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Discrimination and stigma from diagnosis to death
RUTH HUNT looks at why those with a severe mental illness, who can die up to a decade younger than others, need better understanding and support when accessing all forms of healthcare

THE pandemic and lockdowns have focused minds on the mental health of the nation, with a strong focus on what is happening with the young. But the difficulties faced by those with a severe mental illness (SMI) have been long in the making, with stigma affecting them whether they are at the start or the end of their lives.

Stigma permeates all aspects of life, so while there has been a lot of focus on combatting it within some aspects of society, the destructive power within the medical community has not had the same attention.

Such problems can be present from both mental health staff and those medics treating someone with a physical complaint who they know also has a mental health diagnosis, leading to what is called “diagnostic overshadowing.” This is when a patient has a diagnosis, for example depression and there is a tendency for any other health problems to be attributed to that condition.

  • There was a lump on this patient’s leg and they were in excruciating pain. The doctor mentioned the borderline personality disorder diagnosis the patient had and dismissed the leg pain as “probably nothing.” The leg was broken.
  • When a patient who has multiple disabilities including a condition that causes problems with her eyes, had “hydrops” where the cornea can split, the doctor asked, what she “had been doing to herself.”
  • Another patent had considerable back pain, but this was put down by medics to anxiety/PTSD. It was only when she was reluctantly given an MRI that a giant fibroid was discovered requiring major surgery, a consequence of which has been arthritis. The pain still gets dismissed by mental health professionals.
  • A patient was in hospital with Covid and found that the staff were far more interested in her lithium levels than her oxygen, which went as low as 60. When she shared her concerns with nurses, she was told she was being difficult.
  • A doctor examined the breast of a patient who was complaining of pain and noted she had experienced depression in the past. So, as the doctor couldn’t feel a lump, she put it down to anxiety and depression and only sent her for a scan to “put her mind at ease.” This patient had aggressive breast cancer.
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