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.
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