MOTHER TERESA COLLEGE OF NURSING,KUMHARI,

DURG(C.G.)
CHHATTISGARH.
SYNOPSIS PERFOMA FOR REGISRATION OF SUBJECT FOR
DISSERTATION

MR. ASHOK KUMAR SAHU

1ST YEAR M.Sc. NURSING
MENTAL HEALTH NURSING
YEAR 2014 2015

MTCN, KUMHARI DURG

MOTHER TERESA COLLEGE OF NURSING,KUMHARI,

DURG(C.G.)
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.

NAME OF THE
CANDIDATE
AND ADDRESS
(IN BLOCK
LETTERS)

ASHOK KUMAR SAHU

I YEAR M.SC. NURSING

MOTHER TERESA COLLEGE OF

NURSING,KUMHARI, DURG(C.G.)
MOTHER TERESA COLLEGE OF
NURSING,KUMHARI, DURG(C.G.)

2.

NAME OF THE
INSTITUTION

3.

COURSE OF
STUDY AND
SUBJECT

M. Sc. NURSING

DATE OF
ADMISSION TO
THE COURSE

1ST OCT, 2014

4.

5.

PSYCHIATRIC NURSING

TITLE OF THE TOPIC

" A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET
ON MISCONCEPTION TOWARDS MENTAL ILLNESS AMONG FAMILY
MEMBERS OF MENTALLY ILL PATIENT IN SELECTED HOSPITALS AT
BENGALURU, KARNATAKA."

6. BRIEF RESUME OF THE INTENDED STUDY

INTRODUCTION
Only two things are infinite, the universe and human stupidity, and Im not
sure about the former
- Albert Einstein
Good attitudes are magnets for good news. Seen it proven a hundred times. A
mental disorder or mental illness is a psychological or behavioural pattern generally
associated with subjective distress or disability that occurs in an individual, and which is
not a part of normal development or culture.1
Growing up in a world where everyone accept this myth and share this misconception,
what would your reaction be if someone were to tell you suffer from mental illness? If
you have an ounce of dignity, it would be, no, not me. Im nothing like that. And of
course you would be right. No- one is like that, in fact the people who accept the
diagnosis of mental illness tend to be those who have low self esteem. Those who realy
feel good about themselves reject the label and, oftentimes, treatment. Out of a sense of
shame they may withdraw socially from their friends. They may give up on their career,
academic or marriage plans and, seeing themselves as hopeless cases, they may become
dependent on theire treatment providers and others in their lives.2
Mental illness is an age-old problem of mankind as recorded in the literature of the
oldest civilizations the world over. The public view towards mental illness has been
considered as negative, stigmatized, uninformed and fearful entity right from the ancient
time till date which varies according to age, race, ethnicity, religion, culture, tradition, and
education of the different community. 3
Mental health is defined as ... a state of complete physical, mental and social

well-being

in which the individual realises his or her own abilities, 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. In other words, mental health involves finding a balance in all aspects of life:
physically, mentally, emotionally and spiritually. Although mental well-being is believed to
be instrumental to quality living and personal growth, people often take mental health for
granted and may not notice the components of mental well-being until problems and stresses
surface. As a country develops and urbanizes, life becomes more complex, and problems
related to social, cultural, and economic changes arise. Family is a group comprising a
husband and wife and their dependent children, constituting a fundamental unit in a
organizing of society.4
When mental illness first strikes, family members may deny the person has a continuing
illness. Durind the acute episode family members will be alarmed by what is happening to
their loved one. When the episode is over and the family members returns home, everyone
will feel a tremendous sense of relief. All involved want to put this painful time in the past
and focus on the future. Sometimes even after some family members do understand the
reality of the illness, others do not. Those who do accept the truth find that they must protect
the ill person from those who do not and who blame and denigrate the ill person for
unacceptable behavior and lack of achievement. Obviously, this leads to tension within the
family, and isolation and loss of meaningful relationship with those who are not supportive of
the ill person.5

