Ways in which mental health stigma can impact on physical health

It can be essential to get a mental diagnosis in order to access support services such as counselling, or respite from employment whilst working through a traumatic episode, without facing dire poverty.  However a diagnosis may then significantly affect a patient’s physical health condition, in a number of ways.

Firstly, there’s the attitude of doctors, many of whom are at least as ready to stigmatise as the general public. Because of having been fairly itinerant over the years, I’ve had many experiences of signing on with new surgeries.  At the first visit I’ve usually get on well with the doctor – at college I knew a number of medical students, and I’ve worked in the NHS, so I can talk their language – and I’d have no trouble explaining my current symptoms and getting a prescription.  But if I returned a few weeks later – in the meantime my medical records including mental health history having arrived – what met me would be totally different.  The doctor would not look me in the eye, he’d talk loudly over me as if I were stupid, my described symptoms such as where I felt pain would not be believed, and I’d sometimes go away without any medication, feeling a lot worse for my visit.

At a recent local Healthwatch meeting, a carer described how his daughter, who was diagnosed as bipolar, was assigned to a particular doctor in the practice – and however bad her physical health, no other doctor would see her, and the next appointment might be a month away.  By which time her untreated physical health condition might have got  whole lot worse.

On one occasion she urgently needed attention, and had to really shout loudly before anyone listened. Having had a similar experience, I then chipped in that a further problem could arise –  the doctor might write into medical record that “the patient was aggressive” (no I/she wasn’t, we were ill and extremely upset at not being believed!) as a permanent record, and any future doctor would be even less likely to be sympathetic.

Another patient described how he was having real, painful and even life threatening problems with his pace-maker – but was not believed by a number of health professionals – and having only fairly recently had a mental health episode, he was able to differentiate between the attitude of staff before and after he was known as being a mental health survivor.  Eventually after weeks of unnecessary pain, they did decide to investigate, which took a minute or two, a very simple mistake had been made, and the problem rectified in a few seconds.  But in a sense he was fortunate, some mental health survivors are never believed, until a bit too late, after the autopsy,

Then there’s the problem of time.  A patient may go to the GP needing some help with mental health problems as well as one or more physical health conditions.   Physical symptoms are hard enough to describe, mental health problems even more so, and the allotted 10 minutes per appointment can easily not be sufficient.  I’ve had the experience of being told that my time was up, and I hadn’t even mentioned two physical health problems, which therefore got no treatment until I could make a further appointment a week or more away.

I’m sure many mental health survivors have their own stories of receiving below standard care of physical health at the hands of their GP.  And the appalling fact is that the death rate of mental health survivors is significantly higher than the average, even if suicide is factored out.

We shouldn’t and needn’t put up with it, and as a first step I would urge everyone with a personal experience of poor care to contact your local Healthwatch, and pass it on, so they can collate experiences, and take it up with higher authorities within the NHS and government.  And maybe one day medical professionals will treat us with the dignity and respect we deserve, and sometimes so urgently need.

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  1. Stephen Musk says:

    I’M LUCKY,

    I have had just two GPs in the past 28 years and have had my current GP for getting on for a decade. She admits to being no expert in mental health but seems to genuinely care for my well being. I have had some major mental and physical problems this year and have found an ideal method of dealing with her – before an appointment I send her an Email with an attachment of a page of A4, on which I detail the problems as I see them and the possible solution(s) that I favour. This seems to work wonders as, forewarned, she’s recently set up three important appointments at the Norfolk & Norwich Hospital to deal with my physical problems and also permitted me to cease taking Lithium – a big decision for me as I have been prescribed it for years. It undoubtedly helps that I was a research scientist before illness forced me to retire (aged 35) for I am able to get my points across in language that she understands and am careful to suggest rather than demand solutions. But anyone could try a little pre-emptive action…

    1. Martin Rathfelder says:

      Relationships with doctors are just that – relationships. There are two sides to them.

    2. Oliver Swingler says:

      That’s a great solution – may I suggest you let your local Healthwatch and /or MIND know, and try to get them to pass it on – I’m not sure all surgeries would allow pre-appointment emails, but I honestly think that if just a few did it could actually save lives.

      1. Stephen Musk says:

        Thanks for your suggestion. I shall indeed try to pass on my general idea – perhaps adding the suggestion that it would not be inappropriate for a service user to get a little ‘help’ from a friend or family member in writing their Email if they felt that it would help make their case stronger.

        I always mark my Emails as being for the attention of my GP only but I expect that the surgery does ‘snoop’ on my correspondence. If they were to prove obstructive, I might try printing off a hard copy of my Email and enclosing it in a letter marked ‘personal’ and see if that might work better.

