1. Introduction
Among the many diseases today, mental disorders can be considered to be the disease most misunderstood by the general population. Such illiteracy and unawareness to the nature of mental illness have caused stigma, and discriminatory treatment and care to patients. Generally, mentally ill persons are often perceived to be difficult to be treated and needed special attention. This is because the causes of some types of mental illnesses are not yet known. Other perceptions of mental illnesses are that patients are violent, unpredictable, have multiple personalities and other negative perceptions. These perceptions have resulted to stigma which is defined as a mark of disgrace or discredit that isolate a person from others (Byrne, 2001).
Stigma, whichever way you look at it, is a negative label that result to various negative effects on mentally ill patients. Aside from their family, patients often expect and depend on health and medical service providers to understand their condition and somehow reduce their mental and physical disabilities as well as the emotional pain they feel from the stigma associated with them. It is the objective then of this study to determine and investigate the roles of nurses in alleviating or minimising the stigma of metal illness.
To be able to achieve this objective, it is important to review various literatures about stigma of mental illnesses and its causes; the implications of stigma on the personal life of the patients; and the effect of stigma on how the patients are treated, trying to find if medical providers such as psychiatrists, medical providers and nurses also stigmatise their patients and if there are disparities on medical services and treatment provided among the mentally ill patients.
2. Significance of the Study
The research study is significant to nursing field as well as to other medical fields such as psychiatry, psychology and related fields that deals with patients with mental disorders. The paper is an in-depth review of previously conducted and published research studies that provided relevant information, findings and theories. These findings and theories are used and analysed to find out how stigma has started and to determine the problems related to stigma. The findings are also used to determine the current intervention strategies of nurses working for the mentally ill patients.
Through these earlier studies, the roles of the nurses on reducing the stigma can be conceived and the problems and issues with their current practices are identified. The study recommends appropriate strategies that can address the identified problems. These recommendations are based on strong theoretical framework and can be applied in real situations. Basically, the importance of the study is that it identifies, summarizes and gives emphasis on the issues and problems on stigma and nursing interventions on mental illness so that current practices can be improved. It aims to provide a better understanding on the proper treatment of the mentally ill and the roles that nurses can play in providing proper treatment.
3. Literature Review
3.1 Problem Identification and Evaluation
Like with other diseases, mental illnesses can be clearly understood and treated when people have enough knowledge and literacy about the nature of this particular illness. According to Jorm et al (1997) mental health literacy is “the knowledge and beliefs about mental disorders which aid their recognition, management or prevention”.
He further added that “mental health literacy consists of:
- (1) the ability to recognise specific disorders or different types of psychological distress;
- (2) knowledge and beliefs about risk factors and causes;
- (3) knowledge and beliefs about self-help interventions;
- (4) knowledge and beliefs about professional help available;
- (5) attitudes which facilitate recognition and appropriate help-seeking; and
- (6) knowledge of how to seek mental health information” (Jorm, 2000). Mental health literacy plays an important role in dealing properly with mental illness and lack of it caused many problems.
Lack of proper knowledge about mental illness caused many people to have the inability to recognise the different types of mental disorders and understand the meanings of psychiatric terms (Jorm, 2000). The general public cannot actually differentiate depression from schizophrenia and although they know some symptoms of mental illnesses, there are still some misconceptions like that of schizophrenia which is often associated with a split personality (Jorm, 2000).
Lack of proper knowledge on the symptomatology of mental illnesses can lead to improper self-help intervention that may tend to worsen the patient’s condition. Different beliefs about the causes of mental illnesses also pose some problems. Other people believe that mental illnesses are more likely to be caused by biological factors rather than psychosocial causes while others see environmental factors as the most important factors that cause mental illnesses (Jorm, 2000). There are even some cultural beliefs that mental disorders are caused by supernatural phenomena such as witchcraft and evil spirits (Razali et al, 1996). Such beliefs often result to seeking help from non-medical practitioners such as herbalists and witchcraft which cannot improve the condition of the patient (Alem et al, 1999).
The lack of proper knowledge about mental illnesses is primary due to the lack of proper source of information about the risk factors and causes of the disease. Aside from personal experience or experiences of family or friends, the most influential source of information about mental illnesses is media. According to many research studies (Coverdale et al, 2002 [citing Borinstein, 1992; Kalafatelis ; Dowden, 1997; Philo, 1994] on Edney, 2004), the media are the public’s most significant source of information about mental illness. “Media are not just source of information; media representations of mental illnesses are also very powerful that they can override people’s own personal experiences in relation to how they view mental illness” (Philo, 1996, cited in Rose, 1998 on Edney, 2004).
