Stigmas and Social Issues Connected with Mental Health - Essay Example

Introduction Mental health issues have been around us as long as there has been a semblance of civilisation. While many of the stigmas and social issues connected with mental health have been overcome by society, a lot remains to be done before we can arrive at a position that provides optimal care for mental health patients without stigmatising them or lowering their worth. It would be thought, that the stigmatisation and negative imagery would be limited to the general population but in reality it can also be observed among doctors and nurses, who are supposed to be derived of any such negative thoughts or ill feelings. (Crabtree, 2003). Happell (2005) describes an incident, during which she experienced a derogatory remark for a patient suffering from mental health issues. She reports that, "The remark, which was made in an official capacity, questioned, perhaps even refuted, one of the most basic human rights for people diagnosed with a mental illness" (Happell, 2005) and that the remark infuriated her. Considering that the words were coming from a nurse, who had been involved with handling mental health patients, it prompted an examination of how negative stereotypes and stigmatisation of mental health patients continued despite legal barriers. The indignation of mental health professionals and nurses over the discrimination and stigma attached to their patients is certainly well placed but the reasons for the stigma itself are many and complex. It is a matter of concern and some disappointment that in spite of all the progress made by our society, there are still problems which remain when it comes to dealing with and presenting patients, who have mental health problems. Wherever the blame for the stigma associated with mental health patient lies, it has to be accepted, that there is a problem which needs to be dealt with. Harris (2004) suggests that the representation of mental health patients in the media takes a large part of this blame along with the famous cases where women suffering from mental health problems killed their children or other situations where people suffering from mental health showed aggressive behaviour. The discrimination for those suffering from mental health certainly takes a bit of support from the images fed by television and cinema where their portrayal is often negative. By making the image of mentally ill patients violent, villainous or completely different from those who suffer from a physical ailment, the media is certainly displaying lack of responsibility and appreciation of the problems faced by the patients. The problem appears to be more pronounced when it comes to minority groups or the immigrant population where education levels or awareness about the issues may not be that high (Gary, 2005). Mental health problems associated with children or with the elderly also lead to issues, which are difficult to tackle (Turner, 2005). The issues are even more severe when it comes to the second or third world countries since the level of awareness is comparatively lower (Crabtree, 2003). It seems, that the level of awareness regarding mental health issues does not greatly correspond to the level of education or social standing because the gap between mental health patients and society at large is quite substantial (Happell, 2005). The discrimination and exclusion is certainly a matter of concern, especially since the importance of mental health issues remains unrecognised by many people. The relatives of individuals who are seeking mental health services are often completely unaware of the issues and problems associated with it. On the other hand, policy makers and health officials often understand the basic issues but they may not have a complete grasp of all the problems faced by nurses, doctors as well as the patients themselves when it comes to seeking help. The overall problem for the health service is to balance their positions with physically ill patients and the mentally ill patients. The focus on physically ill patients comes at the cost of those, who are mentally ill and there is a strong underlying assumption that mentally ill patients take services away from physically ill patients who are often considered to be more deserving (Happell, 2005). This assumption itself is negative and dangerous because it not only helps to discriminate against mentally ill patients it also leads to negative feelings on behalf of the professional care providers. Importance of the Topic For the nursing profession, the importance of this topic is twofold. Firstly, it helps nurses to understand, that the stigmatisation of mental health patients is a real subject of concern which requires careful attention and devotion before it can be removed from our lives. Secondly, it gives ways and means, which nurses can use to prevent discrimination against mental health patients as well as the path which can be followed to understanding the issues of such patients. Finally, the topic is important for me as a nurse since I know I would like to work with patients who are mentally ill and therefore understanding of the dilemmas faced by them in the society is essential. ritical evaluation of the problem and its complexity It is no argument, that the modern era has displayed certain advances in the theories of mental health nursing. The complexity of the mental health stigma problem has never been exaggerated and recent researches have become the evidence of an attempt to make contributions into the nursery practice of mental health. However, from the critical point of view, there are still two extremely important areas which should be paid attention to: 1. The constantly changing factors, which may create an impact on the mental health nursery delivery; 2. The development of knowledge which will support or deny the presently used practices. It is essential to understand that there are certain factors, which influence the mental health nursery care at present. These factors are presented by certain authors in their works related to the topic discussed. First of all, it is necessary to evaluate the quality of the service which is offered to the consumer - in our case mental health nursery care should be evaluated from the viewpoint of carrying some tint of stigma