Mental Health Staff: Implicit Cognition Attitudes in NHS London

This report investigates the implicit cognition attitudes of mental health staff within the NHS in London, England, focusing on their perceptions of the mentally ill. The study delves into neuroscience theories, including the Integrated Information Theory and the Gene-Culture Co-evolutionary Theory, to provide a theoretical framework for understanding unconscious biases. A comprehensive literature review explores the concept of implicit cognition, the importance of family involvement in patient care, and the impact of professional attitudes on patient outcomes. The methodology section outlines the participants, apparatus, measures, and procedures, including the use of the FAST and questionnaires. The results section presents findings from T-tests and regression analyses, followed by a discussion of the implications and conclusions. The report also includes references and appendices, providing a detailed analysis of the topic.

IMPLICIT COGNITION ATTITUDES FROM MENTAL HEALTH
STAFF OVER THE MENTALLY ILL (NHS LONDON
ENGLAND)
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TABLE OF CONTENTS
Introduction..........................................................................................................................................3
Neuroscience Theories.....................................................................................................................3
Neuroscience new consciousness theory.........................................................................................3
Gene- Culture Co-evolutionary Theory...........................................................................................5
Literature Review.................................................................................................................................6
Concept of Implicit Cognition Attitude...........................................................................................6
Importance of family involvement in the care of mentally ill patients............................................7
Attitude of mental health care professionals towards mentally ill patients.....................................8
Impact of implicit cognition attitude on behaviour of mental health care professionals.................9
Methods..............................................................................................................................................11
Participants.....................................................................................................................................11
Apparatus.......................................................................................................................................11
Measures and procedures...............................................................................................................11
FAST..............................................................................................................................................12
Questionnaire.................................................................................................................................13
Results................................................................................................................................................15
T Test..............................................................................................................................................17
Regression Analysis.......................................................................................................................18
Discussion...........................................................................................................................................22
Conclusion..........................................................................................................................................24
References..........................................................................................................................................25
Appendix............................................................................................................................................27
Questionnaire......................................................................................................................................41
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INTRODUCTION
Neuroscience Theories
Neuroscience is regarded as the scientific study which analyses human nervous system.
Traditionally, it was considered as a branch of biology; however due to changes in technology it is
regarded as an interdisciplinary science that collaborates other fields also such as chemistry,
cognitive science and computer science (Azarian, 2015). Thus, neuroscience is concerned about the
biological basis of consciousness, perception, memory and learning. The concept of neuroscience is
linked with observations about cognitive behaviour with the actual physical processes that assists in
supporting human behaviour. The study of nervous system dates back to ancient Egypt and this has
innovated the concept of trepanation which is a surgical practice of drilling and scraping a hole into
the skull for the purpose of curing headaches and mental disorders.
The scientific study of the nervous system has amended significantly in the 20th century due
to innovation and advancements in the molecular biology and computational neuroscience. The
study of the nervous system can be done at multiple levels ranging from the molecular and cellular
levels to the systems and cognitive levels (Theory of Neuroscience. 2006). Further, cellular
neuroscience includes the mechanisms of how neurons process signals physiologically and
electrochemically. Another major area of neuroscience is directed in the research work which
identifies the development of the nervous system. Among consciousness and behaviour, cognition
states as a psychological power in the neuroscience issues.
Implicit cognition refers to the unconscious influence such as knowledge, perception or
memory that affects a person's attitude and behaviour even when they do not have any awareness
regarding those influences. Implicit cognition includes everything a person can do and learn in the
state of unconsciousness (Victor and et.al. 2011). There are many processes in which implicit
memory works which includes learning the social cognition aspects about human nature. In the
present study, several theories of neuroscience have been discussed so as to specify the implicit
cognition attitude from mental health staff.
Neuroscience new consciousness theory
Integrated Information Theory is developed by neuroscientists Giulio Tononi and Christof
Koch with the framework to describe ways to measure the extent to which a system is conscious.
The theory posits that any system that processes and integrates information experiences the world
subjectively to some degrees (Theory of Neuroscience. 2006). Integrated Information Theory has
become a significant topic in neuroscience which ensures to give brief way to measure the
consciousness state and along with this, it also expresses the phenomenon in mathematical terms.
Just like a computer system, the brain stores and processes information; but it is all about how
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information is shared throughout the brain network that generates rich and vivid conscious
experience.
