Mental Health Stigma and The Healthcare Environment

Mental Health Stigma and the healthcare environment

Stigma is an everyday reality for many Canadians living with a mental health issue, or addiction. They fear that they will be treated and looked upon differently because of their illness and, as such, will lose access to important services.

Healthcare environments can often be highly stigmatizing for patients living with mental illness or addiction. Stigmatization in healthcare and among health care professionals can result in substandard care and serious barriers to access. Additionally, stigmatization can also lead to shame and isolation, as well as overdoses and other risk-taking activities.

“[Stigma] affects health care because when people feel stigmatized, they may feel isolated, unworthy of services, and unwelcome – and therefore unsafe and uncomfortable about going to health centres or hospitals to access services.”

- Andrea Medley, First Nations Health Authority Indigenous Wellness Educator

Mental Health Quick Facts

(From: Mental Health Commission of Canada and Centre for Addiction and Mental Health)

Mental health and substance use problems affect people of all ages, education and income levels, religions, cultures and types of jobs.
One in five Canadians will experience a mental health problem or illness every year
1 in 7 Canadians aged 15 and older (about 3.5 million people) have alcohol-related problems; 1 in 20 (about 1.5 million) have cannabis-related concerns; and some have problems with cocaine, speed, ecstasy (and other hallucinogens), heroin and other illicit drugs.
More than 60% of people with mental health problems and mental illness won’t seek the help they need: stigma is one of the main reasons

What is Stigma?

(From: Centre for Addiction and Mental Health)

Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward people with substance use and mental health problems.

Stigma includes:

Having fixed ideas and judgments – such as thinking that people with substance use and mental health problems are not normal or not like us; that they caused their own problems; or that the can simply get over their problems if they want to
Fearing and avoiding what we don’t understand – such as excluding people with substance use and mental health problems from regular parts of life (for example, from having a job or a safe place to live).

Consequences of Stigma for Access and Quality Care

Compromised patient-provider relationships
Patients not having their symptoms taken seriously, or physical symptoms misattributed to a patient’s mental illness, creating delays in diagnoses and treatment options
Negative outlook about chances of recovery
Early termination of treatment
Poorer physical care
Over reliance on self-treatment

(From Mental illness-related stigma in healthcare (2017))

As one of the most accessible health care professions, having BC’s pharmacy professionals acknowledge the stigmatization of mental illness and addiction in healthcare environments is a key factor in ensuring safety and equal access to quality care for all of our province’s residents.

The unfortunate reality is that stigma often goes unnoticed. Much of this harmful behaviour is unconscious and tends to surface when we are busy, stressed or under pressure in various areas of our lives. Health professionals are not immune to this behaviour, and many are unaware that the language they use, or the way they treat their patients, is harmful.

In a 2018 ReadLinks post discussing the impact of stigma on patient care, past Board-Chair Mona Kwong explains:

“As pharmacy professionals, we are required to always protect and promote the health and well-being of patients and to treat them with respect. I encourage pharmacy professionals to help combat stigma for all impacted individuals by recognizing how our attitudes and judgments affect how we think about and behave toward others, and by learning how to use respectful “person-first” language.”

While combatting the stigmatization of mental illness and addiction requires a complex, multifaceted approach, an important first step in reducing stigma involves recognizing that the language we use matters. Negative, stigmatizing language, whether it is used in healthcare settings, news, or social media, discredits people with mental illness or substance use disorders and can result in discrimination.

Toward The Heart – Language Matters: Create a safer space with less stigma

Making a Difference

The Centre for Addiction and Mental Health recommends the following 7 things for reducing prejudice and discrimination against people with mental health and substance use problems:

1. Know the facts.

Educate yourself about substance use and mental health problems—what can bring them on; who is more likely to develop problems; and how to prevent or reduce the severity of problems.

Learn the facts instead of the myths.

2. Be aware of your attitudes and behaviour.

We’ve all grown up with prejudices and judgmental thinking, which are passed on by society and reinforced by family, friends and the media.

But we can change the way we think—and see people as unique human beings, not as labels or stereotypes.

3. Choose your words carefully.

The way we speak can affect the way other people think and speak.

Use accurate and sensitive words when talking about people with mental health and substance use problems. For example, speak about “a person with schizophrenia” rather than “a schizophrenic.”

4. Educate others.

Find opportunities to pass on facts and positive attitudes about people with substance use and mental health problems.

If people or the media present information that is not true, challenge their myths and stereotypes. Let them know how their negative words and incorrect descriptions affect people with substance use and mental health problems, and keep alive the false ideas.

5. Focus on the positive.

People with mental health and substance use problems make valuable contributions to society. Their health problems are just one part of who they are.

We’ve all heard the negative stories. Let’s recognize and applaud the positive ones. For example, did you know that Ron Ellis was living with depression at the height of his National Hockey League career?

6. Support people.

Treat people who have substance use and mental health problems with dignity and respect. Think about how you’d like others to act toward you if you were in the same situation.

If you have family members, friends or co-workers with substance use or mental health problems, support their choices and encourage their efforts to get well.

7. Include everyone.

In Canada, it is against the law for employers and people who provide services to discriminate against people with mental health and substance use problems. Denying people access to things such as jobs, housing and health care, which the rest of us take for granted, violates human rights.

People with mental health and substance use problems have a right to take an equal part in society. Let’s make sure that happens.

Mental Health and Wellness for BC’s First Nations

Mental wellness and substance use are top priorities for many BC First Nations. While challenges vary from community to community, there are certain key contributing factors including:

Colonization and assimilation
Systemic discrimination and racism
Child apprehension
Land dispossession
Loss of tradition, language and culture
The legacy of residential schools
Intergenerational trauma and its effects

A year after hosting its first Mental Health and Wellness Summit, the First Nations Health Authority has released a new policy outlining its vision for mental health and wellness.

“A priority of the policy is to build awareness among health system partners on the need for equitable access to high-quality, culturally humble and safe, trauma-informed and de-stigmatized mental health and wellness care for First Nations people, wherever they are living.”

“The policy lays out a vision for mental health and wellness for First Nations in BC, including a comprehensive continuum of mental health and wellness approaches, to be implemented in conjunction with FNHA's partners across the health system.”

Learn more about the First Nations Perspective on Health and Wellness

Additional Resources

Cultural Safety and Humility, Code of Ethics

Featured Image:

Mental Health Stigma and The Healthcare Environment May. 9, 2019 Cultural Safety and Humility, Code of Ethics