nan Ramachandra

Undergraduate nursing students' attitudes towards mental illness: Implications for specific academic education

Background: Health care professions are not immune to social prejudices and surprisingly share the general publics attitude attributed to people with mental illness. Nursing students are future health manpower research related to nursing students attitudes toward mental illness is limited. Aim: The aim of this following study is to examine the undergraduate nursing students’ attitudes toward people with mental illness. Materials and Methods: Cross-sectional descriptive design was adopted for the present study. A total of 148 undergraduate nursing students were purposively selected to complete self-reported questionnaires. Results: The nursing students have significant positive attitudes towards mental illness in three of the six attitudes factors: Restrictiveness (8.59), benevolence (29.8) and stigmatization (9.18). However, these students have negative attitudes in separatism (27.1), stereotype (11.5) and pessimistic predictions (11.7) domains as they rated high. Conclusion: Academic education in this area must be planned so as to favor the change of the attitudes that include greater use of teaching strategies that challenge beliefs and assumptions and promote a commitment to provide holistic care to people with mental illness.

Perceived human rights violation in persons with mental illness: Role of education

Background: People with mental illness are vulnerable to human rights violations and people with illiteracy and mental illness are at a double disadvantage. Objective: To determine the role of education in ascertaining human rights needs of people with mental illness. Methodology: This was a descriptive study carried out among randomly selected (N = 100) recovered psychiatric patients with mental illness in the past based on the Clinical Global Impression – Improvement scale at a tertiary care centre. Data were collected through face-to-face interview using structured needs assessment questionnaire comprising two sections related to family and community domains. Data were analysed and interpreted using descriptive and inferential statistics. Findings: Our findings revealed that human rights needs in the physical needs dimension – i.e. access to electricity (χ 2 = 5.523, p < .019) and safe drinking water facilities (χ 2 = 9.665, p < .022) – were rated higher in illiterates than in literates. The human rights needs in emotional dimension – i.e. feeling separated from their families because of their illness (χ 2 = 13.118, p < .004), afraid of family members (χ 2 = 13.388, p < .004) and called filthy nicknames (χ 2 = 17.759, p < .000) – were rated higher in literates than in illiterates. The human rights needs in the religious needs dimension – i.e. allowed to go to temple, church, mosque etc. (χ 2 = 12.000, p < .007) – and in the social needs dimension – i.e. friendliness with family members –were rated higher in illiterates than in literates (χ 2 = 9.661, p < .022). Conclusion: Empowering people with mental illness by providing adequate opportunity to pursue education will play an important role in fulfilling the obligation of the United Nations Convention on the Rights of Persons with Disabilities.

Effect of Yoga Therapy on Anxiety and Depressive Symptoms and Quality-of-Life among Caregivers of In-Patients with Neurological Disorders at a Tertiary Care Center in India: A Randomized Controlled Trial

Context: The concerns of caregivers of patients with neurological disorders have been a felt need for a long time, with many of them experiencing significant psychiatric morbidity. Aims: This study aimed to find the effect of yoga in reducing anxiety and depression, as well as improving quality-of-life in caregivers of patients with neurological disorders. Settings and Design: The study was conducted using a randomized controlled design, with yoga intervention and waitlisted controls. Methodology: Sixty consenting caregivers of inpatients in neurology wards were randomized into two groups: Yoga and control. Demographic variables except years of education and length of caretaking were comparable in the two groups, as also baseline scores of anxiety, depression and quality-of-life. A specific yoga module comprising yogāsanas, prāṇāyāma, and chanting was taught to the participants in the yoga group by the researcher. At follow-up 43 patients (yoga n=20 and control group n=23) were available. Two-way repeated measures analysis of variance was used to test the change from pre-test to post-test scores within and between groups. Analysis of covariance was performed to compare the post-test scores between the groups adjusting for education and length of caretaking. Results: Following one month intervention of yoga therapy, there was a significant (P<0.001) decrease in anxiety and depression scores, as well as improved quality-of-life among the participants in the yoga group as compared with the control group. Conclusion: This study highlights the usefulness of a yoga intervention for caregivers of inpatients with neurological problems. The small sample size and lack of blinding were some of the limitations of this study.

People with mental illness and human rights: A developing countries perspective

Background: Human rights violations among the people with mental illness were not an uncommon occurrence. The present study was aimed to compare persons with psychiatric illness and their caregivers’ perceptions regarding the human rights status of people with mental illness in the community. Materials and Methods: A descriptive design was carried out among randomly selected asymptomatic psychiatric patients and their caregivers (N=200) at a tertiary care center. Data was collected through face-to-face interview, using a structured questionnaire. Data was analyzed and interpreted using descriptive and inferential statistics. Results: Our findings revealed that the caregivers than psychiatric patients perceived negatively to the statements i.e., ‘Receiving equal information and encouragement about career opportunities’ (χ2=10.779, P<0.029), ‘Opposing discriminatory actions, slurs’ (χ2=9.472, P<0.050) ‘Resolving the conflicts with people with mental illness through nonviolent ways’ (χ2=27.091, P<0.000), ‘Responding to the complaints of harassment or discrimination against the people with mental illness’ (χ2=18.697, P<0.001), ‘Encouraged to continue their education’ (χ2=13.029, P<0.023) ‘Exploitation by the community members’ (χ2=18.653, P<0.001) and working under fair conditions (χ2=13.470, P<0.009). Conclusion: The study suggests that there is an urgent need to take necessary steps to protect, promote, and fulfill human rights of people with mental illness through providing care, educating the community, and strengthening the legislations.

Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013

Background: Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India. Aim: To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital. Materials and Methods: This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205) at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire. Results: Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7%) as well as they were sad (67.8%), unpleased (69.7%), confused (73.2%), and frightened (71.2%) with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12). Participants those were admitted involuntarily (P > 0.001), diagnosed to be having psychotic disorders (P > 0.003), and unmarried (P > 0.04) perceived higher levels of coercion. Conclusion: The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures). There is an urgent need to modify the Mental Health Care (MHC) Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered.

Does education plays a role in meeting the human rights needs of Indian women with mental illness

Background: Globally women are one of the vulnerable populations and women without education and with mental illness are doubly disadvantaged. Aim: To find out the role of education in meeting the human rights needs of women with mental illness at family and community levels. Materials and Methods: A descriptive design was carried out among randomly selected recovered women (N = 100) with mental illness at a tertiary care center. Data was collected through face-to-face interview using a structured questionnaire. Results: Our findings revealed that human rights needs in physical needs dimension, i.e. access to safe drinking water (χ2 = 7.447, P < 0.059) and serving in the same utensils (χ2 = 10.866, P < 0.012), were rated higher in women with illiteracy. The human rights needs in emotional dimension, i.e. afraid of family members (χ2 = 13.266, P < 0.004), not involved in making decisions regarding family matters (χ2 = 21.133, P < 0.00) and called with filthy nicknames (χ2 = 8.334, P < 0.040), were rated higher in literate women. The human rights needs in religious needs dimension, i.e. allowed to go to temple, church, mosque etc. (χ2 = 9.459, P < 0.024), were not satisfied by the illiterate women. Similarly, literate women felt that they were discriminated by community members due to their illness (χ2 = 9.823, P < 0.044). Conclusion: The findings of the present study suggested that women without education were more deprived of human rights needs than literate women. Thus, there is an urgent need to improve literacy of women and to strengthen the legal framework to protect the rights of the women with mental illness.

Anti-Retro Viral Therapy (ART) Adherence and Factors affecting Adherence among People living with HIV (PLHIVs)

Background: Anti-retroviral therapy (ART) improves the quality of life in HIV infected persons worldwide. To achieve optimal results from ART high levels of adherence is essential. But various factors prevent PLHIVs in adhering to ART and get the fullest benefit out of it. Methods: A descriptive cross sectional study was conducted among 100 PLHIVs receiving ART for more than 1 year in a selected setting. Using structured interview schedule ART intake in the previous month and the factors that lead to non or poor adherence in the previous 1 year were assessed individually. Results: 77% of subjects had 100% adherence to ART in the previous month. Personal and family support, occupational, and institutional factors affected the ART adherence of PLHIVs. Discussion: Determining the level of adherence to ART, throws light on the utility of the service extended by the Government. The potential barriers identified help the stake holders to focus on those areas specifically, as adherence to ART improves the longevity, productivity and quality of life of PLHIVs.

Human rights violations among economically disadvantaged women with mental illness: An Indian perspective

Background: Globally women confront manifold violations of human rights and women with poverty and mental illness are doubly disadvantaged. Aim: The aim was to examine the influence of poverty in meeting human rights needs among recovered women with mental illness at family and community level. Materials and Methods: This was a descriptive study carried out among randomly selected (n = 100) recovered women with mental illness at a tertiary care center. Data were collected through face-to-face interview using structured needs assessment questionnaire. Results: Our findings revealed that below poverty line (BPL) participants were not satisfied in meeting their physical needs such as “access to safe drinking water” (χ2 = 8.994, P < 0.02), “served in the same utensils” (χ2 = 13.648, P < 0.00), had adequate food (χ2 = 11.025, P < 0.02), and allowed to use toilet facilities (χ2 = 13.565, P < 0.00). The human rights needs in emotional dimension, that is, afraid of family members (χ2 = 8.233, P < 0.04) and hurt by bad words (χ2 = 9.014, P < 0.02) were rated higher in above poverty line (APL) participants. Similarly, 88.9% of women from APL group expressed that they were discriminated and exploited by the community members (χ2 = 17.490, P < 0.00). More than three-fourths of BPL participants (76.1%) believed that there were wondering homeless mentally ill in their community (χ2 = 11.848, P < 0.01). Conclusion: There is an urgent need to implement social welfare programs to provide employment opportunities, disability allowance, housing and other social security for women with mental illness. Further, mental health professionals play an essential role in educating the family and public regarding human rights of people with mental illness.