Order 1358758: MENTAL HEALTH ISSUES

One of the aspects of culture that determine how a community interacts with mental illnesses is the cause of the diseases. The notions about what causes mental illnesses can vary wildly from rational reasons such as emotional distress to irrational beliefs of witchcraft and curses depending on the community in question. The causality may be blamed on the individual, the society or the supernatural depending on the level of education and religiosity of the culture in question. Most of the research carried out in this area has focused on the cultural variations among different ethnicities (Office of the Surgeon General, pg. 2, 2001). A study carried out among African Americans, Latinos and Asian Americans found that there were significant variations among these three groups in their shared beliefs about causes of mental health issues.

African Americans who participated in the study demonstrated a tendency to associate mental health issues with stress and loss. This may be the loss of a job, a loved one or valued property that invited stability into one’s life. In this particular demographic stress over money, loss of family and friends and general worry about life were blamed more often compared to the polled answers of non-Latino Whites. Compared to non-Latino Whites, a greater proportion of Asian Americans believed that family issues, cultural differences and medical illnesses were to blame for mental health issues (Office of the Surgeon General, pg. 5, 2001). Latinos pointed out the stress of moving to a new place as a cause in addition to family issues and loss of family and friends. Aside from the loss of family and friends which is consistent among all the groups, it is clear that the unique attributes and history of each culture influences their perceptions of the cause of mental health issues. African Americans are disadvantaged due to subtle racial discrimination which denies them economic opportunities making financial issues a major stressor. Asian Americans have trouble integrating in to the American society which makes cultural differences a major stressor. Latinos are often immigrants or direct descendants of immigrants from Latin America and Mexico which makes the issues of moving from one place to another a major stressor for them.

The second aspect of culture that influences the response to mental health issues is how people cope when such issues occur. The coping mechanisms to mental illnesses in the family often vary from one culture to the next. In Asian American culture, reticence and avoidance is common. This is because there is a cultural belief that not spending too much time on negative thoughts will make the situation better. They prefer to suppress their emotions and distress rather than express them outwardly and seek help. In the case of mental health issues, this approach can be detrimental since it piles on to the existing mental pressures. On the other hand, African Americans have an inclination to take a proactive approach whereby they confront the issues at hand but prefer to deal with their distress without help from professionals (Office of the Surgeon General, pg. 6, 2001). They are also more likely to rely on spirituality and religion to address their mental health issues. This can also be detrimental where professional help and treatment is needed.

In Thailand, the majority of the country practices Buddhism as a religion. The teachings of Buddhism exalt values such as self-restraint, emotional control and social inhibition. Consequently, Thai people are less likely to confront their stress factors head on since their religion places a premium on having one’s thoughts under control. One study comparing Thai and American children revealed that the former was twice as likely to use covert coping mechanisms when upset compared to the latter who used overt response mechanisms when frustrated or angered (Office of the Surgeon General, pg. 5, 2001). This means that American children are twice as likely as Thai children to scream, kick and shout among other outward expressions of emotion when upset by something. On the other hand, Thai children prefer silence and not talking back when confronted with a stressful situation. This culture of suppression and covert coping that is taught to children likely stays with them even later into their adult lives.

There are several studies that have been conducted examining the treatment seeking habits of various populations in America. A majority of this research has demonstrated that minority communities are less likely to seek professional help for their conditions compared to the Caucasian community (Gopalkrishnan and Babacan, pg. 7, 2015). This trend cuts across both ethnic and racial minorities. The concept of seeking treatment in this case refers to the duration and steps taken before getting to a health professional. Minorities also take generally longer before they recognize that they have a problem that needs to be addressed whether in themselves or in the case of a family member with mental health issues. According to this research, there is a high probability that these minorities will delay seeking help even after recognizing that there is a problem until the symptoms are too severe to ignore. Even at this point, minorities are least likely to contact a professional when compared to Caucasians who are the majority of the population. Rather, minorities have a preference for alternative sources of help that are not trained mental health professionals. For instance, they may turn to their peers, their spiritual and religious leaders or even traditional healers as the first line of defense.

