CHAPTER ONE

INTRODUCTION

Background to the study

Globally, a persistent negative attitude and social rejection of people with mental illness has prevailed throughout history in every social and religious culture (Luty, 2010). These negative feelings are not only limited to mentally ill but also toward career in psychiatric/mental health nursing. Negative feelings are prevalent even among nursing students with nursing training. Adverse attitudes by nursing students, usually in the form of discrimination, separatism, social distancing, and misconceptions are crucial issue not only for the mentally ill and their families, but also for research, advocacy and policy across the world (Kapungwe, 2011).

According to Rameela (2014), people with mental illness as a whole are portrayed as violent and dangerous people that have severely disturbed thought processes and therefore have unpredictable behavior and should be feared and avoided. The media has facilitated this portrayal of the mentally ill by depicting them in various distasteful ways. Horror movies about ‘psycho’ killers that have escaped from mental institutions are a prime example. The public perceived that mental illness is related to the persons own failings, such as weakness of character and morals, laziness, and lack of discipline and self-control (Rameela, 2014). These beliefs and portrayals cause discrimination leading to adverse effects on employment, income, and housing and in effect, self-esteem and self-concept (Markowitz, 2010). The negative attitude towards people with mental illness by healthcare providers results in disparities in access, treatment, and outcomes (Luty, 2010).

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Negative attitudes such as stereotyping behaviors, social restrictiveness towards persons with mental illness are of international concern and have negative personal and social impact on patients and their families (Niaz, Hassan, Hussain & Saeed, 2013). The mentally ill especially those with psychosis -schizophrenia, mood disorders such as depression, mania, and substance abuse disorders are perceived as aggressive, violent and dangerous and not fit for coexistence in the society. A tendency to maintain social distance from the mentally ill and to reject them socially still persists and makes its existence felt. In order to correct misconceptions about mental illness and raise the status of the mentally ill, psycho-educational interventions have been used as a tool in the fight against discrimination related to mental illness by the World Psychiatric Association (WPA) in more than 20 countries but this has not actually yielded the expected positive outcome. Although efforts are made through psycho-education, yet public campaigns which aim to change such views have made inconsistent impact.

There are studies on attitudes of nursing students towards the mentally ill; but the effects of mental health training on students’ attitudes as well as the impact of clinical training in reducing such negative attitude toward mentally ill has been inconsistent(Niaz, Hassan , Hussain &Saeed, 2013). In respect to the challenges faced by the mentally ill, ‘World Mental Health Day’ was set up by the World Federation of Mental Health [WFMH] in 1992 to increase knowledge and understanding of mental health issues(mental health literacy) around the world (Dinesh & Rob, 2012):). The WFMH have always make effort and continue to challenge negative attitude towards the mentally illand promote the rights of people with mental illness. However, despite these initiatives, many people still hold misconceptions and stereotypes about the mentally ill. Nursing students view the mentally ill as violent, strange, unreliable, incapable and incompetent

.These notions of course have a detrimental effect on quality of life of the mentally ill in terms of

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relationships, access to health care services, accommodation, education, and employment. Factors such as gender, nature of mental illness, past experiences, and contact with the mentally ill have been observed in some studies to affect nursing students’ attitude towards the mentally ill (Ukpong & AbasiUbong, 2010). A study by Bayram, Kemal, Omer Gunay, Burc, Cana &Mahmut(2011) observed that females showed a less discriminating attitude than the males. This was based on the fact that females have been considered to be more sympathetic than males. The researcher observed that there are fewer treatment programs for the mentally ill, both in the institutional or community settings in Nigeria.

Consequent upon this, many of the mentally ill in need of help in our society; are now being disowned and abandoned untreated on the streets of communities walking about naked while those in urban cities take shelter under trees, sleep by gutters, and under the bridges. The female ones are often abused sexually, raped and impregnated by unknown persons while some of these mentally ill who managed to survive scavenge for food from refuse dump points. This makes some of them prone to gastrointestinal disorders like diarrhea and dysentery. Again some of them are exposed to road traffic accidents by moving vehicles in an attempt to cross the road unaided with nobody assuming responsibility.

Besides the problem of poor attitude toward the mentally ill, the World Health Organization (WHO) in 2008 also identified a global shortage of nurse psychiatrists, whereas the need for nurse psychiatrists is growing fast (Cour des comptes, 2011). Attitude of nursing student’s is directly related to the quality and outcome of care given to the mentally ill. It is therefore on this background that the present study is designed to determine the attitude of university and hospital based nursing students towards the mentally ill before and after clinical exposure/training.

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Statement of Problem

Having a mental health problem often stimulates with it a negative attitude, and such negative attitudes towards the mentally ill constitute great burden (Neeru, 2011). There is also a link between negative attitudes toward the mentally ill and the choice of career in mental health nursing. Although attitudes toward the mentally ill have been studied extensively among the public worldwide; only few studies were focused onto nursing students (Happell & Gough, 2012). According to Kabir (2011), mental and behavioral disorders are common, affecting more than 25% of all people at some time during their lives. The prevalence of mental illness in various Nigerian communities has been reported to be as high as 27.8% and 21.3% respectively (Wakil, Abdulmalik, Salawu, & Ahidjo, 2010). These figures imply that about one out of every four Nigerians is at risk of developing a mental illness or mental disorder.

Reports in the literature from the United State have show that most nursing students exhibit a negative attitude stemming largely from ignorance, and fear of the mentally ill. This poor, negative attitude may be improved upon through proper reorientation and adequate exposure to psychiatry during basic training. However, based on the researcher’s experience, most nursing students even registered have been observed to develop or have mistrust and fear towards psychiatric patients, there is also lack of interest to choose this area of specialty as the future career by nursing students who considered people with mental illness as risky set of human beings. It is on this premise that the researcher seeks to empirically determine the attitude of nursing students towards the mentally ill before and after psychiatric clinical training experience. The aim is to determine whether or not nursing students attitude towards the mentally ill will change after training i.e. clinical experience in psychiatric hospital, or remain same despite training or whether its gets worse even after training. There is also a paucity of research of this

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nature in the nursing literature in Nigeria. This research therefore intends to fill this gap in knowledge.

Purpose of the Study

This study aimed at assessing the attitude of nursing students towards the mentally ill before and after psychiatry training experience.

Specific Objectives

Specifically the objectives are to:

1.      determine nursing students attitude towards the mentally ill before psychiatric clinical experience.

2.      determine nursing student’s attitude towards the mentally ill after psychiatric clinical experience.

3.      Ascertain influence of socio-demographic characteristics (age, gender, type of training institution) nursing students and their attitude toward mentally ill before and after clinical exposure.

1.      What is nursing students’ attitude towards the mentally ill before psychiatric clinical experience?

2.      What is nursing students’ attitude towards the mentally ill after psychiatric clinical experience?

3.      What are influence of socio-demographic characteristics (age, gender, type of training institution) on nursing students’ attitude toward mentally ill before and after clinical exposure?

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Hypotheses