Asylum blues: staff attitudes towards psychiatric nursing in Sarawak, East Malaysia

Abstract

This paper draws upon findings from an ethnographic study of psychiatric service users in a psychiatric institution in Sarawak, East Malaysia. Findings focus primarily on the accounts of nursing staff in relation to attitudes towards psychiatric work and patients. These indicate that despite a rhetoric of decentralized services, a custodial 'asylum' model continues to influence the care of patients at many levels. Negative professional attitudes towards patients lead to issues of both moral and physical containment. However, an associated attitude of stigma and prejudice towards mental illness impacts upon how attractive a career in psychiatric nursing is perceived to be by respondents, subject to gender differentials.

Determining the effectiveness of a video-based contact intervention in improving attitudes of Penang primary care nurses towards people with mental illness

“…Our figures were however lower than those found on a recent study on Malaysian medical students which utilised the same scale [ 67 ]. Taken together, it appears that significant stigmatising attitudes towards people with mental illness are prevalent among nurses and future doctors in Malaysia, a finding which is consistent with local and international studies [ 4 , 29 , 31 , 34 ]. Anti-stigma interventions which target HCPs in all areas of healthcare provision, and especially those working in primary care should be carried out to improve mental health services.…”

“…This finding may be explained by the fact that only a small number of nurses reported experiences of negative contact (8%) compared to neutral contact (48%). Another possibility for this finding is that the nurses who classified their interactions as neutral were influenced by cultural beliefs which stigmatised mental illness [ 17 , 29 , 72 ]. For example, two studies found a tendency among the Malaysian public to perceive people with mental illness as dangerous, leading to fear and social distance [ 17 , 72 ].…”

“…There is a paucity of research on stigma amongst HCPs towards people with mental illness in Malaysia, so that, by time of writing, there were just three publications relating to this topic [ 29 – 31 ], of which two were qualitative studies. Ashencaen [ 29 ] found stigmatising attitudes among the psychiatric nursing staff in Sarawak state towards people with mental illness.…”

“…There is a paucity of research on stigma amongst HCPs towards people with mental illness in Malaysia, so that, by time of writing, there were just three publications relating to this topic [ 29 – 31 ], of which two were qualitative studies. Ashencaen [ 29 ] found stigmatising attitudes among the psychiatric nursing staff in Sarawak state towards people with mental illness. Also, Hanafiah and Bortel [ 30 ] explored the perspectives of 15 Malaysian mental health professionals and found that these HCPs believed family members, friends and workplace staff, (particularly nurses) to be the greatest perpetrator of mental illness-related stigma.…”

“…The sole quantitative study by Minas et al [ 31 ] found that Malaysian HCPs were more discriminatory towards people with mental illness compared to those with diabetes mellitus. However, the authors did not utilize a scale specifically designed for use with HCPs [ 29 – 31 ].…”