6.1 NEED FOR THE STUDY

Mental health problems and prejudiced attitudes toward mental illness have common risk
factors. The school is a central place for adolescents social interactions and an important

setting for promoting pupils health and well-being . The importance associated with the
opportunity to promote mental health through the school. The pervasive negative public
beliefs about mental illness, in turn, create an environment that impedes both treatment
seeking and recovery. For psychiatrically labeled children and adolescents acutely attuned to
the judgments of their peers, misunderstandings and negative attitudes about mental illnesses
among those peers may be particularly painful. Adolescent mental health disorders are
present in around 10% of the population. Research indicates that many young people possess
negative attitudes towards mental health difficulties among peers. 5
World Health Organization estimates that 10% of the world's population has some
form of mental disability.6
The point prevalence of mental illness in the adult population at any given time is also
10%.7
The consequences of stigma associated with mental illness have attracted the negative
ratings among the public. The public express that the people with mental illness are
unpredictable and dangerous. Thus the knowledge and attitude among adults towards mental
illness bears profound impact on the person with psychiatric illness.8
In India among the total population, 72.22% of the people live in rural areas and
27.78% in urban area. Among these adults between the age group of 15-59 years form 56.9%
of the total population.9
Mental illness affects the people of all age group It is estimated that 450 million
people are experiencing mental illness at any one time, most of whom live in developing
countries.10

The United States Department of Health and Human Services (USDHHS,1999) stated
that more than 48 million people in the United States (1 in 5, or 20%) have a diagnosable
mental disorder or illness, half of all citizens have a mental illness at sometime in their lives
and most of these people however never seek treatment.11
The National Institute of Mental Health and Neuro-Sciences (NIMHANS) report
shows that in India 70 million people suffer from mental ailments and yet, 50-90 percent of
them are not able to access corrective services due to less awareness and negative attitude or
stigma towards mental illness. 12
In rural India, prevalence rates for all mental illness is 64.4 per 1000 population and
urban part of the country it is 66.4 per 1000 population. 13
A descriptive study conducted on Urban Mental health services in India found that,
the service providers perceived that the important barrier besides the financial problem are
stigma and lack of awareness.14
One third of the mental health beds are in one state (MR) and several states have no
mental hospitals.15
A comparative study conducted to examine stigmatizing attitudes towards the severely
mentally ill among rural and urban community dwellers in India. Study revealed that the rural
Indians showed higher stigma and view towards the severely mentally ill was punitive, while
the urban group expressed a liberal view of severe mental illness. Urban Indians rejected to
work with existing mental illness among person whereas rural Indians did not pose such an
opinion.15

An epidemiological study on psychiatry morbidity in India showed that the

prevalence rate of all mental disorders was 65.4% per 1000 population. The urban morbidity
rates were 2 per 1000 higher than the rural morbidity rate.17
A community-based cross-sectional study on the prevalence and pattern of mental
disability in 11 villages of Udupi district, Karnataka revealed that prevalence of mental
disability was 2.3% and prevalence of mental disability was more among female compared to
males.18
A study on screening for psychiatric disorders in adult population reported that 39%
of the adult population has mental illness. Proportion of psychiatric morbidity among males
and females were 36.2% and 42.2% respectively.19
Almost every dimensions of life are affected due to the impact of mental illness such
as personal, interpersonal, social, and economic growth. As a result there is destruction in the
whole personality which in turn would cause damage at the outset.
Thus the researcher found the importance of to assess the misconception regarding
mental illness among the family members of mentally ill patients.

6.2

REVIEW OF LITERATURE
A study to assess the effectiveness of the educational interventions for primary care

providers. An improvement in attitude towards mentally ill person among the public and the
first level health care providers will lead to better practices, early identification of illness,
initiation of appropriate treatment, promt referral to a specialized care setting when necessary,
improvrment in the cure rate and complete rehabilitation at the community level. Nurse
practitioner working in mental health and primary health care setting have large role to play
in this regard. While there were almost equal nimber of men ane women among clients, 70%

