MENTAL ILLNESS STIGMA

Introduction

Health is essential for the growth, development and productivity of a society and is vital

for a happy and healthy life anywhere in the world. The World Health Organization’s definition

of health includes physical, social, spiritual and mental health and not merely an absence of

disease or infirmity.

Mental illness is probably the most misunderstood and stigmatised topic. Stigma against

mentally ill individual is so epidemic that it touches every facet of their lives, it brings with it

many problems at times from getting any treatments at all. Mental illness is nothing to be

ashamed of. It is a medical problem, just like heart disease or diabetes. World Health

Organization (WHO) estimates that 10% of the world’s population has some sort of mental

illness and 1% suffers from incapacitating mental disorders. Mental illness does not discriminate;

it can affect anyone regardless of your age, gender, geography, income, social status,

race/ethnicity, religion/spirituality, sexual orientation, background or other aspect of cultural

identity.

According to a media report on National Mental Health Survey “India needs to talk about

mental illness;”[2] “Every sixth Indian needs mental health help;”[3] “8% of people in Karnataka

have mental illness;”[4] “Mental problems more in 30–49 age group or over 60; low income

linked to occurrence of mental disorders;”[5] and “urban areas to be most affected”[2].

Stigma and misconception regarding mental illnesses is a concern all over the world and

especially India. Compared to physical disabilities, people with mental illnesses are often viewed

harshly and negatively by the general public and often become victims of stereotypes and myths
and are labeled as dangerous, unpredictable and violent. These stigmas result in avoidance, fear

and often lead people to distance themselves from the individuals with mental illnesses.

Kermode M et al. (2009) conducted a mental health literacy survey on community beliefs

about causes and risks for mental disorders in a rural area of Maharashtra, India. This study

aimed to assess local knowledge and understanding of causes and risks for mental disorders and

to assess the prevalence of possible common mental disorders. A questionnaire was administered

to 240 systematically sampled community members and 60 village health workers. Study

indicated that 27% had a possible common mental disorder and that the elderly were at increased

risk.

According to APA(2018), Mental illnesses are health conditions involving changes in

emotion, thinking or behaviour. They are associated with distress and or problems functioning in

social work or family activities.

Section 2(i) of the Persons with Disabilities Act 1995 defines Mental Illness as,(Disabled

Persons in India A statistical profile 2016, 2019)

1. Is taking medicines or other treatment for mental illness; or

2. Exhibits unnecessary and excessive worry and anxiety; or

3. Exhibits repetitive (obsessive-compulsive) behaviour/thoughts; or

4. Exhibits sustained changes of mood or mood swings (joy and sadness); or

5. Has unusual experiences - such as hearing voices, seeing visions, experience of strange

smells or sensations or strange taste; or

6. Exhibits unusual behaviours like talking/laughing to self, staring in space; or

 7. Has difficulty in social interactions and adaptability.

According to World Health Organization, Mental health is defined as a state of well-

being in which every individual realizes his or her own potential, can cope with the normal

stresses of life, can work productively and fruitfully, and is able to make a contribution to her or

his community.

Types of mental illnesses:

 Anxiety Disorders:

● Generalized Anxiety Disorder

● Panic Disorder

● Substance Induced Anxiety Disorder

● Obsessive Compulsive Disorder

 Mood Disorders:

● Depressive Disorders

● Bipolar Disorders

 Schizophrenia and Psychotic Disorders

 Eating Disorders

Prevalence in India
 The National Mental Health Survey 2015-2016 was undertaken in 12 states across six

regions of India , covering Punjab and Uttar Pradesh in the north; Tamil Nadu and Kerala in the

south; Jharkhand and West Bengal in the east; Rajasthan and Gujarat in the west; Madhya

Pradesh and Chhattisgarh in the centre; and Assam and Manipur in the north east. In each state,

the dedicated team of investigators included mental health and public health professionals.

Methodology adopted was multistage, stratified, random cluster sampling technique, with

random selection based on probability proportionate to size at each stage; all individuals 18 years

and above in the selected households were interviewed.

The total sample was 34,802 with about 3000 (range: 2479–3508) in each of the states.

According to results, the overall weighted prevalence for any mental morbidity was 13.7% over

the lifetime. The lowest lifetime prevalence of 8.1% in Assam and the highest lifetime

prevalence of 19.9% in Manipur had been reported, though they shared common background.