Modern neuroscience states that there are a number of different and distinct regions that are
active during any event and each of which process information focuses on different features of the
event separately. There is a region in the visual cortex of the brain which is known as V2 which
processes the form and colour of the yellow and orange sun rays against the clouds. There are
auditory areas in the temporal lobe that inserts information about the sound of the wind in the mind.
That rushing winds also generates pattern of electrical signals in the somatosensory cortex which
further creates a sense of touch (Laland and Feldman, 1996). Apart from this, there are several
things going on in distant places; yet most of the things human being perceive is all unified
conscious experience. As per Integrated Information Theory, this unified experience focuses on
brain's ability to integrate sensory information as a whole.
In order to measure the degree of integration, several mathematical principles have been
taken into account so as to describe data transmission. Moreover, Integrated Information Theory
also claims that these information measures and allows the human brain to calculate exact number
that represents the degree of integrated information which exists in a brain at any specific moment.
In this regard, “Phi” serves as an index for consciousness and greater the Phi, the more conscious
the system is. The bran stores and processes information, but how it takes information is left
unexplained (Lidaka and et.al. 2010). Phi is correlated with the consciousness state; however it does
not have any specific role in its cause. Regarding this, Christof contends that consciousness is a
primary property of the universe. Where there is integrated information, there is presence of
experience as well. Any system that can integrate information should produce conscious state.
The theory also allows for the emergence of an abstract “superorganism” that is comprised
of many individual organisms. In theory, there is no limit determined regarding the conscious
system. This is typically bound by the rate of information and complexity growth. In the theoretical
framework, it is mentioned that that networks with greater internal connectivity reduces input/
output correlations from excitatory synapses and at the same time, it also declines negative
correlations from inhibitory synapses (Lidaka and et.al. 2010). All such changes could be measured
by normalized TE which can be applied to fundamental imagining data which determines the
direction of information flow between all the brain regions. Thus, in terms of specifying the
information theory, it can be said that IIT is thriving in the neuroscience community. It is also
integrated with neuroscience research because it starts to serve as a driver which opens new
directions of inquiry.
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Gene- Culture Co-evolutionary Theory
Gene- culture co-evolutionary theory is a branch of theoretical population that defines the
transmission of genes and cultural traits from one generation to the next. Along with this, it also
explores the methods through which human being interacts (Theory and methods in cultural
neuroscience. 2010). These models have been employed to ascertain the adaptive advantages of
learning and culture. Further, it also investigates the forces of cultural change. At the same time, it
addresses specific cases in human evolution which depicts the interaction between genes and
culture. Culture neuroscience is a developing research discipline that analyses cultural variation in
psychological, neural and genomic processes as a means of articulating the bidirectional
relationship of these processes. Cultural neuroscience also shares diverse research goals which is
related to social neuroscience (Laland and Feldman, 1996). At the same time, it also analyses how
neurobiological mechanisms facilitate cultural transmission in human behaviour.
Besides this, it also includes understanding about identification of primary social processes
that enable humans to learn from one another such as through imitative learning. Cultural
neuroscience is also divergent from other disciplines because it emphasizes explicitly on the ways
that mental and neural events differentiate as a function of cultural traits. At the same time, cultural
neuroscience also depicts how cultural traits may shape the emergence of genomic, neurobiological
and psychological processes over time and how much effects it gives to facilitate complex social
experience (Lazar and Dimitrov, 2011). Broadly, it ascertains behavioural processes in human
beings such as perception and cognition. Human neuroscience includes cognitive, social and
affective neuroscience which has also revolutionized the study of the mind and brain by developing
an arsenal of varied techniques. This also maps neural processes to psychological processes with
different degrees of the spatial and temporal resolution. Molecular genetics shows several
transformations in the scope of data and techniques for ascertaining the functional impact of inter-
individual variability in the structure of human genome (Victor and et.al. 2011). However, a number
of issues and challenges arises at the time of conducting research work on cultural neuroscience.
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LITERATURE REVIEW
Literature review section includes critical understanding of past studies that have been
included in the present research work. The section is a crucial part of the study where in researcher
uses diverse research materials in the form of secondary research. In the current study, numerous
articles and books have been utilized for the purpose of meeting the research aims and objectives.