  2. Oliver Swingler says:

    I was anticipating some fairly immediate responses here from medical professionals – but there’s a deafening silence. Please don’t tell me that even at SHA any criticism is taken very personally, and there’s a closing of professional ranks?
    By the way, I’m in favour of 100% public health care, and perfectly aware that not only have mental health services been grossly underfunded for decades, but also that GPs (and the police) are increasingly being called upon to deal with mental health crises for which they are not adequately trained.
    And with yet more austerity cuts likely from an even more right-wing Tory government, it is going to get a whole lot worse. People with professionally diagnosed and well documented severe disabilities like rheumatoid arthritis, chronic illness like cancer, desperate mental distress like veteran’s PTSD, are being daily disbelieved by DWP agents Atos, Capita and Maximus and declared fit-for-work, their benefits sanctioned adding poverty and stress to serious medical conditions. And already thousands of people have died, either from their physical condition, or pushed to the despair of suicide, not long afterwards.
    Please, don’t close ranks, don’t blame mental health survivors for taking time away from people with ‘real’ problems, don’t start refusing to sign medical certificates without payment, and don’t pretend that it’s all OK when it ain’t.
    Instead of allowing successive governments to get away with playing off funding for physical against mental health – please, if you can’t cope, if the time you spend on mental health survivors is affecting your ability to help with physical health problems – don’t blame us – blame the government, shout loudly, give us your support and all will be forgiven!

  3. Terri Eynon says:

    I am sorry not to have spotted this thread until now. The trouble is, I am a GP and the epithet ‘busy’ goes with ‘GP’ only too readily.

    You sign off “…maybe one day medical professionals will treat us with the dignity and respect we deserve, and sometimes so urgently need.”

    Another axiom is ‘He who pays the piper calls the tune’. Maybe one day GPs paymasters will treat mental health with respect too.

    The GP Quality and Outcomes Framework has driven GP behaviour since 2004. Diabetes, chronic heart disease, asthma and COPD are funded to drive up quality in care. GPs now employ highly skilled nurses with time to listen and time to care.

    The QOF does little for mental health. In 2008, when Alan Johnson rolled out IAPT for anxiety and depression, I and my GP colleagues wanted Leicestershire PCT to employ Mental Health Facilitators to assist us with ‘everything else’. We had to battle on our hands.

    After driving the price of the IAPT contract down in a Dutch auction with neighbouring Trusts, despite having spare cash the spend, the PCT tried to get out of it. When we won, after the MHFs were commissioned, I got to present the service’s outcomes at a London conference on mental health. Voices in the audience complained that GPs were being given staff to ‘do their work for them’.

    Seven years later, the short-sightedness of that attitude is being recognised. GPs need help to manage primary care mental health and some CCGs – including Leicester City – are now commissioning MHFs. Secondary care Trusts.

    GP trainees are still not getting the right kind of training, though. If they are lucky they spend some time in secondary care psychiatry seeing people who are acutely mentally ill. Whilst this is useful and gives confidence in a crisis, it does little to help GPs prepare to manage the 90% of mental healthcare that belongs quite properly in the community.

    Being a GP who is ‘good at mental health’ in a busy practice is not a good career move. Being the popular GP who always runs late – because people with mental health problems often bring two or three issues – doesn’t always get sympathy from colleagues who imagine you and the patient are enjoying a cosy chat instead of doing proper doctoring.

    The above rant is an explanation, not an excuse.

    I have been beating my head against this brick wall for too long and am planning my retirement.

    1. Oliver Swingler says:

      And a very useful rant too.
      You obviously have a lot of experience and passion for this issue, and I would be very interested to know where you think mental health survivor campaigners should be directing out attention, and what feasible and practical improvements we should be demanding, which would allow GPs on the front line to give us the help we need and you want us to have..

  4. Terri Eynon says:

    I would suggest service users campaign for:-

    1) A Mental Health Facilitator and an IAPT primary mental health worker in every practice.

    2) Direct access to primary mental healthcare workers (IAPT) for all patients and to an MHF for anyone registered as having an enduring mental health problem.

    3) All GPs to have training in practical approaches to mental health eg Five Areas Model. Every practice to have one GPwSI in mental health with protected time for peer supervision.

    4) Receptionists trained and practices funded to offer patients presenting with mental distress a minimum 20 minute appointment.

    Leicestershire’s service – provided by Notts Healthcare – provides the first, which shows it can be done. The second could be done with a little more resource for the MHFs. The third needs GP funding – we did a lot of training when the service was rolled out, but the interest has waned along with the money. The current GP trainees get next to nothing.

    The last one is tricky and would involve some thinking about. I worked this model at Prof Lakhani’s (former RCGP Chair). The reception staff were very highly trained and that made all the difference.

    1. Oliver Swingler says:

      I am retired myself and acting as a sort of messenger here, but I’m in touch with service user groups in Newcastle/Tyne & Wear, and campaigning groups via social media – and i will pass on your suggestions and see what people think. Thank you very much for your help.

    2. Oliver Swingler says:

      Just to let you know I’ve so far had a very positive response to your 4 proposals from the Chief Executive of Tyneside & Northumberland MIND, and Launchpad (who is also a representative with NSUN), and a few Healthwatches. I’m still sharing copies, including to Diane Abbott, the new Shadow Health Secretary who recently highlighted the poor state of mental health services.
      I may be that the best approach is national – but from a local point of view, as much for morale than expecting them to effect policy changes, could you possibly assume I know nothing and list which NHS organisations or groups of GPs and other medical professional concerned with medical health (even at the periphery) exist at local and regional levels – or where I might find their contact details?

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