The breakdown of the various ethnic and racial minorities and their preferences is as follows. American Indians are most likely to turn to traditional healers and medicine compared to all other ethnic groups (Jimenez, et.al pg.535, 2012)). Luckily for this demographic, the traditional healers often have programs that run in collaboration with formal mental health professionals who supplement their traditional medicine. However, the fact that this group prefers traditional healers over formal professionals is telling of their mistrust of the public health system. When African Americans seek professional help, they show a preference for African American therapists. This preference is born of the belief that therapists from their ethnicities are more likely to understand their struggles and stressors more than White or Asian therapists. However, in the absence of an African American therapist, this demographic still prefers professionals from other minority groups other than Whites. Some of this mistrust is a result of historical interactions between the African Americans and White healthcare givers in decades past when racism was still a very major factor in American society. A study conducted in the late eighties and early nineties revealed that African Americans feared hospitalization and institutionalization which was assumed to be the go to treatment procedure by White therapists.

As demonstrated above, there are many ways in which the culture of a community influences how they perceive and respond to mental health illnesses. Therefore, professional mental health workers have to be aware of the impact of culture on the approaches to mental health. The mental health professionals have to be competent in the cultural aspects of treatment on top of being academically qualified as therapists. Cross cultural competence requires that therapists who work with ethnic and racial minorities be fully aware of the alternative coping mechanisms, the hesitation to seek treatment and the assumed causes of mental health issues within these communities (Leong and Kalibatseva, pg. 6, 2011). In so doing, they will be better equipped to handle the ethnic and racially diverse minorities who seek out their help thereby building confidence in the practice among the rest of the communities.

In conclusion, it is clear that culture is a big aspect of the mental health debate especially among minority communities. Therefore, radical changes are needed in the profession to account for the impact of culture in their interactions with mental illnesses in their various communities. In addition to this, these communities need to be sensitized about the importance of seeking professional help when faced with mental illnesses. The relevant authorities and policymakers can also work around the impact of culture on the mental health perceptions of minority communities by incorporating their belief and practices into the professional mental health programs. For instance, the training of African American therapists and matching them with clients of the same race and ethnicity will encourage more members of the African American community to seek professional help. More collaboration programs with the alternative avenues of help used by communities such as the American Indians and Native Alaskans will also improve the quality of healthcare services available to individuals from these communities who seek help. Therefore, cross-cultural competence is a very important aspect of dealing with mental illnesses in racial and ethnic minorities.

PART 2

Mental Health Representations in the Media

Introduction

Mental health representations in the media go a long way in increasing stigmatization of people living with mental health issues. When a person thinks of a mental health condition, they are more likely to think of disheveled character running around unhinged or planning to carry out an evil plan in revenge or malice. These representations highly shape the attitudes of people towards mental health and in most cases reduce the willingness of people to access help when experiencing mental health issues. Recent reports by the World Health Organization indicate that one in four people are likely to experience mental health issues in their lifetime (Goodwin, 2014). With these rates, the need for access to mental health care will increase over time. Although in recent times there has been an improvement in the portrayals of mental health issues in the media more efforts need to be made in shaping these portrayals in fiction and non-fiction media to promote the integration of a culture of acceptability where people who have mental health issues are not stigmatized. This paper looks and the portrayal of mental health in fiction; horror films and non-fiction media; newspapers and the effects of these portrayals on stigma levels.

Fictional Portrayals in Horror Films

The portrayal of mentally ill characters in horror films is usually described by aspects of psychosis such as paranoia and hallucinations (Goodwin, 2014). Films such as Girl Interrupted and Gothika feature these elements. International films in Nigeria and India have also been found to involve elements that increase the stigmatization of mental health conditions. A study by Don Diefenbach on portrayals of mental health in films found that characters with mental illness were ten times more likely to commit violent crimes compared to other characters without mental illness (Goodwin, 2014). The comparison of these findings to real-life statistics established that the mentally ill characters were twenty times more likely to commit violent crimes compared to real life people living with mental illnesses. This has formed one of the most common portrayals of people with mental illnesses in horror films. They are seen to be very violent and bound to commit violent often gory crimes at any point in the film. This portrayal is distant from the reality where people with mental illnesses are more likely to be victims of violent crimes.

