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PERCEPTIONS AND ATTITUDE TOWARDS MENTAL ILLNESS AMONG RURAL AND URBAN SECONDARY SCHOOL STUDENTS IN ENUGU METROPOLIS.
Background to the Study
Mental health is a basic component of health and it contributes to living a happy and fulfilled life. Mental health is defined by the WHO. (2011) as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. On the other hand, mental illness refers to conditions that affect cognition, emotion, and thus, the everyday life of the person who suffers it (American Psychological Association, 2015). Mental illness is an important public health issue worldwide (Vijayalakshmi, Reddy, Math & Thimmaiah, 2013). Increasing health and socio-economic burden of mental illnesses and disorders have become a major concern in both developed and developing countries. Globally, it is estimated that more than 450 million people suffer from mental or behavioural disorders and one in four families has at least one member with a mental disorder (Fiasorgbor & Aniah, 2015). According to World Health Organisation (2012), mentally ill people often lack access to education, healthcare and opportunities to earn a decent living, which limit their chances of economic development and deprive them of social protection and recognition within the community. This burden of mental disorders is maximal in young adults, the most productive section of the population, and with the onset notably at adolescence; it issues a serious concern to the economy of any nation (Fiasorgbor and Aniah, 2015).
In Nigeria, as in other parts of the world, the prevalence of mental illness is quite high. It was reported by WHO (2007) that 20 percent of Nigerians are suffering mental illness. With a population of 160 million, this translates to the fact that more than 30 million Nigerians are suffering from one form of mental disorder or another (National Census, 2006). Most surveys on perceptions of mental illness have been largely conducted in western countries, with few studies in developing country contexts. In the course of this present study, it became evident that the major reason for the dearth of resources on public perceptions of mental health and mental illness in Nigeria is the absence of political will to develop a mental health service based on a comprehensive legal and policy framework that encourages research interest on the subject (Iheanacho, 2013). The law covering Mental Health Act in Nigeria is so grossly inadequate that Nigeria is still operating on the Mental Health Policy of 1996 (Godiya, Bala, Bala, Ogbonna, Osumanyi & Ahmed et al., 2013). This is in contrast to what is obtainable in Western countries and even neighboring African countries such as Ghana where a new mental health Act was recently passed (Fiasordor et. al., 2015).
The belief system of people has been known to influence their attitudes and perception of a lot of subjects; mental illness inclusive. A recent Nigerian survey found that urban dwelling, higher educational status, and familiarity with mental illness correlated with belief in biological and psychosocial causation, while rural dwelling correlated with belief in supernatural causes. This identifies culture as likely to influence the experience, expression, and determinants of peoples’ perceptions (Adewuya & Makanjuola, 2008). These beliefs undoubtedly affect how the mentally ill is treated in the society. This was confirmed in a study conducted in South-western Nigeria where it was found that people were unwilling to have social interactions with those with mental illness. Most of the respondents reported that they would be afraid to have a conversation, would be upset or disturbed about working on the same job, would not share a room, and would feel ashamed if people knew that someone in their family had been diagnosed with a mental illness. Only very few reported that they could maintain a friendship with a person with a mental illness (Gureje, Lasebikan, Ephraim-Oluwanuga, Olley, & Kola, 2005).
