CHAPTER ONE
Introduction
Background to the Study
WHO (2001) opined that mental health is an integral component of health through which one realizes one’s own cognitive, affective and rational abilities. It further stated that with a balanced mental disposition, one is more effective in coping with the stress of life, and working productively and fruitfully, and is better able to make a positive contribution to his or her community. In many parts of the world, mental health is still not acknowledged as important as physical and social health, and it remains a low health priority all over the world despite prevailing cases of mental illnesses that are recorded. Today, 450 million people suffer from mental illnesses or disorders in both developed and developing countries (World Health Organization-WHO, 2004). The rates are as follows: United State 26.4 per cent, Ukraine 20.5 per cent, France 18.4 per cent, Columbia 17.8 percent, Lebanon 16.9 per cent, Netherlands 14.9 per cent, Mexico 12.2 per cent, Belgium 12.0 per cent, Spain 9.2 per cent, Germany 9.1 per cent, BEIJING, China 9.1 per cent, Japan 8.8 per cent, Italy 8.2 per cent and Nigeria 4.7 per cent (Global Study Finds Mental illness widespread www.msnbc.msm.com/u/ 51112021/Access 12/8/2008).
Mental health is the capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It involves finding balance in all aspects of our lives, physically, mentally, emotionally and spiritually (WRHA, 2004). That is why, when we wake up from sleep at home and come together as a family, in school as classmates, at work places as colleagues, in recreational centres and play field as playmates among others, we feel satisfy, happy and joyful. This statement indicates the importance of mental health as one of the components of health. Mental health is something that all of us should desire to have for ourselves. It is happiness, peace of mind, enjoyment and satisfaction. Mental health affects people’s everyday life. It affects the work we do and the overall way that people get along with other members of the family, at schools, on the job, at play with their peers, and in the communities. It involves the way that each person balances his or her needs, conditions, abilities, ideas, and feelings in order to meet the demands of every day life. WHO (2001) opined that mental health is a state of wellbeing in which an individual realizes his or her abilities to cope with the normal stress of life.
Hugo, Boshofts, Traut and Dirwagi (2003), explained that mental health is the level of cognitive; that is knowing through sensation and mental structuring, which creates proper awareness of environmental circumstances to make judgement between right and wrong or emotional wellbeing, that is the inner feelings of the individual which is expressed by outward behaviour, such as anger and happiness. According to Nnachi (2007), mental health refers to the positive condition of the individual’s mental state generated by the positive condition or event of the environment, such as joy, happiness, freedom, love, acceptance, appreciation, recognition, affection, peace and satisfaction. Bob (2008), stated that mental heath is the condition in which an individual thinks normally, reasons well, behaves well, relates well, performs well and does things in realization of the person’s potentials. Applying this in the present study, mental health is the capacity of an individual’s personality and emotional attitude, which enables an individual to live harmoniously with his or her fellow men and women at home, in school, at workplace, among others. Mental health implies an individual’s expression of personal happiness, joy, love, affection, peace and satisfaction. Secondary school students need to have good knowledge of mental health in order to exhibit these attributes.
Knowledge concerning mental health is necessary for everybody including secondary school students in Plateau State, where the present study was carried out. Knowledge is the sum of what is known. Tan (2005), opined that, knowledge is the sum of our conceptions, views and prepositions, which has been established and tested as correct reflection as far as they are objective reality. He further stated that knowledge is the body of information and understanding, which an individual has acquired through life experiences and education. Knowledge according to Gupta and Mahajan (2005), is the factual information that is learned initially and then remembered or internalized. This implies that the root of knowledge lies in the sense of perception, the reliability of which is seen in human practice. Nnachi (2007) explained that knowledge is the ability to understand what one has learned and acquired through experiences. Applying this in the present study, knowledge is the ability to reproduce in memory, facts related to mental health, which is referred to as mental health knowledge.
Mental health knowledge, therefore, is the ability to reproduce what is known about mental health Jorm, Korten, Jacomb, Patricia, Christiana, Bryan, Rodgers and Polite (1997a), explained that mental health knowledge as the ability to recognize specific mental health disorder, risk factors, causes and how to seek mental health information, self treatment and available professional help. Hixson (2004) explained that mental health knowledge is the awareness of mental health needs, ability to identify the causes of mental disorders and to manage mental health problems. According to Royal College of Psychiatrists, London (2006), mental health knowledge is the ability to recognize mental health problems in an individual, family member and in the community at large. Mental health knowledge as used in the present study refers to knowing or acquiring information on concept of mental health, mental illness or disorders (psychosis and neurosis) and their prevention, attributes of mentally healthy person, how to prevent mental illness and coping strategies for mental illness.
