatment, whereas managing mental health was a central component of general practice.

Both Dr Magin and Dr Johnson agreed that there were some lessons for specialist practices and hospital emergency departments from the study, saying they also had a role to play in destigmatising mental illness.

– Kath Ryan

1. Family Practice 2012; Online 27 September
2. MJA 2012; 196: 391-394

Posted 8 October 2012