Mental Health in Primary Care stigma and social distance for schizophrenia in psychiatrists, general practitioners and service users

ABSTRACT:THE PROBLEM Patients who suffer from mental illness do not make best use of standard medical facilities such as general practice facilities, and other primary care services. This puts them in a disadvantaged position when it comes to their health needs, especially as there is evidence that primary care is effective, more accessible and produces more positive long-term outcomes leading to a reduction in mortality and morbidity (B. Starfield et al 2005; WHO 2008; M. Funk and G. Ivbijaro 2008). It has been postulated that a reason for this lack of progress is stigma and discrimination which can be assessed by measuring social distance. The concept of social distance is a generic concept that can relate to any form of distancing (E. S. Bogardus E.S. 1925). To tackle the stigma associated with a Serious Mental Illness (SMI) such as schizophrenia and reduce the disparity in physical and mental health in people with serious mental illness so that patients can reap the benefits of a primary care transformation process, there is a need to have a deeper understanding of the barriers patients face in accessing primary care either from the community or from secondary care mental health services. WHY THIS IS IMPORTANT The 2012 Mental Health Case for Change for London noted that mental ill health was a significant barrier to social inclusion in London and limited access to health. This was worse in those people with mental and physical health co-morbidity. Patients with schizophrenia consult general practitioners more often than the average patient, often with somatic complaints rather than symptoms of mental illness and receive very little specific evidence based practice for either their physical or mental health condition (I. Nazareth et al 1993). This could be related to poor knowledge, skills and confidence in general practitioners to manage the health of patients with schizophrenia. A 1997 review noted a low detection rate of physical health problems in those with a mental health diagnosis and linked this to a lack of self-confidence characteristics in patients with a diagnosis of schizophrenia (T. Burns and T. Kendrick 1997). 11 This review also found that patients with schizophrenia present more often to general practitioners for a variety of reasons, including collection of repeat prescriptions, but will rarely talk about their physical or mental health spontaneously. The authors suggested that a reason for the lack of confidence of general practitioners in managing patients with schizophrenia is the low numbers of such patients that they see in their daily practice because the prevalence of this disorder is 0.9%. KEY FINDINGS i. There is a non-significant relationship between psychiatrists social distance for schizophrenia and their confidence in the ability of general practitioners to manage schizophrenia in general practice ii. There is a significant relationship between psychiatrist’s social distance for schizophrenia and their belief that general practitioners should be confident in managing schizophrenia in general practice. iii. There is a significant relationship between psychiatrist’s social distance for schizophrenia and their belief that general practitioners should not manage patients with schizophrenia in general practice. iv. There is a significant relationship between general practitioner’s social distance for schizophrenia and their belief that general practitioners should be confident in managing patients with schizophrenia in general practice. v. There is a significant relationship between general practitioner’s social distance for schizophrenia and their belief that general practitioners should be confident in managing schizophrenia in general practice. vi. There is a significant relationship between general practitioner social distance for schizophrenia and their belief that general practitioners should not manage patients with schizophrenia in general practice. vii. There is no relationship found between mental health service users social distance for schizophrenia and their belief that their general practitioner is confident in managing their mental health 12 viii. There is no relationship found between mental health service users social distance for schizophrenia and their belief that their general practitioner is confident in managing their other health problems ix. There is no relationship found between mental health service users social distance for schizophrenia and their belief that their general practitioner should be confident in managing their mental health problems The literature review showed that mental health stigma and discrimination occurs in mental health service users, mental health service providers, the population at large and policy makers. We therefore require innovative ways of addressing stigma, discrimination and social distance in mental health in order to change attribution and behaviour and the research presented here is part of a larger study. We need to identify new ways to tackle the malignancy of stigma and discrimination in mental health and find a new lens to re-examine the concepts and constructs. We will use the information from the overall study to inform the development of an assessment tool to assess social distance for mental health service users as part of the routine assessment of people with a mental health problem managed in primary care that is sensitive to change over time

Why Should Clinicians Care?

Publisher Copyright: Copyright © 2021 Banerjee, Rabheru, Ivbijaro and Mendonca Lima.With a steady increase in population aging, the proportion of older people living with mental illness is on rise. This has a significant impact on their autonomy, rights, quality of life and functionality. The biomedical approach to mental healthcare has undergone a paradigm shift over the recent years to become more inclusive and rights-based. Dignity comprises of independence, social inclusion, justice, equality, respect and recognition of one's identity. It has both subjective and objective components and influences life-satisfaction, treatment response as well as compliance. The multi-dimensional framework of dignity forms the central anchor to person-centered mental healthcare for older adults. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. However, notwithstanding the growing body of research on the neurobiology of aging and old age mental health disorders, dignity-based mental healthcare is considered to be an abstract and hypothetical identity, often neglected in clinical practice. In this paper, we highlight the various components of dignity in older people, the impact of ageism and mental health interventions based on dignity, rights, respect, and equality (including dignity therapy). It hopes to serve as a framework for clinicians to incorporate dignity as a principle in mental health service delivery and research related to older people.publishersversionpublishe

a global call for action urging revision of the ICD-11 classification of old age

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Models for Treatment of Patients with Complex Medical-Psychiatric Conditions

Patients with co-morbidity and multi-morbidity have worse outcomes and greater healthcare needs. Co-morbid depression and other long-term conditions present health services with challenges in delivering effective care for patients. We provide some recent evidence from the literature to support the need for collaborative care, illustrated by practical examples of how to deliver a collaborative/integrated care continuum by presenting data collected between 2011 and 2012 from a London Borough clinical improvement programme that compared co-morbid diagnosis of depression and other long-term conditions and Accident and Emergency use. We have provided some practical steps for developing collaborative care within primary care and suggest that primary care family practices should adopt closer collaboration with other services in order to improve clinical outcomes and cost-effectiveness.publishersversionpublishe