Mental Health and Stigma, Article Critique Example

In “Mental health patients’ experiences of being misunderstood” (Gaillard et al, 2009) journal article studies the importance of being understood with regards to the relationship between mental health patients and caregivers.

Purpose

The study objective is to survey the experience of mental health patients’ with being misunderstood and how it affects their health, relationship with staff and towards the program. The research was carried out through twenty individual interviews. The study was created in order to highlight the problem through mental health care; very few patients reported that they were feeling understood during their treatment.

Questions

The article is attempting to answer the following questions:

• How patients’ experience of being misunderstood affect the outcome of the treatment
• What the negative effects of feeling misunderstood have on patients’ mental health?

Although the article is able to answer these questions, being a qualitative research, it does not provide statistical data to process and compare to other surveys. It would have been a good idea to compare the results of the survey with the results of another one, interviewing only patients who felt “understood”. It is, however, a fact that the authors indicate that the reason for not surveying “understood” patients was the lack of sample.

Concepts

The authors use various sources confirming that humans need feeling understood in order to feel a connection. Therefore, to build good working relationship with caregivers, there is a need for understanding. Still, the study confirms that: these particular experiences of being misunderstood (figure) would not be experienced without the existence of the person’s mental illness (ground).” (p. 194.)

The main themes the authors use are: protection from vulnerability, feeling like an object to be fixed, being treated like a child and relentless frustration. However, the concept that these feelings would not be present in patients’ lives without intervention is not clear. Indeed, it is not a result of the treatment and mental health staff’s approach; more likely the result of the mental illness itself. The reliability of self-reports, therefore, is questionable. There is no indication that the caregivers have done anything to make the patients that way. It is likely that if a family member approached the patient with the intention to improve their state of mental health, they would feel the same way. Therefore, without comparing different programs, mental health treatment approaches and options, it is impossible to say that one mental health approach is better than another and how this problem can be fixed. Although the journal article reveals the need to reduce patients’ frustration of feeling misunderstood, it hardly offers any solution. Another study is needed in order to reveal the methods leading to patients’ experience to feel more understood and connected to mental health staff.

Critique

Overall, the authors of the current article critique agree that there is a positive impact of feeling understood on the outcome of mental illness treatment. However, as the study solely used self-report interviews, the objectivity of the results can be questioned. Although some patients with mental illness would feel misunderstood, this might not be the indication of the caregivers’ ignorance or lack of skills. Some patients, especially those suffering from depression would generally feel misunderstood, despite the effort of the mental health care staff. Therefore, although the study is an indication of patients’ subjective opinion, it does not fully reveal the development areas. As the research solely focuses on patients’ experience, it is a subjective report. It can only be viewed as a reference alongside with some other studies, revealing the practices, individual treatment schedules and plans of different mental health care providers.

The authors conclude that feeling misunderstood decreases the success rate of the treatment and many of the surveyed people left the program due to this, or the result was no adherence. (p. 193.)

The feeling of being stigmatized and the sense of being misunderstood

The problem of being stigmatized and feeling misunderstood has also been revealed by other studies. Rusch et al. (2005) focused on the fear of stigma and concluded that it was one of the barrier for the effectiveness of mental health services. The authors also concluded that contact and relationships had a positive effect on patients’ perception of the outside world; they felt less stigmatized and more understood. However, the question of what type of contact and connection was used has not been fully revealed. The anti-stigma initiatives (p. 536) were discussed, and the conclusion that the methods to reduce patients’ perception of self-stigma and the barrier of stigmatization within mental health services (also mentioned by Gaillard et al., 2009) does not include working methods. The authors suggest that there is a need for further research to reveal the methods for reducing stigmatization of patients. The answers of the originally examined article (Gaillard et al. 2009) also indicate that patients feel stigmatized; “when participants’ mental health was seen as “something broken that needed to be fixed.” (p. 195) The above is a form of stigmatization and approaches need to be developed in order to improve patients’ perception of the treatment. When being referred to and identified by the mental illness itself, (p. 194.) stigmatization happens and the sense of identity is damaged.

Perry et al. (2007) studied the attitudes of children and adults regarding help with mental illnesses and symptoms. Interestingly, from the large sample only 175 adults answered that when seeking help the “person should see a therapist or a counsellor”, and more people selected friends and family. This does not only indicate a low mental health literacy, but the lack of trust in professional mental health care providers. Although the survey was restricted to depression, it is likely that the results would show a similar pattern. The study also stated that stigmatization was the most important barrier in front of approaching mental health issues correctly. The authors state that “Public knowledge and attitudes may rely on sensationalized media reports or direct-to-consumer advertising for information, as well as “commonsense” (but typically uninformed) inferences.” (p. 634.) The truth is somewhere in between the statements of the two articles: (Perry et al. 2007, and Gaillard et al. 2009). The reason for the lack of trust in mental health care providers is based on the fear of being stigmatized, the perception of patient-counselor relationship and the characteristics of the mental illness (i.e.. depression) itself. It is a combination of various contributing factors, therefore, each and every aspect of patients’ sense of being misunderstood needs to be tackled individually.

It is interesting to review the relationship between the mental illness and stigma and measure the influences. This is exactly what Gaebel et al. (2006) reviewed in their study. The authors also conclude that the lack of knowledge within the public might be a contributing factor for stigmatization. However, this does not relate to the attitudes of mental health care staff; they are well educated and have a solid knowledge of the symptoms and effects of different mental illnesses. This means that stigmatization within health care should not happen. Hence, according to Gaillard et al. (2009), many patients feel let down and misunderstood, treated like a case or a child. The authors also conclude that stigmatization has a negative effect on social contacts and self-esteem. (Gaebel et al, 2006, p. 43.) Therefore, the original statement related to the approaches of mental health staff within the journal article published by Gaillard et al. (2009) are confirmed by this study, as well.

Conclusion

The reviewed article provides a basis for an argument for developing more effective approaches within mental health care and improving patients’ perception of the treatment. Although qualitative research is still needed in order to reveal the direct connection between the perceptions of patients being misunderstood and the success/failure rate of the treatment. A further, qualitative and quantitative study needs to be created using both self-reports and statistical data to reveal the most effective approaches and improve the quality of training provided for mental health care providers related to communication, patient relationship and support. Without this study being carried out, professionals might realize the importance of making mental health care patients feel understood, welcome and treating them fairly, but the methods to be used would not be clearly determined. Without a research comparing patients feeling “understood” and those feeling “misunderstood” and stigmatized based on the outcome of the treatment, adherence and speed of improvement, the real purpose of the article cannot be fulfilled.

References

Gaebel, W., Zaske, H., Baumann, A. (2006) The relationship between mental illness severity and stigma. Acta Psychiatr Scand 2006: 113 (Suppl. 429): 41–45. _ 2006 Blackwell Munksgaard.

Gaillard, L., Shattell, M., Thomas, S. (2009) Mental health patients’ experiences of being Misunderstood. Nursing Publications and Other Works. 1-1-2009

Perry, B., Peacosolido, B., Martin, J., McLeod, J., Jensen, P. (2007) Comparison of Public Attributions, Attitudes, and Stigma in Regard to Depression Among Children and Adults. Psychiatric Services, May 2007 Vol. 58 No. 5

Rusch, N., Angermeyer, M., Corrigan, P. (2005) Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry 20 (2005) 529–539