in it and the level of unmet needs' satisfaction between the patients. The question of stigma is taken into account in this approach as it usually prevents professional nurses from providing their patients with the service of high quality. Loza (2006) suggests, that the quality of mental health nursery care and the absence of stigma in it should be evaluated from the viewpoints and perceptions of the consumers. The question to answer in this case is whether everything we do is as well as we think However, this approach may be argued, as the perceptions, especially in relation to mental disorders, may be far from reality, though of course the presence or absence of stigma in mental health nursery care is mainly evaluated by the patients themselves. In this theory the importance, which the patient assigns to this or that therapy or type of nursery care, may serve as another sign of stigmatizing, but the principal thing here is that the nurse must perceive and understand the level of stigma in the care provided, the correspondence of the care objectives and the care provided, which will create surface for possible improvements and eliminating stigma. Another approach lies in the evaluation of beliefs and values, which interfere with the mental health nursery care. In practice this approach can be viewed through the stable views and beliefs which are held by societies in relation to mental patients. These beliefs prevent the delivery of mental care service from being normal. (Happel, 2005) If in case with physical illnesses the roots of exclusion and discrimination may lie in the ethnicity, race or social status of the patient, resulting in lower access to medical services or their lower quality, in case of mental health nursery care, the root of the lower nursery availability is in stigma, which is created through the already mentioned beliefs. However, in relation to ethnicity, race and social position the issue of stigma in mental health nursery care acquires more serious character. On the other hand, this approach and situation may be critically evaluated as follows: what are the factors, which contribute into these stigmatized attitudes towards people with mental disorders and why do they put some kind of label to the patients with diagnosed mental disorders It is clear, that mental health nursery care should be clear of any stigma, though it is often hard to define, what stigma in reality is. As Leal (2005) puts it, stigma in mental health nursery care should be defined differently from the possible lack of knowledge as for the treatment and diagnosis, which also causes some nurses to put a kind of negative label onto the patient. Simultaneously, the label may also result from the way the nurse copes with care and responds to the behavioral patterns of the patient. There are enough factors, which may be supposed to be contributing into the stigmatized provision of the mental health nursery care; they often interact and should be viewed as a complex and never separately. As soon as these factors are defined, it will be possible to create the long-term strategies for making mental health care more effective and clear. The Modern Era The technological and medical breakthroughs which came about after the second world war led to the idea, that the connection between the brain, emotions and the body was far deeper than it had been previously thought (Wikipedia, 2006). Mentally ill patients could then be treated with the kindness and humanity that had been previously limited for those, who were physically ill. With the understanding of brain chemistry, there also came the ability to treat mental health problems with medicine and taking care of mental health patients became mainstream medicine. The modern era is earmarked with the need to understand the requirements of mental health patients and to provide them with the same level of service that is given to physically ill patients. The practices, used in the mental health nursery care at present, should also be subjected to closer consideration, and the main question here to be asked is how do we know that we use modern practices and approaches The analysis of the knowledge used in contemporary mental health treatment will also lead us to the conclusion that stigma is still present in the modern attitudes. For example, how much is it known about the issue of violence on the side of mental patients in relation to nurses How does this pattern or expectation of violence create certain stigma in providing a definite portion of patients with quality nursery care These questions and many others should be answered, as it is evident, that despite the modernity of the practices used in nursery care, mental health disorders still create stigmas. The Reasons for Mental Health Stigma The fundamental reason for stigmatisation of mental health patients and the discrimination faced by them is the lack of education and understanding, which prevails in the general population of the country. Since that general population sector also includes nurses and doctors, in spite of their education, they can also fall in the trap of stigmatising the patients (Happell, 2005). A mental health patient, for many people, is scary, confusing and someone who is to be avoided since their attitude can not be trusted. These are the same problems which are discussed by Turner (2005), who shows how nursing students themselves had experienced negative emotions when their peers reacted negatively to their condition. He describes his interaction with a nursing student who confessed being diagnosed as clinically depressed and said that, "I saw that his eyes were full of tears. He had heard negative attitudes expressed by fellow students, which made him feel be had to hide his experience" (Turner, 2005). Such reactions show, that discrimination is based on the inability of 'normal' people to accept those who have some mental issues. The weakness of this assumption may be found in the following: stigma is a psychological notion, and it usually accompanies a person all his (her) life. The presence of stigma is not caused by the lack of education itself, - the lack of education only aggravates this stigmatisation, in case it is initially present in the care. Crabtree (2003) discusses at length the case of an institute in Malaysia where