Possession of adequate mental health knowledge by secondary school students such as those in Plateau State is of paramount important because this type of correct mental health knowledge will make them to grow up with correct mental health knowledge and to develop positive mental health attitude and behaviour. Having correct mental health knowledge can lead to reduction in mental health problems or disorders or illnesses, and can assist individuals to coping mental stresses of life.
Attitude is person’s affective feelings of likes and dislikes. Attitude emerges out of personal experience and can be positive or negative. It is positive when a person develops a strong attraction of likes for the situation, objects or other persons or groups while it is negative when the person develops a strong dislike for situations, objects, persons, groups or any other identifiable aspect of our environment. Odunukwe (2002) stated that attitude is our strong likes and dislikes for situation, objects, persons, groups or any other identifiable aspects of our environment. Abanobi (2005) opined that attitude is how reality is perceived by the individual or group. He further stated that it is learned and that attitude towards an individual, group or objects develops with time upon when, where and how it all happens. Park (2007) viewed attitude as acquired characteristics of an individual which predisposes him or her to respond in some preferential manner. Attitude when used in relation to mental health is termed mental health attitude.
Mental Attitude, therefore, refers to the person’s feeling or opinion about something or someone or a way of behaving that follows from the disposition of people towards events, issues and material things, with some degree of favour or disfavour. Applying this to the present study, mental health attitude is the feelings, beliefs and actual action people have toward people, events, issues, materials relating to mental health with some degree of favour or disfavour or likes or dislikes. One of the tasks of this study is to determine the mental health attitude of secondary school students. Mental health attitude in the present study can be measured by determining the degree of agreement or disagreement to certain attitudinal statement. The Likert attitude measurement scale modified by Osuala (2005), Enyi (2006) and Nwargu (2006) as Strongly agree (SA)= 4, Agree (A)= 3, Disagree (D)= 2 and Strongly disagree (SD)= I, on the positive side; and on the negative side will be strongly agree (SA)= I, Agree (A)=2, Disagree (D)= 3, and strongly disagree (SD)= 4. This modified attitude measurement scale will be applied in this present study to measure the mental health attitude of secondary school students in Plateau state, Nigeria.
Hornby (2005) stated that a student is a person who is studying in a school especially a secondary school. This may also include those studying in secondary schools in Plateau State of Nigeria. They consist of junior secondary one to three (JS1- JS3) and senior secondary one to three (SS1- SS3) students. Secondary school students require considerable information about mental health. A student who possesses accurate knowledge or information on mental health should be able to apply the facts acquired to the solution of his or her mental health problems. Jorm (2001) emphasized this point when he opined that it is the people’s knowledge of mental health that gives meaning to their emotional attitude and fixed habits about mental health and also strengthens them. They should also be able to live happily, peacefully and satisfactorily with self and others. They are also expected to be knowledgeable in the various components of mental health and mental illnesses or disorders which are wellness, psychosis and neurosis.
Okafor and Okafor (1998) spelt out two broad components of mental health thus: Psychosis and Neurosis. They stated that psychosis is a mental illness in which the person’s ability to distinguish between what is real and what is imaginary is seriously affected to the extent that the person starts hearing people saying something to him or her while in the real sense nobody is speaking to him or her. They further stated that the person might develop strong persistent beliefs or delusions which are unbelievable to others around him or her who knows him or her. Roper (1999) maintained that psychosis is the major mental disorder or illness in which a person’s ability to think, respond, remember, communicate, interpret reality and behave normally are not there or seriously affected. Psychosis is further sub- divided into schizophrenia, manic depressive psychosis, delusion, hallucination, social phobia, Schizotypal Personality Disorder (Glossary, 2001).
Schizophrenia is a psychotic disorder characterized by a loss of touch with reality, it is disordering of thought process leading to withdrawal from reality and personal relationships. Manic-depressive psychosis also known as bipolar disorder causes a person’s mood to alter between being very energetic, euphoric, exaggerated and/or irritable to being very depressed, and occasionally psychotic. Delusion is a false belief or opinion inconsistent with the individual’s culture, and level of intelligence, which cannot be altered by argument or reasoning. Hallucination is a false perception occurring without any true sensory stimulus. It includes imaginary voices that give commands or insults to the person.