Characters with mental illness in horror films often look different from other characters in these films (Dale, Richards, Bradburn, Tadros and Salama, 2014). They are shown to have messy hair and often disfigured faces where they have “crazy eyes” that make the viewer instantly cautious of their intentions towards other characters in the film. These characters are shown to be derivative from what is considered normal. Their looks stand out from the rest of the characters and therefore from the very introduction of these characters in the film, the viewer is biased and expects them to be involved in harmful activities. These portrayals are different from reality where people with mental illnesses more often than not look just like any other person would.

Mental health disorders in horror films are also shown to be all extreme, and the characters never recover from these conditions (Dale, Richards, Bradburn, Tadros and Salama, 2014). The conditions are also similar among different characters with mental illnesses. In horror films, characters with mental illness participate in extreme activities and are highly delusional and out of touch with reality. The character of Freddy Kruger in A Nightmare on Elm Street is a killer who haunts dreaming children. These characters all portray almost similar intents and often end up being evil and harming the rest of the characters in the film. Mental illness in these films is almost synonymous with the need and urge to hurt other people or engage in activities of mass destruction. These portrayals are misrepresentative of realities; studies show that anxiety disorders are the most common form of mental illness in the US. Anxiety and depression rarely lead to participation in extreme events as shown in these films.

Characters with mental illnesses in horror films never recover. These characters even after engaging in treatment systems often end up being more violent and vengeful to other characters within the film (Goodwin, 2014). The characters’ mental conditions are shown to get worse over time instead of relief. In the film The Shining, the character Jack only becomes more and more violent as the film progresses. The character is seemingly okay at the beginning of the film except for an issue of alcoholism. The character’s mental health deteriorates over the course of the film. The deterioration of the mental health of the character seemingly emerges from “thin air.” There are no considerable elements that can cause a deterioration in the mental health of the character. Time in the film I seen as the only factor in the worsening of the mental illness of the character. Such portrayals create the belief that there is no hope for people who have mental illnesses. This is despite the fact that with treatment and therapy, people with mental conditions can live full productive lives.

Mental hospitals in horror films are portrayed as evil. In the film The Silence of the Lambs, the character Hannibal Lecter is housed in a hospital for the “criminally insane.” The conditions in this hospital are dire and very unsuitable for human existence. The character is seen to be among other people who have been involved in some of the worst human actions. These characters, a majority of whom were involved in murders are seen to be out to get each other. The practitioners working in these facilities also have bad intentions and intentionally harm the characters instead of according them help (Goodwin, 2014). These portrayals prevent people from seeking help because they build assumptions on evil happenings that take place in these facilities.

Non-Fictional Portrayals in Newspapers

There has been an increase in the coverage of mental health issues in non-fictional materials. More famous people such as Stephen Fry have openly spoken about their struggles with mental health issues. A number of documentaries have also been produced to create more awareness of these issues. The coverage of these issues in newspapers, however, remains wanting. The work of a journalist is not only to tell the news but also to sell the news. Selling news often involves taking advantage of elements of controversy which places journalists at loggerheads with mental health advocates (Kenez, O'halloran and Liamputtong, 2015). Newspapers are the most common news sources on issues to do with mental health. To increase sales, the newspapers often amplify stereotypes that have already been established in entertainment such as horror films and therefore increasing stigmatization. Studies have shown that the representation of mental illnesses in newspapers is frequently inaccurate and negative. Reporters are more likely to emphasize the negative aspects of these conditions to gain the attention of readers.