Similar was the striking 2-fold difference in the lifetime prevalence between Punjab and Uttar

Pradesh (18.1% and 8.7%). The same 2-fold difference was seen in the current prevalence rates.

Another significant finding was the vast difference in tobacco use (5.4%–39.6%). Furthermore,

significant finding were the differences in the reported suicidal risk (2.2%–12.2%).

The age group between 40 and 49 years was predominantly affected (psychotic disorders,

bipolar affective disorders [BPADs]), depressive disorders, and neurotic and stress-related

disorders. The prevalence of substance use disorders was highest in the 50–59 years age group

(29.4%). The gender prevalence of psychotic disorders was near similar (lifetime: male: 1.5%;

female: 1.3%; current: male: 0.5%; female: 0.4%). While there was a male predominance in

alcohol use disorders (9.1% vs. 0.5%) and for BPAD (0.6% vs. 0.4%), a female predominance

was observed for depressive disorders (both current [female: 3.0%; male: 2.4%] and lifetime
[female: 5.7%; male: 4.8%]) for neurotic and stress-related disorders. Residents from urban

metro had a greater prevalence across the different disorders. Persons from lower income

quintiles were observed to have a greater prevalence of one or more mental disorders. An

individual’s risk of suicide in the past 1 month from the study was observed to be 0.9% (high

risk) and 0.7% (moderate risk); it was highest in the 40–49 years age group, greater among

females, and those from urban metros.

Treatment gap for mental disorders ranged between 70% and 92% for different disorders:

common mental disorder - 85.0%; severe mental disorder - 73.6%; psychosis - 75.5%; BPAD -

70.4%; alcohol use disorder - 86.3%; and tobacco use - 91.8%. The median duration for seeking

care from the time of the onset of symptoms varied from 2.5 months for depressive disorder. Of

all the findings, the most important from public health point is the long duration of illness of

severe mental disorders. In majority of the cases, a government facility was the most common

source of care. At least half of those with a mental disorder reported disability in all three

domains of work, social, and family life and was relatively less among alcohol use disorder.

Greater disability was reported among people with epilepsy, depression, and BPAD.

Another study reported in WHO, conducted for the NCMH (National Care Of Medical

Health), states that at least 6.5 per cent of the Indian population suffers from some form of the

serious mental disorder, with no discernible rural-urban differences. Though there are effective

measures and treatments, there is an extreme shortage of mental health workers like

psychologists, psychiatrists, and doctors. As reported latest in 2014, it was as low as ''one in

100,000 people''. The average suicide rate in India is 10.9 for every lakh people and the majority

of people who commit suicide are below 44 years of age.

Hence, In India, psychiatric epidemiology remains a challenge.

Stigma and its types and causes

Stigma is defined as an attribute or characteristic that marks a person as different from

others and that extensively disgrace or discredits his/her identity. The term was coined by

ancient Greek which describes a mark cut or burned into the body.

According to sociologist Erving Goffman stigma is defined as an attribute that spoils a

person’s identity, reducing him or her in others minds “from a whole and usual person to a

tainted, discounted one”. Stigma involves three elements; lack of knowledge(ignorance),

negative attitude ( prejudice) and behaviour of people towards the stigmatised

person(discrimination).

Mental illness is stigmatized by perceiving as an indulgence, a sign of weakness and is

viewing with a sense of shame which is often related to a person’s context rather than to his or

her appearance which have a powerful negative attribute.

Social stigma - it is also called as public stigma, which uses negative stereotypes by

discriminating those with mental health problem For eg- person with mental health problem will

feel avoided by others including their friends and colleagues and also finds it difficult to get

employed or get access to healthcare services and believes that they are less likely to be believed

by police if they report a crime.

A 2011 survey found that almost nine out of ten mental health service users in England

had experienced discrimination. The consequences of these discrimination were unemployment

and social isolation, which stigmatized a person further.

 Studies have suggested that stigmatising attitudes towards people with mental health

problems are widespread and commonly held (Crisp, Gelder, Rix, Meltzer et al., 2000; Bryne,

1997; Heginbotham, 1998). In a survey of over 1700 adults in the UK, Crisp et al. (2000) found

that:

(1) the most commonly held belief was that people with mental health problems were

dangerous – especially those with schizophrenia, alcoholism and drug dependence,

(2) people believed that some mental health problems such as eating

disorders and substance abuse were self inflicted, and

(3) respondents believed that people with mental health problems were generally hard to

talk to.

