Ozean Journal of Social Sciences 2(3), 2009 Ozean Journal of Social Sciences 2(3), 2009 ISSN 1943-2577 2009

9 Ozean Publication A Survey Study on the Stigmatization of the Mentally-ill: The case of HA Leqele, Lesotho, Southern Africa
Mahlalele, S. M. & Osiki, J. O. Ph.D National University of Lesotho, Dept. of Theology & Religious Studies, P.O. Roma 180, Lesotho, Southern Africa E-mail address for correspondence: jonathanosiki@yahoo.co.uk

____________________________________________________________________________________________________ Abstract : The study examined the different ways that the mentally-ill are stigmatised in Lesotho. The study also attempts to find out the factors responsible for such stigmatisation as well as the various supports available for the victims. The simple random sampling technique was utilised in picking 137 participants from the population. The participants age range was between 18 and 64 while Mean age was 36.7(SD=14.8). The Stigma to Mentally-ill Opinionate Scale (SMOS) was the research instrument used in the study while the Analysis of Variance (ANOVA) at the 0.05 alpha level was the major statistical method employed. The findings which were statistically significant indicated overall, that the participants perceived the stigma to the mentally-ill differentially. The results showed that, irrespective of the religious affiliation [F(5,131)=0.035;P<0.05]; education [F(5,131)=0.878;P<0.05];and gender[F(5,131)= 0.508;P<0.05] individuals perceive the stigmatisation dissimilarly. It further showed that the factors contributing to the stigmatisation are knowledge [F(5,131)=0.788;P<0.05]; identification [F(5,131)=0.056;P<0.05]; treatment [F(5,131)=0.289;P<0.05] and discriminatory support [F(5,131)=0.550;P<0.05]. Following the findings, it was suggested that various institutions responsible for the care of the mentally-ill and in particular, the Mental Health Departments decentralization has to be implemented to enable the Governments goal of good health for all, be accessible to every one. It was further suggested that adequate funds should be provided to the Mental Health Department to improve the knowledge about mental illness, the treatment and adequate support for the victims. Key Word: Stigmatization; Mentally-ill; Haleqele; Lesotho; Southern Africa ___________________________________________________________________________________________________

BACKGROUND TO THE STUDY The history of mental illness stretches back to ancient times in Lesotho. During those times traditional medicine and exorcism were popular in curing mental illness. This was the case until the arrival of the missionaries, when western medicine was also introduced. Its treatment was highly recommended due to its remarkable results. As at this period, Mohlomi hospital was built as a rehabilitation centre for the mentally-ill. For a long time, the Mohlomi hospital and Mohales hoek Detention Centre were the only places where mental patients were treated in Lesotho, but this disrupted the figure of mental illness and its victims, laying stigma on whoever went to those places to seek help. However, within a short space of time, the attitude of people towards mental illness and, or mentally- ill grew negatively, defining mental illness as incurable and people affected by it, as dirty, violent, evil and dangerous. Concomitantly, the general attitude of the public was and even today, is also very unhealthy. The mental patients/clients are brought to the centre and are usually tied up with ropes while being subjected to severe beating and general state of neglect. For those who are already admitted in the hospitals nearby, members of the public visited the mental rehabilitation centres to amuse themselves. They in fact actually teased and even provoked patients (Mohlomi Report: 2000). It is common to view mental patients as sources of fun. This perception is popular even among families of mental patients and their communities.

