B760 Mental Health Nursing

Introduction:

Overview of the concept of stigma:

Stigma is considered to be present when people of the society view an individual in the negative ways. This is mainly because the individuals possess distinguishing personal traits and characteristics that are believed to be or actually are disadvantageous aspects of the society (Mao et al., 2016) . Expression of negative attitudes as well as beliefs towards a person having mental illness and accordingly showing behaving improperly with the person is considered to be an act of stigmatization. Stigma ultimately results in discrimination. Discrimination resulting from stigma might be obvious and even direct like someone making a negative remark about a particular mental illness or the treatment that the mentally ill people are undertaking (Richards et al., 2015). In other cases, stigmatization can result in discrimination that can be unintentional as well as subtle. This can occur when a person can avoid an individual with mental health disorder, as the individual might seem unstable to the person, violent, or dangerous due to his mental health illness.

Generalized anxiety disorder or GAD:

Generalized anxiety disorder or GAD is mainly characterized by persistent and excessive worrying about a number of different subjects and aspects that are not considered so much significant by others who are not affected by the disorder (Bandelow et al., 2015). Individuals who suffer from this disorder are seen to anticipate disaster and seem to be highly concerned about the money, family, work, health and many other issues. Such individuals find it extremely difficult to control their worrying behaviors (Hoge et al., 2018). They might be worrying more than seems warranted about actual events or they may be also expecting the worst when there are no such apparent cause for the concerns.

Symptoms:

 Some of the symptoms that remain associated with the disorder are persistent worrying or anxiety about different types of areas that might or might not affect lives and events. Issues in difficulty in handling uncertainty and indecisiveness and fear of making different kinds of wrong decisions are also some of the signs that show an individual is suffering from GAD. The persons are seen to face issues where they become unable to set aside or letting go off their worry, inability to relax and feeling of restless as well as developing feelings of being keyed up or on the edge (Ociskova et al., 2015). The people also face issues like difficulty in concentrating and go through the feelings where they feel completely bank.  Physical signs and symptoms are also present in affected individuals as this mental health issue affects physiological systems of individuals as well. They may suffer from fatigue and have trouble sleeping. They also suffer from different issues with muscle tension as well as muscle aches. Some of the other such symptoms are the nervousness or being easily startled and many others like tremendous sweating and trembling along with the feelings of twitching. Others are the nausea, irritable bowel syndrome and also diarrhea and other ittiability (Plummer et al., 2016).

Harmful effects of stigma on the affected individuals surviving with GAD:

Firstly, it has been found that individuals with Gad who are stigmatized may go through intense emotional problems about their inability to cope with stress issues when others similar to them are successful in coping effectively. This already affects their self-esteem and self-respect when they question their own abilities. They gradually lose their confidence on themselves ease of their inabilities to cope with different situations when others can cope successfully. Therefore, it results in huge emotional impact on them (Andrade et al., 2014). In such cases, stigma from other people further intensifies the situations when other people avoid them because of their mental health issues or state insensitive comments about their symptoms and sufferings. Therefore, these further impacts their confidence and self-esteem making them withdraw from socializing with others. Their main reason for withdrawal from others is to hide their symptoms and signs. Studies conducted have shown that affected individuals suffering from GAD gradually withdraw themselves from the society and other connections to prevent others from identifying their symptoms and discriminating them based on their mental health issues. Therefore, they are often seen to face social exclusion (O’Brien et al., 2017). These have humongous effects on their health gradually leading to conditions like depression as well as intensification of their anxiety issues. Secondly, studies have found that families, friends and relatives, coworkers and many close people lack proper understanding of the mental health issues of GAD that is faced by the individual. Therefore, lack of health literacy about the mental health issues of GAD make them undertake improper approaches or unintentional insensitive comments that make the patients feel discriminated and stigmatized and hence they go through feelings of intense pain and suffering that disrupts their relationship with their close near and dear ones (Hepgul et al., 2018). Third, such individuals are also seen to have fewer opportunities like in work, school as well as social activities and even they may face trouble while founding a house as stigmatization prevents society from giving those equal opportunities the affected individuals unlike to that of the unaffected individuals. Fourth, the individuals with such symptoms of GAD are found to be easily exposed to different forms of bullying as well as forms of harassments and physical violence due to stigmatization of the disorder by other people. Such instances might result in traumatic experiences by the affected individuals that worsen their sufferings (Grant et al., 2016). Fifth, studies have found that health insurances often do not cover the treatments of this disorder adequately and hence it can also have negative impacts on the individuals. Therefore, it can be easily understood how stigmatizations result in poor quality life of the affected individuals who already suffer from the negative impacts of the disorder.

