The influence of patient-centered teaching on medical students' stigmatization of the mentally ill.

Aim: Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated. Method: This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis. Results: In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen. Conclusion: Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.

Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use.

PURPOSE: Limited information is known from studies regarding traditional, religious, and cultural perspectives on mental illness and the use of traditional and alternative therapies by mentally ill people in Indonesia. This study explored traditional, religious, and cultural beliefs about causes of mental illness and the use of traditional/alternative treatments for mentally ill patients. METHOD: We adopted a qualitative content analysis method as proposed by Schreier. This study was conducted at a mental Hospital in Indonesia. We interviewed 15 nurses and 15 patients. Data were analysed using qualitative content analysis method. RESULTS: Five discrete but interrelated themes emerged: 1) Possessed illness and belief in supernatural forces; 2) Sinful or cursed illness; 3) Witchcraft or human-made illness; 4) traditional/alternative treatments; and 5) Barriers to treatment of mental illness. CONCLUSION: Traditional/alternative treatments play an important role in meeting the need for mental health treatment. The findings are relevant for mental health nurses who provide direct to their patients, and for other areas of mental health practice. We also found a lack of knowledge about the causes of mental illness among patients and families. Education should be at the heart of mental health promotion to raise the level of mental health literacy in Indonesia.

[Job Retention Process among Working People with Mental Illness: A Grounded Theory Approach].

PURPOSE: The study was conducted to explore the experiences of job retention among working people with mental illness. METHODS: The participants were members with mental illness at the S Community Mental Health Center in Gyeonggi Province and who had been working for more than six months. The data were collected through in-depth interviews with 11 participants between June 27 and August 20, 2018. The data were analyzed through Corbin and Strauss's grounded theory method. RESULTS: The core category was struggling to take root in the community as a productive member. The core phenomenon was the desire to be a productive person, and the causal condition was the willingness to change for a purposeful life. The action and interaction strategies included maintaining regular living patterns, maintaining medication, developing one's tips for self-management, and self-approval. The intervening conditions were difficulties in forming social relationships, presence of symptoms, social resources, and acceptance of one's mental illness. The consequences were restoration of family relationships, healthy pleasure through work, social inclusion, development of self-worth, and transition to an independent person. CONCLUSION: Working people with mental illness are struggling to take root in the community as a productive member. This study suggests that a holistic understanding of the job retention experience among people with mental illness is required. The findings will provide the basis for developing interventions that can improve job retention among working people with mental illness.

Transcending the Profession: Psychiatric Patients' Experiences of Trust in Clinicians.

Classical medical sociological theory argues patients trust doctors in part because they are professionals. Yet in the past half-century, medicine has seen a crisis of trust as well as fundamental changes to the nature of professionalism. To probe the relationship between professionalism and trust today, we analyzed interviews with 50 psychiatric patients receiving care in diverse clinical settings. We found patients experience trust when they perceive clinicians transcending the formal bounds of professionalism. Patients find clinicians to be trustworthy when clinicians pursue connections to their patients beyond organizational strictures, cross boundaries of professional jurisdiction to provide holistic care, and embrace the limits of their professional knowledge. This dynamic of trust in professionals who transcend the profession highlights novel dimensions of contemporary professionalism, and it makes sense of a seeming contradiction in which patients have high trust in individual clinicians but low trust in institutions.

Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service.

WHAT IS KNOWN ON THE SUBJECT?: There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS). Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge. This study found that with "timely support" and "family presence," people who had received the services of ICMHS continued to engage in more social activities ("expanding social networks"), had "better family relationships," were "letting go" of thinking too much and more able to relax, and had "better self-efficacy and self-caring" in the community. Professional contact after ICMHS through continuous conversations (e.g. home visits and follow-up calls) and social activities are essential for both clients and their families to carry on living with the illness. Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Although the ICMHS' resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients. Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost-effectiveness of services and relapse rates over time should also be evaluated for future practice development. Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. ABSTRACT: Introduction More comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. Aim To explore the community life experiences of people after their discharge from the ICMHS. Method A qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi-structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. Results Six themes emerged from the analysis: "timely support," "family presence," "better family relationships," "expanding social networks," "letting go" and "better self-efficacy and self-care," under the main theme of "walking with the illness and life." Discussion Over and after the ICHMS, with timely support and family presence, there was a positive trend in the experiences of clients in expanding social networks, having better family relationships, letting go of thinking too much and being more able to relax, and improving self-efficacy and self-caring. Implications for practice The study provides a more comprehensive understanding of the experiences of clients, family and staff about the community life of people post-ICMHS, providing insights and clearer directions for research and practice development.

The "appropriate adult": What they do and what they should do in police interviews with mentally disordered suspects.

