Assessment of Health Professionals Views and Beliefs about Mental Illnesses: A Survey from Turkey

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1 International Journal of Humanities and Social Science Invention ISSN (Online): , ISSN (Print): Volume 5 Issue 5 May PP Assessment of Health Professionals Views and Beliefs about Mental Illnesses: A Survey from Turkey Gulay YİLDİRİM 1, Etem Erdal ERSAN 2, Sukran ERTEKİN PİNAR 3, Cagla KİLİÇ 4 1 Assoc. Prof., Cumhuriyet University, aculty of Medicine, Medical Ethics and the History of Medicine Deartment, Sivas, Turkey 2 Assoc. Prof., Numune Hosital, Deartment of Psychiatry, Sivas, Turkey 3 Asst. Prof., Cumhuriyet University, aculty of Health Sciences, Sivas, Turkey 4 Psychologist, Numune Hosital, Deartment of Psychiatry, Sivas, Turkey Abstract: Negative beliefs and rejudices might lead to stigmatization, violation of basic human rights and discriminatory behaviors. To determine health rofessionals views and beliefs about mental illnesses. The samle of this descritive study comrised 317 health rofessionals working in Sivas Numune Hosital. Data were collected with the Personal Information orm, Stigma Assessment Questionnaire and Beliefs toward Mental Illness (BMI) Scale. or the statistical analysis, ercentage distribution, t-test, ANOVA and Tukey test were used. Of the articiants, 18.6% had a relative with a mental illness, and 63.7% stated that eole with a mental illness. Whereas half of the health rofessionals stated favorable oinion about atients with schizohrenia, 41% of them said that atients with schizohrenia might be dangerous and cause other eole harm. The mean scores obtained from the subscales of the BMI scale were as follows: 23.74±6.66 (min-max:6-40) for the dangerousness subscale, 29.55±9.88 (min-max:0-55) for the hellessness and oor interersonal relationshis subscale, and 1.76±2.30 (min-max: 0-10) for the shame subscale. The mean total score of the BMI scale was 55.06±16.06 (min-max: 6-100). Of the health care rofessionals, the nurses/midwives, high school graduates, those with income equal to exenditure and those who had negative oinions about atients with schizohrenia obtained significantly higher total scores from the BMI Scale (<0.05). Although the majority of the health care rofessionals had ositive oinions of atients with schizohrenia, nearly, half of them thought that atients with schizohrenia could be dangerous and cause harm to other eole. Keywords: Belief, health care rofessionals, mental illnesses, stigmatization, views of health rofessionals. I. INTRODUCTION Mental illnesses are revalent in develoed and develoing countries [1]. According to the World Health Organization (2002), one out of every four eole in the world face the risk of a mental illness [2]. According to the Mental Health Profile of Turkey, 18% of the oulation suffers a mental illness at some oint in their lives. In the National Mental Health Action Plan reort, among the mental illnesses, schizohrenia ranked second (2.3%) both in men and in women [3]. Schizohrenia itself, side effects of some medication used for schizohrenia, aearance or behaviors of atients with schizohrenia which disturb other eole, and the society s erceiving schizohrenia as violence and a damage-causing disorder can cause society to develo negative attitudes towards schizohrenia [4]. That eole are frightened of atients with a mental illness and that mental illness is not erceived as an illness affect such attitudes [5]. In a community, individuals with mental disorders are usually erceived as weird, scary, hard to communicate, unreliable and dangerous, and thus they are devalued [6,7]. Peole who are the art of socialization in a culture they belong to develo mental-illness related concets and beliefs in the early years of their lives under the influence of the formal education, family, their own ersonal exeriences and media [1,8]. Negative beliefs in society about mental illnesses not only affect adatation of individuals with mental illnesses to society, their coing with the disease effectively, socialization, admission to health facilities, quality of life, and comliance to treatment and care, but also lead to unemloyment, inadequate education and income losses [6,9-11]. These negative results drive individuals with a mental illness to deseration, and reduce their self-esteem and self-confidence [12,13]. Negative beliefs and rejudices might lead to stigmatization, violation of basic human rights and discriminatory behaviors [13]. Stigmatization is a set of behaviors leading to the searation of eole with certain diseases from others or exclusion of them from society by discriminating against and disaraging them [5]. Among the imortant factors causing stigmatization are a erson s having a sychiatric illness, being treated in sychiatric clinics and/or taking sychiatric medication [13]. 55 P a g e

