A Comparative Study to Assess the Level of Attitude Towards

A COMPARATIVE STUDY TO ASSESS THE LEVEL OF ATTITUDE TOWARDS

MENTAL ILLNESS AMONG THE CARETAKERS OF PATIENTS WITH ACUTE

MENTAL ILLNESS AND CHRONIC MENTAL ILLNESS IN SELECTED

PSYCHIATRIC HOSPITAL AND COMMUNITY AREA AT BANGALORE

M.Sc Nursing Dissertation Protocol submitted to

RajivGandhiUniversity of Health Sciences, Karnataka, Bangalore

By

MR.LEJUWILSON.J

M.Sc NURSING 1ST YEAR: 2010-12

Under the Guidance of

HOD, Department of Mental Health Nursing

NightingaleCollege of Nursing

Guruvanna Devara Mutt

Near Binnystongarden

Magadi Road

Bangalore.

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE,

KARNATAKA

CURRICULAM DEVELOPMENT CELL

CONFORMATION FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Registration number :

Name of the candidat : Mr LejuWilson.J

Address : Guruvanna Devara Mutt, Near Binnyston

Garden, Magadi Road, Bangalore-23

Name of the institution : Nightingale College of Nursing

Course of study and subject:M.Sc. Nursing in MentalHealth Nursing.

.

Title of the topic : A comparative study to assess the level of attitude

towards mental illness among the caretakers of

patients with acute mental illness and chronic mental

illness in selected psychiatric hospital and community

area at Bangalore.

Date of admission to course : 20-05-2010

Brief resume of the intended work : Attached

Signature of the student :

Guide Name : Ms.Archana. M.Sc(N)

.

Remarks of the guide :

Signature of the guide :

Co-guide name :

Signature of co-guide :

HOD name:

Signature of HOD :

Principal Name :Mrs.Jayakadambari

Principal Mobile No:09886367287

Principal E-mail ID:

Remarks of the Principal:

Principal signature:

