Society attitudes towards persons with mental illness

Abstract

As social care practitioners the study and research on mental health and behavior disturbance is of great importance .The study of mental health overlaps with all other aspects of the study of human behavior.

The aim of this research is to find out whether “Society attitudes and perceptions towards those with mental illness have changed in recent times”

The researcher has chosen the topic having read the past treatment and experiences of those with mental health conditions in Ireland. Recent media sources indicate that there are still matters that need to be addressed in the living conditions and attitudes. The researcher chooses different genders in order to asses the perceptions of both genders individually. The researcher used Man Whitney to find out the statistical difference between the two groups.

The researcher has used secondary sources to enlighten about the past treatments in his introduction section. Within the introduction the researcher has given an in-depth into the conditions and types of mental illness.

He has used 20 questionnaires with ten statements to help him test the society attitudes on mental illness today. The participants are anonymous and were picked at random in a shopping centre at different times, in order to get a more accurate survey.

The researcher has conducted an interview in order to get a more detailed and varied research.

Introduction
What is Mental Health?

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community World health Organisation (W.H.O)

Much of what we know about human thought and behavior has emerged thanks to various psychology theories. Some theories have fallen out of favor, while others remain widely accepted, but all have contributed tremendously to our understanding of human thought and behavior.

Mental health attitudes surveys in Ireland.

People with mental health difficulties face the most negative public attitudes of any disability group according to survey by the disability act (N.D.A) The Research has shown that those who have had direct contact with a person with a disability have more favorable attitudes towards people with disabilities generally .Mc Carthy maintained that Where there is no direct contact, attitudes can be based on misconceptions or prejudices. E. McCarthy, N.D.A (2003).

Another more recent survey according to Tinsley Orla Irish times, (2009) indicated that 1/3 of people surveyed about their attitudes to mental health said they would not be able to accept someone with a mental health problem as a close friend. The survey of 187 people was conducted by Marketing Network Limited for St Patrick’s hospital ahead of World Mental Health.

Some 40 per cent of respondents said they would discriminate against someone with a history of mental illness on the grounds they were unreliable according to the reports. Orla, T (2009) Irish times.

These were shocking revelation as the survey was conducted a few years commissioned by the Royal College of Psychiatrists, revealed that schizophrenia is the most misunderstood of all mental illnesses. Three-quarters of the public indicated that they knew nothing or very little about the illness, and over half mistakenly believe it to be a split personality.

Negative attitudes were highest among younger people, with almost 80% admitting that they knew nothing or very little about the illness. The level of general knowledge about mental illness is low in Ireland and prejudices and stigmas are still prevalent, according to a recent national survey that measured public attitudes to mental illness. Irish college of psychiatry, (2010).

The above shocking statistics on the attitudes and stigma attached to mental health in Ireland it’s vital for one to look at the in-depth of mental illness possible causes and psychological explanations.

The Health service executive (H.S.E) in Ireland is the umbrella or department dealing with health matters in its mental health campaign publications(2009) which was aimed at improving mental health awareness, they conducted a survey on the attitudes towards mental health.

The major survey received mixed responses with about 85% of the respondent’s agreeing that anyone can experience mental health problem. 62% also admitted that if they had a mental illness problem they wouldn’t want other people to know.

How to Mind your mental health.

According to the booklet by the mental awareness campaign “Your mental health” (2009) campaign developed by H.S.E national office for suicide prevention. The following steps can health us maintain good mental health the same way we mange our physical health;

Accept yourself

We are all different and that none of us is perfect, we have many different things i.e. background, race gender, religion, sexuality etc and everyone has something to offer. So we should try hard to be ourselves.

Get involved

Meeting people or getting involved with others will not only make us feel better but will also help us support others.

Keep active

According to the survey regular exercise helps to boost our mental health. It was noted that the exercises or sport that we enjoy can help us to feel more positive.

Eating healthy

Good food is essential for our body and mind and having a balance diet will improve the way we fell and think.

Stay with friends

Friends are important especially during difficult times and it’s not worth struggling alone.

Creativity

We all have different talents music, writing, painting etc these activities can help us when we are anxious or low.

Talking about it or asking for help

Sometimes we may feel overwhelmed by the problems and talking about it to someone you trust can help, in Ireland organizations like the Samaritans have hotline numbers to assist in times of difficulties.

Coping with life problems

Build self-esteem. Good self-esteem is linked to mental well-being, happiness, and success in many areas of life. It protects mental health during tough times. One way to build self- esteem is to value who you are and what you do. This is hard to do if you judge yourself by other people’s standards or rely on others to make you feel good about yourself. Instead, accept the qualities both strengths and weaknesses that make us unique.

