Standard 6 of Practice in Mental Health Nursing: Eliminating Stigma and Encouraging Inclusion

The 6th Standard of Practice in Mental Health Nursing (2010) proposes that mental health nurses should look for and use all the possible opportunities to eliminate or minimize the stigma attached with mental health problems. They must strive to encourage social inclusion and community engagement for individuals with mental illness. This standard is relevant in the case of dementia as well. Read on to know more about the attributes necessary to meet Standard 6 and how it applies to dementia.

Rationale behind this Standard 6
The 6th Standard of Practice in Mental Health Nursing (2010) proposes that mental health nurses
should look for and use all the possible opportunities to eliminate or minimize the stigma
attached with mental health problems. They must strive to encourage social inclusion and
community engagement for individuals with mental illness. The rationale behind formulating this
standard is that people with mental health issues face seclusion as society has attached various
kinds of stigma with mental illnesses. In addition, stigma and lack of inclusion in society restrain
those individuals and their families from getting access to support services which promote their
recovery. It is not only moral duty but also professional obligation of nurses to remove stigma
and discrimination against the mental illnesses as these are source of self-stigma and withdrawal
which further affects their mental health negatively and leads to social exclusion. In recent times
also, society has poor attitude towards mental illness. People have developed myths about metal
illness and people having them such as dangerousness, incompetence, etc. which causes reduced
sympathy and low acceptance of individuals with mental health problems in the community, and
enhanced exclusion and discrimination. Such attitudes restricts the scope to which individuals
with mental illness can contribute to the economy. Like, it is observed that people with mental
illness get detached from their peers and they often find it difficult to become an active and
productive citizens as adults. It results in a section of unproductive population impacting the
overall economy of the nation apart from the healthcare cost burden. Several elements singly or
in conjugation work together in conceiving and sustaining the stigma against mental health
problems. A common element is that majority of the settings in society label people with mental
health problems leading to development of a certain stereotype. As a person is labeled and
prejudiced in a wrong way, it eventually leads to his/her exclusion from those social settings. A

differentiation is common in communities in which the people with mental health problems are
viewed as “them”, while the general population is viewed as “we”. This differentiation causes
discrimination and the people who face this stigma experience status loss, disapproval, and
seclusion. It is seen that fellow community members feel uneasy when they are around
individuals with mental disorders. They want to maintain a safe distance between themselves and
people with mental health issues. Research suggests that the lesser community understood the
individual with mental health problems, the lesser they wanted to be involved with them, be
surrounded by or be associated to them (Ouellette-Kunz, 2010). In fact people with mental
illness are regarded as extra burden over community and contribute to the stress on the family
and society in general. The labelling and inaccurate understanding regarding people’s mental
problems due to the stigmatization affects the points of views of people around them which leads
to social detachment. Apart from the community, support services also support the
discrimination against people’s mental illness as it is engrained in service worker’s attitude
which results in fear, unfamiliarity, and stereotype for mental health problems. Research
indicates that individuals with mental health issues commonly receive inferior health care
services than the general people (Walker, McGee, & Druss, 2015). The notion that mental
disorders are associated with impairment or incapacities reinforces the negative attitudes and
stigma which promotes discrimination against people with mental health problems. They
completely or partially fall behind from participation within community (Morin, 2013). Social
distancing is an impediment in the course of treatment as for a person with mental illness to
recover a sound and supportive social network is extremely useful. This standard is relevant in
this scenario and can prevent it from occurring.

What are the attributes (knowledge, skills and attitudes)
necessary to meet Standard 6?
Health professionals should have a range of attributes in order to implement Standard 6.
Knowledge
Evidence-based practice- Nurses must be familiar with the best practices linked with different
types of mental disorders and should implement them in service provision. Nursing actions must
be informed by evidence. Nurses should be aware of current guidelines by updating themselves
with current literature in order to provide best possible care based on empirical evidence. Nurses
should work towards continuous professional development so that they can improve their
competence in theory as well as practice continuously.
Educate- Apart from therapeutic duties, nurses also have duties of imparting knowledge through
education to the patients and their families. Nurses must have adequate knowledge about the
anti-stigmatic awareness programme. They should spread awareness regarding evidence-
informed public anti-stigma programmes that are associated with and reinforced by significant
anti-discrimination steps in context of mental health problems. Patients should be taught about
their recovery process so that their confidence can be build and they can get back to their
previous life. Their carers should be made aware on how to avoid intentional or unintentional
stigmatic practices around the person with mental illness. In addition, community programmes
can be planned to address the existing misconceptions regarding mental health issues so that
discriminatory practices can be prevented and inclusion of those people can be enforced in
society.

