Reporting. Mental illness treatments have a long history of bizarre and inhumane practices being performed on mentally ill patients which has given rise to a variety of professional, social as well as ethical issues. (Evans, 2009) At first, the situation in the given article seemed quite normal to me because my thought process was based on my previous beliefs and knowledge. As soon as I have learned the purpose of mental health nursing, I came out with some crucial issues that need to be addressed. One of the issues I have identified is the ‘stigma’ related to mental illness which in the given situation has labeled the patients as ‘unfortunates’, treated them as criminals (three men having no charges against them), seizing their freedom and socially isolating them. Moreover, subjecting these mentally ill patients to an ‘involuntary treatment’ is an another issue in which paternalistic care is forcefully being imposed on them without obtaining their formal consent that has resulted in the loss of patient-centered care as well as person’s autonomy. (Rodriguez-Osorio & Dominguez-Cherit, 2008)
I strongly believe that mental illness results predominately from various social causes including our day to day problems, someone’s death in the family, any painful event or any issues from childhood and, some risk factors such as divorce or separation from partner, loneliness, social isolation or unemployment. (Nakane et al., 2005) Also, I believe that the people suffering from mental disorder might feel emotionally as well as physically weak, remain tensed most of the time or may not share their problems with anyone. Moreover, in my viewpoint, the symptoms of depression or unwell mental state are quite noticeable especially in case of one’s own family, friends or colleagues. But there is a need of understanding that mental illness should not be stigmatized. We should not discriminate with the people suffering from mental illness nor make them feel worthless. My beliefs, experiences, and knowledge has always directed me to approach mentally disturbed people in a positive way so that any possible help could be provided to them. Because in my opinion, the mental disorders due to such social causes or risk factors can easily be prevented from getting worse by helping people on personal front. The worsened mental condition may lead to self-harm or harm to others. The prevention methods which I usually follow include interacting with the sufferers, making them feel comfortable, sharing their problems, spending some quality time with them, empathizing them, involving them in other activities, help them to come out from the distressful conditions and if required, encourage them to go for an appropriate medical treatment.
There is a long history of stigmatization of the people suffering from mental health issues throughout the world. (Flaskerud, 2017) I come from India, where mental health issues remain unreported due to prevalence of stigma, lack of self-awareness, social bias, fear of rejection or avoidance and embarrassment. (Kishore, Jiloha, Gupta & Bantman, 2011) I have seen that people in rural as well as urban India, irrespective of their class, still believe that mental health issues are caused by some evil spirits, sins of the past, curse of God, evil eye or bad karma. Therefore, people tend to visit faith healers or tantric for the cure of mental illness rather than going to a psychiatrist. (Kermode, Bowen, Arole, Pathare & Jorm, 2009) This indicates the lack of knowledge about the treatment of mental illness. I have also observed that transgender community face increased social stigma, discernment, rejection from family along with high physical violence which results in depression and anxiety with risk of suicide. (Iyer et al., 2019) My observation about my society and culture is that people hesitate to disclose their mental status. Moreover, the fear of ignorance and being judged, discrimination, unfair denial of employment, loss of confidentiality and autonomy and societal isolation remain at top of their mind. (Sarkar et al., 2017). In addition to this, I strongly believe that news media, as well as social media, has a major effect on people’s particular attitudes and behaviors as I have experienced it by myself. I was greatly motivated when a famous Bollywood celebrity named Deepika Padukone openly and broadly expressed her struggle with depression on India’s one of the biggest news channel. This also affected people’s perception of mental health issues and, to large extent, brought a positive change in their attitude and intentions to seek appropriate medical treatment. (Jain, Pandey & Roy, 2017)
My knowledge, attitude and thinking about mental health and illness have changed with time and experience. As in given case, there is a stigma of criminalizing the mentally ill patients, discrimination in giving them fair medical treatment, ignoring the chances of their recovery and isolating them which according to my existing knowledge, possess a huge risk to the mankind and such stigma should be eliminated. Furthermore, it is clear that these mentally ill patients are being subjected to paternalistic care. Their right to know about treatment, right to refuse the treatment, their autonomy and confidentiality are all ignored. Their involuntary institutionalization without prior consent will give them poor quality of treatment and severely deteriorate their mental health, making them more weak, violent and self-harmful. I have learned that the healthcare and treatment ethics should not be ignored when it comes to the mental health.
