Stigma and Discrimination & Recovery

Question 1

What is the definition of Stigma?

Answer 1

A sign of shame, disgrace or disapproval, To shun or reject

Question 2

How does stigma impact on people experiencing mental illness, and their friends and family?

Answer 2

• Makes them feel embarrassed

- Limits their ability to want to access healthcare

Question 3

What is the definition of Discrimination?

Answer 3

Systematic, unfair treatment of people because they are different to someone else

It is a behaviour that says to people with mental illnesses that:
“We don’t want you here”
“You aren’t as good as we are”

Question 4

What groups can discriminate against people with mental health issues?

Answer 4

• Health professionals
• Family
• Public
• Government policies

Question 5

What are three strategies which can reduce stigma and discrimination?

Answer 5

• Education
• Protesting (making a complaint)
• Use of language
• Focus on strengths, not deficits
• Health promotion

Question 6

Name three aspects of life that can be impacted by stigma and discrimination

Answer 6

• Social
• Relationships
• Employment
• Education
• Sport
• Inclusion
• Community
• Housing
• Physical health
• Self perception/esteem

Question 7

What are 3 words that contribute to stigmatisation of schizophrenia?

Answer 7

• Crazy
• Dangerous
• Schizo
• Stupid
• Psych
• Unpredictable

Question 8

What is recovery?

Answer 8

Recovery is about having a life outside of mental illness,

Recovery is not the same as being cured. Recovery is an attitude, a way of approaching the day and facing the challenges. Recovery is about being in control

Question 9

What are the 10 principals for recovery?

Answer 9

• Is borne of HOPE
• Is a JOURNEY defined by the individual
• Needs a SUPPORTIVE environment to thrive
• Involves individuals REDEFINING WHO THEY ARE in the presence of a psychiatric label.
• Is an ACTIVE AND ONGOING process
• Is a NON-LINEAR journey
• Recovery skills can be LEARNT
• Involves a person EDUCATING THEMSELVES about their illness
• Learning to manage both INTERNALISED AND EXTERNAL stigma and discrimination

Question 10

What are some essentials of a recovery orientated practice?

Answer 10

• Take time to find out how the person feels and what you can do to help them feel safe and secure (creating relationships of safety)
• Explore with the person where they can exercise some choices and decision making (Encouraging patient)
• Adopt a stance of curious questioning, engage from the stance of really wanting to know how they understand their experiences (curiosity)
• Be aware of the potential impact of diagnosis on a person’s identity (Self-identity/esteem)
• Be careful how we label people’s experiences
• We are all experts in our own life (own capacity for self-knowing)
• Focus on the ME (the person) and not the IT (the illness), we are not there to fix people – they need to learn how to “fix” themselves

Question 11

What is trauma?

Answer 11

Lasting adverse effects on a person’s or collective’s functioning and mental, physical, social, emotional or spiritual wellbeing, caused by events, circumstances or intergenerational historical traumatic experiences.

Question 12

What is the broad definition of trauma informed care?

Answer 12

A framework for human service delivery that is based on knowledge and understanding of how trauma effects the peoples lives that emphasises physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.

Question 13

What does a strength based service deliver?

Answer 13

An approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment

Question 14

What is a trauma-informed approach?

Answer 14

Strengths-based model of care delivery which focuses on the persons strengths and competencies.

Question 15

More specifically, what is trauma informed care?

Answer 15

• Acknowledges the role that violence plays in the lives of people seeking
• Mental health and addictions services
• Addressing the impact that traumatic events have had on peoples lives and relationships
• Recognising adaptive functions of “symptoms”
• Not based in medical models (e.g. diagnosis)
• Promotion of empowerment and ‘self’

Making sure we delve into the history of our clients and look for reasons for poor coping skills, emotional dysregulation and why aggressive behaviour is present. It is about identifying triggers and stressors that contribute to poor mental health and mismanagement of perceived crisis.

Question 16

What are some key features for Trauma informed care

Answer 16

Focusing on what happened to you? Instead of what is wrong with you?

Asking questions about current abuse

Addressing the current risk and developing a safety plan for discharge

One person sensitively asking the questions

Noting that people who are psychotic and delusional can respond reliably to trauma assessments if questions are asked appropriately

Question 17

What is recovery about?

Answer 17

Recovery is NOT cure focused but rather is about living well in the presence or absence of illness

Question 18

What is the primary focus of mental health nursing?

Answer 18

Is the consumer and how nurses can facilitate the consumers recovery

Question 19

What are the Guidelines for the use of language in reducing stigma?

Answer 19

• Refer to people as people first and add specific characteristics only as required – for example, a person with addiction, not an addict, or a person with dementia, not demented
• Avoid referring to people as their illness
• Avoid extending the nature of the person’s illness with terms such as chronic, persistent or severely
• Avoid emotionally negative terms such as victim or suffering from emphasise abilities not limitations
• Avoid offensive expressions such as psycho or crazy
• Avoid metaphoric references to illnesses, such as schizophrenic situation
  refer to people as contributing community members, rather than as a burden or a problem.

Question 20

What is Mental Health?

Answer 20

Psychological state where a person functions at a suitable level of emotional and behavioural stability and comprises the persons ability to enjoy life and balance life events and energies to achieve psychological equilibrium

Question 21

What is Mental Illness?

Answer 21

Any disease or condition that influences the way a person thinks, feels, behaves and/ or relates to others

Question 22

What are some impacts on the community with someone experiencing discrimination?

Answer 22

• Social avoidance and exclusion
• Lack of tolerance and knowledge from public services (school, church, general hospitals, police)
• Reputations being inherited.
• Migrant populations

Question 23

What are some impacts on mental health with someone experiencing discrimination?

