NURSING TOOL BOX SERIES

  Mental Health Stigma and Discrimination F or over four decades, particularly, since an influential work by Goffman (1963), the notion of stigma has attracted a great deal of attention in sociology and social psychology. Stigma is a complex phenomenon involving an interplay between social and economic factors in the environment and psychosocial issues of affected individuals. A basic thesis of the sociological literature on stigma is that individuals who (for some reason) have failed to conform to social norms could be persistently denied full acceptance by the society (Goffman, 1963). Seminal work by Goffman (1963) and Thomas Scheff (1966) described the stigmatizing process that may follow from being identified as having a mental illness, and numerous research studies have attempted to demonstrate the unfavourable effects of mental illness labelling. Labelling and discrimination against people with mental disorders is widespread, often formalised, and sometimes even codified in law.

  Informed Consent, Confidentiality, and Patient Record-Keeping H ealth workers think that when patients seek competent help from them, it is assumed that the burden of carrying the sickness outweighs an individual and on their own they have no control. Indeed, the sick person has an obligation to seek technically competent help and they have to cooperate with the health worker (physician according to Talcot Parsons, 1951). The patient’s obligation to seek competent help may find its counterpart in the doctor’s obligations to be solely guided by the welfare of the patient (Parsons, 195la: 438, 477). Likewise, as counterpart of the patient’s obligation to get well, Parson’s frequent reference to the need that the doctor must apply the highest possible standards of technical, competence and scientific knowledge may indicate a role obligation (Parsons, 1951a: 437). Thus the two duties making up the doctor’s role are those to serve but the patient’s welfare, and to ensure that this is done

  HIV/AIDS and Mental Health There are no community surveys in Zambia of the prevalence of mental health problems in people with HIV, only personalised estimates from outpatient and in-patient settings. Whether levels of mental health problems are comparable with other medical conditions is also unknown. Similar to other serious illnesses, HIV is associated with a wide range of mental health problems. Organic problems such as delirium are common and are managed in the usual manner; however, a cause may be particularly difficult to find because this is often multifactorial. Specific HIV-related dementias have been described in detail elsewhere (Badkoobehi et al., 2006) . Older individuals are at greater risk of HIV-related cognitive impairment and dementia (Becker et al., 2004) and experience more social isolation (Meadows et al., 1998) with improved survival and ageing cohorts, these problems may increase. Gender and associated social consequences contribute to increased risk of m