It's not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare

Ruth Cunningham; Fiona Imlach; Tracy Haitana; Susanna Every-Palmer; Cameron Lacey; Helen Lockett; Debbie Peterson

doi:10.3389/fpsyt.2023.1285431

It's not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare

Front Psychiatry. 2023 Oct 16:14:1285431. doi: 10.3389/fpsyt.2023.1285431. eCollection 2023.

Authors

Ruth Cunningham¹, Fiona Imlach¹, Tracy Haitana², Susanna Every-Palmer³, Cameron Lacey², Helen Lockett¹, Debbie Peterson¹

Affiliations

¹ Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
² Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand.
³ Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand.

Abstract

Introduction: Clinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician's beliefs and assumptions in physical health service provision.

Methods: We surveyed people with MHSUC who accessed physical healthcare services. Of 354 eligible participants, 253 responded to open-ended questions about experiences of those services. Thematic descriptive analysis of survey responses was completed using existing stigma frameworks and inductive coding.

Results: One dominant theme from survey responses was that diagnostic overshadowing by clinicians was driven by clinician mistrust. Another theme was that clinicians assumed respondent's physical symptoms, including pain, were caused by MHSUC. This influenced decisions not to initiate investigations or treatment. Respondents perceived that clinicians focused on mental health over physical health, contributing to suboptimal care.

Discussion: Discrimination based on MHSUC leads to poor quality care. Health systems and clinicians need to focus quality improvement processes on access to and delivery of equitable physical healthcare to people with MHSUC, address stereotypes about people with MHSUC and improve integration of mental and physical healthcare.

Keywords: discrimination; health care; mental health; overshadowing; quality of care; severe mental disorder; substance use disorder.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Health Research Council New Zealand (#20-216). The funder was not involved in the design of the study; the collection, analysis, or interpretation of data; or writing the manuscript and did not impose any restrictions regarding the publication of the manuscript.