2 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. Both society and health rofessionals lay a art in the stigmatization of individuals with deteriorated mental health [13]. Of the mental illnesses, the one stigmatized most is schizohrenia [7]. Studies investigating health rofessionals attitudes towards atients with schizohrenia revealed that their attitudes were similar to other eole s attitudes [10]. Society and health rofessionals schizohrenia-related misbeliefs are that schizohrenia is untreatable, atients with schizohrenia are dangerous and aggressive, and they should not be emloyed [5]. Attitudes of health rofessionals roviding health services, education and counseling for atients with mental disorders are imortant because their attitudes directly affect the hel these atients receive [4,8]. Given that mental, social and cultural factors shae attitudes and that health rofessionals reresent the community they serve, it is necessary to determine health rofessionals attitudes. Health rofessionals awareness of their attitudes towards mental disorders and coing with their negative attitudes will affect the quality of care and thus atients' quality of life and satisfaction. This will also hel atients with mental disorders receive otimal health services without being exosed to any discrimination. Health rofessionals negative attitudes towards schizohrenia, their aroaches leading to social isolation and stigmatization will adversely affect the community s attitudes towards schizohrenia and thus might lead to discrimination. The resent study aims to determine health rofessionals views and beliefs regarding mental illnesses. II. Materials And Methods Samle The target oulation of this descritive study comrised 450 health rofessionals including hysicians, nurses, midwives and other health rofessionals working in deartments other than mental health in Sivas Numune Hosital in Turkey. Of the target oulation, 317 acceted to articiate in the study between 15 and 30 Aril 2013 comrised the study samle. Data collection The research data were collected with ersonal information form, Stigma Assessment Questionnaire and Beliefs toward Mental Illness Scale. Personal Information orm: The form develoed by the researchers through the review of the literature includes 9 questions on the socio-demograhic characteristics of the articiants and 7 questions on their views related to mental illnesses [14,15]. Stigma Assessment Questionnaire: The questionnaire consists of eight questions to determine the articiants views on schizohrenia. The items are rated on a 5-oint Likert scale (1=Strongly disagree 2=disagree, 3=neither agree nor disagree, 4=agree, 5=strongly agree). The lowest and highest ossible scores to be obtained from the scale are 8 and 40 resectively [15]. Beliefs toward Mental Illness (BMI) Scale: The scale was develoed by Hirai and Clum (2000) to determine ositive and negative beliefs of individuals with different cultural characteristics towards mental illnesses in the United States. The scale consists of 21 items rated on a 6-oint Likert tye scale (0=comletely disagree, 1=mostly disagree, 2=artly disagree, 3=artly agree, 4=mostly agree, 5=comletely agree). The lowest and highest ossible scores to be obtained from the scale are 0 and 105 resectively. Higher scores obtained from the overall scale and subscales indicate negative beliefs. The BMI scale consists of three subscales (Dangerousness subscale, Hellessness and oor interersonal relationshis subscale, Shame subscale). In the validity and reliability study of the scale conducted by Bilge and Çam (2008) in Turkey, Cronbach's alha coefficient for the overall scale was 0.82 [14]. Procedure Before the alication, the articiants were informed about how they would fill in the data collection tools. The researchers handed out the questionnaires to the articiants and collected them after the articiants filled them in. It took aroximately minutes to fill in the questionnaires. Data analysis The data obtained from the study were evaluated using the Statistical Package for Social Sciences for Windows In the analysis of data, ercentage distribution, significance of the difference between two means test and ANOVA were used whereas the Tukey test was used to determine from which grou the difference arises. In determining whether there was a statistically significant relationshi between the variables, <0.05 was used. Ethical considerations Before the study was started, the aroval of Clinical Research Ethics Committee (Decision no: /12) and the written ermission from Numune Hosital where the study was to be carried out were obtained. 56 P a g e

