Socio-Political Factors And Mental Health - Essay Example

Socio-Political Factors And Mental Health Introduction Mental illness is a debilitating disease that is embedded with the stigma attributed to it (Centre for Social Justice 2011; Corrigan 2004; Corrigan & Penn 1999). Stigma is a “collection of negative attitudes, beliefs, thoughts, and behaviours that influences the individual, or the general public, to fear, reject, avoid, be prejudiced, and discriminate against people with mental disorders” (Gary 2005, p. 980). This is manifested in behaviours, disrespectful actions, and language (Gary 2005). However, some people who are suffering from mental illness are not only subjected to stigma. There are patients who are further disempowered by the socio-political factors enveloping their life circumstances. Some of these factors include race, culture, ethnicity, gender, social class, and other similar factors. This double burden is referred to as double stigma (Corrigan et al. 2004; Rowe 2005). The double stigma does not only perpetuate the self-depreciation that patients experiences, but it also fortifies the public stigma that is manifested in the forms of discrimination, prejudice, and stereotyping against mentally ill patients. In this effect, double stigma heightens the negative impact of stigma that mentally ill patients experience. Recognising the seriousness of the condition, this study will answer the question how socio-political factors may influence mental health? In attempting to answer the question, the study will focus only on one socio-political factor – ethnicity. This acts as a form of limitation and the focus needed in addressing the query of the study. Ethnicity is now used to indicate, “the different and unequal experiences of social groups with specific social attributes such as language, religion, and dress codes” (Giddens & Sutton 2010, p. 136). Ethnicity is necessary because it is one of the foundations of a person’s worldview (Sue & Sue 2003; Sumari & Jalal 2008). The motivation behind choosing ethnicity over other socio-political factors is the fact that one of the key aspects of contemporary society is pluralism and ethnicity is its concrete reality. In a pluralistic society, there is the increasing tendency that the minority group is viewed from the perspective of the majority group as they cohabit within the same physical space. This creates pressure since there are mark distinctions among ethnic groups. In this regard, ethnicity is pivotal in mental health because of the double stigma that patients in the minority group are experiencing. Its negative impact will continue if it is not consciously address. In addressing the problem of this study, the answer is drawn both from the experience of the service user and scholarly journals and books dealing with the issue of ethnicity and mental health. The Response Mental health practitioners have the ethical and moral obligation to respect the cultural context from where the patient is coming (Trimble & Fisher 2006). The increasing multicultural diversity of patients with mental illness increases the responsibility of mental health practitioners in providing the venue wherein the patient’s cultural heritage is included as an integral component in formulating accessible and quality therapy for the patient (Sue & Sue 2003). Nonetheless, it has been observed, there appears to be a gap between the theoretical knowledge of the role of ethnicity and the empirical belief justifying that health care providers have to respect the reality of ethnicity, since some practitioners are reluctant to modify their current practises to accommodate ethnicity (Griner & Smith 2006). This situation amplifies the double stigma among ethnic groups. The Western Approach of Self-Disclosure. P A, an Asian and one of the patients in the Community Health Centre, shares, “I do not understand why I have to tell somebody my fears, my thoughts, my delusions. It is a secret. There are people that I know back in my old country who were tied to a tree or made to live in pigpens because they talk about it, they act it. It is supposed to be a secret; a curse that I have to bear silently. I am afraid.” some of the stereotype attributes of Asians is that they are ‘model ethnic group’ and they do not suffer from any social or substance abuse (Gary 2005). This creates an imbalance in providing therapy to Asians, since it hides the real reason why they do not come out, “It is supposed to be a secret; a curse that I have to bear silently.” As such, the Western approach of talking face-to face with the practitioner is not effective. It fails to recognise the cultural framework of P A – ‘we do not tell’. The traditional approach becomes inadequate in addressing the issue of PA. Instead, it confounds the situation leaving the Asian patient more afraid, confuse, and isolated as the therapy