Abstract
The rising trend in mental illness in Nigeria has led to serious concerns for healthcare providers. Even more worrisome, is the misconceptions surrounding this illness and the healthcare providers particularly nurses managing the condition. Psychiatric nurses are faced with several challenges ranging from shortage of staff to stigma from the society. Other challenges affecting psychiatric nursing is the rebuttal by nursing students to advance their careers in psychiatric nursing. These issues could be curbed if misconceptions surrounding mental illness are corrected in the society, which may in turn influence career choices of nursing students towards psychiatric nursing.
Mini Review
Challenges of Mental Health
Mental ill health continues to remain a misunderstood
phenomenon associated with widespread misconception and
prejudice. Negative attitudes and beliefs surrounding mental
illness abound which stimulate the general fear, rejection and
discrimination against victims. This poses great concern because
the global burden of mental health disorders is projected to reach
15% by the year 2020. As such, common mental disorders such
as depression, anxiety, and substance abuse-related disorders are
predicted to incapacitate more people than complications arising
from AIDS, heart disease, accidents, and wars combined [1]. If this
disturbing statistic is the case, then it is as a matter of urgency,
crucial to give mental health illness the close attention it requires.
In Nigeria, a significant proportion (20% to 30%) of the population
are believed to be affected by one or more mental disorders [2]
unfortunately, regardless of the pint-size responsiveness accorded
mental health, there is poor awareness and understanding of
mental health in the country. This is reflected in the unfavorable
attitude directed at mentally ill patients in Nigeria, probably
influenced by preconceived ideas held against mental illness.
In Nigeria, a significant number of people suffer from mental
illness and unfortunately, mental health happens to be the most
neglected aspect of health in the country. Mentally ill patients
are faced with numerous challenges such as poor mental health
services, poor financing of mental health programs, limited access
to available services and also limited number of providers [2].
Even more worrisome is the misconceptions held against people
suffering from mental health challenges in the society. Often times,
the society interacts with people with mental disorders from a
prejudiced perspective, mostly stemming from stigma. According to
[2], stigma continually remains the most rudimentary, cultural and
moral impediment to the relief of mental health challenges thereby
abusing human rights and impacting negatively on the dignity of
mentally disabled persons as human beings.
One of the major challenges in the management of mental
illness in Nigeria is the shortage in number of health care facilities
and mental health care professionals or the inadequacy of wellequipped
facilities to handle the burden of mental illness [3].
Another issue is the societal preference to safeguard care rendered
to physical health problems rather than mental illness [4]. This
occurs because of thriving misconceptions and stigma common
with marginal groups, of which mental illness is not an exception
and continues to remain a misunderstood phenomenon [5]. In
addition, several barriers to access and acceptance of mental
illness treatment in Nigeria persist such as poor understanding
of the aetiology of mental illness, poor facility funding, absence of
social support (family, friends, neighbours), fear of stigmatization
regarding being labelled as mentally ill or being in association with the mentally ill, and patronage to traditional native healers
who may unsuspectingly extend the illness, instead of tackling and
treating them due to illiteracy and nonstandard treatments [3].
Challenges of Psychiatric Nursing
The dearth of specialists or experts in the field of psychiatry is another disturbing challenge [6]. Particularly, psychiatric nurses are scarce compared to the number of nurses in other specialties [7]. In 2014, it was reported that there were only about 7.7 nurses per 100,000 people and one psychiatrist for the same population in nearly half of the world’s population [8]. This evident shortage, has gross implications on the field of psychiatric nursing and even psychiatry as a whole. Past studies have also reported the repudiation of nursing and medical students to further their careers in psychiatry. The study by Samari, et al. [9] reported that 78.2% of nursing and medical students were not interested in specialising in psychiatry and also had unfavorable attitude towards psychiatry. Other studies have reported prevailing negative attitudes towards mental illness among medical and nursing students [10-12]. Similarly, some studies have also revealed negative attitude towards mental illness among health professionals [13,14] although some studies reported positive attitudes [15,16].
Factors Influencing Psychiatry as a Career Choice
While there are numerous factors influencing the choice of specialty for an individual, the perception an individual or the society holds regarding that field of specialization is essential. There are several factors responsible for the unfavorable attitude towards psychiatry by health care workers and their students; they include job opportunities, credibility and influence, income, and advanced educational prospects [17]. Of major concern is the low treatment success stories associated with psychiatry, this is because a good number of psychiatric patients fail to recover fully or relapse often. These and many more contribute immensely to the pessimistic view of psychiatry held by the public and health care professionals [9]. Additionally, societal preconceived ideas and misperceptions that exist about psychiatric patients and psychiatric settings contribute greatly to the negative opinions and attitudes held towards them. Often, these patients are considered to be unpredictable, dangerous and unlikeable and such stigmatization occurs globally [9]. The most unfortunate part of this stigmatizing stereotypes is that it extends to the health care professionals attending to them (stigma by association) for instance, psychiatric nurses have been described as less skilled, not dynamic and accorded less respect compared to their peers in other fields (Henderson, Noblett, Parke et al., 2014) [18]. This often leads to lower job satisfaction and emotional exhaustion thus making psychiatry less appealing (Verhaeghe & Bracke, 2012) [19].
Furthermore, Heyman (2012) [5] stressed that health professionals who worked with mental health services have always been the subject of misconceptions in the public sphere and among their peers. The concept of “courtesy stigma” which is stigma by association has been used to explain these effects. Courtesy stigma, as argued by Ng et al. (2010) [20] is a reality dwelling amongst psychiatric nurses not because they relate to the disease but by their connection with the way the society views mental illness in its entirety. They added that researches have reported obnoxious views of the public about psychiatric nurses as evil, mentally abnormal corrupt. The skills and roles of psychiatric nurses are underappreciated. In their study, Ng et al. (2010) [20] reported that misconceptions on psychiatric nursing held by other nurses include:
a) Poor patronage as a specialty compared to other
specialties;
b) Uncomplicated knowledge and skill base;
c) Poor vision for prospective development;
d) It should be considered an after-thought career: probably
a second specialty.
In a bid to address the existing and uprising stigma and misconceptions about psychiatric nursing, the Nursing and Midwifery council (NMC) in 2010 stated that health practitioners must endeavor to endorse mental health and wellbeing in their interaction with patients, as well as defy the disparities and discrimination stemming or contributing to mental health issues. Also, they stated the importance of fostering mental health awareness by offering advice and encouragement to all health care professionals irrespective of their disciplines, in social care and health settings (Heyman, 2012) [5]. In conclusion, a paradigm shift is required in psychiatric nursing urgently, and this can only be achieved through collective effort of psychiatric nurses and nurses in other fields. Misconceptions regarding mental illness and psychiatric nursing should be dispelled first, this could be achieved through the following recommendations:
1. Nurse training schools should strengthen the psychiatric
training component in their curriculum with psychiatric clinical
postings so as to instill and encourage favourable attitudes
toward mental illness and psychiatry.
2. Remuneration package of psychiatric nurses should be
made more attractive by including certain allowances in order
to boost patronage in psychiatric nursing specialty.
3. Government and policy makers could liaise with
psychiatric schools and departments to design awareness
and sensitisation seminars and workshops in communities on
mental health and illness to aid in waning off misconceptions.
4. Further studies relating to misconceptions on mental
illness and psychiatric nursing should be conducted especially
among nurses and nursing students.
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