Social Exclusion on Mental Health Service Users - Literature review Example

? The Impact of Social Exclusion on Mental Health Service Users in Dublin A Research Proposal Table of Contents Page Number Chapter 1 A. Literature Review 4 1. The Negative Impact of Social Exclusion 6 2. Public’s Negative Attitudes towards People with Mental Illness 7 3. Preventing Social Exclusion 8 B. Research Question 9 C. Aims and Objectives 9 Chapter 2 A. Research Methodology 11 B. Design/Proposed Method 11 C. Population/Sample 13 D. Data Collection 14 E. Rigour and Trustworthiness of Study 14 F. Data Analysis 15 G. Pilot Study 16 H. Ethical Considerations 16 Chapter III A. Proposed Outcome of the Study 18 B. Time Scale 19 C. Budget/ Resources 20 References 21 Appendix 23 Abstract This research proposal is inspired by organisations in Ireland which work for the welfare and well-being of mental health service users. These organisations emphasised the issues for certain social groups who are mentally ill. For instance, the Royal College of Psychiatrists embodies mental health professional from Northern Ireland, Wales, and England. As a representative organisation, it is willing to participate in the risks and threats for mental health service users all over UK’s regions and countries. One of the most pressing issues is the social exclusion of individuals who are mentally ill, and prospects to deal with this are embodied by the developments in policy, attitudes, models, services, and treatment over the recent decades. Social exclusion denotes the level to which people are incapable of taking part in major domains of cultural, social and economic life. The focus of this study is on non-involvement emerging from limitation, instead of free will. This study has adopted a wide perspective of the socially inclusive model, considering equality and human rights, citizenship, and social justice, aside from a clinical point of view. It is from this point of view that the harmful impacts of social exclusion and the significance of social inclusion for the mentally ill and intellectually disabled can be most strongly recognised, and that the responsibility that the Irish political and social institutions have in encouraging this to occur can be greatly understood. Social exclusion is a preventable occurrence in the lives of numerous individuals with mental illnesses or intellectual impairments. These individuals are among the most stigmatised and disenfranchised people in Irish society and elsewhere in the world. There is strong substantiation that they could be socially excluded due to the fact that they have scarce material assets and they are incapable of taking part in socially or economic activities. The main objective of this current study is to develop a workable partnership between the community and the academe, hence establishing the grounds for putting into effect a practical, appropriate intervention intended for individuals with serious mental health problems. This study explains the qualitative method of the process of developing partnership. The participatory action research method employed puts emphasis on the strong points of the sample site and welcomed relevant knowledge of participants. Using a primary group of eager mental health service providers and a bigger array of professional and ordinary stakeholders, hopefully, after several months of gathering information from participants and specialists, the partnership will opt for an intervention to be applied at the (name of the mental health clinic) in Dublin. The biggest challenge that the study encounters in employing the participatory action research method is the conflict between the insider and the outsider and the extra time and resources required to design the study. The biggest advantages of employing PAR, on the other hand, included permitting the community mental health clinic to voice out their concerns and raise questions throughout the conduct of the study, be dynamically involved in the various research tasks, take part in the deliberation about applying SDM and its influence on mental health policy and practice, and to acquire a greater sense of ownership of the research outcomes. Chapter 1 The perspective of this research proposal lies in the transformations in Irish society that have taken place since the 1940s. Although there were certain developments in the standards of living and in the quality of life, housing, education, and health during the recent decades, the income disparity between the poorest and richest in the Irish society expanded (Watson 2005). Inequalities heightened and the relative poverty statistics reached a momentous peak in the 1990s (Hillyard, Kelly, McLaughlin, Patsios & Tomlinson 2003). From then on, there has been a certain level of decrease in relative poverty, yet a significant percentage of children remains poor (Hillyard et al. 2003) and this not likely to be greatly alleviated in the coming years. For numerous people, poverty, even though unfavourable, is quite transitory. Nevertheless, roughly 2-4% of the population of the UK experience chronic poverty (Noble et al. 2003). Individuals with several disadvantages are most prone to social exclusion and poverty. People who are unemployed, single parents, the elderly, and people who are permanently disabled and ill are overrepresented in the category of multiple disadvantages, as are those who are mentally ill and intellectually disabled (Social Exclusion Unit 2004). Individuals from minority ethnic groups, such as African-Americans, are also more prone to encounter social exclusion, particularly if they are new migrants or belong to culturally or linguistically segregated groups (Social Exclusion