BACKGROUND: In almost all countries worldwide, the first point of contact with the criminal justice system is with the police. A large proportion of these individuals may have vulnerabilities, such as mental health difficulties. Given the complexities associated with vulnerable suspects, such interviews may be compromised, which could lead to a miscarriage of justice. In England and Wales, the Police and Criminal Evidence Act (PACE) 1984 and its accompanying Codes of Practice lay down requirements for interviewing vulnerable suspects and provide for attendance of "appropriate adults" to support communication between police and the vulnerable suspect. To date, however, their role has been underresearched. AIMS/HYPOTHESES: To explore the role of appropriate adults in police interviews and test the hypotheses, first, that appropriate adults more commonly remain passive during interview than expected from guidance and, second, that any interventions are more likely than not to follow examples in current guidance. METHODS: Transcripts of police interviews conducted with suspects with possible mental disorder and an appropriate adult present (N = 27) were analysed using a specially developed coding framework. RESULTS: Appropriate adults were significantly more likely to remain passive than to intervene, even when current guidance would suggest intervention. When they did intervene, however, such interventions were significantly more likely than not to follow from guidance than the vulnerable suspect's needs. Police and Criminal Evidence Act (PACE) 1984. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In our sample, appropriate adults were not fulfilling their role as outlined in the Police and Criminal Evidence Act (PACE) 1984 and accompanying Codes of Practice; specifically, they appeared to know what to do but not when to do it. There is a heightened risk of a miscarriage of justice in such circumstances without improvements.

Patient perspectives on how living with a mental illness affects making and maintaining healthy lifestyle changes.

OBJECTIVE: To understand the ways that mental health symptoms interfere with achieving health goals. METHODS: Individuals with mental illness diagnoses and varying levels of preventive service use were recruited from federally qualified health centers and an integrated health care delivery system and interviewed. Thematic analysis was used to characterize descriptions of how mental illness experiences influenced lifestyle change efforts. RESULTS: Three themes described patients' (n = 163) perspectives on barriers to making healthy lifestyle changes: 1) Thinking about making lifestyle changes is overwhelming for individuals already managing the burdens of mental illnesses; 2) Depression makes it difficult to care about a healthy future; and 3) When mental illness symptoms are not adequately treated unhealthy behaviors that provide relief are unlikely to be discontinued. Participants also made suggestions for improving health care delivery to facilitate positive behavior change. CONCLUSION: Patients with mental illnesses need their clinicians to be empathic, help them envision a healthier future, address unmet mental health needs, and provide resources. PRACTICE IMPLICATIONS: Primary care clinicians should encourage their patients with mental illnesses to make healthy lifestyle changes within the context of a supportive relationship. Lifestyle change can be overwhelming; clinicians should acknowledge progress and provide ongoing tangible support.

[Stigmatisation of mental illness by medical students in Conakry, Guinea]. / Stigmatisation de la maladie mentale par les étudiants en médecine en Guinée, Conakry.

INTRODUCTION: Stigmatisation of mental illness constitutes a major problem in the development of mental healthcare programs, especially when it originates from health professionals themselves. The aim of this research is to investigate possible attitudes of stigmatisation among first and final year medical students registered at the University of Conakry faculty of medicine in Guinea-Conakry (West Africa). METHODS: Focus group discussions identified students' attitudes and perceptions in relation to mental illness, their explanatory models, their opinions concerning traditional and modern therapeutic practices with regard to mental illness, and their interest to possibly incorporate psychiatry in their future medical practice. RESULTS: Many students explicitly regret the stigmatisation of mental health patients, but nevertheless share the general population's prevailing attitudes of discrimination. The dominant stereotype of mental illness is that of madness, although final year medical students describe a more diverse spectrum of mental health problems. There is strong adherence to secular occult explanations of mental illness and advocacy for traditional medicine in addressing these illnesses, including among final year medical students. DISCUSSION: No student would opt for psychiatry as a specialisation, although some expressed interest in integrating psychiatry into their future medical practice. However, this research indicates that stigmatising attitudes are not cut in stone. Under the impetus of specific teaching programmes, attitudes can evolve to create room for tolerance and compassion.

[DGPPN compass of participation for vocational integration of persons with mental illnesses]. / DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen.

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

Are individuals living with mental illness and their preferred alternative decision-makers attuned and aligned in their attitudes regarding treatment decisions?

BACKGROUND: Mental disorders account for considerable suffering and societal burden. Prospective alternative decision-makers may be engaged in helping make treatment decisions for those who live with serious mental disorders. Little is known about the ways in which alternative decision makers arrive at treatment recommendations and whether the perspectives of alternative decision makers and ill individuals are aligned. METHODS: The authors queried community-dwelling individuals diagnosed with schizophrenia, anxiety, or mood disorders and their preferred alternative decision-makers on issues regarding treatment decisions and underlying ethically-salient perspectives using a written survey instrument. Complete data were obtained on 26 pairs (n = 52, total). Outcomes included perspectives on clinical decision-making and underlying values that may shape their life choices. Two-sided paired t-tests and graphical representations were used. RESULTS: We found that preferred alternative decision-makers overall accurately predicted the views of ill individuals with respect to the role of the individual and of family in treatment decision making. Preferred alternative decision-makers slightly overestimated autonomy-related perspectives. The personal views of ill individuals and preferred alternative decision-makers were aligned with respect to different physical and mental disorders, except in relation to alcohol and substance use where alternative decision-makers placed greater emphasis on autonomy. Alignment was also discovered on underlying life values, except the role of spirituality which was greater among alternative decision-makers. CONCLUSION: Preferred alternative decision-makers are an ethical safeguard to ensure the wellbeing and rights of seriously ill individuals. In this pilot study, preferred alternative decision makers were aligned with their ill family members concerning treatment-related decisions and underlying life values. Future research should continue to explore and clarify the views of ill individuals and alternative decision makers to determine the quality of this safeguard used in clinical settings.

