Coping with Mental Illness: A Closer Look at Psychoeducation
A 30 year old female, admitted at Karachi Psychiatric Hospital, in Pakistan, with the diagnosis of Schizophrenia since 2006. She had multiple history of hospitalization due to relapse of the disease, divorced 10 years back, her relationship with family was not good, sleeping excessively, not talking to anyone, physically weak, and aggressive, concerned with her aggressive behavior and was willing to know about coping strategies.
It is an individual’s right and health care provider’s responsibility to provide proper knowledge of disease process, so that, one can better cope with the disease condition and effectively minimize or control the progress or relapse of illness. According to (Rummel-Kluge & Kissling, 2008, p. 169), “Psychoeducation – a non pharmacological treatment – is defined as systematic, structured, didactic information on the illness and its treatment, and includes integrating emotional aspects in order to enable the participants – patients as well as family members – to cope with the illness”.
During my clinical rotation, I observed 5 out of 7 patients, admitted with relapse of Schizophrenia – “a complex mental disorder, which deteriorates thinking, perception, and emotion with manifestation of positive and negative symptoms” (Stuart, 2009, pp. 334-336) – and had very little or no information related to their illness and it’s management. Most of the patients re-hospitalize with relapse of disease, likely due to inadequate knowledge, lack of insight, lack of motivation, fear of stigma, and complex treatment regimen (Kazadi, Moosa, & Jeenah, 2008, p. 52).
Schizophrenia is chronic in nature and frequent relapse of active symptoms can affect the patient from varying point view. Firstly, at personal level, relapse and lack of knowledge about the disease’s nature creates a state of distress and affects psychological and mental health of patient. Secondly, psychotic symptoms become a major distress between patient and his/her significant figures and affects quality relationship with spouse, parents, siblings and friends. It also disturbs the social life of patients and they become socially isolated (Lasebikan & Ayinde, 2013, pp. 60-66).
Due to the chronic nature and complex regimen in the treatment of Schizophrenia, it becomes a major financial burden for the patients and their families (Koujalgi & Patil, 2013, p. 251). Years of treatment and months of re-hospitalization require a great financial investment. Furthermore, (Afridi, 2008) states that the government of Pakistan spends less than 2% of its GDP on healthcare services (p.226), whereas, WHO recommends at least 5% of GDP to be spent on health sector (Savedoff, 2007, p. 962).
Mental health sector is largely ignored, thus, relapse and re-hospitalization of patients with Schizophrenia remains a significant national health issue. Pakistan’s almost half of the adult population, cannot read and write (UNICEF, 2012). Therefore, in a population, where increased illiteracy rate and frequent read missions due to relapse of chronic illness indicates for the need of a proper disease intervention. According to (Afridi, 2008), mentally ill patients are highly stigmatized in Pakistani culture.
They are often linked with bad and evil spirits (p.225). Pakistani society has limited resources in health sector, even lesser in mental health sector (p.225). Therefore, educating the population about nature of disease, i.e., Schizophrenia, through psycho-education can significantly impact quality of care and empathy towards mentally ill patients. Also, in such a culture, psycho-education is a cost effective intervention and it can collectively reduce financial burden of patients, their families and on national level too.
Integration of Model
“Psychoeducation is a professionally delivered treatment modality that integrates and synergizes psychotherapeutic and educational interventions. The psychoeducation model comprises of five other complimentary models and theories, which are: The Ecological System theory, Cognitive behavioral theory, Group practice models, Stress and coping models, Narrative approach.” (Lukens & McFarlane, 2004, p. 206).
For simplicity purpose, I used only two components of psychoeducation model. First, CBT is based on how patients think, feel and act. The main aim of CBT is to change patient’s altered thought process (i.e. being paranoid, aggressive), with alternative positive thinking (i.e. love, trust, calm), which will ultimately lead to normal psycho-social life. Secondly, it is often noted that Schizophrenic patients have ineffective coping styles, as evident by exhibiting aggressive behaviors and poor interpersonal relationships, which was also manifested by patient in the case scenario.
Integration of Stress Coping Model is well suited because it guides clinicians to identify patients’ stressors and their response to them and to propose effective coping styles. Therefore, CBT and stress coping model can be perfectly integrated with Schizophrenic patients, hence, reduces the relapse of disease. Based on the need of my patient and other patients in KPH, we, student nurses, conducted a teaching session on “How to Control Aggression” to help patients cope with their aggressive behaviours.
Several studies proved the positive impact of psychoeducation model by decreasing relapse of chronic disease and improving social functioning. In Pakistan, a randomized trial of 108 patients with schizophrenia was divided in two groups. One group was provided psychoeducation along with the routine treatment, whereas, the other group was only on routine treatment.