Effects when mental health professionals are stigmatized:

Mental health professionals who are stigmatized can never ensure competent care to the patients. They can never develop therapeutic relationship with the mental health patients if they are themselves stigmatized. They will not be able to develop effective communication with the patients and hence this would hamper the trust and bond required for the patients to feel empowered and confident. The professionals would not be able to initiate the confidence among the patients about their own selves and this will affect the therapy sessions (O’Brien et al., 2017). Moreover, the patients will feel disrespected and dishonored and their help seeking behavior would reduce. They would also not comply and adhere with the advices of the professionals and their conditions would further worsen. Their dignity and autonomy would be affected.

Treatments and approaches for mental illness:

People suffering from mental health issues can develop strength as well as recovery through effective participation in different types of individuals as well as group treatments. One of the treatments is psychotherapy treatments. These are mainly provided by trained mental health professionals and mostly include talking therapies helping in emotional stimulation, changing thinking procedures, motivational developments and others. The second method is medication, which also help in balancing different chemicals in brain and controlling moods and emotions (Grant et al., 2016). The third issue is the case management, which coordinates services for an individual with the help of case managers who assess, plan, and implement a number of strategies to facilitate recovery. Another method is support group where each member in the group meetings guide each other towards the hared goals of recovery. Besides. Self-help plan, peer groyps and any other aspects are also present.

Impact of mental illness:

A person suffering from mental illness not only suffers from immediate symptoms of the disorders but the disorders also have severe impact on their emotional health and social lives. A person with mental illness suffers from stigma and discrimination from the society and this affects their self-esteem. As a result, they withdraw themselves suffering from social exclusion and they are also avoided by the society (Andersson et al., 2014). Apart from this impact of mental health on their social lives, they are also seen to suffer financially. They are not given employments by any organizations and hence their source of income gets affected making them suffer from poor financial stability. This adds to their mental, emotional as well as physical suffering. The caregivers of mental health patients also suffer from severe depression as most of their times need to be dedicated to the patient. They suffer from frustration, agitation as well as disappointments at certain points of time. However, some caregivers also face from guilt feeling that their patients are suffering because of their ability to care. Hence, mental illness can affect people in various ways.

Development of self-stigma:

As mentioned in the previous segment that pubic and societal stigma can impact the patients in various ways that affect their emotional stability and further intensifies their sufferings and pain and result in social exclusion and withdrawals. Public stigma mainly represents the various prejudices and discrimination directed by a group of the larger population towards the affected individuals. Prolonged exposure to this, often results in a particular condition where affected individuals develop self-stigma. Experts are of the opinion that self-stigma mainly occurs when affected individuals internalize the different types of public attitudes towards the symptoms of Gad displayed by them making tem suffer numerous negative consequences as the result. Ociskova et al. (2015) are of the opinion that self-stigma can be often equated with that of the perceived stigma. The latter can be defined as the thinking procedures of the affected individual where he believes that public holds prejudice against them and that they will discriminate them because of their mental illness label. He had further added that perceived devaluation and discrimination by the affected individuals often lead to diminished self-efficacy and self-esteem (Itzin, 2018). The self-model of self-stigma believes that this is the first stage of the progressive model.

A Stage Model of Self-Stigma:

It is extremely important for the mental healthcare professionals to understand the gradual development of self-stigma among people that are diagnosed with the mental health disorders like GAD. This would help them in devising interventions and care plans by which the individuals can be cared and managed effectively. The first stage is the awareness stage. In this stage, the person with the mental health issue becomes aware of the different public stigma about their condition (Andersson et al., 2014). The next stage is the agreement stage. In this stage, the affected individual is seen to agree that the different negative public stereotypes are true about him or her. The next stage is called the application stage. Here, the affected individual with the mental health disorder concurs that the different negative stereotypes indeed apply to him or her. This condition might lead to harming the patients resulting in significant decrease in the self –esteem and well as self-efficacy (Ridsdale et al., 2018).