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The experience of the patients is that discriminatory attitudes are widespread within the general public, the medical profession, employers, banks, insurance companies, media and many other organisations (BBC News: 2000). The general public where mentally ill people have worked, employers of the patients, banks, insurance companies and many other organisations that mental patients once were, when they have recovered they do not accept them because of the belief that mental illness is highly really incurable. Therefore, their decisions are undermined in the work setting, within their families and communities. The government of Lesotho created the Mental Observation and Treatment Units (M.O.T.U.) in every government hospital as a forum for the decentralization of mental health services and controlling high influx rate at caring centres at that time. The purse of decentralization was a way of integrating mental illness in the general health as a way of combating the stigma that was highly prevailing at the time. Bockoven (1963) says as mental hospitals multiplied severe money and staffing shortages developed, recovery rate declined and overcrowding in the hospitals became major problem thus such conditions made it impossible to provide individual care and genuine concern. Hence in Lesotho mental patients are seen all over in the public places without proper care. Most of the residents in poor supervised or unsupervised settings survive on government disability payments (Torrey, 2001) and many spend their days wandering through neighbourhood streets, thus dumped in the community, just as they were once warehoused in the institutions. Comer (2004) and as cited in (Gilligan 2001; Torrey, 2001) submitted that a great number of people with schizophrenia have become homeless. In the United States for instance, between 250,000 and 550,000 homeless people in the United States, an approximate number (i.e one-third) has a severe mental disorder, commonly schizophrenia (Torrey, 2001). Many such persons have been released from hospitals. Others are young adults who were never hospitalised in the first place. Another 135,000 or more people with severe mental disorders end up in prisons because their disorders have led them to break the law. Statement of the Problem In Lesotho, the national health policies are influenced by the situation regarding the health status of the population and the health geo-political situation. In fact all factors which ultimately have an impact on the health status of Basotho or adversely affect the delivery of health care or the implementation of health programmes contributes to poor health care in Lesotho. Mohlomi hospital and Mohales hoek Detention Centre were the only places catering for mentally ill patients/clients. As time past, the government of Lesotho (GOL) decentralised mental services by establishing what is known as Mental Observation and Treatment Units (M.O.T.U.) in every government hospital in the country. The aim of decentralising mental services was to promote the integration of mental health services into general health system, thus combating discrimination of mental illness and its victims. However, in the decentralisation of mental health services, there is not much solution as mental patients are seen all over in the public places without proper care. In most cases, the mental patients are untidy but they are within their relatives. There is also a discriminatory attitude towards mental patients during service delivery. The relatives, community and government of Lesotho seem not to care much. The least priority is given on mental health services; instead the blame is place on the mental health patients professions. As a result, it is apparent that the type of stigma attached to mental illness and its victims becomes on obstacle to proper care and service of mental patients. In consequence therefore, the present study was muted to explore some of the stigma attached to mental illness as a way of combating it while suggesting the way forward for the improvement of care towards the mentally ill patients. Hypotheses Four hypotheses were generated and tested in the study at the 0.05 alpha levels. 1. Gender of respondents will not significantly affect the perception of the stigma attached to the Mentally ill at Ha Leqele. 2. Respondents educational status will not significantly affect their perception of the sigma attached at the mentally ill at Ha Leqele. 3. Religious affiliations of respondents will not significantly affect the perception of the stigma attached of the mentally ill. 4. Respondents perception (i.e. knowledge, identification, treatment and support will no significantly differ when the notion of their stigmatisation is considered.

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Perception of the Mentally-ill down the ages Comer (2004: 24) writes that prehistoric societies apparently viewed abnormal behaviour as the work of the evil spirits. There is evidence that Stone Age cultures used trephination, a primitive form of brain surgery, to treat abnormal behaviour. He further says that people of early societies also sought to drive evil sprits by exorcism. He concludes that people in the dark ages believed that the mentally-ill were possessed by the devil, therefore, the exorcists physically tortured the mentally-ill to drive the evil spirit out of their bodies. Sharma (2000), adds that many women who were mentally-ill were branded as witches and were ceremonially burned on the village post, ironically as an act of kindness to save their souls (even today the naming and practice still exists). She further says for time immemorial, patients with mental illness were feared therefore tortured and chained so others could live safely. These practices were solely out of kindness but it shows that they (practices) evoked feelings of fear of the mental clients/patients. The fear gained its roots in the dark ages when mental illness was seen as the devils work which now stigmatises mental clients, she says. In his book, Abnormal Behaviour, Comer (2004) says, in the middle ages, Europeans returned to demonological explanations of abnormal behaviour. The clergy was very influential and held that mental disorders were the work of the devil though, as the middle ages drew to a close, such explanations and treatments began to decline, and people with mental disorders were increasingly treated in hospital instead of by the clergy. Care of people with mental disorders continued to improve during the early part of the Renaissance. Certain religious shrines became dedicated to the humane treatment of such individuals. By middle of the sixteenth century, however, persons with mental disorders were being warehoused in asylums. Physicians of the Greek and the Roman Empire offered more enlightenment explanation of mental disorders but the stigma was there though was under control. During the eighteenth century, the western health care in Lesotho started in 1884 when the Paris Evangelical Missionary Society (now know as Lesotho Evangelical Church) brought the very first medical practitioner to work in what was then called Basutoland (Mohlomi Report: 2000). From these humble beginnings has emerged a health service which compares favourably with any in Africa. From this time, Basotho started using both traditional and western medicine for health problems, especially mental illness. Traditional healers may be able to plug gaps in primary mental health services in Africa, according to Anglo-Ugandan Research (1999). Hippocrates (sic) believed that abnormal behaviour was due to an imbalance of the four bodily fluids or humours: black bile, yellow bile, blood and phlegm and treatment consisted of correcting the underlying physical pathology through diet and lifestyle (Comer 2004: pg 24). He continues to say that inheritance plays a part in mood disorders yet with few exceptions, researchers have not been able to identify the specific genes that tare the culprits, nor do they yet know the extent to which genetic factors contribute to various mental disorders. In addition to Comers view, Andreasen (2001) said that scientists have known for years that genes help determine such physical characteristics as hair colour, height, and eyesight, so genes can make people more prone to heart disease, cancer or diabetes and perhaps to possessing artistic or musical skills as much as they may also influence behaviour including abnormal behaviour. He concludes by saying that many genes combine to help produce our actions and reactions, both functional and dysfunctional that can be prolonged and so stigma be attached to it. Torrey (2001) reasoned that since the discovery of these medications, mental health professional in most of the developed nations of the world have followed a policy of de-institutionalisation, releasing hundreds of thousands of patients from public mental hospitals. He additionally says out patient care has now become the primary mode of treatment for people with severe psychological disturbances as well as for those with more moderate problems, so today when severely impaired people do need institutionalisation, they are usually given short-term hospitalisation and ideally they are then given outpatient psychotherapy and medication in community programs and residences without educating the communities of these people about the mental illness and stigma attached to mentally ill people is increasing. In Barnes and Maple (1992), mentally-ill people on the other hand are seen by the public in a different light: the studies they reviewed earlier have shown that people often attribute psychiatric problems to character, weakness and defects, consequently, responsibility is imputed to the individual for the condition, likewise the feeling is often present that all would

