Persons With Mental Illness Research Articles

Unveiling Shadows: Challenges Encountered by Mental Health Nurses and Health Cadres in the Delivery of Care to Persons With Mental Illness in Indonesia.

Mental health nurses and health cadres in Indonesia who provide care to persons with mental illness (PWMI) report encountering several challenges and obstacles to the delivery of quality care. At present, there is a paucity of research on this topic. The objective of this study was to examine the challenges encountered by mental health nurses and health cadres in their interactions with the families of PWMI in the community. This descriptive qualitative study employed focus group discussions, conducted in three Indonesian cities: Banda Aceh, Surabaya and Yogyakarta. Thematic analysis was utilised to analyse the data. The study revealed that the theme of this research is nurses and health cadres experienced challenging family behaviours toward a PWMI. The initial subtheme of family behaviour is 'concealing the PWMI.' This subtheme encompasses instances where families attempted to hide the mental health condition of the PWMI. The second subtheme is 'unsupportive families'. This subtheme is characterised by reluctance to engage in treatment or outright rejection of hospital care. This is often due to factors such as familial busyness. The third subtheme is 'poor parenting styles'. This subtheme highlights how inadequate parenting practices, domestic violence and lack of family support contribute to stress and exacerbation of mental disorders in PWMI. The fourth subtheme is 'hidden motive related to wills and testaments', which reveals how families may attempt to manipulate treatment to remove the inheritance rights of PWMI. The fifth subtheme is 'abandonment by family', which describes scenarios where families completely neglect PWMI, leading to inadequate care and medication adherence. The final subtheme, 'removal of PWMI from family units', describes instances where families sent PWMI to mental health facilities for permanent separation, sometimes even relocating to another city. To address these issues, a comprehensive approach is required that considers both the affected individuals and their families. An understanding of the motivations behind these behaviours is essential for the development of targeted interventions that promote family support, reduce stigma and improve the overall mental health environment in communities.

Chinese College Students' Stigmatization towards People with Mental Illness: Familiarity, Perceived Dangerousness, Fear, and Social Distance.

Attribution models have been examined in Western countries. However, little is known about the applicability of the attitude-emotion-behavior model within Chinese culture. This study aimed to examine the association between familiarity, perceived dangerousness, fear, and social distance towards persons with mental illness (PMI) in the Chinese context. An online cross-sectional survey was conducted from October to November 2022 in mainland China. A total of 1493 college students completed a questionnaire evaluating familiarity, perception of dangerousness, fear, and social distance regarding PMI. Path analysis was employed to validate the model proposed in this study. Participants expressed moderate to high levels of stigma towards PMI. Familiarity was negatively associated with social distance (p < 0.01). Participants who perceived PMI as dangerous were more prone to exhibit a reaction of fear (p < 0.001), consequently leading to social distance (p < 0.01). However, the mediating effect of perceived dangerousness and fear on the relationship between familiarity and social distance was not significant (p > 0.05). The results of this study provide support for Corrigan's attributional model of stigma in the Chinese context. Contact-based interventions for stigma reduction should emphasize multiple elements of contact, including the quality of contact, rather than familiarity.

Effects of group identification and stigma resistance on affiliate stigma and empowerment among families of people with mental illness

ABSTRACT To explore effective overcoming strategies for the social stigma experienced by families of persons with mental illness (PWMI), this study examined the impact of group identification on affiliate stigma and empowerment, mediated by stigma resistance. The participants comprised 227 family members of PWMI who utilised services provided by community-based organisations in Korea. The finding of the study showed that sociodemographic factors, particularly education level, had a significant impact on empowerment. In addition, group identification was positively associated with stigma resistance. Furthermore, higher stigma resistance was associated with significantly lower levels of affiliate stigma and higher levels of empowerment. Moreover, group identification significantly indirectly affects affiliate stigma and empowerment by stigma resistance. These findings highlight the importance of social bonds and support in combating stigma, suggesting that active engagement in group-based advocacy and support groups can enhance empowerment for families of PWMI.

