Stigma persists for patients diagnosed with a mental health disease, resulting in discrimination, shame and blame in a way that would never accompany a cancer diagnosis. And that stigma isn’t just in the outside world. Patients often feel it in their primary care physician offices, too, even if it is unintentional.
It often comes in the form of avoidance by a physician of these behavioral and mental health conditions, explained child and adolescent psychiatrist Sourav Sengupta, MD, MPH, during a Behavioral Health Integration (BHI) Collaborative webinar the AMA hosted, “Physicians Leading the Charge: Dismantling Stigma around Behavioral Health Conditions and Treatment” (slides).
Fear and a lack of knowledge about mental health conditions frequently underlie avoidance of these conditions, said Dr. Sengupta, an assistant professor of psychiatry and pediatrics and director of training for child and adolescent psychiatry at the University at Buffalo School of Medicine and Biomedical Sciences.
But there are steps primary care and other physicians can take—and resources they can access—to help integrate mental health care into their own practices and to overcome and eliminate the effects of stigma, experts said. In the end, physicians will be able to better care for their patients.
“This is a unique time with a tremendous amount of opportunity because the silver lining of COVID is it really has normalized the conversation around mental health,” said Mary Giliberti, executive vice president of policy for Mental Health America. “And I think that is helpful because it’s not seen so much as outside or something to be ashamed of. Everybody is experiencing anxiety. Everybody is dealing with this epidemic.”
The AMA established the BHI Collaborative with seven other leading medical associations to help overcome obstacles to integrating behavioral and mental health care into primary care practices. The goal is for the patient to receive mental health care within the primary care office, whether from a psychiatrist, other mental health professional or a combination in a team-based care approach.
Learn more about AMA efforts to improve behavioral health, amid COVID-19 and after the pandemic has ended.
Experts shared examples of how physicians and others on the care team can help break the stigma barrier and normalize treatment for those with mental health conditions, including providing mental health screenings during routine care such as prenatal and postnatal care.
Physicians can also change the language they use when talking about patients with mental illnesses. For example, instead of describing a patient as a 60-year-old schizophrenic, describe a patient as a 60-year-old who has been diagnosed with schizophrenia.
“The person is not the illness. The illness does not define them and we need to stop talking about people that way,” said psychiatrist Nancy Byatt, DO, medical director for the Massachusetts Child Psychiatry Access Program.
She also said physicians should change how they speak with patients, using what she called a strength-based approach. For example, instead of asking what is wrong, ask about what is going well for a patient and how they managed to get through a situation.
And physicians should talk about their own or their family members mental health conditions in a more upfront way.
“If your kid had asthma, if your kid had a malignancy, you would just talk about it. You would say, ‘I’m not coming in because my kid is getting chemotherapy,’” Dr. Byatt said. Mental health illnesses should be no different.
During the webinar, speakers also described how practices can integrate an interdisciplinary approach in their practice settings to reduce the stigma and support patients in reporting symptoms and seeking care.
Along with the AMA, the American Academy of Family Physicians, American Psychiatric Association, American Academy of Pediatrics, American College of Obstetrics and Gynecology, American College of Physicians, American Osteopathic Association and American Academy of Child and Adolescent Psychiatry comprise the BHI Collaborative.
To help physicians offer mental and behavioral health services their practices, the BHI Collaborative has created the “Overcoming Obstacles” webinar series. By year’s end, the collaborative plans to release a playbook that includes information from guide books various specialties have already created to help smaller and medium-sized practices integrate behavioral health.