Is Mental Health Stigma Decreasing?: An Eye-Opening Study Into Healthcare Students' Knowledge, Attitudes and Behaviours

Today is Bell Let's Talk Day (#BellLetsTalk). By now, most Canadians are aware of this mental health campaign either through direct or indirect participation and understand the goal is to raise funds, eradicate stigma and increase public education. The key message concerns the importance of openly discussing our mental health in homes, schools and workplaces. The motivation behind this is an effort to work towards decreasing negative stereotypes and discrimination towards those living with a mental illness. 

Given the widespread engagement through this campaign, we might think that we are positively changing our attitudes towards mental illness. Bell Let’s Talk advocates, Clara Hughes and Michael Landsberg, have played a pivotal role in helping Canadians make headway with respect to mental health education and awareness by openly sharing their own struggles with mental illness.  

However, a 2020 research study conducted by Occupational Therapist, Taylor Riffel and University of Alberta Assistant Professor of Occupational Therapy, Dr. Shu-Ping Chen found that stigma is still widespread among Canadian University healthcare students. More needs to be done to equip healthcare students with a thorough understanding of mental health issues and to prepare healthcare students to provide compassionate care for those living with mental illness in their future professional endeavours. While there have been many different mental health initiatives, there appears to be a fundamental lack of education from elementary school through to post-secondary school. This study highlights how this even applies to healthcare studies, where students who will be working directly with people living with mental illness at some point in their healthcare careers not only lack fundamental education in mental health, but more importantly reveal deep-seated beliefs and attitudes that are stigmatizing and discriminatory.

 

WHAT IS MENTAL HEALTH STIGMA?

The Mental Health Commission of Canada defines stigma as “... a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group.”  

Stigma of mental illness occurs at three different levels: intrapersonally (self-stigma), interpersonally and structurally. 

THOUGHT EXPERIMENT RELATED TO MENTAL HEALTH STIGMAS

Imagine that you have been silently struggling with symptoms of psychosis for the past six months, leading to a hospital admission. You didn’t tell anyone you were struggling with symptoms of psychosis because you felt ashamed. This is an example of intrapersonal stigma (self-stigma).   

Imagine that you are a fourth-year university student, applying to law school. You require a supportive letter from your doctor because you were sick as a result of your bipolar disorder and took time off from your studies. Your doctor refuses to write you a letter because he believes it will give you an unfair advantage. This is an example of interpersonal stigma because your doctor is speaking and acting in discriminatory ways.

Imagine that your depression has been becoming increasingly more severe, leading you to attempt suicide. You are treated differently when you are in the hospital ER because your presenting concern is mental health-related rather than physical health-related. This is an example of structural stigma. 

WHY IS THIS RELEVANT NOW MORE THAN EVER?

In their interactions with healthcare professionals, many people with mental illness report feeling “devalued, dismissed and dehumanized”. Patients diagnosed with mental illness have reported that the negative attitudes of healthcare professionals has adversely impacted the quality of care they have received, their recovery journey and their willingness to remain in treatment programs. 

WHAT DID THE RESEARCHERS DO?

The researchers conducted semi-structured interviews with 18 Canadian University healthcare students. Disciplines included were: Dental Hygiene/Surgery, Dietetics/Nutrition, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, Psychology and Speech-Language Pathology. Half (9/18) of participants reported themselves having either diagnosed or undiagnosed mental health concerns. The researchers asked the participants about their knowledge, attitudes and behavioural responses toward those with mental illness. 

WHAT DID THE RESEARCHERS LEARN FROM INTERVIEWING POST-SECONDARY STUDENTS IN HEALTHCARE?

Through their research, the researchers learned that: 

• Although all of the participants reported that they would feel comfortable disclosing a mental health issue to family members, friends or a professional, the majority stated that they would not disclose a hypothetical mental health issue in a work or school setting. 

• Several participants shared that they would be comfortable around those with less severe and more familiar mental illnesses like depression and anxiety, but not more serious ones. 

• Participants expressed the view that mental illness is more permanent, long-lasting and stigmatizing than physical illnesses, and that they are rooted in curses and religion.

• Most participants reported changes in worldview and perception and development of empathy through their experiences.  

WHAT IS THE MAIN TAKE-AWAY?

The stigma of mental illness is present in many aspects of our lives. This study honed in on a specific population: healthcare students. Healthcare students are our future healthcare professionals. They will be entrusted to care for our most vulnerable, which includes those with mental illness. This is precisely why more formal education is needed. We have come a long way, but we still have a long way to go.

