Dialogue Volume 15 Issue 1 2019 - Page 29

PRACTICE PARTNER than a science. “They often feel ill prepared addressing the problems,” says Dr. Christine Courbasson, a clinical psychologist who works with the Ca- nadian Mental Health Association in Ontario. These are complex health challenges. Still, stigma plays a part in the way patients are treated. The Mental Health Commission of Canada has reported that many people with mental health problems experience some of the most deeply felt stigma from frontline health-care professionals. These patients often feel disrespected, i.e. the doctor doesn’t see a person, just a label. Doctors might feel (and send a message) that recovery is improbable or impossible. Re- search shows too that some doctors associate pessimism about recovery with a sense of helplessness. It can lead them to believe that what they do doesn’t matter. Stigma can play out in other ways. Do doctors probe for mental health or substance abuse issues? Do they miss a diagnosis because they attribute a symptom to mental health or substance abuse challenges, rather than to another physical condition? Do they withhold certain services or referrals until a patient’s mental health or substance abuse issues are better managed? Or do they, as Dr. Bakker feels, downplay the disease? “Maybe we fear to make it worse,” says Dr. Bakker. “Maybe we don’t want to admit the prognosis ourselves, as we often lack effective and timely treat- ment options. Maybe we too have "We aren’t experienced mental illness, or have loved ones who are mentally declaring mental ill and fear the diagnosis. Inad- illness as the vertently, these behaviours are very real and stigmatizing. We aren’t declaring mental illness as the very real and serious disease serious disease that it can be. In that it can be." fact, our response says that we aren’t taking it seriously.” Over time, she says, Stephen was seem- ingly doing better. He became an AA spon- sor and spoke publicly about his recovery. He won a Transforming Lives Award from the Centre for Addiction and Mental Health (CAMH). In October 2017, Stephen was completing his Masters, and had just submitted a grant proposal for his PhD. Then, a day later, he used cocaine that, unbeknownst to him, was laced with Fentanyl. He died with five times the lethal dose of Fentanyl in his blood – a victim, says his mother, of a relapse in his mental illness and addiction. He was 25. Access to Care Beyond being more reluctant to seek care, stigmatized to care for higher-need and/or complex patients, includ- patients may have trouble finding a doctor. The CPSO’s ing those requiring urgent access to care, those with Accepting New Patients policy notes that physicians chronic conditions, disabilities and/or mental illness. must accept new patients in a manner that respects the rights, autonomy, dignity and diversity of all prospective The policy also notes that it is inappropriate for physi- patients. cians to use introductory meetings such as ‘meet-and- greet’ appointments, and/or medical questionnaires While a first-come, first-served approach must be used to vet prospective patients and determine whether to to accept new patients, the policy states that sometimes accept those patients into the practice. Doing so may be it may be appropriate for physicians to prioritize access considered discrimination against prospective patients. ISSUE 1, 2019 DIALOGUE 29