of the family members interviewed were men. The clients and family members were similer
with respect to level of education and occupation. Majority of clients and interviewees were
hindu, Tamil speaking rural resident. Thus the study concluded as educational intervention is
necessary to improve the general knowledge of family members regarding mental illness.20
A descriptive study was conducted on the knowledge and attitude towards mental
illness in Abuja. Two thousand and forty samples were selected using multistage clustered
sampling technique. The result revealed that 96.5% of subjects perceived that people with
mental illness were dangerous, 82.7% expressed fear to converse with mentally ill persons,
and only 16.9% showed agreement regarding the marriage of mentally ill persons. Therefore,
the study concluded that there was widespread stigmatisation of mental illness persisting. 21
A study was conducted to assess the attitude towards mental illness found association
of age with the attitude of the people towards mental illness, in that people with age of more
than 14-41 years favoured social isolation and withdrawal of social responsibility for the
people with mental illness, which throws light on the attitude the urban community holds
towards the person with mental illness.22
A descriptive study conducted on attitude of Indian urban young adults towards
mental illnesses. In an urban area of Jhansi 238 samples were interviewed to assess their
views regarding mental illnesses. Mental illness was not perceived as a serious disease.
Cancer was perceived as the most serious disease. Worries, faulty upbringing, overwork were
perceived as a cause of mental illness by majority. Early identification sings of mental illness
described by them were difficulty in sleeping, changes in facial expression and feeling of
impending mental imbalance. Marital alliance with them was not favoured. However, a
sympathetic attitude towards mental patients was favoured. Avoiding tension, adapting

oneself to circumstances, consulting with elders were considered as preventive measures

against mental illness by majority.23
A descriptive study conducted in Maharastra to assess the knowledge, attitude and
practices of family members including childres of clients with mental illness, they found that
the family members had an adequate level of knowledge regarding mental illness. All
subjects were able to state at least one symptom or sign of mental illness and 78% were able
to identify a cause or factor precipitating the onset of illness. Almost all (97%) stated that
mental illness is curable with medication. Almost one-third accepted that they used physical
restraint to keep the ill client under control and said that modalities other than medication
including ECT (8%) were necessary to affect a cure. More than 80% allowed the mentally ill
client to attend social gatherings or visit public places. While two thirds did not advocate
marriage as a cure for mental illness, 25% objected to marrying family members of a
mentally ill person for fear of social stigma. Less than half the family members (40%) have
expressed the misconceptions regarding mental illness.24
A study published in the November 2010 American Journal Of Psychiatry found that
much stigma remains. In fact when researchers compared 1996 and 2006 general social
survey (GSS) data, stigma has increased in some areas. The present of survey respondent who
beloved the cause of mental illness to be neurological increased significantly from 1996 to
2006 across all surveyed conditions. Despite the increase in public knowledge and
understanding, stigma level remaine high. Result: alcohol de[pendence in 1996 were 38%
while in 2006 47%, major depression in 1996 54% while in 2006 67%, schizophrenia in 1996
76% while in 2006 86%. 25
An evaluative study was conducted to examine research on care giving in families of
individual with mental illness living in Taiwan, Hong Kong, and Mainland china. A search

using computarised data base, public search engines, and reference from retrieved articles
revealed 37 studies published from 1990 to 2009. Four studies were theory driven at an
individual level, and one study was guided by a family- level framework. Thirty two articles
were quantitative studies, and 5 were qualitative studies. All but 5 of 37 studies were cross
sectional. Findings suggest that misconception about mental illness, behavior disturbances,
inadequate social support, and the limited value placed on care giving contribute to mal
adaptation. Future research should include longitudinal studies guided by culturally
appropriate family frameworks and studies using mixed methods.26
An experimental study on efficacy of psycho- educational programme in promotion of
social and family functioning among Iranian psychiatric clients in the theme of this study.
170 schizophrenics with 174 clients with mood disorders were included in the present study
and adopting Solomons

experimental design they were assigned into 4 groups: 2

experimental and 2 control group for each illness category. Key family members from
experimental groups participated in weekly educational

programme for a duration of6

months. Comparing the experimental and control groups, more attitudinal, cognitive and
behavioral changes among families followed by more desirable role performance ability by
the clients in experimental groups were observed. Results indicated that family education can
bring about desirable change in the family dynamics and better outcome of psychiatric
disorders.27
A study conducted on the new neighbour experience of living next door to people
suffering from long-term mental illness. Nineteen neighbours of group homes for people with
long-term mental illness, in seven different communities in eastern Norway, have been
interviewed. The grounded theory procedures as well as the constant comparative method
were employed to analyse the findings. From the data, one main category was identified that
is the need for information.28

