Addressing the Stigma: Pitt Student Hopes to Create Positive Change in Mental Health Care

Brandon Thomas fires up his PowerPoint presentation as he stands in front of a group of about 15 nurses and doctors at a local hospital. Across the projector screen reads: “Quick to Judge: Removing the Stigma.”

Thomas, a senior at the University of Pittsburgh School of Social Work, is leading the group through one hour of training to address stigmatic attitudes toward patients who visit the emergency room with mental health and substance abuse disorders.

To begin the training session, Thomas shares a real-life case study:

A 16-year-old begins a long struggle with mental health when their parents get divorced. In this person’s 20s, there is suffering through a breakup, failing in school, losing a friend to murder, experiencing flashbacks, getting charged with a DUI, becoming a parent, attempting suicide and ultimately being diagnosed with major depressive disorder and bipolar disorder. This person goes to jail for a DUI in their 30s, and loses their father to murder. Through this time, there are more flashbacks — and feelings of failure, loneliness and guilt.

After presenting the case study, Thomas walks the group through surprising facts and statistics, for example, that 20% of nurses will have problems with substance use, according to the Journal of Clinical Nursing. He leads an exercise of how to restructure phrases that are commonly used but can severely affect patients who overhear them.

“Patients are already defeated when they come in and say ‘sorry I’m back here again.’ They have so much guilt,” said Thomas. “And health care providers are sometimes perpetrating that more on them, by saying ‘oh you’re back again, you’re a frequent flier.’”

The training is emotional and eye-opening. But the nurses and doctors never would’ve guessed what would come at the end of the session, as Thomas leads them back to the session’s opening narrative.

Thomas said: “Your case study is my story.”

Thomas’ journey

Thomas’ story puts him in a meaningful position to address stigma and bias on behalf of health care professionals: he’s been on both sides.

While Thomas said he is still on his own journey with mental health, he’s come a long way. Now working toward his degree in social work at Pitt, he’s also served as a firefighter and worked in a variety of health care settings over the course of his adult life. Currently, he works as a patient care technician in the detox unit of a major hospital while juggling life as a student at Pitt.

And between working in emergency rooms and psychiatric units, he said he’s heard words and labels like “crazy,” “frequent flier” and “attention-seeker” spoken by doctors and nurses, every day.

Ironically, Thomas found himself using these words, too.

“Since I was farther along in my journey than my patients, I thought of myself differently. I had a lot of stigma and biases toward these people,” said Thomas. “For me to realize it, I had to take a step back and say: ‘I’m in that population. That’s me.’”

That’s why, with the support of his Community Research Fellowship with the University Honors College, he aims to research how to address mental health and substance use stigma and bias with emergency room health care providers.

The research

While it’s widely understood that stigma and bias impact the health and mental health of patients, studies to actually address it are rarely published in the United States, according to Brianna Lombardi, assistant professor in the School of Social Work, who also served as Thomas’ faculty adviser on the project.

 “The intervention piece, what we’re evaluating, is less studied,” said Lombardi.

To conduct his research, Thomas recruited approximately 30 resident doctors and emergency room nurses at a local hospital. According to Thomas, at this particular hospital, 11% of emergency room visits in one month were related to substance use and mental health disorders.

“Brandon made a smart decision by narrowing the study down to the emergency department, because that’s a place where anyone can go to receive care,” said Lombardi. “But there’s a lot of stigma and bias placed on who walks in the door, what they want and what their real intentions are.”

First, Thomas measured the stigma and bias toward those with substance use and mental health disorders. In the survey, the medical professionals answered 43 questions such as: “Do I struggle to feel compassion for a person with mental illness?” and “Are patients with drug and alcohol problems particularly difficult for me to work with?”

Next, they attended Thomas’ training on stigma and bias, and then filled out the same survey again to measure their change in attitudes. The results were promising:

• In the first survey, 37% of the participants said patients with mental illness were particularly difficult to work with. After the training, the result was only 13%.
• In the first survey, 13% of the participants said that they struggled to feel compassion for a person who is addicted to drugs or alcohol. After the training, the result was 0%.

The training has been so well-received that Thomas expanded his program and has conducted about 15 training sessions for resident doctors and ER nurses.

Thomas said he hopes sharing his own experience — coupled with the training — can help to make a positive impact.

“I made it here alive, but there were moments that I was fighting for my life,” Thomas said. “I never want anyone to feel down or sorry for me. I like to use myself as an example for those to realize the prevalence of mental health and substance abuse disorders.”