Unit 2004). It is certain that mental health services transformed, and in some ways developed, during the final stage of the 20th century; major institutions and large-scale organisations were abolished and most services are currently given in a community setting. Yet, there is no room for self-righteousness and mediocrity and, in the first half of the 21st century, it is opportune to study the condition of community mental health services in Ireland (in this study, Dublin in particular), the situation of individuals who are mentally ill and people who are intellectually disabled, and the means where in psychiatrists and other providers of mental health services can act in response to the issue of social exclusion. A. Literature Review Social exclusion is defined as the level to which people are incapable of participating in major domains of cultural, social, and economic life. As stated in the working definition of the Centre for Analysis of Social Exclusion (CASE): “An individual is socially excluded if he or she does not participate in key activities of the society in which he or she lives” (Pantazis, Gordon & Levitas 2006, 134). The focus in this description is on non-involvement resulting from limitation, instead of choice or free will. Social exclusion is obviously one of the ways of understanding disadvantage (The Irish Times 2006). This has been normally viewed, according to Burchardt and colleagues (2002), in relation to ‘impoverishment’, ‘predicament’, ‘poverty’, all of which put emphasis on material scarcity and the resulting personal misery and depression. Social exclusion broadens this established model to transcend non-involvement because of deficiency in material assets. This permits increase in the array of markers and assessments of disadvantage; it sustains the goal of naming people who are deficient of resources to take part but also names people whose non-involvement occurs in others ways, such as by means of cultural stereotype, chronic sickness, discrimination, and prejudice (Mason, Carlisle, Watkins & Whiteheads 2001). Social inclusion and exclusion are notions with political and moral implications, specifically in relation to discrimination and stigma, human rights, justice, and citizenship (Mason et al. 2001). Individuals with mental health problems and people with intellectual impairments may be deficient of physical resources; they are usually poor and have minimal earnings or incomes (Pevalin & Rose 2002). They may encounter difficulty in taking part in socially or economically important activities like education and employment. Pevalin and Rose (2002) furthers that they may be excluded and segregated from neighbourhoods, social interactions, and the larger community. Individuals with mental health illnesses or intellectual impairments may also be barred from essential political and civic activities. Whelan & Maitre (2007) argue that individuals who are mentally ill should be capable of participating in national or domestic decision-making, of voicing their plight, of asserting their control, and of being able to participate in the broader facets of civil society that could, consequently, affect their lives. In the past, according to Whelan & Maitre (2007), participation in civic activities has been negligible among individuals with serious mental illness. Voting rights is prohibited to a large number of hospitalised patients and the involvement of mental service users in elections is frequently trivial. A lot of individuals with intellectual impairments or mental health problems are also prohibited to occupy jury positions (Knapp, McDaid, Mossialos & Thornicroft 2006). In the worst scenario, Members of Parliament will involuntarily be unseated if they are kept in custody under the Mental Health Act, but would not lose their jobs if they were incapable of carrying out their responsibilities due to poor health (Knapp et al. 2006). Seen in this wider perspective, social exclusion is not merely about isolation from social roles, but also about limited access to essential services. 1. The Negative Impact of Social Exclusion Whatever the initial roots of mental health illnesses, the unfavourable social implications of being a mental health ‘service user’ are enormous. The personal exclusion and stigma this invokes are coupled by a high possibility of exclusion from the labour market and the consequent experience of poverty According to the Disability Federation of Ireland (2005), adults who are mentally ill are one of the most marginalised people in society. Even though a lot of people want to find jobs, fewer in reality do; the lowest rate of employment of any of the primary groups of people with disability (Disability Federation of Ireland (2005). Quite frequently these individuals do not have other tasks to occupy their days and splurge their time in seclusion. Mental health problem is both a source and impact of social exclusion and there are multidimensional and intricate connections between mental health problem and disadvantage (Almedon 2005). There are, hence, basic explanations why psychiatrists cannot discredit social exclusion. Still, as stated by Almedon (2005), the comparative feature of social exclusion implies that the same common present-day social factors impinge upon all individuals in the group, including those experiencing mental illness. Closing the disparities between people with mental illness and others, be it due to employment, income, or preference and free will, will have favourable implications for all. Potential responses may involve enhancing access to privileges, education, employment, and social involvement. The roots of these several disadvantages can be found at