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be well if the person pulled himself together, mended his ways, and tried harder to overcome his problems. This study suggests that public belief that the mentally-ill peoples condition is a consequence of being neglectful about mental health. Furthermore, the report from Mohlomi Hospital (2000) say that the general attitude of the public was also very unhealthy because those who were brought to the centre were usually tied up with ropes and had been subjected to severe beating and general state of neglect. For those who were already admitted, the members of the public visited the Mental Detention Centre to amuse them and infact, actually teased and even provoke patients. This type of attitude also prevailed in the communities in which mental patients were found. Even today it is common to view mental patients as sources of fun. Harphan and Blue (1996) when reviewing some studies on mental illness, found that in a sense, all types of illness are stigmatising. If the term stigma is accepted to mean an undesirable differences, that is an attribute evaluated as something bad and discrediting, then any illness falls into this category. This means mental illness is like any other illness though it is at the most stigmatising end of the continuum; as the studies results shows that mental illness is consistently ranked by people as more undesirable and fearful than physical illness (Swartz, 1998). He further says that mental illness is popularly thought of as serious conditions with little chance of full recovery; and the stigmatised person is often regarded less human (Goffman,1963). In McPherson, Richardson and Leroux (2003), prospective patients and members of the family are reluctant to seek medical care/help because of the frightening nature of stigma. Thus many of the mentally-ill themselves share the traditional negative stereotype of mental illness which causes individuals response to the suggestion that their being mental patient is much coloured by the image of what that means; regarded them less human. The outcome of a related survey indicate that 43 percent of respondents believe that people (i.e. those with supernatural powers) and evil can induce mental disorders on others while 35 percent consider such disorders to be caused by sinful behaviour, and 19 percent point to a lack of willpower or self-discipline (NAPHS, 1999). Though the American Psychiatric Association (APA) (2000) has provided some distinction that a person with mental retardation have a great difficulty in areas such as communication, home living, self direction, work or safety, it has not however ameliorated how the mentally-ill are perceived. This is due to fact that individuals have difficulties in distinguishing between the mentally-ill and the mentally retarded people. And thus consequently the confusion and notion that mental illness is incurable while retardation is the most likely not to heal. Reinforcing Paradigms on Public Attitude of the Mentally-ill Quite a number of paradigms are available for explanation. Two of such paradigms and for which the present study is concern is the labelling and behaviour theories. Prominently developed by Lemert (1951-1964) and with the support of Becker (1963), the labelling theory argue that the act of labelling someone as mentally ill creates the mental illness behaviour; and that, if their original symptoms are unimportant and without labelling, the illness would go unnoticed. For example, if the person asks who is mentally ill, the labelling theorist would answer that everyone who is labelled as such, are. The implication of this argument is that the persons who are labelled mentally ill would be quite right if it were nor for the act of labelling. This is very different from pointing out the social consequences of being identified as mentally ill. To minimise the importance of the original psychiatric symptoms to that extent is essentially to agree with Thomas Szasz (1970) that mental disorder is not recognisable in any specific form before the label is applied to it. If the illness is prolonged and is accompanied by an unpleasant or repulsive sights or smell then the stigma will be attached to it. So, the stigma is attached to mentally ill people because of the prolonged deviance from social expectations. The labelling theorists are judgemental by the attribution of certain social constructs that the person deviated from. The focus of behaviour therapy is on a persons actions not thoughts and feelings. The major emphasis of skinners theory is the functional analysis of behaviour. Reinforcements are consequences that lead to an increase in a behaviour, and punishments are consequences that lead to a decrease in the behaviour. The principle of reinforcement states that a response is strengthened when reinforcement is given. Behavioural models are helpful in planning client education and designing programmes for a variety of mental health clients and families. So that behaviour is learned. People learn to be depressed in response to an external locus of control as they perceive themselves lacking control over their live experiences. Throughout life, depressed people experience little success in achieving gratification, and little positive reinforcement for their attempts to cope sit negative incidents. These repeated failure teach them that what they do has no