Community surveys reveal that the public thinks of people with mental illness as
always being unable to make any rational desicions, incapable, unpredictable and worthless. a
well-known 1960s American survey conducted by Nunally concludes that they are viewed by
the public with "fear, distrust and dislike." In short ,"all things bad." Subsequent research has
shown little or no improvement. This stereotype leads on to all kinds of misconceptions about
mental illness. Half the people answering a public survey in Britain in the 1990s thought that
setting fire to buildings was a "very likely" consequence of mental illness. American surveys
of the same period found that the majority of the public blamed mental illness on "lack of
discipline," and believed that people with mental illness were more responasible for their
condition than were people with AIDS or the obese or any other stigmatized group. Worse
still, people with mental illness themselves, and their family members, share these
misconception. A survey of family members in Madrid revealed that more than half felt that
people with schizophrenia should not be allowed to study, drive or have children.3
In this study, the author investigates the burden of 30 Chinese American caregivers of
patients with schizophrenia using both quantitative and qualitative data. The relatives
experienced enormous burden because of being intensely involved in patient care. Burdens
were strongly positively related to family conflicts. In the literature, conflicts among
caregivers have rarely been examined, but these conflicts seem particularly important to
Chinese families because of the intense involvement of more than 1 member in caregiving.
The significant relationship between length of stay in the United States and burden is perhaps
related to caregivers sense of mastery in language and knowledge of community resources in
coping with stress.29
A comparative study on African-Caribbean participants indicated less stigmatizing
beliefs towards both the symptoms and diagnostic label of schizophrenia compared to the
white European participants. White European participants were more likely to label vignettes

as implying 'mental illness' and also more likely to recommened professional health
treatment. These results are inconsistent with a hypothesis that on average African-Caribbean
people stigmatize schizophrenia more than White European people. While White European
participants' beliefs were more likely to follow a western model of mental illness, AfricanCaribbean participants were more likely to have alternative beliefs. The influence of racial
discrimination, mental illness knowledge and societal structurers are discussed.30

6.3

STATEMENT OF PROBLEM

" A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON

MISCONCEPTION TOWARDS MENTAL ILLNESS AMONG FAMILY MEMBERS
OF MENTALLY ILL PATIENT IN SELECTED HOSPITALS AT BENGALURU,
KARNATAKA."

6.4

OBJECTIVE OF STUDY
1. To assess the misconception regarding the mental illness among the family member
before providing the information booklet.
2. To find the association between the level of misconception regarding mental illness
due to information booklet through pre-test with selected demographic variables.
3. To evaluate the effectiveness of information booklet on misconception regarding
mental illness with selected demographic variables.

. 6.5 OPERATIONAL DEFINITIONS

1. Assess: In this study it refers to the act of determining knowledge and attitude
regarding mental illness as measured by a close ended questionnaire and Likert type
scale.
2. Information booklet: In this study it is the small booklet containing the general
misconcepts and facts regarding mental illness.
3. Misconception: In this study it refers to the mistaken thought, idea or notion and
incorrect information.
4.

Mental illness: In this study it refers to the clinically significant behaviour of

individual, which leads to disturbance in the social, occupational, psychological and

physical functioning.
5. Family members: In this study it refers to all the members of household under one
roof and work as a primary care provider.
6. Mentally ill patient: In this study it refers to a person who admitted in mental hospital
and having clinically significant behaviour.

6.6 ASSUMPTIONS
The study assumes that

6.7

Family members have some misconception regarding mental illness.

HYPOTHESES

Hypotheses will be tested at 0.05 level of statistical significance.

H1: There will be a significant association between misconception score of the

family members and the selected demographic variables.

