PROFORMAFOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING HUMAN RIGHTS OF MENTALLY ILL PERSONS AMONG ADULTS IN A SELECTED URBAN AREA, TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”.
SUBMITTED BY:
Mr. SHIBU JACOB BABY
IST YEAR M.Sc. NURSING,
MENTAL HEALTH NURSING,
SHRIDEVI COLLEGE OF NURSING
TUMKUR
2010 - 2012.
RAJIVGANDHIUNIVERSITYOFHEALTHSCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS. / Mr.SHIBU JACOB BABYSHRIDEVI COLLEGE OF NURSING,
SIRA ROAD,
TUMKUR.
2 / NAME OF THE INSTITUTE / SHRIDEVI COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / 1st YEAR MSc NURSING
MENTAL HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 15/5/2010
5 / TITLE OF THE TOPIC / A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING HUMAN RIGHTS OF MENTALLY ILL PERSONS AMONG ADULTS IN A SELECTED URBAN AREA TUMKUR, WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET
6.BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION
“The ability to be in the present moment is a major component of mental wellness”.
-Abraham Maslow
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.1
A mental illness is an illness of mind.People with amental illness often behave in strange ways or have strange thoughts, in the view of others. Certain mental illness seem to be their from birth, others develop during the life of a person.What is considered as amental illness has changed overtime.What is considered to be a mental illness may not be one in different culture.People with mental illness often have problems dealing with other people, or leading what is called a normal life.Treatment and certain drugs can help mentally ill people to lead a better life.2
Human rights are rights and freedoms to which all humans are entitled.Proponents of the concept usually assert that everyone is endowed with certain entitlements merely by reason of being human.Human rights are thus conceived in a universalist egalitarian fashion.Such entitlements can exist as shared norms of actual human moralities, as justified moral norms or natural rights supported by strong reasons or as legal rights either at a national level or within international law.2
The provisions relating to human rights of mentally ill patients have hitherto been neither specifically documented in any code or been prescribed or elaborated by Judiciary in India.But it is admitted on all hands that bearing few expectations. The mentally ill persons deserves the same privileges as enjoyed by any other human being.They include a right to better and more accessible care,to good recovery and increased hopes of reintegration into society.However the stigma,residual disability and it’s intolerance,ability of mentally ill, to protest against exploitation,have all made basic human rights of the mentally ill,a major cause of growing concern.The term human rights in a broad sense mean” those claims which every individual has or should have upon the society in which he or she lives.3
“According to Richard Wasseerstorm,human rights of a mentally ill patient means,one ought to beable to claims as entitlements those minimal things without which is impossible to develop ones capabilities and to live life as human beings.Thus human rights is about balancing the rights of all of us context of mentally ill persons,it not only refers to their privileges but remedial right of protection against infringement of their human and other statutory rights. However the human rights of mentally ill persons should be ensured by the society.3
For the promotion of human rights of mentally ill persons,users who have already benefited from their experiences should encourage and motivate the self help groups and parent groups.Besides,awareness about the rights of mentally ill person requires enhanced in public,media, personnel,law enforcement personnel and care givers.Media also have a major role in the promotion of human rights of mentally ill persons.4
“Freedom means you are unobstructed in living your life as you choose.Anything less is a formofslavery”.
--Wayne Dyer
6.1 NEED FOR THE STUDY
“ Begin to see yourself as a soul with a body rather than a body with a soul” -- Wayne Dyer
In many hospitals in India, there are anecdotal reports of violation of human rights of the persons with mental illness. Human rights, nothing more than entitlement due legally and morally,to an individual. All human beings are born free and equal in dignity and rights.
Everyone has the right to astandard of living, adequate for the health and wellbeing of himself and his family including food,clothing,housing and medical care and necessary social services.The mentally ill have the fundamental/ human right to receive equality mental health care and to humane living conditions in the mental hospitals and in the community.