COVID-19 Pandemic and the Provision for Electroconvulsive Therapy and Other Non-Invasive Brain Stimulation in India: A Template for Future Pandemics.

The coronavirus disease (COVID-19) has emerged as a major public health concern worldwide. While containing the infection and caring for the ill has been a focus over the last 2 years, there has also been a burgeoning concern for mental health issues during this never-ending pandemic. The focus of health care machinery prioritized confronting and containing the pandemic that had majorly side-lined other aspects of public health. This also impacted persons with mental illness (PMI) requiring Electroconvulsive Therapy (ECT), an often essential and life-saving treatment and thus an essential procedure. ECT and other non-invasive brain stimulation (NIBS) services have seen a setback during this pandemic both in terms of its accessibility by the PMI and in effectively delivering its benefits by psychiatrists. In this article, we will be discussing the problems with provision and delivery of ECT services as well as other NIBS during this pandemic with a brief outline on the solutions for such with special focus on a developing country like India. This article will also endeavour in providing a roadmap in the delivery and provision of NIBS modalities of therapy for future pandemics, if any.

Stigma and discrimination among persons with mental illness in a tertiary care medical institution in Southern India.

The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Stigma and discrimination are major barriers to seeking treatment for persons with mental illness (PMI). Stigma reduction strategies are thus crucial, and for this, there needs to be an understanding of the various factors associated with them. The current study intended to assess stigma and discrimination in PMI visiting the department of psychiatry in a teaching hospital in Southern India and their association with various clinical and sociodemographic factors in them. The index study was a descriptive cross-sectional study involving consenting adults who presented to the department of psychiatry with mental disorders from August 2013 to January 2014. Socio-demographic and clinical data were collected using a semi-structured proforma, and the Discrimination and Stigma Scale (DISC-12) was used to assess discrimination and stigma. Most of PMI suffered from bipolar disorder, followed by depression, schizophrenia, and other disorders, such as obsessive-compulsive disorder, somatoform disorder, and substance use disorder. Discrimination was experienced by 56% of them and 46% had stigmatizing experiences. Both discrimination and stigma were found to be significantly associated with their age, gender, education, occupation, place of residence, and illness duration. While PMI suffering from depression experienced the highest discrimination, those with schizophrenia faced the stronger stigma. Binary logistic regression revealed depression, family history of psychiatric illness, age of less than 45 years, and rural locality of residence to be the significant determinants of discrimination and stigma. The study thus found that stigma and discrimination were associated with multiple social, demographic, and clinical factors in PMI. A rights-based approach to PMI is the need of the hour to tackle stigma and discrimination, which is already included in recent Indian acts and statutes. Implementation of these approaches is the need of the hour.

Development and Validation of Clinical Schedule for Primary Care Psychiatric Nursing (CSP-N) for Primary Care Nurses.

As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community.

The ‘Criminalization’ of the Cop: How Incremental, Systematic Flaws Lead to Misunderstanding Police Calls for Service Involving Persons with Mental Illness

Abstract Recently, there has been an increased push for the adoption of alternative responses to policing. With mental health calls, these efforts take the form of co-responder models, in which mental health professionals respond to calls alongside police, or more recently behavioural health teams that respond alone. For any alternative, it is important to understand the prevalence of the problem, here measured as the volume of calls. However, measuring calls involving persons with mental illness (PwMI) has been historically problematic due to data ambiguity and missing context. We partner with the Burlington Police Department in North Carolina to better identify the full universe of calls involving PwMI. Using supplementary data sources and mental health keyword identification, we find that less than half of all calls involving PwMI are identified as such in the original call. Understanding the full universe of calls has implications for resource allocation, decisions to adopt alternate responses, and providing context for the current state of interaction between police and the population of PwMI.

