Mental health stigma and primary health care decisions

Abstract

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

Keywords: Health decisions; Primary care; Serious mental illness; Stigma.

Conflict of interest statement

Conflict of interest

There are no conflicts of interest for any authors.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Standardized solutions (β) of structural equation modeling examining three paths between stigma and health decisions: specialist referrals or medication prescriptions. Fit indicators (χ2 and Root Mean Square Error of Approximation (RMSEA)) are provided.