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Stigma and Barriers to Care in Disaster 31
help,” and “prefer to handle it on their own.” “Insurance or cost concerns” was an
issue for some. I think these are instructive and they fit in nicely with some of the
other data that have been presented earlier about other contexts.
It seems that stigma is less of an important issue than just having negative expectations
about counseling. Why might that be Why would it be that some people
feel negatively about counseling Sam Goldwyn, the film producer, said, “Anyone
who would go to a psychiatrist ought to have his head examined.” That is an old
quote but I suspect that many people would extend that to psychologists and other
mental health professionals, too. It is probably still operative.
Then there are some highly marketed treatments that make fairly radical claims.
This is the kind of material that might help us understand why people have some
misgivings about treatment.
Many of you may have seen a recent Newsweek front cover reporting the
depressing news about antidepressant studies suggesting that the popular drugs are
no more effective than placebo. In fact, they may be worse. I am not getting into
debating whether antidepressants work or not. I am presenting this because many
people probably read this and when their doctor says, “You should undergo a course
of antidepressants,” they might have some questions about it. The way these things
are presented in the media does have an effect.
There are some things about disasters that may be different in terms of barriers
to care. One is the disruption in services. Secondly, basic needs are probably more
important than mental health needs and so if you are attending to those you cannot
attend to the other. Then, as I have said before, there may be less blaming of
disaster victims.
I would like to leave you with some ideas about ways that we might address this.
Stigma issues associated with web-based things might be less prominent. Web-based
interventions may provide a way of tapping into some of our self-help oriented,
rugged individualist tendencies, such as, “I can do it on my own. I don’t have to go
forward. I don’t have to label myself as being a psychiatric or psychological patient.”
Long story short, these things represent self-help opportunities and mechanisms.
They have videos with them, and good information about utilization suggests that
people seem to like these things. Some preliminary data suggest that people who go
through this compared to controls actually get better on some measures.
In conclusion, ways of addressing stigma and barriers include crafting a way to
spread the word about effective treatments in ways that people can understand them.
We also need to be more careful in how we discuss resilience. Without question,
most people after disasters are resilient. However, when we stress that, which may
be a good thing to do, suppose I am not resilient What does that say about me Is
that stigmatizing me Is that going to make it more likely for me to come in and get
treatment I think we need to figure out a way to hit the sweet spot as opposed to
the way we do it now. I do think that the web-based psychosocial self-help interventions
may have a great deal to offer because they get around some of the barriers.
DR. GALEA: Good morning. It is an honor to be here. As Dean said, we have
done a great deal of work together and we agreed that I would present some new
data from one of our recent studies. Before I do that I want to talk a little bit about
disasters because there are some of us who have done a fair amount of work on
disasters and some of you who understandably do not think as much about disasters.
I want to make a point as to why we should think about disasters.
This is the bad news from the best database that exists about disasters worldwide
In conclusion,
ways of addressing
stigma and barriers
include crafting a
way to spread the
word about effective
treatments in ways
that people can
understand them.