People tends to hold these negative beliefs regardless of their age, their knowledge about

mental health problems, and whether they knew someone who had a mental health problem. A

significant proportion of them considered that people with mental health problems such as

depression or schizophrenia were unpredictable, dangerous and they would be less likely to

employ someone with a mental health problem ( Wang & Lai, 2008; Reavley & Jorm,2011)

Self-stigma- it is also called as perceived stigma , is the internalizing of negative

stereotypes by the mental health sufferer through their perceptions of discrimination (Link,

Cullen, Struening & Shrout, 1989), and which can significantly cause low self-esteem, feelings

of shame and lead to poorer treatment outcomes (Perlick, Rosenheck, Clarkin, Sirey et al.,

2001). In particular, self-stigma is correlated with poorer vocational outcomes (employment

success) and increased social isolation (Yanos, Roe & Lysaker, 2010).
 Both types of stigma can lead a person to avoid seeking help for their mental health

problem due to embarrassment or fear of being shunned or rejected which leads to the lack of

treatment of underlying problem causing unnecessary suffering, delay in receiving treatment also

worsen the outlook of some conditions as it causes stress and anxiety due to experiencing

stigma.

Courtesy stigma- family members and friends become stigmatized by relative having a

mental health problem. ( Goffman,1963).

The stigma associated has multiple causes which are as follows:

-Throughout history people with mental health problems are treated differently, excluded

and even brutalized such treatment comes from the misguided views that people with mental

health problems are more violent or unpredictable than people without such problems, or

somehow just “different”, such beliefs has no basis in fact (e.g. Swanson, Holzer, Ganju & Jono,

1990).

-Earlier belief and explanations about the causes of mental health problems, due to

demonic or spirit possession, has given rise to reactions of caution, fear and discrimination.

-Mental health stigma is even widespread in the medical profession, at least in part

because it is given a low priority during the training of physicians (Wallace, 2010)).Even the

medical model of mental health problems itself is an unwitting source of stigmatizing beliefs. It

implies that mental health problems are on a par with physical illnesses and may result from

medical or physical dysfunction in some way (when many may not be simply reducible to

biological or medical causes). This itself implies that people with mental health problems are in

some way ‘different’ from ‘normally’ functioning individuals. It also implies diagnosis, and
diagnosis implies a label that is applied to a ‘patient’. That label may well be associated with

undesirable attributes (e.g. ‘mad’ people cannot function properly in society, or can sometimes

be violent), and which perpetuate the view that people with mental health problems are different

and should be treated with caution.

- Media regularly plays a role in perpetuating stigmatizing stereotypes of people with

mental health problems. Entertainment media through cinematic depictions of schizophrenia

which are often stereotypic and characterized by misinformation about symptoms, causes and

treatment. In an analysis of English-language movies released between 1990-2010 that depicted

at least one character with schizophrenia, Owen (2012) found that most schizophrenic characters

displayed violent behaviour, one-third of these violent characters engaged in homicidal

behaviour, and a quarter committed suicide and thus negative portrayals of schizophrenia in

contemporary movies are common and are sure to reinforce biased beliefs and stigmatizing

attitudes towards people with mental health problems. While the media may be getting better at

increasing their portrayal of anti-stigmatising material over recent years, studies suggest that

there has been no proportional decrease in the news media’s publication of stigmatising articles,

suggesting that the media is still a significant source of stigma-relevant misinformation

(Thornicroft,Goulden,Shefer, Rhydderch et al.,2013)

-Prejudicial attitudes and discriminating behaviour towards individuals with mental

health problems, and the social effects which includes exclusion, poor social support, poorer

subjective quality of life, and low self-esteem (Livingston & Boyd, 2010). As well as it’s affect

on the quality of daily living, stigma also has a detrimental affect on treatment outcomes, and so

hinders efficient and effective recovery from mental health problems (Perlick, Rosenheck,

Clarkin, Sirey et al., 2001). For example, Moses (2010) found that stigma directed at adolescents
with mental health problems came from family members, peers, and teachers. 46% of these

adolescents described experiencing stigmatization by family members in the form of

unwarranted assumptions (e.g. the sufferer was being manipulative), distrust, avoidance, pity and

gossip, 62% experienced stigma from peers which often led to friendship losses and social

rejection (Connolly, Geller, Marton & Kutcher (1992), and 35% reported stigma perpetrated by

teachers and school staff, who expressed fear, dislike, avoidance, and under-estimation of

abilities.