Not all features of mental health in newspapers are inaccurate. The balanced news coverage on violent acts that have been a result of mental health issues is, however, more likely to stick with the reader (Kenez, O'halloran and Liamputtong, 2015). This coverage often contributes to stigma by reinforcing the existing assumptions that have already been introduced by fictional materials. The reporters are more likely to be graphical in their description of these events and therefore increasing the retention of the reader on the isolated effects of mental illness. Recent newspaper coverage on the school shootings in the US, for instance, has been insistent on the effects of the mental health conditions of the perpetrators. While these reports are factual, they play into stereotypes that have already been established by fiction.

Stories coverage on issues to do with mental health also have limited perspectives. The lack of differing perspectives increases the confirmation of these stories to stereotypes (Murphy, Fatoye and Wibberley, 2013). In covering stories to do with mental health, there are two main perspectives that have often been overlooked by newspaper journalists. One of them is the perspective of people with mental illnesses which are rarely included in stories covering mental conditions. A study in New Zealand found that only 5 stories out of 600 stories reviewed offered the readers a perspective from people with mental disorders. Another perspective that is missing in news coverage of mental conditions is that of health professionals in the field. The study in New Zealand found that only 15% of the articles had the perspective of a mental health professional. The lack of these perspectives lead to increased assumptions and stereotyping of these conditions.

Influence of the Media

Heavy exposure to media acts as an agent in the spread of stigmatization of the mentally ill in the society. Television shows in the genre of horror, for instance, provide graphic views onto the misperceived lives of people living with mental conditions. These misconceptions are further enforced in news articles and newspapers which have a wide audience and reach high numbers of people. There are two main mass communication and social psychology theories that establish the effects that the media has in the spread of misinformation of elements to do with mental health. These theories are the transportation theory and the social learning theory.

The transportation theory states that when people are involved in the consumption of a story, their attitudes change in a way to reflect the elements of the story in their lives (DeFleur and DeFleur, 2016). This theory focuses on the persuasive effects that stories have on the lives of people. Transportation of narratives is highly likely to occur in entertainment media where people will transfer notions from these materials into their real lives. The portrayals of mental illness in entertainment such as horror films, therefore, fosters stigmatization and the discrimination of people with mental health conditions. Transportation theory also applies in the case of newspapers since one of the elements that affect transportation, in this case, is the perception of how real these portrayals are. Newspaper portrayals of mental illnesses are considered to be factual and therefore are more likely to influence attitudes towards these conditions. The other factor that influences transportation is identification which is the level to which the viewer sees the similarity to the stories and characters being portrayed. Transportation theory, therefore, establishes that media portrayals influence the real-life attitudes of people towards mental illness.

The social learning theory states that new behaviors can be acquired by observing others (DeFleur and DeFleur, 2016). The continued portrayals of mental illnesses in the media in a negative way will only increase the stigmatization of these issues in society. This theory states that people’s attitudes and behaviors are shaped by their environments. Negative portrayals such as the show of mentally ill people engaging in violent activities in horror films will, therefore, influence the view of people towards mental illness. Emphasis on negative elements in newspapers will also contribute to negative attitudes towards mental illness.

Conclusion

In conclusion, mental health representations in the media have highly increased stigmatization around the issue of mental health. Fictional media such as horror films show characters with mental illnesses engaging in violent crimes which have shaped the view of mental illnesses negatively. Newspapers often emphasize elements that fulfill the assumptions of the readers. The transportation and social learning theories illustrate the effects that these portrayals have in the spread of stigmatization.

Part 3: e-Mental Health

E-mental Heath

The care for mental health issues is naturally challenging. The problem is made worse by contemporary issues surrounding the mental health problem. It is true that the society in which people live in play an important role in determining their mental health. Therefore, as the society, technology, and other aspects of a community change, it is likely that the state of the people’s mental health will be impacted. Some of the changes in a society that can influence the mental wellbeing of a population include changes in political issues, environmental issues, ways of working, development of technology, and other factors (Mucic and Hilty, 2015). The relationship between technological developments is one of the areas contemporary factors that influence the care for people with mental health.