does not meet the patient at his or her own cultural context. Peplau’s interpersonal theory (1952, 1992, 1997) helps nurses establish a nursing care wherein the patient is met at their difficulties. Human relation between the nurse and the patient is created through authentic respect to the personhood of the patient. In order to accomplish this, a dialogue with the patient has been adopted. Dialogue has been chosen because it is a two-way exchange of ideas. it is not the kind of conversation wherein one is a passive listener (normally, the practitioner) while the patient speaks about himself. The nurse makes it a point to relate with the patient by adopting behaviours and language that will build trust between them. In this scenario, the nurse used only open-ended starters for communication like “tell me about...”. At the same time, emotions were not masked, and reflections were taken with the patient. These were not just communication techniques, but it is empathising with the patient letting them feel that you are with them. Understanding the patient involves several related real conditions. One of the identified problems, when dealing with ethnic minorities, is the language barrier (Flaskerud, 2000). Communication is a vital element in identifying and determining the appropriate therapy for the ethnic patient. However, there are instances where in the patient does not speak up. When this scenario happens, the patient is sometimes judged as “uncooperative, unable to communicate and dependent” (Sumari & Jalal 2010, p. 3). This condition can develop into increased risk of misdiagnosis, decreased well-being, harm and increased mental distress (Gary 2005, p 983). Communication needs not necessarily be limited only to verbal discussion. Touch, having the time to be with them and relating with them are other means that can be used in order to communicate and relate with them (Shatter, Starr & Thomas 2007). Double stigma arises because of the inability of some ethnic patients to communicate in English or primary language used in the society where they live. In a situation where in the patient has difficulty in communicating his needs and circumstances, there is an increased likelihood that misdiagnosis, maltreatment, prejudiced and discrimination may occur (Gary 2005). This can result in distrust towards the institution and lower self-esteem for the patient. As such, it can be stipulated that the mental health needs of an ethnic patient is not addressed, thus leaving the patient in more dire condition. In this way, ethnicity becomes a barrier for the patient in attaining mental health. In addressing the situation, by recognising the language barrier when talking with some of the patients, alternative forms of communications such as the act of pointing to the objects that are being referred to were adapted. This may be an extremely naive way of crossing the barrier of communication, but it worked. Of course, sometimes there are frustrations when you cannot point to the object being referred to because it is not there, but it became a challenged in becoming more creative and imaginative in attempting to communicate with patients who do not speak English. Likewise, it was noticed that their inability to communicate in the primary language used adds to their confusion and helplessness in addressing their situation. As such, there were times when other means of communication were adopted such as letting them draw or use an object that may represent what they feel. At the same time, a conscious effort on the part of the health care provider in knowing some of the basic words use in their mother tongue. This helps in crossing language barriers and at the same time making the patient feel comfortable and an effective way in building a trustful relationship with them. P B, another patient in the centre is also an Asian and she shares, “I am ashamed. This is a disgrace to the family.” An important aspect of Asian culture is the predominant place the family plays in the lives and decision-making of the members of the family. In effect, decision-making is a collectivist activity undertaken by everybody in the family (Sumari & Jalal 2010). Although there are many instances wherein only some of the family members make the decision, still the decision made is for the entire family. In fact, the identity of one is deeply rooted in the family identity. In trying to understand the patient, it becomes imperative that the nurse connects with the patient authentically. This means establishing a personal relationship with the patient. Some scholars are saying that the relationship between nurses and the patient should remain professional with no emotional attachments as it can obscure the professional judgment of the nurse (de Reave 2002a, 2002 b). However, Travelbee (1966, 1969) claims that in order for the nurse to reach authentically the