Concept of Implicit Cognition Attitude
According to Matthias (2013), Implicit Cognition is regarded as unconscious influences
(knowledge, perception and understanding) which influences the behaviour of a person. In this
state, the person do not have any conscious awareness regarding those influences. These evaluations
are generally favourable or unfavourable and this also keeps on changing according to individual
experience. Hence, implicit attitude are typically not identified and these are the traces of past
experience that generates favourable or unfavourable feeling towards social objects (Implicit Social
Cognition. 2015). However, on the other hand, it can be said that an attitude is different from the
concept of a stereotype as that functions according to the broad perspective of favourable and
unfavourable attributes of a social object. Further, Hansson (2013), also contended that implicit
social cognition is a field of social psychology which accesses and analyses the thoughts and
feelings without directly involving the participants in the process. Regarding this, Matthias (2013)
also supported this by saying that implicit measures are based on the idea that states that activation
of a mental concept can spread to other associated concepts in the memory.
This also reflects that there exists strong association between two concepts which occurs
automatically in unconscious state. Implicit measure also make use of automatic processes through
evaluating the effect of stimuli or stimulus features on performance of the integrated people. Laura
(2013), argued that implicit learning starts in early childhood where people are unable to identify
right and wrong aspects. Implicit cognition also plays crucial role in social cognition wherein
people tend to see objects and individuals for encouraging aspects. Arguing the statement, Kopera
(2014), said that implicit cognition is more involved with how people view each other and how they
interact with each other in social cognition. It has been witnessed that people often tend to consider
other people identical especially in similar groups. They start relating that to past relationships
which used to be a part major of their social cognition.
On the contrary, the views of Laura (2013), states that the terms implicit and explicit
describes the processes through which the influence of a psychological attribute on measurement
outcomes can be identified. Nonetheless, measurement outcomes are regarded as implicit if they are
to be measured responses. According to the views of Blair (2011), individuals who are primarily
raised by the care takers and family members’ shows development of more long lasting implicit
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attitude. However, contradicting the above views, it can be summoned that implicit attitude are a
result of repeated pairing which includes positive and negative stimuli with an object. From several
studies, it has also been identified that culture has a very noticeable effect on implicit attitude
merely in the ways it differs with other individuals. Relating it to medical studies, it can be said that
while dealing with the patients, health care professionals need to focus more on their implicit
attitude.
Importance of family involvement in the care of mentally ill patients
According to the views of Goguen (2016), mental illness contributes more global burden of
disease on the nation. The presence of a serious mental health problem poses significant
consequences for all family members; hence they need to add more support in the wellbeing of
mentally ill patients. As pointed by Werntz (2016), families are often regarded as a principle support
available with mental illness patients. The important roles that family support can play in recovery
from mental health is well analysed and documented (Family interventions for mental disorders:
efficacy and effectiveness. 2003). The level of family involvement needs to be increased so that
mentally ill people can manage their ongoing activities in proper manner. However, at the same
time Kopera (2014), argued that family members act as informal case managers that encourages
supports and treats people through providing them secured house and care services. Involvement of
family members is essential as they can maintain the records of previous treatments, medications
and hospitalizations.
Thus, in terms of impact of involvement of family member, it can be said that it decreases
the rate of hospitalization and relapse and at the same time, it enhances adherence to treatment
choices. However Goguen (2016), contended that most of the family members often face problem
in treating such patients because they are not well trained with the trauma. It is an apparent fact that
family involvement is a key element of a child’s success especially when the children are in
residential treatment (Family Involvement. 2008). Parents and family members fulfil the roles of
staff members at many mental health service agencies. Outcomes of research done by author depicts
that in case of serious mental health problem, the involvement of families in treatment could reduce
the relapse rates and it greatly enhances the possibilities of recovery. Family members becomes
significant resource for mentally ill patients in terms of getting motivation in all health aspects.
Thus, it can be stated that family involvement plays very important or crucial role in
providing adequate treatment to care patients. In the present scenario, the trend of involving family
members in such type of care is increasing along with the passage of time. There are various areas
that are affected by adapting such type of approach to treat patients. For example, it helps in
carrying out better communication because family of mentally ill patients understand the need and
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demand of patients in more effective manner as compared to other care provider. Apart from this,
involving parents also supports in lowering down the level of stress among the patients. However, it
can be argued that involving family members is not an easy task and care workers are required to
take several kinds of measures. For example- adequate information to family members regarding
mental condition of patients. Involvement of family member in care of mentally ill patient is
important because it can result in delivering more effective care and attain desired outcomes
(Family Involvement. 2008). Therefore, clinicians and care workers are required to involve family
members at the time of providing treatment or care to patients who are mentally ill.
