Skip to main content

Advertisement

SpringerLink
Log in

General Medical Clinicians’ Attitudes Toward People with Serious Mental Illness: A Scoping Review

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians’ attitudes may affect care provision or health outcomes. This review describes general medical clinicians’ attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Daumit G, Anthony C, Ford DE, et al. Pattern of mortality in a sample of maryland residents with severe mental illness. Psychiatry Research. 2010;176(2–3):242–245.

    PubMed  PubMed Central  Google Scholar 

  2. Olfson M, Gerhard T, Huang C, et al. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry. 2015;72(12):1172–1181.

    PubMed  Google Scholar 

  3. Parks J, Svendsen D, Singer P, et al. Morbidity and Mortality in People with Serious Mental Illness. Alexandria: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council 2006.

    Google Scholar 

  4. Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology. 2010;24(4 Suppl):61–68.

    PubMed  Google Scholar 

  5. Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. Journal of the American Medical Association. 2007;298:1794–1796.

    CAS  PubMed  Google Scholar 

  6. Sajatovic M, Dawson NV. The emerging problem of diabetes in the seriously mentally ill. Psychiatria Danubina. 2010;22 Suppl 1:S4–5.

    PubMed  Google Scholar 

  7. McGinty EE, Baller J, Azrin ST, et al. Quality of medical care for persons with serious mental illness: A comprehensive review. Schizophrenia Research. 2015;165(2–3):227–235.

    PubMed  PubMed Central  Google Scholar 

  8. Carney CP, Jones LE. The influence of type and severity of mental illness on receipt of screening mammography. Journal of General Internal Medicine. 2006;21(10):1097–1104.

    PubMed  PubMed Central  Google Scholar 

  9. Desai MM, Rosenheck RA, Druss BG, et al. Mental disorders and quality of diabetes care in the veterans health administration. American Journal of Psychiatry. 2002;159(9):1584–1590.

    PubMed  Google Scholar 

  10. Kisely S, Campbell LA, Wang Y. Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare. The British Journal of Psychiatry. 2009;195(6):545–550.

    PubMed  Google Scholar 

  11. Daumit GL, McGinty EE, Pronovost P, et al. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. Psychiatric Services. 2016;67(10):1068–1075.

    PubMed  Google Scholar 

  12. Pescosolido BA, Medina TR, Martin JK, et al. The “Backbone” of Stigma: Identifying the Global Core of Public Prejudice Associated With Mental Illness. American Journal of Public Health. 2013;103(5):853–860.

    PubMed  PubMed Central  Google Scholar 

  13. Cooper LA, Roter DL, Carson KA, et al. The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health. 2012;102(5):979–987.

    PubMed  PubMed Central  Google Scholar 

  14. Haywood C, Jr., Lanzkron S, Bediako S, et al. Perceived discrimination, patient trust, and adherence to medical recommendations among persons with sickle cell disease. Journal of General Internal Medicine. 2014;29(12):1657–1662.

    PubMed  PubMed Central  Google Scholar 

  15. Sabin JA, Riskind RG, Nosek BA. Health Care Providers' Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. American Journal of Public Health. 2015;105(9):1831–1841.

    PubMed  PubMed Central  Google Scholar 

  16. Zestcott CA, Blair IV, Stone J. Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review. Group Processes & Intergroup Relations. 2016;19(4):528–542.

    Google Scholar 

  17. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine. 2007;22(9):1231–1238.

    PubMed  PubMed Central  Google Scholar 

  18. Hall WJ, Chapman MV, Lee KM, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health. 2015;105(12):e60–76.

    PubMed  PubMed Central  Google Scholar 

  19. Milton AC, Mullan B. Views and experience of communication when receiving a serious mental health diagnosis: satisfaction levels, communication preferences, and acceptability of the SPIKES protocol. Journal of Mental Health. 2017;26(5):395–404.

    PubMed  Google Scholar 

  20. Cunningham C, Peters K, Mannix J. Physical health inequities in people with severe mental illness: identifying initiatives for practice change. Issues in Mental Health Nursing. 2013;34(12):855–862.

    PubMed  Google Scholar 

  21. Ljungberg A, Denhov A, Topor A. Non-helpful relationships with professionals–a literature review of the perspective of persons with severe mental illness. Journal of Mental Health. 2016;25(3):267–277.

    PubMed  Google Scholar 

  22. Thornicroft G, Rose D, Kassam A. Discrimination in health care against people with mental illness. International Review of Psychiatry. 2007;19(2):113–122.

    PubMed  Google Scholar 

  23. Henderson C, Noblett J, Parke H, et al. Mental health-related stigma in health care and mental health-care settings. The Lancet Psychiatry. 2014;1(6):467–482.

    PubMed  Google Scholar 

  24. Pescosolido BA, Martin JK, Long JS, et al. “A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence. The American Journal of Psychiatry. 2010;167:1321–1330.