All these factors significantly represents reasons for attempting to eradicate mental health

stigma and ensure that social inclusion is facilitated and recovery is efficiently achieved.

Beliefs about mental illness in India

A study was conducted to assess the myths, beliefs and perceptions about mental

disorders and health-seeking behavior in general population and medical professionals of India.

The mental disorders were thought to be because of loss of semen or vaginal secretion (33.9%

rural, 8.6% urban, 1.3% professionals), less sexual desire (23.7% rural, 18% urban), excessive

masturbation (15.3% rural, 9.8% urban), God’s punishment for their past sins (39.6% rural,

20.7% urban, 5.2% professionals), and polluted air (51.5% rural, 11.5% urban, 5.2%

professionals). More people (37.7%) living in joint families than in nuclear families (26.5%)

believed that sadness and unhappiness cause mental disorders. 34.8% of the rural subjects and

18% of the urban subjects believed that children do not get mental disorders, which means they

have conception of adult-oriented mental disorders. 40.2% in rural areas, 33.3% in urban areas,

and 7.9% professionals believed that mental illnesses are untreatable.

More people in rural areas than in urban area thought that keeping fasting or a faith healer can

cure them from mental illnesses, whereas 11.8% of medical professionals believed the same.

Only 15.6% of urban and 34.4% of the rural population reported that they would like to go

to a psychiatrist when they or their family members are suffering from mental illness

(Kishore et al, 2011).

Another small study conducted on a hospital-based sample of North Indian schizophrenia

patients showed that belief in supernatural influences is common in relatives of patients from

an urban background, and treatment based upon such beliefs is sought to a considerable extent in

such cases (Kulhara, Avasthi & Sharma, 2000).

Another study about Perception and Attitude towards Mental Illness in

an Urban Community in South Delhi was conducted; Although mental stress was identified as

the most common cause of mental illness, 25% attributed it to evil spirits.

Mental illness was perceived as treatable; 12% preferred treatment from Tantric/Ojha.

Community showed negative attitude for stereotyping, restrictiveness, and

pessimistic prediction domains of OMICC scale with mean score of 4.5 (SD: 0.2), 3.9 (SD: 0.9),

and 3.8 (SD: 0.4), respectively, with no statistically significant difference across age, sex, and

literacy. Study observed lack of awareness regarding bio‑medical concept of mental illness with

socially restrictive, stereotyping, pessimistic, and non‑stigmatizing attitude toward mental illness

in the capital city(Salve & Goswami, 2013).

Psychoeducation - What is it?

 Psychoeducation can be defined as the process of making individuals aware and

imparting knowledge to them for an enhanced understanding of an issue. The most common

issues for which psychoeducation is used include mental illnesses and disorders, physical and

physiological conditions, career options that one can pursue, and so on. Psychoeducation

however, is not restricted to the imparting of knowledge, but also refers to providing a supportive

environment that is conducive of growth and change. Psychoeducation can be described as

‘systematic, structured, didactic information on the illness and its treatment, and includes

integrating emotional aspects in order to enable patients – as well as family members – to cope

with the illness (Bauml & Pitschel-Walz, 2008).

Psychoeducation can be conducted in a variety of ways for differing populations, driven

by a lot of goals.

 To help people understand better

 Information transfer

 Emotional discharge

 Support a medication or other treatment

 Assistance towards self help

Tools and Techniques

Psychoeducation may not necessarily only be a dialogue between individuals. On the

contrary verbal informational content is usually paired with a number of tools and techniques

that result in better understanding of concepts and an increased appeal of the

psychoeducational program. Some of these are discussed below:

 Brochures, pamphlets and posters

 Workshops, presentations and seminars

 Videos

 Role plays and demonstrations

 Team building activities

Psychoeducation as a tool to facilitate progress has numerous advantages. It can give

immense support and hope to the individual with an illness and/or the family members that

the problem can be dealt with, in addition to helping them understand the cause and factors

affecting the condition better.

Studies also indicate that psychoeducation leads to a decrease in pain and

dependency, improved functioning and mental health, and a significant increase in life

satisfaction and self efficacy (LeFort et al, 1998). In a study involving patients suffering from

obesity it was notices that psychoeducation helped them control their eating habits and led to

higher body satisfaction and self esteem levels (Ciliska, 1998). Indian evaluations of

psychoeducation have also been conducted wherein it was found out that parents with

differently abled children showed dramatic increase in the understanding and management of

their child’s disability (Russel, al John & Lakshmanan, 1999).

