Stop the Stigma

Adventures in Mental Illness Stigma in the ER

Just a psych patient? Mental illness stigma in the ER

A few days ago, my family doctor had sent me into hospital because of worsening shortness of breath. I wasn’t overly surprised when I was met with stigma in the ER. It seemed like the ER doc took one look at my list of psych meds and wrote me off as “just a psych patient.” He barely listened to anything I said, and he kept asking what the point was of my GP sending me in. All he wanted to do was repeat the tests my GP had ordered and refer me to an outpatient clinic. I was frustrated with being dismissed, and since I didn’t want to be in the ER to do what my doctor had already done, I left.

To go or not to go to ER?

Then yesterday comes along, and the stigma in the ER situation really kicked into high gear. From the time I woke up, I was extremely dizzy. Even walking around my apartment was difficult. I checked my blood pressure a few times, and it was very high. My heart rate was also high. On one recheck of my blood pressure, it was 170/118, which is extremely high. I still didn’t really want to go back to ER after the experience I had a couple of days before. Uncertain, I called the provincial Healthlink phone line and talked to a nurse, who thought I should definitely go to the ER.

I was too dizzy to get to my building’s front entrance to catch a taxi, so I called an ambulance. The paramedics showed up a short time later. When they loaded me in the ambulance, they rechecked my blood pressure. It was still high, but not dangerously so. At that point, I was freaking out that ER was going to brush me off with the “all in your head” nonsense again. I was upset and started crying, and told the paramedics there was no point in me going to ER. They assured me that my physical issues were concerning and they would advocate for those to be taken seriously. After several minutes of cry-fest, I decided to go ahead and go to ER; the main reason was that I didn’t think I could walk back to my apartment from the ambulance.

Presenting complaint: depression?

After waiting for a while in the waiting room with paramedics, a triage nurse directed me to a chair in the triage area to wait in. I had no further contact with ER staff until 3 hours later. At that point, tada! The psychiatric triage nurse came to talk to me. The initial triage nurse had entered into their system that my presenting complaint was depression.

I was so disgusted with this, and I wish I hadn’t had such a strong emotional reaction, because it made me less able to stand up for myself. I asked to talk to the nurse who had triaged me, who defended her decision, saying I was in ER for a mix of things and she had to pick one, so she had picked depression. She showed me the triage form she’d completed for me based on what the paramedics had said; based on that, my presenting concerns were shortness of breath, dizziness, and hypertension, and depression was part of my history. Yet when she entered me into the hospital system, it was all about the depression. 

I told her that had nothing to do with why I was there, but she kept insisting that yes, it did She minimized all of my physical concerns, to the point of being really offensive. She told me that my vital signs were stable, although it had been three hours since they were last checked. Her argument that I didn’t make eye contact during the two seconds at triage when she directed me to a chair, therefore I was there because of depression, was totally absurd. I told her that this was typical of the stigma around mental illness. Her response? She didn’t have stigmatized beliefs, because she has friends with mental illness. Well that takes care of that, then, doesn’t it?!

Giving up

I asked to speak to the manager. Unfortunately, it being a weekend, the next best thing was the charge nurse. Of course, the charge nurse backed the triage nurse, minimized my physical concerns, and was disgustingly patronizing. Any time I swore, she shushed me and told me not to swear because there were senior citizens around.

At that point, I was just done, so I left. No marching confidently out; I was still extremely dizzy, so my walking was slow, tentative, and wobbly. But who gives a crap about that, right? I’m JUST a psych patient. Who was I to think I could escape being faced with stigma in the ER?

A big fork poke

Unsurprisingly, this has set me back in terms of my depression. I’m prone to developing psychomotor retardation (a depressive symptom involving slowing of movement and thoughts) in response to overwhelming stressors (big honkin’ forks in fork theory). Combine that with ongoing dizziness and moving around is quite the challenge.

This kind of thing is not okay. There’s more than enough stigma to go around without health care providers hopping on board so that patients are facing stigma in the ER and other parts of the health care system. Just because someone has a mental illness does not mean that it’s always to primary issue or that their physical concerns are trivial.