3 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. III. indings Of the articiants in the resent study, 27.4% were in the age grou, 63.1% were university graduates, 67.5% were women, 79.2% were married, 62.1% were nurses/midwives, 89.6% grew u in urban areas, 73.5% had children, 54.6% had an income equal to exenses, 90.5% had a nuclear family, and 18.6% had a relative with a mental disorder. Sixty-three oint seven ercent of the resondents stated that eole with mental disorders caused them distress. Whereas half of the health rofessionals stated favorable oinion about atients with schizohrenia, 41% of them said that atients with schizohrenia might be dangerous and cause other eole harm, 47% did not want to have neighbors with schizohrenia and 44.8% stated that eole with schizohrenia are bizarre eole (Table 1) Table 1: Scores Health Professionals Obtained from the Stigma Assessment Questionnaire Statements Neither Patients with schizohrenia have oor ersonality traits Patients with schizohrenia cannot take care of themselves Patients with schizohrenia are dangerous and can cause harm any moment Patients with schizohrenia are not different from the children Patients with schizohrenia cannot carry out their resonsibilities disagree nor agree n % n % n % I do not want to have neighbors with schizohrenia Patients with schizohrenia are bizarre eole It is not worth sending time and money for atients with schizohrenia The mean scores obtained from the subscales of the BMI scale were as follows: ± 6.66 (min-max: 6-40) for the dangerousness subscale, ± 9.88 (min-max: 0-55) for the hellessness and oor interersonal relationshis subscale, and 1.76 ± 2.30 (min-max: 0-10) for the shame subscale. The mean total score of the scale was ± (min-max: The mean scores obtained from the dangerousness and hellessness and oor interersonal relationshis subscales were above the average (Table 2). Table 2: Mean Scores Obtained from the Beliefs Toward Mental Illness (BMI) Scale Subscales Min Max Mean Dangerousness Hellessness and oor interersonal relationshis Shame Total 6 40 * (0-40) ** 0 55 * (0-55) ** 0 10 * (0-10) ** * (0-105) ** * scores health rofessionals obtained from the BMI scale ** min-max scores for the BMI scale 23.74± ± ± ± P a g e

4 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. A statistically significant difference was found between the mean scores obtained from the BMI scale and its dangerousness and hellessness and oor interersonal relationshis subscales, and the following items in the Stigma Assessment Questionnaire: "Patients with schizohrenia have oor ersonality traits," "Patients with schizohrenia are dangerous and can cause harm any moment", "Patients with schizohrenia are not different from the children," "Patients with schizohrenia cannot carry out their resonsibilities," "I do not want to have neighbors with schizohrenia" (<0.05). A statistically significant difference was determined between the mean scores obtained from the BMI scale, its dangerousness, hellessness and oor interersonal relationshis and shame subscales, and the following statements: "Patients with schizohrenia are bizarre eole" and "It is not worth sending time and money for atients with schizohrenia" (<0.05). The mean total scores obtained from the BMI scale by the health rofessionals who had negative oinion of atients with schizohrenia were high. The difference between the mean scores for the BMI scale, its dangerousness, hellessness and oor interersonal relationshis and shame subscales, and the statement "Patients with schizohrenia cannot take care of themselves" was not statistically significant (>0.05) (Table 3). Table 3: Mean Scores Health Professionals Obtained from the Beliefs Toward Mental Illness (BMI) Scale and its Subscales According to the Items in the Stigma Assessment Questionnaire Subscales of the BMI Scale Patients with schizohrenia have oor ersonality traits Patients with schizohrenia cannot take care of themselves Patients with schizohrenia are dangerous and can cause harm any moment Patients with schizohrenia are not different from the children Patients with schizohrenia cannot carry out their resonsibilities I do not want to have neighbors with Dangerousness 22.45± ± ±7.23 = ± ± ±6.81 =0.354 = ± ± ±6.49 = ± ± ±6.73 = ± ± ±7.13 =6.327 =0.002 * Hellessness and oor interersonal relationshis 27.76±9, ±9, ±10,16 = ± ± ±8.50 =1.202 = ± ± ±10.30 =4.089 =0.018 * 27.36± ± ±9.64 = ± ± ±9.54 =5.451 =0.005 * Shame 1.60± ± ±2.39 =1.283 = ± ± ±2.24 =0.857 = ± ± ±2.24 =1.985 = ± ± ±2.29 =1.542 = ± ± ±2.22 =2.564 =0.079 Total BMI Scale 51.81± ± ±17.17 = ± ± ±1.49 =0.819 = ± ± ±16.35 = ± ± ±15.68 = ± ± ±16.37 =6.346 =0.002 * 58 P a g e

