Addressing stigma to strengthen psychiatric education.

Neuropsychiatric disorders are recognized by the World Health Organization as the most important cause of disability, accounting for approximately one-third of years lost due to disability (YLD) among individuals age 15-andover, across gender and income, around the world (1). Unipolar depressive disorders alone are the third-largest contributor to global burden of disease, and the first in middleand high-income countries, ranking above ischemic heart disease, HIV/AIDS, and cerebrovascular disease. In the United States, it is estimated that 25% of adults have a mental illness, and nearly half will develop at least one mental illness during their lifetime (2–4). However, in 2005, of the approximately 11% of the population that met criteria for a high probability of serious mental illness, fewer than one-half (45%) reported receiving any mental health treatment in the previous year (5). The number of American mental health professionals available is already inadequate to provide for this need: there are only 13.7 psychiatrists per 100,000 population (6)—whereas the burden of psychiatric disease is projected to continue to grow (1). In the context of these findings, it is incumbent upon the medical field to effectively prepare its next generation to address psychiatric disorders. This effort to prepare the future physician workforce includes training specialists to treat mental illness, as well as educating providers in other medical specialties to be versed in general psychiatric issues, since most physicians, regardless of discipline, will treat many patients with coexisting mental illness. The field of psychiatric education is inexorably influenced, however, by the shadow of societal stigma inwhich it stands. Many studies have documented the negative stereotypes and prejudicial beliefs that the general public holds toward individuals with mental illness, toward psychiatry and psychiatric treatments, and toward psychiatrists and other mental health professionals (7, 8). Although holding a neurobiological conception of psychiatric disorders has been correlated with an increased likelihood of support for psychiatric treatment, it has not been consistently shown to decrease stigma or community rejection (9). Indeed, stigma surrounding psychiatry spills over into the medical school, as well. Medical students have been found to share many of the negative stereotypes about mentally ill people that are present in the general population (10). Psychiatry as a discipline, as compared with other specialties, tends to be viewed very negatively by entering medical students, in a manner suggesting that, to many, the field is not considered part of mainstream medical practice (11). Harsh attributions toward trainees in or approaching psychiatry have been observed both in the United States and internationally. Clerkship students note that psychiatry has low prestige among the general public and also does not have high status within medicine (12–15). These clerks describe hearing disparaging comments made about psychiatry by physicians in other fields, including residents and faculty with whom they work (16). A significant number report that family and friends discourage them from considering psychiatry as a career and that students who express interest in psychiatry risk being viewed as “odd, peculiar, or neurotic.” In some countries, psychiatric trainees are also seen as weak academically, with a large number of medicalstudent respondents indicating that “many people who could not obtain a residency position in other specialties eventually enter psychiatry” (12–15). Perhaps most tragic is the observation that medical students and residents in Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA. Send correspondence to Belinda ShenYu Bandstra, M.D., M.A., Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA; e-mail: [email protected] Copyright © 2012 Academic Psychiatry