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Stigma and Barriers to Care in Disaster 39
duced the question of access. We have introduced the question of whether primary
care is prepared to use the latest treatments and whether they have the time. If not,
what do they need
DR. LINK: We have discussed the different reasons people do not seek care, and
comments have been made that reasons related to stigma are less common than ones
like, “I can handle it on my own.” If you imagine a respondent reacting to a question
suggesting “Why aren’t you doing something that would be good for you” they
are less likely to say, “I would be embarrassed” than “I can handle it on my own.”
There could be demand characteristics in the questions that shape the responses.
The second point is that if you ask the respondent why do they want to handle
it on their own, you might see that there are identity issues about what that would
mean about them. You would see stigma issues rolled in with respect to beliefs about
what kind of person needs treatment. Put another way, imagine us saying that we
would go out and change people’s beliefs about that one narrow thing, “I can handle
it on my own,” to say, “No, I can’t handle it on my own.” Do we really think that
we would make them come into treatment
DR. KESSLER: One important aspect of disasters is that stigma can get flipped.
If you look at national data among people who have a mental illness and predict
whether they got into treatment in the last year, having trauma is a very strong
predictor of them getting into treatment, and the reason is that there is a good
reason to get into treatment. “This terrible thing happened to me that is beyond
the range of normal human experience.” Anybody would be upset by that. It gives
you a license to talk about it in a way that you would not otherwise. Very often
the people who get into treatment after being in a car crash or a natural disaster
are talking about their mother not loving them 30 years ago. The trauma is an
occasion for getting into treatment, so many of the people you see have chronic,
ongoing problems.
We did a study looking at the impact of the Virginia Tech shootings on students,
and there were 32 students killed in a population of 30,000. There was a massive
increase in the number of kids who got into treatment for mental health problems.
The main reason reported was that a close friend of theirs died. However, each of
the kids who died had to have had 370 close friends for that to be true, which is
pretty unlikely. Twitter studies of close friendships show that people tend to have
around eight.
Trauma is an occasion for going into treatment. One problem with trauma
treatment setups, particularly in natural disasters, is that they are set up on an
acute disease model. A team swoops in for two weeks with Cipro and these chronic
schizophrenics are wandering in with this little bag of pills that are sort of purple.
“I don’t have my pills.” “What’s it called” “I don’t know.” They do not have any
antipsychotic medications or antidepressant medications in the strategic drug file.
We have to figure out some way of giving longer term treatment and mass treatment
after a disaster because this is the opportunity to reach an enormous number
of people. They feel it is okay to come in a way they normally do not. They do not
want to come in for two weeks. They want to come in long term, so we have to figure
out some way of doing something. One possibility is to work more on telemedicine.
There have been some movements in that direction in the last few years. For a couple
of natural disasters recently, the American Psychiatric Association and the American
Psychological Association had people who were volunteering to see two patients
a week for free forever on the telephone. The problem was that if the patient was in