Mental disorder social impacts

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Professions and fields

Main article: Mental health professional

A number of professions have developed that specialise in the treatment of mental disorders, including the medical speciality of psychiatry (including psychiatric nursing)[1][2][3], the division of psychology known as clinical psychology[4], Social Work[5], as well as Mental Health Counselors, Marriage and Family Therapists, Psychotherapists, Counselors and Public Health professionals. Those with personal experience of using mental health services are also increasingly involved in researching and delivering mental health services and working as mental health professionals.[6][7][8][9] The different clinical and scientific perspectives draw on diverse fields of research and theory, and different disciplines may favor differing models, explanations and goals.[10]

Movements

The Consumer/Survivor Movement (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves "survivors" of mental health services. The movement campaigns for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society.[11][12][13] Patient advocacy organizations have expanded with increasing deinstitutionalization in developed countries, working to challenge the stereotypes, stigma and exclusion associated with psychiatric conditions. An antipsychiatry movement fundamentally challenges mainstream psychiatric theory and practice, including the reality or utility of psychiatric diagnoses of mental illnesses.[14][15] [16]

Laws and policies

Three quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as Involuntary commitment or sectioning), is a controversial topic. From some points of view it can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social and other reasons; from other points of view, it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when unable to decide in their own interests.[17]

All human-rights orientated mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often utilized grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted may usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-orientated laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.[17] An individual must be shown to lack the capacity to give or withhold informed consent (i.e. to understand treatment information and its implications). Proxy consent (also known as substituted decision-making) may be given to a personal representative, a family member or a legally appointed guardian, or patients may have been able to enact an advance directive as to how they wish to be treated.[17] The right to supported decision-making may also be included in legislation.[18] Involuntary treatment laws may be extended to those living in the community, for example Community Treatment Orders (CTOs) are used in New Zealand, Australia and 38 states in the US and are being planned in the UK.[19]

The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.[17] In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006 the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities[20]

The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term.

Perception and discrimination

Media

Main article: Mental disorders in art and literature

Media coverage of mental illness comprises predominantly negative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or human rights issues.[21][22][23] Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.[24][25]

General public

The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.[26] Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.[27]

Violence

The public fear of violence due to mental illness is a contentious topic. One US national survey indicated that a far higher percentage of Americans rated individuals described as displaying the characteristics of a mental disorder (for example Schizophrenia or Substance Use Disorder) as "likely to do something violent to others" compared to those described as being 'troubled'.[28] Research indicates, on balance, a higher than average number of violent acts by some individuals with certain diagnoses, notably antisocial or psychopathic personality disorders, but conflicting findings about specific symptoms (for example links between psychosis and violence in community settings) - but the mediating factors of such acts are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, male, of lower socio-economic status and, in particular, substance abuse (including alcohol).[29][30][10] Findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victim rather than the perpetrator of violence.[29][31] Violence by or against individuals with mental illness typically occurs in the context of complex social interactions (including in atmosphere of mutually high "expressed emotion"), including within a family setting,[32] as well as being an issue in healthcare settings[33] and the wider community.[34]

Employment

Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness[35] Schemes to combat stigma have been prioritized by global and national psychiatric organizations, but their methods and outcomes have been criticized as counterproductive.[36]

