Picot Study: Literature Review Presented by [insert name here]

State of Mental Illness People with mental status experience different levels of discrimination and stigma Stigma and discrimination influence the health seeking behavior of the patients and recovery process Pharmacological interventions are available for people living with mental illness Managing discrimination and stigma vis-à-vis strict pharmacologic interventions have different levels of benefit and outcome in the recovery of the patient and treatment adherence

PICOT Question In non-behavioral health nurses who care for psychiatric patients at the emergency department, how does education on ways of combating social stigmatization compared to the strict administration of drugs impact on the overall services offered to psychiatric patients over five months?

PICOT cont… P – Mental nurses I - education on ways of combating social stigmatization C – strict administration of drugs O - services offered to psychiatric patients T – 5 months

Pharmacologic interventions and Mental illness Factors considered include patient’s preference to medication, development, and approval of drugs Clinicians have a problem in establishing standard dose for patients because of different preferences Possible adverse drugs reactions affects adherence However, little research evidence exist showing effect of strict pharmacological interventions. More studies needed to establish the correlation (Eiring et al., 2015)

Stigma and Mental illness Abundant literature exist to relate mental illness, stigma, and discrimination Knowledge and skills offer long term solution to discrimination and stigma Significant finding indicate moderate influence of professional intervention as a solution to addressing stigma. The mass media play a greater role in influencing the attitudes, intended behavior, and stigma related knowledge. Author recommends long term use of public education to enhance stigma prevention (Gronholm et al., 2017)

Stigma and socioeconomic status In case control study- evidence relate stigma to poor recovery and poverty in mental disorder Female more vulnerable to poverty Poverty due to loss of employment Healthcare awareness on effect of stigma in mental illness aid in comprehensive care and efficacy

Stigma, discrimination, and Mental disorder Sigma and discrimination is a barrier to healthcare and recovery Understanding the causes of stigma is essential in modifying care Family members, community, healthcare professionals involve in discrimination The issue arise from misconception of mental illness among different individuals Nurses, family members, and patient require education to help handle stigma in mental illness (Egbe et al., 2014)

Mental illness and Nurses Attitude Evidence indicates increasing awareness onadverse effects of stigma on mental illness Nurses competency influence management of stigma and mental illness Nurses attitude influence recovery and outcome (Mårtensson, Jacobsson, and Engström, 2014)

Conclusion Stigma is a problem in Mental illness Community, family members and nurses propagate stigma in various ways Social impact has more effect on prognosis than pharmacologic interventions Nurses knowledge on stigma and discrimination results in better management and outcome of mental illness.

Reference Egbe, C. O., Brooke-Sumner, C., Kathree, T., Selohilwe, O., Thornicroft, G., & Petersen, I. (2014). Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders. BMC Psychiatry, 14, 191. http://doi.org/10.1186/1471-244X-14-191 Eiring, Ø., Landmark, B. F., Aas, E., Salkeld, G., Nylenna, M., & Nytrøen, K. (2015). What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders. BMJ open, 5(4), e007848. Gronholm, P. C., Henderson, C., Deb, T., & Thornicroft, G. (2017). Interventions to reduce discrimination and stigma: the state of the art. Social psychiatry and psychiatric epidemiology, 52(3), 249-258. Mårtensson, G., Jacobsson, J. W., & Engström, M. (2014). Mental health nursing staff’s attitudes towards mental illness: an analysis of related factors. Journal of Psychiatric and Mental Health Nursing, 21(9), 782–788. http://doi.org/10.1111/jpm.12145 Trani, J. F., Bakhshi, P., Kuhlberg, J., Narayanan, S. S., Venkataraman, H., Mishra, N. N., ... & Deshpande, S. (2015). Mental illness, poverty and stigma in India: a case–control study. BMJ open, 5(2), e006355.