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Hunt AJ, Guth REY, Setiyawati D. Evaluating the Indonesia Free Pasung Movement: Understanding continuing use of restraint of the mentally ill in rural Java. Transcult Psychiatry 2023; 60:552-565. [PMID: 33966503 DOI: 10.1177/13634615211009626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Forcible restraint and confinement of persons suffering from mental illness occurs throughout the world, including in Indonesia. Since 2010, when Gerakan Bebas Pasung (GBP) or the Indonesian Freedom from Forcible Restraint (Pasung) of Mentally Ill Persons movement was launched, national policy has been published to eradicate Pasung in Indonesia by improving the mental healthcare system. This article analyses this policy, specifically the National Mental Health Legislation (2014) and the Ministry of Health Regulation Tackling Forcible Restraint of People with Mental Illness (2017), and evaluates their current state of implementation through a local, in-depth case study. Using mental health institution mapping, two sets of semi-structured qualitative interviews with government officials and healthcare workers, and participant observation in a facility practicing Pasung, we identify the extent to which the 2017 regulation has been implemented in Winong village and discuss current efforts and persistent obstacles to eradicating Pasung. We suggest that despite reforms and the new treatment facility in our case study, the continuing use of Pasung is due to a combination of access to care issues and a widely held explanatory model of mental illness characterized by strong curative beliefs that, when disappointed, lead to a sense of threat and hopelessness.
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Affiliation(s)
| | | | - Diana Setiyawati
- Center for Public Mental Health, Faculty of Psychology, Universitas Gadjah Mada
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Hidayat MT, Oster C, Muir-Cochrane E, Lawn S. Indonesia free from pasung: a policy analysis. Int J Ment Health Syst 2023; 17:12. [PMID: 37138360 PMCID: PMC10155453 DOI: 10.1186/s13033-023-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Many people with mental illnesses remain isolated, chained, and inside cages, called Pasung in Indonesia. Despite numerous policies introduced to eradicate Pasung, Indonesia has made slow progress in decreasing this practice. This policy analysis examined existing policies, plans and initiatives in Indonesia targeted at eradicating Pasung. Policy gaps and contextual constraints are identified in order to propose stronger policy solutions. METHODS Eighteen policy documents were examined, including government news releases and organisational archives. A content analysis was undertaken of national-level policies that address Pasung within the context of the health system, social system and human rights since the establishment of Indonesia. This was followed by a case study analysis of policy and program responses particularly in West Java Province. FINDINGS While policy to address Pasung exists at a national level, implementation at national and local levels is complicated. Pasung policy has generated a sense of awareness but the different directions and ambiguous messaging across all stakeholders, including policy actors, has created a lack of clarity about institutions' roles and responsibilities in the implementation process, as well as accountability for outcomes. This situation is exacerbated by an incomplete decentralisation of healthcare policymaking and service delivery, particularly at the primary level. It is possible that policymakers have overlooked international obligations and lessons learned from successful policymaking in comparable regional countries, resulting in disparities in target-setting, implementation mechanisms, and evaluation. CONCLUSION While the public has become more informed of the need to eradicate Pasung, ongoing communication with the various clusters of policy actors on the aforementioned issues will be critical. Addressing the various segments of the policy actors and their challenges in response to policy will be critical as part of building the evidence base to establish a feasible and effective policy to combat Pasung in Indonesia.
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Affiliation(s)
- Muhamad Taufik Hidayat
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia
- West Java Psychiatric Hospital, Bandung, Indonesia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, 5001, Adelaide, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia.
- Lived Experience Australia Ltd, Adelaide, Australia.
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"Not shifting, but sharing": stakeholders' perspectives on mental health task-shifting in Indonesia. BMC Nurs 2022; 21:165. [PMID: 35751061 PMCID: PMC9229425 DOI: 10.1186/s12912-022-00945-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background Task-shifting, the distribution of tasks among health workers to address health workforce shortage, has been widely used to tackle mental health treatment gaps. However, its implementation in Indonesia has still been rarely explored. This study aimed to explore stakeholders’ perspectives on the implementation of mental health task-shifting to nurses in Indonesia's primary health care. Methods An exploratory descriptive approach using in-depth interviews and focused group discussions (FGDs) was used. The study involved 19 stakeholders from the government's ministry directorates, professional organisations, and mental health practitioners. Thematic analysis was used to analyse the data. Results Three themes emerged namely, task-shifting feasibility and acceptability, shared task implementation, and nurse role enhancement issues, with 14 sub-themes. Conclusions Task-shifting on mental health issues in the eye of Indonesian stakeholders is viewed as a matter of sharing and collaboration. Implementation of task-shifting in Indonesia may require policies in place and political will across stakeholders. Further scrutiny on task-shifting implementation is needed by considering the local context and national environment.
