PSYCHOEDUCATION FOR MENTAL ILLNESS: A REVIEW ANALYSIS.

The stigma based on myths and misconceptions related to mental illness can be considered as an obstacle in providing mental illness treatment and care. An effective intervention to reduce the stigma can be beneficial. Most family members are not prepared to accept their loved ones has mental illness. Teaching patients and their care givers are of utmost importance. A psychoeducation can be considered as a systematic interventional tool to provide information. Developing awareness is an essential focus of a psychoeducation program. Understanding the impact of Psychoeducation can not only reduce the stigma but it can also enable the social reintegration of the individual suffering from mental illness. Implementation of structured Psychoeducation will surely deliver optimistic messages about the nature and treatability of mental health problems. Improved knowledge will abolish the negative perception associated with mental illness.

The stigma based on myths and misconceptions related to mental illness can be considered as an obstacle in providing mental illness treatment and care. An effective intervention to reduce the stigma can be beneficial. Most family members are not prepared to accept their loved ones has mental illness. Teaching patients and their care givers are of utmost importance. A psychoeducation can be considered as a systematic interventional tool to provide information. Developing awareness is an essential focus of a psychoeducation program. Understanding the impact of Psychoeducation can not only reduce the stigma but it can also enable the social reintegration of the individual suffering from mental illness. Implementation of structured Psychoeducation will surely deliver optimistic messages about the nature and treatability of mental health problems. Improved knowledge will abolish the negative perception associated with mental illness. The world is changing with much technological advancement but attitude towards mental illness is still somewhere endorsed with negative beliefs. Many individuals have negative myths about mental illness like once a member in the family develops mental illness he will never recover; individual with mental illness is harmful and unpredictable. People are reluctant to discuss about the long -standing problems related to mental illness. Individuals with mental illness are stigmatized which leads to discrimination in the society because of the existing myths and misconceptions. A myth can be considered as a traditional tale which consists of supernatural events that is used to interpreted unknown phenomenon. On the other side misconception is a wrong perception which is usually based on flawed thoughts and understanding.
The present review aims to focus on the impact of psychoeducation on myths and misconception, nature of mental illness which will help to reduce the stigma that is passed from one generation to the next.

Stigma towards mental illness:
The stigma towards the concept of mental illness is devastating for both the affected individual and the care givers. It prevents them from seeking mental health treatment. Hence due to the existing myths, leads to the development of ISSN: 2320-5407 Int. J. Adv. Res. 7 (5), 193-197 194 prejudices which ultimately affects the sufferer. To name a few the sufferers face the consequences of low-selfesteem, self -stigmatization, social insecurity etc.
According to the National Mental Health Survey 2016, 10.6% of adults in India have "any mental disorder" (excluding tobacco use) and 2.7% have depressive disorders, with a treatment gap of >75% for psychotic disorders and neurosis. [1] The reason for the treatment gap include low awareness, inaccessible health care, costs, alternative remedies like religious/ supernatural, as well as stigma, which is widespread, especially in Asia. [2] Stigmatization towards individuals who have mental illness was reported to be higher in Asian than in Western countries. [3] Knowing that the behavior is due to a brain dysfunction rather than the outcome of a sin is important to cope successfully. In addition, however, an empathic understanding of their relative's experience in living with mental illness is necessary. Families of the mentally ill are avid to know all that they can about mental illness-its nature, causes, prognosis, and treatment. It is only with these kind of understandings that they can relate to their relative appropriately and solve a myriad of problems that arise because of mental illness. [4] Psychoeducation: What it means? The term "psychoeducation" was first employed by Anderson et aland was used to describe a behavioral therapeutic concept consisting of 4 elements; briefing the patients about their illness, problem solving training, communication training, and self-assertiveness training, whereby relatives were also included. [5] Psychoeducation may be defined as the education of a person with a psychiatric disorder regarding the symptoms, treatments and prognosis of that illness. It is not simply'providing information', but rather empowering training for patients targeted at promoting awareness, providing tools to manage, cope and live with a chronic psychiatric condition, and changing behaviors and attitudes related to the condition (Colom 2011). [6] It is an educational component about a certain condition that causes disturbance in overall personality of an individual. Psychoeduaction includes cognitive, behavioral, and supportive elements which serves the goal of treatment and rehabilitation for the individual as well for the family members for the individuals suffering from mental illness. Developing awareness is also an essential feature of a psychoeducation program for reducing the stigma associated with mental illness. The provision of understanding the symptomatology, outcomes, management of illness reduces the fear of insecurity and its associated negative emotional responses. Further it helps to deal effectively with the disease like most other physical illnesses.