Family involvement is essential for the purpose of giving specific care to mentally ill
patients and through this patients can also be protected from abusive and violent actions. This is the
appropriate way of treating mentally ill people. However, on the other hand, author argued that
excessive family involvement sometimes leads the patients to become dependent on emotional care
which is not appropriate for their wellbeing.
Attitude of mental health care professionals towards mentally ill patients
Along with general public, health care professionals also have several negative beliefs
towards mental illness. Most often they are regarded as violent and dangerous; hence several
practitioners find it difficult to deal with such patients. Nolan (2016), contended that people with
mental illness tend not to recover soon as they are unable to comprehend social values, attitudes and
beliefs. Further, Hansson (2013), also supported the views by saying that mentally ill people are
separated from social groups as well (Hansson and et.al. 2013). However, there should be
appropriate support from the staff members to mentally ill patients so that they can comprehend
different aspects that have a great influence over the mind. This also assist them to analyze the
factors that changes their behaviour and attitude. Arguing this, Goguen (2016), pointed that
familiarity and regular contact with mental illness is perhaps the strongest predictor for more
positive attitude. Along with this, several factors have been explored (such as less professional
experience, lower educational level, lack of knowledge and unavailability of social groups) which
develops more negative and unfavourable attitudes among health care professionals who treat
mentally ill patients.
Hansson (2013), pointed out that most of the staff members do not treat mentally ill patients
in appropriate manner because they are unable to live a normal life. Hence, mental health care
professionals are also unable to give emotional support to the mentally ill patients which further not
only affects patient’s health but also demoralizes them on higher extent. However, arguing this, it
can be contended that negative attitude is more common among all the hospital staff and also
among resident, physicians and nurses (Matthias and et.al. 2013). There are several reasons
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identified by the research work of author for which staff members behave negatively while treating
mentally ill patients. Regarding this, it can be said that sometimes family involvement is too much
in care provision which hampers the care efficiency and at the same time, it creates more
disturbance in health care services. Family involvement should be appropriate when required so that
it does not affect the overall medication process. This creates negative attitude among care health
professionals and as a consequence, they depict more aggression towards the patients.
Kopera (2014), said that it is an apparent fact that mentally ill patients become violent as
they have no idea regarding human behaviour. This is yet another reason that influences as well as
changes the attitude of health care professionals. It not only develops fear among the care
practitioners; but also restricts them to deliver proper care to mentally ill patients. However, on the
other hand there are several health professionals who treat mentally ill patients in the best possible
manner which underpins their service provision (Mental health nursing staff’s attitudes towards
mental illness: an analysis of related factors. 2014). Patience level is another dimension that
changes the behaviour and attitude of mental health staff towards mentally ill patients. Those health
care professionals continuously monitor the level of improvement which helps them to put more
efforts in the care plan. Hence, from both the aspects it can be said that attitude of health care
professionals keeps on changing as per their mental stimuli. Mental ill patients are experiencing
several problems from the staff members and most often it also results in abusive practices.
Impact of implicit cognition attitude on behaviour of mental health care professionals
Disparities in health care hold a great concern with much attention focused on the potential
for implicit bias. From the past research work, it has been identified that unrecognized bias against
members of social group such as racial and ethnic minorities affect the communication process or
care provision that is offered to those individuals (Kopera and et.al., 2014). However, on the other
side, it can be contradicted that implicit bias operates in an unintentional and even in unconscious
manner. This type of bias does not need perceiver to devote the attention through expression. Rather
this, implicit bias can be activated unknowingly or unintentionally through situational cues. This
exerts its influence on perception, memory and behaviour. At the same time, author also contended
that implicit bias can operate without a person’s intent or awareness; therefore it does not allow
people to have controlling aspects on the behaviour.
Further, the study developed by Blair (2011), portrays that the stigma surrounding mental
illness can be act as a universal barrier which reduces the opportunities of living a good life. Stigma
involves many factors such as stereotypes, prejudice and discrimination. Inappropriately, mental
health professionals also have been found to endorse negative stereotypes about mental illness.
Attitude has a direct impact on behaviour and positive attitude amends the capability to assist the
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stigmatized group (Laura and et.al. 2013). In contrast to this, it is argued that negative attitude
predict if mental health professionals delegate more diagnosis and poorer prognoses to consumers
that depicts through clinical articles. When a condition is tend to show more anger; health care
professionals have to predict the changes that might occur in their cognition behaviour. At the same
time, it is also vital for the care professionals to measure the implicit measure which provides
unique information on biased attitudes. Similarly, it enhances predictions of discriminatory
behaviours (Blair and et.al. 2011).