However, media representations of mental illness are often both false and negative (Edney, 2004). A study at George Madison University in Virginia, USA, for example, show that very few of the 300 newspaper articles containing references to mental illness presented positive images of people with mental illness or depicted them as productive (Edney, 2004), making the public conclude that people with mental illness are burdens to society and incapable of contributing in positive ways to their communities (Wahl, 2001 on Edney, 2004).
In the study done at Glasgow University on the content of 562 newspaper articles containing references with mental illnesses, 62%of the articles link mental illness, crime and violence (Edney, 2004). In television programs, about 72.1% of adult characters depicted as mentally ill injured or kill others, making mentally ill persons 10 to 20 times more violent than real individuals with mental illness (Edney, 2004). Television programs also shows that 43% of mentally ill characters lacked comprehension of everyday adult roles, were helpless, poor, homeless, and were being held by police for a crime (Wilson et al, 1999 on Edney, 2004). Yet, only 3-5% of violence in the United States is committed by someone with mental illness while the research conducted in a detention center in west Canada (Stuart ; Arboleda-Florez, 2001) shows that less than 3% of violent crime could be attributed to persons with mental illness.
Because of these misrepresentations, stigma was often associated with mental illness in the contemporary society. Stigma has been a burden to mentally ill persons as well as to their family. “Mental patients are among the most stigmatised all social groups particularly those who manifest obvious signs of their condition either because of the symptoms or the side effects of medications; who are socially construed as being weak of character, lazy, or free-loaders; and who display threatening behaviours” (Arboleda-Florez, 2005). Defining stigma, “it is a prejudicial attitude attributed to people who have mental illness that may result in discriminatory practices” (Corrigan, 2000). Link ; Phelan (2001) also defined stigma as “a reflection of a broader social process with cognitive, attitudinal, behavioral, and structural elements that interact to create and perpetuate social inequalities, discriminatory treatment and disadvantage of people who have mental disorder”. It is therefore the result of a social dynamic that may result in different specific manifestations and occurs when negative and prejudicial attributes are accepted by the dominant culture as defining the stigmatised person, and become ascribed to all members of the group (Arboleda-Florez, 2005).
Stigma is also termed as negative stereotyping or labeling (Corrigan ; Penn, 1999; Hayward ; Bright, 1997) which is a result of stigmatisation or the process of establishing deviant identities (Schlosberg, 1993). Historically, sick individuals who sought for treatment were commonly labeled or categorized as ill (Rossol, 2001). The labeling process can result to a permanent or transitory stigma for labeled individuals (Rosecrance, 1989). For example, physicians have labeled people with schizophrenia as schizophrenics, as if the patient himself is the illness. In other words, diagnostic label has been the source of stigmatisation. Medical diagnosis are helpful tools in medicine as it is the source of information about a patient’s illness and it is tool in facilitating communications among members of the profession. However, they become a source of stigmatisation when used by non-health professionals because they do not understand the correct definition of the terms or there are already misinterpretations of the terms (Sartorius, 2002). However, according to Byrne (2000), stigma is culturally determined and long been existed even before psychiatry. People stigmatised other they perceived to act, think, and look like the way they stigmatised people of different race, religion, and gender and sexuality.
As a negative label, stigma carries a negative image. Most people often think that mentally ill people have the tendency to be violent and to have criminal instinct, lack comprehension, lost and confused, and helpless. Byrne (2001) added that “to be marked as mentally ill carries internal consequences such as secrecy, lower self-esteem, lost of self respect, and shame, and external consequences including social exclusion, prejudice, discrimination, fear, avoidance and discomfort being with mentally ill persons”. This implies that stigma has serious negative effects that even the mentally ill persons themselves may create stigma within themselves. Self stigmatisation has been the primary cause why some people opted to hide their illness and are ashamed of consulting medical professionals. According to Byrne (2000), secrecy is a major obstacle to the presentation and treatment of mental illness. Consequently, the more a patient hides his illness, the more it will get worse until such time it becomes a chronic mental disorder that the patients are needed to be admitted in mental institutions, away from family, relatives and friends. When the patient’s social networks are reduced, poorer outcomes are more likely to happen (Brugha et al, 1993). This is because patients are removed from the emotional and moral support provided by the members of their social networks.