young doctors themselves displayed considerable anxiety at working in a mental hospital. The reason they presented for the stigma had a lot to do with the non-professional attitude of their peers, who considered working with patients with mental disabilities to be very dangerous. One of the doctors reported that: "When you tell people, other doctors, you work at Hospital X, they say, 'oh, that place!' It's not easy to be here. Some people, even you know, doctors, seem to think that if you work here long enough you might become insane as well - it's contagious, sort of thing (Crabtree, 2003, Pg. 717)." This assertion supports the idea - the doctors were initially closer to stigmatisation of the care for their mentally ill patients, and the lack of the proper knowledge and professionalism only contributed into this process. A lack of acceptance also comes from looking at people with mental issues as the other, and the fear, which comes when an individual does not understand something clearly well. (Turner, 2005) While such behaviour certainly hurts the self esteem of the person being discriminated against, when it comes from strangers, the effect is the worst when it comes from peers and a person's own family who might find it difficult to understand the need for multiple resolving of mental health issues (Ostman, 2004). As mentioned by Ostman (2004), for the first few the relatives might be burdened with concern but after some time such issues become routine and even annoying. While the situation in the UK may not be as bad as it seems to be, it does go to show, how stereotypes and images can affect people. Disillusionment can lead to nurses and doctors losing patience with the staff, the relatives of the patients or the patients themselves. Even if a person is not completely disillusioned by the position he (she) is placed in, he (she) can certainly become pessimistic in their outlook which hurts their professional abilities and takes away from their judgement capacity. This is certainly the situation, which must be avoided since nurses can not afford to be bigoted themselves while they are fighting against bigotry in others. From the objective viewpoint, the roots of stigma are close to the feeling of powerlessness, (Sadek, 2006) though the author views this stigmatisation from the point of view of patients, who prefer hiding the fact of their illness and not addressing specialists afraid of being called mentally ill. The similar principle may be applied to the nursery care, as being powerless in providing the appropriate level of treatment for these or those patients, medical personnel tends to put stigmas on them, which is against all rules of ethics. As mentally ill people don't look at medical care as strength, which will positively change their lives, medical workers justify their weakness through stigmas. Discrimination and Social Exclusion Discrimination and exclusion are still present in our medical community to some extent and even greater among the general public. This takes away from the quality of life for a patient, who already has a negative position to begin with due to mental health issues which have created a massive disruption in his (her) life. Social exclusion and discrimination have been cited as one of the reasons for a lowered quality of life for mental health patients as it was discussed by Lehman and Steinwachs (1998). The same thoughts have been expressed by Chan and Yu (2003) regarding patients with schizophrenia when they said that that: "People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population As well as experiencing distressing mental symptoms, they had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities that resulted from stigma and discrimination." (Chan &Yu, 2003) In this relation it is also under argument, who is the main cause of social exclusion and stigmatisation. Of course, families often serve as the principal source of stigmas, how paradoxical it may sound, but according to the modern research and statistics, mentally ill people are likely to seek advice in their families, thus it may be suggested that families should provide their mentally ill members with full and appropriate care, and serve as a protection against stigmatisation in the nursery care with which the family member is provided. Ostman (2004) states, that 93% of the patients, who suspected themselves of having some metal disorders, firstly addressed one of several family members or relatives before visiting the doctor, that is why the support of the family in avoiding stigma in mental health nursery care is essential. An International Problem The situation seems to be the same across continents since Lehman et. al. (1982) more than twenty years ago showed that the quality of life for mental health patients in America had been much lower than of those, who had been seen to be physically ill. The same has been seen to be true in reports published for mental health patients in the United Kingdom as well as Hong Kong (Chan &Yu, 2003). One can expect that the stigma associated with mental health issues will be removed once the patient recovers, but Atkinson et al. (1997) show that the problems and the discrimination continue even after the patient has fully recovered. Fundamentally, a patient who suffers prolonged bouts of mental instability comes to a position, where their severe and persistent mental health issues might lead them to believe in the false opinion that they can never be cured (World Health Organisation, 2001). With that idea in mind along with the behaviour and attitude of those who are around them, they get to a point where they lower their expectations from life itself. With this issue there is the problem of depression and a lack of interest in anything which can possibly relieve them of their situation. Once they get to this point, the mental health patient often loses the will to bring about any change in their life (Chan &Yu, 2003). As opposed to those who have recovered from a physical ailment, individuals who recover from a mental disorder often find employment opportunities difficult to come across or difficult to hold jobs. Although these individuals are mentally stable, they see the stigma of being a mental patient as something they can not shake off (World Health Organisation, 2001). Without