5 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. schizohrenia Patients with schizohrenia are bizarre eole It is not worth sending time and money for atients with schizohrenia * < ± ± ±6.75 = ± ± ±6.56 = ± ± ±7.09 =6.376 =0.002 * 26.36± ± ±9.55 = ± ± ±9.73 =7.081 =0.001 * 28.85± ± ±9.75 =5.555 =0.004 * 1.44± ± ±2.22 =2.863 = ± ± ±2.34 =4.900 =0.008 * 1.59± ± ±3.03 =6.856 =0.001 * 48.69± ± ±15.81 = ± ± ±1608 = ± ± ±16.76 =8.073 Comarison of socio-demograhic characteristics with the BMI scale revealed that the total BMI scale scores of the nurses/midwives, high school graduates and those with the income equal to exenses were statistically higher (<0.05). When the subscales of the BMI scale were evaluated, it was determined that the nurses/midwives and high school graduates obtained higher scores from the dangerousness, hellessness and oor interersonal relationshis and shame subscales whereas those in the age grou and those having income equal to exenses obtained higher scores only from the shame subscale (<0.05) (Table 4). Table 4: Mean Scores Health Professionals Obtained from the Beliefs Toward Mental Illness (BMI) Scale and its Subscales According to Their Socio-Demograhic Characteristics Subscales of the BMI Scale Age Education High school University Postgraduate Profession Nurse/midwife Physician Other health ersonnel Dangerousness 25.40± ± ± ± ±6.51 =2.089 = ± ± ±6.53 = ± ± ±7.54 =8.895 Hellessness and oor interersonal relationshis 30.31± ± ± ± ±9.65 =0.692 = ± ± ±8.42 = ± ± ±12.85 =4.056 =0.018 * Shame 3.09± ± ± ± ±209 =2.703 =0.031 * 2.26± ± ±1.61 =5.363 =0.005 * 2.04± ± ±2.47 =4.201 =0.016 * Total BMI Scale 58.81± ± ± ± ±15.21 =1.408 = ± ± ±14.21 = ± ± ±20.48 =7.517 =0.001 * 59 P a g e

6 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. Income-exenditure status Income less than exenses Income equal to exenses Income greater than exenses * < ± ± ±6.89 =2.309 = ± ± ±8.93 =2.701 =0.069 * 1.84± ± ±1.80 =3.552 =0.030 * 56.75± ± ±15.23 =3.394 =0.035 * IV. Discussion In this resent study, most of the health care rofessionals had ositive oinions of atients with schizohrenia. This is robably because they did not deal with individuals with mental illnesses or did not directly witness negative behaviors dislayed by those eole or the symtoms of mental illnesses. Another reason was that eole in general feel ity for eole with disabilities. Similar to the results of the resent study, the results obtained in Shyangwa et al. s (2003) study conducted to assess nurses' knowledge of and attitudes towards mental illnesses indicated that the majority of the nurses dislayed ositive attitudes towards mental illnesses [11]. Nearly half of the resondents stated that atients with schizohrenia might be dangerous and cause other eole harm. This might be due to reulsive hysical aearance of atients with schizohrenia, and their behaviors. The health rofessionals may have thought that individuals with mental disorders are incometent, aggressive, dangerous and unreliable, because these atients are erceived to have the otential to engage in unredictable behaviors such as irresonsibility and lack of self-control. urthermore, these findings suggest that health rofessionals need more information about the treatment and course of schizohrenia, and do not know much about mental illnesses. Of the attitudes non-sychiatric health rofessionals dislay towards atients with mental disorders, uneasiness and reluctance to establish contact with these atients are noteworthy. In several studies, the majority of non-sychiatric health rofessionals erceive atients with mental illnesses as offensive [16-18]. In Shyangwa et al. s (2003) study conducted to assess nurses knowledge of and attitudes toward mental illnesses, while 30% of the resondents erceived individuals with mental illnesses as aggressive and dangerous, 