Responding to persons with mental illness (PWMI): Police recruit perceptions of mental health response training and engagement

Many Australian police organisations embed mental health response training (MHRT) into their recruit training packages. Yet critics argue police officers are under-trained and ill-equipped to engage with persons with mental illness (PWMI) in crisis, and officers frequently police PWMI using discretional techniques that are procedurally unfair and unjust. Applying a procedural justice lens, this research sought to better understand whether MHRT offered by one Australian state police organisation (de-identified as part of the ethics agreement) equips its recruits to engage appropriately with PWMI in future practice, and whether the MHRT effectively prepares recruits to use procedurally fair policing techniques when responding to PWMI in crisis. Conducting semi-structured interviews with recruits upon completion of the MHRT, this research determines that recruits are aware of their lack of knowledge regarding policing PWMI in crisis and are concerned that they may engage in differential policing because the MHRT has under-prepared them for future policing practice.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

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Background:Employability prospects for persons with mental illness (PMIs) in India remain limited. E.g, new job opportunities and accommodation in already existing frameworks are scarce, and public action to reduce stigma for these persons is scarce too. Although India ratified The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) on 01 Oct 2007, there are discriminatory and unlawful national policies which have provisions in contradiction to those of UNCRPD related to employability of PMIs.Aim:This study aims to assess employability prospects of PMIs in India as per current legislation and policies, using UNCRPD as a guideline.Materials and Methods:This paper is a review of national laws and policies in India, on employability prospects of PMIs, using UNCRPD as a guideline. This study looks mainly into Article 27 of UNCRPD (‘work and employment’ rights of persons with disabilities) in relation to the Rights of persons with Disability (RPWD) Act, 2016 in India.Findings:RPWD act 2016, has various loopholes utilizing which, Government as well as private sectors continue discriminatory practices with regards to PMIs. Provision of exemption from various sections on the matter of work and employment of disabled persons (including PMIs) in the Act is a potential area for discriminatory practices. This does not gel very well with ethos of UNCRPD on the matter of work and employment.Conclusion:Persons with psychosocial disability have to deal with various challenges such as critical and stigmatizing attitude at workplace. When top-down approach is non-discriminatory, it improves attitude of general public too, towards persons with mental illness and their capability to work.

List of essential psychotherapeutic medicines 2019 of India: When science was left behind.

List of essential psychotherapeutic medicines 2019 of India: When science was left behind.

Prevalence and correlates of negative disposition to marital homogamy among a sample of psychiatric outpatients in Nigeria

Objective: Persons with mental illness (PWMI) have reduced chances of getting married to individuals without mental illness, yet, so much controversy surrounds the propriety or otherwise of a psychiatric patient marrying another psychiatric patient (marital homogamy). The factors that are associated with patients' disposition towards homogamy have received little attention from researchers, creating a gap in literature. In this study, I intended to examine the proportion of psychiatric patients that are negatively disposed towards marrying another psychiatric patient and to find the factors that are associated with their disposition. Methods: A descriptive cross-sectional design was used, and participants included 208 consecutive attendees at the psychiatric outpatient clinic of a tertiary hospital in Benin City, Nigeria. Data were collected from the participants using a sociodemographic data collection sheet and three standard instruments - the Bogardus Social Distance Scale, the World Psychiatric Association Stigma Questionnaire, and the Brief Psychiatric Rating Scale. Results: About two-thirds of the patients (67.3%) were not willing to marry a psychiatric patient, citing concerns about heredity of mental illness; potential financial difficulty and lack of social/spousal support; and perceived dangerousness of psychiatric patients as the reasons. About two-thirds of them desired moderate to high social distance from another psychiatric patient. Three factors - the desire for low social distance (p < 0.001), belief that marriage is a necessity in life (p < 0.001), and belief that people with mental illness who recovered are eligible to marry (p < 0.001) - significantly differentiated between patients who were willing to marry a psychiatric patient and those not willing. Conclusion: Many patients in this study expressed a negative disposition toward marrying a psychiatric patient, yet previous researchers reported that they have reduced chances of marrying persons without mental illness. Appropriate intervention to address the factors that are related to their negative disposition may change their disposition and increase their chances of getting married, either to a nonmentally ill individual or a PWMI if they must not remain single all their life.

