Provider staff training: Close the treatment gap on health inequities
People with mental illness have a hard time accessing mental health care, especially compared to physical health care. In fact, worldwide, more than 70 percent of individuals with mental illness do not receive any mental health treatment.
Stigma and discrimination contribute to that treatment gap, according to one study. What may surprise some people is that such stigma sometimes comes from within the healthcare system itself, preventing individuals with mental illness from seeking treatment. It also can result in subpar physical health care.
Feelings of dismissal
The study reveals that individuals with mental illness sometimes feel “devalued, dismissed, and dehumanized” when receiving care. Specifically, they report experiencing the following:
- Exclusion from decisions
- Receiving subtle or overt threats of coercive treatment
- Being made to wait too long for treatment
- Receiving insufficient information about one’s condition or treatment options •
- Being treated in a paternalistic or demeaning manner
- Being told they would never get well
- Being spoken to or about using stigmatizing language
For people who do not have mental illness, such feelings are not the norm in most healthcare experiences. What, then, explains this dynamic coming from an industry whose very mission is to make people better, normally living up to that standard, as evidenced by today’s pandemic?
A problem from within
Healthcare professionals have a strenuous job with very high stakes. After all, what’s more important than one’s health?
Understandably, burnout and compassion fatigue can contribute to this stigma, according to the study, but there are other concerns as well, such as:
- Lack of awareness and unconscious bias
- Pessimistic views about the likelihood of recovery, which contributes to a sense of provider helplessness
- Inadequate skills and training
- A culture of mental illness-related stigma, even for healthcare professionals’ own mental health
Such views act as barriers to care in multiple ways, continues the study. For example, they can lead to “delays in help-seeking, discontinuation of treatment, suboptimal therapeutic relationships, patient safety concerns, and poorer quality mental and physical care”.
A second study confirms similar findings, identifying four issues that contribute to individuals not seeking care. In brief, those four issues include lack of knowledge about the treatability of mental illnesses; inexperience around accessing mental health treatment; prejudice against people with mental illness; and expectations of discrimination against people with mental illness.
Culture change, leadership support drive change
Research conducted in Canada suggests there are encouraging strategies for reducing stigma in healthcare settings, including organizational culture change and strong leadership support, according to the first study referenced above.
Culture change is never easy, but training is essential to that effort and should teach healthcare providers to know “what to say” and “what to do”. Ideally, those training efforts would also include “first-voice testimonies” from people with lived experience of mental illness where they are the educators and not the patients.
Culture change is never easy, but training is essential to that effort and should teach healthcare providers to know “what to say” and “what to do”.
Additionally, training should require “myth-busting” learning to help healthcare professionals overcome unconscious bias that could be affecting their delivery of care. It should also show how healthcare professionals have a role to play in the process of recovery to help mitigate that sense of professional helplessness.
Organizations, of course, need to be sure that such trainings are effective. Researchers suggest that one successful tactic would be to develop stigma-reduction metrics that target health and safety and accreditation standards. In other words, address the problem from a quality-of-care perspective, an approach that healthcare professionals know well.
A win-win: Improved care, improved lives
Improved care delivery for people with mental illness benefits everybody. Of course, better care improves the health and quality of life for the patients themselves. Staff’s improved competence and confidence in delivering that care helps them to overcome personal bias about mental illness. Finally, as these two factors align, healthcare organizations can potentially improve their financial outlook through the delivery of more effective care.
It’s not easy to be a healthcare professional, and we don’t have to be one to recognize that. However, research indicates that focused training and a general consciousness about the true nature of mental illness will go a long way in improving lives. Beacon Health Options calls upon all healthcare organizations and their leadership to help staff be even better at their jobs by raising awareness and competence around mental illness, regardless of staff role.