Answer 23

• Not being involved in clinical decisions
• Lack of consultation
• Exclusive treatment of individuals
• Assumption of ignorance
• Blamed for problem – Child and adolescent

Question 24

What are some impacts on the family when someone experiences discrimination

Answer 24

• Lack of education = Inaccuracy in knowledge = possibility of unhelpful/ abusive responses
• Feeling responsible, ashamed of the reputation = less likely to ask for help
• More likely to wait to long before accessing services
• Feeling helpless to fix their loved one and frustrated that Mental Health services can’t either

Question 25

What are the effects on the person when someone experiences discrimination? (self-discrimination)

Answer 25

- Discrimination of Families/ Whanau - Lack of information - Often Blamed for illness - Discrimination within Families/ Whanau - Lack of tolerance and understanding - Guilt and Shame - Frustration

Question 26

What are the 11 factors of recovery?

Answer 26

1. Doing something worthwhile 2. Being involved in things not related to their own problems 3. Having ordinary discussions with others 4. Being included and connected 5. Recognising everyday ups and downs are normal and accepted, not pathologised 6. Regaining belief in self 7. Recognising loss 8. Making meaning out of one’s experience 9. Recovery is not a cure 10. Recovery is an attitude 11. Having a life outside of mental illness

Question 27

How can the environment facilitate recovery?

Answer 27

- Personal support, community relationships, having a healthcare system that creates optimism, shifting focus to self-determination, empowerment and resourcefulness rather than focussing on the debilitation caused by mental illness. - Least restrictive care, enabling environments where relationships are valued. - Decision making is shared, everyone contributes, behaviour is seen as communication and power and authority are open for discussion.

Question 28

How does reflection in nursing improve recovery-informed practice?

Answer 28

Increases awareness and clarifies aspects of themselves and their role, being open to new challenges and seeking opportunity, reflection, critical thinking and analysis are essential skills for the nurse in mental health reflection allows for analysis and critical evaluation of a skill, knowledge deficit or challenging case for example.

Question 29

How does Hope (and keeping it alive) support recovery?

Answer 29

- Positive expectations | - Optimism creates a sense of value and worth

Question 30

How does creating relationships of safety support recovery-informed practice?

Answer 30

- Professional boundaries - Trust and mutual regard - A genuine desire to help the person and their family

Question 31

How does self-determination support recovery-informed practice?

Answer 31

Promoting autonomy with a focus upon personal strengths and personal responsibility while engaging in collaborative relationships and reflection

Question 32

How does engaging with curiosity support recovery-informed practice?

Answer 32

Having a genuine interest in the person, their lives and beliefs

Question 33

How does promoting citizenship support recovery-informed practice?

Answer 33

Attending to rights, social inclusion and meaningful occupation

Question 34

How does social inclusion support recovery-informed practice?

Answer 34

Advocacy on social determinants, challenging stigma and discrimination, developing community partnerships

Question 35

How does facilitating self-help and personal responsibility support recovery-informed practice?

Answer 35

- Recovery is a journey that is non-linear and the client is the expert - The clinicians role is to support recovery though fostering hope and optimism, reducing self-stigma and seeking opportunity

Question 36

When experiencing trauma, why do people find it difficult to think clearly?

Answer 36

It is much harder to access the thinking part of the brain and focus is on the distressing emotion rather than perspective and fear will drive behaviours such as avoidance, and fight-flight response.

Question 37

How can hospitalisation induce further trauma?

Answer 37

- Restricted environment - Heightened sense of authority and loss of autonomy - Loss of security and safety - Not knowing others around you - Lack of knowledge - Being torn away from familiar environments and people

Question 38

What are the 5 areas that require recognition which will enhance understanding of trauma-related care and care delivery

Answer 38

1. Trauma survivors often feel a lack of safety in receiving services 2. Coercive interventions may re-traumatise people 3. Interventions may be seen as shaming and humiliating 4. Need to focus on what is happening to the person 5. Impacts of trauma can affect how people react to potentially helpful relationships

Question 39

Give a brief summary of Trauma survivors often feel a lack of safety in receiving services and how this is related to care delivery

Answer 39

Nurses need to make clients feel safe and welcomed with explanations on the facility, why they are here as well as being a good listener to the client to create a therapeutic connection. Sharing techniques are relaxation can be therapeutic for the person as well if they are feeling anxious in hospital

Question 40

Give a brief summary of the area 'Impacts of trauma can affect how people react to potentially helpful relationships'

Answer 40

Trauma often occurs when people’s trust in another person or in a situation has been violated which can often shape difficulties in forming relationships with other people. Need to understand how trauma and abuse have an impact on their ability to form relationships

Question 41

Give a brief summary of the area 'Coercive interventions may re-traumatise people'

Answer 41

Nurses are often seen as figures of authority. Using this power that comes with this to exercise control over the person to do what you think they ‘should’ do will most likely be counterproductive, being seen as coercive and re-traumatise the person. Nurses need to recognise the person’s strengths and support them to develop care plans that affirm their preferences for care and how they manage distress

Question 42

Give a brief summary of the area 'interventions may be seen as shaming and humiliating'

Answer 42

Interventions that may be perceived as shaming and humiliating should be avoided. Nurses are responsible for always maintaining the dignity and individual rights of the person and providing services that are flexible, individualised, culturally competent, respectful and based on best practice

Question 43

Give a brief summary of the area 'needs to focus on what is happening to the person'

Answer 43

Avoid pathologising the person’s presenting symptoms and instead see the person and their experience. Nurses need to develop an understanding of presenting behaviour and symptoms in the context of the person’s experience. Behaviour is a communication and response, often to the distress