It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare

Frontiers in Psychiatry

Psychiatry

Susanna Every-Palmer¹  Helen Lockett²  Ruth Cunningham²  Fiona Imlach²  Debbie Peterson²  Tracy Haitana³  Cameron Lacey³ 

[1] Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand;Department of Public Health, University of Otago Wellington, Wellington, New Zealand;Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand;

关键词: discrimination;    health care;    mental health;    quality of care;    overshadowing;    severe mental disorder;    substance use disorder;   

DOI  :  10.3389/fpsyt.2023.1285431

 received in 2023-08-30, accepted in 2023-10-04,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionClinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician’s beliefs and assumptions in physical health service provision.MethodsWe surveyed people with MHSUC who accessed physical healthcare services. Of 354 eligible participants, 253 responded to open-ended questions about experiences of those services. Thematic descriptive analysis of survey responses was completed using existing stigma frameworks and inductive coding.ResultsOne dominant theme from survey responses was that diagnostic overshadowing by clinicians was driven by clinician mistrust. Another theme was that clinicians assumed respondent’s physical symptoms, including pain, were caused by MHSUC. This influenced decisions not to initiate investigations or treatment. Respondents perceived that clinicians focused on mental health over physical health, contributing to suboptimal care.DiscussionDiscrimination based on MHSUC leads to poor quality care. Health systems and clinicians need to focus quality improvement processes on access to and delivery of equitable physical healthcare to people with MHSUC, address stereotypes about people with MHSUC and improve integration of mental and physical healthcare.

【 授权许可】

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Copyright © 2023 Cunningham, Imlach, Haitana, Every-Palmer, Lacey, Lockett and Peterson.