a number of distinct and interrelating stages. This means that the actions should be oriented towards diverse targets and intended both for individuals and at broader institutions, by exercising an array of agencies, such as housing, education, social care, and health. According to De Leonardis (2006), mental illnesses, and the consequent social exclusion, have a serious effect on families. Roughly 420,000 individuals in the UK look after a mentally ill person (Whelan & Maitre 2008, p. 142). Carers are more likely to develop mental illnesses themselves if they tender extensive care. These disadvantages have a tendency to be transmitted from one generation to the next and can impinge on the life chances of several members of the family (Whelan & Maitre 2008). This involves the requirement for early promotion, prevention, and intervention to stop these successions of disadvantage. 2. Public’s Negative Attitudes towards People with Mental Illness According to Albrecht and colleagues (1982 as cited in Knapp et al. 2006), mental health problem is a greatly stigmatised condition in the Irish society and elsewhere in the world. Individuals with mental health problems encounter all of the major attributes of the process of stigmatisation; they are formally labelled and stereotyped, secluded, linked to unpleasant traits, and widely segregated against as an outcome (Mason et al. 2001). A core feature of stigma for individuals with mental health problems is the view that they are impulsive and threatening (Mason et al. 2001). A mounting body of literature and empirical evidence shows that personal encounter with individuals who are mentally ill can lessen these stigmatising outlooks (Bonner 2007). Nevertheless, in the lack of actual world experience with mental health problems, individuals should depend on the messages of their community and the media for prompts. The general public in Dublin admit receiving messages/information about mental health problems from the media (Daly, Walsh, Comish, Kartolova, Moran & O’Reilly 2005). In the Irish society, these depictions are usually erroneous and quite unpleasant, depicting individuals with mental health problems as distasteful, useless, impulsive, dangerous, and aggressive (Daly et al. 2005). Through the mass media, the general public becomes aware that the people with mental health problems are threatening and that they must be stayed away from. 3. Preventing Social Exclusion As claimed by Bonner (2007), numerous of the changes that benefit individuals with mental health problems in their fight to live a life they choose and cherish, and to deal with the bias and discrimination that they encounter each day, will be realised through reforms in society and by initiatives at a national level. However, there are several current interventions, with sound evidence of success, that deal with both mental health problem and social exclusion. Cases in point comprise family therapy for behaviour problem and similar behavioural problems in children, assisted employment for individuals with schizophrenia, and early intervention in initial diagnosis of psychosis (Haase & McKeown 2003). Additional substantiation is present for techniques of helping individuals with intellectual impairments who display behavioural disorders and for self-confident outreach models for individuals with intellectual impairments. B. Research Question This study will try to answer this main question: How does social exclusion affects community mental health service users within a local health services executive (H.S.E)? The local health service executive area chosen for this study is Dublin. In order to answer the aforesaid question comprehensively and accurately, the following specific questions will be answered: (1) What are the negative impacts of social exclusion on mental health service users in Dublin? (2) What are the negative attitudes of the public towards people with mental illness in Dublin? (3) How does the Dublin’s H.S.E prevent social exclusion? C. Aims and Objectives This research proposal will be carried out to: (1) contribute in the current knowledge of the specific issues affecting individual’s mental health, particularly the hindrances to accessing services for care and prevention; (2) determine strategies to fulfilling mental health requirements that might function as frameworks of best practice in the Irish context; and (3) examine the possibility of generating more suitable and productive responses to the needs of the mentally ill, considering current limitations and opportunities within the major Irish policy and service settings. Chapter 2 A. Research Methodology A participatory action research method will be adopted for this study, in the sense that efforts will be made to interpret results into actual and feasible approaches for future activities and action. In order for this to be productive and effective, the active participation of important ‘stakeholders’, such as mental health providers and service users, considering strategic outcomes will be viewed as fundamental. In light of this, an advisory group will be formed to acquire representation from the community of service users and health practitioners (i.e. psychologists, psychiatrists, general physician, etc). This advisory group will meet as necessary as possible during the conduct of the study. However, three major meetings will be set. First is to talk about the methodology; second is to assess current empirical evidence and take into account potential influences on future practice and policy; and third is to discuss a formal draft statement, with an emphasis on the difficulties involved in making recommendations in mental health