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effect on their sense of helplessness is reinforced. When people reach the point of believing that they have no control, they no longer have the will or energy to cope with life and a depressive state result. The cognitive schemas influence the way people with mood disorders experience themselves and others. The content of depressed individuals appraisals of the situations and events that they uncounted did much to explain their mood and behaviour and revealed a consistent negative bias in information processing. Beck et al (1979) initially developed a cognitive model of emotional disorders to explain the biases and distortions in information processing that he observed in depressed individuals. Those who are depressed focus on negative messages in the environment and ignore positive experiences. The negative schemas contribute to a view of the self as incompetent, unworthy and unlikely. All present experiences are vied as negative, and there is no hope for the future, (Zust, 2000). In the manic phase, people focus on positive message in the environment and ignore negative experiences. These positive schemas contribute to a grandiose view of themselves. Thus everything that occurs is seen as positive, and the future holds no limits. When people get caught up in this process a number of cognitive distortions may occur which makes every body prone to have mental illness, hence no need to stigmatise the victims of the mental illness as it can strike anyone anytime. The cognitive behaviourism theory explains how people interpret their daily lives, adapt and make changes and develop the insights to make those changes. The type of attitudes people play towards the mentally ill people are the results of the learned behaviour in their early childhood, hence the stigmatisation of mentally ill people is deep rooted as people learnt it as part of their life. Piaget (1973) thought that children learn by changing stimuli that challenge their experiences and perceptions. He identified our sensory-motor, pre-operational, concrete operational and formal operational stages as stages that a child can learn or unlearn negative behaviours like stigmatisation. Becks cognitive theory focuses on how people view themselves and their world. He identified cognitive schemas as personal controlling believes that influence the way people process data about themselves and others. Cognitive distortions results from cognitive triad of inadequate view of self, a negative misinterpretation of present and negative view of future. Cognitive models help to assess clients learning capabilities. They also help to analyse cognitive distortions that are symptoms of a number of mental disorders. Personality is the unique way people respond to the environment and includes patterns of behaviour, emotion and cognition that remain constant from one situation to another, (Fontaine, 2003). The Study and Setting The aim of this study was to examine the different ways that indicate how the mentally-ill are stigmatised. The study also attempts to find out the factors responsible for such stigmatisation among the people of Ha Leqele, Lesotho. As part of the intent of the study the various support available for the mentally-ill are also investigated. The setting of the study was generally in Maseru Province but specifically, Ha-Leqele, a suburb area, Lesotho, Southern Africa. Haleqele is the village adjacent to the Makoanyane military base and is near the Mohlomi Mental Hospital where there are quite a lot of mentally ill people who are so defined, due to the peculiar nature of the area. Despite being near the hospital, the place is peri-urban which enabled the researchers to elicit the views of the people in both rural and urban areas in the country. At Ha Leqele, the most community of men are soldiers and women are working at the public sectors. Least of the community is not working at formal settings but carry out the daily duties at the fields and gardens. In considering adherence to professional standard in the conduct of research, unethical treatment of the participants was meticulously avoided in the study. As the ethics of the research require that participation in a social research study be voluntary, no participant was forced to respond to the questionnaire. This is because social research at times involves imposition into peoples lives. It may also require people to reveal their personal information to strangers (Capuzzi and Gross, 2005). Capuzzi and Gross continue to say researchers must protect research participants from harm of any kind. This includes voluntary participation, informed consent, ensuring confidentiality and paying attention to issues of diversity. The participants were well informed about the purpose of the research study. For example, the names of the participant were insignificant to the study to avoid any possible harm to the questionnaire while the findings reported were as summarized in the results (ACAs Code of Ethics and Standards of Practice booklet, 1995).