On the contrary, the mental illness has not got enough attention by the state in health policy and programmes.The people are derived from the right to treatment and health services.Only hospitals for mental health and some district hospitals are main sources of treatments.5
People with mental illness tend to lose their rights in two ways.First,the problems with which they are.Coping require energy,so much energy,that sometimes reality eludes them.Second,the organization of the mental health delivery system can impose limits on client’s abilities to exercise their rights.In addition many mental health clients are not able to recognize their right ,much less exercise them.To protect the rights of these vulnerable people,the Mental Health systems Act Bill of Rights was passed by the US congress in 1980.This bill served as a pattern from which state bills of rights for the mentally ill were developed.7
In India,25 psychiatric patients were burned to death in Erwadi a district belongs to Tamilnadu in2001 when a fire swept the traditional healing shrine.Most of the 46 inpatients had been chained to their beds.Erwadi was considered a centre for religious observation and pilgrimage, and in the course of their treatment patients were frequently” caned,whipped,and beaten”- driving away the evil during the day they were tied to trees with thick ropes- at the night they were tied to their beds with iron chains.3
A cross sectional survey was conducted on Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. The survey was conducted on 240 samples with the help of questionnaire. Samples were presented with 2 group; one group describing the attitudes towards symptoms of mental disorder and other describing the attitude to measure stigma related to mental disorder. The results revealed that majority of samples did not agree that mental illness is a ‘real medical illness’. Thus the study concluded that promotion of bio-medical explanation for mental disorders is essential to exacerbate discriminating attitudes towards mental disorder21
Constitution of India provides all those human and fundamental rights which are guaranteed to each and every citizens,to the extent there disability do not prevent them from enjoying those rights or their enjoyment is expressly or impliedly barred by the constitution or by any other statutory law.The constitution of India provides fundamental or human right to receive equality mental health care and to human living conditions.3
According to current statistics made by NIMHANS,about 2 to 5% of Indian population suffers, some form of mental or behavioral disorders.Around 1% has a serious form of mental disorder requiring urgent care at any one point of time.Not less than 10to15% of those attending general health facilities have acommon mental disorder.There are around 400,000 wandering mental patients in India. They are often seen in bus stands,railway stations,pilgrim centers and on street corners.The wandering mentally ill belong mainly to economically backward and socially marginalized families.9 out of 10 have diagnosable and treatable mental disorders.6
As the investigator’s experience in the past, during the community postings noticed a mentally ill patient being harassed and tortured by the local people,as they lacked knowledge regarding rights of mentally ill people.As a post graduate student,the researcher feels that extensive program should be conducted to impart knowledge regarding mental health rights to the public.
So that society has a major role in the protection and promotion of rights of mentally ill people.There is a need for continuous education program regarding protection andpromotion of mental health.
“Everything you are against weakens you. Everything you are for empowers you”. Wayne Dyer
6.2 REVIEW OF LITERATURE
BenerA et.al.(2010)conducted a study on “gender differences in the knowledge,attitude and practice towards mental health illness”A cross sectional survey was used to determine the gender differences in knowledge, attitudes and practice towards mental illness, among people residing in state of Qatar.Researcher used a multistage sampling design with 3300 people.In that 2514 subjects(76.2%) participated in the study.Researcher collected data through a self report questionnaire.The result revealed that men had a better knowledge,attitude and beliefs towards mental illness than woman.The findings highlighted that,recognition of common mental disorders was very poor in men and women,but men had a better attitude or perception towards mental illness when compared to woman.8
Jain M et.al.(2009)conducted a study on “Oral health status of mentally disabled”to determine the oral health status and investigate the association of oral health status with various socio-demographic (age, gender, parent's education, income) and clinical variables (etiology for mental disability and IQ level) among mentally disabled subjects. Researcher used 225 mentally retarded subjects aged 12-30 years attending a special school in Udaipur, India. Researcher collected data on Caries status, oral hygiene status and periodontal status were assessed by DMFT Index, Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion and Community Periodontal Index, respectively. Chi-square test, one way analysis of variance (ANOVA), multiple linear stepwise regression analysis, and multiple logistic regression analysis were employed for statistical analysis. There was a statistically significant difference (P = 0.001) between all the age groups in all the variables of Oral hygiene index and DMFT index. The study revealed that the oldest age group had the highest scores for all the indices measured. Having Down's syndrome, parents with lower educational status and low I.Q, were the most important predictors for poor oral health status. Researcher concluded that the oral health status of this mentally retarded population was poor and was influenced by etiology of the disability, I.Q. level, and parent's level of education.9
