Quick to judge: Let’s reform how healthcare workers treat people with substance use and mental health disorders

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Brandon Thomas is a patient care technician at an inpatient detox and rehab unit in a major hospital in Pittsburgh. (Photo by Jay Manning/PublicSource)

The emergence of COVID-19 has put health care in breaking news. Every day, we hear of the tragic deaths due to this pandemic. We are also hearing of heroic efforts by healthcare workers, what they are doing for their patients and how communities are coming together to help one another out in this trying time.

COVID-19 has also exposed weaknesses in the U.S. healthcare system, like the lack of personal protective equipment, poor regulations on long-term care facilities and poor response from government agencies. 

Another weakness to consider is the stigma and bias that those with mental health disorders and substance use disorders experience in the healthcare system. The bias and stigma come directly from healthcare professionals. 

I know firsthand the effects of stigma and bias on patients because I have been working in health care for 22 years; 19 of those years have been serving people with mental health and substance use disorders. As a healthcare professional, I have been guilty of perpetrating stigma and fell victim to my own bias while serving this population. I made disparaging remarks such as, “They are just playing the game,” or, “They are psychotic.” I even went as far as to say things like patients were “attention seeking” and, “They are just manipulating us.” 

What I did directly affected the quality of services that I was delivering to those living with these disorders. I even discounted my clients’ experiences and avoided working with certain disorders.

The irony is that for 20 years I, myself, have been on a journey with five mental health diagnoses: bipolar II disorder, post-traumatic stress disorder, major depressive disorder, anxiety disorder and alcohol abuse disorder. I found myself in some very dark places in my life, up to and including a suicide attempt. I have been on a multitude of medications, seen many different mental health specialists and had a few inpatient hospital stays.

You may be asking how I could be a part of the culture of stigma while dealing with mental health issues of my own. I found that I did not want to be distinguished as part of “that group,” the “outsiders.” I was internalizing labels that society had placed on me, labels such as crazy, failure and dangerous. This internalization caused me to dislike myself which I started to project on those I viewed as being like me.

 It wasn’t one event that made me take a closer look at myself but a series of events. I had always been uncomfortable with hearing stigmatizing comments about mental health and substance use disorders but seeing the faces of those patients coming into the emergency room really was the piece that made me look at myself and them differently. These patients came in with the look of defeat, despair, sadness and loneliness. Then someone close to me was suffering and I realized I was stigmatizing her, which helped me change the quality of care I gave. I learned to embrace myself, love myself and finally accept myself. I realized that I am in a position to help people with these disorders and to help providers positively interact with them for the best treatment outcome. 

After witnessing and participating in what I call a culture of stigma, I realized I needed to change my attitude and actions while serving this population. I decided to develop an educational intervention for healthcare providers to try and reduce disparaging practices within myself and within health care. The title of the intervention is Quick to Judge: Removing the Stigma; this program has been presented for audiences throughout multiple healthcare settings. The audiences have been made up of physicians, residents, social workers, social work students, nurses, nursing students, EMS personnel, case management and university healthcare students.

The 90-minute program discusses and defines stigma and biases, consequences of stigma within health care, and interventions as to how healthcare providers can reduce stigmatic practices. 

Here is what I want you to remember from this essay. First, to those who are on a journey with mental health disorder and/or substance use disorder: You are not your disorder!! You are a person, a person who is living with a disorder. It’s no different than a person living with heart disease, diabetes or cancer and, like those physical disorders, it is treatable. The next message for you is that you are worthy, you deserve dignity, respect, compassion, love, joy and happiness. My last message for you is that there is hope for recovery. We do get better.

For those of us in health care, nurses, doctors, therapists and others, it is our job to advocate for all patients. We chose health care because we wanted to help people at their most vulnerable times. Now, during a pandemic, is one of those vulnerable times. For a patient who is on a journey with either of these disorders, they need our support in addition to our expertise. 

Isolation, difficulty in accessing health care, receiving quality healthcare services, and stigma and biases from healthcare professionals are all barriers that patients with mental health and substance use disorders already face. Hospitals and clinics are being pushed to capacity and those with mental health and substance use disorders will face greater barriers when seeking treatment for COVID-19, according to the National Institute on Drug Abuse

We, as healthcare professionals, need to use empathy and put ourselves in their shoes, understand their vulnerability, the pain, their fear and loss. If you were seeking services, how would you feel? Healthcare professionals need to understand these individuals are people first and foremost — people with names, dreams, hopes and aspirations. I am one of these individuals, with a name, dreams, hopes and a story of re-birth.

Brandon Thomas is a patient care technician at an inpatient detox and rehab unit in a major hospital in Pittsburgh, and a master’s candidate at the University of Pittsburgh School of Social Work. Thomas can be reached at bst7@pitt.edu.

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