Stigmatization and discrimination towards people with mental disorders are common throughout the world and can have severe consequences for both the stigmatized individuals concerned and the wider society at large. Unfortunately, people with mental illness not only face stigma in their everyday lives but also when seeking medical help (Henderson et al., 2014). At the moment, stigma against being diagnosed as having a mental disorder and receiving psychiatric treatment for it is one of the most demanding challenges in low and middle-income countries (De Sousa et al., 2020). Attitudes towards patients from mental health professionals (including psychiatrists) are more favorable than that of other health care providers. However, patients can still experience stigmatization from them (Reavley et al., 2014). Psychiatrists are also identified as a source of the stigma that can either cause or contribute to feelings of devaluation or dehumanization in people with lived experience of psychiatric problems. Furthermore, perceived stigma from healthcare providers can “get under the skin” and serve as a predictor for service users’ internalized stigma and disempowerment (Wang et al., 2018). A Canadian research group listed the sources of stigma among healthcare workers, in which it highlighted the importance of aspects such as negative attitudes and behaviors, a lack of awareness, therapeutic pessimism, lack of skills, and stigma in the workplace culture (Knaak et al., 2017).
COVID-19 is one of the most pressing issues we are currently facing. It has had a heavy psychological impact on many frontline healthcare workers, including psychiatrists (Segers, 2020). Moreover, according to a recent review, COVID-19 can serve as an independent risk factor for stress in healthcare workers (Spoorthy et al., 2020). For mental health professionals, the weight of the perceived stress could easily result in burnout (Segers, 2020), which is fertile soil for generating stigma towards patients (Solmi et al., 2020). Since the number of personal visits has decreased due to the pandemic, patients can feel more isolated and may present more help-seeking behaviors (Maba et al., 2020). Therefore, it appears particularly important to minimize the aforementioned feelings of devaluation and dehumanization in people with mental health problems whom psychiatrists come into contact with.
Stigmatization can occur at any stage of a patient’s care. At a personal level, there are several ways how psychiatrists can contribute towards reducing stigma for the benefit of their patients. According to Thornicroft, preferring people-first language to combat labeling, avoiding pessimistic terms like “chronic”, and involving service users more fully as active participants in treatment are key actions in eradicating stigma (Thornicroft et al., 2010). Additionally, the growing prevalence of telepsychiatry has narrowed non-verbal communication and as a result words now do matter more than ever. Consequently, it seems extremely important for psychiatrists to express more positive attitudes and less social distance towards their patients. Furthermore, this online setting demands a more active engagement from the patients themselves. The perception of more favorable attitudes and active involvement could increase self-efficacy and the sense of empowerment that are important factors against internalized stigma (Wang et al., 2018).
During the ongoing COVID-19 pandemic, mental health care staff are often transferred to different units. On the systemic level, therefore, it is particularly important to be open and willing to treat psychiatric patients at specific services and at the level of care that they need (De Sousa et al., 2020). It is crucial to be able to provide valuable support and appropriate treatment for patients who need psychiatric help. It is also vital to reduce their risk of being stigmatized, which is more likely to occur in other medical services. In addition, adequate and necessary attention should be given to specific and targeted burnout prevention and anti-stigma interventions tailored not only to healthcare professionals but to mental health workers including psychiatrists as well.
Covid-19 can overwhelm psychiatrists as well as other healthcare workers. Since patients with mental health problems could be considered as extremely vulnerable, both emotionally and often somatically, psychiatrists should be more aware than ever of their subtle and unintended stigmatizing behavior towards their patients because the long-term consequences of which extend well beyond the stigmatization itself.
Authors' contributions
Dr. Dorottya Ori conceptualised the work and synthesised the manuscript. Dr. Tamás Molnár and Dr. Péter Szocsics contributed to the manuscript and also approved the final draft.
Role of funding source
Not applicable. Authors have no conflicts of interest or financial ties to disclose.
Ethics committee approval
Not applicable.
Declaration of Conflict of Interest
None of the authors have any conflict of interest to declare, pertaining to content of this manuscript.
Acknowledgement
We are sincerely grateful to Daniel Foyster for language editing and proofreading of the manuscript. We thank our patients as well as their relatives and carers for providing us with further insight into the psychological impact of stigmatisation and drawing our special attention to this phenomenon during the COVID-19 pandemic.
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