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RESEARCH METHODOLOGY The study adopted the descriptive survey method. The simple rationale informing the use of the descriptive research design was the investigation on the kind of stigma that is attached to the mentally- ill and mental illness in general in Ha-Leqele, Maseru, Lesotho. The study Participants and sampling Technique The participants are made up of 137 respondents including 56 (40.9%) males and 81(59.1%) females using the household as a yardstick for sample cluster while the simple random technique was the selection format adopted. Out of the total sample, 87 (63.5%) were literate men and women (i.e could read without assistance) while 50(36.5%) are not literate. For the participants religious affiliation, 9 (6.6%) are from the traditional setting, while 47 (34.3%) are born again (i.e. individuals with esoteric prayer lives and are either Pentecostal and, or evangelical in belief) as another 7 (5.1%) also came from the orthodox churches (i.e. Catholic and Anglican background) just as 74 (54.0%) of the respondents did not indicate their religious affiliation. The participants age range was between 18 and 64 years and had a Mean age of 36.7(SD=14.8) respectively. Research Instrument The Stigma to Mentally-ill Opinionate Scale (SMOS) was developed, validated and utilized as the research instrument for collect data in the study. The SMOS has four sub-categories (I, II, III, and IV), namely, knowledge (sub-category I), identification (sub-category II), treatment (sub-category III) and that of support (sub-category IV). Under knowledge there are eleven (11) items, identification eleven (11) items, treatment thirteen (13) items and support had ten (10) items. The items were responded to by the respondents using a tick of any kind under the columns on agree, disagree and neutral. The scale was so designed in this way because the background of the study and the literature reviewed revealed that the stigma attached to the mentally-ill arose from the individuals misperception within the community. Some of the items in the questionnaire were picked from the literature of the study while others were the outcome of scrutinised and reprocessed information from Focused Group Discussion (FGD) that elicited their perception of the mentally-ill people and the illness. Each of the sub-categories was submitted for expert screening with actual item-composition pruned to reflect the suggested corrections. The sub-categories in the SMOS were observed for content validity having both the face and logical (i.e. subsection composition) dimensions. Using the Cronbach alpha its reliability measures for the respective sub-categories are (r=0.72) for sub-category I, (r=0.79) for II, (r=0.80) for III and (r=0.75) for IV respectively. The validation followed a twoweek administration of the SMOS. Data Analysis The data analysis adopted was the One-Way Analysis of Variance (One Way ANOVA) as provided in the Statistical Package for Social Scientists (SPSS). The One-Way ANOVA procedure produces a one-way analysis of variance for a quantitative dependent variable by a single factor (independent) variable. Analysis of variance is used to test the hypothesis that several means are equal. Results and Findings/Discussion The results of the analysis of variance (ANOVA) were summarized on the basis of the hypotheses advanced in the study. The hypotheses were tested one by one. Hypothesis One The first hypothesis stated that the gender of respondents will not significantly affect the perception of the stigma attached to mentally-ill people. In testing this hypothesis the data was analyzed using analysis of variance (ANOVA) while statistical inferences were made at the alpha level of 0.05. The results are displayed on table 1 below. From the table, results which showed that there was significant statistical difference [F(5,131)=0.508;P<0.05] did not confirm the null hypothesized statement. On the basis of the findings therefore the hypothesis was rejected. The graphical summary following this is shown in figure 1.1 below.

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Table 1: ANOVA indicating perception Along Gender Dimension Source of Variation Sum of squares df Mean Squares Between Groups 1.056 5 .211 Within Groups 32.053 131 .245 Total 33.109 136

F .863

Sig. .508

gender
100

80

60

40

Frequency

20

Std. Dev = .49 Mean = 1.59 N = 137.00 1.00 1.50 2.00

Fig. 1.1

gender

The findings of the study as shown by the results of ANOVA summarized in table 1 above did not confirm this hypothesis. This by implication means that the respondents perception along gender dimension is statistically significant and tremendously varies. The indication going by this findings seem to have supported the notion that all human beings are unique while by inference our perception of concepts and, or situation as typified in the study, would ultimately not be the same. In consequence therefore, human uniqueness not-with-standing, whether the individuals are males or female, would almost always affect the way they reason, perceive and interpret events just as it is the case with the mentally-ill in Ha Leqele, Lesotho. Hypothesis Two The second hypothesis stated that religious affiliation of respondents will not affect their perception of the stigma attached to the mentally-ill people at Ha Leqele. In testing this hypothesis the data was analyzed using ANOVA. The results are displayed in table 2 below. From the table, the results [F(5,131)=0.035;P<0.05] indicate that there was a statistical significance difference. On the basis of the findings therefore the hypothesis was rejected. The graphical summary is shown in figure 2.2. Table 2: ANOVA Comparing Participants along Religious Affiliations Source of Variation Sum of squares df Mean Square Between Groups 13.557 5 2.711 Within Groups 142.851 131 1.090 Total 156.409 136