Set realistic standards and goals. It’s vital for us to be proud of our achievements as positive thinking boosts our self esteem.

Searching for Value and purpose of life.

According to the H.S.E research on mental health reports (2009) People who pursue goals based on their own values and dreams enjoy stronger mental well-being. Think about your values and dreams.

Self harm and suicide

Having thoughts of suicide is not uncommon. Other problems caused by distress include self harm as away to escape or to deal with pain and distress that person cannot cope in their lives.

The annual report of the National Office for Suicide Prevention shows that Ireland has the fifth highest rate of youth suicide in Europe. (2007).

See fig bellow;

According to the reports there is need for education and awareness within the community about mental health and funding needed to be secured during the oncoming budgets.H.S.E (2009).

Figure source;

http://www.rte.ie/news/2008/0910/suicidepreventionreport.pdf

According to An international emergency, suicide has no borders; with the WHO (World Health Organisation) estimates 1 million people take their own life each and every year.

Ireland has one of the worst incidences of suicide, with reported suicides rising by over 25% in the last 10 years the above statistics from the H.S.E clearly shows suicide rates in the youth as compares to other E.U countries.

What are Causes of mental illness?

Although the exact cause of most mental illnesses is not known, it is becoming clear through research that many of these conditions are caused by a combination of biological, psychological, and environmental factors.

For decades psychiatrics have been subjected to critics because of their mysterious in in-comprehensible explanations of the way they define and understand human mind and especially those with mental illness.

Types of mental health illness

There are many different conditions that are recognized as mental illnesses. The more common types include:

Anxiety disorders group of chronic disorders ranging from feelings of uneasiness to immobilizing bouts of terror. Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias, and generalized anxiety disorder.

Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, mania, and bipolar disorder

Depression

Depression is a psychological condition that changes how you think and feel, and also affects your social behavior and sense of physical well-being.

Depression causes psychological explanations.

According to text books, some of the possible causes of depression include; Substance abuse, alcohol abuse, nutrition deficiencies (omega3) and major illness. Psychologists have different explanations and theories as to why a person suffers from depression.

Passer and others maintained that everyone has experienced depression at least on its milder and temporal forms Passer at al (2009)

.One of psychoanalytic theory of depression is by, Aaron Beck (1974, 1997), an American psychiatrist who pioneered research on psychotherapy, psychopathology, suicide and psychometrics and developed the cognitive therapy.

Beck’s cognitive model states that “An individuals emotional response to an event or experience is determined by the conscious meaning placed on it”. Gross, (2000:715).Beck maintained that depression is based in self defeating negative believes and negative cognitive sets.

According to Turner, (2003) “depressed people develop negative schemas”, they have tendency to view themselves, the world in pessimistic ways. She suggested that a person might develop negative schemas as a result of bad experiences with parents, other family members, authority figures or peers. (2003:67).

Psychologist Beck’s (1974, 1997) the cognitive triad consisting of three interlocking negative beliefs, these concern “the self,” “the world” and “the future” Gross, (2000:716). This distorted believe, that causes people to magnify the failure or the bad and minimize or ignore the good experiences contributed to depression.

Other psychoanalysts have their own explanation to depression, Sigmund Freud one of leading Psychoanalysts of the 20th century claimed that depression and anxiety are influenced by factors that affect us in childhood, and that interpreting dreams can lead us to the childhood causes.

In his cerebrated paper “Mourning and Melacholia” Freud (1917/1950) theorized that the potential for depression is created in child hold during oral period.

Freud suggested that a child needs may be in-sufficiently or over sufficiently gratified, causing the person to became fixated in this stage and dependant on instinctual gratifications particular to it. With this arrest in psychosexual maturation or fixation at the oral stage, the person develops tendency to depend on other people for maintenance of self esteem.

The only question we can ask ourselves about Freud explanations is how would something that happened to us during child hood come to suffer as an adult from depression?

According to Freud (1917/1950) hypothesis which he based on depression trigger on bereavement or loss.

Psychotic disorders: Psychotic disorders are a group of serious illnesses that affect the mind. These illnesses alter a person’s ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life. However, even the most severe psychotic disorders usually treated

Schizophrenia

Schizophrenia is believed to be a psychotic disorder featuring dis-ordered thinking and communications; poor contact with reality, blunted or inappropriate emotion and disordered behaviour, (Passer et al, 2009:919) .Schizophrenia is probably the most severe mental illness, the term was introduced by a Swiss psychiatrist Eugene Bleuler (1911. Schizophrenia is believed to have two classes of symptoms positive (excess) negative (behaviour deficit).the patients are believed to suffer from hallucinations and delusions.

