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Spring 2010 | Vol 13 No 3

Myth busters

“They’re real people”

Nurses play role in combating stigma

Kim Goggins

In almost 30 years of working as a psychiatric and general nurse, Charlotte Ross has never been attacked by a client with mental illness. Nor have her colleagues who teach with her at Douglas College in Coquitlam, British Columbia. Yet this scenario is one of the most common fears of the nursing students they train.

“We have to get past their first day of rotations where they’re expecting people to be violent and have very disordered behaviour, like in the movies,” says Ross. “But after that first day when they talk to patients, they come out saying, ‘They’re just regular people with an illness. They’re real people.’ It’s quite an eye-opener for the students.”

Challenging these stereotypes early in training is important because health care professionals often reflect the public’s stereotypes of people with mental health problems, which means they themselves can perpetuate stigma and discrimination in a profession that is supposed to help people. Although one of the most common myths about people with a psychiatric illness is that they are violent, statistically, says Ross, they are more likely to be victims of violence. “They’re a far more vulnerable population than a dangerous one,” she says.

While fear that people with mental illness may erupt into violence is the biggest myth, Ross says that most health care professionals feel some degree of compassion for people with mental illness. But that empathy does not extend toward individuals with addiction or those who self-harm. In those situations health care providers tend to blame the person, says Ross, whose literature review of stigma in the nursing profession, which she wrote with Dr. Elliot Goldner, appears in a 2009 issue of the Journal of Psychiatric and Mental Health Nursing.
“Nursing staff in emergency departments (when patients were suicidal or in psychiatric crises), and intensive care units (for care post-suicide attempt) in particular, were found to hold blaming/hostile attitudes, and were often reported to have treated this client population in a demeaning manner for these reasons,” the review reports. Ross’ own experience as a nurse and nurse educator has exposed her to similar situations.

“If you hear colleagues making negative comments, you have to do something about it, both as a professional and as a citizen. Take action.”

“These misconceptions are related to not understanding that these are illnesses,” says Ross. “There remain aspects of the stigma of blame, especially with self-harm. You really sense – and I’ve heard it – the feeling of wasting resources on somebody who doesn’t want to live. Some health care workers don’t have any conception of the fact that this person is actually dying from the illness. The illness is psychiatric, which is leading to behaviour that can kill them.”

The literature review found one study where only 10 per cent of nurses agreed with the statement “People who commit suicide are mentally ill.” Another study yielded similar results.

Fragmentation – not wanting to treat psychiatric symptoms in a medical setting – is another manifestation of stigma that Ross has seen first hand and in research. “I tell my students, ‘We don’t stop at the neck.’ I have seen it in psychiatric settings – not attending fully to medical and physical issues. There’s a lack of treating the whole person.”

The consequent negative effect on client care is one of the chief reasons mental health consumers identify for not seeking or continuing with treatment, according to the literature review. “You can’t provide care if you have hostility, which means the therapeutic relationship that is integral to the nursing relationship is not there,” says Ross. “What you have then is a task orientation without much caring behind it.”

However, Ross adds that sometimes it is not about hostility and blame, but that health care professionals were never taught what to do. “They don’t have the basic skill base to assess or provide appropriate psychiatric care to their client population, despite their best intentions,” she says. Key to combating stigma and discrimination are education and contact with psychiatric clients early on. “Nursing students pick up their biases from society,” says Ross. “But the literature showed something interesting: The people who have connections to a person with mental illness in their private life had much less stigma.”

More attention to psychiatry is required in general medical training, urges Ross, who says that Canada falls behind other countries when it comes to training health care professionals in this area of medicine. She also calls for the establishment of behavioural expectations that medical professionals advocate for people with mental illness when they hear colleagues making derogatory comments, rather than making it discretionary. “If you hear colleagues making negative comments, you have to do something about it, both as a professional and as a citizen,” Ross says. “Take action.”