Articles

Mental illness discrimination in primary care common in New Zealand

Prejudice towards those with a mental health or substance use condition is affecting quality of care in New Zealand, a new research paper by the University of Otago shows.

The results from a national online survey of 335 people with mental health or substance use conditions found that nine per cent of respondents reported sometimes or never being treated with respect and 21 per cent reported sometimes or never being listened to in primary care settings.

Concerningly, 10 per cent of respondents experienced discrimination always or most of the time and 20 per cent experienced diagnostic overshadowing always or most of the time.

“People with mental health and substance use conditions [MHSUC] are at higher risk of poorer outcomes and mortality from physical health conditions. Quality of health care is a contributory factor,” the study notes.

The study found that while most people have good experiences with their primary care providers, that is not the case for everyone.

People with four or more MHSUC diagnoses, a diagnosis of bipolar disorder or schizophrenia, Māori, LGBTQ+ and female respondents reported worse experiences.

People with anxiety and depression, the most common mental disorders, consistently reported better experiences on all quality measures. In contrast, addiction, bipolar disorder, and schizophrenia diagnoses were associated with poorer experiences.

This could be because negative stereotypes about people with substance use disorder and schizophrenia are extremely common in the general population and amongst clinicians, the study notes.

“Lack of knowledge and stigma from providers have been identified as barriers to accessing care, whereas positive relationships, characterised as empathetic, non-judgmental, and person-centred, enabled access.”

“Having a regular GP, with the associated benefits of continuity of care and building a trusted relationship, leads to greater satisfaction with primary care services.”

The study points to an ongoing need to address bias in health professionals to ensure that people are consistently taken seriously and treated fairly and with respect.

“In primary care, ensuring that all practitioners are trained, skilled and comfortable with interacting and supporting people with MHSUC is not only foundational for improving health outcomes, but also for reducing stigma and discrimination towards people with MHSUC.”

- 20 October 2023