37.3% used the word "crazy" to describe them [11]. In Kaungwe et al. s (2011) study, nearly half of the resondents erceived individuals with mental illnesses as aggressive [19]. Another reason underlying health rofessionals negative oinions of schizohrenia might be due the fact that they are not knowledgeable enough about how to deal with atients with schizohrenia and their behaviors [12]. Society s rejudices, general conditions of sychiatric services, media and movies about sychiatric atients and sychiatric clinics may affect health rofessionals negative views of and stigmatizing attitudes toward eole with mental disorders [20]. There are also studies reorting that even health rofessionals working in sychiatry clinics dislay negative attitudes toward eole with mental disorders [6]. This might be attributed to their exeriences in their rofessional life rather than rejudices. Comarison of views about mental illnesses and the scores for the BMI scale revealed that total BMI scale scores of health rofessionals with negative oinions were higher. Nearly half of the resondents stated that they did not want to have neighbors with schizohrenia and that eole with schizohrenia were bizarre eole. Studies conducted with non-sychiatric health rofessionals revealed that more than half of them ket social distance with atients with schizohrenia, and that the vast majority of them exhibited negative and dismissive attitudes towards atients with schizohrenia [18]. In Aker et al. s (2002) study investigating rimary-care hysicians oinions about eole with schizohrenia, more than half of the hysicians stated that atients with schizohrenia should not be allowed to freely act in the community, that they would be uncomfortable having a neighbor with schizohrenia, and that these eole would not make right decisions about their lives [17]. In the literature, it has been emhasized that not knowledge but negative attitudes toward and judgments about atients come to the foreground, that attitudes toward mental health roblems are not sufficiently ositive, and that dismissive and stigmatizing attitudes towards atients with schizohrenia among hysicians are revalent [10]. Studies conducted in Turkey indicate that lay eole have negative oinions of atients with schizohrenia as do health rofessionals [7]. Students who are candidates of health rofessions also have negative oinions about atients with schizohrenia. Negative oinions they form during school years cause them to maintain the same oinion in work life [21]. The scores obtained from the BMI scale and its subscales excet for the shame subscale were above average. Based on this, it can be said that the articiants had favorable beliefs about mental illnesses only in terms of the shame subscale. Peole as art of the socialization rocess in a culture they belong to develo mental illnessrelated concets and beliefs in the early years of their lives. In other studies on the issue, adolescents and individuals who did not yet begin working life achieved scores similar to those of adults working in the health field [21,22]. Comarison of socio-demograhic characteristics with the BMI scale scores revealed that the health rofessionals in the age grou had more negative beliefs about mental illnesses than did the health 60 P a g e

7 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. rofessionals over age 40. The younger health rofessionals having more negative beliefs about mental illnesses might be due the fact that they lack adequate knowledge and exerience about the diagnosis, etiology and treatment of mental diseases, and face atients with mental illnesses less often. However, that international and national rojects on the revention of stigmatization have been ut into effect only recently and that these toics are not included in the curricula may have affected this situation. ears and lack of knowledge lead to rejudices in society. Therefore, to reduce these rejudices and stigmatization in the society, informative and educational camaigns should be widely held in the different segments of society [23]. By imroving negative attitudes towards sychiatric disorders during adolescence, social distance between adults to sychiatric atients can be reduced [22]. Studies conducted with adolescents and medical school students indicate that they exhibit stigmatizing and negative attitudes towards schizohrenia [23,24]. Ndetei et al., (2011) conducted a study with 684 non-sychiatric hosital emloyees and found that awareness of mental illnesses