 

RESOURCES

If you are experiencing a mental health crisis and/or need support, I encourage you to reach out to the following resources:

Kids Help Phone 

Phone Number: 1 800-668-6868

Website: https://kidshelpphone.ca/ 

Canada Suicide Prevention Service

Phone Number: 1 833-456-4566

Website: https://www.crisisservicescanada.ca/en/  

As someone with lived experience of mental illness, I encourage you to look into the following resources to learn more about mental illness from the perspectives of people living with them. 

The Mighty - https://themighty.com/ 

SickNotWeak - https://www.sicknotweak.com/  

 

REFERENCES

Mental Health Commission of Canada. (n.d.). Structural stigma. Stigma and Discrimination. https://www.mentalhealthcommission.ca/English/structural-stigma 

Riffel, T., & Chen, S. (2020). Exploring the knowledge, attitudes, and behavioural responses of healthcare students towards mental illnesses: A qualitative study. International Journal of Environmental Research & Public Health, 17(25), 1-11. 

  

Hey Gen Z, if you want to be depressed and suicidal before you’re 30…smoke weed everyday!

Brandon Vecchiola

Click bait?  Yes, this is true.  But now that you’re here, ask yourself a question:  What are you willing to do to ensure that you have the best experience of life you possibly can?  Think…Think…Think… okay stop thinking.  If the answer wasn’t “anything I have to!” then you need to think about it some more.

Life is far from perfect. We all strive, in different ways, to seek comfort and sooth ourselves.  When the going gets tough, some of us run, some swim, some of us seek sex or drugs.  Some of us embed in community or seek out nature; some crave adventure. Some folks love to see red. 

Some of these ways of coping, dealing, and experiencing are healthier than others (that’s just a fact).  Certainly, each Human Being reserves their right to do whatever they wish with their own body (provided it doesn’t harm others).  But if they wish to have the most pleasant experience of life as possible, then we should learn to listen, albeit with some healthy skepticism, to our scientists. 

Though they look like a sinister bunch, adorned in white smocks, conducting experiments and gathering around data rolling their fingers and conjuring statistics from cauldrons of confusion.  They have valuable information to offer us.  Remember when doctors used to say that smoking was good for you?  Well, unfortunately, a similar misinformation campaign has been ongoing in our culture regarding cannabis.

Hey, don’t get me wrong, I’m not against adults recreationally, or even vocationally, enjoying drugs: it’s your life grown-ups, live it however you wanna.  It even has utility as a medicine for some people. However, I am concerned that the 20% of Canadian adolescents who used cannabis last year are not adequately informed about the dangers associated with prolonged and early drug use.  I certainly wasn’t.

To my surprise a study released last year claims that cannabis, weed, Mary-Jane, Krypto-Chronic-Kryptonite and the Killa’ Kush: might actually kill you (not a scare tactic, keep reading). 

Dr. Gabriella Gobbi MD, PhD, CSPQ is an associate professor and researcher from McGill University, and the first author of the study “Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis.” 

Dr Gobbi studies, among other things, the “short- and long-term effects of cannabis use in mood and anxiety and the potential beneficial effects of the drugs acting on the endocannabinoid system”.  Though, she has nothing good to report.  

The goal of their study was to determine if there was a long term association between cannabis use in adolescence and depression, anxiety, and suicidality in young adults (between the ages of 18 and 32).  I’ll save you the suspense, the answer is yes.  Adolescents who use cannabis at higher frequencies are more likely to experience the negative outcomes listed above in young adulthood.  There have already been studies which have linked cannabis use with high rates of depression in adolescence.  What made this study novel, was that it utilized a longitudinal study  to assessed the mental health outcomes of people who “blaze it up.”

Longitudinal studies are studies in which researches follow a group of people over time and assess the outcomes of interest at different time points.  Although this method isn’t’ as robust as experimentation in determining the causal relationship between different events, it is a valuable form of evidence when used with other research techniques.  The combined evidence from multiple lines of investigation can be used to arrive at a conclusion about some issue.

This study was a meta-analysis.  Let me explain what that is and why it’s important.  A meta-analysis gathers up several studies in a particular area, averages the findings of those studies and makes a determination as to whether or not a claim about something can be justified.  For example, a single study that claims antidepressants help alleviate depression isn’t enough evidence to support the widespread distribution of an antidepressant drug.  However, if there were 10 studies, some which said anti-depressants work, and a couple that said they didn’t work, a meta-analysis would average those findings and make a determination: on average, anti-depressants alleviate depression, and so doctors should prescribe them as a first line of defense for depression (end of example).