F 2.487

Sig. 0.35

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religion
80

60

40

Frequency

20 Std. Dev = 1.07 Mean = 3.1 0 1.0 2.0 3.0 4.0 N = 137.00

religion
Figure 2.2 The results of ANOVA as shown in table 2 above did not confirm this hypothesis. Thus, with the findings, the educational status of respondents play a significant influence in the perception of the stigma attached to mentally-ill people. Though the argument may not be too different from that given already, the fact still remains that when people are well educated they are easily not gullible in their perception and reception and, or rejection of information and, or ideas considered inimical and obnoxious. This finding, in consequence, therefore corroborate Scaife (2001) that educational status of individuals would usually have its effect when he opined that the younger and better educated people are, the more they tend to express a more favourable accepting attitudes than it should have been if they are less educated. Although, while noting the trend as portrayed in the finding, it is also imperative to emphasize here that education as an important index in attitude change, might have been equally influenced by other personality factors which the present study was limited to. Hypothesis Three The third hypothesis stated that the respondents educational status will not significantly affect their perception of the stigma attached to the mentally-ill people at Ha Leqele. In testing this hypothesis, ANOVA was employed. The results are displayed in Table 3 below. From the table, the results [F(5,131)=0.878;P<0.05] indicated that there was a significance difference, and this also implies that the hypothesis tested was rejected. The graphical illustration of the details is as shown in figure 3.3 below.

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Table 3: ANOVA comparing the participants Response along the Education Status Source of Variation Sum of Squares df Mean Square Between Groups .424 5 .124 Within Groups 31.328 131 .256 Total 31.752 136

F .355

Sig. .878

education
100

80

60

40

Frequency

20

Std. Dev = .48 Mean = 1.36 N = 137.00 1.00 1.50 2.00

Figure3.3

education

The findings of the third hypothesis as shown by the ANOVA results summarized in table 3 above were not confirmed. In other words the hypothesis was rejected. This means that the religion of the respondents is significant to the extent that individuals perceived the stigma attached to the mentally ill people at Ha Leqele. Corroborating such studies as Comer (2004); Sharma (2000); and Harphan and Blue (1996) individual belief are potent fuel for reinforcing cultural stereotypes and, of course the stigma attached to mentally ill people over time. In addition to the above view, socio-cultural theorists equally believe that abnormal functioning is influenced greatly by the labels and role assigned to troubled people (Szasz, 2000). Religion and beliefs fall under culture of which every member of any given society affiliates to. These cultural beliefs, most of the time builds the conceptions as well as the misconceptions about mental illness, sanity and general human phenomena. The misconceptions in the cultures are roots for the stigmatization of the victims of mental illness and the illness itself. Hypothesis Four The fourth hypothesis stated that the respondents perception (i.e. knowledge, identification, treatment and support to the mentally ill) will not significantly differ when the notion of their stigmatization is considered. ANOVA was used in testing this hypothesis. The results are shown in table 4. From the table, the results in the four categories showed that while it was statistically significant at the levels of participants knowledge [F(5,131)=0.788;P<0.05]; treatment [F(5,131)=0.289;P<0.05] and support [F(5,131)=0.550;P<0.05],it was not significant at the level of identification [F(5,131)=0.056;P<0.05]. The graphical illustrations following the computation are shown in figure 4.1-4.4.

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Table 4:

ANOVA Comparing the Participants along Knowledge, Identification, Treatment and Support respectively Source of Variations Sum of Squares df Mean Square Knowledge Between Groups .620 5 .124 Within Groups 33.585 131 .256 Total 34.204 136 Identification Between Groups Within Groups Total Treatment Between Groups Within Groups Total Between Groups Within Groups Total 2.167 25.614 27.781 1.709 35.765 37.474 .753 24.605 25.358 5 131 136 5 131 136 5 131 136 .433 .196 .342 .273 .151 .188

F .483

Sig. .788

2.217

.056

1.252

.289

Support

.802

.550

knowledge
80

60

40

Frequency

20 Std. Dev = .50 Mean = 1.48 0 1.00 1.50 2.00 N = 137.00

4.1

knowledge

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identification
140 120

100

80

60

40

Frequency

20 0 1.00 1.50 2.00 2.50 3.00

Std. Dev = .45 Mean = 1.15 N = 137.00

4.2

identification

treatment
100

80

60

40

Frequency

20

Std. Dev = .52 Mean = 1.36 N = 137.00 1.00 1.50 2.00 2.50 3.00

4.3

treatment

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support
140 120

100

80

60

40

Frequency

20 0 1.00 1.50 2.00 2.50 3.00

Std. Dev = .43 Mean = 1.11 N = 137.00

Figure4.4

support

The findings of the above tested hypothesis as shown by the ANOVA in table 4 above were not supported. This means that the respondents perception would significantly differ when the notion of their stigmatization is considered. As the result portrayed already, it was only confirmed when the participants responses were compared along the dimension of identification. Thus, by inference, it showed that while the participants are unanimous, they might have perceived generally that the behaviour of the mentally-ill is without equivocation, the same every where. Where the participants took their decisions on the divide especially as regards the three dimensions of knowledge, treatment and support however, the same argument that individuals position to information and situation would vary as long as they are different people with atypical cultural background, orientations and life experiences would hold. The argument here is that no matter what individual, would disagree on a number of issues as long as they are unique.