Book cover: A Brief History of Stigma by Ashley L. Peterson

My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.

You can find it on Amazon and Google Play.

Mental illness: Stop the stigma - graphic of face and megaphone with the words "speak up"

You can find more on mental illness stigma on the Stop the Stigma page.

45 thoughts on “Adventures in Mental Illness Stigma in the ER”

  1. So sorry to hear of the disgusting way you have been treated. It makes it more worrying for future trips in the event something happened, because your mind will be on what happened before. Well it would be if this had happened to me. Xx

      1. I can imagine it doing that to you.

        Mine experience wasn’t on the basis of mental health, but I was treated in a way that I found upsetting. It happened some years ago. I went to work, which I should not have not have done. But I been to my doctor’s prior about my left side. I was getting a pulling pain that was happening regular and at this point it was most painful. It was pulling into my left half of my chest. It was confirmed as I thought, a pulled muscle.
        I was allowed a stronger pain killer and I should have tested for a few days, but being scared of having time off, I went.
        I was nearly through most of my shift cleaning. Decided to do an extra job that really aggravated it. I was in so much pain, I could not breathe.
        As a precaution, they wanted my in A&E as they knew someone who was my age having a heart issue, not surviving.
        Me, I would have just gone home.
        First person I seen was nice. I was monitored. Second person came, not very nice. Basically asking me why I was like I was.
        I really wanted to shout back, but couldn’t. I wanted to cry, but didn’t. I was discharged and nothing to worry about as I knew. But there was nothing there at all with this person. I asked myself what had I done? Did I make her go into overtime, instead of her being home? And other stuff. I wasn’t in a hurry going back to A&E if I could help it.

  2. I’m so sorry this happened to you. A few months ago, when I went in because I was having a panic attack (which caused me to think I might have rabies, you probably read that) I was trying to explain to the triage nurse that I knew I was having a panic attack, that I also knew my fears, though outlandish, were valid, and that I had started a new medication which I thought might be contributing to the panic. She goes “Okay, you need to just calm down.” Which devastated me. It was so incredibly patronizing. I just started crying…like, when has telling someone to calm down EVER made them calm down? I knew I was a mess, that was why I was there…but couldn’t she have chosen different words? Anyway, luckily, they listened to me and decided I should get the rabies vaccine. I can’t imagine having doctors dismiss me because I have “anxiety” written in my history.

  3. I’m so sorry. I’ve had this happen to me as well multiple times. I’ve had social work called on me when I was in for physical issues. It’s demeaning. I’m so sorry.

  4. Wow, that’s terrible.

    How are you now? Your breathing as well as mental health. Are you going back to your GP? I’m concerned that you seem to have a physical health issue that the professionals are refusing to notice, let alone treat.

  5. Damn! That hospital was downright awful!!! I am so disgusted over how they treated you… Can you file a complaint? I mean that is seriously wrong what they did to you. If they are doing it to you, they are most certainly doing to other patients that have a mental illness. They should be ashamed of themselves!!

  6. I already told you on Twitter about my experience at the ER of being diagnosed with a panic attack and being convinced I WAS NOT having an allergic reaction to a medicine, when I actually was. The next time I took that medicine I got horribly sick and had an undeniable reaction with whole body rash, trouble breathing, etc. It is criminal how they tend to dismiss very real physical concerns just because we have a history of depression and anxiety.

