Just a Psych Patient? Stigma in the ER

Just a psych patient? - Mental illness stigma in the ER

People with mental illness can come up against stigmatized attitudes within mental health care, but having a mental illness diagnosis can also make it difficult to access appropriate care for physical health issues. A recent CBC News story provides an example of a man whose physical issues were written off because he was just a psych patient.

In April 2018, David Pontone went to the emergency department at Humber River Hospital in Toronto, Canada. He was experiencing severe leg pain. He also happened to have bipolar disorder, which was stable. The ER doc ordered an MRI and also referred him to the on-call psychiatrist. Notes from his chart state the reason for his visit was bipolar, and the psychiatrist wrote that his main symptom was anxiety.

Come on, big boy

When nothing showed up on the MRI, Mr. Pontone was given the boot. The fact that he was in too much pain to walk was apparently not a problem for them. I’m not sure if the video embedded below will play outside of Canada, but it shows Mr. Pontone falling and then part crawling, part dragging himself along the floor towards the exit. A staff member is standing over him the whole time; the story says it’s a nurse, but it would be very unusual for an ER nurse to be in street clothes. Regardless, Mr. Pontone is quoted as saying the staff member told him “You’re a big boy! You’re strong! Come on, big boy, stand up!”

A few days later, he was diagnosed with Guillain-Barré Syndrome, an autoimmune disorder in which the immune system attacks the nerves. Serious stuff.

While this happened almost three years ago, it’s only being made public now because it was quite the production for the family to get a copy of the video, due to the hospital’s privacy concerns regarding other people who appear in it. Apparently, the twit standing over him in the video was fired.

All too common

This is gross. Sadly, it’s not surprising, but still gross. It reminds me of an ER encounter I had a couple of years ago. I went in because I’d been having problems breathing, my blood pressure was really high, and I was so dizzy I was having a really hard time walking. They decided I was 100% psych. I called them out on this, and the nurse who had triaged me insisted it couldn’t possibly be stigma, because she had a friend with a mental illness. Oh, well that changes everything! That friend needed to ditch this beeyotch pronto.

This isn’t just the odd instance here and there. People with mental illnesses are less likely to have their physical health concerns taken seriously, as care providers blame it all on their mental illness and punt them over to psychiatry. If two people go into ER with identical symptoms consistent with a heart attack, and one has a history of mental illness and the other doesn’t, who do you think is going to the cardiac cath lab and who’s getting a psych consult and perhaps, begrudgingly, an Ativan? If you guessed that the “psych patient” is less likely to be sent for cardiac catheterization because it’s “all in their head“, research would say you’re right (for example, see the paper Stigma Kills in European Psychiatry).

You’d think health professionals should know enough to not be this stupid, but that’s clearly not the case. It’s a weird blind spot to have, but I think it’s pretty pervasive, even when it’s not malicious. I remember when my partner at the time was in ICU and I was spending a lot of time there, and they were so impressed that I worked in psychiatry because it must be so hard. For all their knowledge dealing with serious physical health stuff, mental illness was totally outside their sphere of familiarity.

What next?

I don’t know what needs to happen to change this kind of thing. I think it could help if there was staff in-service training where patients with different conditions came in and talked about what their journey through ER had been like. That’s probably not going to do anything about the really entrenched stigma, but it might do some good where it’s more of a blind spot issue.

As for dumbasses like the woman shown in the video, perhaps we need to wait for brain transplants to come along. Until then, I hope she stays far, far away from me and anyone else who is “just a psych patient.”

The post Serenity Integrated Mentoring: Suicide Attempt? Do Not Pass Go has more on stigma in health care.

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.

There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.

64 thoughts on “Just a Psych Patient? Stigma in the ER”

  1. Yes, this kind of bias exists, just as racial and sexist bias exist, and they all affect us in that way: we are not heard, particularly when one has all three at once.
    How do we help build the empathy and the willingness to pause long enough to evaluate the person standing before us, for all of us?

      1. Hmm, I think/imagine/suspect/desperately hope that building empathy and connnection will help, and maybe some more training in spotting ingrained biases?

  2. When it comes to the social reality of (at least for the foreseeable future) the prevalence of mental illness I’m often left frustrated by the contradictory proclamations and conduct coming from one of the seven pillars of our supposedly enlightened culture—the media, or more specifically that of entertainment and news.

    They’ll state the obvious, that society must open up its collective minds and common dialogue when it comes to far more progressively addressing the real challenge of more fruitfully treating and preventing such illness. After all, its social ramifications exist all around us; indeed, it’s suffered by people of whom we are aware and familiar, and/or even more so to whom so many of us are related to some degree or another.

    Perhaps needless to say, the above-mentioned most commonly occurs when a greatly endeared celebrity passes away or dies an untimely death. This fact was in particular exemplified immediately following the many predictable platitudinous sound bites and mini-memorial commentaries from the late actor/comedian Robin Williams’ contemporaries as well as in many newspaper letters and editorials following his tragic suicide.

    However, that’s when the doublespeak so boldly occurred. The vast majority of the mainstream media, if not in its virtual entirety, distinctly appeared to willfully overlook Williams’ full mental health diagnosis, if not current condition—i.e. bipolar disorder (a.k.a. manic depression).

  3. I haven’t been keeping up with you, only because I’ve been under extreme stress trying to get all my work done according to things such as deadlines and schedules and other elements of the “mainstream” that I don’t manage very well. (Other elements of the mainstream include computer failures, program crashes, and insomnia.)

    But this post intrigues me, because I was about to make create a post or podcast about how, when I was experiencing homelessness, I was given lower priority in the E.R. because I was “just a homeless person.”

    That I was a known homeless person who had been to a certain E.R. enough times to be recognized probably didn’t help. But it was definitely the case that if I went to a hospital where I was unknown, and when I didn’t “look like a homeless person,” I received more equitable treatment.

    This particular stigma probably developed because many homeless people do use the E.R., especially during graveyard shift, as a temporary shelter. The stigmatic preconception is that all homeless people do so.

    A quick Wiki search reveals: “Social stigma is the disapproval of, or discrimination against, a person based on perceivable social characteristics that serve to distinguish them from other members of a society.”

    This stigma spoils the identities of psych patients in emergency rooms, and homeless people in emergency rooms as well. Fascinating stuff.

    1. Substance abuse is another instant black mark. I remember once when I was working in community mental health being so pissed off because I had put in a lot of work to get this totally bonkers dude in front of a doctor to get him committed, and then the ER turfed him later that day saying he was just a drug user. So not okay.

      1. Yes, that’s another one. And of course there is the stigma that homelessness and drug addiction are synonymous. Maybe I’ll write a quick blog post with a personal account on one of my breaks today.

          1. I’d do it right now but I’m putting myself on a 45 minute work / 15 minute break schedule to maximize efficiency, and it just turned 9:30. Check back in one hour.

            1. OK Ashley it’s posted. I posted the conversation to the best of my memory. I’ll edit it later but the information is there. (Gotta get back to work).

  4. You wrote about it! 🙂 I didn’t know that there was actually research that backed up the discrepancy. Wow. I like your idea about having patients talk to the doctors. I think that could be helpful with a lot of things, really. It’s often hard to express yourself coherently when you’re in intense pain or in a crisis (aka when you’re in the ER), and sometimes we only really realize/understand things after the fact.

    Okay now I googled it because I was curious, and yup, there’s a ton of research on it!! https://www.sciencedirect.com/science/article/pii/S2215036614000236

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