Another serious consequences of stigma is discrimination in the workplace and health care disparities. Most employers have stigmatising views for people with mental disorder that is surveys of US employers, half of the participants are reluctant to hire someone with history of psychiatric illness or substance abuse, or currently undergoing treatment for depression or taking antipsychotic medication (Stuart, 2006). Employees who return to work after being reported and diagnosed to have mental illness commonly experienced discrimination from their co-employee (Stuart, 2006). As a result, most of them hide their illness to avoid the stigma and majority of them fail to receive proper treatment because they chose not to avail of medical and financial assistance from their company (Stuart, 2004).
Even health care providers who are perceived to understand the condition of mentally ill people due to their knowledge about mental illness show stigmatising attitudes towards their patients. Many psychiatrists also have their share of discriminating attitudes. “Psychiatrists reacted to vignettes differently if the person had been given the diagnosis of a personality disorder: one labeled, primary diagnoses differed and value judgements like ‘manipulative’, ‘unlikely to improve’ and ‘likely to annoy’ appeared more frequently”, (Byrne, 2000). There are also unfavorable attitudes towards patients who overdose and are known to have alcohol or drug dependence by medical and nursing staff (Ghodse et al, 1986).
Patients with anorexia or eating disorder are less liked by health professionals because of the patients’ being responsible for their illness (Fleming ; Szmukler, 1992). Even health professionals who had relatives with mental illness frequently heard colleagues saying negative remarks about their patients thus majority of these professionals kept silent about their relative’s illness in fear of being stigmatised too (Lefley, 1987). From these, it can be viewed that health professionals themselves, although they have the proper knowledge about mental illness, still show discrimination and prejudice towards the mentally ill people, becoming one of the source of stigma and a contributing factor to the emotional and mental burden of the patients. On the contrary, in a study by Kingdon et al (2004), it was found out that psychiatrists in general has no stigmatising views compared to the general population and that attitudes of psychiatrists is more positive than that of the general public. It was also found out that psychiatrist are generally optimistic about the recovery of mentally ill patients.
Therefore, this research study is centered on finding strategies that will minimise the stigma associated with mental illness through the nursing perspective. The problems with stigma is chosen because it is a serious problem that affect the treatment outcome of mental patients. Stigma has been a barrier to treatment and as health professionals, it is the responsibility of nurses to promote effective treatment.
3.2 The Case of the Minority Group
The minority group of different culture and race is also one of the social group commonly discriminated and associated with stigma. This type of discrimination is called as racism. “Racism is a form of discrimination which is based on the belief that groups should be treated differently according to phenotypic difference and individual factors (e.g. skin colour, culture, socio-economic status and coping style)” (Chakrobarty, 2002).
Racism can be in the form of verbal attack, interpersonal communication or inequity in the receipt of services and such attacks along with a discriminatory environment are perceived to have am impact on the individual’s mental health because such racist acts serve as stressors to the life of the individuals belonging to the minority group (Laveist, 1996; Sharpley et al, 2001). Racism is therefore a type of stigma experienced by minority groups. Like those with mental illness, most people belonging to minority groups have lower incomes and have lower socio-economic status due to undesirable occupations and longer periods of unemployment (Nazroo, 1998) and are more likely to experience disparities in access to health services (Davey et al, 2000).
Studies in the United Kingdom show relationship between depression and racism practices (Burke 1984; Fernando, 1984). Another study by Gilvarry et al (1999) found out that the possibility of suffering life events among African-Caribbean psychosis patients is the same as the possibility with that of the Whites. However, “African-Caribbean patients attribute their problems to racism than to their mental illness” (Chakraborty et al, 2002). In the USA where it is the African-American and the African-Indian are the minority groups, interpersonal discrimination has been associated with increased rates in hypertension, psychological distress depression and stress; poorer self-rated health; and more reported days spent unwell in bed (Krieger, 2000 cited in Chakrabarty ; McKenzie, 2002). Laveist (1996) added that ethnic minorities in the USA with very small population are more likely to suffer from mental illness. Karlsen and Nazroo (2002) investigated on the association of racism to mental illness involving Caribbean, African and Asian and found out that people who suffered from verbal discrimination and abuse are three times more likely to suffer from depression or psychosis; those who experienced racial are about three times more likely to experience depression and five times more likely to have psychosis.
