Carla D. Cobb, PharmD, BCPP
CPNP Foundation Board Member
Everyone has personal biases. Think about your own biases: Coke versus Pepsi, Ford versus Chevy, or your political leanings. These are long-held, firm beliefs, often formed in childhood. Personal biases around people with mental illnesses or substance use disorders was the topic of a presentation by Dr. Michael Friedman, at the CPNP Foundation-sponsored presentation at CPNP 2015.
Now examine your own beliefs on more substantial topics such as race, gender, or sexual preference. You are likely to come up with some feelings that are unavoidable even though you may have worked to overcome them in your interactions with others.
The same thought and effort must be applied when thinking about personal biases around people with mental illnesses or substance use disorders. This was the topic of a presentation by psychologist, Dr. Michael Friedman, at the CPNP Foundation-sponsored presentation in April 2015 at CPNP 2015. Dr. Friedman, a clinical psychologist in New York City, presented some startling evidence that shows that patients with these conditions are treated differently than those without, even by healthcare professionals. Patients have been told to “snap out” of depression or “just relax” during a panic attack. Some individuals may be compassionate toward alcoholics but less so with intravenous drug users. There are pharmacists who refuse to dispense syringes to intravenous drug users. We know that there is a procedural bias that prevents patients with opioid dependence from receiving methadone or suboxone due to the strict regulations placed upon the medications. A survey of 1737 adults found that people with schizophrenia or substance use disorders were considered more dangerous and unpredictable than people with depression.1 Another survey showed that 36% of 111 community pharmacists were annoyed with, rather than sympathetic to patients with addiction.2
It’s important to think about our own biases with these patients. Do you refer to patients using derogatory terms or treat them differently? Are your beliefs about the causes of these disorders consistent with research? Do you think that certain individuals are beyond hope or help? Do you minimize or disregard their treatment preferences over your own?
How can we overcome our biases? Be curious, not critical, about your own beliefs. Keep an open mind and educate yourself and others about the truth surrounding these illnesses, their causes, and manifestations. Reach out to patients to learn about their personal experiences living with these illnesses. Work with students, residents, and other healthcare professionals to expose them to patients with these disorders, to reduce their discomfort or fear when they encounter these patients in their future practice settings. Be willing to advocate on behalf of people suffering from these disorders to reduce the stigma.
Doing so will help to improve the social isolation and poor access to care and proper treatment that patients with mental illness or substance use disorders often experience.
The CPNP Foundation is committed to bringing programming and projects to the CPNP Annual Meetings which emphasize patients’ perspectives and reduce stigma and other barriers to appropriate care of patients with neuropsychiatric illnesses.
1Crisp A, Gelder M, Rix S, et al. Stigmatisation of people with mental illnesses. British Journal of Psychiatry 2000;177:4-7.
2Tomko J, Gianetti V. Knowledge, attitudes, and professional practices versus personal beliefs of pharmacists regarding chemically dependent patients. The Mental Health Clinician 2013;3:302-8.