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I decided to write about stigma related to mental health disorders because it is an unfortunately widespread social issue, even within healthcare systems. The thought that mental illness is a choice or weakness is all too common. This can cause feelings of guilt, despair, and worthlessness, stemming from non-therapeutic thought processes and preconceptions.

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My first artifact for this topic is a watercolour painting I created for the aesthetic art project. I painted this to symbolize the struggles and issues that mental health patients face. The green background represents a clear mind, and the darker dots and lines represent the unhealthy thought patterns that are often experienced with poor mental health. The flower represents the desire to recover and flourish, but also the difficulties and challenges associated with healing.

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My second artifact for this topic is a relevant quote by journalist and news anchor Margaret Larson. I chose this quote because it is a beautifully simple example of how mental illness touches everyone. Most of us have or will have people in our lives who are affected by mental illness, yet it remains a taboo and stigmatized subject in many conversations. This quote examines that stigma and its harmful effect on managing and treating mental illness.

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My final artifact for this subject is a short video about the harm created by stigma and stereotypes. I found this video relevant because it touches on hate, harm, and othering, showing how negative preconceptions can be cruel, unhelpful, and untrue. It evokes feelings of compassion, and creates a connection between people who are different in lifestyle, history, and circumstance. Putting it simply, "stigma equals hate" and "hate equals harm" hits the point I am trying to convey on this subject.

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Eyllon, M., Vallas, S., Dennerlein, J., Garverich, S., Weinstein, D., Owens, K. & Lincoln, A. (2020). Mental health stigma and wellbeing among commercial construction workers. Journal of Occupational and Environmental Medicine, 62 (8), e423-e430. doi: 10.1097/JOM.0000000000001929.

https://oce-ovid-com.proxy1.lib.trentu.ca/article/00043764-202008000-00021/HTML

Collins, R. L., Wong, E. C., Breslau, J., Burnam, M. A., Cefalu, M., & Roth, E. (2019). Social marketing of mental health treatment: California's mental illness stigma reduction campaign. American journal of public health, 109(S3), S228–S235. https://doi-org.proxy1.lib.trentu.ca/10.2105/AJPH.2019.305129

https://pmc-ncbi-nlm-nih-gov.proxy1.lib.trentu.ca/articles/PMC6595511/

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Collins, R. L., Wong, E. C., Breslau, J., Burnam, M. A., Cefalu, M., & Roth, E. (2019). Social marketing of mental health treatment: California's mental illness stigma reduction campaign. American journal of public health, 109(S3), S228–S235. https://doi-org.proxy1.lib.trentu.ca/10.2105/AJPH.2019.305129

Eyllon, M., Vallas, S., Dennerlein, J., Garverich, S., Weinstein, D., Owens, K. & Lincoln, A. (2020). Mental health stigma and wellbeing among commercial construction workers. Journal of Occupational and Environmental Medicine, 62 (8), e423-e430. doi: 10.1097/JOM.0000000000001929.

Image By Design. (2015). Stop the Stigma video [Video]. YouTube. https://www.youtube.com/watch?v=DWaOsPiv-gw

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During my placement, I encountered several people who had developed mental health issues as a result of substance use. Addiction is a mental illness, and it is our role as nurses to not only provide treatment to others without judgement, but to be informed on their issues and advocate for their safety outside of the hospital. The complete, immediate cessation of substance use is not possible for many people. Safer use strategies can be used to help people recover, and can also be used to help save lives.

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This artifact is an image of Peterborough's safe consumption site on Simcoe Street. This space provides a clean, safe place for individuals to consume previously acquired drugs, supervised by professional healthcare workers. It is relevant to the topic of safer consumption because sites like this one destigmatize drug use and help to save lives when things go wrong.

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My second artifact for this topic is an image of people protesting against a Waterloo safe consumption site. I included this image to highlight the controversy spawned by conversations surrounding safe consumption. Many people feel that safe consumption sites will not help those struggling with addiction, and that our resources should instead be put towards improvement of rehab and detox facilities. This is an example of the conflicting ideas and opinions surrounding this subject.

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Barry, C. L., Sherman, S. G., Stone, E., Kennedy-Hendricks, A., Niederdeppe, J., Linden, S., & McGinty, E. E. (2018). Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy, 63, 18–22. https://doi.org/10.1016/j.drugpo.2018.10.008

https://www-sciencedirect-com.proxy1.lib.trentu.ca/science/article/pii/S0955395918302706

McNeilly, R., Berardi, L., Haggerty, K. D., Bucerius, S. M., & Krahn, H. (2024). ‘Valuable lives to save’ vs. ‘babysitting these people while they try to kill themselves’: Changing police attitudes towards safe consumption sites. The British Journal of Criminology. https://doi.org/10.1093/bjc/azae021

https://academic-oup-com.proxy1.lib.trentu.ca/bjc/article/64/6/1275/7643537

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Barry, C. L., Sherman, S. G., Stone, E., Kennedy-Hendricks, A., Niederdeppe, J., Linden, S., & McGinty, E. E. (2018). Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy, 63, 18–22. https://doi.org/10.1016/j.drugpo.2018.10.008