It was also reported that minority people with more population in a particular area are less likely to suffer from psychosis compared to areas where there is a low density of population of minority people (Boydel et al, 2001). These studies show that racial stigma can be related to having a mental illness. This is because minority people is a social group, a member of the society that needed to interact with the other social group, thus a discriminating environment has a serious effect on these people’s mental, emotional and health condition.
Because minority groups and those with mental illness are two social class that experience stigma, increased stigmatism is more like to be experienced by minority people who happen to have mental illness especially that they have the tendency to suffer from mental illness due to racism. The stigma associated with mental illness and racism would probably increased the burden held by these people.
Moreover, disparities in and barriers to health care services exist in the health care system. According to Uba (1982 cited in Spencer & Chen, 2004), “the following serve as the barriers to mental health service utilisation for Asian Americans/Pacific islanders in the USA: (1) racial and cultural biases such as culturally inappropriate services, differential receipt of services compared with Whites, a history of institutional discrimination and insensitivity, a feeling of unwelcome, and suspicion of the service delivery system; (2) conflicts between the epistemological underpinnings and characteristics of ‘Western’ psychotherapy and the personality syndromes, values, expectations and interpersonal styles of Asian Americans/Pacific Islanders; (3) Asian/Pacific Islander cultural attitudes toward seeking help and perceptions of the usefulness of such help; (4) language barriers; (5) a shortage of bilingual and culturally sensitive service providers; and (6) lack of knowledge of existing services”.
Minority individuals like that of Africans Americans and Latinos mistrust clinicians due to the prejudice, bias and unfair treatment, stereotyping and disrespect of doctors or health providers because of their race or ethnic background (Spencer and Chen, 2004). Such kind of treatment on the minority may affect the treatment outcomes of minority with mental illness because of discontinued treatment and non-compliance to health care in order to avoid further discriminations from clinicians whom they have to deal with when utilising health care services. However, the study of Kingdon et al (2004) about the positive perceptions of psychiatrists about the mentally ill can also be held true with other clinicians, thus it is important to investigate on the roles as well as the perceptions of other health professionals such as nurses towards mental illness. In that way, the roles that nurses can play in minimising the stigma in general and the stigma of mentally ill minorities can be determined.
3. Role of the Nurse in the Problem
Nurses that specialise in the care of mental illness is popularly known as psychiatric nurses. Psychiatric nurses primary role is to provide primary mental health care (Haber and Billings, 1995). Primary mental health care, as the term suggests, is the care given to those at risk of having mental illness or already in need of mental health services (Haber and Billings, 1995).
Primary mental health care includes: promotion of mental health, prevention of mental illness, health maintenance, management and treatment of mental health problems (Haber and Billings, 1995). Promotion of mental health is also considered to be the universal preventive interventions which target a wider population including those without mental illness and are not at risk of having mental illness (Mrazek & Haggerty, 1994 on Haber & Billings, 1995). Universal preventive intervention helps inform the general public on the nature, prevention and treatment of mental illness. It also provides awareness on the symptoms of the illness, being able to differentiate and identify the types of mental illness to be able to apply appropriate self-help. This type of prevention also inform the public on the real attitudes and characteristics of mentally ill persons in order to reduced, if not eliminate some of the negative notions about mental illness depicted by media.
There is also another type of preventive intervention, called selective preventive intervention, included in the roles of psychiatric nurse. Selective preventive interventions is basically for selected or target subgroups of the population who have higher-than-average risk of suffering from mental illness (Mrazek & Haggerty, 1994 on Haber and Billings, 1995). Such subgroups include the minority group. By targeting particular subgroups, nurses help them become informed on the proper prevention or from further development of mental illness . Selective prevention intervention programmes also eliminate some of the barriers that may hinder subgroups to seek for professional help and may also help them manage the factors that may trigger mental illness, making recovery from the illness faster.
Lastly, indicated preventive intervention, or early intervention programmes, is also part of the roles of nurses. It is the type of preventive intervention that targets those who also have higher risk but presently show minimal signs or symptoms of having mental disorder (Haber & Billings, 1995). Example of population targeted for this type of intervention are children whose either of his biological parents or relatives have mental illness or have history of mental illness. This type of intervention is very useful in reducing the stigma felt by the relatives of mentally ill persons and at the same time make them avoid the factors that may influence the occurrence of mental illness.