Experiencing Madness: Mental Patients in Medieval Arabo-Islamic Medicine.

This paper focuses on the mental patients in Arabo-Islamic Middle Ages. Patients suffering from mental illnesses generated a lot of interest for Arabo-Islamic physicians. The first objective of this study is to identify who were the mentally infirm and to compare the Arab physicians' typologies of mental patients to that of their Greek predecessors. The second part of this paper shifts the focus from theoretical descriptions to case histories and biographical sources, in order to understand how the physicians treated their mental patients, and to find out what was the social impact of this medical approach. Finally, because the special provision for the insane is a distinctive feature of the Islamic hospital, the third part of my paper examines whether the main purpose of these hospitals was the patients' confinement or their treatment.

Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists.

BACKGROUND: In order to scale up mental health care nationally, barriers to health services utilisation need to be identified and addressed. AIM: The aim of this study was to identify barriers to mental health services utilization in Sudan from the perspectives of carer's of mentally ill patients and psychiatrists and to make recommendations to address the identified barriers. METHODS: Mixed research methods were used in this cross sectional survey. The quantitative part was conducted with carers of mentally ill patients who were staying in Tijani Elmahi psychiatric hospital in Sudan, and the qualitative part was conducted with the psychiatric consultants in the country. RESULTS: 103 carers and six psychiatric consultants participated in the study. According to carers, the main barriers to utilisation of mental health services includes: the beliefs around mental illness, resorting to alternative treatments such as religious and traditional healers, centralization of mental health services, inadequate number of mental health staff, and mental health not being a priority by policy makers. In addition to these barriers, the psychiatric consultants identified stigma, cost of medications, and worries about medication's side effects as barriers to the utilisation of mental health services. The carers and psychiatrists proposed several solutions to address the barriers to health services utilisation. CONCLUSION: Carers and psychiatrists are aware of the barriers to mental health services utilisation in Sudan. Addressing these barriers require a health policy and political response.

[The role of art therapy in the rehabilitation of psycho-socially disabled people]. / A mövészetterápia szerepe a pszichoszociális fogyatékkal élok rehabilitációjában.

The present review focuses on the generally accepted and applied community psychiatry based models of psycho-social rehabilitation. The basics of the Strenghts model and the Recovery based model are introduced in this paper. Both models can be assisted by art therapy in various ways. The forms and the therapeutic factors of art therapy are also discussed, as well as the effects of the creating experience during the art therapy sessions. The authors introduce the good practice of the Moravcsik Foundation with highlights in two special areas that are beyond the generally applied art therapy work and representing important support in reaching the goals set during the rehabilitation process. Further, the authors describe the Budapest Art Brut Gallery and the PsychArt24 art marathon project in details.

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill.

This article discusses, from the grandmother's perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52-90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.

"Hope crept in": a phenomenological study of mentally ill artists' biographic narrative.

BACKGROUND: The ways in which involvement in art practice may support a recovery trajectory in the lives of the mentally ill are well documented although evidence is charged with lacking clarity and of being inconclusive. Numerous studies, however, indicate benefits such as cognitive distraction; "derailing" of negative thinking patterns; increased social capital; and enhanced sense of belonging. AIMS: This study used narrative interviews to explore what meanings were made by people with mental health difficulties of engaging in an ongoing visual art practice. METHODS: Phenomenological Interpretative Analysis (IPA) was used to analyse 50 interviews. Two superordinate themes of regression and progression were identified through which to explore the shifts in narrative between exploring one's past and looking ahead to the future. In this context, the theme of hope emerged, and the research explored the ways in which the individual's art practice was implicated in engendering and sustaining it. RESULTS: Results suggest that artistic activity facilitated a contained autobiographical analysis and a reimagining of oneself in the future, in which hope played a fundamental part. CONCLUSION: This research suggests that a dialectic between despair and hope is facilitated by the autobiographic elements of an art practice. Through this movement from a perceived static past to a more fluid future is experienced.

Mural art therapy for young offenders hospitalised with a mental illness.

OBJECTIVE: To describe a mural art therapy project completed within an adolescent unit of a secure forensic psychiatric hospital. METHOD: The planning, implementation and consecutive stages of the mural art therapy project are described. Pertinent themes are identified. RESULTS: A cohort of adolescent forensic inpatients was engaged in a group therapeutic process involving collaboration, design and the completion of an art mural. The participants generally approved of the project and identified themes of gaining a sense of achievement, empowerment, teamwork, involvement and ownership. The art mural transformed and improved the visual and spatial environment of the Adolescent unit courtyard. CONCLUSIONS: Mural art therapy was acceptable to young offenders hospitalised with mental illness, which has relevance for adolescent psychiatric units and youth detention centres.