Perceptions and Awareness of Mental Health Illness amongst Nursing Students.
IntroductionMental health illnesses are health conditions that are identified by non-adaptive frame of mind, thoughts or behaviors, following distress and/or diminished functionality in society. (Bekhet, Murrock, Mu and Singh-Gill, 2017). According to the World Health Organization (WHO), South Africa is stated to have a higher suicide mortality rate, which in 2012 there was a rate of 6133 of suicides reported, 1665 young adults passed away as the result of suicide, making the suicide the fourth leading reason for mortality. (Wilkinson, 2017) Of which the American College Health Association (ACHA) reported suicide as the most common cause of death in undergraduate students and young adults. (Burrel, 2015) Considering the pressure, expectations and being away from known surroundings.
ObjectivesIn this review of literature, the aim is to enquire on the views of nursing students regarding mental health illness, to enquire about the knowledge nursing students have regarding mental health illness and to make recommendations how to break the cycle of stigma surrounding mental health illness.
Background
The perceptions and awareness of mental health illness amongst nurses will be discussed against literature and anecdotal evidence. Literature according to (Sharma, Sharma, Kanwar, Kanwar and Manta, 2017) describes that the attitudes and knowledge of nursing students also depends on an individual’s cultural, social and intellectual status. The literature also states that religious beliefs have an effect on the stereotypes about mental health illness as that of possession by evil spirits.
Anecdotal evidence suggests that all healthcare professionals experience significant challenges while working in a health care environment which may be stressful and challenging, thus encountering unfavorable conditions of being understaffed due to acuity demands.
According to literature health care professionals are under scrutiny from the general public in caring for individuals with mental health illnesses. (Indian Journal of Psychological Medicine, 2014)Young adults who fall within the ages of 15 – 24 showed an increased rate of suicide, suicide has become the most common cause of death among undergraduates (Burrel, 2018) Critical awareness of mental health illness by undergraduates relate to the stigma they may be facing (Mitchell, 2015) There is evidence that students themselves face challenges and they need to be supported. Mitchell further states that the challenges relate to adjusting to change to higher education, being away from family, higher academic expectation, monetary issues and peer pressure. All those challenges pre-dispose undergraduates to a higher risk of suicide. The South African Depression and Anxiety Group (SADAG) released statistics that 1 in 4 university students have been diagnosed with depression (SADAG, 2018) of which Shulman concurs that 75% of undergraduate students have an increased risk of developing mental health illness (Shulman, 2018) and are at a risk of committing suicide.
Nursing education focuses on acquiring knowledge through theory and obtaining necessary skills in a clinical setting. Students are expected to manage the demands and challenges pertaining to the nursing profession. Learning occurs through real life situations which make nursing a vital profession. They also have to adapt to work in different clinical specialty units which require discipline, responsibility and accountability. (Mathebula, 2016) The harsh reality is that student nurses suffer in silence.Bekhet et al. found that 77% of student nurses that participated in a study pertaining to mental health illness either suffers from mental health illness themselves or have acquaintance with someone who suffers from mental illness.
Discussion
With the enrollment of undergraduate students into a higher education faculty or facility for a nursing course, they arrive with preconceived opinions and attitudes that affect their behavior towards a person or patient that has a mental health illness. (Sharma et al, 2017) thus an individual’s perceptions and background including the knowledge they possess has an impact on how they perceive mental health illness.Sharma et al. further states that individuals that are affected by mental health illness are prone to unfair behavior from their peers in multifaceted ways in daily living, this unfair behavior may include some of the following; disapproval, prejudice and unjust treatment by the general public during social interaction. The fear of being bullied and shamed brings forth the vow to silence, which results in more pressure, eventually leading to self-harm even worse suicide.In the study conducted by Sharma et al. the knowledge towards mental illness was examined. During the study a total of 220 undergraduate students ranging from 1st to 4th year of study were interviewed ranging between the ages of 17 – 25. The participants were selected from different demographic areas i.e. urban and rural. By extending these demographic areas the study was also inclusive of an average family’s annual income. As per the statistics that is evident the majority namely 63% of the students interviewed were predominantly from the urban areas. Taking into consideration that the majority of participants are from urban areas, the level of awareness and knowledge will be greater than that of the participants from rural areas.
The study was conducted using a questionnaire that focused on six ideal factors that included; thoughtfulness, division, categorizing, constraining, negative forecast and denouncement. (Sharma et al. 2017)According to the six ideal factors they can be described as:Thoughtfulness This factor is designed to estimate the oppressive and pitying views of the students towards mental health illness that had been part of the study.DivisionThis factor is designed to estimate the mindset the students have towards prejudice.CategorizingThis was designed to estimate the degree of the student’s preservation of collective distance towards the individual suffering from mental health illness.ConstrainingThis relates to the view that the individual with mental health illness is a hazard to the general public. Negative forecastThe negative forecast refers to the negative assessment component seen relating to the approach used with the mentally ill.