Furthermore, Haber and Billings (1995) created the Primary Mental Health Care Model, a framework that illustrates the professional mental health clinical practices and responsibilities. According to the model, the roles of psychiatric nurses at basic and advanced level include: advocacy, community intervention, and professional interventions. As patient advocates, nurses are involved in professional and community organisations in order to implement community actions that influence public policy on mental illness (Haber and Billings, 1995). Psychiatric nurses perform direct intervention activities such as counseling, crisis intervention, health teaching, self-care activities, milieu therapy, case management, and psychobiological interventions that involves therapy and treatment regimens (ANA, 1994 on Haber and Billings, 1995).
Nurses are also responsible in the assessment, monitoring and securing of referrals in patients who have marginal contact with other segments of the health care system (Koldjeski, 1993 on Haber & Billings, 1995). This reflects that it is the nurses who have direct contact with mentally ill patients and it is their responsibility to communicate with other health professionals in behalf of the patients. This also implies that the needs and problems of the patients either psychological, social or physical needs, are well understood and addresses by nurses. From this, it can be viewed that nurses can influence the perception of other health professionals on the patients because when the nurse understand the needs of the patients and communicated them clearly on other health professionals. For example, nurses monitor the medication of the patient in order to avoid overdose and to ensure that the medicine are taken as prescribed. Consequently, the perception that mentally ill patients always show non-compliance to treatment and medications.
Another important responsibilities of nurses are to understand and be sensitive to issues related to ethical dilemmas, cultural diversity, and health care access (Campinha-Bacote, 1994 on Haber & Billings, 1995). These particular responsibilities help in reducing if not eliminating inequalities and discrimination in the health care system. Nurses then can help address the barriers that prevent underserved population in accessing health care services.
Furthermore, Gournay (2005) outlined the important roles psychiatric nursing which include: (1) family interventions; (2) physical healthcare; (3) medication management; (4) working with dual diagnosis patients; and (5) cognitive-behavioural therapy for delusions and hallucinations. Family intervention is basically the involvement of the patient’s family in the intervention, Family interventions includes “family assessment methods; providing education to the family; working collaboratively with families and patients; identifying strengths and deficits of families; providing interventions to reduce family stress; and providing families with basic intervention skills (Gournay, 2000). Physical healthcare is also an important role of nurses because some mentally ill people have the tendency to neglect or become demotivated with self care and physical activities, thus they more likely to suffer cardiovascular and respiratory diseases as well as poor sexual health (Gournay, 2005).
Medication management is the role of nurses that deals with the monitoring and evaluation of medication and treatment of patients. Medication management involves knowledge of psychopharmacology, mental state assesments, assessment of medication side effects; motivational interviewing skills, and strategies to improve adherence (Gournay, 2005). Negative perceptions about medication that may lead to failure to seek medical help and noncompliance with any medication recommended (Fischer et al, 1999) are more likely to be reduced or even eliminated through proper medication management. Consequently, when proper treatment and medication are given to patients, the time that mental health problems exists will be reduced.
In summary, the roles of nurses in mental health care and in reducing the stigma associated with mental illness is as follows: (1) preventive intervention which includes promotion, and community intervention that provides information and mental health literacy on the general public and target population which are mostly composed of individuals who are at high risk of having mental illness; (2) advocacy which is the participative role of nurses to pursue institutional and organisational policy that address problems and issues of the mental patients; (3) home and family intervention; (4) medical management and therapy; (5) professional consultation; (6) promotion of self care activities; and (7) promotion of good communication between the patients and doctors.
These roles and responsibilities of nurses have, although were published from reputable and reliable literatures have also some shortcomings in terms of its implementation and practice in real health care settings. According to Hunt (1993) stigmatisation occurs among health professionals including nurses because it serves to rationalise the avoidance of a patient who is somehow different. Nurses also avoid mental patients so that they can concentrate their skills and efforts on patients who can reassure them of their competence as nurses (Brinn, 2000). Brinn (2000) also reported on his research that nurses with more experiences and who underwent training in dealing with mental patients are more likely to have positive attitudes towards mental patients because mental patients served as challenges to them. On the other hand, less qualified nurses tend to have stigma on mental patients along with perception that these patients need more health care, requiring more effort from nurses. The general finding from the study of Brinn (2000) suggests that nurses in general prefer less the illnesses related to mental health than those illnesses not related to mental health.
