3.2 Client Perception of Illness

Client Beliefs and Stigma

Where do people obtain or learn beliefs and attitudes in general? They come from numerous sources, including families, schools, workplaces, culture, society, and religion. Beliefs and attitudes are formed by those who teach, model, and influence people. Clients’ beliefs about mental illness are often formed by societal stigma, cultural beliefs, and treatment issues specific to illnesses rather than by academic sources of information.

There are many misconceptions about mental health in the United States. There are people who believe that individuals choose all of their behaviors. Some people do not understand the degree of pain associated with illnesses like depression and panic or anxiety disorder. They may believe that people dealing with depression are “just lazy,” “don’t want to work for a living wage,” or “want to stay home and not have to interact with difficult people.” Others may think that if a person combatting anxiety would “just get over their fear with enough willpower, they could function and not have a problem.” These types of ideas and beliefs often lead to a stigma that can lead those living with mental illness to refuse help and begin to believe that they are beyond help, leading to thoughts of suicide.

In the medical field, illness is related to the physical body and organs of the body. Research has shown that mental health or mental illness can also be related to the physical body. For example, chemicals in the brain called neurotransmitters are released and taken into the neurons, or cells of the brain, to allow the brain to function. Without the chemical release in the necessary amounts, correct timing, and proper reabsorption, the brain does not function at its optimum. In other words, mental illness has organic, physical causes.

Another reason behind the stigma is the historic institutionalization of individuals living with mental illness. These clients were once considered incurable so found themselves housed in institutions where they possessed very few rights. This treatment approach created a stigma because clients’ liberties were removed, so they were labeled as “separate,” and they were not permitted to live in society. As pharmaceutical research advanced, however, new psychiatric medications came about to treat mental illness. Clients receiving effective medications no longer found themselves locked in hospitals and instead were able to live and function within their communities.

When nurses and other health professionals are educated on these facts, the stigma of mental illness lessens. Nurses are taught to observe the client as a holistic being living with an illness. In these cases, the illness involves thoughts, mood, and behaviors.

Factors Influencing Perceptions

Different cultures may have different beliefs and attitudes about mental health and mental illness, and this affects how clients perceive their own conditions. For example, some indigenous cultures in America, such as the Apache and the Iroquois, may believe a person exhibiting signs and symptoms of mental illness is possessed by evil spirits (Danchevskaya, 2020). For this reason, an indigenous practitioner (or someone intimately knowledgeable about the culture) may be the best person to interview and care for such clients. The indigenous health-care provider knows the rituals and can create an environment that shows support for indigenous beliefs while treating with other techniques. Western medical methods to treat mental illness can exist with traditional underpinnings.

Perceptions that influence behaviors make up a person’s belief system. Nursing consideration of the client’s perceptions can clarify assessment findings. Some who value competition may not seem cooperative to those not sharing that value. Those who suppress outward responses may be undertreated for pain. Clients distrustful of providers may receive misdiagnoses, inappropriate medication dosages, or ineffective monitoring for medication side effects.

Families may be blended across cultures, religions, belief systems, and languages, so nurses can only rely on the therapeutic relationship to establish a connection with clients. Nurses must focus on client-centered care and inquire about the client’s social identity, for example, the nurse may say, “Within your culture or personal beliefs, what are ways we can help you while you are here?”

Treatment Compliance and Resources

Clients’ beliefs and attitudes factor heavily into their understanding of and compliance with treatment. When assessing compliance, meaning adherence to treatment recommendations, there are many factors that the nurse must consider in mental health. Some of these factors are within the control of the client and others are not.

Factors that the client cannot control are termed nonmodifiable risk factors and are important to consider. Cognitive impairments, poor insight, cost factors, limited access to health care, and the lack of social support are examples of these factors. Factors that the client can control related to compliance are known as modifiable risk factors. These can include clients’ attitudes toward their own health, becoming informed about their medications and the side effects, and discussing these matters with their provider and nurse. The nurse should establish a therapeutic relationship to encourage health plan compliance. The nurse can offer information related to the client’s questions to help the client comply with their treatment plan. The nurse can also inform the client about local resources that can help with social connections, costs, and access to health care. Often, there are social resources the nurse can refer the client to for other issues the client may be facing, such as housing or food insecurities.

Directions that clients take related to the problems with their health are called a help-seeking pathway. Because of the stigma related to mental illness, there are perceptions that influence clients who want help and affect their treatment compliance. Often, clients do not know how or where to go for help. The primary care provider is often the first link to reaching out for assistance. There may be reluctance to confide the issues related to mental illness. If the client has a therapeutic relationship with the primary care provider, this can aid in getting assistance. Clients who do not have a primary care provider or a local clinic to attend for health-care needs encounter a major barrier to assistance. For the clients who are on medications, they may experience side effects that they cannot explain or describe. These side effects may draw unwanted attention to them and require explanation to their peers, coworkers, friends, family members, and others in their circles. A cultural aspect of the United States is that people can independently resolve their own problems without seeking outside help. These assumptions negatively influence a client if they seek help. Educating the client and their significant others is very important to avoid or change perceptions related to seeking assistance. An analogy often used is if a person has a physical problem, seeking help from a medical professional is expected. The same can be applied to the one experiencing a mental health problem. There are health pathways to assist, treat, and potentially resolve the problem.

There are multiple sources from which clients and families can obtain information about mental health and mental illness. The CDC is a great place to start when investigating psychiatric illness. Here is a list of websites that offer information on mental health issues and how to cope.

• Centers for Disease Control and Prevention
• Mental Health First Aid from the National Council for Mental Wellbeing
• National Institute of Mental Health
• 211 help line
• World Health Organization
• National Alliance on Mental Illness
• Substance Abuse and Mental Health Services Administration