Conversely, studies from western societies have shown that biological factors (diseases of the brain and genetic factors) and eventual factors (trauma and stress) are more likely to be considered causal while in Africa, supernatural causes are widely considered (Sadik, Bradley, Al-Hasoon and Jenkins, 2010). A study in India of community beliefs about causes and risks for mental disorders, found that the most commonly acknowledged causes were a range of socio-economic factors, while neither supernatural causes nor biological explanation were widely endorsed. In this case the main predictors of the variable of social distance from people with mental illness was perceiving the person as dangerous, while the main predictors of reduced social distance was being a volunteer health worker, and seeing the problem as a personal weakness. For depression, believing the cause to be family tension reduced social distance. For psychosis, labelling the illness as a mind/ brain problem, a genetic problem or a lack of control over life increased social distance. (Kermode , Bowen , Arole , Joag & Jorm, 2009)
Adolescence is the phase of development in which the individual is making the most effort to seek independent identity and control over his/her life, which includes the desire to start making more of his/her own decisions. Erroneously adolescents are generally perceived as the healthy age group but the irony of it remains that mental illness usually strike individuals in the prime of their lives, often during adolescence and young adulthood. In the United States alone, more than ten percent of children and adolescents suffer from mental disorders severe enough to cause some level of impairment more common than diabetes, cancer, or heart disease could (American Psychiatric Association, 2011). Studies in Nigeria have shown that as many as one in ten of Nigerian adolescents aged between ten and twenty four has a clinically recognizable mental health problem (Kabir, Zubair, Isa & Muktar, 2004). This high susceptibility in adolescents and young adults to developing a mental disorder correlates with their incessant compulsion to indulge in mental health risk behaviors such as taking psycho-active drugs and unhealthy sexual relationship among others (Rickwood, 2007)
As a result of all these circumstances surrounding a typical adolescent, understanding the perceptions and beliefs of the youths towards mental illness and people with mental illness has proven to be a very important step in addressing the negative public attitude reported so very often in mental health studies (Vijayalakashmi & Thimmaiah, 2013). The qualitative study by Tolulope, Olayinka, Nisha and Yetunde (2011), on the perceptions of mental illness among rural and urban adolescents in Southwestern Nigeria clearly shows that adolescents indeed are strongly opinionated on the subject of the nature, causes, characteristics and treatment of mental illness. Their study succeeded in exposing the gaps in the respondents’ knowledge which had varying degrees of cultural and religious inclinations. To further demonstrate the importance of young peoples’ view of mental illness, a study in Athens Greece by Sakerelli (2014) to explore perceptions of mental health and mental illness as well as the perceptions towards people with mental illness among adolescents, found that young people had a lot of negative attitude towards mental illness and the mentally ill. His study further showed that following a period of enlightening educational sessions, a marked improvement was evident in their attitude especially regarding the importance of social care and social integration of the mentally ill.
In determining the factors that shape the adolescents’ attitude and perceptions of mental illness, Said (20011) revealed that socialization and mass media play major roles. The community in which the adolescent finds himself being the socialization agent has been found to interfere with help-seeking behavior among adolescents suffering from some form of mental illness. Specifically, a reluctance to acknowledge mental health problems, social stigma, a culture of self-reliance, and a view that equates mental illness with “insanity” have been identified as the main factors influencing the help seeking behavior (and ultimately mental illness in general) of people suffering from mental illnesses who were residing in rural and remote communities (Adewuola and Makanjuola, 2009, Gulliver, Griffiths and Christensen, 2010). The reasons are not far fetched, because many of the perceptions of mental illness were formed from the basic childhood socialization (The mad woman at the village square, the frightening mental institutions, the mentally ill relative in the family closet et cetra –all these are part of the many experiences that form an individual’s perceptions of mental illness) transferred by parents and the society which eventually translates to the belief systems of the youth who then becomes an adult, and the cycle continues..
Therefore having validated the role of the community in the prevention and care of the mentally ill has now been widely acknowledged and is regarded as the most appropriate basis for the development of mental health programmes. Several studies have shown that knowledge of public perception (the youths inclusive) of mental illness and its treatment is a vitally important prerequisite to the realization of successful community-based programmes (Kabir et al., 2004; Fiasorgbor & Aniah, 2015). This is due to the fact that the recognition of mental disorders first and foremost depends on a careful evaluation of the norms, beliefs and customs within the individual’s cultural environment. Unarguably therefore, adolescents’ perceptions of mental illness which includes beliefs, ignorance and stigma, play significant roles in determining help-seeking behavior, successful treatment of the mentally ill and eventually, the mental health status of the nation.
Statement of Problem
Mental illness through exaggeration and misunderstanding has been the subject of ridicule and disrespect since ages. Mental illness was abhorred and detested as a curse and mentally ill patients ostracized and subjected to inhuman cruelty. The damaging consequences of such notions are – stigma; rejection; loss of esteem; discrimination; restriction of opportunity; reluctance to seek, accept or reveal psychiatric treatment. During the twentieth century with the advent of improved patient care, large psychopharmacological armamentarium, psycho-education, advances in communications and technology, there has been a change of attitude toward mental illness.