being well integrated into society their mental disorders affect their psychological condition which in the course of time could take them back to the institute which they left with a sound mind and a clean bill of health. This is why it is essential to develop public strategies for employers for them to understand that people who have been mentally ill but have fully recovered don't represent any danger to their business or other employees, and can fulfil their work obligations properly. Stigmatisation at workplace comes from the stable beliefs that ex-mentally ill people are different from those why are mentally sane. Nursery care in this case plays an important role, as employers should have an opportunity to consult nurses about the issues which are of major concern to them. It is the nursery care worker, who is able to give the best explanation to the employer in relation to the employment of people who have been mentally ill; but in order to fulfil this task the sphere of mental health nursery care itself should be derived of any presence of stigma. In terms of looking at discrimination and stigmatisation within a hospital, Crabtree (2003) reports that mental health hospitals might be treated as asylums by some professionals. Goffman (1991) had stated that the use of the term asylum and the image of the asylum are unhealthy since it denotes that the people confined within are in situations similar to criminal prisoners or those who have no hope for a cure. This attitude amongst the professionals within the field certainly adds to the stigma of those, who are already suffering from mental health problems. To challenge this stigma, Crabtree (2003) recommends seeing and reclassifying mental health institutes as therapeutic havens. These would still continue to hold a diverse population and help cure the sick but at the same time it would not be seen or function as a custodial regime which was only going to control, contain, restrain and keep mentally ill individuals away from interacting with society at large. This would certainly be a change from the historical image of mental asylum as they were largely operated in the 19th and early part of the 20th centuries (Shorter, 1997); but are modern governments capable of creating such medical establishments for mentally ill, without restricting their freedom; and won't it be viewed as a means of higher social exclusion of patients with mental disorders It certainly depends on the diagnosis, and in some cases, when a person represents danger for the people around, this person should be placed into a special medical establishment; but the criteria of defining the level of this danger should be improved and brought into order. Simultaneously, the nursery care provided by such establishments, should be also be clean of stigma, and with this aim medical staff should be carefully chosen and regularly taught and consulted on various subjects connected with mental health nursery care. The Role of the Nurse One of the methods, with which nurses can reduce the stigma associated with mental health patients as well as the discrimination and negative social experience they go through, is to create therapeutic alliances. The concept of this sort of alliance between the nurse and the patient is greatly appreciated by Safran and Segal (1990) and they recommend a support system to be created between the patient and the nurses involved in the care. This system of support against negative social influences is certainly not new since Cole (2006) reports that as early as in 1912 Sigmund Freud considered a healthy relationship between analyst and client to be positive and called it a working alliance. The humanist therapist, Carl Rodgers took the concept to a higher level since he called it necessary as a support tool and essential for the growth and improvement of the client's condition. The development of ethical principles for the bond between the caregiver and receiver were defined by the Association for the Advancement of Behaviour Therapy (AABT) and these rules safeguard the interests of both the client and the nurses involved in the treatment (Cole, 2006). A nurse plays an essential (and even key) role in providing appropriate health care for the mentally ill patients, without any stigmatisation; the nurse in coordination with other medical staff should work for the broader availability of the nursery care among such patients, without accounting their social status, race, ethnicity, diagnosis. Nurses and medical specialists have a key role of working with the society through explaining them all unclear questions connected with mental illnesses and for eliminating the already existing and new stigmas. While the idea of creating separate hospitals for the patients who have psychological or mental disorders is losing its appeal, mainstreaming is still not the singular system under which all nurses can operate. Happell (2005) makes the recommendation that the same standards of treatment should be maintained for those individuals, who seek mental care and for those, who are physically ill. The idea of the universal healthcare at the highest level as a fundamental human right is not merely an idyllic dream, but it is a philosophy, which everyone connected with the media profession should strive for. The level of care given to a person should not depend on their ailment or their social position, since the obligation of the nurse is to increase the efficiency of the process of care giving as much as he (she) is able to (Happell, 2005). However, while it is comparatively easy to change the policies involved in the National Health Service, it is rather more difficult to change the attitudes and the beliefs of people about individuals who need assistance with mental health problems (Ostman, 2004). Going with the suggestions about and the descriptions of mental health patients as presented in the general media (Harris, 2004), these attitudes might be even harder to change than it has been thought previously. This approach is partially correct, as there is seldom any stigma in relation to physical diseases, and it has even been possible to destroy the prejudices and stigmas, which existed in the 19th century and earlier. This is the strength of the assumption; and its weakness is in the fact that in reality not too many