The Mental Health Commission of Canada (MHCC) has partnered with the University of Calgary's Faculty of Medicine to evaluate a special course for second year medical students which aims to reduce the prejudice and discrimination associated with mental illness.
"The Mind Course ignites a curiosity in students to understand mental health," explains Dr. Andriyka Papish, who after taking the course, decided she wanted to become a psychiatrist.
Papish, now a fourth-year psychiatric resident at the University of Calgary, is curious about whether the course is indeed changing students' attitudes about mental illnesses.
"Stigma is quite prevalent in the medical community just as it is in the general population," says Papish. "Although many mental health patients receive excellent care, it saddens me that some patients are treated poorly or ignored by doctors."
The Mental Health Commission of Canada's 10-year anti‐stigma/anti-discrimination initiative, Opening Minds, is currently evaluating the Mind Course and working with other organizations across the country to study and identify programs that are successful in changing behaviours and attitudes toward those who live with a mental illness. The Mind Course utilizes contact based education, a method which has been shown to help reduce stigma through the sharing of personal stories.
The Mind Course is a requirement for all second-year U of C medical students, regardless of what area of practice they ultimately pursue. The three week program combines lectures from practicing psychiatrists and visits to a hospital to observe how doctors treat and interact with psychiatric patients. The course also features guest speakers who have experienced a mental illness and have since recovered or are managing their disorder.
This year, seven million Canadians will experience a mental health problem. Stigma is a major barrier preventing many people with living a mental illness from seeking treatment. Some describe the stigma they face as worse than the disease itself.
Growing up in Medicine Hat, Alberta, Gina Vaz considered many careers before finally deciding on medicine. Then the University of Calgary medical student faced another big decision - what area of practice to focus on. There were so many exciting options, but one field in particular was never very high on her list.
"I thought psychiatrists just talked to patients on their couch - patients who never got better," she says.
All of that changed this past January when Vaz took a mandatory course at the University of Calgary.
"The Mind Course showed me that psychiatry is a beautiful blend of the art and science in medicine and that these doctors truly improve their patients' lives," she says.
The Mind Course is a requirement for all second-year U of C medical students, regardless of what area of practice they ultimately pursue. The three week program combines lectures from practicing psychiatrists, visits to a hospital to observe how doctors treat and interact with psychiatric patients, and guest speakers who have experienced a mental illness.
Each of these speakers is preceded by a lecture about his or her specific illness, which was key for Vaz. "Everything you learned in the previous three hours can be applied to that patient's experience. This helps students to understand how mental illness affects that person's life and how they got better."
One of the speakers in January was Barbara Doyle. The 54-year-old talked about having experienced psychosis, the result of a bad reaction to medication she was taking to treat Hepatitis C.
Doyle explained how during that two year episode she was convinced she was seeing and hearing things. A mouse was skittering around her home, shadowy figures were lurking in her peripheral vision, and her neighbours were conspiring against her. None of it was real.
"I could tell the students were interested in what I had to say and that I was clearly being heard," Doyle says.
That wasn't the case during the height of her illness. She saw a psychiatrist in a hospital and felt he was condescending and treating her like a lab rat. Staff at walk-in clinics lacked compassion and made her feel like she was being judged.
Doyle agreed to speak to the class to help reduce that kind of stigmatizing behaviour, and to show her gratitude to the doctor she credits with eventually saving her life.
"We create an environment in which mental illness is normalized and embraced," says Dr. Lauren Zanussi, a psychiatrist at Calgary's Foothills Medical Centre who treated Doyle and who manages the Mind Course. "And we show how helping mental health patients can be an incredibly rewarding career."
Zanussi began managing the course the day after completing his residency nine years ago. He rebuilt the curriculum from scratch and still tweaks it regularly. It's been ranked the favourite class among U of C medical schools students in eight of the last nine years.
Though he demurs when congratulated on its popularity, attributing it instead to a team of enthusiastic professionals, the environment he's shaped is clearly having an impact. In 2010, just under 6% of medical school graduates in Canada applied to a psychiatric residency program. At the U of C, however, the figure was nearly 18%.
"The Mind Course ignites a curiosity in students to understand mental health," explains Dr. Andriyka Papish, who adds that taking the course made her want to become a psychiatrist.
The course also fired Papish's curiosity about whether it is indeed changing students' attitudes about mental illnesses.
"Stigma is quite prevalent in the medical community just as it is in the general population," says Papish, a fourth-year psychiatric resident at the University of Calgary. "Although many mental health patients receive excellent care it saddens me that some patients are treated poorly or ignored by doctors."
Recently, in partnership with the Mental Health Commission of Canada's (MHCC) anti-stigma initiative called Opening Minds, Papish embarked on a research project, sitting through a number of lectures again and surveying the students.
Her results showed 89% thought the course was useful in reducing prejudice and discrimination against people with a mental illness, and two-thirds felt it would change their own behaviour towards mental health patients.
"This course does a great job of helping students become more comfortable in interacting with patients with a mental illness," says Papish. "It is educating future doctors, regardless of whether they're a psychiatrist or a cardiologist, on how to give these people the proper treatment they deserve."
The MHCC is currently evaluating the results of the survey conducted in partnership with Papish. The Opening Minds initiative is aimed at reducing the stigma experienced by individuals with a mental health illness. Healthcare providers are one of its target groups. The MHCC is examining programs, such as the Mind Course, across Canada with the goal of promoting and implementing the best of them in other parts of the country.
"Knowing that this course can change attitudes in the health profession is encouraging," says Zanussi, who adds that mental health is one of the most challenging areas where stigma pervades in the medical community, where patients are sometimes seen as annoyances.
The Mind Course doesn't have a section addressing stigma directly, but the issue is embedded into the course in several ways. For example, there are times when the class will examine case studies and discuss how stigma affected a patient's access to care.
Student Gina Vaz points to another example.
"For me, the most poignant statement a lecturer made was that often people with mental health concerns have their medical concerns dismissed," she says. "The fact that the course can change those attitudes and make us cognizant of how our preconceptions can impact our patients is very important."
Now determined to be an advocate for mental health patients, Vaz is planning to apply for a psychiatric residency when she finishes her final year of medical school.
Zanussi says the discipline - and the patients - will be lucky to have her.
"Gina is exactly the kind of person we hope to attract to the psychiatry program," he says. "She's energetic, thoughtful and compassionate, which is exactly the kind of doctor our mental health patients need."
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