How Mental Health Stigma can Impact on Physical Health
It can be essential to get a mental diagnosis in order to access support services such as counselling, or respite from employment whilst working through a traumatic episode, without facing dire poverty. However, a diagnosis may then significantly affect a patient’s physical health condition, in a number of ways.
Firstly, there’s the attitude of doctors, many of whom are at least as ready to stigmatise as the general public. Because of having been fairly itinerant over the years, I’ve had many experiences of signing on with new surgeries. At the first visit, I’ve usually get on well with the doctor – at college I knew a number of medical students, and I’ve worked in the NHS, so I can talk their language – and I’d have no trouble explaining my current symptoms and getting a prescription.
But if I returned a few weeks later – in the meantime my medical records including mental health history having arrived – what met me would be totally different. The doctor would not look me in the eye, he’d talk loudly over me as if I were stupid, my described symptoms such as where I felt pain would not be believed, and I’d sometimes go away without any medication, feeling a lot worse for my visit.
At a recent local HealthWatch meeting, a carer described how his daughter, who was diagnosed as bipolar, was assigned to a particular doctor in the practice – and however bad her physical health, no other doctor would see her, and the next appointment might be a month away. By which time her untreated physical health condition might have got whole lot worse.
On one occasion she urgently needed attention and had to really shout loudly before anyone listened. Having had a similar experience, I then chipped in that a further problem could arise – the doctor might write into medical record that “the patient was aggressive” (no I/she wasn’t, we were ill and extremely upset at not being believed!) as a permanent record, and any future doctor would be even less likely to be sympathetic.
Another patient described how he was having real, painful and even life-threatening problems with his pace-maker – but was not believed by a number of health professionals – and having only fairly recently had a mental health episode. He was able to differentiate between the attitude of staff before and after he was known as being a mental health survivor. Eventually, after weeks of unnecessary pain, they did decide to investigate, which took a minute or two, a very simple mistake had been made, and the problem rectified in a few seconds. But in a sense he was fortunate, some mental health survivors are never believed, until a bit too late, after the autopsy,
Then there’s the problem of time.
A patient may go to the GP needing some help with mental health problems as well as one or more physical health conditions. Physical symptoms are hard enough to describe, mental health problems even more so, and the allotted 10 minutes per appointment can easily not be sufficient. I’ve had the experience of being told that my time was up, and I hadn’t even mentioned two physical health problems, which therefore got no treatment until I could make a further appointment a week or more away.
Finally, Socialist Health Association, of which I'm a member, published an article of mine earlier this year which drew a response from a Doctor nearing retirement. He clearly had a lot of experience and passion in the field of mental health so I specifically asked him "where you think mental health survivor campaigners should be directing out attention, and what feasible and practical improvements we should be demanding, which would allow GPs on the front line to give us the help we need and you want us to have."
His answer drew four concrete suggestions. He said '‘I would suggest service users campaign for:-
- A Mental Health Facilitator and an IAPT primary mental health worker in every practice.
- Direct access to primary mental healthcare workers (IAPT) for all patients and to an MHF for anyone registered as having an enduring mental health problem.
- All GPs to have training in practical approaches to mental health eg Five Areas Model. Every practice to have one GPwSI in mental health with protected time for peer supervision.
- Receptionists trained and practices funded to offer patients presenting with mental distress a minimum 20 minute appointment.
I’m sure many mental health survivors have their own stories of receiving below standard care of physical health at the hands of their GP. And the appalling fact is that the death rate of mental health survivors is significantly higher than the average, even if suicide is factored out.
We shouldn’t and needn’t put up with it, and as a first step I would urge everyone with a personal experience of poor care to contact your local Healthwatch, and pass it on, so they can collate experiences, and take it up with higher authorities within the NHS and government. And maybe one day medical professionals will treat us with the dignity and respect we deserve, and sometimes so urgently need.
With all the cuts to mental health services, we're sure many people be able to relate to the difficulties Oliver has experienced. We'd love to know your thoughts in the comments below; either through good or bad experiences.
Oliver has wrote a book which includes a collection of articles, personal experiences, poems and songs, mostly centred around the theme of mental health, which is linked just there -->
All proceeds go to Launchpad