Psychiatrists suffer from stigma too

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

Background. The global burden of mental disorders continues to grow with significant health, social, and economic consequences. Unfortunately, the gap between the need for mental healthcare and its provision remains wide all over the world. The recruitment and retention of psychiatrists is a long-standing concern in the United Arab Emirates, with social stigma playing a potential role. This study is aimed at investigating the factors that affect psychiatrists’ choice of psychiatry as an area of practice in the United Arab Emirates. Methods. This cross-sectional study was undertaken using an anonymized 30-item online questionnaire. Ethical approval was obtained from the United Arab Emirates University Social Sciences Research Ethics Committee prior to participant recruitment. We recruited qualified psychiatrists currently working in the United Arab Emirates. The structured questionnaire assessed the participants’ sociodemographic factors and reasons for choosing psychiatry. Statistical analysis, including Pearson correlations and chi-square tests, was performed using the statistical package for the social sciences (SPSS) version 26. Results. We found that the doctors trained in the United Arab Emirates were statistically more likely to face opposition to specializing in psychiatry ( $p$ value < 0.001). Participants with a family member or friend as a psychiatrist were more likely to choose psychiatry as a first-choice specialty ( $p$ value 0.01). Psychiatrists below the age of 35 were more statistically likely to face opposition to their decision to specialize in psychiatry ( $p$ value 0.006). Psychiatrists who regretted their decision to specialize in psychiatry were statistically more likely to feel this way in their first year of residency ( $p$ value < 0.001). Conclusions. Multiple sociodemographic factors influence responses to the decision to specialize in psychiatry in the United Arab Emirates. Younger people and people who studied in or were a citizen of the United Arab Emirates were more likely to face opposition to their decision to specialize in psychiatry, indicating why there are such high rates of psychiatrists from overseas in the United Arab Emirates and shortages in the profession.

'Love comes first, and it is ahead of any different political partisanism': How political polarizations compare to other forms of discrimination in Buenos Aires (Argentina)

BACKGROUND

Affective polarization and stigma toward individuals with schizophrenia and toward immigrants in Argentina are not new despite its importance and dissemination. However, no research has been conducted taking into consideration political partisanship and attitudes toward these groups.

AIMS

Political polarization and attitudes toward socialization across party lines are studied in conjunction with attitudes toward immigrants and toward individuals with schizophrenia.

METHOD

Individuals from Buenos Aires (n = 712) were surveyed for their political partisanship and their attitudes toward Peruvian and Bolivian immigrants, people with schizophrenia and partisans from the opposing political party. A modified version of the Bogardus scale was used.

RESULTS

Social distance was from highest to lowest toward people with schizophrenia, political opponents, and immigrants. Individuals with schizophrenia were strongly discriminated against by most participants: 86% would definitely or probably not want them to take care of their children, 83% would not want them to be their healthcare provider, and 81% would not want to marry them. Immigrants were comparatively not discriminated against: 10% would not want them to take care of their children, 8% would not want to receive health care from them, and 28% would not want to marry them. Cristina Fernández de Kirchner partisans showed the lowest level of discrimination toward these two groups, compared to Mauricio Macri partisans and to independent voters. However, the former group had greater discriminatory attitudes toward Mauricio Macri partisans than the latter.

CONCLUSIONS

As compared to other discriminatory attitudes, discrimination toward persons with schizophrenia is widespread and pervasive. Lower levels of discrimination toward people with schizophrenia and toward immigrants would not predict attitudes toward the opposing political partisans.

The limits of responsibility

While attending a rancorous and ill-tempered meeting of the Hackney Community Health Council in 1985 it was brought home to me that psychiatry was different from other branches of medicine. Not in the sense that it was the only one that dealt with intangibles, we all know that X-rays, scans and the like are far less precise than their purveyors let on. But it seemed that the mental health professionals and the groups that represented the clients, relatives and users of the service couldn't agree on a single thing, not even whether people were ill in the first place. It was difficult to imagine, say, the British Diabetic Association and a group of Endocrine Clinic staff knocking verbal lumps out of each other in this way even though diabetes and schizophrenia have a good deal in common.

Psychiatry and the media: from pitfalls to possibilities

In war, truth is said to be the first casualty. Something similar may be said for psychiatry. The ability of the media to distort public understanding of mental illness is well described (Wahl, 1995; Philo et al, 1994). Psychiatric disorders, their treatments and those who provide them are all subject to overwhelmingly negative portrayals in the print and broadcast media (Hyler et al, 1991). Dehumanisation, inaccuracy and sensationalism seem to be the media's stock-in-trade. Media professionals make no apology for this, citing the provision of impartial, emotionally-neutral accounts as one of their least pressing concerns (Salter & Byrne, 2000). They also reject the notion that they are responsible for the perpetuation of harmful stereotypes, claiming instead that they merely mirror the values and beliefs of our society (Bolton, 2000). This distorting mirror is of great relevance to psychiatry. It is probably no exaggeration to state that the celebrated cases of Christopher Clunis and Ben Silcock have done more to change the practice of community psychiatry than any College President or Secretary of State over the past 5 decades.

Newspaper depictions of mental and physical health

Aims and method Media portrayals of mental illness have long been recognised as being misleading and stigmatising. Following the campaigns of several advocacy groups to address this issue, we aimed to evaluate the impact on mental health reporting over time. We repeated a survey we did 15 years ago using the same methods. Nine UK daily newspapers were surveyed over a 4-week period and coded with a schema to analyse the reporting of mental health compared with physical health. Results In total, 963 articles - 200 on mental health and 763 on physical health - were identified. Over half of the articles on mental health were negative in tone: 18.5% indicated an association with violence compared with 0.3% of articles on physical health. However, there were more quotes from patients with mental disorders than physical disorders (22.5% v. 19.7%) and an equal mention of treatment and rehabilitation. Clinical implications Mental health in print media remains tainted by themes of violence, however some improvement in reporting in recent years is evident, in particular by providing a voice for people with mental illness.