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE`

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MR.LEJUWILSON.J
I YEAR M.Sc. NURSING,
NIGHTINGALECOLLEGE OF NURING
GURUVANNA DEVARA MUTT, NEAR BINNYSTONGARDEN,
MAGADI ROAD
BANGALORE-23
2 / NAME OF THE INSTITUTION / NIGHTINGALECOLLEGE OF NURING, GURUVANNA DEVARA MUTT, NEAR BINNYSTONGARDEN, MAGADI ROAD,
BANGALORE-23
3 / COURSE OF STUDY AND SUBJECT / M.sc nursing IN MENTAL HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE
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8.0 / TITLE OF THE TOPIC:
“ A COMPARATIVE STUDY TO ASSESS THE LEVEL OF ATTITUDE TOWARDS MENTAL ILLNESS AMONG THE CARETAKERS OF PATIENTS WITH ACUTE MENTAL ILLNESS AND CHRONIC MENTAL ILLNESS IN SELECTED PSYCHIATRIC HOSPITAL AND COMMUNITY AREA AT BANGALORE”.
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
Mental illnesses can be defined as” real and involve disturbances of thought, experience, and emotion serious enough to cause functional impairment in people, making it more difficult for them to sustain interpersonal relationships and carry on their jobs, and sometimes leading to self-destructive behavior and even suicide”.
Psychiatry involves theories of the mind, theories of the causes of mental disorders, classification schemes for those disorders, research about the disorders, proven treatments and research into new treatments, and a number of professions whose job it is to work with or on behalf of people with mental disorders. The philosophical study of psychiatry discusses conceptual, ethical, metaphysical, social, and epistemological issues that arise in all these aspects of psychiatry. Central to this study is the nature of mental illness.
The central philosophical debate over mental illness is not about its existence, but rather over how to define it, and whether it can be given a scientific or objective definition,
or whether normative and subjective elements are essential to our concept of mental illness. One desideratum for a successful definition of mental illness is that it will settle debates over particular purported mental illnesses.
The connection between philosophical issues in the study and treatment of mental illness and these other areas of philosophy is in many cases obvious, as in the question of when and how people with mental disorders are responsible for their actions is connected with the insanity defense in law, and the more general debate over the justification of punishment. The philosophical investigation of the nature of mental illness is therefore relevant to many other areas of philosophy. While there is no sharp divide between the philosophical discussion of the nature of mental illness and the wider philosophical discussion of psychiatry, we can focus on four major issues that have preoccupied the philosophical literature.
According to National Alliance for Mental Illness III, twenty-three percent of North American adults will have a mental illness in a given year. But less than half of them will be had enough to disrupt their normal activities. What we now call mental illness was not always treated as a medical problem. Descriptions of the behaviors now labeled as symptomatic of mental illness or disorder were sometimes framed in quite different terms, such as possession by supernatural forces. Anthropological work in non-Western cultures suggests that there are many cases of behavior that Western psychiatry would classify as symptomatic of mental disorder, which are not seen within their own cultures as signs of mental illness (Warner, 2004, p. 173). One may even raise the question whether all other
cultures even have a concept of mental illness that corresponds even approximately to the Western concept, although, as Kleinman (1988) points out, this question is closely tied to that of adequately translating from other languages, and in societies without equivalent medical technology to the west, it will be hard to settle what counts as a concept of disease.
NEED FOR THE STUDY:
A mental illness is an illness of the mind. People with a mental illness often behave in strange ways, or have strange thoughts, in the view of others. Certain mental illnesses seem to be there from birth, they are the result of a birth disorder; others develop during the life of a person. What is considered as a mental illness has changed over time. What is considered to be a mental illness may not be one in a different culture.
People with a mental illness often have problems dealing with other people, or leading what is called a normal life. Treatment and certain drugs can help people with certain mental illnesses lead a better life.
A study was conducted in three out of the five medical teaching institutions of Delhi. For the purpose of this study, a pre-tested, validated, 25-item, self-reported questionnaire assessed attitudes towards mental illness; knowledge about causes of mental illness, contact with mental illness and treatment modalities used. The questionnaire was distributed to interns, residents and medical officers working in these institutions. All the participants had exposure to psychiatry during their undergraduate curriculum. Purpose of the study was
explained and responses were kept anonymous to encourage candid opinions. Informed consent from each participant was obtained. Seventy-six medical professionals, as a convenient sample, were contacted to get their responses on the questionnaire. Only about 60% of the respondents considered mental illness to be a disease. Nearly 80% of the respondents considered psychiatry to be a difficult discipline. Despite this, it was seen that 72% found psychiatry to be a stimulating subject. The most heartening change observed was that now only 4% believed that psychiatrists do nothing and know nothing. However, it was also encouraging to note that 41% wanted to take up psychiatry9.
The mainstream view in the West is that the changes in our description and treatment of mental illness are a result of our increasing knowledge and greater conceptual sophistication. On this view, we have conquered our former ignorance and now know that mental illness exists, even though there is a great deal of further research to be done on the causes and treatment of mental illness. Evidence from anthropological studies makes it clear that some mental illnesses are expressed differently in different cultures and it is also clear that non-Western cultures often have a different way of thinking about mental illness. For example, some cultures may see trance-like states as a form of possession. This has led some to argue that Western psychiatry also needs to change its approach to mental illness. (Klein man, 1988, Simons and Hughes, 1985) However, the anthropological research is not set in the same conceptual terms as philosophy, and so it is unclear to what extent it implies that mental illness is primarily a Western out come.
A study was conducted to reveal a significant difference in attitudes toward people with mental illness compared to attitudes toward people with physical disabilities(Neil H. Penny) At the end of occupational therapy education, attitudes toward people with mental illness were more favorable than at the start of course work, but less so than those towards people with physical disabilities. Attitudes changed in a negative direction after a level I mental health fieldwork. Academic course work was more effective in producing favorable attitudes for participants whose initial attitude was least favorable, and level II fieldwork was most effective in achieving favorable attitudes for participants whose initial attitude was in the mid-range. Favorable attitudes towards people with mental illness were not predictive of first10.
A health study was conducted in Malaysia, the intervention systems for mental and social deviants operate through two distinct channels: in one, primarily medical and psychiatric, the village folk healer (bomoh) plays a pivotal role; in the other, for the criminal and insane the village headman (ketua), police, and higher government officers are most influential. When the folk system of response to crises is insufficient, then these extraordinary caretakers become involved. However, folk healers are gradually being discredited, and a lack of trained mental health personnel to fill their roles and a tendency to incarcerate harmless urban deviants are becoming apparent.11