patient and see his/her condition from their own perspective, it becomes necessary that they establish an emotional connection with their patient. For it is in this way that nurses learn to understand and respect the worldview of the patient. Having an emotional connection with the patient is emotionally demanding for the health care provider. Since, it demands that you be who you are, without pretensions, when being with the patient. However, the emotional connection does not occur in an instant. It requires the establishment of trust and respect towards each other. In this regard, what has been adopted as a measure is respect in all facets of the relationship (Gallagher 2007). This has to be consistently adopted. This is shown by behaviours and action such as looking at them when they are talking or not taking as negative when they do not look at you when they talk. Respect, this is what we have given them. Conclusion Ethnicity, one of the socio-political factors affecting mental health, creates a condition of double stigma for patients of ethnic group suffering from mental illness. Unwillingness to reformulate care approach that will integrate ethnic patient’s own worldviews, culture, religion and other similar factors, is detrimental for the patient as it increases the chance of misdiagnosis, maltreatment, discrimination, prejudice and creation of a care plan that is not responsive to the patient's real needs. However, the concern pertinent to the negative impact of ‘double stigma’ of ethnicity and mental illness can be addressed by respecting the dignity, ethnicity, integrity and personhood of the patient in actions, words and behaviours as care providers create a respectful and honest relationship with the patients. In effect, our different cultural heritage can be one of the basis of our common humanity. References: Bhui, K., Stansfeld, S., Hull, S., Priebe, S., Mole, F., & Feder, G., 2003. Ethnic variations in pathways to and use of specialists mental health services in the UK: Systematic review. BJP, 182, 105 – 116. Brown, T., Williams, D.R., Jackson, J.S., Neighbors, H. W., Torres, M., Sellers, S.L., & Brown, K., 2000. Being black and feeling blue: The mental health consequences of racial discrimination. Race & Society, 2(2), 117 – 131. Corrigan, P. W., & Penn, D. L., 1999. Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765–776. Corrigan, P. W., Watson, A. C., Warpinski, A. C., & Gracia, G. (2004b). Stigmatizing attitudes about mental illness and allocation of resources to mental health services. Community Mental Health Journal, 40, 297–307. de Raeve, L., Sept 2002. The Modification of Emotional Responses: A Problem of Trust in Nurse-Patient Relationships?” Nursing Ethics Vol. 9, Is 5, pp. 465 – 471. --- “Trust and trustworthiness in nurse-patient relationships”. Nursing Philosophy (2002): 3, pp. 152 – 162. Gallagher, A., 2007. The Respectful Nurse. Nursing Ethics 14(3), pp. 360 –371. Gary, F.A., 2005. Stigma: Barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing, 26, 979–999. Giddens, A., & Sutton, P. (Eds), 2010. Sociology: Introductory Readings 3rd Edition. London: Polity Press. Griner, D., & Smith, T.B. 2006. Culturally adopted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531- 548. Narayanasamy, A., 1999. Transcultural nursing health 1: barriers and limitations. British Journal of Nursing, 8(10), 1 – 6. Peplau, H. E.,1952. Interpersonal Relations in Nursing. New York: G.P. Putnam’s Sons. Peplau, H. E., 1992. Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5 (1), 13–18. Peplau, H. E.,1997. Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 10 (4), 162–167. Rogers, A. & Pilgrim, D., 2005. A Sociology of Mental Health and Illness 3rd Edition. Open Press University. Rowe, D. C., 2005. Under the skin: On the impartial treatment of genetic and environmental hypotheses of racial differences. American Psychologist 60, 60– 70. Sayce, L. 2000. From psychiatric patient to citizen: overcoming discrimination and exclusion. Basingstoke: Palgrave. Sue, D. W., & Sue, D., 2003. Counseling the culturally diverse: Theory and practice. New York, NY: John Wiley & Sons. Shattell, M.M., Starr, S.S., & Thomas, S.P., 2007. “Take my hand, help me out:” Mental health service recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing, 16. 274-284. Sumari, M., & Jalal, F. H., 2008. Cultural issues in counseling: An international Perspective, Counselling, Psychotherapy, and Health, 4(1), Counseling in the Asia Pacific Rim: A Coming Together of Neighbors Special Issue, 24-34. The Centre for Social Justice, 2011. Mental Health: Poverty, Ethnicity and Family Breakdown. London: Centre for Social Justice. Travelbee, J.,1966. Intervention in Psychiatric Nursing:Process in the One-to-One Relationship. Philadelphia, PA:FA Davis. Travelbee, J.,1969. Interpersonal Aspects of Nursing. Philadelphia, PA: FA Davis. Read More