How do Stigma and Discrimination Hinder Recovery of Patients with Schizophrenia - Essay Example

?How does Stigma and Discrimination hinder Recovery of Patients with Schizophrenia? How does Stigma and Discrimination Hinder Recovery of Patients with Schizophrenia? Background: A lot of attention was put on anxiety and depression but the health care sector seemed to forget about some extremely intense mental conditions like schizophrenia Key words: stigma, discrimination, schizophrenia, recovery, and mental illness. Research question: In what ways does stigma and discrimination hinder the recovery of schizophrenic patients? Research purpose: The aim of this study will be to investigate the various ways in which stigma and discrimination impede the recuperation of schizophrenic patients. Research Method: Qualitative research will be done on this study and a thematic approach will be used as the study seeks to examine, investigate, locate and record patterns. A survey will be conducted. Sample: Non probability sampling method. A total of 60 sample units will be used, 40 being schizophrenic patients and 20 nurses or family members. Data collection: Interviews and focus groups will be used as tool of data collection. Data analysis: Data analysis will be conducted through SPSS software and the Burnard model of coding, which provides a model for data organisation. Findings and Result: Stigma and discrimination were observed to affect the schizophrenic patients through hindering recovery and even exacerbating the illness. Conclusion: Without the stigma and discrimination, schizophrenic people would recover fast and easily thus contributing to the society. The stigma and discrimination that follows a person after being diagnosed with schizophrenia is usually what leads them to an early grave. Schizophrenic patients have been misunderstood by many people for a long time How does Stigma and Discrimination hinder Recovery of Patients with Schizophrenia? Introduction Many individuals with mental illnesses such as schizophrenia have confirmed that the stigma they face from other people usually leads to more pain than the disease itself. Stigma reduces the patient’s self-esteem and denies them many social opportunities stigma. Stigma can be explained as the negative attitudes that people have towards others while discrimination is explained as unfair treatment of people due to their social grouping (Parle, 2012:2). Schizophrenia refers to a mental condition that extends over a long period of time, and causes numerous distinct psychological symptoms such as, hallucinations, delusions, and unusual behaviours (Sachdev and Keshavan, 2010:4). It is a psychotic condition where patients are incapable of discerning reality from their own thoughts and imagination (Chan and Sireling, 2010:107). The people suffering from this condition are pre-judged, therefore, finding it hard to maintain and sustain relationships, friendships and employment. Stereotype portrayed by the media have been blamed for the fear and ignorance about schizophrenic people (Bos, 2009:510). Background I came across a report at the beginning of the year, which suggested that out of every six workers in the United Kingdom, one usually suffers from a mental illness at a certain time in their career (Bevan, et al. 2013:5). With the country experiencing tough economic times recently, there was an upsurge in the number of working age people suffering from a variety of mental illnesses. A lot of attention was put on anxiety and depression but the health care sector seemed to forget about some extremely intense mental conditions like schizophrenia. It dawned on me that proper attention should be paid on schizophrenic patients and I decided to look at ways that a patient could recover from such an illness. That was when I got the idea of investigating stigma and its effect on the recovery of schizophrenic patients came into mind. Research question formulation An excellent research question has to be accurate and precise. The research question formulated in this study is:In what ways does stigma and discrimination hinder the recovery of schizophrenic patients? Literature Review The review of the other researchers’ work was conducted systematically via an electronic search. The literature review emanated from various databases such as Google scholar, BMJ, CINHAL, Nursing Times, British Journal of Psychiatry and NICE. The keywords used were; stigma, discrimination, schizophrenia, recovery, and mental illness. Three articles were selected from the five databases and then five articles that were most relevant to the study were selected. Nicolas et al (2009) carried out a qualitative study to investigate whether stigma interfered with mental health services. They had a sample of eighty five schizophrenic people while measured stigma-related cognitions and self-stigma within the sample. After six months of using the thematic approach they were able to come up with the conclusion that eighty eight percent of their sample population had used mental health services. They found evidence that factors related to stigma affected the schizophrenic patients’ use of mental health services. The researchers concentrated on self-stigma thus the need for my study to investigate stigma factors originating from the society. Knight, Wykes and Hayward (2010) used a qualitative study where they interviewed a sample of six respondents. They investigated how schizophrenic patients went about with their lives in order to explore the levels of stigmatization and discrimination. The study utilised Interpretative