Current Scenario of Psycho-education in India

There is a dire and urgent need for a focus on improving the mental health

conditions of the Indian population. According to a research statistics in 2018, India has
been ranked as the country with the highest rates of depression. Other research evidence

also indicates that the statistics for mental health illnesses that were to be reached in the

year 2020 were also crossed in 2012. Studies in India have focused on whether the

burden of care in families with a single mentally ill member is different than what is

faced by families with multiple mentally ill persons, and whether psycho-education

should be adapted for these multiplex families for better effectiveness. Results indicate

that there is a significant difference in burden, which is faced by the multiplex families,

but the levels of coping for both groups are the same. Psycho-education was used as a

method of intervention for both types of families and helped with both in decreasing

burden and increasing coping.

However, psycho-education in India has only been deemed as moderately

effective for such families (Kishore et al, 2011). Psycho-education in India is still in the

initial stages, and lack of awareness, expertise and appropriate manpower are all the

factors that have contributed to this. However, because of its nature of having a high

impact of positive nature in conjunction with other interventions, the use of

psychoeducation is imperative in today’s time. As per the statistics related to mental

health in India, existing mental health units are over stretched which is why conducting

psychoeducation sessions at the individual level is not feasible (Jadhav, 2011). To be able

to make a significant difference, psychoeducation in India should be conducted at the

group or community levels for maximum benefit. In addition to this, psychologists,

therapists and psychoeducators in India must also work to reduce or diminish the

language and cultural barriers, since India is a vastly diverse country.

 Other barriers to psychoeducation include the traditional approaches to dealing with

mental illnesses, such as going to tantriks and the ways prescribed by them, which include (but

are not restricted to) pujas and herbal medicines and concoctions.

REVIEW OF LITERATURE

A study was conducted by Kishore et. al. in New Delhi to determine the extent of

awareness the city has about mental health. It also aimed at finding out the myths and

perceptions the general population and medical professionals hold about the same. 360

participants from general population and 76 medical professionals were chosen for the same and

given a pre-tested questionnaire. 43% of the participants did not know that psychiatry is a branch

of medicine. 20% of them believed that psychiatrists know and do nothing. The major belief

about the cause of a mental illness is polluted air(22.73%), followed by, God’s punishment for

past sins(21.8%), less sexual desire(20.8%),loss of semen(14.6%) and excessive

masturbation(12.6%), with these percentages highest in rural communities and the least among

medical professionals. 34.4% of the participants from rural areas and 15.6 of the urban areas

were open to go to a psychiatrist when in need whereas 17.13% of them believed that mental

disorders are untreatable. 11.8% of the medical professionals, and a larger number of rural

population than urban population also believed that they could be treated by traditional healers.

Another study, by Saravanan et al. aimed at assessing explanatory models of psychosis in

first episode schizophrenic patients in South India. 131 patients were assessed to find patient’s

rating of insight, explanatory models and symptoms of psychosis. It was found out that around

73% of the participants believed that the psychosis was a result of black magic. Evil spirits,
karma and punishment from God were other reasons mentioned for the same. Hence, it was

proved that majority of schizophrenic the participants held non-medical beliefs.

The article by Padmavati ,Thara & Corin aims at understanding the reasons as to why

Indians seek religious help for mental illnesses by interviewing 26 patients and their families.

The responses they got were largely based on the misconceptions in the society. The parents did

not consider mental disorders as illnesses and believed that they were a cause of black magic or

karma from past lives. They also felt that anyone who goes to seek help from these healers come

out cured. Rituals like going around a hill for certain number of times without eating anything

are performed in these places. People also said that they would be told by the baba through the

dreams they get that they are not fine to leave.

Another paper by Kulhara, Avasthi and Sharma aimed at measuring attitudes of relatives

of schizophrenic patients towards various perceived supernatural beliefs. The relatives of 40

schizophrenic patients who accompanied them and the patients themselves were asked to fill the

supernatural attitude questionnaire. The perceived causes of mental illness included sorcery,

spirit intrusion, evil spirits, astrological influences, divine wrath and karma. More than 50% of

relatives reported of consulting a priest or faith healer and around 58% reported of performing

religious rituals for the patient or anyone else going through mental illness. 35% of the patients

believed sorcery to be the reason of their suffering while only 20% of them had themselves gone

for treatment to traditional healers.