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METHODS
Participants
In the present study, 50 participants participated as subjects where in all were included for
the FAST test. 5 participants from each of the group are selected such as from MH Forensic (people
were segregated among low and medium secure), older persons unit with MH problems, Female
eating disorder unit, PICU, Neuropsychological disorder, Neuropsychiatric disorder units, Male
Personality disorder unit, CAMHS, Triage acute ward and Substance misuse community services
(Nolan and et.al., 2016). During this period, health care practitioners are required to treat several
diseases that are related to mental health problem. As a part of the care team, people have been
selected according to knowledge about mental illness who have specific knowledge about
schizophrenia, mental disorder and dementia and psychiatry.
Specific psychiatrics have been used who have knowledge and experience regarding mental
health. This could be the first opportunity to treat mentally ill patients who are in the residential care
home for several years. According to their roles and responsibilities, care practitioners assess
problems of the patients through analysing the symptoms and also through conducting proper
medical tests (Goguen and et.al. 2016). This helps the mental health care practitioners to treat
people under adequate supervision. In the study, participants were also asked to assess their own
attitude towards mentally ill patients by using FAST test and questionnaire. The subjects were also
recruited both from acquaintances of the experimenter. This can be done through using a
snowballing technique in which the subjects are asked to recruit a further subject for participation.
Further, informed consent was also obtained in writing from all the subjects selected.
Apparatus
The entire experiment have been completed with the help of computer system which helped
the participants to clearly identify the words appearing on the screen. FAST test has been utilized
for the study for the purpose of observing the stimulus of the responses.
Measures and procedures
To assess the implicit cognition attitude towards mentally ill patients and for this the
participants underwent FAST test. After conducting the test, people filled the questionnaire which
had numerous questions. General procedure has been followed in the study and two basic
dimensions (consistent and inconsistent test blocks) are utilized for getting the responses. All the
phases have been presented through computer software where in specific instructions were given to
the responses prior getting into any phase (Werntz and et.al. 2016). Subjects were appropriately
presented on the computer screen with the distance of around 60 to 70 cm at eye level.
The test is conducted on three major phases where in Phase 1 denotes the check practice in
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which the participant learn the ways to carry out the test. At this phase, researcher explained the
participants that the first block is a practice run. Participants have also asked several questions
related to phase 1. Further, Phase 2 is an experiment stage wherein participants begin properly with
the test; however at this stage also, they asked for several questions. At the time of completing the
test, participants were requested to press O for the purpose of recording the data. Hence, as per the
instructions, each and every participant did the same. After conducting the study, questionnaire has
been provided to the respective participants so that specific data can be acquired.
FAST
The Function Acquisition Speed Test (FAST) is a test methodology which accesses the
participant’s historical aspects regarding the way they respond. This also uses their stimulus
relations. The methodology is based on analysing already established stimulus which has relations
interfere with the formation of new stimulus relations. Further, it also focuses on the concept of
behavioural momentum (Cartwright and et.al. 2016). In this test, it is essential for the participants to
complete two simple discrimination test blocks where in each block uses the same four stimuli.
Each and every trial presents a single stimulus and participants also learn through corrective
feedback; hence this assists them to analyse if they are going wrong or right. “z” or “m” are the two
major keys which needs to be used for the purpose of responding towards the words that are
presented in the computer system.
In the subsequent section, it was essential for the researcher to learn which button to press
when the word appears on the screen. The responses derived from the participants are consistent
according to learning history of people. This quickly depicts the results according to high rate
responding. The two different blocks are diverse according to their purpose in which consistent
block shows the same responses which can be denoted through “Z” and that is reinforced for the
unrelated stimuli (O'Reilly and et.al. 2012). These responses are also regarded as consistent because
it represents participant’s learning. On the other hand, inconsistent block reinforces responses which
are inconsistent with the participant’s learning history. This is so far dissimilar while getting the
responses and that can be denoted by “M”. Hence, this is related to previously related stimuli.
Thus, it can be said that an acquisition rate difference in trail requirement to criterion can be
identified through several consistent and inconsistent test blocks in the predicted direction.
Therefore, it can be said that the FAST test allows the researcher to ascertain the history of
associating the two classes of stimuli. Direct relationship among stimuli can be identified with the
help of using FAST procedure (Goguen and et.al. 2016). As per the views of author, FAST
procedure is functionally similar to Many-to-one training procedure which analyses two separate
associations between geometric shapes. Considerably, recent studies have been analysed which is
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