of hysicians at the age of 40 or over were more ositive, which suorts the results obtained from the resent study [8]. However, the results of Aker et al. s (2002) study of rimary-care hysicians were different from the results of this resent study, because their results indicated that mean scores were deendent on the age factor, and that as the age increased so did the rate of negative oinions of schizohrenia [17]. In Kaungwe et al.'s (2011) study of rimary caregivers, articiants over the age of 40 were more uncomfortable with individuals with mental illnesses than were articiants in the age grou [19]. Unlike the results of the resent study, the results of a study conducted by Bağ and Ekinci (2005) to investigate attitudes dislayed by health ersonnel towards individuals with mental health roblems revealed that there was no significant relationshi between age grous and attitudes towards mental health roblems [18]. This is robably due to the fact that the articiants age grous in the two studies were different. Health rofessionals with the Master s degree had a more ositive belief about the items in the dangerousness, hellessness, oor interersonal relationshis and shame subscales. In their study (2005), Bağ and Ekinci found results similar to those in the resent study indicating that university graduate health rofessionals attitudes towards individuals with mental health roblems were more ositive [18]. In their study (2011), Ndetei et al. determined that knowledge ositively contributed to attitudes towards mental illnesses [8]. Performing attemts to develo health students awareness of their own feelings and thoughts, and rather than roviding theoretical training on attitudes towards mental illnesses, enabling them to form favorable beliefs and oinions of mental illnesses during ractical training are considered to lay a role in reducing their negative beliefs and oinions likely to arise early in their rofessional lives in the future. Corrigan and Watson (2002) stated that roviding accurate information about mental illnesses might hel eliminate false beliefs and doubts in the community and reduce mental illness-related fears and social distance [9]. Physicians beliefs about the items in the dangerousness, hellessness and oor interersonal relationshis and shame subscales were more ositive. The fact that atients are in direct contact with nurses and health workers other than hysicians accounts for these health rofessionals negative attitudes [20]. Many health rofessionals might have difficulty in understanding eole with mental illnesses in clinics and in the community and thus might form negative oinions [18]. Medical staff with income greater than exenses had a more ositive belief about the items in the dangerousness, hellessness and oor interersonal relationshis and shame subscales. An individual s ercetion of his/her economic level as inadequate leads to negative feelings and judgments such as worthlessness, fear of rejection, desair, shame and low self-confidence and thus reduction in self-esteem. Individuals who erceive themselves as worthless and inadequate might have negative judgment about individuals with mental illnesses. In Çam and Bilge s study (2011) conducted with non-medical eole, eole with low economic levels erceived eole with mental illness as dangerous and had negative beliefs about them [25]. V. Conclusion And Suggestions Although the majority of health care rofessionals had ositive oinions of atients with schizohrenia, nearly half of them thought that atients with schizohrenia could be dangerous and cause other eole harm. The total mean score they obtained from the BMI scale was above 50%. Of the articiants, nurses/midwives, high school graduates and those with income equal to exenses had negative oinions about mental illnesses. In the light of these results, it is recommended to rovide training for health care ersonnel during school years and after graduation to hel them raise awareness of their thoughts and feelings regarding mental illnesses, recognize the underlying causes of their feelings or behaviors and carry out the treatment and care as required by their rofessions free of social rejudices. It is also recommended to inform them of ethical issues. Limitations of the study The results obtained from this study are alicable only to the study samle and cannot be generalized. 61 P a g e