The authors of this study wanted to answer the question “is cannabis use in adolescence associated with depression, anxiety and suicidality in adulthood?"  But they wanted to make sure that as many factors as possible were accounted for before answering that question. So, the authors only included studies that were peer-reviewed, longitudinal, focused on cannabis, measured depression, anxiety, and suicide, assessed  younger than 18, and then again at least one more time in their adulthood. The authors also adjusted their findings for age, sex, and depression at initial assessment.  Level of parental education, socioeconomic status, alcohol use, and tobacco use were also controlled for.  All this to ask, all things being equal, what effect does weed have on your mental?

From the scientific research databases 3142 articles of interest were identified, 269 articles were reviewed, 35 were critically assessed, and 11 articles including 23 317 people were included in the final statistical analysis.  The researchers used something called an Odds Ratio to determine the likely hood of developing these disorders. An odds ratio, in this situation, tells us the likelihood of developing a mood disorder if you used cannabis in adolescence.  For people who use cannabis in adolescence, the researches determined the following:

There was no association between anxiety and cannabis use discovered.

You are 1.37 times more likely to develop depression in adulthood than nonusers

You are 1.50 times more likely to develop suicidal ideation than nonusers

You are 3.46 times more likely to attempt suicide than nonusers

Teens who started earlier in life (14-15) and those who continued using into their college years fair worse than others. However, the relationship stays the same no matter how young you are when you stop.  Interestingly, the association was not present at the 1 year follow up, but it was at the ten year follow up (something to consider).

The authors also report on significant brain changes that are linked to cannabis use.  Brain volume and density changes, neurotransmitter irregularities, and cross over effects such as increased tolerance for morphine, amphetamine, and cocaine in cannabis users. This last effect may be thought of as good depending on your perspective, but my gut tells me this is probably not ideal for healthy development.

So here we are again folks.  Some adult telling the youth not to use drugs: “if you use drugs your going to die”, “your brain on drugs is basically a fried egg in an oil pan.” Priceless, timeless advice.  Here is the thing, not everyone develops these problems.  The odds ratios are low.  However, the nearly 3.5 times likelihood of someone attempting suicide is an alarming figure.

The problem with correlational and longitudinal studies is that they cannot fully establish causation.  And even if they could, the outcome wouldn't be the same for everyone.  In science we deal with probabilities.  Some smokers never develop cancer.  That doesn't mean smoking doesn't cause cancer.  It just means, by chance, and some other factors, some individuals beat the odds.  So, It may not be that cannabis is the main causal factor.  And in fact, I don’t think it is.

Enter some informed speculation.  

Which factors drive people to daily, debilitating, and prolonged drug use?  This is the important question.  There is a strong correlation between substances of abuse and many other mental health disorders; depression, suicide, post traumatic stress, traumas of all kinds, and borderline personality disorder to name a few.  People abuse drugs to mask pain.  For me, it is as simple as that.  The problem is that drugs don't always make things better.  By altering your physiology and reducing your capacity for healthy coping, they can make things much worse.  Even those "soft drugs" like little Ol' Mary-Jane.

Then what is the solution?

Alleviate the pain!  Find a way to connect, heal and create new meaning.  Fabricate your supreme fiction (but in a good way okay?).  Engage with inspiring people more often.  If your friends are bringing you down...find new friends.  If your partner sucks...leave them.  If your job sucks...find something better.  If you need therapy...go get therapy!  Yes easy for me to say...I know.  I'm not the one who has to make the changes.  Well in fact, I have made changes like these.  And so have many other people.  They are creeping among us like day walking vampires, hiding in plain sight.  Living new lives free from the fetters of the past.  

Recovery is possible. 

Change is possible.  

It's yours for the taking!

So, I’ll ask you again: What are you willing to do to ensure that you have the best experience of life you possibly can?

Thames Valley Addiction Services 

http://adstv.on.ca/

Canadian Mental Health Association
https://ontario.cmha.ca/documents/finding-and-navigating-addiction-services-for-children-and-youth/

Craigwood Youth Services

https://www.rehab.ca/craigwood-youth-services/1100051-r

Gobbi, G., Atkin, T., Zytynski, T., Wang, S., Askari, S., Boruff, J., … Mayo, N. (2019). Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry, 76(4), 426–434. https://doi.org/10.1001/jamapsychiatry.2018.4500