    PubMed  PubMed Central  Google Scholar 

  25. Colquhoun HL, Levac D, O'Brien KK, et al. Scoping reviews: time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology. 2014;67(12):1291–1294.

    PubMed  Google Scholar 

  26. Substance Abuse and Mental Health Services Administration. Mental and Substance Use Disorders. https://www.samhsa.gov/disorders. 2017; Accessed 1/2/2018.

  27. Star SA. The public's ideas about mental illness. 1955.

    Google Scholar 

  28. Arkar H. The social refusing of mental patients. Journal of Psychiatry and Neurological Sciences. 1991;4:6–9.

    Google Scholar 

  29. Eker D. Attitudes toward mental illness: Recognition, desired social distance, expected burden and negative influence on mental health among Turkish freshmen. Social Psychiatry and Psychiatric Epidemiology. 1989;24(3):146–150.

    CAS  PubMed  Google Scholar 

  30. Crisp AH, Gelder MG, Rix S, et al. Stigmatisation of people with mental illnesses. The British Journal of Psychiatry. 2000;177(1):4–7.

    CAS  PubMed  Google Scholar 

  31. Luty J, Fekadu D, Umoh O, et al. Validation of a short instrument to measure stigmatised attitudes towards mental illness. The Psychiatrist. 2006;30(7):257–260.

    Google Scholar 

  32. Üçok A, Soyguer H, Atakli C, et al. The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia. Psychiatry and Clinical Neurosciences. 2006;60(4):439–443.

    PubMed  Google Scholar 

  33. Hoshigoe K. A study of the social attitudes of psychiatic hospital staffs towards the mentally disabled in Kagawa Prefecture. Japanese Bulletin of Social Psychiatry. 1994;2:93–104.

    Google Scholar 

  34. Trute B, Tefft B, Segall A. Social rejection of the mentally ill: a replication study of public attitude. Social Psychiatry and Psychiatric Epidemiology. 1989;24(2):69–76.

    CAS  PubMed  Google Scholar 

  35. Magliano L, Read J, Sagliocchi A, et al. “Social dangerousness and incurability in schizophrenia”: Results of an educational intervention for medical and psychology students. Psychiatry Research. 2014;219(3):457–463.

    PubMed  Google Scholar 

  36. Link BG, Cullen FT, Frank J, et al. The social rejection of former mental patients: Understanding why labels matter. American Journal of Sociology. 1987;92(6):1461–1500.

    Google Scholar 

  37. Lawrie S, Martin K, McNeill G, et al. General practitioners’ attitudes to psychiatric and medical illness. Psychological Medicine. 1998;28(6):1463–1467.

    CAS  PubMed  Google Scholar 

  38. Mukherjee R, Fialho A, Wijetunge A, et al. The stigmatisation of psychiatric illness. The Psychiatrist. 2002;26(5):178–181.

    Google Scholar 

  39. Noblett JE, Lawrence R, Smith JG. The attitudes of general hospital doctors toward patients with comorbid mental illness. The International Journal of Psychiatry in Medicine. 2015;50(4):370–382.

    PubMed  Google Scholar 

  40. Jorm AF, Korten AE, Jacomb PA, et al. Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry. 1999;33(1):77–83.

    CAS  PubMed  Google Scholar 

  41. Rogers TS, Kashima Y. Nurses’ responses to people with schizophrenia. Journal of Advanced Nursing. 1998;27(1):195–203.

    CAS  PubMed  Google Scholar 

  42. Hori H, Richards M, Kawamoto Y, et al. Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan. Psychiatry Research. 2011;186(2):183–189.

    PubMed  Google Scholar 

  43. Ishige N, Hayashi N. Occupation and social experience: Factors influencing attitude towards people with schizophrenia. Psychiatry and Clinical Neurosciences. 2005;59(1):89–95.

    PubMed  Google Scholar 

  44. Aydin N, Yigit A, Inandi T, et al. Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey. International Journal of Social Psychiatry. 2003;49(1):17–26.

    PubMed  Google Scholar 

  45. Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Research. 2014;218(1):35–38.

    PubMed  PubMed Central  Google Scholar 

  46. Mittal D, Corrigan P, Sherman MD, et al. Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatric Rehabilitation Journal. 2014;37(4):297.

    PubMed  Google Scholar 

  47. Sullivan G, Mittal D, Reaves CM, et al. Influence of schizophrenia diagnosis on providers' practice decisions. The Journal of Clinical Psychiatry. 2015;76(8):1068–1074; quiz 1074.

    PubMed  Google Scholar 

  48. Smith JD, Mittal D, Chekuri L, et al. A comparison of provider attitudes toward serious mental illness across different health care disciplines. Stigma and Health. 2017;2(4):327.