Strategies to fight stigma toward people with mental disorders: perspectives from different stakeholders

This study aims to provide a more complete and exhaustive perspective on the whole range of potential strategies to fight stigma by considering the perspectives of different stakeholders. Delegates to a Canadian conference were invited to participate in a survey that focused on stigma, from which the responses to the following question were analyzed: tell us briefly what you do to reduce prejudice and stigma toward people with a diagnosis of mental disorder? From 253 participants, 15 categories of strategies to fight stigma were identified from the verbatim (e.g., sharing/encouraging disclosure). These categories fell under six main themes: education, contact, protestation, person centered, working on recovery and social inclusion, and reflexive consciousness. The occurrence of these themes was different among stakeholders (clinical, organizational, and experiential knowledge). For example, people with mental disorders (experiential knowledge) often mentioned contact and person centered strategies, while mental health professionals (clinical knowledge) preferred education and working on recovery and social inclusion strategies. The results from this study highlight the need to pay more attention to the concept of disclosure of mental disorders in the process for de-stigmatization. Future studies are needed to assess the impact of the emerging strategies to fight stigma in the community.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Development and responsiveness of a scale to measure clinicians' attitudes to people with mental illness (medical student version)

OBJECTIVE

We report the rationale, reliability, validity and responsiveness studies of the Mental Illness: Clinicians' Attitudes (MICA) Scale, a 16-item scale designed to measure attitudes of health care professionals towards people with mental illness.

METHOD

Items were generated through focus groups with service users, carers, medical students and trainee psychiatrists. Psychometric testing was completed in a number of student samples. The responsiveness of the scale was tested after a 1.5 h mental illness stigma related intervention with medical students.

RESULTS

The MICA scale showed good internal consistency, alpha = 0.79. The test-retest reliability (concordance) was 0.80 (95% CI: 0.68-0.91). The standardised response mean for the scale was 0.4 (95% CI 0.02-0.8) after a mental illness related stigma intervention.

CONCLUSION

The MICA scale is a responsive, reliable and valid tool, which can be used in medical education and mental health promotion settings and studies.

Are psychiatrists an endangered species? Observations on internal and external challenges to the profession

Based on recently voiced concerns about a crisis in psychiatry, six challenges to our profession are identified and discussed. As we approach the revisions of ICD-10 and DSM-IV, the validity of psychiatry's diagnostic definitions and classification systems is increasingly questioned also from inside psychiatry. In addition, confidence in the results of therapeutic intervention studies is waning. A further challenge is the existence of de facto subgroups with opposing ideologies, a situation which is responsible for an unclear role profile of the psychiatrist. Challenges from outside include mounting patient and carer criticism, intrusion of other professions into psychiatry's traditional field of competence, and psychiatry's low status within medicine and in society in general. Studies suggest that the decline of the recruitment into psychiatry, as it is observed in many countries, might be related to problems arising from these challenges. It is unclear whether psychiatry will survive as a unitary medical discipline or whether those segments which are more rewarding, both financially and in status, will break away, leaving the unattractive tasks to carry out by what remains of psychiatry. The demise of the generalist and the rise of the specialist in modern society may contribute to this development. Attempts are underway by professional bodies to define the profile of a "general psychiatrist". Such discussions should be complemented by an analysis of the incentives which contribute to the centrifugal tendencies in psychiatry.

Perception of stigmatization in forensic patients with schizophrenia

BACKGROUND

The literature about perceived stigmatization of forensic patients with schizophrenia is sparse.

AIMS

To examine relations between the perceived stigmatization of forensic patients with schizophrenia and the intensity of the symptoms, age, regular home visiting, kind of offence, perceived family support and duration of hospitalization.

METHOD

Sixty-two male forensic patients with schizophrenia were included. Perceived stigmatization was measured by the modified questions from the World Health Organization Disability Assessment Schedule II. Symptomatology was assessed with the Positive and Negative Syndrome Scale. Perception of family support was assessed with a visual-analogue scale. Due to different characteristics of offences and possibilities for home visiting, patients were divided into groups of those who had committed violent and non-violent offences, and those with and without the possibility of regular home visiting.

RESULTS

Symptoms have an impact on the perception of stigma. The kind of offence committed does not have a significant role in the perception of discrimination. Age was negatively correlated with the perception of stigma.

CONCLUSION

Results might have significance for a better understanding of social relations between forensic patients and their environment and provide us with information about institutionalized forms of stigma. Results might have implications for the treatment and the quality of life of these patients.

Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness?

This article reviews dominant media portrayals of mental illness, the mentally ill and mental health interventions, and examines what social, emotional and treatment-related effects these may have. Studies consistently show that both entertainment and news media provide overwhelmingly dramatic and distorted images of mental illness that emphasise dangerousness, criminality and unpredictability. They also model negative reactions to the mentally ill, including fear, rejection, derision and ridicule. The consequences of negative media images for people who have a mental illness are profound. They impair self-esteem, help-seeking behaviours, medication adherence and overall recovery. Mental health advocates blame the media for promoting stigma and discrimination toward people with a mental illness. However, the media may also be an important ally in challenging public prejudices, initiating public debate, and projecting positive, human interest stories about people who live with mental illness. Media lobbying and press liaison should take on a central role for mental health professionals, not only as a way of speaking out for patients who may not be able to speak out for themselves, but as a means of improving public education and awareness. Also, given the consistency of research findings in this field, it may now be time to shift attention away from further cataloguing of media representations of mental illness to the more challenging prospect of how to use the media to improve the life chances and recovery possibilities for the one in four people living with mental disorders.