The concept of digital mental health has a significant impact and give hope when it comes to addressing mental health issues. It is a revolutionary approach that is being applied to the prevention and safeguarding of the public's mental health. One of the positive impacts of technology is that it assists in overcoming the barriers of accessing mental health that is caused by social anxiety and long waiting lists (Mucic and Hilty, 2015). For instance, the use of smartphone applications and other techniques makes it possible for people to seek help and talk about mental health issues. Moreover, through technology, the stigma surrounding one’s mental health has been reduced significantly (Lal and Adair, 2014). If one is not comfortable with others knowing their mental health status, they can secretly access mental health care through their smartphones and other technological applications.

E-mental has undergone significant advancement, and it is something to be applauded. There is now an increased potential of reducing exposure to mental health risks, as well as the ability to provide response prevention therapy to mental health problems from all over across the world. One of the positive impacts of e-mental health is that it has increased the speed and access to care. According to Hill (2016), one of the major challenges that have faced many health care systems is access to evidence-based care for people with mental health patients. Moreover, even when people with mental health problems access to care, a large number of them did not get in o time (Hill, 2016). There is hope that this problem may end soon due to the idea of e-mental health.

Tele-mental health helps in enhancing access to health care no matter the point of service or care involved. For instance, as it was indicated before, one can access mental health services from qualified professional just by calling them. Tele-mental health has been proved to be a useful technique of care and is effective across different types of mental disorders, population, age and other factors (Lal and Adair, 2014). It is also a valid option for providing individualized care. Both the provision of personalized and timely care for people with mental health problems is evidence-based. Early or timely care is not only good for people with mental health care issues but the entire population (Lal and Adair, 2014). It helps in dealing with barriers to care that may be associated with medical or cultural disadvantages that a specific group may have. As compared to in-person care, telemental health has a lot of benefits, which can be explained the clinical concept of patient-centered care and Psychodynamic theory.

Depression

Although there is a broad range of mental illnesses, depression has been the most common condition that has been impacted through e-mental health. Depression is a severe mood disorder that affects people of all ages. It has a significant impact on how one thinks, feels, as well as how they deal with a diverse range of activities such as working, eating, and sleeping. There is a broad range of depression which includes postpartum depression, persistent depressive disorder, psychotic depression, seasonal affective disorder, and bipolar disorder. Some of the symptoms of depression include digestive problems, cramps, headaches, and aches without any clear physical cause (Segal, Williams, and Teasdale, 2018). Irritability, difficulty in sleeping, feeling of hopelessness, and suicidal thoughts are among the many symptoms are associated with depression.

According to Van den Broeck et al. (2017), it has always been difficult for depression patients to get adequate treatment through collaborative care. This point explains why the adoption of e-mental health or telemental health will provide a solution to this problem. Depressive disorders are highly prevalent today and have adverse impacts at both individual and societal levels. Despite these facts, only a limited number of people across the world receive adequate care and effective intervention. Some of the factors that contribute to the treatment gaps include that the mental health patients may be reluctant to seek help.

Moreover, a large number of depressive or mental health issues may not be diagnosed well, something that hinders the treatment (Segal, Williams, and Teasdale, 2018). It is even shown that those patients that seek help, or are diagnosed with the problem, end up not getting the necessary care. These challenges are now being overcome through the adoption of concepts of telemental health.

Patient-centred Care for mental health

The patient-centered care model can explain why e-mental health in an essential step in the current health care system. Over the past years, psychiatry has in most cases being treated as a medical specialty that focusses on listening to patients. However, psychiatry is changing, and there is more focus on a patient-centered model of care. The model places most of the emphasis on the needs of the patients and their involvement in the care process.

Additionally, the patients help in determining the course of care and set their goals for treatment. The model also operates on the principle of shared decision-making (SDM), in which there is a balance of authority between the caregivers and the patients (Bell, 2014). It is a collaborative process that helps brings the mental health patients with the providers together during the decision-making process. The aspect of collaboration between mental health patients (depression) and care providers can handle through the application of modern technology.

