Koop Symposium Addresses Societal Stigma in Behavioral Health
Societal stigma is one of the biggest barriers for those seeking treatment for behavioral health challenges, said panelists and speakers at the 10th Annual C. Everett Koop Addiction Medicine Symposium at Dartmouth-Hitchcock Medical Center (DHMC) on December 8. Entitled "Reducing Behavioral Health Stigma in Healthcare Systems and Communities," the symposium was held on the same day the Centers for Disease Control and Prevention (CDC) announced that opioid deaths in 2015 surpassed 30,000 for the first time in recent history, up more than 5,000 from 2014.
Will Torrey, MD, vice chair of clinical services for DHMC's Department of Psychiatry, told the near capacity crowd in Auditorium H in the Williamson Translational Research Building, that "we need to be outraged" about stigma and the impact it has on health care. People would be up in arms, he said, if medical treatments were not available for those suffering from heart problems or breast cancer. "We have a huge number of people seeking health care services for substance misuse disorders and mental health concerns, and it's hard to meet the demand," said Torrey, who is the clinical champion for D-H's Substance Use and Mental Health Initiative. "I think stigma is the reason more care is not available."
D-H's Substance Use and Mental Health Initiative Advisor Seddon Savage, MD, MS, who organized the symposium, said, "We know stigma is a major impediment to care." Yet the DHMC symposium is one of very few conferences around the world that have devoted an entire day to tackling the challenges that stigma presents, she told the nearly 160 assembled health care and health and human service providers.
Substance Use is Not a Moral Failure
One of those challenges is the public's outdated perception of substance misuse, said James Vara, the New Hampshire governor's advisor on addiction and behavioral health. "We have to talk about substance misuse as a disease," he said. "This is not a moral failure and we can't assign blame."
The notion that individuals with substance misuse disorder have "brought it on themselves" is still widespread, said panelist Joseph Hannon, MD, a former New Hampshire state representative. When he co-sponsored the bill that permits doctors to prescribe Naloxone to families with loved ones at risk of overdosing, which Governor Maggie Hassan signed in June 2015, someone told him that people with an addiction to substances "should just die and go away. And this was not an isolated incident."
Hannon added, "It's the only disease that we use stigma to combat. We lock people up and consider them less than human because of their disease. We don't do that with anything else. We don't lock diabetics up because they ate too many donuts. You have to remember that most people who become addicts start very young."
The connection between substance misuse and mental health
Other panelists noted that substance misuse is often connected to mental health challenges. Partners for Community Wellness Director Karen Borgstrom spoke about her late ex-husband's battle with substance misuse and bipolar disorder. A prominent physician, she said the stigma surrounding mental health, including his own self-stigma, "prevented him from asking for help from his colleagues. As health care providers, we need to heighten our own sensitivities to people," Borgstrom said, and not be judgmental about behavioral health issues.
John Broderick, the former chief justice of the New Hampshire Supreme Court, also spoke at the symposium. In 2002, he was attacked by his son, who was suffering from undiagnosed anxiety, depression and panic attacks. Broderick now leads the "Five Signs" campaign in New Hampshire for the Change Directions organization, which is striving to change the culture of mental health in the U.S. The Five Signs that may mean someone is in emotional pain and potentially needs help are: personality change, agitated, withdrawal, poor self-care and hopelessness. "There are a lot of people waiting in the shadows to come out, but unless we change, they won't," said Broderick.
Reducing Stigma in Healthcare Settings
Aita Romain, MPH, the Upper Valley Regional Substance Misuse Continuum of Care facilitator and team leader in DHMC's Community Health Department, facilitated a panel discussion that addressed "Reducing Stigma in Healthcare Settings: Creating Welcoming Healthcare Environments." The panel consisted of Mark Horton, MD, from Cheshire Medical Center/Dartmouth-Hitchcock Keene's Pain Clinic; DHMC Chief Nursing Officer Karen Clements, MSB, BSN, RN, FACHE; DHMC Inpatient Psychiatry Unit Nurse Manager Maureen Gardella, BSN, MPA, RN; and Family Support Specialist at D-H Manchester Kristen Cherry, BSW.
Clements said that staff education and training, as well as a positive environment, are key to creating welcoming environments for patients with substance misuse and mental health concerns. She noted that a special behavioral health hallway with painted murals was established in DHMC's Emergency Department, which provides "a safe place for patients." Clements also echoed many of the panelists when she said, "Every single one of us is touched by this and we have to work together to get rid of the stigma these patients frequently encounter."
Gardella agreed that education is the first step, particularly education around behavior that may stigmatize patients. "One of our biggest goals is to provide a caring environment and to accept people where they're at," Gardella said.
Horton said he asks patients open-ended questions and uses office visits to "figure out where patients are at. Often they're not ready to change, and that's okay. Sometimes just listening is enough." Cherry added that she tries to help clinicians by always using and trying to teach them terminology that doesn't stigmatize patients. "We're all active participants in trying to reduce stigma and can help by doing our jobs a little differently and being more aware."
Treating the whole person
Romain, who also assisted with the symposium logistics along with Denise Adams of the New England Institute of Addiction Studies (NEIAS), said she was pleased with the turnout and the diversity of information presented. "Many people came up to me to tell me how impressed they were by all the speakers and how happy they were to see so many people in the room for an issue they care so deeply about," she said. Romain added that she knew the symposium "was going be exceptional" when panelist Jim Matthews concluded his story about the health care barriers he faced as the father of a son with mental health challenges.
"Jim said, 'I can imagine an alternate universe where this story went very differently. Where our son's pilonidal cyst and his anxiety disorder were both considered medical issues deserving attention and care, rather than judgment. Where we and our son felt free to disclose his challenges in a matter of fact way. Where doctors and hospitals proactively sought the information they need. Where our son was treated as a whole person. That universe can feel very far away, but we can choose to bring it closer.'"
The symposium was hosted by the Dartmouth-Hitchcock Substance Use and Mental Health Initiative and NEIAS, and co-sponsored by the Northeast Node of the National Drug Abuse Treatment Clinical Trails Network, the New Hampshire Training Institute on Addictive Disorders, and ALL Together, a D-H Community Health Department program.
Symposium recordings, PowerPoint presentations, handouts and recommended resources are available at the NEIAS website.