Western researchers are recording improved societal treatment of the mentally ill especially in urban areas, but they were able to trace these improvements through methodical and timely researches. Unfortunately, in our environment, paucity of research materials on the subject only goes to show the disinterest of the policy makers and even the academics on knowing the status quo of adolescent mental health in Nigeria so as to engineer strategies that will bring us in par with the rest of the world. From the researcher’s experiences in a psychiatric hospital during clinical postings, more and more people living with mental illness are falling victims of societal maliciousness and maltreatment every day. It is ruining sufferers’ chances of getting prompt treatment as well as good prognosis, and those that are able to ignore the society, admit that they need help and get treated, return to an even more hostile society where no one is willing to hire them, live near them, go to school with them, talk less of marrying them (Sharac et. Al., 2010)
Research studies among the youths have noted ethnic and religious orientations among others as having effect on young people’s attitude and perceptions of mental illness (Otto, Susin, Lax, Kaplan and Zatina, 2012; Olayinka, et al 2011). This was found to make them slow in recognizing illnesses experienced by themselves or by peers, leading to delays in effective help seeking and confusion or misunderstanding of psychiatric labels that may be used to describe themselves or others. As a result of this gap in knowledge also, many people’s first option in seeking help/treatment is to run to prayer houses (Aniebue & Ekwueme, 2009) and only find their way to a psychiatric hospital when the condition has become too advanced thereby resulting in very poor prognosis.
At an age when peer approval and inclusion are especially important and when many serious mental conditions emerge, one finds youths ignorantly engaging in risky behavior (such as smoking and abusing drugs) that predisposes them to mental illness oblivious of the consequences. And because this group of individuals are the hope of tomorrow, their mental health is essential for the building and maintenance of stable societies since today’s adolescents are the future adults who through participation can have an impact on the quality of life of the whole community.
Literature has validated that finding out adolescents’ knowledge, views and beliefs of mental illness is integral to the future of mental health in Nigeria; that knowledge of the prevailing attitudes of these people will help in adopting strategies that will help make peoples’ attitudes more positive and thus help in early patient detection, better patient care and cooperation, planning of supportive after care and relapse prevention. The researcher therefore, having witnessed firsthand the travails of young mentally ill clients and their families wonders what the perceptions of the adolescents in this Eastern part of the country are on the subject of mental illness.
Purpose of the Study
The purpose of the study was to investigate the perceptions and attitudes towards mental illness among adolescents in selected rural and urban secondary schools in Enugu Metropolis, Enugu State.
The specific objectives set for this study were to:
- determine the attitude of rural and urban secondary school adolescents towards mental illness.
- determine the views and beliefs about the causes of mental illness among rural and urban secondary school adolescents.
- elicit the views and beliefs of rural and urban secondary school adolescents regarding self help measures and professional help for mental illness
- determine the views and beliefs of rural and urban secondary school adolescents regarding the treatment of mental illness.
- determine the views and beliefs of rural and urban secondary school adolescents regarding the prognosis of mental illness.
- identify the sources of knowledge of mental illness among rural and urban secondary school adolescents.
- What are the attitudes of rural and urban secondary school adolescents towards mental illness?
- What are the views and beliefs about the causes of mental illness among rural and urban secondary school adolescents?
- What are the views and beliefs of rural and urban secondary school adolescents regarding self help measures and professional help for mental illness?
- What are the views and beliefs of rural and urban secondary school adolescents regarding the treatment of mental illness?
- What are the views and beliefs of rural and urban secondary school adolescents regarding the prognosis of mental illness?
- What are the sources of knowledge of mental illness among rural and urban secondary school adolescents?
- There will be no significant difference in the attitude towards mental illness between rural and urban adolescents
- There will be no significant difference in the perceptions of causes of mental illness between rural and urban adolescents.
- There will be no significant difference in the perceptions of self-help measures of mental illness between rural and urban adolescents
- There will be no significant difference in the perceptions of treatment/ prognosis of mental illness between rural and urban adolescents.
