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Barriers to Care
DBSA 2001 Annual Conference
August, 2001
Lydia Lewis, Executive Director
Depression and Bipolar Support Alliance
Yesterday, we heard about the process of
bringing new medications to the market. The news is exciting –
treatments continue to improve and great strides in understanding the
brain will be made in the next few years.
Research funding for the National Institute of Mental Health and for
universities around the world continues to increase. We might even see a
cure for mood disorders discovered in our lifetime. All of this should
encourage us. As more is learned about the brain, the shame, fear and
secrecy surrounding mood disorders should decrease.
Unfortunately, there’s a cloud with this silver lining.
These developments won’t mean a thing if people aren’t accurately
diagnosed, will not or cannot seek help, can’t find or afford a doctor
well trained in mood disorders, or will not or cannot comply with their
treatment plan.
There are so many barriers keeping people
with mood disorders from getting help, from getting well and from
staying well. These barriers need to be identified so that we can
develop strategies to break through the roadblocks.
The ten barriers to wellness I’m going to outline this morning were
all uncovered through recent DBSA surveys. These barriers can’t be
removed through legislation or by throwing money at them because most
have to do with feelings, attitudes or prejudices. These are the
toughest barriers to overcome.
Barrier #1: Diagnosis problems
- We don’t report our symptoms
- We are misdiagnosed, even by
psychiatrists
- Gender plays a role in our diagnosis
- Primary doctors find it hard to
diagnose mania and don’t screen for it
- There’s not enough time for the exam
- We wait a long time before seeking
help for bipolar and then to get a correct diagnosis
Barrier #2: side effects
- Eight in 10 experience side effects
- Four in 10 think side effects can’t
be avoided
- We stop taking our medication or skip
doses because of side effects
- Far too many of us experience sexual
dysfunction and/or fatigue
Barrier #3: Treatment compliance
- We stop taking medication against
medical advice
- We forget to take our medication
Barrier #4: Treatment effectiveness
- ¼ of us don’t feel any change after
treatment
- Primary care doctors don’t treat to
wellness
- We worry our medications will stop
working
- We have a high rate of hospitalization
Barrier #5: There’s a communication
disconnect.
- Our doctors say they tell us something
but we don’t hear it
- We are not being asked about our
treatment preferences
Barrier #6: Our assessment of our doctor
- Many of us believe our relationship
with our doctor hinders our compliance
- One in four of us is dissatisfied with
our doctor
Barrier #7: The beliefs of primary care
physicians also pose a problem.
- Doctors cite the #1 barrier to
compliance is patient resistance. Why are we being blamed for not
getting better?
Barrier #8: Attitude toward self-help
- At first many of us are fearful,
unwilling or indifferent about attending a DBSA group
- Doctors aren’t referring to our
groups
Barrier #9: Our opinions of
anti-depressants can hinder recovery.
- Many of us have an incorrect
understanding about how medications work because of the strong
stigma our society
Barrier #10: Our own attitude toward
our bipolar illness can leave us isolated, with diminished hope and
reluctant to ask for help.
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