IMPLICATIONS OF FINDINGS The findings from this study have a lot of far reaching implications; among which are: * it showed that as long as individuals are unique they would perceive things differently. *It also equally indicated that the way the mentally-ill are treated can be greatly influenced by the way individuals within the community perceive them and thus affecting consequently the discriminatory supports provided to maintain the victims. * The attitude of people to the mentally-ill is continuously negative.

CONCLUSION The study found that the stigma attached to the mentally-ill is rooted in the interactions of the mentally-ill with people living within the community. Moreover, individual position and perception of the mentally-ill is greatly influenced by the knowledge they have and how they identify with the victims which equally affect the needed treatment and support that is shown to the mentally-ill. As Miles (1988) suggests the stigma attached to mentally ill people is a social stigma because it is the reaction of the society which singles out certain attributes, evaluates them as undesirable and devalues the person who possesses them. Gender is socially constructed and is yet another factor that generates the stigma attached to the mentally ill people. Women are more stigmatized than men even in this dimension (mental illness). The mental disorders in the psyche

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and emotions of the person are caused by the persons non-improved social environment and disturbing experiences they have lived and are still living in.

RECOMMANDATIONS The following recommendations are based on the findings of this study; and include: People have to be educated about mental illness. This can be achieved through village gatherings, making use of media, and making information about the illness available. Young, middle age and elderly people have to be taught about mental illness by engaging them in programs that demonstrates how the life of the mentally ill person can be improved should they live within an environment. Programs may include peer counseling to enhance mentally ill socialization levels, recreational activities that are consistent with their capabilities; in the acute phase, keep activities short and simple. Educating people by making information accessible helps the mentally ill person and their community and families to reduce the stigma attached to mental illness and its victims. For instance for clients to become self-managers, it is essential they learn every thing they can about their diagnosis and treatment strategies and their families should be included in this educational process. The community agencies have to be developed. The community agent can be a social therapist. The community therapist offer therapy and teach problem-solving and social skills to the community at large without discrimination but giving each individual activity that suits their capabilities. They also ensure that medications are being taken properly. They should coordinate available community services, guide clients through the community system, and perhaps most importantly, help protect clients rights. The community health professionals and families of the mentally ill should help the mentally ill people by setting limits on the time the mentally ill people talk about their failures because they may get more depressed or their grandiose beliefs that may cause them deny that they need help, by teaching them positive affirmations as a way to counter act negative talk which may cause the mentally ill to relapse. Engaging the mentally ill people in community activities and families helps them in identifying purposefully with life. They should have opportunity for sense of belonging, value to friends short term goals, availability of supportive people and make use of spiritual resources to decrease distress to facilitate early recovery of their condition. The department of Mental Health Departments decentralization of its activities should facilitate adequate implementation of the Government goal of good health for all as well as the provision of funds needed for the treatment and support of the victims.

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REFERENCES ACA Code of Ethics & Standards of Practice, 1995.Accessed 21 April 2007 from www.counseling.org/ Resources/CodeOfEthics/TP/Home/CT2.aspx Andreasen, N.C. (2001). Resolution of Polarization in Psychiatry. Accessed 17 March 2007 from mensanamonographs.tripod.com/id105.html Anglo-Ugandan Research, 1999: Healing mental illness the traditional way. Accessed 21 April 2007 from http://news.bbc.co.uk/1/hi/health/332641.stm APA (American Psychological Association). 2000. DSM-IV text revision. Washington. DC: Author. Barnes, M & Marple, N. A. (1992). Women and Mental health: Challenging the Stereotypes. Britain. Birmingham. BBC News 2000 in the News Press for Change. Accessed 7 May 2007 from http://www.pfc.org.uk/ node/692 Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press. Becker, H. S. (1963). Outsiders: Studies in the Sociology of Deviance. New York: Free Press. Bockoven, J.S. (1963).Moral Treatment in American Psychiatry. New York, Springer Publishing Coy.