Denouncement
This describes the feelings of shame or degradation, which differentiates one person from another person. This was designed to be included to estimate the prejudicial demeanor the nursing students have towards an individual with mental health illness.In concurrence a study done by Bekhet et al. that was directed at the specific opinions nursing students have towards the stigma associated with mental health illness. The study results identified three distinct areas that were explored namely; the direct opinion nursing students have towards stigma of mental health illness, the nursing students own views regarding mental health illness and lastly a recommendation on how to change the way the general public approach mental health illness. (Bekhet et al. 2017) It came to light that interventions are essential in order to change the perception towards mental health illness.
According to (Wilson, Tinklin, McIntyre, Quinn and Buchan, 2007) the statistics show an increase in the number of students encountering challenges with mental health illness. The rate of suicide has grown from 2.4 per 100 000 (1983-84) to 9.7 per 100 000 (1993-94). Official data collected by the Higher Education Statistics Agency (HESA) propose that the number of undergraduate students acknowledging the presence of mental health challenges on entrance into a higher education institution has increased from 5 in 10 000 (1994-95) to three 3 in 1000 (2004-05).An important discovery made by the study conducted by Wilson et al. suggests that the students showed a reluctance to ask for assistance with regard to mental health challenges. It further states that there are a number of reasons the reluctance for asking help exists. A number of students stated that they are aware of the assistance given by the institution for mental health challenges they did not consider themselves as having the limitation in mental health illness. (Wilson et al. 2007) Strategies need to be put in place to encourage and acknowledge self-awareness that promotes person centered interventions which is individualized.
In review of a paper written by (Pumpuang, Seeherunwong and Vongsirimas, 2017) the notion further continues as to rather avoiding and not acknowledging mental health illness or distress as well as not seeking professional psychological help the degree of the presenting symptoms increase. It further goes on to say that due to the reluctance of seeking help results in poor academic outcomes, displeasing patient care, increase tendency of substance abuse and in turn also self-harm behavior. (Pumpuang et al. 2017)Collectively a study done by (Vijayalakshmi, Reddy, Math and Thimmaiah, 2013) regarding the views of undergraduate students related to mental health illness comparative between nursing students and business management students.
The study conducted by Vijayalakshmi et al. illuminates the statistical incidence of mental illness in India is increased, the study stated that approximately 58/1000 of people living in India has an existing mental illness, and furthermore a total of 10 million people in India live with serious mental health illness.(Vijayalakshmi et al. 2013) A recent study was conducted in India on 1st and 2nd year nursing students to identify their views on mental health illness, before they are advanced to their 3rd year of studies which includes the theoretical implication of psychiatric nursing science and the clinical exposure to patients with mental health illness. Student nurses require training in a way that will ascertain a positive regard on people who are in need of help, seeing the fact that undergraduate student nurses reveal an undesirable approach towards mental health illness. (Sharma et al. 2018) in turn it will implicate the openness towards the topic itself and how they deal with day to day stressors. (Kelly, Jorm and Wright, 2007) concurs by stating that, limited intercessions of importance to better mental health illness education for undergraduate nursing students has been evaluated and found that a smaller amount has been thoroughly evaluated correctly. Sufficient education on mental health illness will therefore better equip the undergraduate student nurse to recognize mental health illnesses with their accompanying symptoms, therefore enabling to seek help when required.
Conclusion
Perceptions and awareness of mental health illness is of importance in the management users and that of the family they come from. What seem to be forgotten or rather overlooked is the undergraduate student nurses who are exposed to this harsh and critical environment without any consideration, making the nursing student prone to mental health illness. With the fear of being seen as ‘weak’ staying silent appears to be key.Attitude, fear and shame sets out barriers to seek help. This is due to lack of knowledge and being unaware. Student nurses need to be reassured and learn that it is okay not to be okay, and change begins within oneself. The statistics have proved that suicide has become the second most common cause of death in young adults. Undergraduate nursing students need to be made aware of the warning signs and the importance of seeking help should be stressed.RecommendationsAfter review of literature that has been discussed, methods should be put in place to break the occurrence of stigmatization, awareness drives in nursing environment on mental health illness, and surveys on the psychological status and emotional status of undergraduate students.
Bibliography
Behet AK, Murrock CJ, Mu Q and Sing-Gill H. Nursing Students’ Perception of the Stigma of Mental Illness, SM J Nurs. 2017; 3(2): 1013Sharma RC, Sharma DD, Kanwar N, Kanwar and Manta S. Undergraduate nursing students’s attitude toward mental illness: a cross sectional study, International Journal of Research in Medical Sciences, January 2018; Vol 6; Issue 1; page 275-278Vijayalakshmi P, Reddy D, Math SB, and Thimmaiah R.
Attitudes of undergraduates towards mental illness: A comparison between nursing students and business management students in India, SAJDP, August 2013; Vol 19 No 3; page 66-73Kelly CM, Jorm AF and Wright A. Improving mental health literacy as a strategy to facilitate early intervention for mental disorder, MJA; October 2007; Volume 187 Number 7
Pumpuang W, Seeherunwong A and Vongsirimas N. Factors Predicting Intention Among Nursing Students to Seek Professional Psychological Help, Pacific Rim Int J Nurs Res 2018; 22(3) 200-211Martin P.D and Daniel F.M. a Model of emotional support for student nurses working in mental Health Settings in Western Cape, South Africa. Doctoral Thesis, University of the Western Cape, Belville, Cape TownJackie Burrell, November 2018.
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