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Vulnerabilidade social e transtornos mentais. TEXTOS & CONTEXTOS (PORTO ALEGRE) 2021. [DOI: 10.15448/1677-9509.2021.1.38616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.
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Subu MA, Wati DF, Netrida N, Priscilla V, Dias JM, Abraham MS, Slewa-Younan S, Al-Yateem N. Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. Int J Ment Health Syst 2021; 15:77. [PMID: 34663399 PMCID: PMC8524985 DOI: 10.1186/s13033-021-00502-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Stigma refers to the discrediting, devaluing, and shaming of a person because of characteristics or attributes that they possess. Generally, stigma leads to negative social experiences such as isolation, rejection, marginalization, and discrimination. If related to a health condition such as mental illness, stigma may affect a person’s illness and treatment course, including access to appropriate and professional medical treatment. Stigma has also been reported to affect patients’ families or relatives, along with professionals who work in mental healthcare settings. Stigma is strongly influenced by cultural and contextual value systems that differ over time and across contexts. However, limited information is available on how types of stigma are experienced by patients with mental illness and mental health nurses in Indonesia. Method We explored the stigma-related experiences of 15 nurses and 15 patients in Indonesia. The study design and analysis of interview data were guided by deductive (directed) content analysis. Results Five themes emerged. Four themes were patient-related: personal/patients’ stigma, public/social stigma, family stigma, and employment stigma. The fifth theme related to stigma toward healthcare professionals working with patients with mental illnesses, which we categorized as professional stigma. Conclusions This study has achieved a deep understanding of the concept of stigma in the Indonesian context. This understanding is a prerequisite for developing appropriate interventions that address this phenomenon and thereby for the development of mental health services in Indonesia. This study may also be transferable to other countries that share similar cultural backgrounds and adhere to traditional and religious value systems.
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Affiliation(s)
| | | | | | | | | | | | | | - Nabeel Al-Yateem
- University of Sharjah, Sharjah, UAE. .,School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Orange, NSW, Australia.
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Pariseau-Legault P, Vallée-Ouimet S, Jacob JD, Goulet MH. Intégration des droits humains dans la pratique du personnel infirmier faisant usage de coercition en santé mentale : recension systématique des écrits et méta-ethnographie. Rech Soins Infirm 2021:53-76. [PMID: 33319718 DOI: 10.3917/rsi.142.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction and background : The last decade has seen a steady and rising use of coercion in mental health care, as well as an increase in the number of forms it takes. The application of these measures frequently relies on the work of nurses, but few studies have analyzed the human rights issues raised by these practices.Aim : To produce a qualitative synthesis of how human rights are integrated into the practice of nurses who use coercion in mental health care.Methodology : A systematic review of qualitative scientific literature published between 2008 and 2018 was conducted and supplemented by a meta-ethnographic analysis.Results : The analysis of the forty-six selected studies revealed four distinct themes : coercion in mental health care as a socio-legal object, issues of recognition of human rights in mental health care, role conflict experienced by nurses, and the conceptualization of coercion as a necessary evil or a critical incident.Discussion and conclusion : Further research is needed to understand the specifics of the continuum of support and control that characterizes the coercive work of psychiatric nurses.
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Hidayat MT, Lawn S, Muir-Cochrane E, Oster C. The use of pasung for people with mental illness: a systematic review and narrative synthesis. Int J Ment Health Syst 2020; 14:90. [PMID: 33372617 PMCID: PMC7720453 DOI: 10.1186/s13033-020-00424-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of ‘unlocking’; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD
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Affiliation(s)
- Muhamad Taufik Hidayat
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia.,West Java Psychiatric Hospital, Bandung, Indonesia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia. .,South Australian Mental Health Commissioner, Adelaide, South Australia, Australia.