In India, families represent the key resource persons in the care of patients with chronic mental illness. Families are assigned the role of primary caretakers for two reasons. First, there is a paucity of trained professionals required to execute psychosocial interventions and second, most Indian families would like to be meaningfully involved in all
aspects of care of their ill relative.Social stigma and misconception often prevent the family from seeking proper assistance. The different ways in which families view, interpret and cope with psychiatric disorders, the role of religion and traditional treatments as well as how culture might shape the attitudes of service providers in psychosocial rehabilitation should be borne in mind. The families want understanding of the symptoms, specific suggestions for coping with clients' behavior and relating to people with similar experiences.Significant family members need persuasion to erase ignorance and to get educated to help themselves by utilizing available facilities. Families need to be convinced that, in addition to clinical treatment, rehabilitation programmes bring the client into the mainstream of society. Family interventions have assumed greater importance as a result of the shift of clients from the hospital to the community. The process of care and rehabilitation often takes a long time and places heavy responsibilities and financial constraints on the family. Caregivers need coping
skills, social support and active engagement in the educational process. They are encouraged by involving them as collaborators at all stages of treatment. As much as possible, empirically validated treatment principles drawn from the clinical psychiatric literature are used in psycho education, carefully modified to the level of comprehension of laypersons.
Family psycho educational interventions can help family members cope with various distressing symptoms. Studies show that family psycho education programmes have significant benefits in areas other than symptom and relapse management for the family member with a chronic psychiatric disorder. When psycho education and skills training are conducted in a multiple family group format, family burden is lowered and relatives' sense of self-efficacy regarding the ill family member improves. Participating in a multiple family
group meeting can reduce the stress, isolation and stigma experienced by family members; the burden of care no longer seems unique, and families can exchange helpful suggestions and coping techniques with each other. Evaluation of the clinical effect of multiple family group meetings suggests that the format may be at least as effective as single family psycho education in reducing relapse. Family intervention increases the level of the patient's social competence, decreases the subjective burden on relatives, changes the communication pattern and the overall interaction within the family.
Not many studies have been done regarding the attitudes the mental illness. The present study is primarily designed to assess the attitude of . Based on literature and investigatorsexperience it is felt that, it is essential to assess the attitude of . So, I planned to assess the attitude towards mental Illness amongthe caretakers of patient with acute mental illness and chronic mental illness in a selected psychiatric hospital and community area at Bangalore.
REVIEW OF LITERATURE:
“Review of literature is a critical summary of research on a topic of interest often prepared to put a research problem in a context or as the basis for an implementation project”.Review of literature is an essential part of the study. This helps the researchers to formulate hypothesis, aims and objectives of the study. It gives some idea how to assess the
problem and to adapt suitable methodology.
The review of literature attempts to cover the broad areas of requirements of this study are
assessment of perceived benefits and difficulties among caregivers of persons with mental illness: Persons with schizophrenia and those with bipolar mood disorders with associated psychosocial problems and on maintenance medication were identified at the Psychiatric Rehabilitation Unit of the Department of Psychiatry, FatherMullerMedicalCollege. Significant caregivers of the identified patients were informed about the group meeting. Group meetings were conducted for about 45 minutes once a month for caregivers of patients with schizophrenia and bipolar mood disorders. Data regarding the psychosocial aspects of caregivers were collected before entry to the meeting and after 17 months of their participation. Participants who attended the meetings irregularly were excluded from the study. The group meetings led to effective monitoring of the functioning of individuals, a reduction in the subjective family burden and family distress, a better support system with adequate coping skills and good compliance with treatment programmes.Conducting regular group meetings for a homogeneous population at a GHPU is feasible and beneficial.2
A study was conducted to assess the attitude towards mental illness: With the advent of community psychiatry, the pressure of care of the mentally ill will increasingly fall on the family and the community. In order for this transition to succeed, it is important to bear in mind the attitudes of the community and the caregivers. This article reviews the literature on public attitudes and suggestions are made for future research and lessons to be learnt from the experience in North America.3
A study was conducted to assess the attitude towards mental health services: age-group differences: The present study examined the attitudes toward mental health services held by younger (aged 20-45, n = 209) and older (aged 60 and older, n = 462) groups of Korean Americans. Following Andersen's (1968; A behavioral model of families' use of health service, Center for Health Administration Studies) behavioral health model, predisposing (age, gender, marital status and education), need (anxiety and symptoms) and enabling (acculturation, health insurance coverage and personal experience and beliefs) variables were considered. In the mean-level assessment, younger and older adults were found to hold a similar level of positive attitudes toward mental health services. In the multivariate analysis, culture-influenced beliefs were shown to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was found to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among
those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Our findings show that older adults are not only more subject to cultural misconceptions and stigma related to mental disorders, but also their attitudes toward service use are negatively influenced by the cultural stigma. The findings provide important implications for interventions targeted to improve access to mental health care among minority populations. Based on the similarities and differences found between young and old, both general and age-specific strategies need to be developed in order to increase effectiveness of thesePrograms.4
A study was conducted to assess the attitudes of mental health professionals towards patients with mental illness: Culture plays a vital role in shaping public and professional attitudes towards mental illness. In Arab cultures negative attitudes toward patients experiencing mental illnesses are common. There is a lack of studies that investigate the attitudes of professionals towards patients in inpatient mental health settings. This study aimed to assess the attitudes of professionals towards patients with mental illnesses in the only psychiatric hospital in Palestine. A survey was undertaken using the Attitudes toward Acute Mental Health Scale (ATAMHS 33). The scale was distributed to a variety of professionals at the only psychiatric hospital in Bethlehem. Data was managed and analyzed by using SPSS 15 (a statistical package for social sciences). Theparticipants (mostly nurses) expressed both negative and positive attitudes toward patients, however, results revealed more negative than positive attitudes, particularly in relation to alcohol misuse, medication, patients' ability to control their emotions, and genetic predisposition to mentalillness. This paper provides baseline data about the attitude of mental health professionals towardspatients experiencing mental illnesses. Education and direct contact with patients with mental illness may not be enough to foster positive attitudes towards them. This may indicate the need to revise educational curriculum at the Palestinian universities and offer more training for mental health professionals in order to change their attitudes.5