CHAPTER ONE

INTRODUCTION

1.1       Background of the Study

The universality of harmful beliefs and subsequent negative attitudes towards the mentally ill is not in doubt (Thara and Srinivasan 2000; Murphy 2002; Botha et al. 2006). This study is set out to identify the persistent socio-cultural factors impeding the acceptability of mentally sick persons in Nigeria, particularly among health care providers in Ogun State. The concept of mental health or illness has a problematic definition because it is largely subjective. It can only achieve a near uniformity of meaning in the medical arena although a complete state of mental health or well being is almost impossible to attain. The sufferers of mental illness are part of the society but are viewed differently by the society (C.M.H.A. 1993; Murphy 2002; Paterson 2006). Therefore, societal reaction to the mentally sick varies from society to society, as the culture of a people is also a model for human behaviour.

African societies have a peculiar attitude towards the sick or mentally ill persons and this is evident in the rejection, scornful disposition and a negative perception of the sick individual (Sharma 1998; Mohammed et al. 2004; Mohammed and Mohammed 2008). Mental illness is a disorder of one or more of the functions of the mind such as emotion, perception, memory or thoughts, which causes suffering to the person and embarrassment to the family and society. There are a varied number of mental illnesses but the most common and broader classification is psychoses, neuroses and mental retardation. Mental illness could be spurred by environmental or cultural factors and also, by physiological malfunctioning and heredity, these are referred to as functional and organic psychoses respectively.

Allport (1961) posited that an attitude is “mental and neural state of readiness organized through experience, exerting a dynamic influence upon the individual response to all objects or to situations with which it is related”. Similarly (Ewhrudjakpor 1995; Mohammed and Mohammed 2008) defines an attitude as a “learned orientation or disposition, toward an object or situation which provides a tendency to respond favourably or unfavourably to the object or situation”. However strong these attitude definitions are, it was (Zimbardo and Ebbesen 1969) that put it in proper structure when they defined it as “a predisposition, toward any person, ideas or objects, it contains cognitive, affective and behavioural components”.

Thus, individuals disposition becomes an attitude if it contains in some parts, aspects of  knowing and acting. Zimbardo and Ebbesen (1969) further assert that, affective component of our attitude consists of a person’s evaluation of liking or emotional response to some objects or person. The cognitive component refers to the way the object or person is perceived. It is in fact the mental picture formed in the individual’s brain. This includes the person’s thoughts, beliefs and knowledge about the object. The behaviour component involves the person’s overt acts directed towards another person or group of persons or objects.

Nigerians make attributions in respect of their attitudes towards sufferers of mental illness. They in most cases do this naively (Ugwuegbu 1994). Attribution theory as postulated by (Heider 1958) states the rules people use to infer the causes of observed behaviour. He divides this process into two: dispositional and situational attribution processes. The dispositional attribution is the process where a person’s actions is attributed to internal dispositions (attitudes, traits, motives). While situational attribution is attributing a person’s actions to factors in the environment such as witchcraft, poverty, beliefs, and so forth.

Although mental health problems are extremely common in our society, there has historically been a negative attitude towards people with mental disorders. A study found that public attitudes towards people with mental illness in England and Scotland became less positive between 1994 and 2003 (Mehta N,et al, 2009).  Stigma is thought to stop those with mental health problems seeking appropriate medical help (Jorm AF,2000 ). Stigmatising attitudes towards mental disorders may be influenced by lack of knowledge of psychiatric illness, (Schomerus G, Angelmeyer MC, 2008)  and contact with people with mental disorders may lead to more positive attitudes and enlightened views. (Addison SJ, Thorpe SJ, 2004).

1.2       Statement of Problem

Mental illness is a diseased condition, which is deemed undesirable for both the affected individual and the society because it affects adversely the normal functioning of the mental, psychological and emotional make-up of the individual and so it makes the capacity for insight, orientation, judgment, thought, mood and perception blurred (WHO 2001; WPA 2002). The mentally sick in Nigeria culture, most traditional communities ought to look after them since they are still a part of the community and there are possible traditional therapeutic regimens to bring them to a relative state of normality (Jegede 1981; Adebowale and Ogunlesi 1999; Gureje et al. 2005). However, in Nigeria the situation is now different as mentally ill individuals are socially stigmatized even after they have been cured of this illness (Jegede 2005; Brinn 2000; Binitie 1970). This is in contrast with the communal and closely-knit kinship system in which each person has a responsibility for the well being of the other which dominated African societies (Ayorinde 1983). The mentally sick people constitute nuisance since their consciousness is affected, this is why they need treatment and rehabilitation but the Nigerian situation is quite different as government and the family unit have not done much towards their rehabilitation since many mentally sick persons are not taken care of but allowed to  become vagrants. Also, health workers who should know better seem not to display positive attitude towards such sick people. There is also the problem of cultural factors, which label such people as evil possessed and witchcraft ‘infested’. Most Nigerians believe that mental illness are afflictions caused by supernatural forces (Udoh 2002). Therefore they hold unorthodox beliefs that only traditional and syncretic religious healers can offer more effective and sustainable treatment than orthodox health practitioners.

1.3       Aim and Objectives of the Study

Healthcare professionals have crucial contact with people with mental disorders; hence the aim of this study is to assess the attitudes of health workers towards psychiatric patients. This can further divided into the following objectives:

        i.            To access reasons for the negative attitude of healthcare workers towards psychiatric patients.

     ii.             To determine whether there is adequate healthcare equipment and facility for taking care of the mentally ill.

   iii.            To determine the impacts of fear on attitude of health workers towards psychiatric patients.

   iv.            To proffer necessary solutions to the identified problems.

1.4       Research Questions

i.          What are the reasons for the negative attitude of healthcare workers towards psychiatric patients?

ii.         Are there adequate healthcare equipment and facility for the taking care of psychiatric patients?

iii.       Is there a link between fear and attitude of health workers towards psychiatric patients?

iv.        What are the likely solutions to the identified problems?

1.5       Hypotheses

H01:     There is no significant relationship between medical knowledge, cultural beliefs and health workers’ attitudes towards the mentally sick.

H02:     There is no significant relationship between fear and attitude health workers’ attitudes towards the mentally sick.

1.6       Significance of the Study

This study will provide information on the general attitude of Nigerians particularly health workers towards the mentally sick. Also, it will increase the knowledge of people on mental illness in general and correct all misconceptions about the disease and prompt governments and non-governmental agencies efforts in making more readily available resources for treatment facilities and rehabilitation of mentally ill persons.

1.7       Scope of the Study

For the purpose of this study, we shall only consider the Federal Neuropsychiatric Hospital, Aro, Abeokuta as our area of study. Hence, this study is limited in scope to Abeokuta area of Ogun State as other locations will not be considered.

1.8       Definition of Terms

Attitude: manner, disposition, feeling, position, etc., with regard to a person or thing; tendency or orientation, especially of the mind.

Health Workers: are people whose job it is to protect and improve the health of their com- munities.