services. B. Design/Proposed Method Participatory action research (PAR) was introduced by McIntyre (2008) as one of the distinct forms of action-oriented study, including feminist research, empowerment research, and action research, all of which are founded on a post-positivist model in which human subjects are treated as self-reflective, involved subjects who fulfil a crucial function. In PAR the researcher will vigorously partner with service users, community members, and other stakeholders in the whole conduct of the study (Kindon, Pain & Kesby 2008). The partnership between the researcher and the subjects will lead to an enhanced possibility that important and appropriate issues are raised and asked, that findings are trusted and responded upon, and that research subjects are empowered and transformed. The research design will also encourage local ownership of the research and the results, and provides legitimacy and value to different types and sources of knowledge (Kindon et al. 2008). In this design, the researcher is not seen as the only gatekeeper or owner of knowledge, does not have absolute power over design and execution, and is not entirely responsible for dissemination. Nevertheless, PAR has been employed productively as a paradigm to collaborate with community organisations in definitely disallowed, researcher-invoked issues (Koch & Kralik 2006). Researchers employing PAR recognise that the study should give importance to researchers and participants alike and acknowledge and give importance to the knowledge and experience of the participants (Koch & Kralik 2006). Hence, in this study the researcher will not be free to choose the features of design and execution; instead these choices will transform as an outcome of uninterrupted communication and group dynamics. SDM will also be used in this study. SDM is an interpersonal and transactional paradigm of communication where service users and mental health care providers work hand-in-hand to decide over care and treatment that involves the health experiences, such as social exclusion, of service users (Koch & Kralik 2006). SDM necessitates the sharing of information between two stakeholders—the provider and the service user. The knowledge and experience should be equally recognised and incorporated in a negotiation which results in the ultimate recommendation (McIntyre 2008). Within the framework of SDM, “the practitioner becomes a consultant to the client, helping to provide information, to discuss options, to clarify values and preferences, and to support the client’s autonomy” (McIntyre 2008, 82); SDM could be one way of building better participation and responsibility in treatment and experience of individuals with mental health problems. Even though self-management methods have traditionally been recognised as evidence-based practice in the field of mental health (Koch & Kralik 2006), there are practitioners, caregivers, and service users who remain hesitant to adopt self-management. C. Population/Sample The (name of the mental health clinic) in Dublin will be the sampling site of this study. The participants will be purposively selected. The support personnel will be asked to assist in the sampling procedure. They will inform the potential participants about the nature of the research, explain its aims and objectives and identify the interest of the potential participants in taking part at each stage of the study. Participants will be equally comprised of women and men, born in Ireland, with a primary diagnosis of mental illness, such as schizophrenia. They have histories of recurrent and continuing hospitalisation, insecure occupancies, low levels of psychological, social, and occupational functioning, negligible living abilities, and considerable degrees of behavioural and psychological problems. D. Data Collection A primary group of service providers will be identified at the (name of the mental health clinic) who are willing to use SDM in individuals with severe mental health problems and form networks between the community and the academy. A meeting will be organised to form a work committee to examine SDM. The management of (name of the mental health clinic) will hopefully show a clear willingness to involving clients whom they cater to. A partnership between the researcher and the mental health providers will be formalised. An integrated specialised group of professionals in academic, clinical, and leadership positions embodying health services research, social work, occupational therapy, pharmacy, nursing, and psychiatry. The group will convene as necessary as possible. Detailed documentations will be kept of each session and minutes will be produced and disseminated to the members of the group after each session. E. Rigour and Trustworthiness of Study As long as the researcher is responsive to and ethical towards their community, it may be not important or advisable to show rigor in action research (McIntyre 2008). It rests on the audience for the study. Where action research has productively generated professional or organisational development, it is the response that officials recognise, not the research (McIntyre 2008). Nevertheless, when an action research practitioner attempts to form his/her kind of research in a mental health organisation there is a requirement to acquire assistance from influential authorities to become successful at anything more than the methodological level with a group of professionals. If the advocates of action research are attempting to disseminate the action research tradition as a scholarly effort (Kindon et al. 2008), such as this study, it is essential to show that this is rigorous or valid study. Several of the