The many aspects of mental health education among mental health consumer groups or their families; case study of Schizophrenia
The traditional format of the health care involves a clinician or a health worker being the major decision making factors on the modality of treatment, with a relatively insignificant proportion of inputs from the consumers. However, in modern settings such inputs from the targeted consumer population are highly appreciated, especially in chronic and debilitating disease management, where concerted efforts of the clinical staff, patients and their families is essential in tackling the disease. A key to such inputs and interactions is to raise the awareness of the targeted consumers or their families on the various aspects of the disease, its monetary and social costs, as well as to raise the psychological acceptance of the patients in the society. Mental health is one such area where beneficiary interactions between the patients/caretakers and the providers of health services on the many aspects of the decision making could be of maximum utility. This is because of mental health disorders are not only generally chronic in nature, but also because social interactions play equal role as much as medicine in the successful treatment of the disease.
Schizophrenia is a chronic and debilitating mental health disorder, with an abnormal social behaviour and failure of objective thinking. Confused state of mind, hallucinations, abject thinking and lack of motivational thinking are some of the general symptoms of the disease. There is also a higher rate of suicidal thinking among the schizophrenic patients. While both a genetic makeup as well the conditions of upbringing have been shown to influence the disease, the general understanding is that schizophrenia is a syndrome, with multiple or complex causative factors. Due to the complex and the chronic nature of the disease, prolonged or even lifelong treatment is essential. In addition, social rehabilitation as well as sympathetic public perception and counselling are extremely necessary for the successful management of the disease condition. Due to the generally poor social interactions and abject thinking, it is important that the patients and associated family members or caregivers are aptly educated on the various available modalities of therapy as well as being provided with the necessary moral support of the institutions and health workers who are involved in the treatment of the patient.
Benefits of educating the consumers of schizophrenia treatment
Close observation, sympathetic care, timely therapeutic interventions are extremely essential for schizophrenia cases and it is important that the care givers are also educated on the many aspects of successful and prolonged care. In many developing countries, the family of the patient is the primary effectors for the care of the patient due to constraints of money, lack of physician’s effective attention time and poor number of supporting staff. In such a scenario proper education of the consumers not only ease the process, but also helps in relieving the psychological distress of the patient. Proper education also helps in dealing with the caregiver’s stress and maintaining a healthy environment around the patient who needs a social support more than the medicines. If the family of a patient is properly educated, they are well informed about the illness and are more “skilled” to deal with their deceased relative. Moreover, it also helps in a smooth process of settling insurance claims, money management and availing welfare benefits from the designated agencies. At a national level, there should be a streamlined education program and a process so that each care giver knows which physician to consult, how to reach the hospital for consultation, and how to mange the initial expenditure. It is essential to consider the psycho-sociological impact of the nature of this syndrome.
Potential barriers to effective education with the selected group
Schizophrenic patients generally have poor social interactions, and some of the symptoms such as suicidal instincts, auditory hallucinations and abject thinking, make the sufferers alienated from the general population where the patients form part of. Such alienation at work place, educational institutions or close societies could be detrimental for the patient and could in turn lead to increased social reticence and suicidal tendencies. Similarly, like other chronic mental health disorders, the family members of schizophrenic patients face unfriendly behaviour from close societies, in addition to the difficulties in managing the patients. In totality, a schizophrenic patient’s family is itself not in a healthy frame of mind and hence special concerns or skills should be employed to properly educate them. Caregivers at hospitals, mostly have to deal with a higher number of patient’s per head basis and are already under stress. Money is another potential barrier and the caregivers also point to the need of proper transport, medical insurance and food in developing countries. Most of the time in a developing country, it is a cultural problem, the family is not highly educated and if the case is the first in their family, they do not know how to proceed at the first hand. Effective communication skills to a larger group with different social background are another potential barrier in a multiethnic, multilingual society such as India and Australia. Education cannot be provided to each and every individual on a personal basis in highly populated societies where the patient load is higher. Hesitation to participate in a community based rehabilitation program is another constraint as you have to convince maximum number of the individuals to get educated and participate in such an event. ‘Self determined medical discontinuation’ is another hindrance as many patients would stop consulting the physician and discontinue taking their psychotic medication. Hence, the patients should be educated on a recurrent basis and should be informed well that even if they think they are healthy they should continue their follow up management. Schizophrenia patients also suffer from a vocational impairment due to various reasons and according to the social drift hypothesis they are driven towards are social backwardness. This has to be addressed not only by proper education from therapy point of view, but also from the point of view of vocational empowerment. Psychosis and Schizophrenia in children poses an additional barrier as it shows a worse prognosis and educating the consumer in such cases needs special skills.
Skills required by the nurses
Schizophrenia cases involved an enhanced psychological stress and many a times the situation gets complicated by the family attitude, patients’ failure to adhere to the treatment regime, tolerability issues, embarrassment and recurrence. In such a scenario the educating nurse should exhibit an exceptional degree of restraint, compose in their behaviour and control of their own stress.
Since the patient itself and its family have an educational gap with respect to the medical field, a nurse should have the ability to bridge the gap between a layman and a professional. The nurse should have exceptional communication skills, should be available during off hours, should be willing to tolerate seemingly off the subject queries and should be able to understand the needs of the consumer. Most of the needs of the consumers are related to money, medical reimbursement and insurance issues and as such the nurse should be well acquainted with the relevant subject, although not directly related to medicine. Many a time’s patients are unwilling to adhere to the schedule. The severity of the side effects of the schizophrenia treatment such as sedation, weight gain or pain etc is the major concern of the patients. The nurse should in such cases educate the patient as well as their family about the alternative methods such as long acting injectable (LAIs) instead of oral therapy, etc. Nurse should be able to identify the patient’s strength area and make use of that strength for proper counselling approach. It has been observed that the preferences of patients and their family doctors vary, say for example, patient does not like the idea of shared care records while the health practitioner advocate for it. In such case the responsibility of the educating nurse is to ensure that patient and their family members are educated in the benefits of community participation. In many cases of patients undergoing treatment with the second generation antipsychotics, we have to induce them for a regular exercise schedule. Nurses should be able to motivate the patients and hence a nurse should also have motivational skills. Proper fitness is also required as the nurse should lead by example, that regular exercise is beneficial.
Schizophrenia is not only a medical problem, but a socioeconomic crisis. It not only harms the patient per se, but also affects its family as well as the whole community. Consumer education that involved counselling of the patient as well as educating the family and involving the whole community is an important tool for improved outcome. It not only reduces the stress environment, but also helps in improving adherence to the treatment regime, delaying the reduction in the social attainment, delay in the loss of cognitive skills and improve the overall status. Nurses imparting the education hence have an added social responsibility in addition to their medical duty and thus should be equipped with special communication skills. Controlling the stress, inspirational and motivational behaviour and above all a positive attitude is the most important requirement.
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