Attitudes to psychiatry can change but what about stigma?

For many doctors, the only exposure to psychiatry is during a rotation in medical school. The knowledge, interest, and attitudes formed in those few weeks will hopefully last throughout their medical careers. Unless they choose to specialise in psychiatry or other related disciplines that include aspects of psychological care, this exposure is very much dependent on the individual doctor's subsequent conscious acquisition of knowledge in this area to support patient care. This is important, as psychological care is a crucial component of holistic care, viz. the World Health Organization (WHO) dictum, " there is no health without mental health ". 1 Attitudes to psychiatry affect personal and professional behaviours, even amongst psychiatrists and mental health nurses who have been found to hold the same prejudices as primary care teams about schizophrenic patients. Fifteen years ago, Feifel et al, in studying the declining interest in choosing psychiatry as a career amongst US medical graduates, found that students entering medical school already viewed psychiatry as " distinctly and consistently less attractive than other specialties ". 4 They recommended that underlying false beliefs be actively targeted for remediation in the medical school curriculum. Studies have also shown that mentally ill patients provoke less favourable responses that were unaltered by furthering education in medical students. 5 The fi ndings of Fischel et al that attitudes amongst medical students in different cities did not signifi cantly change following a psychiatry rotation led Richard Balon, editor of Academic Psychiatry, to decry, " no matter what we do, what we teach and how we do it, we are basically doomed and students do not like us! ". 6,7 Yet, some studies still reveal positive attitudinal changes following a psychiatry rotation. Kuhgnik and Taryan, for example, found that the educational and personal experience from direct patient contact and observing psychiatrists interacting with patients not only enhanced students' clinical skills, but also contributed to positive attitudinal change. Our study in 2008 using the same Attitudes to Psychiatry (ATP) scale revealed similar fi ndings amongst medical students at the National University of Singapore (NUS) (n = 146, P = 0.002); students recognised and appreciated the effi cacy of psychiatric treatment and they could transfer the knowledge and attitudes to other disciplines. 10 However, we found no changes in some areas, in particular, the perception that psychiatrists and psychiatry make little use of medical training, raising concerns about collegiality and professional …