CTV News. (2019). Protesters rally against safe consumption sites. CTV News. Protesters rally against safe consumption sites | CTV News

Fourcast. (n.d.). Consumption and treatment services site (CTS). Fourcast. https://www.fourcast.ca/programs-and-services/opioid-services/consumption-and-treatment-services-site-cts/

McNeilly, R., Berardi, L., Haggerty, K. D., Bucerius, S. M., & Krahn, H. (2024). ‘Valuable lives to save’ vs. ‘babysitting these people while they try to kill themselves’: Changing police attitudes towards safe consumption sites. The British Journal of Criminology. https://doi.org/10.1093/bjc/azae021

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Consumption and Treatment Services Site (CTS) - Fourcast

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The Consumption and Treatment Services site (CTS) at 220 Simcoe in Peterborough is a health service that provides a safe, clean space for people to consume pre-obtained drugs under the supervision of health professionals. Staff are present at all times to respond to medical emergencies. Individuals are also provided with sterile injection supplies, education on […]

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While I was placed on the mental health unit at PRHC, I had the opportunity to spend a shift on the short-stay PICU floor. During this time I participated in the treatment of those who had attempted suicide. This was an eye-opening experience, and I was grateful to have such a personal learning opportunity. Preventing suicide is a high-acuity aspect of mental health nursing, and is something that nurses of all specialties should be informed about.

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My first artifact for this topic addresses suicide prevention in adolescents. This short video features common warning signs of mental illness and suicidal thoughts. In teens and children, mental illness can be mistaken for behavioral issues, so it is of the utmost importance to take these warning signs seriously. All mentions of suicidal thoughts should be taken seriously. Suicide is preventable, and as nurses we need to know the signs and be able to intervene.

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My second artifact is a copy of the Columbia Suicide-Severity Rating Scale. This is an assessment tool that I had the opportunity to use during my mental health placement. It helps nurses to compile risk factors for suicidal and self-harming thoughts in those struggling with mental illness, and may also be used off the mental health floor. It is an incredibly important tool to understand in order to create a safe, healing environment for those at risk of suicide.

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Bilog, A. D. (2024). Contemporary issue: Starting nurse suicide prevention during pre-licensure education. Nurse Education Today, 140, 106288. https://doi.org/10.1016/j.nedt.2024.106288

https://www-sciencedirect-com.proxy1.lib.trentu.ca/science/article/pii/S0260691724001989

Cottrell, D. , Gonzalez, J. , Atchison, P. , Evans, S. & Stokes, A. (2022). Suicide risk and prevention in LGBTQ+ youth. Nursing, 52 (2), 40-45. doi: 10.1097/01.NURSE.0000803432.31284.34.

https://oce-ovid-com.proxy1.lib.trentu.ca/article/00152193-202202000-00012/HTML

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Bilog, A. D. (2024). Contemporary issue: Starting nurse suicide prevention during pre-licensure education. Nurse Education Today, 140, 106288. https://doi.org/10.1016/j.nedt.2024.106288

Cottrell, D. , Gonzalez, J. , Atchison, P. , Evans, S. & Stokes, A. (2022). Suicide risk and prevention in LGBTQ+ youth. Nursing, 52 (2), 40-45. doi: 10.1097/01.NURSE.0000803432.31284.34.

HPBSG. (2023). Look out for the warning signs of self-harm and suicide [Video]. YouTube. https://www.youtube.com/watch?v=AgllYRnLIkw

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Compliance ideology in nursing and healthcare contributes to the labelling of patients as "difficult" or "troublesome". This can lead us to have negative preconceptions about the people under our care. I wanted to address compliance ideology and negative language in the context of healthcare because it is common and harmful. My experiences in placement have shown me that healthcare workers can become desensitized to negative, inappropriate language. It is our responsibility to ensure that we are using patient-centered, positive terms in order to promote an effective nurse-patient relationship.

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For this artifact, I chose an art piece that is meant to represent the experience of psychosis. I chose this art piece to demonstrate not only the challenges of managing mental illness symptoms, but also managing medications and treatments. Labelling a person as non-compliant is not helpful because it does not address the deeper issues that may be causing missed doses or inappropriate medication use.

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This art piece encapsulates the uncertainty that many people face during treatment of mental illness. Stigma surrounding antidepressants or other medications can cause people to fear addiction or losing their "true self". These factors are important to take into consideration when we are attempting to establish steady routines in mental health treatment. As nurses, we can provide education and reduce fear surrounding medications and treatment.

