Dialogue Volume 15 Issue 1 2019 - Page 27

PRACTICE PARTNER How to Treat Stigma People with mental health or substance abuse issues can face barriers to care DOC TALK By Stuart Foxman W hen her son Stephen began experiencing depression and anxiety in high school, Dorothy Bakker didn’t realize it at first. “People don’t always want others to know that they’re struggling,” she says. “Maybe it’s about stigma. He didn’t want to be labelled. Or he didn’t want me to worry.” Later, in university, Stephen was diagnosed with a bipolar mood disorder, and also had an alcohol and cocaine addiction. Yet a big hurdle to his care remained stigma. Bakker recognizes this not just as the moth- er of a patient, but as a doctor herself. She is a family physician at the University of Guelph’s Student Health department, and an associate clinical professor at McMaster University. There are all sorts of ways stigma plays out, from keeping issues secret to feeling marginal- ized. Other manifestations may seem benign, but reinforce the idea that patients are on their own. Or that the problem isn’t really serious. Dr. Bakker would like to see physicians be more willing to engage in substantial conver- sations about the mental health or substance abuse issues of their patients. She feels they, too often, honour an assumed reluctance to disclose, so they don’t push. That’s stigma. Just as troubling to Dr. Bakker is the pos- sible minimizing of these issues. She often accompanied Stephen when he saw health- care professionals – to emergency after his first manic episode; to an early intervention psychosis clinic to see a psychiatrist and fam- ily therapist; to an inpatient alcohol and drug rehabilitation program for his addictions; and to subsequent meetings with health and mental health-care providers. “Never once did they say my son had a seri- ous disease. Never did they plainly lay out the prognosis, as troubling as it may have been. ISSUE 1, 2019 DIALOGUE 27