Technology plays a central role in ensuring the depressed person have access to patient-centered care. This is mainly in line with the health care reforms that require the implementation of patient-centered care frameworks. Individuals and the entire society now depend on technology than before. Wireless handled devices, smartphones, and laptops are now being applied in many areas of heath care. Many patients are connected to the internet and can get health care services, including diagnosis and counselling through the internet. Therefore, mental health care organization should embrace modern technology as a means of improving their effectiveness. The broad range of technologies ensures that mental health providers can easily interact with their patients.

One of the primary objectives of adopting e-mental health is that it is a strategy that can be adopted in creating a collaborative environment and a patient-centered system of care in which the physicians make decisions based on the feedback and personalized engagement they have with the patients (Bell, 2014). There is a need for patient-centered care organizations to invest in diverse ways that can help them in connecting to their patients. Some of these technologies include the internet and social media, mobile technology, patient kiosks, and telemedicine. For instance, telemedicine involves the application of telephones, electronic health records (EHRs), internet connectivity, and video technology work together with the intent of enhancing the patient's access to care. Additionally, health care professional can operate and reach a large number of patients no matter their geographical location.

Psychodynamic Theory

Other than the concept of patient-centered care, the psychodynamic theory also plays a central role in explaining why telemental health or e-mental health is significant progress in the care for mental health issues such as depression. According to this theory, the experiences that people go through is what influences their actions or behaviors (Guntrip, 2018). The argument is based on the assumption that all behaviors are affected by the experiences that people have. Fred Sigmund, who is the first developer of the theory, notes that no behavior is accidental, especially concerning the aspect of abnormal psychology (Guntrip, 2018). Moreover, Freud Sigmund notes that there are three forces (the id, the ego, and the superego) which have a significant impact on people’s behavior. Moreover, the theory explains how people adjust through the different stages, and the effect such changes may have on abnormal functioning.

The psychodynamic theory is used to provide guidance on several therapies for mental health patients. Firstly, there is the concept of free association in which the patient describes the image, feeling, or thoughts that are in their mind, even when it appears to be irrelevant. As it was indicated before, the mental health patients may be reluctant to describe such events in in-person care. However, they can easily explain it in the context of e-mental health care. After the patients have revealed their experiences, the therapists look for clues so that they share the interpretations with their clients. A physician can give three types of responses including interpretation, transference, and resistance (Guntrip, 2018). In resistance, the patient may refuse to take part in the therapy while in transference, patients are comfortable and feel part of the therapy. All these can be achieved using the internet, mobile technologies, or through the concepts of telemedicine, without a need for in-person care.

Furthermore, catharsis is another essential care for mental health that can take place through the application of the concept of digital mental health. In catharsis, the patients are helped to relieve their past feelings that have been repressed. It is an important step that patients need to go through as a means of setting conflicts within them (Guntrip, 2018). The patients and practitioners can establish a healthy relationship where they can work through the process with higher levels of clarity. The sessions can take many years without being interrupted since the patient, and mental health care providers can easily interact due to the diverse range of technology options available to them.

Recommendations

It is without a doubt that technology is one of the contemporary issues that has revolutionized health care. Modern technologies have increased access to health care, quality of care, as well as the affordability of care. Most of the medical interventions have been applied in other areas and infections but have not been primarily implemented in psychiatry. It is also true that the nature of mental health problems makes it difficult for patients to get the required care. For instance, mental illnesses are in some cases associated with stigma, something that makes it difficult for people to seek help. There is also a shortage of qualified personnel, who can help in providing high-quality mental health care.

Therefore, it is recommendable that the care for mental illnesses should be digitized. Modern technologies including telemedicine, mobile technology, patient kiosks, the internet, and social media should be adopted as approaches to providing care for people with mental health problems. Adopting e-mental health will not only improve the quality of care but will also increase access to care and reduce costs. Similarly, it is a technique that will promote a patient-centered model of care for mental illnesses.

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