After six months follow-up, relapse rate was lower (5.8%) in-group provided psychoeducation as compared with the control group (35.7%) (Kausar & Nasr, 2009, p. 73). This study shows that by providing education to patient and their families about disease process along with usual treatment markedly minimized the readmission of patients with schizophrenia. Another study, found that incidences of readmission, relapse, and non-compliance were lower in psychoeducation group and had improved quality of life with better social functioning. (Xia, Merinder & Belgamwar, 2011, p. 2)
Strategies / Intervention
The most important part of psychoeducation is building of an optimistic “process of interaction” among the caregiver and patient (Bauml et al., 2006, p. S3). Voluntary exercise programs, i.e. problem-solving training, self-assertiveness training, individual behavioral therapy, communication training allows comprehending and accepting the disease and manage it effectively (p. S1).
The institute should have well-stated policy guidelines and teaching materials and human expertise, such as, Psychologist, therapists, Psychiatric Nurses, and Doctors for conducting psycho-education sessions as a routine care protocol. Whereas, in Karachi Psychiatric Hospital, I observed that teaching sessions were not being conducted, neither I found any recorded teaching materials in the patient’s file. Involvement of government and international communities are critical for the mental well-being. A well-established, well-funded and well-equipped mental health center focusing on psycho-education is beneficial for the patients.
Psychoeducation enhances patient’s self-help potential by increasing the understanding of the illness, developing insight, improving coping strategies, and reducing general stressors, decreasing subsequent psychotic symptoms. Collectively, it helps in minimizing the relapse of chronic disease (i.e. schizophrenia) and improves social functioning of patients.
- Afridi, M. (2008). Mental health: Priorities in Pakistan. Journal Of Pakistan Medical Association, 58(5), 225-226.
- Bauml, J., Frobose, T., Kraemer, S., Rentrop, M., & Pitschel-Walz, G. (2006). Psychoeducation: A Basic Psychotherapeutic Intervention for Patients With Schizophrenia and Their Families. Schizophrenia Bulletin, 32(Supplement 1), S1-S9.
- Kausar, R., & Nasr, T. (2009). EFFECTS OF FAMILY PSYCHO EDUCATION ON RELAPSE PREVENTION OF SCHIZOPHRENIA PATIENTS IN PAKISTAN. Journal Of Pakistan Psychiatric Society, 6(2).
- Kazadi, N., Moosa, M., & Jeenah, F. (2008). Factors associated with relapse in schizophrenia. SAJP, 14(2), 52 – 60.
- Koujalgi, S., & Patil, S. (2013). Family burden in patient with schizophrenia and depressive disorder: A comparative study. Indian J Psychol Med, 35(3), 251.
- Lasebikan, V., & Ayinde, O. (2013). Family burden in caregivers of schizophrenia patients: Prevalence and socio-demographic correlates. Indian J Psychol Med, 35(1), 60.
- Lukens, E., & McFarlane, W. (2004). Psychoeducation as Evidence-Based Practice: Considerations for Practice, Research, and Policy. Brief Treatment And Crisis Intervention, 4(3), 205-225.
- Rummel-Kluge, C., & Kissling, W. (2008). Psychoeducation in schizophrenia: new developments and approaches in the field. Current Opinion In Psychiatry, 21(2), 168- 172.
Statistics. (2012). UNICEF. Retrieved 6 April 2016, from http://www.unicef.org/infobycountry/pakistan_pakistan_statistics.html
Stuart, G. (2009). Principles and practice of psychiatric nursing (9th ed., pp. 1-761). St. Louis, Mo: Mosby Elsevier.
Townsend, M., & Angelo, L. (2012). Psychiatric mental health nursing (7th ed.).
Xia, J., Merinder, L., & Belgamwar, M. (2011). Psychoeducation for schizophrenia. Cochrane Database Of Systematic Reviews, 6, 1-157.
Join JPMS Medical Blogs Team as Editor or Contributor, email your cover letter and resume to [email protected]
We welcome Guest posts. Submit online via: http://blogs.jpmsonline.com/submit/
Disclaimer: JPMS Medical Blogs are published by the publisher of Journal of Pioneering Medical Sciences (JPMS). This article does not reflect the policies of JPMS or its Staff or Editorial nor does it intend to provide legal, financial or medical advice. Refer to Disclaimer and Policies section for more details.
Advertisement: Call for Papers for Journal of Pioneering Medical Sciences (www.jpmsonline.com): Submit Original Article, Review Article, Case Report, Letter to the Editor, News Article, Clinical Images, Perspectives or Elective Report to JPMS. We also publish Conference Proceedings and Conference Abstracts as Supplement. No paper submission or publication charges. Submit your articles online (click here) or send them as an Email to: [email protected]