- There will be no significant difference in the sources of knowledge of mental health/ illness between rural and urban adolescents.
- There will be no significant relationship between the attitudes of rural and urban adolescents towards mental illness and certain demographic variables (age, sex, level of education, and religious orientation)
- There will be no significant relationship between the perceptions(of causes, treatment, prognosis and self help measures) of rural and urban adolescents towards mental illness and certain demographic variables (age, sex, level of education, and religious orientation).
Significance of the study
This study and its findings will be of great benefit to the mental health community in Enugu state which is made up of psychiatric hospitals, mental health /agencies, schools, families leaving with mental health challenges, the government and the general public. The study will reveal gaps in knowledge about mental illness, its causes, treatment and prognosis which might have been affecting the adolescents’ help seeking behavior and thus early detection onset or relapse of mental conditions.
The findings of the study will identify existing stigma regarding mental illness which goes a long way in determining the possibility of de-institutionalization in this part of Nigeria which is now the focus of psychiatry globally.
The information will be used by mental health professionals to put together mental health awareness strategies that will help address existing myths and misconceptions about mental illness among one of the most important age group of every community.
The findings of this study will inform the government and other policy makers on the areas where new policies or amendment of existing ones are needed in mental health and psychiatry.
Finally, the findings will add to the existing body of knowledge on child and adolescent psychiatry.
Scope of the Study
The study is delimited to senior secondary schools students attending secondary schools in Enugu metropolis. The variables to be studied are attitudes and perceptions about mental illness: the causes, self help measures, treatment, prognosis and their sources of knowledge of mental health among adolescents in Enugu state. It is also delimited to four secondary schools in Enugu metropolis: Two Urban secondary schools (Comprehensive High School, Emene and Army Day Secondary school, Enugu) and two rural secondary schools (Community Secondary school Ugwogo – Nike and Community Secondary school Obeagu – Amechi)
- Senior secondary students: Refer to adolescent male and female students in classes Senior Secondary one to Senior Secondary three (SSI – SS3) and attending secondary schools in Enugu
- Urban secondary schools: Refer to secondary schools located within the city of Enugu; in this case community High school Emene and Army Day Secondary School, Enugu.
- Rural secondary school: Refer to secondary schools located outside the city of Enugu but still within the metropolis. In this study, they are community secondary school Ugwogo Nike and Community secondary School Amechi Awkunanaw.
- Perceptions of Mental Illness: This refer to the views and beliefs of senior secondary school students regarding the causes, self help measures, treatment, prognosis of mental illness as well as their views of, and sources of mental health/illness information.
- Perceptions of the causes of mental illness: The views and beliefs of the adolescents regarding the causes of mental illness. This covers both the biological, spiritual and psychological causes as perceived by the students.
- Perceptions of the treatment for mental illness: The views and beliefs of the adolescents regarding the treatment modalities of mental illness. This covers the orthodox, complementary, alternative and traditional treatment practices they have seen and heard existing in their different localities.
- Perceptions prognosis of mental illness: This refers to whether they belief that mental illness can be cured or cannot be cured; whether they believe that the victims are capable of any semblance of normal life ( such as employment, education and marriage)
- Perceptions of self help measures in case of mental illness: This refer to what the adolescents believe they should do to help themselves and obtain help should they, their friends or family member fall victim of mental illness.
- Perceptions of knowledge of mental illness: this refer to their views of the adequacy or inadequacy of information they have with regards to mental illness
- Sources of knowledge of mental illness: These are the different agencies both frmal and informal that contributed in shaping their knowledge of mental illness.
- Attitude towards mental illness: This refers to the students’ positive or negative evaluation of mental illness as categorized under separatism, stereotype, restrictiveness, pessimistic predictions and stigmatization.
- Benevolence: This refers to the paternalistic and sympathetic attitude of secondary school students about mental illness and the mentally ill.
- Separatism: This is the attitude of secondary school students towards discrimination of the mentally ill.
- Stereotyping: This examines the students’ degree of social distance maintained from the mentally ill and mental illness.
- Restrictiveness: This examines the students’ perception of the mentally ill as a threat to society.
- Pessimistic prediction: This examines the students’ level of prejudice towards mental illness.