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Capuzzi, D & Gross. R. (2005). Counseling and Psychotherapy: Theories and Interventions, 3rd Edition. New York, Prentice Hall Comer, R.J. (2004).Abnormal Psychology. New York, Worth Publishers. Fontaine, L. k. (2003). Mental Health Nursing. 5th Ed. New Jersey. Pearson Education. Inc. Gilligan, J.(2001). What works in Residential Care? Accessed 3 May 2007 from www.acu.edu.au/__ data/assets/pdf_file/0007/53962/WHAT_WORKS_IN_RESIDENTIAL_CARE_for_MYC_2209.pdf Goffman, E. (1963). Stigma: notes on the management of spoiled identity. New York. Prentice Hall. Harpham, T. & Blue, I. B. (1996). Urbanisation and Mental Health in Developing Countries. England. Avebury. McPherson, S., Richardson, P. & Leroux, P. (2003). Clinical Effectiveness in Psychotherapy and Mental Health. London. Karnac. Miles, A. 1988. The Mentally-ill in the Contemporary Society: A Sociological Introduction. 2nd Ed. Basil. Blackwell Mohlomi Report, Lesotho 2000.Accessed 20 June 2005 from http://www.who.int/hac/techguidance/ pht/womenshealth/Lesotho_Report_women_in_crisis_June2005.pdf. National Association of Psychiatric Health System (NAPHS)(1999), Assessing Performance at the Millennium. Access 11 May 2007 from http://www.mhsip.org/assessing.htm Piajet, J. (1973). The Psychology of the Child. New York, Basic Books. Scaife, J. 2001. Supervision in the Mental Health Professions: A Practitioners guide. Canada. Brunner- Routledge. Sharma, T. (2000). Insights and treatment options for psychiatric disorders guided by functional MRI. Journal of Clinical Investigation, vol.112, 10-18 Swartz, L. 1998. Culture and Mental Health: A Southern African View. Oxford University Press. SA Cape Town. SA Szasz, T. S. 1970. The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. Syracuse. New York. Syracuse University Press. Szasz, T. S. 2000. Second Commentary on Aristotles Function Argument. Philosophical Psychiatry. Psychology. 7 (1), 3 16 Torrey, E. F. 2001. Surviving Schizophrenia: A manual for Families Consumers and Providers. 4 th Ed. New York. Harper Collins. Zust, B. L. 2000. Effect of Cognitive Therapy on Depression in Rural, Battered Women. Archives of Psychiatry Nursing. 14 (2), 51-63.

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APPENDIX QUESTIONNAIRE Kindly answer the following questions as honestly as possible. Please do not write your name anywhere on this paper because it is only for research purposes. Thank you for your cooperation. Age: Gender: Male/Female (Please tick) Education: Literate/ not literate (Please tick) Religious Affliction: Traditional Born Again Orthodox ... Others (Please tick in the appropriate box) Table 5:Knowledge Sub-category Mental illness is possession by the devil. Mental illness is like any other illness. Mental illness is absolute craziness. Mental illness is incurable. People bring on the illness on themselves. Mentally ill people are sick because they are self neglecting. Every body harbours symptoms of mental illness. Mental ill people are no different from mentally retarded people. Exorcism (ritual performed to drive away demons) is used to cure mental illness. Mentally ill people do not conform to social structures. They do not listen to the rules of their societies. Mentally ill people are not cooperative.

Agree

Disagree

neutral

Table 6: Identification Sub-category Mentally ill people have weak character. Mentally ill people are violent and therefore they are dangerous. People who are affected by mental illness loiter. Mentally ill people behave like children even when they are elderly. Mentally ill people are dirty. People who are affected by mental illness are always carrying oddities. Mentally ill people talk endlessly to themselves. The speech of mentally ill people is haphazard and incoherent. They often talk many ideas at the same time without logic. The mentally ill people often do not like to be around sane people. Mentally ill people smell badly due to life styles. People who are mentally ill are full of energy that needs to be diverted into more constructive ways.

Agree

Disagree

Neutral

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Table 7: Treatment Sub-category Mentally ill people are sources of fun. Mentally ill people must be tortured to immobilize them. The opinions of mentally ill people are undermined. People provoke mentally ill people as an intention to amuse themselves. The mentally ill people must be treated like children. Mentally ill people are not capable of making independent decision. They need approval of sane people. The mentally ill people are seen as minors by the law. Mentally ill people should be kept indoors as a way to protect other people from their violent behaviour. Mentally ill people are useless. Both Western and traditional medicine can cure mental illness, not social support. Western and traditional medicine cannot cure mental illness absolutely. Mentally ill people have got not to have friends. Mentally ill people need not to work at public offices.

Agree

Disagree

Neutral

Table 8: Support Sub-category Offering mentally ill people social support helps them to recover quickly. Mentally ill people need to be cared for by their communities, families and government in the villages. It is a waste of money to fund mental health services to improve quality of life for mentally ill people. Giving mental ill people tasks help to improve their concentration. As much as mentally ill people need medicine as much they need social support. Mentally ill peoples rights should be protected by law. Mentally ill people cannot be treated from home. They should all be hospitalised. If the person seek help from a mental department or professional it means they are wimps. Social support or no social support, the mentally ill cannot always get better. Enacting laws for the mentally ill is a waste of time.

Agree

Disagree

Neutral

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