The Distance between Doctors and Psychiatric Patients: A Subtle Form of Discrimination against the Mentally Ill?
If we consider the word “reject”, it means to not give someone the attention, love and care they want and expect. It also means to keep a distance and refuse to give sufficient care. Normally everybody needs love and affection but if a person is suffering from any kind of physical or mental disability, they require special care and support from family and health care professionals. One would expect that the attitude of health care professionals toward mentally ill patients would be more positive and caring as it matters a lot to achieve a better health.
During my mental health clinical rotation at one of the Psychiatric Hospital in Karachi, I encountered a 45 year old female patient who was diagnosed with paranoid schizophrenia. When I approached the patient to investigate her current condition, she did not want to talk, and her attitude was aggressive. Initially I was fearful to talk to her and it took me long time to calm her down.
The patient stated, “I am fine and I don’t have any problem”, and asked me to leave her alone. From her facial expression she seemed to be in a low mood. She was sitting isolated from all the patients there. I observed that not a single staff member was looking after her, and giving her care, attention and support. I learnt from the staff that she had a history of homicidal and destructive behavior toward others and I also observed that the healthcare providers were maintaining a distance to protect themselves from her aggressive behavior.
The reason behind selecting this topic to write is that I observed that my patient was being ignored; she did not get attention and care from the health care providers which she deserved, due to her destructive behavior. After witnessing this firsthand, I thought that as a student nurse I should take the initiative of addressing this issue and to give awareness through this write-up by me.
Good care is very important for improving mental health of such clients and matters a lot. However, caring for a mentally ill patient has been a challenging area for health care professionals. Mental illness hinders interaction of staff and patients, as patients have number of negative interpersonal and behavioral symptoms like splitting, stalking behaviors, rage reaction, self-injury and suicidal attempts.
Considering the nature of these complex symptoms, some mental health care providers may emotionally distance from such patients to protect themselves from these distressing types of behaviors. Moreover, some patients may verbally or practically harm others which may make health care providers to avoid these types of patients. However, it is important for the health care providers to establish understanding, develop trust and show empathy toward them.
The “labeling theory” perspective by researcher Scheefs (from University of Chicago) and Star Vignettes explains that “patients who are labeled as the cases of mental illness were more rejected than those who were not.” A self-reported survey in the UK by Markham and Trower examined the attitudes of 45 and 48 psychiatric nurses toward treating mentally ill patients. In these surveys they took three types of patients with mental disorders including schizophrenia, border line personality disorder, and depression. They compared the responses of nurses about patients with different types of disorders and found that patients with schizophrenia and depression are more negatively and socially distanced by health care professionals.
In addition patients with borderline disorders had more withdrawn behaviors toward others and due to which health care professional have shown less empathy and response toward them. Because of this discriminatory behavior by the staff towards the mentally ill patients, patients refuse to seek out proper treatment on time. This is supported by another research, “Rejection of mentally ill patients directly affects their involvement in therapy and compliance with medication regimens”. This shows that ignoring such patient have a negative impact on their treatment and recovery as well. (Ben-Porth, 2002; Sirey et al 2001).
Moreover many other causes lead to rejection of mentally ill patients, such as display of violence by mentally ill patients, which largely misrepresented in mass media. People also have stereotypes that all such patients are dangerous and harmful. However some mentally ill patients do show aggression and violence when they are involved in alcohol and illegal drugs. Stigma is also an obstacle regarding mental health care as such clients are isolated from others and from young children to adults people use words like ‘mad and weird’ for these patients.
Furthermore, people with mental illness also experience self stigma and low self-esteem which negatively impact their recovery. I have observed in clinical settings that even health care professionals show the same stereotypic attitudes towards these patients. Additionally, it has been noted that if a mentally ill patient is from low socio-economic background, they may not get enough care and attention as compared to another patient who is from a well-to-do family.
Inappropriate interventions such as restraining and isolation are used for violent and destructive behavior of mentally ill patients to reduce agitation and prevent from injury, but on the other hand it has a negative psychological effect on patient and may pose fear in staff as well. Due to which these clients receive less care, attention and support compared to patients who are not restrained. However, warning signs may also exist in psychiatric setting that should be picked up before the occurrence of violent incidents.
Distancing behavior by mental health professionals may cause these patients to engage in harmful behaviors (e.g., self-harm behaviors, withdrawal from treatment). The management of difficult behaviors of patients’ i.e. suicidal attempts and self destructive behaviors often makes the care for these patients more demanding and challenging for the staff members, hence such patients should not be rejected. Instead, a good communication can enhance patient’s coping and recovery. “A good communication has proven to be the best plan for reducing negative attitudes towards mental illness” (Corrigan al, 2001).
Generally, as health care professionals we must know that not all types of mental illness are associated with violence. The risk of violence in a psychiatric patient is associated with certain types of illness, alcohol and drug abuse, non-cooperation in treatment and in patients having strange experiences such as command hallucinations and paranoid beliefs of persecution or with a history of violence and criminality.
Thus, keeping these symptoms and conditions in mind, it is vital for health care providers to build a good rapport and trusting relationship with such patients for their fast recovery and better health. Further to reduce the stereotyping and stigmatization of mentally ill patients, hospitals should train and counsel staff so they can better show empathy toward them. Arranging awareness programs is also an effective approach in increasing knowledge and understanding, and to improve the care and attention required for psychiatric illnesses. Hospitals must ensure that their psychiatric nurses are trained well regarding communication skills to overcome barriers to caring for aggressive patients.
Lundberg, Bertil et al. “Experiences Of Rejection By Mental Health Patients” A Qualitative Study”. Health 05.10 (2013): 1553-1560. Web. 5 Apr. 2016.
“Attitudes towards Patients with a Diagnosis of Borderline Personality Disorder€™: Social Rejection and Dangerousness”. Journal of Mental Health (2016): n. page. Web. 5 Apr. 2016.
Corrigan, Patrick. “How Stigma Interferes With Mental Health Care.” American Psychologist 59.7 (2004): 614-625. Web.
Wright, Eric R., William P. Gronfein, and Timothy J. Owens. “Deinstitutionalization, Social Rejection, and the Self-Esteem of Former Mental Patients”. Journal of Health and Social Behavior 41.1 (2000): 68. Web.
Markham, Dominic. “Attitudes towards Patients with a Diagnosis Of â€˜Borderline Personality Disorder€™: Social Rejection and Dangerousness”. Journal of Mental Health 12.6 (2003): 595-612. Web.
Chung, K.F., E. Y.H. Chen, and C. S.M. Liu. “University Students’ Attitudes towards Mental Patients and Psychiatric Treatment”. International Journal of Social Psychiatry 47.2 (2001): 63-72. Web. 5 Apr. 2016.
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