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People, worldwide, experience stigma and discrimination of different kinds because of the impaired mental status. Stigma from treatment is a leading determinant of the health-seeking behavior. Individual experience various forms of stigma from public and self. Stigma can be cumulative in the sense that one form of stigma often gives rise to another. Stigma in people with mental illness has grave consequences. Low self-esteem, social anxiety, unemployment, marginalization, social isolation, poor social support, and social anxiety are common life events that people living mental illness endure. Consequently, the individuals affected develop low self-esteem and depression worsened by a barrier to health access and difficult to secure employment. Therefore, education on the means to cope with stigma apparently has a role in the management of people living with mental illness as it is with the administration of drugs to manage the mental illness. The paper is thus a PICO analysis of the research question: In non-behavioral health nurses who care for psychiatric patients at the emergency department, how does education on ways of combating social stigmatization compared to the strict administration of drugs impact on the overall services offered to psychiatric patients over five months? Literature review Eiring et al. (2015) conducted a study on what matters to the people living with mental disorder regarding medication-associated outcomes. The study considers a patient preference to medication as avenue to aid in the development of drugs and approval. The challenges that arise with medication are preference sensitive, which involves multiple outcomes, and the trade-off of conflicts. Therefore, clinicians and healthcare service providers have a problem in establishing standard medication for people living with mental illness because of the diverse nature of patient preferences. Eiring et al. (2015), thus conducted a study to establish the preferred outcome in correlation to psychoactive medications. The systematic review had no setting restriction. The study included studies with quantitative data on the value in adults living with mental illness regarding the treatment outcome with psychoactive medications. The study, however, did not include research considered to have a high risk of bias, which could compromise the results. The systemic review measured both the primary and secondary outcomes based on preferences and consequences of the medication. The review included 16 articles with the majority stating that people living with mental illness (depression, schizophrenia, ADHD, and bipolar disorder) considered side effects and symptom outcome, and hospitalization as critical factors in the management. Eiring et al. (2015) concluded that that little evidence exists relating the mental illness place and the medical-associated outcomes. Hence, suggest further research determine the correlation. According to Gronholm et al. (2017), there is abundant literature on the study of the relationship between stigma related to mental illness and the effect of stigma on the quality and life of people living with mental illness. Petra et al. (2017), however, consider the use of knowledge and skills reduce discrimination as a complex and long-term, which long-term benefits. The researchers conducted a narrative synthesis systematic review of literature published since 2012. The findings indicated a small to moderate the positive influence of professional intervention and mass media on individuals living with mental illness. The mass media and interventions influenced the attitudes, stigma related knowledge, and intended behavior of the individuals and the public. Nonetheless, the interventions showed little evidence on the benefit of short-term follow-up on the long-term effect on the people living with the mental disorder. The author recommended further investigations to establish the effect of the long-term on the prevention of stigma.

Trani et al. (2015) conducted a matching case-control study to determine the impact of stigma experienced following the poverty of people with severe mental illness India. The study involved 647 subjects with a current diagnosis of affective disorders or schizophrenia and another 647 individuals of the same sex, age, and geographical location acted as a control. The findings indicated a significant risk of poverty because of stigma among people with the severe mental illness. The results showed a higher measure of poverty (38.5%) among people with severe mental illness compared to 22.2% among the control population. The multidimensional poverty had a strong association with the stigma, mental illness, female gender, and scheduled castes. However, among the affected individual's females living with severe mental illness were poorer than were their male counterparts. Trani et al. (2015) concluded that there exists an intertwined and pervasive correlation between multidimensional poverty and public stigma. Women are more vulnerable to stigma than men do because of exclusion from employment opportunities compounded with lack of income and negative attitudes. The high index of multidimensional poverty increases dependence and burden to the family members. The authors conclude healthcare professionals require awareness on the effect of stigma among patients living with a severe mental illness to help in the comprehensive care of individuals with mental illness. South Africa report the significant incidence of stigma and discrimination against people with mental disorders. Egbe et al. (2014) name stigma and discrimination against individuals living mental disability as a barrier to health care and recovery. However, little investigations focus on the experience of the stigma that people living with mental disability face while seeking help in developing countries. In the study, Egbe et al. (2014) focused on the experience of psychiatry stigma to help establish measures and interventions against discrimination and stigma. The study involved 77 adult participants including service providers; 20 lay counselors, 10 professional nurses, 2 auxiliary workers, and 45 clients. The study deduced that that family members, healthcare providers, employers, friends, and members of the community were responsible for the propagation of stigma and discrimination of individuals suffering from mental illness. Misconceptions about mental illness with delayed healthcare interventions were the leading cause of psychiatric stigma. The involvement of healthcare providers worsened the recovery and health-seeking trend. Egbe et al. (2014) suggested counseling of caregivers, family members, and clients alike on the means of handling stigma. Mårtensson, Jacobsson, and Engström (2014) acknowledge the increasing awareness on the adverse effects of negative attitude on people living with a mental disability. The focus of the nursing study was to determine the factors linked to the attitude of nursing staff towards clients living with mental illness. The researchers collected data from 256 mental health nursing staff form a particular county with 10 municipalities. The study revealed a strong association between the nursing competency and stigmatization. The finding shows that staff attitude towards individuals with mental illness influences the outcome positively with less stigmatization. The study concluded that a staff attitude on the client with mental illness is critical to the care of such patients. Hence, the need to inculcate the culture among nurses. Summary and Conclusion The literature review focused on the relevance of stigma and pharmacologic intervention in the management of people living with a mental disability. The purpose was to address the picot question, In non-behavioral health nurses who care for psychiatric patients at the emergency department, how does education on ways of combating social stigmatization compared to the strict administration of drugs impact on the overall services offered to psychiatric patients over five months? The five literature reviewed indicates that stigma and attitude greatly influence the health outcome for people living with mental illness. One of the literature indicates the challenge of establishing the correct medication for a given psychotic disorder. The findings, hence, point to the inadequacy of pharmacologic interventions in the absolute management of people suffering from mental disorder. The remaining four articles concurred that stigma is the greatest challenge that patients living with mental illness struggle with because it emanates from the family, workplace, and, worst-case scenario, from health care providers who should protect and serve the patients. Misconceptions about mental illness and delayed management worsened psychiatric stigma. Discrimination is the leading cause of poverty, especially, among women living with a disability. Individuals living with disability have poor health-seeking behavior, which worsens the situation. Stigma lowers the productivity while increasing the dependence of the affected population on family members. Public health intervention such as mass media, counseling, and a change in nurses’ perception proved positive in the health-seeking behavior and recovery of the patients. One of the journals proposed that healthcare professionals enhance their awareness on the impact of stigma as a way of enhancing care and minimizing the negative effects of stigma. Therefore, education on the stigma and discrimination among nurses and other healthcare professionals has a role in helping patients living mental disability.