advantages of participatory research rest on the application of conversational language as the language of interpretation and the informational language (McIntyre 2008). Conversational language enables participants to gain access to the findings, participation in its use and interpretation, and the power to question the researcher’s interpretations. At the core of the structure the researcher will use in this study lies a straightforward but helpful concept. This study captures its importance in three premises: (1) emphasis on the issue of social exclusion which comes from at least two participants; (2) if there is common opinion about the nature or the understanding of social exclusion, in subsequent data collection verification and question that common opinion by searching for anomalies; and (3) if there is conflict about the nature or understanding of social exclusion, in subsequent data collection search for reasons for the conflict. F. Data Analysis From the recordings of the meetings with mental health providers and experts, detailed transcriptions will be generated for the intention of evaluating the participation-action tasks and method. The transcriptions will recognise all contributors and will identify any disruptions in speech. The information/data will be verified and deconstructed. By means of content analyses trends in the data will be determined, coded, and classified. The data will be evaluated and re-evaluated to identify major pieces, issues and common problems. Broader classifications will be created on the basis of commonalities between the issues, and they will be afterwards structured into the most usual responses. In order to evaluate reliability, the entire transcripts will be assessed separately and the coding will be evaluated. At some stage of this process, any new items of significance will be taken note of. The issues will afterwards be communicated to the group to improve the accuracy and validity of the findings. G. Pilot Study A pilot study will be conducted with focus group discussions with mental health providers and professionals, as well as purposively selected service users. The pilot study will also consider searching the literature, attending a symposium by national specialists, and contacting other mental health clinics all over Dublin. H. Ethical Considerations How mental health providers/professionals and service users perceive their duties within the research is related to several ethical concerns that emerge during the participatory change process. Given the specifications of participatory action research, the location, the individuals involved, the issue at hand, and the distinct components that distinguish this study, it is not possible to consider all of them here. Several ethical concerns of this study, such as authority issues, resource access, and determining the extent of social exclusion in mental health services, are obvious at the start of the participatory action research activities. Others, such as choosing who will participate, answering research questions, developing relationship, what recommendations should be put forth, and how findings will be communicated to outsiders, normally arise as the process advances. These concerns are not exclusive to participatory action research. Several professional groups across several disciplines have offered parameters and codes of ethics and behaviour that inform specific forms of community-based studies. Chapter III A. Proposed Outcome of the Study The hope will be articulated in this study that even though the emphasis would begin with the prevention of social exclusion, as well as use of medication, it would perhaps extend to other features of care outside prescriptions. Professional partners would hopefully indicate the need to create innovative means to assess social exclusion in attaining individual objectives instead of assessing submissiveness or obedience. Recommendations will include the level or extent of participation, motivation level, the emotional level, whether participants participate more, and participation in the larger community. One possible outcome involved making use of current satisfaction information that is collected by the mental health clinic on a yearly basis from service users and non-users they cater to at the clinic as a benchmark. Outcome measures discussed in existing literature will be reviewed, such as the relationship between mental health provider and service user, the effectiveness of communication, satisfaction, the level of client involvement, and adherence. It will be decided that contribution from different stakeholders concerning findings may assist in guiding the effort of the group. And finally, this study will hopefully find out the negative effects of social exclusion on mental health service users. As indicated in the literature review, social exclusion creates stigma which then contributes to emotional, psychological, and even physical deterioration. B. Time Scale Proposal Development Activity March April Detailed review of related literature 1st week The three major meetings with mental health providers and professionals 1st 1st week 2nd 2nd week 3rd 3rd week Conducting Research Activity April May Data Collection (Focus Group Discussions) 1st week & 2nd week Data Analysis 3rd week & 4th week Writing the Dissertation Activity May June August Writing of Chapter 1 1st week & 2nd week Proof Reading 3rd week Writing of Chapter 2 4th week 1st week Proof Reading 2nd week Writing of Chapter 3 3rd week & 4th week Proof Reading 1st week Wrting of Chapter 4 2nd week Proof Reading 2 days Submit completed draft 3rd week Revisions 4th week Binding of the Dissertation 2 days Budget/Resources After much deliberation, it has been assessed that this study will require approximately €820 to carry out the study discussed. A large portion of the resources will be allocated to personnel costs since they will be the main thrust of this study. Moreover, the higher budget for personnel expense is justified by the important but time-extensive tasks of carrying out and analysing several interviews. The details of the budget are shown below: Budget Personnel Undergraduate Assistants……………………………………........ €150 Mental Health Providers…………………………………………… €100/each Research Participants Pilot testing and Focus Group…………………………………....... €200 Materials and Supplies Video Recorder (rental)…………………………………………….. €50 Tape Recorder (rental)………………………………………........... €50 Coupon Bond/Envelopes…………………………………………... €20 Travel…………………………………………………………………..€250 Total Expenses………………………………………………………. €820 References Almedon, A. M. (2005) Social capital and mental health: An interdisciplinary review of primary evidence. Social Science & Medicine 61, 943-964. Amnesty International (2003a) Mental Illness: The neglected quarter- Children. Dublin: Amnesty International (Irish Section). Amnesty International (2003b) Mental Illness: The neglected quarter- Homelessness. Dublin: Amnesty International (Irish Section). Bonner, A. (2007) Social Exclusion and the Way Out: An individual and community response to human social dysfunction. England: Wiley. Burchardt, T., Le Grand, J. and Piachaud, D. (2002) Understanding Social Exclusion. Oxford University Press, Oxford. Daly, A., Walsh, D., Comish, J., Kartolova O’Doherty, Y., Moran, R. and O’Reilly, A. (2005) Activities of Irish psychiatric units and hospitals 2004. Dublin: Mental Health Research Division, Health Research Board. De Leonardis, O. (2006) Social Capital and Health: Research Findings and Questions on a Modern Public Health Perspectives. European Journal of Social Quality 6, 19+ Disability Federation of Ireland (2005) Disability and population health discussion paper. Dublin: DFI. Haase, T. and McKeown, K. (2003) Developing Disadvantaged Areas through Area-Based Initiatives –Reflections on over a Decade of Local Development Strategies. Dublin: Pobal. Hillyard, P., Kelly, G., McLaughlin, E., Patsios, D. and Tomlinson, M. (2003) Bare necessities: poverty and social exclusion in Northern Ireland – key findings. Belfast: Democratic Dialogue Kindon, S., Pain, R. & Kesby, M. (2008) Participatory Action Research Approaches and Methods: Connecting People, Participation and Place. New York: Routledge. Koch, T. & Kralik, D. (2006) Participatory Action Research in Health Care. UK: Wiley-Blackwell. Knapp, M., McDaid, D., Mossialos, E. & Thornicroft, G. (2006) Mental Health Policy and Practice Across Europe (European Observatory on Health Systems and Policies). UK: Open University Press. Mason, T., Carlisle, C., Watkins, C. & Whitehead, E. (2001) Stigma and Social Exclusion in Healthcare. London: Routledge. McIntyre, A. (2008) Participatory action research. UK: Sage Publications. Noble B. et al. (2001) Measures of Deprivation in Northern Ireland. Belfast: Northern Ireland Statistics and Research Agency. Pantazis, C., Gordon, D. & Levitas, R. (2006) Poverty and Social Exclusion in Britain: The Millennium Survey (Studies in Poverty, Inequality and Social Exclusion). UK: Policy Press. Pevalin, DJ and Rose, D. (2002) Social capital for health: investigating the links between social capital and health using the British Household Panel Survey. London: Health Development Agency Watson, D. et al. (2005) Mapping Poverty: National, Regional and County Patterns. Dublin: CPA, ESRI. Whelan, Christopher T & Maitre, Bertrand. (2007) Social Exclusion and Multiple Deprivation in Ireland. Administration 55. Whelan, Christopher T & Maitre, Bertrand. (2008) “New” and “Old” Social Risks: Life Cycle and Social Class Perspectives on Social Exclusion in Ireland. Economic and Social Review 39, 131–156 Social Exclusion Unit (2004) Mental health and social exclusion. London: HMSO. The Irish Times (2006) Stigma of mental illness. Muiris Houston 23rd. Appendix A Letter of Consent Dear (Name of Prospective Participant): I would like to invite you to take part in a research study on the effect of social exclusion on mental health service users in Dublin. This study will require a considerable amount of your time. The focus group discussions will be conducted on schedule and will be documented. There are no expected anxieties or threats connected to this study. By participating in this study, you may help the mental health institution in Dublin by contributing to the understanding of social exclusion in our society and how individuals with mental health problems can recover from stigma or social exclusion. Your identity will be protected in this study. Even though the focus group discussions will be recorded, the tapes will be discarded after they have been transcribed. Your participation in this study is absolutely voluntary. You will receive a small sum of money for your time and effort if ever you decide to take part in the study. You may withdraw from further participation in the research at any time. The outcomes of this study will be published in sociology and psychology journals. The findings may also be conveyed personally to mental health professionals. No mention of your name and other personal information will occur in the presentation of the findings. If you would like to receive a copy of the findings, you may contact me at the contact number provided below. Thank you! __________________________________________ (Printed Name) __________________________________________ (Signature) __________________________________________ (Date) Read More