Sawicka M et.al. (2008)conducted a study on“the meaning of the consulting trade place in breaking through mental illness.”to show the effects of the Trade place for people seeking employment “On the way to work”,inorder to stimulate mentally ill people to lead a socially acceptable life.Researcher collected data from 215 people throughout 1year especially Schizophrenic patients.Results revealed that the willingness to live increases and so does faith in normal functioning,this change occurred due to an improvement in their financial situation,and by implication the improvement of the family relations.Thus the researcher concluded that,it is a new and original method of helping mentally ill persons who are trying to overcome theexisting disability.10
Lawska W et.al.(2006)did a study on,“the mentally ill:the way they perceive their own illness and their expectations from their relations in the society”.Researcher conducted the study to show how the mentally ill perceive their illness as well as specify the patient’s expectations concerning with other healthy people in the society. Researcher collected data by questionnaire,52 patients were participated in the study.Results of the study revealed that all of them were aware of their illness although the research was held during the lighter phase of disease or it’s remission.Thus the study concluded that the ill perceived their disease as a burden and obstacle to fulfill their principal aims also endangered negative emotional reactions in them and significantly impaired the quality of their life.11
Menard I et.al.(2006)conducted a study on“Canadian psychiatrist’s attitudes,practices and knowledge regarding fitness to drive in individuals with mental illness”.The objectives of the study was to assess current attitudes, practices and knowledge of Canadian psychiatrists regarding fitness to drive in individuals with mental illness,and variations according to provincial legislation. The researcher collected data using a cross-sectional survey by using random sampling, 248 psychiatrists participated.The response rate was 54.2% on traced subjects,64.1% strongly agreed or agreed that addressing patient’s fitness to drive is an important issue.18% of respondents were always aware of whether their patients were active drivers.One fourth strongly agreed or agreed that they are confident in their ability to evaluate.In discretionary provinces 29.3% of psychiatrists are unaware of provincial legislations,14.6% of psychiatrists in mandatory provinces are also unaware.54% from discretionary provinces &2.8% from mandatory provinces gave incorrect answers.Thus the study concluded that,there is a clear need for education and guidelines to assist psychiatrist in decision making in driving fitness.12
Passmore K et.al. (2003)conducted a study on “psychiatrists knowledge of the Human Rights Act and it’s prevalence to mental health practice”.The objective of the study was to assess psychiatrists knowledge of the Human Rights Act and examine whether difference in knowledge acquired is related to seniority or experience.Researcher collected data by sending questionnaires to 154 psychiatrists.Both factual knowledge of Human Rights Act and their ability to apply it to clinical scenarios.Results revealed that,96 psychiatrists responded and they demonstrated good overall knowledge and ability to apply the Human Rights Act;and half of them were not aware.The scores of the psychiatrists who had detained atleast one patient under Mental Health Act 1983 over the last six months were significantly higher than those who had not.Thus the study concluded that,there is a still need for further training on relevant aspects on Human Rights Act.13
Kathryn M et.al. (2003)conducted a study on “prevalence and experience on harassment of people with mental health problems living in community.”The objectives of the study was tomeasure the levels and experience of harassment experienced by people with mental health problems in the community.165 individuals with mental health problems and a control group of 165people from general population was surveyed.Result revealed that harassment was reported more in individuals with mental health problems(41%) than for those in general population(15%).Thus the study concluded that harassment has a significant higher prevalence among people with mental illness and is believed to have a detrimental effect on mental health.14
Roe D et.al. (2002)conducted a study on “patients and staff members attitudes about the rights of hospitalized psychiatric patients”.The objective of the study was to assess and compare patients and staff members attitudes about the rights of hospitalized psychiatric patients.The researcher collected data through a 31-item inventory.122 hospitalized psychiatric patients and35 staff members included in the study.The study revealed that there were no significant differences in attitude towards patient’s rights.Thus the study concluded that differences in attitudes found in the study highlight the importance of considering multiple facets of patients.15
Wolff G et.al.(1996)conducted a study on “ community attitude to mental illness”.The objective of the study was to find out the effect of public education on community attitudes towards mental illness.This controlled study was conducted in two areas prior to the opening of supported houses, for the mentally ill.Factor analysis of community attitude towards mental illness revealed three components:Fear and Exclusion,Social Control and Goodwill.The study results showed that the only determinants of Fear andExclusion was having children.Social control were social class,ethnic origin,age having suffered mental illness and having children.The main determinant of Goodwill was educational level.The attitude factors were predictive of respondents behavioral intentions towards the mentally ill,and the respondents with children were more likely to object to the mentally ill.Thus the study concluded that,any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children,as these groups are more likely to object.16