H2: There will be a significant correlation between pre- test score and post- test
score of family members regarding misconception on mental illness.

6.8

7.

DELIMITATIONS

Study limited to family members who are coming to the selected hospitals.

Study limited to family members who are primary care giver and literate.

MATERIAL AND METHOD

7.1 Source of data

Family members of mentally ill patient in selected hospitals at Bengaluru.
7.1.1 Research design
In this study PRE-Experimental one pre-test and post-test design will be used.
7.1.2 Setting
The study is planned to conduct at selected hospitals at Bengaluru.
7.1.3 Population
Family members of mentally ill patient in selected hospitals at Bengaluru.

7.2 Methods of data collection

7.2.1 Sampling procedure

In view of the nature of the problem and to accomplish the objectives of the study
convenient sampling will be used to select 50 family members of mentally ill
patient who are admitted in the selected hospitals.

7.2.2 Sample size

the sample size will consist of 50 family members who meet the inclusion criteria.
7.2.3 Inclusion criteria
1. Family members who will be present during the time of data collection.
2. Family members who are willing to participate in the study.
3. Family members who know the kannada and English.
7.2.4 Exclusion criteria
1. Family members who are not coming to meet the patient.
2. Family members who are previously reported educational programme pertaining
to mental illness.
7.2.5 Instruments intended to be used
A close ended knowledge questionnaire and likert scale will be used.
7.2.6 Data collection method
Step 1: The researcher will obtain permission from concerned authority.
Step 2: Conduct general survey to check the availability of the samples in selected
hospitals.

Step 3: Convenient sampling method will be used and samples will be selected based on
the inclusion criteria.
Step 4:

Informed consent will be taken from the samples before administering

questionnaires.
Step 5: Assessing the misconception on mental illness among the family members in
selected hospitals.
Step 6: Assessing the misconception on mental illness among the family members after
providing the information booklet in selected hospitals.
Step 7: prepare for data analysis.
7.2.7 Plan for the data analysis
1. Data will be analyzed using descriptive and inferential stastics methods and tests.
2. Analyzed data will be presented using tables, figures and graphs.
7.3 Does the study require any investigation / intervention to be conducted?
Yes.
7.4 Has ethical consideration been obtained from your institution in case of 7.3?
Yes. Ethical clearance has been obtained.

8. LIST OF REFERENCES
1. Wikipedia;
2. The stigma inside Us. Available
On:http://coloradorecovery.com/the- stigma-inside-us.htm.
3. Asuni T, Schoenberg F, Swift C. Mental health and disease in Africa. Ibadan:
Spectrum Books Ltd; 1994.
4. Accurate and reliable dictionary. Available
On:http://ardictionary.com/family562.
5. Pathways to promise. Available
On:http://www.pathways2promise.org/family/assess.htm.
6. World Health Organization Training in the community for people with
disabilities.WHO: Geneva; 1989.
7. WHO. The World Health Report 2001 Mental health: New understanding; new hope.
Geneva: WHO. Available on: URL:http://www.who.int/whr2001/2001/.
8. Jorm AF. Public knowledge and beliefs about mental disorders. The British Journal of
Psychiatry 2000;177:396-401.
9. Office of the Registrar General and Census Commissioner, India; 2001.
10. Neeraja KP. Essentials of mental health and psychiatric nursing. Vol. I. New Delhi:
Jaypee Brothers Medical Publishers (P) Ltd; 2008.
11. Mohr Wk. Psychiatric mental health nursing. 6th ed. Philadelphia: Lippincott Williams
and Wilkins: 2006.
12. New Kerala [editorial]. October 30, 2008. Available on:
URL:http://www.newkerala.com/topstory-fullnews-38320.html.
13. Lalitha K. Mental Health and Psychiatric Nursing. Gajanana Publishers: Bangalore.
2000 p 244.
14. : Desai NG, Tiwari SC, nimbi S, Shah B et al. urban mental health services in India:
How complete or incomplete?. Indian Journal of Psychiatry.2004; 46(3):194-212.
15. Mental health atlas. Geneva: WHO- Library cataloguing-in-publication data;2005.
16. Jadhav S, Littlewood R, Ryder AG, Chakraborty A, Jain S, Barua M. Stigmatization
of severe mental illness in India: Against the simple industrialization hypothesis.
Indian J Psychiatry 2007;49:189-94

