Mental illness stigmas can undermine patients

A female patient comes in to see me complaining of fatigue, decreased appetite, sleep disturbances and feeling unmotivated. She wants lab work done to check her thyroid and ensure she is not anemic.

At her follow-up visit, we discuss her normal labs, and she is reluctant to admit that she has a strong family history of mental illness. There is a sense of shame when a diagnosis of depression is brought up. She perceives it as a sign of weakness.

She has been hiding her struggle from her loved ones. Her relationships at home and work are suffering. She is afraid of what others will think if they know she has major depression and is seeing a therapist three times a week. This is an example of the stereotypes that patients with a mental illness face, and it makes it harder for primary care providers to manage and treat.

Psychiatric problems such as anxiety and depression are major health issues, and they occur more often in women than men. Depression ranks as a significant cause of disability among adults.

Of Washington’s more than 7 million residents, close to 219,000 adults and about 71,000 children live with serious mental illness. Mental health expenditures in the United States for a year are approaching $100 billion.

This burden is projected to increase tremendously with two-thirds of these costs attributed to disability and loss of work. And yet shockingly, of the people who suffer from mental health conditions, the majority (60 percent) do not receive any form of care.

The general reluctance of patients to seek care for mental health problems complicates the diagnosis of mental illness. Survey results show that 40 percent of patients with major depression do not want or think they need treatment until it’s too late. Patients consistently under-report emotional issues to their physicians.

Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. This comes from both the public and health care providers.

As a result, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care and affiliation with a diverse group of people. Although research has gone far to understand the impact of the disease, it has only recently begun to explain stigma in mental illness. Much work needs to be done to fully understand the breadth and scope of prejudice against people with mental illness.

Undoubtedly, mental health does affect an individual’s physical health.

Many people “somatize” their psychological issues. We have a tendency to experience and communicate psychological distress in the form of physical symptoms. One in three patients who go to the emergency department with acute chest pain are suffering from either panic disorder or depression. Eighty percent of patients with depression present initially with physical symptoms such as pain or fatigue.

The major cause of death from mental illness is suicide, which may occur before a patient seeks care for a mental health related symptom. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, influenza and chronic lung disease combined. Suicide is almost always the result of untreated or under-treated mental illness. In 2014, 1,111 Washingtonians died by suicide.

When it comes to mental health, being isolated and alone is the worst response. Eradicating the stigma and social distancing of people with mental illness must be a top priority to help improve mental and physical health. It cannot be ignored.

This story was originally published May 15, 2016 at 6:41 PM with the headline "Mental illness stigmas can undermine patients."