Phenomenological Analysis where issues of superior themes of comparison, judgement, and personal understanding emerged. Public and elf stigma were evident and were seen as disabling. However, the study did not touch on the roles that stigma plays in the recovery of the patients. Sibitz et al (2009) conducted an investigation on stigma resistance, which is defined as a person’s ability to neutralise the stigma. This was a new study and the triangulation methodology was used on a sample of one hundred and fifty seven participants. Perceived discrimination and devaluation were measured in addition to empowerment, self-esteem, depression, quality of life, and clinical variables. Results showed that two-thirds of the participants indicated a high stigma resistance. However, the study did not demonstrate how the stigma resistance would allow or hinder recovery of patients with schizophrenia. My study would further the research to provide the information needed. Webber et al (2013) evaluated if discrimination against people with schizophrenia could be linked to social capital, which was mutually related to mental health. A cross sectional survey was used where data from one thousand and sixteen participants was collected. To identify the correlates of social capital, exploratory univariate analysis was utilised and linear regression models were used in evaluation. Limited access to capital was associated with discrimination from the immediate family and friends but was not affected by the neighbours, or the hospital staff. Further research is needed to establish how this aspect would hinder recovery for a patient with schizophrenia. Harrison and Gill (2010) talk about stigma and discrimination and how they contribute to disempowerment of the patients suffering from schizophrenia. The article explores the effect of stigma and its role in lowering the quality of life. The article made propositions on reducing the negative effects of schizophrenia. The literature review is aimed at exploring stigma as experienced by people with schizophrenia. Though the construct of stigma has been explored, the article fails to indicate the effects of stigma on the recovery of a person with schizophrenia. Discussion Studies conducted previously have hinted of a trend occurring on schizophrenic patients where they are discriminated against and stigmatized. People have continued to stereotype schizophrenia and the people who are diagnosed with the disease are being mistreated. This has trend has resulted to aggravation of the disease and thus hindering the recovery of patients (Blenkiron, 2009:14). The research papers and articles found have failed to address the issue of stigma and discrimination and the role that they play in hindering the recovery of patients with schizophrenia. Strength of the evidence After carefully analysing the evaluations of the papers, it was evident that they had been published after other professionals had reviewed them thus bearing credible material. The research papers and article can be accessed with ease via the numerous websites and research databases available. They all can be trusted to give direction in this research since they provide the support for further study. The methods utilised and the findings are suitable with the research study (Hill and Startup 2012:152). Purpose of study The aim of this study will be to investigate the various ways in which stigma and discrimination impede the recuperation of schizophrenic patients. Research design The methodology used in a research depends on the qualities or characteristics of the phenomenon that is undergoing the study. This research aims at understanding behavioural patterns of schizophrenic people in their environment (Burns and Grove, 2009:15). This means that qualitative research will be done on this study to provide the correct results. A thematic approach will be used as it stresses on examining, investigating, locating and recording patterns. A survey will be conducted. In the research, patients will record their accounts and the researcher will examine and correlate the variables accordingly. Method Sample/Setting This research will be restricted to Non probability sampling method. This is because only schizophrenic patients will be targeted; therefore, only hospital records will be used to determine the sample population. When selecting the hospital to visit in order to obtain the records and study the patients, cluster sampling will be utilised. This is because I will only choose the hospitals within my geographical area as it is easier and cheaper to carry out a study locally (Gerrish and Lacey, 2010:24). There are three hospitals in my geographical area and I will interview and make observations on forty patients and twenty carers or family members. All the patients who are schizophrenic will be interviewed. This is because there are few people with schizophrenia; therefore, including them all will assist in gathering the sample required. Ethical considerations A research needs to follow principles and ethical rules that assist in authentication and ensuring that it has integrity and credibility. These rules include asking for permission to conduct the research from the relevant authorities, respecting the privacy of the respondents in your study, asking for permission from your correspondents before conducting a research on them and other ethical issues (Moule and Goodman, 2009:17). First, relevant authorities will be approached at the school and hospital level to ensure that the research is approved and can continue as planned. Assistance will be