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  • J. Dean Spence

Let's Ensure that the Housed are also Healthy


One of the main goals of R.E.S.T. is to ensure that youth aging out of foster care have access to safe affordable housing. I can’t imagine the looming dread such youth feel when they hit a certain age and realize that soon they will be left to fend for themselves.

Obviously, some are able to secure housing after foster care. But a valid concern is keeping them healthy particularly when some of these youth, with mental health and addictions issues, access primary care. I know from my time working as a CAMH Research Assistant on the Access to Primary Care Study (APC), that mentally ill people have higher rates of mortality and morbidity than the general population. It’s common for mental health patients to live only until their thirties, and die of such preventable conditions as heart disease, diabetes, and some forms of cancer.

Why is this so? The issue is complex. Certainly, mentally ill people themselves would do well to make healthier lifestyle choices. Myriad systemic barriers to accessing primary care also exist. (Stay tuned for more blogs on these issues!) And service providers should also share some of the blame.

It was my job during the APC study to interview service providers, and I found out, disturbingly, that some service providers do not treat people with mental illness the same way as the do “normal people” who are accessing primary care.

VALUES and ATTITUDES

First, service users interviewed for the study told my colleagues stories of service providers who seemed judgmental and who had negative attitudes about mentally ill people. Service providers, it was apparent, couldn’t see past their patient’s mental illnesses. One way this manifested itself was through “diagnostic overshadowing”, that is, when patients complain about physical symptoms but doctors erroneously think the cause of the problem is psychological.

One interviewee, named “Dan” (not his real name) mentioned that he was talking to an emergency doctor about physical symptoms, as the doctor took notes. As soon as Dan mentioned that he had a mental illness, however, “the doctor immediately put the pen down.”

As well, for substance users seeking treatment for physical ailments such as pain, some service providers automatically assume that they are drug-seeking. Interviewee “Arlene” said, “You certainly can’t go to a walk-in clinic and mention [substance use] because they call it drug-seeking.”

In one of the most disturbing interviews that I conducted, a service provider admitted to me that some doctors will refuse to take on a patient who smells bad!

LACK OF KNOWLEDGE ABOUT MENTAL HEALTH SERVICES

Second, service providers that people in our study approached for primary care didn’t seem to know what resources were available for people living with mental illness—including referral services.

Arlene says, “[Walk-in clinic physicians] don’t [address addictions issues] because number one they’re not trained for it, you know. Number two, they wouldn’t really know where to send you.”

SCOPE OF PRACTICE

Third, as Arlene’s above quote suggests, we discovered that many primary care service providers feel that they don’t have adequate training to deal with people living with mental illness. Interviewee “Gail” says, “Well, you know it’s a kind of subtle message that says ‘Well look. I am here for your physical health’ and they don’t look at the big picture—how the mental impacts on the physical, you know, and that we are a whole…’I can’t help you, sorry. I want to help you, but my area is the body.’”

Service providers even suggested to me that some doctors are unwilling to take on patients who are viewed as having complex needs.

The recommendations that came out of the APC study included more education for service providers on the lived realities and needs of mentally ill people, more education for service providers about referral resources related to mental illness, and expanding opportunities for physicians to network with mental health specialists.

One indirect benefit of the implementation of such recommendations would be to reassure youth aging out of foster care into various forms of housing. It would tell them now that you have found a place to live, the health care system will do its best to keep you healthy in your home.

#Diagnosticovershadowing #Primarycare

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