efforts have been made to eliminate the mental health stigmatisation not only in the general society, but among medical nurses, who should be viewed as the staff of the high level of medical knowledge and who first of all should posses no stigmas in providing nursery care. The issue of stigmas in mental health nursery care has only recently been addressed, and speaking about the difficulties in clearing out these stigmas is too early, to my mind. Nursing strategies for overcoming stigma in mental health nursery care As it has been already said, despite the advanced enough developments in the mental health care knowledge, the work on fighting the stigma in mental health nursery care has just started and what is needed now, is the development of certain recommendations and strategies for nurses in this relation. The nurses are the ones to provide better care and improve the culture of this care. As possible strategies for the mental health care nurses the actions in the following directions may be undertaken: in the sphere of providing mental health there should be used close cooperation with other medical professionals through public education, creating various advocacy groups and treatment services, as well as parenting programs and programs on life skills education; in the sphere of broadening access to the mental nursery care there can be created a network of the nursery care services at the local level which will be supported by the local community and thus provide the services clear of any stigmas; getting the nurses who work with mentally ill patients into various national programs, with paying greater attention to vulnerable populations, which will for sure broaden their access to the mental healthcare services. These actions should also acquire national scales and be combined with the overall de-institutionalization of the mental healthcare system of the country; (Harris, 2004) the elimination of exclusion and stigmatising in the mental health nursery should be done through starting to speak openly about mental illnesses as the ones which should not be stigmatised and should be treated as usual diseases; stigmatising may serve the basis for the human rights disrespect and thus lead to serious consequences in the legal area, this is why it is important to teach public to address mental illness in the proper way. On the side of each nurse separately it may be done through explanation to relatives and friends of each patient the safety and usualness of the mental disease a person has, and the way it should be treated. (Chang & Cheng, 2001) To eliminate the stigma in mental health nursery care, community participation in mental health care activities should be promoted. (Atkinson et al., 1997) Conclusion The central reason for the stigma associated with being a mental health patient is the lack of understanding and education which is prevalent in the general public. At the same time, some of the strongest supporters of mainstreaming as well as those who advocate the rights of individuals with mental health problems have accepted that there can be morale issues for nurses working with mental health patients. While such morale failure is only natural after years of fighting against discrimination and a lack of understanding, nurses must understand that it is their role in society to prevent stigmatisation. Even when they are nothing more than students, nurses can engage their teachers and other nurses in conversations, discussions and evaluations to help each other understand the bigger picture of mental health care as well as the social issues of mental health patients. This understanding can also come from the relatives of those individuals who have been accepted into mental health wards of hospitals but which is most important, such understanding can come from interacting and providing care services for mentally ill patients. Mental health nurses can minimise the stigma of being a mental health patient if they continually challenge their own discriminatory attitudes as well as the attitude of other general health professionals. By actively influencing the decisions made by nursing communities and other health service provider groups, nurses can force the move towards medical as well as general attitude, which is more open towards mental health patients as well as more inclusive and understanding of their needs. It is certainly not an easy task and it will definitely not be accomplished in a day, week, month or even a year, but it is something which nurses around the world can work towards since it certainly more than something devoutly to be wished. It is something towards which we can all devoutly work towards. Nurses appear to play a key role in eliminating the stigma of mental health nursery care through educating the public and serving as an example for other medical workers of this sphere. Though there have been made serious advances in the mental healthcare, the question of stigmatisation is still to be discussed and resolved. It is the evolving process, which should be continuous - the striving for improvements in mental health nursery care. We now witness rapid changes in the technologies and sciences, which give us an opportunity to re-consider the nursery strategies we use in treating mentally ill patients. Eliminating the stigma will lift mental health nursery care to a new advanced level, making it possible to give people with mental disorders the right to lead full life without any discrimination and exclusion. The destruction of stigma will open new opportunities of nursery care for those who are diagnosed to be mentally ill. However, it should also be remembered that without the development of special strategies in relation to the stigmatisation issue, the efforts applied won't bring the desired effect, and only in cooperation and concentration of actions it will be possible to totally forget about the notion of stigma in mental health nursery care. References Atkinson, M., Zibin S. & Chuang H. 1997, 'Characterising quality of life among patients with chronic mental illness', The American Journal of Psychiatry vol. 154, no. 1, pp. 99-105. Chan, S. & Yu, I. 2003, 'Quality of life of clients with schizophrenia', Journal of Advanced Nursing, vol. 45, no. 1, pp. 72-83. 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