They may also have withdrawal from others and may have a flat affect.However, the expression of these symptoms varies greatly from individual, in this early phase; people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates. Passer et al,( 2009:

We will be looking later on the recovery of schizophrenia patients in the Harding studies.

Personality disorders These are enduring; a life-time pattern of maladaptive behavior that deviates markedly from the expectations of the person’s culture, is pervasive and inflexible, and has an onset in adolescence or early adulthood. …

Other, less common types of mental illnesses include: Adjustment, Desiccative disorders, factitious disorders, Sexual and gender disorders, Somatoform disorders:

Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer’s disease, are sometimes classified as mental illnesses because they involve the brain.

Eating disorders: An eating disorder is a mental disorder that interferes with normal food consumption. Eating disorders often affect people with a negative body image. The most common Eating disorders are anorexia and bulimia.

Anorexia is an eating disorder where people starve themselves. Anorexia usually begins in young people around the onset of puberty. Individuals suffering from anorexia have extreme weight loss. Weight loss is usually 15% below the person’s normal body weight.

Bulimia, also called bulimia nervosa, is a Psychological eating disorder. Bulimia is characterized by episodes of binge-eating followed by inappropriate methods of weight control (purging). Inappropriate methods of weight control include vomiting, fasting, enemas, excessive use of laxatives and diuretics, or compulsive exercising. Excessive shape and weight concerns are also characteristics of bulimia

Several psychological explanations have been linked to those eating disorders. According to Gross, (2000) one disorder represents an unconscious effort of a girl to remain pre-pub sent.

Another psychodynamic explanation are that the girl distorted mind wants to avoid issue of sexuality by avoiding weight which is associated with rounding of breasts and other areas for feminine looks. By avoiding the issue of sexuality she manages to avoid pregnancy.

Psychologists ,Davison et al, (2004) cited Goodsitt ,(1997) proposed that the symptoms of eating disorder will fulfill some needs; such as increasing ones personal effectiveness by being able to maintain a strict diet and avoiding to be usual female shape. (2004).

History of intellectual disability and mental health in Ireland.

As students in the health and social care it’s vital for us to examine the historical treatment of disabled persons, and it’s the only way we can understand its development and appreciate how services developed in Ireland and how this influences how disability is viewed. We will also be looking on the drawing of a strategic Irish policy on disability was an important context of change in the attitudes towards people with disabilities in Ireland. We will also be looking into the changes, and what lead to a shift from medical model to social model. Negative attitudes can present the biggest barrier to inclusion that people with disabilities face in Irish society “we will be looking into barriers and labels and how changes in policies have brought in some changes, and finally into the effect of the Disability act 2005.

Before the industrial revolution people with disabilities were living into the community in which they were born. They were treated as outcasts hidden in rooms and homes. The terminology used in the 17, 18, century referred them as “idiots or witches”. They were kept under ground cells and sometimes displayed in public in hope of provoking sympathy and receiving support.

It was not until the 18th century when prosperity and urbanization attracted people to rural areas that some of the “undesirables”, vagabonds and” beggars” on the streets gave rise concern to citizens.( Share&lalor2009). The authorities were concerned in Dublin and responded by opening Dublin house of industry where the “undesirables” were incarcerated known as work houses. The institutions were over crowded and rehabilitating people return to the community became neglected. Abuse was common, the residents worked in laundries, work shops and farms to maintain economic and running of the institutions (Robins, 1986:.165).

During the 19th century new and vaguely defined classification were added to already confused terminology. In Ireland The terms such as “incurables”, “imbeciles”, “defectives”, “feeble minded” and “simpletons “were at various times to describe persons with Intellectual disability.

Kearney & Skehill (2005)also notes that the British idiots act of 1886 and the 1879 commission on the poor law, both recommended the separating of those with Intellectual Disability from those with mental health, were largely ignored in Ireland. One of the exceptions was the foundation of in 1869; the Stewarts institution for “idiotic and imbecile children” was opened in Dublin. This centre offered unique facilities emphasizing the education of children with Intellectual Disabilities, whom they termed as “pupils” and not “patients” (Kearney & Skehill, 2005:108).the foundation of the day services in Ireland was initiated by religious and voluntary organizations. Barriers and attitudes towards people with disabilities can influence many aspects of their lives, including their self-esteem, how they are treated by wider society, and public policy and service provision.