Legislations and frameworks in the UK:

Mental Health Act 1983: Code of Practice usually provides constitutional direction to all the registered medicinal practitioners, managers as well as staff providers, permitted clinicians and other official mental health professionals about the ways by which they should carry out their functions  under the Mental Health Act in their practices. This Act mainly provides importance to the five of the guiding principles that mental health professionals need to follow strictly when making all the choices relative to care as well as support and treatment provided under the act. These should be mainly including the principles of least restrictive options and maximization of the independences (Greene et al., 2016). It also includes the principles of empowerment and involvement as well as respect and dignity. The other principles are the following of the purposes and effectiveness and the other one is the efficiency and the equity. The Health and the Social Care Act 2012 helped in introducing the first explicit recognition of that of the Secretary of State for Health and discussed about its duty towards both mental and physical health. This had helped in developing a commitment in the NHs constitution where NHS had taken the oath for designing effective diagnosis, treatment and improvement of both mental and physical health by recruitment of expert professionals. Similarly, in the year 2015, Government’s Mandate to NHS England, had declared “NHS England’s purpose is to plant mental health on a par through physical health”. The rules and regulations of all these acts need to be clearly read, understood and followed and incorporated in the care plans developed by the professionals so that high quality care can be ensured (Vallury et al., 2015). Another important law that should be followed is the Mental Health Discrimination Act published in 2013. It clearly states that discrimination of the people who are suffering from mental health problems should not be tolerated and could be even penalized. It helps in removing three legal barriers that are seen to be contributing to a stigmatized view of the mental health problems.

Method:

It is important to find out different articles that are based on the different interventions and strategies that have proved to be successful in managing patients with GAD who have faced severe discrimination and stigmatization. Therefore, evidence based search would be mainly conducted so that the strategies that are developed would be based on most recent and up-to-date interventions tested by different researchers through their experiments.  Online searches through electronic databases should be done. These databases would be the CINAHL, PUBMED, MEDLINE, GOOGLE SCHOLAR and many others. The inclusion criteria that should be included are that all the articles would be after the year of 2014an should be peer reviewed only. Moreover, they should be present in English language.  The different search terms that should be included are the “stigma faced by mental health patients”, “strategies for managing stigmatized patients”. “mental-health patients with Generalized anxiety disorders” and many others. Boolean operators like “AND” and “or” would be used as it helps in the permutation and combination of the different search terms and thereby increases the number of articles that satisfy the searches. It also helps in increasing the number of hits in each of the databases making articles that are more relevant available to the readers. Finally, the different important articles that align with the requirements and meet the criteria would be selected and accordingly they would be allocated for the report development.

Findings:

It has been found that almost 1 in every 6 people experience the common mental disorders like that of depression as well as anxiety. Generalized anxiety disorder was found to be most commonly identified in the year 2014 that were followed by different depressive episodes. It was found to be highest among the black and black British, followed by mixed interracial subjects that account for 20%. About 18% of the Asian and Asian British suffers from these common mental disorders followed by 145 in the other whites and about 17% of the white British.  A survey has found that almost 8 out of 10 mental health service areas in England experiences discrimination. Another data has suggested that one in every four people will be experiencing a mental health difficulty at certain spot in their lives and around one in every ten children face mental health troubles. A rate of self-harm in the nation was seen to be highest in Europe at 400 per 100000 and 450 million people worldwide have mental health problems. Most of them accounting for about nearly 60to 705 people are discriminated by the society.

Different types of interventions that can be applied:

Ociskova et al. (2016) had initiated the psycho-education strategies or that of psycho0education strategies with that of the cognitive restructuring techniques. Studies have shown that some of the investigators had tried to examine the effect of the printed materials only or that of materials used on the internet like that of brochures where some other investigators had used the effects of educational sessions that were delivered by a therapist or a trainer. These forms of psycho-educational therapies were seen to be done with the help of the group formats. The number of educational sessions was seen to be ranging from one to twenty-three sessions and used wide varieties of contents as well as procedures. While one of the studies conducted by  Ali et al. (2015) stressed on the consequences an eth effects of disgrace and expectant participants to share their individual experiences and then talk about behavioral strategies, others have taken different approaches. Another study by Rona et al. (2017) shows that the investigators had applied interventions for educating participants for interpreting the illness experiences and thereby minimizing self-stigmatizing attitudes and accordingly build up hope and pursuing significant goals of the life. Another study by Patel et al. 2016 had been seen to utilize a more medically oriented approach that had focused on humanizing participants  about sickness, medication effects as well as disgrace, deterioration prevention and even disaster management, communication and stress administration skills, self-help attributes and proper community supply operation. These researchers were also seen to utilize the visual aids like that of charts and handouts for re-inforcing didactic materials.