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia
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Praharso NF, Pols H, Tiliopoulos N. Mental health literacy of Indonesian health practitioners and implications for mental health system development. Asian J Psychiatr 2020; 54:102168. [PMID: 33271677 DOI: 10.1016/j.ajp.2020.102168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
Compared to other countries in the South-East Asian region, Indonesia's mental health system remains underdeveloped from significant treatment gaps, which subsequently contribute to human rights violations of mental health patients who do not receive adequate medical care. In line with the introduction of universal health coverage in 2014, the Indonesian government plans to redress this by delegating detection and early intervention of mental health services to health practitioners without specialist training in mental health, however, there is limited evidence that they can perform this role effectively. This study aims to evaluate current workforce capacity by assessing differences in mental health literacy between Indonesian mental health and non-mental health practitioners. Compared to non-mental health practitioners, mental health practitioners are significantly less likely to hold stigmatising views towards individuals with mental illness. They are also significantly more likely to correctly recognise symptoms of depression and schizophrenia and recommend and implement evidence-based interventions for these conditions. These findings suggest that task-shifting is unlikely to be an effective solution to reduce the mental health treatment gap, and it is recommended that mental health system reform in Indonesia should initially focus on expansion and retention of the specialist mental health workforce.
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Affiliation(s)
- Nurul F Praharso
- School of Psychology, The University of Sydney, NSW, Australia; School of History and Philosophy of Science, The University of Sydney, NSW, Australia.
| | - Hans Pols
- School of History and Philosophy of Science, The University of Sydney, NSW, Australia
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Nenobais A, Jatimi A, Jufriyanto M. Family Burden for the Caregivers of People with Mental Disorders: A Systematic Review. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i3.16971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: The main caregivers of people with mental disorders are their family members. Families as the caregivers of people with mental disorders is associated with a significant burden. This systematic review aims to identify and summarize the main focus based on the scientific evidence about family burden as the caregivers of people with mental disorders.Methods: The databases used were Scopus, Science Direct and Sage Journal with the keywords ‘burden’, ‘family’, ‘caregiver’, ‘mental’, ‘health’, ‘illness’, ‘disorder’ and they were limited to 2014 – 2018 from within nursing and health science journals. One hundred and four full text articles were reviewed. The 14 articles that fulfilled the inclusion criteria were analyzed using narrative synthesis followed the Joanna Briggs Methodology model for the Qualitative Systematic Review to find the main themes of each article.Results: Seven main themes were found to be related to family burden as the caregivers of a family member with mental disorders. The 7 themes were knowledge, emotional burden, physical burden, medication, financial burden, social burden, health services and government support.Conclusion: The findings suggest that the family burden on the caregivers was diverse and that this has an effect on the ability of the family to care for patients with mental disorders. Family burden has become an important indicator for the provision of mental health services.
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Hsiao CY, Lu HL, Tsai YF. Factors Associated With Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice. J Nurs Scholarsh 2019; 51:680-688. [PMID: 31697045 DOI: 10.1111/jnu.12526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to examine the quality of family-centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice. DESIGN A cross-sectional, correlational study. METHODS A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses' attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family-centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson's product-moment correlations, independent t-test, one-way analysis of variance, and stepwise regression analyses. RESULTS Quality of family-centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses' attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers' perceptions of quality of family-centered care. Nurses' supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family-centered care. CONCLUSIONS Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems. CLINICAL RELEVANCE Efforts in professional training to address stigma and encourage a family-centered approach into recovery-oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.
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Affiliation(s)
- Chiu-Yueh Hsiao
- Lambda Beta-At-Large, Professor, School of Nursing, College of Medicine, Chang Gung University, Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Huei-Lan Lu
- Nurse director, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China
| | - Yun-Fang Tsai
- Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, and Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, and Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, all in Taiwan, Republic of China
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Liem A, Newcombe PA. Knowledge, attitudes, and usage of complementary-alternative medicine (CAM): A national survey of clinical psychologists in Indonesia. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00290-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Tanaka C, Tuliao MTR, Tanaka E, Yamashita T, Matsuo H. A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry 2018; 18:325. [PMID: 30290782 PMCID: PMC6173886 DOI: 10.1186/s12888-018-1902-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines. METHODS A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. RESULTS The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. CONCLUSIONS The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.
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Affiliation(s)
- Chika Tanaka
- Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo, 650-0003, Japan.
| | | | - Eizaburo Tanaka
- 0000 0004 0466 6360grid.474282.fHyogo Institute for Traumatic Stress, Kobe, Japan
| | | | - Hiroya Matsuo
- 0000 0001 1092 3077grid.31432.37Graduate School of Health Sciences, Kobe University, 701, 2-6-2, Yamamoto-dori, Chuo-ku, Kobe, Hyogo 650-0003 Japan
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Nxumalo CT, Mchunu GG. Exploring the stigma related experiences of family members of persons with mental illness in a selected community in the iLembe district, KwaZulu-Natal. Health SA 2017. [DOI: 10.1016/j.hsag.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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