8 Assessment of Health Professionals Views and Beliefs about Mental Illnesses: a Survey rom.. Conflict of interest The authors declare that there are no conflicts of interest. *The study was resented at a osterresentation in the 6th International Congress on Psychoharmacology & 2nd International Symosium on Child and Adolescent Psychoharmacology Aril 2014, Antalya, Turkey. REERENCES [1] Pande, V., Saini, R., & Chaudhury, S. (2011). Attitude toward mental illness amongst urban non sychiatric health rofessionals. Industrial Psychiatry Journal, 20, [2] The World Health Organization (WHO) (2002). htt:// (accessed 18 July 2015). [3] National Mental Health Action Plan ( ) (2011). Ankara: T.C. Sağlık Bakanlığı. (accessed 18 July 2015). [4] Bahar, A. (2007). Schizohrenia and stigmatisation. Journal of the ırat Health Services, 2, [5] Bilge, A., & Çam, O. (2010). The fight against stigma toward mental illness. TA Preventive Medicine Bulletin, 9, [6] Hansson, L., Jormfeldt, H., Svedberg, P., & Svensson, B. (2011). Mental health rofessionals attitudes towards eole with mental illness: Do they differ from attitudes held by eole with mental illness? International Journal of Social Psychiatry, 59, [7] Cris, A.H., Gelder, M.G., & Susannah, R. (2000). Stigmatisation of eole with mental illnesses. Br J Psychiatry, 177, 4 7. [8] Ndetei, D.M., Khasakhala, L.I., Mutiso, V., & Mbwayo, A.W. (2011). Knowledge, attitude and ractice (KAP) of mental illness among staff in general medical facilities in Kenya: Practice and olicy imlications. Afr J Psychiatry, 14, [9] Corrigan, P.W., & Watson, A.C. (2002). Understanding the imact of stigma on eole with mental illness. World Psychiatry, 1, [10] Gürlek Yüksel, E., & Taşkın, E.O. (2005). The attitudes and knowledge of the hysicians and the medical school students towards mental disorders in Turkey. Anatolian Journal of Psychiatry, 6, [11] Shyangwa, P.M., Singh, S., & Khandelwal, S.K. (2003). Knowledge and attitude about mental illness among nursing staff. Journal of Neal Medical Association, 42, [12] Crabb, J., Stewart, R.C., Kokota, D., Masson, N., Chabunya, S., & Krishnadas, R. (2012). Attitudes towards mental illness in Malawi: A cross-sectional survey. BMC Public Health, 12, 541. [13] Coşkun, S., & Güven Caymaz, N. (2012). Comarison of internalized stigma level of atients attending to a ublic and rivate sychiatric institution. Journal of Psychiatric Nursing, 3, [14] Bilge, A., & Çam, O. (2008). Validity and reliability of Beliefs towards Mental Illness Scale. Anatolian Journal of Psychiatry, 9, [15] Yıldız, M., Özten, E., Işık, S., Özyıldırım, İ., Karayün, D., Cerit, C., et al. (2012). Self-stigmatization among atients with schizohrenia, their relatives and atients with major deressive disorder. Anatolian Journal of Psychiatry, 13, 1 7. [16] Afolayan, J.A., Maureen, N., & Buodeigha, W. (2014). Attitude of non-sychiatric trained nurses toward the management of sychiatric atients in a Nigerian hosital. Archives of Alied Science Research, 6, [17] Aker, T., Özmen, E., Ögel, K., Sağduyu, A., Uğuz, Ş., Tamar, D., et al. (2002). The oint of view of the rimary care hysicians about schizohrenia. Anatolian Journal of Psychiatry, 3, [18] Bağ, B., & Ekinci, M. (2005). Examining of attitudes towards mentally ill eole in a samle health rofessionals working. Electronic Journal of Social Sciences, 3, [19] Kaungwe, A., Cooer, S., Mayeya, J., Mwanza, J., Mwae, L., Sikwese, A., et al. (2011). Attitudes of rimary health care roviders towards eole with mental illness: Evidence from two districts in Zambia. Afr J Psychiatry, 14, [20] Üçok, A. (2007). Other eole stigmatize but, what about us? attitudes of mental health rofessionals towards atients with schizohrenia. Archives of Neurosychiatry, 44, [21] Ünal, S., Hisar,., Çelik, B., & Özgüven, Z. (2010). Beliefs of university students on mental illness. Düşünen Adam: The Journal of Psychiatry and Neurological Sciences, 23, [22] Oban, G., & Küçük, L. (2011). Stigma starts early: The role of education among young eole combating stigma about mental illnesses. Journal of Psychiatric Nursing, 2, [23] Kıvırcık Akdede, B.B., Altekin, K., Tokaya, Ş.Ö., Belkız, B., Nazlı, E., Özsin, E., et al. (2004). The rank of stigma of schizohrenia among young eole. New Symosium Journal, 42, [24] Corrigan, P.W., Lurie, B.D., Goldman, H.H., Sloen, N., Medasani, K., & Phelan, S. (2005). How adolescent serceive the stigma of mental illness and alcohol abuse. Psychiatr Serv, 56, [25] Çam, O., & Bilge, A. (2011). Determination of beliefs and attitudes toward mental illness and atients of ublic who live in western art of Turkey. New Symosium Journal, 49, P a g e