How does stigma show itself in a healthcare setting?
In a healthcare setting, stigma can have different representations. For example, we talked about self-stigma, but also the stigma of a provider of mental health services. Sometimes that takes the form of patronizing and telling people what to do because they have mental illness and are perceived to not be able to understand what is right. Other times it might take the form of shunning; people not being associated with because of their mental illness or they are blamed for mental illness that they've brought it onto themselves. It may take different ways of representation.
How can we challenge that?
Challenging stigma is very difficult. When you look at it it's a misinformation. It looks like if you just inform everybody about what mental illness is and if you do a mass educational program, the stigma wouldn't exist. Numerous educational programs have been planned and done and unfortunately they do not seem to have the desired lasting effects. The education alone does not seem to change stigma or the stigma of mental illness because these are really deeply established beliefs and they are established to such an extent that it is very difficult through education to change them - especially in adults. It might be possible to change these stigmatizing views in earlier ages in children when teaching sensitivity and acceptance might play more of a role. The mass educational events in adults do not seem to lead to any reduction of the stigma, unfortunately.
Touching on the new hospital and having mental health, palliative and rehabilitative care under one roof - will this exposure and interaction help with stigma? What can Providence Care do?
Generally speaking, I think that staff need to be educated and staff need to work towards that. Even if the beliefs are difficult to change and they can't be easily eradicated, at least what we can strive to achieve is not to translate the beliefs into discrimination and discriminatory behaviour and that will be a step in the right direction. On the other side, something that can be done and that we've been doing for some time, in collaboration with Professor Heather Stuart - who is a leading stigma researcher at Queen's - is we have turned things around and said while we are waiting for the new generation to become more sensitive and accepting and things change in society what can we do to help the individual patient and individual sufferer.
We have created a psycho-educational behavioural modification course called "Overcoming Stigma" which is a group course, with small group sessions about 10 to twelve people per session, seven weekly sessions, 2 hours each, where a lot of education is done as well as also suggestions of how to deal with stigma, role-playing and establishing practical homework. We are currently studying it. We've completed our open level trials and we are planning to have a randomized control trial for hopefully this fall or winter.
Who is that program available to?
We have made the course available to people with mood and anxiety disorders, people who have some ability to actually learn and have some behavioural modification changes.
So you're saying the effort is in our children, our future and in the meantime we help the sufferers of stigma?
Yes, day-to-day issues, including issues with disclosure. Most recently there has been a major movement towards encouraging disclosure of mental illness. And intuitively it will appear to be a good solution if everybody who had a mental illness came today and said "I do have a mental illness" theoretically stigma would disappear. I'm not sure that I subscribe to that view, but the more people that disclose their mental illness, the more that acceptance might increase. We have seen some selective disclosure especially of some disorders. In the range of stigma it seems that there are diagnosis which are more stigmatizing than others. There are more preferable diagnosis as well. An example would be PTSD, which is now becoming an accepted disorder in military personnel. Some of the anxiety disorders seem to have fewer stigmas attached to them and are easier to disclose, but some of the other disorders may not be at that stage yet.
Do you think that having the new hospital as the first hospital in North America to have mental health, rehabilitative and palliative care together will make a difference? Do you think that exposure will help with stigma?
It's difficult to predict. I believe Providence Care Hospital has taken some measures and we have created a committee with Heather Stuart and Terry Krupa that are involved from outside of Providence Care and Karin Carmichael and others from PCH [Providence Care Hospital]. There's been good work towards that. It will be difficult to predict in a way. Exposure is one thing and once you see that people aren't a significant threat it may reduce the stigma, but it's possible that it may work the other way around. There's one stigmatizing phenomenon called NIMBY (Not in My Backyard). So, very accepting of everything like treatment facilities or shelters, but it's "not in my neighbourhood." You have to put it somewhere else.
I think inevitably it will reduce the stigma. It will be more persistent seeing mental illness and chronic illness become part of the mainstream medical and physical rehabilitation, so I am optimistic for the future.
What are your thoughts on the new hospital?
It's an excellent new development and step forward. I think from a hospital perspective and patient perspective: much better facilities, much better possibilities to do a lot of rehabilitation work and a lot of other work. So yes, I am actually quite excited.