  7. The whole thing is way out of order. I could rant on your behalf but you know it already. You have been treated appallingly and are right to make a complaint whether it changes anything or not.
    You know you have our support but that won’t fix your symptoms.
    Sending hugs across the Atlantic xx

  8. Hugs. You need to take care of yourself. I won’t go into the details of that medical emergency caused by trauma I alluded to in my post, but the ER initially tried to turn my sibling away because they are willing to believe anything of “those kids.” Needless to say, that stigma would have had disastrous consequences given what had really happened and how serious the situation was. I still have nightmares about literally looking up guidelines from open source medical guidelines from other countries and spending an hour on the phone with an ER neurologist desperately trying to convince him to take this seriously and run specific tests and admit. I was right, and he was admitted, but in that moment thanks to first abuse and then prejudice stigma someone else’s life was quite literally in my hands and I still have nightmares of “what if it happens again and the initial symptoms either aren’t noticed by my co-guardian – or I fail to be able to figure it out on my own and convince the staff before it’s too late.” I also had to diagnose myself with the dysautonomia and EDS first. Ironically, I only knew what they were because I had been desperately searching *first* for something to explain what all might be going on with my sibling. I’ve had both diagnoses independently confirmed by at least three doctors each no, because doctors seem to never like to just take each other’s word for it, but the first didn’t believe me because at that point I, too, was just a psych patient. Stigma is dangerous, and you as a nurse need to advocate for yourself with your training because you can’t assume anyone else will – or that it is safe not to. I suspect depression will tell you at some point to just give up, stop being a bother, and that maybe none of these new symptoms are real. As hard as it is, don’t listen to it. Hugs.

  9. That’s very frustrating. We all have to be our own advocates for healthcare. When I was pregnant with my youngest I had cholestasis (a condition that can lead to still birth and qualified me as having a high risk pregnancy)…and when I started getting sick a couple weeks before my scheduled C-section still both my OB and primary wrote it off as a virus. I kept pushing and long story short my daughter was born that day. That wasn’t the first time I’d had to fight for what was right. And these were good doctors who knew me. I feel for people who can’t advocate for themselves. My daughter could have died…

  10. What a terrible display of stigma. I’m so sorry you were treated this way. It’s upsetting to think that health professionals could disregard your physical symptoms and completely misconstrue why you presented at the ER. Just awful. I hope you’re feeling better today.

  11. I’m sorry they treated you like this. It was appalling and unacceptable. Thanks for writing about it because otherwise we would never know from the user perspective.

  12. I’m really sorry that you treated you that well. That’s really unacceptable. Not everything has to be about your mental illness. I also can feel so dizzy and it’s when I have my period for instance and not because of anxiety. Of course, I can feel dizzy too when I feel really anxious. I hope you find the help you need. I’m here for you. I hope you feel better soon ❤️

  13. That’s so, so awful. Grrrr. I’ve learned to not mention any mental illnesses I have unless it’s necessary for the doctor to know. I went to a cardiologist recently, and although I was adamant that my dizziness and heart palpitations happened at times when I was not anxious at at, e.g. standing up, exercising, on my period, he wrote it off as probably just anxiety.

    1. It’s so frustrating that people make assumptions that way. No one should have to hide part of their health history, but you’re right, that’s often the best way to go.

  14. I think you’ve done amazingly well to write this, given how awful you must be feeling. I’m angry as hell on your behalf, your treatment was absolutely unacceptable. I’m so sorry you had to go through all of that. It’s pathetic, sad, frustrating and appalling that psych stuff gets in the way of physical stuff in this way, that things can be brushed off as being psych-related because ‘oh it’s just depression’, ‘oh it’s just anxiety’… When I had breathing problems one nurse kept saying it was anxiety and I was having panic attacks, which I knew I wasn’t (later diagnosed asthma). I was fobbed off for my stomach issues for years (depression, eating disorders, making the whole thing up, you name it), then diagnosed various issues not to mention a dead bowel! They don’t realise the damage they do, the risks they’re putting people at, by treating patients this way. Again, I’m just so damn sorry you had to go through all of what you did… How are you doing today?
    Caz xxxxx

    1. Thanks so much for your support. ❤️ This kind of thing can really be dangerous.
      Sorry for the delayed response – for some reason your comment ended up in my spam folder.

  15. I think most medical professionals’ overall practice would benefit from suffering a brief and temporary, but complex medical episode that left them unable to understand or advocate for themselves, with a dash of anxiety and gaslighting for good measure.

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