Dr Harding Studies on Mental illness recovery.

Mental health recovery can be described as a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in the community, while striving to achieve his of her full potential. One of the most respected research on recovery and integration was the Harding research.

Harding research, a study was centered on a group of patients from Vermont state hospital between 1955 and 1960, in state funded early model bio-psycho-social rehabilitation program. The 269 patients were chosen from the Vermont study was classic backward cases and those deemed unable to recover and those with chronic mental illness. This was the first program of the kind conducted and left the state hospital empty for 20 years.

The program relied on a team of care givers including psychiatrists, a nurse, sociologist and a vocational counselor (multi-disciplinary team).

The program incorporated community housing, education as well as social supports and skills training. The rehabilitation program was run for a ten years period. The study according to Harding, found that two thirds of the ex-patients did well on the end of the program. The group of ex-patients had already connected with natural communities and the outcome was remarkable.

Harding extended the picture in the 1980’s when she and her colleagues tracked down and interviewed all but seven of the original 269 patients and on average of 32 years after their first admission the hospital.

America journal of psychiatry vol: 144 showed that 62%-68% of those former back wad cases showed no signs at all of schizophrenia.

Harding suspected that the psychosocial treatment had made the difference and went further to determine the case. He spent 8 years with a similar group in Augusta state hospital in Maine; the results of the recovery rate of 48%were impressive.

In comparison of the two studies Harding says Vermont showed fewer symptoms and many of the ex-patients were working and much better community adjustment, the only difference was that both Maine and Vermont systems were driven but different treatment strategies. Dr Harding, C. et al 1987.

Barriers to effective Treatment of mental illness in Ireland.

In 1966 the Irish Government Commission of Enquiry on Mental Illness began the pattern of change to a modern mental health service. The main recommendations of this enquiry were to provide small acute psychiatric units in general hospitals, to provide a range of community based facilities, to develop multi-disciplinary teams, to involve general practitioners more in mental health care, and to develop child psychiatric services.

According to Webb (2002) little money was spent and very slow progress was made toward these targets.

In 2006 the report of the Expert Group on Mental Health Policy ‘A Vision for Change’ was launched. This report sets out the direction for mental health Services in Ireland. It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness. One of the key recommendations this report is that links between specialist mental health services and primary care should be enhanced and formalized. This proposal is in agreement with the WHO Report New Mental Health: New Understanding New Hope (2001) which endorses the provision of treatment within primary care services.

According to WHO, the World Psychiatry Association and the World Association for Social Psychiatry, amongst others, have identified stigma as a key public health challenge. They maintain that stigma, and its associated discrimination, comprises the “single most important barrier” facing people with mental health and behavioral issues. Irish medical times (2009)

Department of health campaigns “see change initiative” suggested that “Stigma has no place in Irish society today. It damages people’s lives and can be deeply hurtful and isolating, and is one of the most significant problems encountered by people with mental health problems.” Datta and Frewen (2010)

The reports further suggested that despite the acknowledged prevalence of mental health problems in society, those who experience them are frequently regarded with suspicion and fear, this stigma leaves mental health service users suffering from low self-esteem, reduced employment prospects, difficulties in obtaining accommodation and broken relationships. www.seechange.ie

What is stigma?

We have all reasons to suggest that stigma against those with mental illness is so pervasive that it affects every aspect of their life and hiders them from community inclusion.

Stigma is a perceived negative attribute that causes someone to devalue or think less of the whole person. People tend to distance themselves from individuals in stigmatized groups, to blame individuals in these groups for the perceived negative attributes, and to discriminate against and diminish the stigmatized individuals.

For example, stigma is often an issue that arises in mental health. Many individuals with mental health difficulties are perceived as weak, inhuman, or “less than” because of their psychological symptoms.

It has been argued that the provision of mental health treatment in psychiatric institutions, which isolate the mental health service user from the community, has played a negative role with respect to stigma. The development of an effective community mental health system, complete with multi-disciplinary teams, would enable mental health services users receive the support they need with minimal disruption to their everyday life. This would, in turn increase inclusion into their local community help to curb potential stigmatization.

Public attitudes towards mental health in Ireland.

National Disability Authority (NDA) study” Public Attitudes to Disability”2002 showed that although 82 per cent believed a disabled person should enjoy the same access to employment as non-disabled people, only 55 per cent thought the same should apply for those experiencing a mental health problem.