Okafor and Okafor (1998) viewed neurosis as a mental illness or disorder in which a person suffers strong feelings of fear and worry that has been produced by frustrations and conflicts. Neurosis, according to Surgeon General Report [1999], is the collection of all diagnosable mental disorders; characterized by alteration in thinking, mood or behaviour associated with distress or impaired functioning. It also has subgroups as anxiety, reactive depression, and hysteria; obsess ional neurosis, depression, post traumatic stress disorder, social phobia, and anorexia nervosa among others. Tabor (2006) described anxiety as fearfulness or uneasiness that arises from anticipation of danger. The anxiety may be focused on a certain thing or situation or it may be generalized, or may also be experienced in periods of sudden onset of fear and accompanied by physical symptoms like panic attack. Reactive depression is a persistent unhappiness with decreased energy, loss of appetite, change in sleep patterns, withdrawal and suicidal thoughts. Hysteria usually arises from mental conflict and repression and is characterised by the production of a diversity of physical disorder such as paralysis. Obsess ional neurosis is the state in which a person’s mind is completely filled with thoughts of one particular thing or person in a way that is not normal or consists of a feeling of compulsion to perform repeatedly a simple task or event; example, hand washing, touching door knobs and so on. It can be argued that when adequate knowledge on mental health is acquired by secondary school students it will help them to avoid situations which can lead to mental illness as well as develop measures for the control and prevention of mental illness.
Mental illnesses or disorders can be controlled and prevented at three levels: Primary, secondary and tertiary .Okafor and Okafor (1998) spelt out primary preventive measures as follows: individual and family counselling services; marriage counselling session; parents’ discussion or family forum for all family members; promotion of cultural interests in the society; recreational program for all ages; counselling for children at home and in school; remedial program in school for pupils and staff; mental health instruction as a phase of school healthful services. According to Surgeon General Report (1999) primary prevention also includes early detection of abnormal behaviour change in the students’ and prompt administration of intervention measures and, if possible, referral for expert or skilful measures.Cancro and Wallannce (2003) stated that primary prevention involves provision of strong love and conducive environment for every body to feel a sense of belonging among others.
Secondary prevention involves early and prompt or immediate intervention before significant damage to the nervous system is done. Mental health education program can be organized for young children to create awareness in them about mental health, and training of health personnel in the field of mental health for proper provision of mental health services to the community. The recognition and capacity for treatment of common mental illnesses in the community should also be improved. Secondary prevention also includes creating conducive home and school environment for the school children to grow and develop mentally. Mental health course when included in the school curriculum for the students’ to learn and acquire correct knowledge on mental health will go a long way in preventing mental health problems/illnesses
Tertiary prevention involves acceptance of mentally ill patients referred from secondary level by giving prompt and proper medication to the patients; and retraining of health personnel with more advance skills and technique in handling the patients. The people who recover from mental illness are rehabilitated and integrated into the community without stigmatization and discrimination as a means of preventing the reoccurrence of the condition. As an aspect of tertiary prevention, research work should be carried out on those who have started showing the signs and symptoms of deviation from normal attributes of mentally healthy individuals for prompt intervention measures, so as to prevent such conditions from becoming severe.
The characteristics of a mentally healthy person according to Okafor and Okafor (1998), are that the person feels comfortable about himself and enjoys his capabilities, putting his best effort into what he or she is doing; getting satisfaction from simple everyday things, having tolerant and easy going attitude and laughing at himself/herself; and regularly experiencing a sense of fulfillment in life and in terms of life objectives and he is productive. Kjas (1999), stated that a mentally healthy person thinks, feels and acts positively when faced with life’s situations; that the person provides love and affection for others and he or she is fully eager to learn about mental health and mental illness. Abosede(2003) opined that a mentally healthy person faces problems and solves them intelligently.
A student who possesses very high level of knowledge about the attributes of mentally healthy individuals will be able to apply the facts learned to the solution of his or her mental health problems. Royal College of Psychiatrists, London [2006], explained that mental health promotion is the process of enabling people to increase control over, and thereby improve their health status. It further stated that the aims of mental health promotion is to reduce differences in current health status and ensure equal opportunities and resources to enable people achieve their fullest health potential by making those conditions that have an impact on health, such as political, economic, social, cultural, behavioural and biological factors, favourable through coordinated action by all concerned, including government, health workers , social and voluntary organizations, local authorities, industries and the media.