Management of issues relating to marriage, mental illness, and Indian legislation.

Management of issues relating to marriage, mental illness, and Indian legislation.

Internalized Stigma in Persons With Mental Illness in Qatar: A Cross-Sectional Study.

Stigma impacts persons with mental illness (PWMI), their families and network of friends, the public and health care professionals. Stigma is a major barrier for PWMI to seeking treatment, which contributes to the burden of disease, disability, and mortality. Research on stigma is relatively scant in the Middle East region and particularly in Qatar. To address stigma effectively in each culture, it is essential to study its nature in the context where the PWMI experience stigma. The purpose of this study was to assess the prevalence of internalized stigma in PWMI in Qatar. A cross-sectional study of PWMI receiving outpatient mental health services in Qatar was done. We interviewed 417 PWMI using a modified 18-item version of the short form of the Internalized Stigma of Mental Illness (ISMI) Scale. Descriptive and regression models were used to analyze the data. The Cronbach alpha for the modified 18-items ISMI was 0.87. Participants' average score on this scale was 2.07 ± 0.38 with 41 (9.8%) of them scoring more than 2.5 which is considered “high” stigma score. In multivariate logistic regression, high stigma (modified ISMI score >2.5) was significantly higher among PWMI with no formal education and among those who reported lower levels of social support. The reported levels of internalized stigma in this vulnerable population of Qatar fall at the lower spectrum reported worldwide. An anti-stigma education program designed for the context of Qatar emphasizing on education and support for PWMI may be conducive to creating an all-inclusive society.

Does the crisis intervention team (CIT) training improve police officers’ knowledge, attitude, and mental health stigma?

IntroductionThe Crisis Intervention Team (CIT) training was developed to educate police officers regarding the complexity of mental health (MHI) issues, and better prepare them for crisis encounters with persons with mental illness (PwMI).ObjectivesTo determine if CIT training improves police officers’ knowledge, attitude, and stigma about mental health issues.MethodsA systematic review followed the PRISMA protocol and was conducted on the PubMed database (Figure 1). Search strings were “crisis intervention team training,” “crisis intervention team,” “CIT,” “effectiveness,” and “police.” Inclusion eligibility required primary studies using surveys that measured the CIT training outcomes (i.e., knowledge, attitude, and stigma). Literature/narrative reviews or opinions were excluded.ResultsThe comprehensive meta-analysis software version 3.0 was utilized during analysis. Randomized odds ratios using a 95% confidence interval (CI) were obtained. Officers’ scores for knowledge, attitude, and stigma about MHI were taken before and after the survey. The Control group consisted of officers without CIT training. The CIT trained officers displayed an improvement in knowledge (OR 2.35, CI: 1.51– 3.67), attitude (OR 2.55, CI: 1.36–4.78), and stigma (OR 3.11, CI: 1.88–5.17). The results were statistically significant, with a p-value of less than 0.001 (Figure 2).ConclusionsCIT trained police officers displayed a significant improvement in their knowledge, attitude, and reduced stigma towards PwMI. Although our study displays CIT training’s positive effects, previous studies reported a nullified effect of CIT in reducing arrests and the use of force during police officers encounters with PwMI. Future researchers must explore this gap, mainly focusing on gender and race bias.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

Clientele's attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru. The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann-Whitney U test was computed to see the association and differences on selected variables. The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains. PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.