Similarly, the reports reviewed that only 55 per cent felt a person with a mental health issue should enjoy the same entitlement to fulfillment through relationships as the general public.

A report by Department of children (2009) -Cited a Survey on attitudes nutrition and social wellbeing in Ireland learnt that 52 per cent agreed or strongly agreed with the statement ‘If I was experiencing mental health problems, I wouldn’t want people knowing about it.’ On the other hand HSE research the same year found one-third of Irish people were scared to talk to those diagnosed with a mental illness. (SLAN (2007)

The reports also noted that while the vast majorities (94 per cent) of Irish people were aware any-one could experience a mental health issue; exactly half indicated they would not want anyone to know anyone who has.

The attitudes survey noted disturbing intolerance that 33 per cent believing people with schizophrenia should not be allowed have children. S.LAN (2007)

The findings from the SLAN 2007 survey highlights the urgency of implementing of the mental health policy “A Vision for Change” It points out that, the clear relationship between mental health, social well-being, quality of life, are self-and needs to be integrated.

According to Walker, and Levy, (1982) many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life.

Other psychiatrists Research suggest that Education provides information so that the public can make more informed decisions about mental illness, for example, that a person who holds a better understanding of mental illness are less likely to endorse stigma and discrimination Hence, the strategic provision of information about mental illness seems to lessen negative stereotypes. Keane (1990).

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Statement of hypothesis

The researcher holds a view that society negative attitudes towards persons with mental illness have not changed. The researcher will be using secondary sources, i.e. newspapers, books academic journals and other media sources within the limitations of this piece of research to prove his view on the inadequacy and stigma attached to mental illness to date.

Methodology.

The researcher has chosen to use qualitative method in his research which is believed to have hard evidence. This type of research method seeks to gain understanding through study of individuals.

Qualitative method that goes back a long way is the case study. When physicians like Sigmund Freud (1977) became interested in psychological problems, they continued their tradition of writing and publishing descriptions of their most interesting patients, the treatments they attempted to use, and the progress of the disorder. Much of the content of abnormal psychology, for example, is built upon these case studies. The methods in qualitative research are not new and have been used in various academic disciplines Murphy et all 1998.

The method also holds other advantages i.e. the persons completing the questionnaire remains anonymous.

The researcher prepared a questionnaire with positive and negative statements for his respondents which will help him to

Sampling:

The researcher will be using sampling method.

Sampling in qualitative research according to Kvale (1999) is a described or as the subject can be chosen deliberately in order to test particular theoretical purpose i.e. in this case the researcher has chosen to test society attitudes towards mental health.

The researcher has used (likert scale) in his primary research. A Likert Scale is often used in survey design to get around the problem of obtaining meaningful quantitative answers to restricted questions. A Likert scale is recognizable when you are asked to indicate your strength of feeling about a particular issue on a 1-5 rating scale. I will be Using a Likert Scale with closed questions generates statistical measurements of people’s attitudes and opinions. The researcher has targeted over 18 participants and within the questionnaire provided a tick box for gender and age. This will help him to analyse the findings in terms of gender and age.

The researcher has compiled 10 statements in which the respondent will tick the boxes ranging from;

Strongly Agree (S.A)

, 2 Agree (A),

Neutral 3 (N),

Disagree (D) 4

. Strongly Disagree (S.A) 5

Ethics

Ethical guidelines will be closely followed during this research.

The researcher has a responsibility of protecting the participants in this research; the researcher has responsibility of assuring that there is no risk or harm to the participants during this research.

When most people think of ethics (or morals), they think of rules for distinguishing between right and wrong, such as the Golden Rule (“Do unto others as you would have them do unto you”), a code of professional conduct like the Hippocratic Oath (“First of all, do no harm”), a religious creed like the Ten Commandments (“Thou Shalt not kill…”), or a wise aphorisms like the sayings of Confucius. This is the most common way of defining “ethics”: norms for conduct that distinguish between acceptable and unacceptable behavior.

There are several reasons why it is important to adhere to ethical norms in research. First, norms promote the aims of research, such as knowledge, truth, and avoidance of error. For example, prohibitions against fabricating, falsifying, or misrepresenting research data promote the truth and avoid error.

Ethical standards also require that researchers not put participants in a situation where they might be at risk of harm as a result of their participation. Harm can be defined as both physical and psychological. The researcher aims at ensuring protection for all his participants.

These include the data protection in line with data protection act 1998 amended 2003.

Confidentiality

The participants of this research have the right to avoid any question the feel will breach their confidential