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This image represents non-therapeutic communication techniques and harmful language in nursing. Using negative labels such as "difficult" or "drug-seeking" can cause healthcare providers to become biased in their care, leading to harm and adverse outcomes. It is our responsibility to use non-judgmental, positive language in order to provide the highest level of care to every patient.

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Healy, M., Richard, A., & Kidia, K. (2022). How to reduce stigma and bias in clinical communication: a narrative review. Journal of General Internal Medicine, 37(10), 2533–2540. https://doi.org/10.1007/s11606-022-07609-y

How to Reduce Stigma and Bias in Clinical Communication: a Narrative Review | Journal of General Internal Medicine

Valdez, A. (2021). Words matter: Labelling, bias and stigma in nursing. Journal of Advanced Nursing, 77(11). https://doi.org/10.1111/jan.14967

Words matter: Labelling, bias and stigma in nursing - Valdez - 2021 - Journal of Advanced Nursing - Wiley Online Library

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How to Reduce Stigma and Bias in Clinical Communication: a Narrative Review - Journal of General Internal Medicine

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A growing body of literature demonstrates that healthcare providers use stigmatizing language when speaking and writing about patients. In April 2021, the 21st Century Cures Act compelled clinicians to make medical records open to patients. We believe that this is a unique moment to provide clinicians with guidance on how to avoid stigma and bias in our language as part of larger efforts to promote health equity. We performed an exhaustive scoping review of the gray and academic literature on stigmatizing medical language. We used thematic analysis and concept mapping to organize the findings into core principles for use in clinical practice. We compiled a list of terms to avoid and seven strategies to promote non-judgmental health record keeping: (1) use person-first language, (2) eliminate pejorative terms, (3) make communication inclusive, (4) avoid labels, (5) stop weaponizing quotes, (6) avoid blaming patients, and (7) abandon the practice of leading with social identifiers. While we offer guidance clinicians can use to promote equity through language on an individual level, health inequities are structural and demand simultaneous systems and policy change. By improving our language, we can disrupt the harmful narratives that allow health disparities to persist.

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Foss-Feig, J. (2024, October 1). Signs of psychosis in people with autism warrant serious concern. The Transmitter: Neuroscience News and Perspectives. https://www.thetransmitter.org/spectrum/signs-psychosis-people-autism-warrant-serious-concern/?fspec=1

Gometz, E. (2023). Depression isn’t caused by low serotonin. So how do antidepressants work? Science Friday. https://www.sciencefriday.com/segments/chemical-imbalance-depression-medication/

Healy, M., Richard, A., & Kidia, K. (2022). How to reduce stigma and bias in clinical communication: a narrative review. Journal of General Internal Medicine, 37(10), 2533–2540. https://doi.org/10.1007/s11606-022-07609-y

Valdez, A. (2021). Words matter: Labelling, bias and stigma in nursing. Journal of Advanced Nursing, 77(11). https://doi.org/10.1111/jan.14967

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My patient discharge presentation for my mental health placement focused on community supports after hospital discharge, an essential part of remission and recovery from mental illness. Many people living with poor mental health do not have sufficient social or community supports, which can exacerbate unwanted symptoms. Advocating for social and community supports is very important as a nurse, because the overall goal is to keep people healthy out in the community.

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This image demonstrates the help and support that a strong community can provide. Tackling mental illness is a difficult feat even with a strong support system, so creating socially inclusive and supportive community spaces for all to use is essential in mental health treatment.

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This graphic shows that the health of individuals and communities are inter-related. Social determinants of health such as environment, socioeconomic status, and education can affect communities at every level. This leads to varying levels of health and wellness in disadvantaged communities, highlighting the need for advocacy and healthcare worker's support of social change.

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This stylized photograph represents the feeling of being alone, even if you aren't. Mental illness can cause feelings of loneliness, misunderstanding, and futility. As community members, looking out for one another and recognizing the signs of mental illness can help us to create our own supportive communities. This can be applied to our fellow nurses, students, family members, and friends.

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Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality. Perspectives on Psychological Science, 10(2), 227–237. https://journals-sagepub-com.proxy1.lib.trentu.ca/doi/full/10.1177/1745691614568352

https://journals-sagepub-com.proxy1.lib.trentu.ca/doi/full/10.1177/1745691614568352

Gilbert, S. (2019). The importance of community and mental health. National Alliance of Mental Health. https://www.nami.org/family-member-caregivers/the-importance-of-community-and-mental-health/

The Importance of Community and Mental Health | NAMI: National Alliance on Mental Illness

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Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality. Perspectives on Psychological Science, 10(2), 227–237. https://journals-sagepub-com.proxy1.lib.trentu.ca/doi/full/10.1177/1745691614568352

Gilbert, S. (2019). The importance of community and mental health. National Alliance of Mental Illness. https://www.nami.org/family-member-caregivers/the-importance-of-community-and-mental-health/

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