Another form of therapy that had also been discussed in many literatures for the management and effective coping o the stigma issues faced by professionals are reduction of the effect of acceptance and commitment therapy. This was explained as the contemporary behavioral analytic theory of language that shows that the different participants would be instructed for watching their own thoughts mindfully and thereby they should revisit their feelings completely (Griffiths et al. 2014). The participants were effectively taught for responding to their stigmatizing behaviors and attitudes with the successful application of the principles of acceptance, contact and diffusion.

Another form of therapy that many of the researchers had also focused is the combined intervention for the psycho education with that of the elements of the cognitive behavioral therapies. One of the studies have focused on encouraging the participants in sharing their illness experiences as well as educated them about the various types of the symptoms, stress, self-help, coping and stigma and its impact (Ford et al. 2016). The researchers had found that the different principles of CBT had challenged specific beliefs about the stigma. Another of the studies (Meuret et al. 2016) also showed that success rates were higher when they used cognitive behavioral elements for the improvement of the self-esteem by increasing of the self-stigma. They were also given psycho-education about disgrace and tradition as well as realities regarding mental disease.

Multimodal-strategies that are more complex were also found to be present in many of the studies. One of the studies had developed an intervention that combined five intervention strategies. This included “psycho-education, CBT, inspiring interviewing, community interaction training, and aim achievement”. Another study had focused on a newly developed program called the Ending Self-stigma. This is the agenda that had concerned an arrangement of the cognitive behavioral movements as well as conversation, collection sustain and cognitive-behavioral movements, skill training, sharing of the experiences as well as problem solving. Another study had talked of a unique approach called the efficiency of Battlemind debriefing and Battlemind guidance. This is a form of tactic that is mainly seen to combine skill-based as well as cognitive approaches (Meuret et al. 2016).

Therefore, it can be concluded that people who are suffering from stigmatization can get help from the integrative therapists would be benefitted if they are treated with the principle of CBT as this would help in changing their negative thoughts of being stigmatized and avoided with positive thoughts of overcoming such feelings. This should be combined with psycho-educational programs, as this would help in increasing the success rates of the treatment therapies by the integrative therapists.

Another interesting form of intervention is the peer support programs. Consumer operated programs can offer one of the most effective ways for the people who are suffering from the mental illness like that of GAD. This form of programs can successfully help in enhancing their sense of empowerment. Different types of groups like these can successfully provide  a range of different of services and this might include support for those who are coming out of the problem. This would also include the recreation and different shared experiences that would help in fostering the sense of community within the larger hostile culture along with advocacy and political efforts for further promotion of the group pride. Therefore, the nursing professionals would be mainly helping the peer groups in arranging programs and guiding them in every step for ensuring success of the programs. Many of the researches conducted over the years have shown that many of the patients have shown dissatisfaction with the different mental health services as they dis-empower persons by providing services in restricted settings. Therefore, peer-support activities and programs can help patients affected by stigma sue to their GAS symptoms to learn about coping strategies from other individuals who have gone through similar days and have successfully overcome the feelings of self-stigmatization through coping mechanisms (Chen et al. 2016). Participants would feel more comfortable in sharing their experiences and participating in the groups where similar individuals facing same issues and sufferings would be more comfortable in gaining support and developing coping behaviors. Therefore, healthcare professionals caring for such individuals may refer them to peer support programs in addition to their own interventions.  Outcomes of the qualitative assessment of the customer operated programs have shown that participants in the program reported enhancement in the self reliance as well as sovereignty. It also helped in development of the coping skills as well as the knowledge and feelings of empowerment.  

Conclusion:

From the above experiences, it can be found that people with mental disorders often face social and public stigma that make to difficult for them to lead better quality life. People in the society avoid them because of their symptoms or people make insensitive comments about them, bully them or harass them. They are also prevented from exercising equal rights at their workplace or their academic centers and many others. Hence, in course of time, they are often seen to develop self-stigma that in turn affects their confidence as well as their self-esteem. They undergo social exclusion that further intensifies their conditions of mental health making them suffer massively. Therefore, the healthcare professionals need to take different actions by which they can reduce such negative feelings among mental health patients and develop their lives. Two types of interventions that were proposed are the interventions that help in modifying the stigmatizing beliefs and attitudes among the patients through psychotherapies and educations. The other one is to commitment therapies and similar mixed methods of CBT that help to ensure developments in empowerment, self-esteem, and help-seeking activities. Besides, referring them to peer group programs is also found to be helpful.

References:

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