This present study will be anchored on three theories. These theories are; mental theory, knowledge theory and cognitive theory. Mental theory is a representation in the mind, of real or imaginary situations. Mental theory can be constructed from perception imagination or the comprehension of discourse. This theory will be applied in the present study because the essential process in learning is perception, comprehension and representation of the situation or mental health or mental illnesses image by the secondary school students. Knowledge theory means that people know about things, event and situation around them through their senses of sight, hearing, smell, touch, and taste. This theory viewed in relation to the present study implies that, secondary school students can come to know about mental health and mental illness, and be certain that, they can recognize and identify what they have heard and seen and can even distinguish between a mentally healthy individual and mentally ill individual. Cognitive theory means the process of knowing through sensation and mental structuring how to create the proper awareness of the environmental circumstances and make judgement between right and wrong. This theory will be used in the present study because for a particular behaviour to occur or not to occur, the individual student must be involved in it. If he or she is convinced that the society’s approval will bring about positive outcome, then, he or she will go ahead to behave so. But if on the other hand, he or she is convinced that, the society’s disapproval will result in negative outcome the reverse will be the case (Nnachi, 2007, htt://en.wikipedia.org/wiki/Epistemology access 6/24/2008
There are variables that seem to influence mental health knowledge and attitude of students’. One of such variables is age. Amoran, Lawoyin and Oni (2005) carried out a study on risk factors associated with mental illness in Oyo State, Nigeria. A community based study revealed that little differences existed between various age groups on mental health knowledge and attitude. The study also observed that age bracket 18-24 tended to have higher mental health knowledge and attitude than ages below.
Another variable is gender. In a study carried out by Akhtar-danesh and Ladeen (2007), it was observed that little differences existed between boys and girls in mental health knowledge and attitude. According to the study, boys tended to have high mental health knowledge than girls while girls tended to have more positive mental health attitude than boys.
Level of education also seems to influence mental health knowledge and attitude. A study by Patel (2007) revealed that those respondents whose educational level was less than secondary school had the lowest mental health knowledge and negative mental health attitude; while those with secondary or post secondary education had high mental health knowledge and positive mental health attitude.
Besides age, gender and level of education, another variable that seems to influence mental health knowledge and attitude is location. Dalgard, Mykletun, Rognerud, Johansen and zahl (2007) conducted a study on education, sense of mastery and mental health in Norway. The findings indicated low level of mental health knowledge and negative mental health attitude among the rural communities while high level of mental health knowledge and positive mental health attitude were found among urban communities.
The state of affairs in Plateau State regarding mental health knowledge and attitude of secondary school students may be perceived as uncertain. This focused at determining the mental health knowledge (MHK) and attitude of students as well as to find out if age, gender, and location of students’ are associated with mental health knowledge and attitude of students in Plateau State, Nigeria. Against this background, therefore, the study is aimed at determining the mental health knowledge and attitude of secondary school students in Plateau State, Nigeria.
The present study on mental health knowledge and attitude of secondary school students’ will be carried out in Plateau State. Plateau State is one of the states in the North central geopolitical zone of Nigeria with a population of 3.2 million representing, 2.3 per cent of the entire Nigerian population according to 2006 National population commission (NPC. 2006). There are seven hundred and seventy-six (776) both government and private owned secondary schools in the State. In the State one notices several things. Some people seem to have an easy time, while others have much greater difficulties in accomplishing the things they want to do in life. They actually fail to get what they want. In the pursuit of their goals, they cause trouble or pain to others; and they suffer from feelings of failure, unhappiness, worry, and even from unpleasant physical symptoms like lack of sleep among others. Some individuals go through short periods of relatively minor difficulties, while others seem to be in trouble all the time or at least for large part of their lives. General observation shows that those with marginal job skill, poor education or poor state of health are also to a considerable degree those who have the most difficulty in coping with life situations. These situations can predispose people to poor mental health and subsequently make coping difficult.
Statement of the Problem
Knowledge regarding mental health is important as it is the first step to primary prevention of mental illness. Mental health professionals maintained that primary prevention of mental health aims at promoting the general public’s psychological health; and it aims at forestalling of psychological problem (Cowen, 1983). One obvious way by which primary prevention can be carried out is through health education (Oberteufer, 1960 $ Somers, 1977). In the area of primary prevention of mental health, the role of mental health education is important. Adequate or correct knowledge of mental health is important for some obvious reasons. Apart from strengthening individual competence or enhancing an individual’s psychological well-being, the introduction of mental health education is important to the rehabilitation of those who have mental health problems. It can be argued that in order to re-integrate mental health patients to society, the general public understanding of the nature of mental illness is a necessary pre-requisite.
Literature has revealed that an increase in the understanding of those with mental health problems would lead to more favourable perceptions toward them, (Rabin, 1972; Berg, 1978; Bauer & Gottieb, 1980; Camphel & Troxel, 1985). Although the practical mechanisms underlying the relationship between mental health knowledge and attitude to mental illness and other related issues are not clear, it can be speculated that information through mental health education (learning and understanding of the nature of mental health and mental illness), contrary to one’s beliefs, would lead to attitude change according to the dissonance perceptive theory (Festinger, 1957) or other social information processing views (Gergen & Gergen, 1981).
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