Therefore, although the roles of nurses in minimising stigma associated with mental illness are clear, theories and findings are not enough to reduce stigmatism, not until nurses themselves have learned to eliminate stigma in dealing with mental patients. The next section then discusses some of the suggested strategies that can be applied to nursing field in order to minimise and overcome the stigma of mental illness.
3.4 Nursing Strategies to Overcome Stigma
Based on the above reviewed literatures, nurses definitely have significant roles in reducing stigmatism on mental illness. However, it is the implementation which is needed to be improved. Generally, the defined roles of nurses are nearly enough to reduce stigma along with the strategies recommended by some health professionals concern in reducing stigma. Wolff et al (1996) for example, suggest educational interventions that target specific groups. They created a model that involves identification of the attitudes of the target groups which can be from different settings such as workplace, schools and community. The model must include psychoeducational modules, the stigma-discrmination paradigm and information specific to the needs of the target group (Byrne, 2000). This strategy is aligned with the community intervention roles of nurses; can be considered as a more customised intervention; and must be further pursued and supported by many nurses and organisations in clinical and private consultation settings. Using such educational intervention model, which targets not only selected groups but also most of the groups of the general public, can reduce stigma associated with mental illness because the public has been informed and provided proper knowledge that addresses the issues and needs of the group.
Another strategy that is seem to be effective in overcoming stigma is suggested by Byrne (2000), aiming to move psychoeducation from clinical setting to public education not just target groups. The model aim to “convince the public on the importance of stigma, challenge stereotypes within ourselves and others and pursue the ongoing task of unravelling the nature of prejudice”(Byrne, 2000).
The above mentioned strategies could be more effective when before providing education and disseminating information to target groups, the target group’s beliefs must be determined first. According to Secker (1999), “simply imparting accurate information is not likely to be successful unless people’s own beliefs are taken into account”. For example, it would be useless to disseminate information about the medications of schizophrenia when the target audience is the people at the workplace who are interested about the capabilities and dangerousness of people with schizophrenia..
It is also the nurses’ role to act as advocates of patients, thus nurses should associate themselves with organisations with the same objectives in order for the anti-stigma initiatives to be effective and to gain long term improvement. Additionally, it should also involves multiple agencies (Smith, 2002) including social worker groups, government agencies and various related institutions. When various agencies are involved in anti-stigma campaigns, there are many resources available that can ensure the success of initiatives.
Likewise, it is also important that anti-stigma initiatives must be seen across several domains such as public education, academic research and more particularly the media and the legislation (Smith, 2002). when anti-stigma programmes reached the legislation, such programmes are more likely to be publicised and be the topic of many debates, gaining popularity even to those who are against it. The legislation will also help control stigmatising practices such as inequity to health care access and provision of health care services that address the needs of the mentally ill patients and mental patients from the minority group. Additionally, media is the most influential source of negative images thus it is also more likely to be the most influential source of anti-stigma campaigns, counteracting and criticising the stigma from television programmes, movies and shows that portray negative characters of mental illness.
Lastly, a more important strategy for nurses to overcome stigma is to learn to remove stigma within themselves. There are various findings (Brinn, 2000; Spencer and Chen, 2004; Uba, 1982) showing about the discriminatory practices of health professionals including the mental health nurses. Anti-stigma programmes and practices are more effective when health professionals themselves personally support such programmes and pursue inequities in the health care system. It is is not only a moral obligation of mental health professionals, it is also their ethical obligation to ensure equality among patients regardless of social group they belong to.
4. Conclusion
Stigmatisation of mental illness is rooted in culture; a result of lack of proper and mental health literacy and has been a part of social interaction that in fact media has learned to incorporate stigma in entertaining people. Stigma is a negative association to people with mental health problems as well as on minority groups. Stigmatisation is likely to increased especially when the member of the minority group are the ones diagnosed with mental illness. Not only that stigma triggers mental illness among minority groups, it also serve as barrier to access mental health services. The most serious effect of stigma is self-stigmatisation that causes mental patients to loose self respect, self esteem and trust on health care providers, preventing them to admit their illness, seek professional help and continue treatment and medication.
As health care professionals, nurses are given roles that can help improve the perceptions of the public towards mental patients. Through effective strategies, nurses can use their roles to minimise all types of stigma associated with mental illness. However, further research studies are needed to determine the effectiveness of the recommended strategies and also to determine how nurses perform the roles given to them and whether they are effective in performing their roles.
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