    Google Scholar 

  49. Welch LC, Litman HJ, Borba CP, et al. Does a Physician’s Attitude toward a Patient with Mental Illness Affect Clinical Management of Diabetes? Results from a Mixed-Method Study. Health Services Research. 2015;50(4):998–1020.

    PubMed  Google Scholar 

  50. Lam TP, Lam KF, Lam EWW, et al. Attitudes of primary care physicians towards patients with mental illness in Hong Kong. Asia-Pacific Psychiatry. 2013;5(1):E19-E28.

    PubMed  Google Scholar 

  51. Chandramouleeswaran S, Rajaleelan W, Edwin NC, et al. Stigma and attitudes toward patients with psychiatric illness among postgraduate Indian physicians. Indian Journal of Psychological Medicine. 2017;39(6):746.

    PubMed  PubMed Central  Google Scholar 

  52. Magliano L, Punzo R, Strino A, et al. General practitioners’ beliefs about people with schizophrenia and whether they should be subject to discriminatory treatment when in medical hospital: The mediating role of dangerousness perception. American Journal of Orthopsychiatry. 2017;87(5):559.

    PubMed  Google Scholar 

  53. Naeem F, Ayub M, Javed Z, et al. Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan. Journal of Ayub Medical College Abbottabad. 2006;18(3):46–49.

    Google Scholar 

  54. Fernando SM, Deane FP, McLeod HJ. Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Social Psychiatry and Psychiatric Epidemiology. 2010;45(7):733–739.

    PubMed  Google Scholar 

  55. Björkman T, Angelman T, Jönsson M. Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care. Scandinavian Journal of Caring Sciences. 2008;22(2):170–177.

    PubMed  Google Scholar 

  56. Seeman N, Tang S, Brown AD, et al. World survey of mental illness stigma. Journal of Affective Disorders. 2016;190:115–121.

    PubMed  Google Scholar 

  57. Schomerus G, Schwahn C, Holzinger A, et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica. 2012;125(6):440–452.

    CAS  PubMed  Google Scholar 

  58. McGinty EE, Goldman HH, Pescosolido BA, et al. Portraying Mental Illness and Drug Addiction as Treatable Health Conditions: Effects of a Randomized Experiment on Stigma and Discrimination. Social Science & Medicine. 2015;126:73–85.

    Google Scholar 

  59. Druss B. Improving medical care for persons with serious mental illness: challenges and solutions. The Journal of Clinical Psychiatry. 2007;68:40.

    PubMed  Google Scholar 

  60. Morabito MS, Socia KM. Is dangerousness a myth? Injuries and police encounters with people with mental illnesses. Criminology & Public Policy. 2015;14(2):253–276.

    Google Scholar 

  61. Glied S, Frank RG. Mental illness and violence: Lessons from the evidence. American Journal of Public Health. 2014;104(2):e5-e6.

    PubMed  PubMed Central  Google Scholar 

  62. Clausen W, Watanabe-Galloway S, Baerentzen MB, et al. Health literacy among people with serious mental illness. Community Mental Health Journal. 2016;52(4):399–405.

    PubMed  Google Scholar 

  63. Cullen BA, Mojtabai R, Bordbar E, et al. Social network, recovery attitudes and internal stigma among those with serious mental illness. International Journal of Social Psychiatry. 2017;63(5):448–458.

    PubMed  Google Scholar 

  64. Blixen CE, Kanuch S, Perzynski AT, et al. Barriers to self-management of serious mental illness and diabetes. American Journal of Health Behavior. 2016;40(2):194–204.

    PubMed  PubMed Central  Google Scholar 

  65. Burgess DJ, Beach MC, Saha S. Mindfulness practice: A promising approach to reducing the effects of clinician implicit bias on patients. Patient Education and Counseling. 2017;100(2):372–376.

    PubMed  Google Scholar 

  66. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Journal of the American Medical Association. 2009;302(12):1284–1293.

    CAS  PubMed  Google Scholar 

  67. Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it? Medical Education. 2011;45(8):768–776.

    PubMed  Google Scholar 

  68. Knaak S, Modgill G, Patten SB. Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. The Canadian Journal of Psychiatry. 2014;59(1_suppl):19–26.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Room 2-620, Baltimore, MD, USA

    Elizabeth M. Stone MSPH, Gail L. Daumit MD, MHS & Sarah Linden MPH

  2. Division of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Lisa Nawei Chen MD

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Emma E. McGinty PhD, MS

Authors
  1. Elizabeth M. Stone MSPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Nawei Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gail L. Daumit MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Linden MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emma E. McGinty PhD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth M. Stone MSPH.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 267 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stone, E.M., Chen, L.N., Daumit, G.L. et al. General Medical Clinicians’ Attitudes Toward People with Serious Mental Illness: A Scoping Review. J Behav Health Serv Res 46, 656–679 (2019). https://doi.org/10.1007/s11414-019-09652-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-019-09652-w

Search

Navigation