Legal compliance- Nurses must be aware of the legal system of Australia which complies the
Australian citizens against discriminatory practice on the basis of mental capacity. Nurses should
ensure that they remain non-judgmental throughout their sessions with people with mental
illness. They should refrain from passing any prejudiced comments knowingly or unknowingly
as discriminatory practices in health setting can contribute towards self-stigma. Moreover,
individuals with mental health issues and their families must be empowered and encouraged to
exercise their fundamental and human rights with regards to care and treatment. Nurses should
reinforce their efforts to remove legal, executive, societal, financial or other barriers which may
refrain individuals with mental health issues from having complete and equal participation in
community. In addition, nurses should ensure that compulsory treatment must be put under
thorough review about its medical suitability and compliance to domestic and international law.
Attitude
Interpersonal relationship- A very common type of stigma is self-stigma which builds within a
person with mental illness. To prevent or eliminate self-stigma, it is essential to understand the
person’s perspective and thoughts. People only open up with people whom they trust and believe
that they care for them genuinely. Nurses must be able to build an interpersonal relationship with
those people based on trust so that they feel comfort in sharing their thoughts.
Empathetic attitude- Nurses should have an empathetic attitude towards people with mental
illness so that they can understand their position accurately which will subsequently assist them
in understanding the source of self-stigma. Once the underlying causes of self-stigma are
identified, further actions can be taken to remove them. In addition, these relationships can also
be the first step towards inhibited social engagements from patient’s side.

Holistic care-Being a part of community is an overall concept including a person’s physical and
mental presence. So, nurses should not only focus on a person’s mental symptomatic treatment
rather, they should include every aspect of a person’s well-being including mental, physical,
social and spiritual well-being.
Inclusion of people- People with mental disorders must be involved in decision-making at every
step of care planning to most of their mental capacity. When nurse involves individuals with
mental health issues in formulation and implementation of their intervention, it boosts their self-
esteem and empower them which eventually help them in challenging and overcoming the deep-
rooted prejudiced social attitudes.
Skills
Care planning- During care planning of people with mental illness, nurses must strive to promote
people's emotional well-being. Health interventions must be designed by the nurse in a way that
reinforces community participation. They should be able to design and implement the
interventions in way that are not overwhelming or underwhelming for people and at the same
time encourage social engagements. This would require nurses to have skills to accurately judge
the person’s mental capacity.
Person-centered management- Nurses should be able to provide care which is person-centered.
Such type of care delivery puts the patient at the centre and interventions are built around their
preferences, requirements, thoughts and beliefs. A tailored intervention based on an individual’s
need is more useful than the general recommendations. Nurses should be able to identify a
person’s needs and inclinations and customise the management so that stigma around their
illness can be removed.

Collaborative approach- Nurses should work in partnership with professionals from other
support services such social work, employment, housing, academic institutions, etc. in order to
build a stigma free environment for people with mental health problems. Nurses must be able to
plan and formulate a complete mental health care system which is community based by making
use of the community development approach to develop and sustain collaborations with local
communities. Nurses must have interdisciplinary team working skills in order to collaborate and
cooperate with other professionals so that requirements of the patient can be fulfilled and he/she
could be protected from all kinds of discrimination.
How does this Standard apply to dementia?
It is found that several people with organic disorders such as dementia do seek or receive the
care provision due to the stigma attached with their illness which eventually secludes them from
their community (Knaak, Mantler, & Szeto, 2017). Health professionals including nurses should
view dementia as a disability which will allow addressing of stigma associated with dementia.
Nurses can tailor interventions at personal, organisational and societal levels based on the needs
of the person with the aim of addressing prejudice linked with dementia. Nurses should keep in
mind that the ultimate aim of these interventions is to improve quality of life of the individual
with dementia and his/her carer/family. Health sector must collaborate with other support
services to provide person-centred dementia specific services to support the abilities of
individuals with dementia. Nurses must keep reviewing their care delivery by seeking feedback
from patients and their families and the aspects of their practice which require improvement must
be addressed. Nurses must ensure inclusion of people with dementia to the best of their mental

capabilities and their family in the care planning and delivery to promote empowerment. When
people with dementia are involved in their own care, it is likely that they will regard themselves
as part of the care process which subsequently becomes their first step of considering themselves
as part of the community as well.
Health professionals can make use of make use of person’s social network for delivering care
and enforcing social inclusion. Professionals can make use of techniques of motivation, role
modelling and collaboration so that people with dementia view themselves as a vital part of the
community and overcome the social distancing and promote inclusion. Health professionals in
collaboration with other sectors such as social agencies or local community bodies can aim to
minimize labelling of people with dementia by education and interaction within the community.
Spreading awareness in the society can burst various misconceptions around mental health issues
such as dangerous, incompetence, hopelessness, etc.
Apart from the public stigma, it is essential that self-stigma among people with dementia should
be removed so that they desire and are able to be a part of the community. Nurses must remain
unprejudiced with those people during the entire service provision. They should be careful of
their language and their communication should inflict a sense of hope and optimism towards life
in people with dementia. Further, nurses should address the self-stigma internalized by people
with dementia by making strategic decisions about revealing their mental health history and
treating him as equally to others.
References
Knaak, Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare. Healthc
Manage Forum, 30(2), 111-116.

Morin, D. (2013). Public Attitudes Towards Intellectual Disability: A Multidimensional
Perspective. Journal of Intellectual Disability Research, 57(3), 279-292.
Ouellette-Kunz. (2010). Public Attitudes Towards Individuals with Intellectual Disabilities as
Measured by the Concept of Social Distance. Journal of Applied Research in Intellectual
Disability, 23(2), 132-142.
Walker, McGee, & Druss. (2015). Mortality in mental disorders and global disease burden
implications: A systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334-341