Significance of Psychoeducation:
Psychoeducation for patients and their family members can result in numerous benefits. The enhancement of knowledge will always be acknowledged, the family members of the patients will perceive a decreased family burden and their quality of life will improve. Understanding the nature and cause of mental illness, its symptoms, treatment modalities will minimize the chances of relapse within the patient. The prevailing concept that mental illness is the result of supernatural phenomenon such as demonic possession, instead will move towards the actual understanding of the neurotransmitter imbalances in the brain through structured Psychoeducation. Psychoeducation involves multidimensional aspects that include familial, social, biological, emotional and pharmacological perspectives.

Types of Psychoeducation 1. Family Psychoeducation
Family psychoeducation refers to a broad range of programs that provide education, support, and guidance to families about coping with mental illness. Education is provided about the nature of mental illness and its treatment; families are taught more effective problem solving and communication skills to cope with the challenges of mental illness; and support are offered through the group setting. The family psychoeducation approach recognizes that mental illness is a brain disorder and that families play a significant role in their relative's recovery. Families who attend psychoeducation programs report high levels of satisfaction with the program and show increase knowledge about mental illness and its treatment. [7] Fontaine believes that caring of patients with schizophrenia in home imposed on families a lot of stress. The families often have little knowledge about the nature of mental illness and receive little information from mental health professionals about how to manage their patient's behavior. Mental illness also has negative impact on family's 195 physical and mental health. Therefore, the family and caregivers should be informed about mental illness and receive more support from medical staff to cope with their situation. [8] Family psychoeducation is an effective psychosocial treatment for schizophrenia. As the results of this study showed that attitude toward mental illness improved with the use of family psychoeducation intervention. Thus, family psychoeducation is an important part of comprehensive care for patients with schizophrenia and is applicable in clinical settings. The application of group psychoeducation is recommended as a supportive intervention for improving families' attitude toward mental illness. [9] Shafri F et al confirmed the effectiveness of family-centered psychoeducation program on Mental Health and Quality of life of the families of adolescents with Bipolar Mood Disorder. [10] A systemic review has demonstrated the efficacy of family psycho-educational intervention in reducing relapse rate, improved recovery of patients, and improved family well-being among participants. [11] 2. Individual Psychoeducation Individual psychoeducation can be more specific and focused and can cover information and content that is more relevant for an individual situation. If group situations are not comfortable then individual psychotherapy with the safety and confidentiality of one to one interaction with a therapist would be suitable. Individual psychoeducation has more impact than the other modalities as it is client focused and more intensive. [12] Gumus F et al examined the effectiveness of individual psycho-education on the functionality and QOL of individuals with Bipolar Disorder. The findings reveled that Four-session of individual psycho-education increases the rate of participation in social activities; however, individual psycho-education seems to be ineffective for improving other functioning and overall quality of life. [13]

Group Psychoeducation
Group psychoeducation is a focused therapeutic intervention which works with a small group of individuals together forming a group usually homogenous in nature. The content of psychoeducation focuses on increasing knowledge about the disorder that can include nature of illness, related myths existing in the society, prodromal symptoms, need for treatment, adherence to medication, relapse prevention.
Six-month group psychoeducation has long-lasting prophylactic effects in individuals with bipolar disorders. Group psychoeducation is the first psychological intervention showing such a long-term maintained efficacy in people with bipolar disorders (Colom F et al). [14] A controlled trial study demonstrated that a six-week psychoeducation program can be a useful intervention to improve adherence in patients undergoing bipolar affective disorder rehabilitation. After six weeks, the psychoeducation program significantly improved patients' adherence. The treatment adherence rate of the patients in the intervention group increased from 40.0% (14 patients on pre-test), to 86.7% (26 patients on post-test). Meanwhile, the treatment adherence rate of the control group was 38.9% (14 patients) for the pre-test and 24.2% (8 patients) for the post-test. [15] Results from more than 30 studies indicate psychoeducation improves family wellbeing, lower rates of relapse and improves recovery. [16] Impact of Psychoeducation: Findings from the study "Direct effects of short-term psychoeducational intervention for relatives of patients with schizophrenia in Japan" reveals that showed that both state and trait anxiety on the State-Trait Anxiety Inventory were significantly lower after psychoeducational intervention than before intervention. In addition, subjective burden and distress reported by the family significantly decreased on the subscales for family confusion resulting from a lack of knowledge of the illness and anxiety about the future, subjective burden and depression resulting from the patient's illness, and difficulties in the relatives' relationships with the patient. Comparison of high and low expressed emotion families showed that the intervention was almost equally effective for the two groups. However, its effectiveness with regard to the subjective burden and depression experienced by the families was significantly greater among high expressed emotion families. The present study confirmed that family psychoeducation during hospitalization, even for a short period, is effective for all families, whether high or low expressed emotion (yamaguchi et al 2006). [17] Structured psychoeducational intervention was significantly better than routine out-patient care among Indian outpatients with schizophrenia and their caregivers in the areas of amelioration of psychopathology, reduction of