  1. ↑ A, N.C. (1997). What is Psychiatry? The American Journal of Psychiatry, 154, 591-593.
  2. ↑ University of Melbourne. (2005, August 19). What is Psychiatry?. Retrieved April 19, 2007, from http://www.psychiatry.unimelb.edu.au/info/what_is_psych.html
  3. ↑ California Psychiatric Association. (2007, February 28). Frequently Asked Questions About Psychiatry & Psychiatrists. Retrieved April 19, 2007, from http://www.calpsych.org/publications/cpa/faqs.html
  4. ↑ American Psychological Association, Division 12, http://www.apa.org/divisions/div12/aboutcp.html
  5. ↑ Golightley, M. (2004) Social work and Mental Health Learning Matters, UK
  6. ↑ Goldstrom ID, Campbell J, Rogers JA, et al (2006) National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services. Administration and Policy in Mental Health and Mental Health Services Research, 33:92–102
  7. ↑ The Joseph Rowntree Foundation (1998) The experiences of mental health service users as mental health professionals
  8. ↑ Chamberlin J. (2005) User/consumer involvement in mental health service delivery. Epidemiol Psichiatr Soc. Jan-Mar;14(1):10-4. PMID 15792289
  9. ↑ Terence V. McCann, John Baird, Eileen Clark, Sai Lu (2006) Beliefs about using consumer consultants in inpatient psychiatric units International Journal of Mental Health Nursing 15 (4), 258–265.
  10. ↑ 10.0 10.1 Rogers, A. & Pilgram, D. (2005) A Sociology of Mental Health and Illness, Open University Press, 3rd Edition. ISBN 0335215831
  11. ↑ Everett, B. (1994) Something is happening: the contemporary consumer and psychiatric survivor movement in historical context. Journal of Mind and Behavior, 15:55–7
  12. ↑ Rissmiller DJ & Rissmiller JH (2006) Evolution of the antipsychiatry movement into mental health consumerism. Psychiatric Services, Jun;57(6):863-6.
  13. ↑ Oaks, D. (2006) The Evolution of the Consumer Movement Psychiatric Services 57:1212
  14. ↑ The Antipsychiatry Coalition. (2005, November 26). The Antipsychiatry Coalition. Retrieved April 19, 2007, from www.antipsychiatry.org
  15. ↑ Anthony Paul O'Brien, Martin Woods, Christine Palmer (2001) The emancipation of nursing practice: Applying anti-psychiatry to the therapeutic community. Australian and New Zealand Journal of Mental Health Nursing 10 (1), 3–9.
  16. ↑ Weitz D. (2003) Call me antipsychiatry activist--not "consumer" Ethical Hum Sci Serv. Spring;5(1):71-2. PMID 15279009
  17. ↑ 17.0 17.1 17.2 17.3 World Health Organization (2005) WHO Resource Book on Mental Health: Human rights and legislation ISBN 924156282 (PDF)
  18. ↑ Manitoba Family Services and Housing. The Vulnerable Persons Living with a Mental Disability Act, 1996
  19. ↑ The Big Question: Will the new mental health Bill make Britain a safer place?
  20. ↑ ENABLE website UN section on disability
  21. ↑ Coverdate, J., Nairn, R. & Claasen, D. (2001) Depictions of mental illness in print media: a prospective national sample Australian and New Zealand Journal of Psychiatry, 36 (5), 697–700.
  22. ↑ Edney, RD. (2004) Mass Media and Mental Illness: A Literature Review Canadian Mental Health Association
  23. ↑ Diefenbach, D.L. (1998) The portrayal of mental illness on prime-time television Journal of Community Psychology Vol 25, Issue 3, Pages 289-302
  24. ↑ Sieff, E. (2003) Media frames of mental illnesses: The potential impact of negative frames Journal of Mental Health, Vol 12(3) pp. 259-269
  25. ↑ Wahl, O.F. (2003) News Media Portrayal of Mental Illness: Implications for Public Policy American Behavioral Scientist Vol. 46, No. 12, 1594-1600
  26. ↑ Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. Sep;89(9):1328-33.
  27. ↑ Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. (2006) Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry. May 23;6:21.
  28. ↑ Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S. (1999) The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health. Sep;89(9):1339-45.
  29. ↑ 29.0 29.1 Stuart, H. (2003) Violence and mental illness: an overview. World Psychiatry. June; 2(2): 121–124
  30. ↑ Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E. (1998) Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry. May;55(5):393-401.
  31. ↑ Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services. Oct;52(10):1358–66. PMID 11585953
  32. ↑ Solomon, PL., Cavanaugh, MM., Gelles, RJ. (2005) Family Violence among Adults with Severe Mental Illness. Trauma, Violence, & Abuse, Vol. 6, No. 1, 40-54
  33. ↑ Chou, KR., Lu, RB., Chang, M. (2001) Assaultive behavior by psychiatric in-patients and its related factors. Journal of Nursing Research. Dec;9(5):139-51
  34. ↑ B. Lögdberg, L.-L. Nilsson, M. T. Levander, S. Levander (2004) Schizophrenia, neighbourhood, and crime. Acta Psychiatrica Scandinavica, 110(2) Page 92.
  35. ↑ Heather Stuart (2006) Mental Illness and Employment Discrimination Current Opinion in Psychiatry 19(5):522-526.
  36. ↑ Read, J., Haslam, N., Sayce, L., Davies, E. (2006) Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach Acta Psychiatrica Scandinavica Nov;114(5):303-18
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