required at the hospital, therefore, I will write to the hospital asking for necessary assistance as I conduct the research. Confidentiality and anonymity will be assured for all the patients. Only the willing patients will be included in my research. Their parents, guardians, and the hospital staff will help determine if a patient can be available for the research (Gerrish and Lacey, 2010:21). Procedure Three people will assist me in collecting data. We will go to the three hospitals located near my geographical area and after obtaining the necessary information about the schizophrenic patients, we will interview at least ten from each hospital. We will then interview six nurses in each hospital to find out about the conditions of the schizophrenic patients. Interviews will be conducted. We will then find out their views when we engage the schizophrenic patients in focus groups. Data Collection The most suitable data collection tool for this study will be the interview. An interview guide will be prepared to help the researcher ask the relevant questions. The interview will be semi-structured having questions that need precise answers and other that are derived from the patient’s account. Observation made such as gestures and body movements will be indicated on a notebook as well as the answers given by the patients. Focus groups will also be used where the patients will discuss some of the issues that affect them. Hospital records will be utilised to show the recovery process and compare it with the level of stigma that a patient has experienced (Livingston and Boyd, 2010:2157). Data Analysis The aim of analysing data is to arrange the data in a systematic way for easier evaluation and assessment. Data will be keyed into the computer and software will analyse it. Analysis software such as Statistical Package for the Social Sciences (SPSS) will be used to analyse the data and make relevant inferences on the results provided. The Burnard model for data organisation will be used to analyse the notes made during the interview (Molinari and Bushy, 2011:56). Findings/results The findings will be typed and handed to the relevant instructor. They also will be published with some help from the research department. Limitations of the study The research may have some few limitations. Some guardians may not be open to the idea of allowing their relatives to be part of an interview. Some patients may give false information, which may affect the results of the research. Some schizophrenic patients exhibit patterns of violence hence proper care may be required when handling such patients. Reliability and Validity When dealing with volatile people, some information may go unnoticed and sometimes one can be distracted by the environment. Hospitals have many activities going on, which may lead to distraction. To minimise this effect, interviews will be conducted privately where distraction is minimal. The interview questions will be tested through conducting a dummy experiment to correct some of the mistake in the research (Polit and Beck, 2010). Resources, timetable Resources will be utilised in this study, which include time, money, human labour and others. Implication for nursing This research will help in nursing for it will be a source of information on the various ways in which stigma and discrimination impede the recuperation of schizophrenic patients. It will establish a base for awareness creation starting with the nurses and following to the other people. Conclusion Schizophrenic patients have been misunderstood by many people for a long time. Awareness has not been created to help the masses understand that schizophrenia is an illness and like many illnesses, patients exhibit abnormal behaviours (Queensland Alliance for Mental Health, 2010). The stigma and discrimination that follows a person after being diagnosed with schizophrenia is usually what leads thems to an early grave. The media and all responsible people should create awareness and teach the people to refrain from stigmatizing schizophrenic people (Blenkiron, 2009:13). Without the stigma and discrimination, schizophrenic people would recover fast and easily thus contributing to the society. References Alonso, J. et al. (2009) ‘Perceived stigma among individuals with common mental disorders,’ Journal of Affective Disorders, vol. 118, pp. 180-186. Bevan, et al. (2013) Working with schizophrenia: pathways to employment, Recovery & Inclusion. Blenkiron, P. (2009) Psychiatry in the Media, London, Royal College of Psychiatrists. Bos, A.E. et al. (2009) ‘Mental illness stigma and disclosure: consequences of coming out of the closet,’ Issues in Mental Health Nursing, vol. 30, pp. 509-513. Chan, D. & Sireling, L. (2010) ‘I want to be bipolar’ …a new phenomenon,’ The Psychiatrist; vol. 34, pp. 103-105. Gerrish, K. & Lacey, A. (2010) The research process in nursing, United Kingdom, Blackwell Publishing. Harrison, J. & Gill, A. (2010) ‘The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward,’ Journal of Psychiatric and Mental Health Nursing, vol. 17, no. 3, pp. 242-250. Hill, K. & Startup, M. (2012) ‘The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy,’ Psychiatry Research, vol. 206, no. 2, pp. 151-157. Knight, M., Wykes, T. & Hayward, P. (2010) 'People don't understand': an investigation of stigma in schizophrenia using interpretative phenomenological analysis (IPA),’Journal of Mental Health, vol. 12, no. 3, pp. 209-222. Livingston, J. & Boyd, J. (2010) ‘Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis,’ Social Science and Medicine, vol. 7, no. 1, pp.2150-2161. Lyons, C. et al. (2009) ‘A decade of stigma and discrimination in mental health,’ Journal of Psychiatric and Mental Health Nursing, vol.16, pp. 501-507. Mestdagh, A. & Hansen, B. (2013) Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies, London, Informa Healthcare. Molinari & Bushy (2011) The Rural Nurse: Transition to Practice, Cambridge, Cambridge University Press. Moule, P. & Goodman, M. (2009) Nursing Research: An introduction, London, Sage publishing Ltd. Nicolas, et al. (2009) ‘Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use,’ British Journal of Psychiatry, vol. 195, no. 6, pp. 551-552. Parle, S. (2012) ‘How does stigma affect people with mental illness?’ Nursing Times, vol. 108, no. 28, pp. 12-14. Queensland Alliance for Mental Health. (2010) From Discrimination to Social Inclusion. A Review of the Literature on Anti Stigma Initiatives in Mental Health, viewed 12 Nov 2013 from . Sachdev, P. & Keshavan, M.S. (2010). Secondary schizophrenia, Cambridge, Cambridge University Press. Sartorius, N. (2010) ‘Fighting Stigma and Discrimination Because Of Schizophrenia,’ European Psychiatry, vol. 15, pp. 271. Sibitz, et al. (2009) ‘Stigma Resistance in Patients with Schizophrenia,’ Oxford Journals Medicine, vol. 37, no. 2, pp. 316-323. Webber, et al. (2013), ‘Discrimination against people with severe mental illness and their access to social capital: findings from the Viewpoint survey, Epidemiology and Psychiatric Sciences,’ Epidemiology and Psychiatric Sciences, vol. 1, no. 1, pp. 1-11. Appendix 1 Budget Proposal writing stationery Internet use Printing the research proposal report Sub total 20 20 20 60 Data collection Printing interview guides Subtotal 10 10 Report writing Stationaries Printing the report Subtotal 20 10 30 Transportation Software and computer accessories Lunch and eateries Contingencies External Reviewer fee Subtotal 100 100 100 100 500 TOTALS = 1100 pounds Appendix 2 Timetable Activity Months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Design Research proposal Present, defend and update research proposal Seek permission to carry out the research in the target schools Printout and photocopy research tools Recruit and train assistants if necessary Secure appointments with pre-testing respondents and pre-test survey tools Adjust research tools based on results Make appointments with research respondents Program the data collection tools into SPSS® Administer research tool Clean up data and sort it out Key-in the data and analyse Write draft report and present Update research report, defend and submit final version Appendix 3: Table summarizing the five articles used in the literature review Authors and Date Study aim Method used Sample Results. Nicolas Rusch, Patrick W. Corrigan, Abigail Wassel, Patrick Michaels Jonathon E. Larson (2009) To investigate whether stigma interfered with mental health services Qualitative study using a thematic approach 85 schizophrenic people 88% of the people interviewed had accessed mental health services. They found evidence that factors related to stigma affected the schizophrenic patients’ use of mental health services Knight, M. Wykes, T. D. Hayward. P (2010) To explore the levels of stigmatization and discrimination in schizophrenic patients. Qualitative study Interpretative Phenomenological Analysis 6 respondents Research proved that public and self-stigma were aggravating the situation of schizophrenic patients. Sibitz I, Unger, A. Woppmann, A. Zidek, T. (2009) To investigate the level stigma resistance on schizophrenic patients Triangulation methodology 157 participants Two-thirds of the participants indicated a high stigma resistance when surrounded by close family and friends. Webber, M. Corker, E. Hamilton, S. Weeks, C. Pinfold, V. Rose, D. Thornicroft, G. Henderson, C. (2013) Investigate if discrimination against people with schizophrenia could be linked to social capital. Cross sectional survey 1016 participants Limited access to capital was associated with discrimination from the immediate family and friends but was not affected by the neighbours, or the hospital staff Harrison, J. Gill, A (2010) Review on stigma and discrimination and how they contribute to disempowerment of the patients suffering from schizophrenia Literature review The article found out that there were negative effects of schizophrenia and exploration of stigma was reviewed. Appendix 4: Letter asking for ethical approval 19 June 2013 Ethics Committee The National Research Ethics service Dear Sir/Madam Re: Approval for a Research Study investigating the various ways in which stigma and discrimination impede the recuperation of schizophrenic patients. I am a student at Middlesex University and in order to complete my course I have to carry out a research study. This letter aims at requesting for permission in order to continue with the research, which will be essential for me to complete my undergraduate degree. The research will follow a descriptive study that will have a thematic approach and will seek to investigate the various ways in which stigma and discrimination impede the recuperation of schizophrenic patients. The tools for collecting data in this research will be interviews and focus groups. Data will be collected from three hospitals in my geographical area. Data will only be collected on the patients and nurses that have consented to the research. All the data will be treated confidentially. A research proposal is attached with this form and my contacts are also indicated, therefore, in case any issue arises, please contact me. Yours sincerely Read More