I believe that my new understanding of mental health and illness will definitely have a positive influence on my nursing practice. The issues related to mental health which I used to intentionally or unintentionally ignore in the past will be eradicated and I will tend to be more sensitive while handling the patients with mental illness. The issues like stigma/discrimination and involuntary institutionalization/treatment are very significant. (Jaeger et al., 2013 & Flaskerud, 2017) As in the given situation putting mentally ill patients in jail can be highly destructive to the patients itself, their illness, the clinician-patient relationship and to the society as whole. (Nurse, 2003) As a mental health nurse, I will work towards developing and maintaining a proper therapeutic relationship with the patient and not being judgemental or discriminatory. This will further help in providing patients with the most appropriate treatment which will improve the quality of their life. (Harrison, Hauck & Ashby, 2017) The nurse-client relationship is strongly recommended to establish human connectedness which is based on the genuine interest in understanding the patient and how they come to be in their current situation. (Jackson & O’Brien, 2009) I have now learned that mental health nursing also requires interpersonal skills along with the clinical knowledge and experience. Therefore, Self-awareness should be there as it will help me to know about the way I respond to a particular situation, make me aware of my values and beliefs and help me to understand my attitudes and biases towards people and situation. (Jackson & O’Brien, 2009) My understanding about obtaining the consent from the patient has also changed. I have realized that coercion, forceful medical treatment, involuntary hospitalization possess a high risk to patients’ safety, privacy, and confidentiality. (Salize & Dressing, 2005) As a mental health nurse, I will treat patients fairly and appropriately, maintaining their dignity and confidentiality, obtain consent before subjecting them to treatment and respect their decision of refusing the treatment.
- Evans, K. (2009). Historical foundations. In Elder, R., Evans, K., & Nizette, D. (Eds.), Psychiatric and mental health nursing (pp. 33-47). Chatswood, N.S.W.: Elsevier Australia.
- Flaskerud, J. (2017). Stigma and Psychiatric/Mental Health Nursing. Issues In Mental Health Nursing, 39(2), 188-191. doi: 10.1080/01612840.2017.1307887
- Harrison, C., Hauck, Y., & Ashby, R. (2017). Breaking down the stigma of mental health nursing: A qualitative study reflecting opinions from western australian nurses. Journal Of Psychiatric And Mental Health Nursing, 24(7), 513-522. doi: 10.1111/jpm.12392
- Iyer, R., Ramanaik, S., Prakash, R., Parmar, P., Kumar, P., Mishra, J., & Isac, S. (2019). P273 Understanding the mental health issues and service needs of the transgender community in delhi, india. Sexually Transmitted Infections, 95(Suppl 1), A157-A158. Retrieved from https://sti-bmj-com.ezp01.library.qut.edu.au/content/sextrans/95/Suppl_1/A157.3.full.pdf
- Jackson, D., & O’Brien, L. (2009). The Effective Nurse. In Elder, R., Evans, K., & Nizette, D. (Eds.), Psychiatric and mental health nursing (pp. 4-10). Chatswood, N.S.W.: Elsevier Australia.
- Jaeger, S., Pfiffner, C., Weiser, P., Längle, G., Croissant, D., & Schepp, W. et al. (2013). Long-term effects of involuntary hospitalization on medication adherence, treatment engagement and perception of coercion. Social Psychiatry And Psychiatric Epidemiology, 48(11), 1787-1796. doi: 10.1007/s00127-013-0687-x
- Jain, P., Pandey, U., & Roy, E. (2017). Perceived Efficacy and Intentions Regarding Seeking Mental Healthcare: Impact of Deepika Padukone, A Bollywood Celebrity’s Public Announcement of Struggle with Depression. Journal Of Health Communication, 22(8), 713-720. doi: 10.1080/10810730.2017.1343878
- Kermode, M., Bowen, K., Arole, S., Pathare, S., & Jorm, A. (2009). Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Social Psychiatry And Psychiatric Epidemiology, 44(12), 1087-1096. doi: 10.1007/s00127-009-0031-7
- Kishore, J., Jiloha, R., Gupta, A., & Bantman, P. (2011). Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal Of Psychiatry, 53(4), 324. doi: 10.4103/0019-5545.91906
- Nakane, Y., Jorm, A., Yoshioka, K., Christensen, H., Nakane, H., & Griffiths, K. (2005). Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia. BMC Psychiatry, 5(1). doi: 10.1186/1471-244x-5-33
- Nurse, J. (2003). Influence of environmental factors on mental health within prisons: focus group study. BMJ, 327(7413), 480-0. doi: 10.1136/bmj.327.7413.480
- Rodriguez-Osorio, C., & Dominguez-Cherit, G. (2008). Medical decision making: paternalism versus patient-centered (autonomous) care. Current Opinion In Critical Care, 14(6), 708-713. doi: 10.1097/mcc.0b013e328315a611
- Salize, H., & Dressing, H. (2005). Coercion, involuntary treatment and quality of mental health care: is there any link?. Current Opinion In Psychiatry, 18(5), 576-584. doi: 10.1097/01.yco.0000179501.69053.d3
- Sarkar, S., Patra, B., Patil, V., Gupta, S., Mallanik, S., & Pandey, A. (2017). Patient and Caregiver Perspectives on Ethical Issues in Mental Health Care: an Exploratory Study from India. International Journal Of Mental Health And Addiction, 16(3), 714-721. doi: 10.1007/s11469-017-9833-0
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