In an article by Shankar, Saravanan & Jacob tried to find out the perspective of traditional

healers on mental disorders, their causes and treatment. This was done by conducting in-depth

interviews and focus group discussions with them as well as with the patients who attended

these. The traditional healers associated mental illness with madness, black magic or evil spirits
but also understood it as a cause of factors like family problems. Psychotic illnesses were

perceived to be incurable and family relationships were perceived to be the most affected due to

the illnesses. Margosa leaves, herbal medicines and offering prayers were the methods of treating

patients but the patients who needed medical help were also asked to seek so.

PSYCHOEDUACTION:

A study conducted by Rodgers and Batterham in 2014 aimed at looking at the efficacy of

an online psychoeducational intervention. The intervention was to destigmatize depression and

anxiety and to increase awareness for seeking help. The study was done on 67 young adults who

were divided into control group and experimental group. It was seen that the subjects who were

psychoeducated were more aware of anxiety problems and had more positive attitudes towards

reaching out for treatment for mental illnesses.

Another study was conducted by Gutiérrez-Maldonado, & Caqueo-Urízar in 2007 to

explore the effectiveness of a psychoeducational family intervention program for reducing

burden in caregivers of patients with schizophrenia in a developing country. Forty-five

caregivers participated, 22 in a psychoeducational family intervention group and 23 in a control

group. Even though in the control group caregivers received standard intervention it was found

that burden decreased significantly in the psychoeducational group(mean scores from 85.06 pre-

Intervention to 52.44 post-intervention) while scores fell only slightly in the control group(from

87.65 to 87.22).

A study was conducted by Mino, Yasuda et. al in 2001 to study the effects of a

educational program developed to change attitudes towards mental illness on medical students’
attitudes to mental illness. Favorable attitudinal changes were observed in terms of ‘psychiatric

services’ and the results suggested that attitudes towards mental illness could be changed

favorably by this program.

Psycho-education in India

A study by Kulhara et. al. (2009) aimed to measure the impact of structured

psychoeducation on patients suffering from schizophrenia as well as their caregivers. The study

was conducted on 76 patients in India who were divided into two groups; one receiving

psychoeducation and the other one receiving the standard out-patient treatment. The subjects in

both the groups received the same monthly for 9 months. It was seen that psychoeducation had a

better impact in terms of caregiving satisfaction, support, coping and burden and also on

disability levels. There was an evident difference in both the groups on psychosocial and clinical

outcomes by the end of the study.

A study was conducted by Richards et. al in 2016, to assess the usefulness of a series of

psychoeducational and skills based workshops offered within rehabilitation services as part of

routine care. The care offered within rehabilitation aimed to increase access to

psychoeducational and social approaches to understanding and overcoming distress, improve life

skills and provide the opportunity for service users to engage in meaningful activity. The

workshops had been delivered as part of routine care within Inpatient rehabilitation services

since February 2014 and had consisted of multiple workshops that offered a mixture of education

surrounding psychological therapies (such as CBT and Third Wave approaches), and skills based

workshops such as cooking, planning and meaningful activity. The workshops were open to
service users from two rehabilitation units with a combined maximum capacity of 30 and the

groups were run weekly. In total, 37 individuals attended workshops, 28 males (75.6 %) and 9

females (24.4 %). Participants were all aged between 18 and 65 (M = 44.13 SD = 10.28). A

workshop evaluation questionnaire was developed to informally measure attendee’s experience

of the workshops offered and the usefulness of the workshops within rehabilitation services. The

questionnaire consisted of 14 statements and service users were asked to indicate how much they

agree/disagree with the statement on a 5 point Likert scale. The feedback given was overall

positive with participants expressing that the groups were ‘‘useful’’ and that they ‘‘gained a lot

from them’’. Participants stated that they felt ‘‘happy’’ in the workshops and felt that they were

‘‘understood’’. Furthermore participants felt that attending the workshops had assisted them to

‘‘set goals for the future’’

A study was conducted by Günaydın & Barlas in 2017 to examine the effectiveness of a

group and brochure psychoeducation intervention to improve depression level and treatment

continuity among adults with depression in Turkey. This study was a semi-experimental with a

pre-test, post-test, control group and follow-up. The sample of this study consisted of patients

with depression (n=153). Based on their scores in depression inventory, the patients were divided

into three groups. The groups received Continuity Enhancement Treatment for Antidepressants