17. Murali MS, Epidemiological study of prevalence of mental disorders in India, Indian
Journal of Community Medicine 2001;26(4):10-2.
18. Kumar SG, Das A, Bhandary PV, Soans SJ, Harsha Kumar HN, Kotian MS.
Prevalence and pattern of mental disability in rural community of Karnataka. Indian
Journal of Psychiatry 2008;50:21-3.
19. Baruna A et al. A study on screening for psychiatric disorders in adult population.
Indian Journal of Community Medicine.2001;26(4):198-200.
20. D,Vimala a study ti assess the knowledge, attitude and practices of family members
of clients with mental illness. Nursing Journal Of India. Find article.com. 03
may,2011.
21. Gureje O, Lasebikon V O, Ephraim-Oluwaniga O, Olley B O, Kola L. Community
study of knowledge of and attitude to mental illness in Nigeria. British Journal of
Psychiatry 2005; 186: 436-41.
22. Mental health atlas. Geneva: WHO- Library cataloguing-in-publication data;2005.
23. Singh AJ, Shukla GD, Verma BL, Kumar A, Srivastava RN. Attitude of Indian urban
adults towards mental illnesses. Indian J Public Health. 1992 Apr-Jun; 36(2): 51-4.
24. Vimala D, Rajan, Annantha Kumari, Siva, Rajeswari, Bragnanza, Deepa. Assess the
knowledge, attitude and practices of family members of clients with mental illness.
Brit J Psychiatry 2003; 178(42): 231-5.
25. Jenifer Kelly. Stigma proves hard to eradicate despite multiple advances. Psychiatric
news January 7, 2011. Volume 46 number 1 page 10. American Psychiartic
Associatipon.
26. Chiu- Yueh Hsiao. Research on caregiving in Chinese families living with mental
illness: A critical review. Chung Shan medical university, Taichung, Taiwan.ava on:
http://jfn.sagepub.com/content/16/1/68.abstacts.
27. GHASSEMI, et al. FAMILY EDUCATION AND SOCIAL ADJUSTMENTS OF
PSYCHIATRIC CLIENTS. 80 medical journal of Islamic world academy of sciences
15:2, 73-80, 2005. Available on: http://www.medicaljournalias.org/belgelerim/belge/ghassemiSXHDVQAFOT75980.PDF.

28. Granerud A, Severinsson E. The new neighbour: experience of living next door to
people suffering from long-term mental illness. Int J Ment Health Nurs. 2003 Mar;
12(1): 3-10.
29. Winnie W. Kung.Burdens on Chinese American caregivers of patients with
schizophrenia, Available
on:http://Hawaii.edu/hivandaids/the_illness_stgma_cultute_or_immigration/pdf.
30. L. Stone A Comparison of African-Caribbean and white European young adults
conception of schizophrenia symptoms and the diagnostic label. Clinical psychology
service, west Middlesex university hospital. Available
on:http://isp.sageup.com/content/54/3/242.absract.

9.

Signature
of
the
candidate
10. Remarks of the guide

11. Name and designation of (in block letters)

11.1

Guide

MISS RAVIDISHA NAND

Professor, M.Sc. Nursing,

MOTHER TERESA COLLEGE

OF NURSING,KUMHARI,
DURG(C.G.)
11.2

Signature

11.3

Co-guide (if any)

11.4

Signature

MRS. BHAVNA VERMA

MOTHER TERESA COLLEGE

OF NURSING,KUMHARI,

12. 12.1
Head of
department

the Mrs.RACHANA GUPTA

Professor CUM PRINCIPAL, M.Sc.
Nursing,

MOTHER TERESA COLLEGE

OF NURSING,KUMHARI,
DURG(C.G.)
12.2

Signature

13. 13.1 Remarks

Principal
13.2

of

Signature

the