What My First Week in Psychiatry Taught Me About Mental Health Bias
- Triya Chakravorty
- 1 day ago
- 4 min read
On a Sunday evening in August this year, I was on my first on-call shift as a trainee psychiatrist in a leafy psychiatric hospital. After a day of walking between old buildings which had been converted into wards, tending to patients’ mental and physical health needs, I decided to have dinner on the grounds.
As I sat on a bench with my microwave meal, I noticed a man coming towards me over the hill. The setting sun obscured his face, but I could see he was dressed in casual clothes, stooped over and heading in my direction. He was probably a patient on one of the wards I had worked on that day.
I thought about how we allow some patients on unescorted leave to roam the grounds, even when they have been sectioned. Apart from him and me, the place was entirely deserted. Stories came into my head of psychiatrists facing harassment and violence on hospital grounds. I thought about getting up, but how would it look if I, a doctor, tried to avoid one of my patients? So, I stayed put, but I could feel my heart begin to race.
When he reached me, his face became clear. Judging by his salt-and-pepper beard, he was in his sixties. He stopped, smiled, and said, “Lovely evening, isn’t it? Nice to see you.” Then he continued onwards.
As he walked away, I was filled with a sense of relief. After the relief came the shame. In that moment, I had made a snap judgment: I saw a psychiatric patient and instinctively feared for my safety. That moment was the painful wakeup call that l, a woman who has been studying and working in the medical field for almost a decade, still held a deep-rooted bias against my patients.
I see echoes of that moment in my experience with other colleagues in the hospital every day. In A&E and on acute medical wards that serve the sickest patients, people who are suffering with acute mental health problems are often seen as inconvenient, difficult and dangerous. A person who is having an episode of psychosis may misinterpret a friendly face as a sinister one, then react with outbursts of verbal and physical aggression in an attempt at self-protection. Another patient may be confused and in need of the attention of several healthcare staff, who then have to neglect their other patients to give this one time. Many medical colleagues cannot wait to hand patients like these over to the psychiatrists, with the hope that they will get whisked away to an entirely separate hospital, like the one where I work.
It is important to emphasise that people living with serious mental illnesses, such as schizophrenia, are not a danger to others. In fact, people living with mental illness are far more likely to be the victims of crime than perpetrators. Yet, the stigma against mental health exists in the public space, and it is in fact getting worse.
This also trickles into the medical community too. From as early as medical school, people find it challenging to deal with mental health patients, and try to avoid doing so as much as possible. Mental health is one of the biggest causes of disability worldwide, however in relation to physical health conditions, such as diabetes and heart disease, it is relatively less understood, researched, and funded.
Doctors carry this stigma not only towards their patients, but also towards themselves. Levels of anxiety, depression, and burnout are at an all time high among clinicians, yet many are reluctant to seek treatment. Many doctors believe that if they disclose their own mental health struggles or ask for help, then they may be inviting potential repercussions for their career. If those of us inside the system cannot acknowledge our own struggles without shame, how can we be expected to treat patients without judgement?
The attitudes of healthcare professionals toward psychiatric patients may also be shaped by racial bias. In the UK, black people are nearly four times more likely to be detained under the Mental Health Act (‘sectioned’) than white people. Under the Act, people with mental health problems can be held in hospital for assessment and treatment, against their will. Detaining someone under the Act is restrictive and often considered to be a last resort: to be used when efforts to help someone in the community have failed. Once discharged from hospital, people who are given a Community Treatment Order (CTO) can be made to return if they do not comply with certain rules. Black people are eight times more likely to face excessive restrictions through CTOs.
The reasons for this disparity are multifaceted. People from minoritised ethnic groups are less able to access mental health support when they need it. As well as racism, other contributing factors may include socioeconomic inequalities and mistrust of services due to historical barriers, which can lead to people presenting later and only once already in mental health crises.
That evening on the bench taught me a difficult truth, which is that doctors are not exempt from the very prejudices we criticise in the system. Mental health stigma, especially based on race, is harmful for everyone involved.
One of the first steps is to acknowledge that the problem exists, and accept our role in its perpetration. Dealing with this issue will require an honest and collective effort between communities, mental health professionals, and policy makers.
In a time of rising racial tensions in the UK, let us not shy away from difficult conversations about our view of mental health, and the biases that colour it.