(CETA) with form of group and brochure. The psychoeducation and brochure groups both

received psychoeducation and antidepressant treatment. The control (CG) group did not receive

psychoeducation and only continued antidepressant treatment. The “Personal Information Form”

and “Beck Depression Inventory” (BDI) were used.The results showed the scores of the

depressed patients in the experimental groups and control group were compared at the pre-test,

posttest and 3 and 6 months follow ups and a significant difference was only found in BDI post-
test scores. It was concluded that Group and brochure psychoeducation included CETA program

was effective for improving antidepressant adherence. Psychoeducational approaches to be

applied by psychiatric nurses to outpatients who received diagnosis of depression for the first

time were also considered as cost-effective methods.

RATIONALE

Despite advances in society’s understanding and acceptance, there is still a stigma

attached to mental illness, according to National Alliance on Mental Illness, 2016.

Remember you’re not alone.

Even though there has been greater acceptance and understanding of mental illness in

recent years, there is still a stigma, or sense of shame, attached to having a mental illness. The

stigma come from the general public’s lack of understanding about mental illness. Even though

we are living in an era of modern educated society, going to a general physician for diagnosis of

fever or common diseases is acceptable, But there are hundred thoughts before going to visit any

mental health professional.

Target population:

A study reported in WHO, conducted for the NCMH(), states that at least 6.5% of the

Indian population suffers from some form of the serious mental disorder, with no discernible

rural-urban differences. The average suicide rate in India is 10.9 for every lakh people and the

majority of people who commit suicide are below 44 years of age.

 According to the previous studies and reports, the rate of mental illness is higher due to

the lack of awareness of various facilities and treatment plans available for mental illness

prevention.

According to WHO report (2001), estimated that nearly 450 million people suffer from

mental disorders in the world, I.e.,10% of the total population suffers from mental disorders.

Reports states that depressive disorders, alcohol abuse, suicides, schizophrenia, bipolar disorders

and panic disorders rank high among the population ranging from 15-44 years.

The rate of individuals reporting symptoms consistent with major depression in the last

12 months increased 52 percent in adolescents from 2005 to 2017 (from 8.7 percent to 13.2

percent) and 63 percent in young adults age 18 to 25 from 2009 to 2017 (from 8.1 percent to 13.2

percent). There was also a 71 percent increase in young adults experiencing serious

psychological distress in the previous 30 days from 2008 to 2017 (from 7.7 percent to 13.1

percent). The rate of young adults with suicidal thoughts or other suicide-related outcomes

increased 47 percent from 2008 to 2017 (from 7.0 percent to 10.3 percent).

GOALS

1. To provide basic understanding and spread awareness about the various disorders and

illnesses that affects one’s mental health

2. To make them realize that “You’re not alone” and it is okay to ask for help

3. To facilitate in removing the stigma and taboo attached to it

4. To provide knowledge of various coping strategies and preventive measures

5. To provide them about various resources available around them.

TECHNIQUES

 Brochures

 Video

 Presentations/ seminars

 Activities for team building

 Demonstrations or role plays

SELF HELP STRATEGIES

It is important to remember that one is not alone. Many people cope with having a mental

illness. Depression, anxiety, substance abuse, and other mental health problems are common.

One should follow the 3A process - Acknowledge, Accept, and finally Ask for help.

Many patients with mental illness remain underserved, in part because of the stigma of seeking

help. Mental illness is like any other kind of illness. Treatment helps and people recover, and

they recover sooner when they are treated.

In the age of technological and medicinal advancement, safe, and effective medicines and

psychosocial treatments are available, and newer treatments are being developed. As a result,

most individuals with mental health issues enjoy productive lives in society with their families.

One should be realistic when working towards the resolution of mental illness, and know that
mental health treatment can be difficult. Patience is often needed when trying new medicines.

Coping with side effects and learning new behaviors are often frustrating, but, in the long run,

rewarding. One needs to support from family and friends and be an active part of treatment, by

discussing with the doctor the outcomes that are of importance.

Remain active and surround yourself with supportive people. Social isolation can be a

negative side effect of the stigma linked to mental illness. Isolating yourself and discontinuing

enjoyable activities put you at high risk for depression and burnout. Take a risk and try new

activities in your community( National Alliance on Mental Illness,2016).

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