Police Responses to Persons with Mental Illness: The Policy and Procedures Manual of One Australian Police Agency and ‘Procedural Justice Policy’

Persons with mental illness (PWMI) often report negative perceptions of police treatment following receiving criminalising and heavy-handed police responses. To appropriately control officer discretion and to harness ethical, legal, and efficient police practice when encountering vulnerable and diverse individuals, police agencies across the world issue policy documents to their officers. These documents serve as a reflection regarding how police agencies aspire to manage PWMI in the community. Using a procedural justice framework, this research measures how a large police agency in Australia aspires to manage PWMI and whether the police policy document provides sufficient detail in advocating the appropriate and just police treatment of PWMI. A content analysis of the policy document revealed a lack of sufficient procedural guidelines in effectively controlling police officer discretion when encountering PWMI in the community. This article argues that without further consolidation to embed appropriate procedural guidelines into the policy document, the procedural policy gaps may have a negative effect on the experiences of PWMI when encountering the police.

The limits of our knowledge: tracking the size and scope of police involvement with persons with mental illness

Significant public discourse has focused recently on police–civilian interactions involving with persons with mental illness (PMI). Despite increasing public attention, and growing demands for policy change, little is actually known about the myriad of ways in which Canadian police encounter PMI in the context of routine police work. To assist policymakers in developing evidence-informed policy, this paper attempts to shed light on present difficulties associated with addressing fundamental questions, such as the prevalence of mental health related issues in police calls for service. To do this, we attempt to map the size and scope of police calls for service involving PMI, drawing on both the available scientific data and the limited knowledge to be gleaned from available police reports. Our focus is on two broad categories of police interactions with citizens: public safety concerns (wellness checks, suicide threats, missing persons, mental health apprehensions) and crime prevention and response (encountering PMI as victims–complainants and (or) as potential suspects). We also explore the challenges policy-makers face in relying on police data and the importance of overcoming weaknesses in data collection and sharing in relation to the policing of uniquely vulnerable groups. This paper concludes with some key recommendations for addressing gaps highlighted.

Perception of Nursing Students on Recovery of Persons with Mental Illness

The concept of recovery assumes various meanings, depending on the context in which it is raised. The present study aimed at exploring the perceptions of the nursing students about recovery of persons with mental illness (PwMI). Based on convenience sampling and their willingness, 460 undergraduate (UG) and postgraduate nursing students from 85 colleges of nursing in India who came for Psychiatric Nursing clinical experience at the study institute, which is a tertiary care psychiatric institute in South India between May 2017 and December 2018, took part in the study. A semi-structured, self-administered questionnaire was distributed to the students. The data were analysed using statistical software (SPSS 22 version) and P &lt; 0.05 was considered as the level of significance. Majority (86.5%) of the students were females and UGs (77.6%). Among them, 4% had a family history of mental illness. More than half (54.1%) of the students had experience of taking care of PwMI. Results revealed that more than three-fourth (76.1%) of the students had used the term 'recovery' in the psychiatric setting. Majority of them agreed that early detection of mental illness helps in recovery (90.4%), and patient's self-confidence can be increased by keeping him/her busy and engaging in meaningful activities (91.1%). However, nearly 70% agreed that isolating patients with mental illness from family/friends/support groups can be a barrier to recovery. The study provides the preliminary findings of the perception of nursing students on recovery from mental illness. The study has implications on improving the perception on the recovery of PwMI and the need for educating the public on mental illness.

Police Perceptions of Training on Interactions with Persons with Mental Illness

Persons with mental illness (PMI) often come into contact with police, sometimes simply because their mental illness is manifesting in their behaviors. At the same time, many officers in the USA lack the proper training to handle situations involving PMI, which can result in deadly outcomes. Police need effective training in mental health education and de-escalation techniques for interactions with PMI. However, little is known about whether officers are receiving the training they believe they need. The purpose of this study is to explore police officers’ perceptions on whether the training they have received is helpful during situations with PMI. A sample of 217 men and women who are currently working in policing agencies in Pennsylvania were interviewed between February and April 2019. Results show that the majority (55.6%) of police officers surveyed frequently interact with PMI and only 21.8% of officers were trained in de-escalation techniques specifically for incidents involving PMI. Although officers felt prepared to handle situations, those who had more experience on the job tended to feel more prepared to handle such situations (p < 0.10).