Interview with Vinisha Dsouza

As President of the International Society of Psychiatric-Mental Health Nurses, I am excited about our recent formal collaboration with the Indian Society of Psychiatric Nurses (whose acronym is also ISPN). This collaboration, in addition to our recent and similar partnership with Sri Lankan Professional Nurses Clinical Society, is part of our organization’s effort to expand our international network and engagement. I had the opportunity to connect with Vinisha Dsouza, a psychiatric nurse and member of the Indian Society of Psychiatric Nurses. Vinisha is also a PhD student at the University of North Carolina at Chapel Hill School of Nursing. Vinisha shared reflections about psychiatric nursing in India, mental health stigma, nurse well-being, and a vision for future collaborative activities between ISPN and the Indian Society of Psychiatric Nurses.  Vinisha’s thoughtful comments inspired me as I look forward to working with our organizations to enhance mental health and the well-being of nurses around the globe!

 ~ Cheryl Giscombe, PhD, PMHNP-BC, FAAN, FABMR

CG: It is great to have the opportunity to speak to you about your experience as a psychiatric nurse from India. Can you tell us about nursing in India and what attracted you to become a psychiatric nurse?

VD: Nursing in India is like that in the USA, however, we are not as tech-savvy. My journey as a nurse started 22 years back. Phew… It's been a long time. But it feels like yesterday. I have always wanted to be a nurse since my younger days. My dad worked in a government hospital, and I grew up in a household where being in the medical field was a way of life.  My thoughts were tuned to help the community. In India, nursing is considered a women's profession. Being a member of the medical fraternity means being a link that allows the family, neighbors, and community to access good health services and guide better care. Therefore, friends and their friends used to consult my father to understand how to avail benefits from the hospital where he works. I thereby learned about the troubles that people faced in their lives. This made me sensitive to the community's problems and understood the reasons behind their thought process. Since India is a developing country with a significant rural population, the IndianNursing Council requires a nurse to be all-rounded in all specialties. Due to these outlined requirements, I had postings in the Psychiatric Ward and came across the aspect of life that I had never seen before.

I could see how a psychiatric nurse develops her body of knowledge and comes to the unit to be the best for her client, who cannot understand and comprehend the help provided. I questioned myself, can a professional person be so selfless in relieving another person's internal conflicts by keeping aside one's own. This profoundly impacted me and motivated me to become a psychiatric nurse. The term 'Psychiatric' still has a stigma attached to it. So, I often describe myself as a mental health nurse to become approachable and help people understand its essence.

CG: Can you describe "a day in the life" of your work as a psychiatric nurse? In what settings did you work? What did you like most about your work?

VD: As a mental health nurse, I have worked in both the public and private sectors.  I have observed that a Psychiatric Nurse has a similar day as any other Nurse.  However, the difference lies in their approach. The mental health nurse must react and respond to their patient's medical and behavioral conditions instead of focusing only on their medical conditions.

I had the privilege of being in the National Institute of Mental Health and Neuroscience (NIMHANS) as a part of their student exchange program. This premier institute has been providing its profound services since 1925. I was overwhelmed to witness their services and contributions towards mental health. NIMHANS has varied types of patients who cannot be part of society and are referred here from all parts of India. This led me to participate in group and individual counseling sessions like family therapy, child therapy, de-addiction center, rehabilitation services, vocational services, and many more.

The most challenging project I participated in was the community outreach program, which successfully combatted the stigma towards mental illness and provided free treatment in the adopted villages. It is a multidisciplinary approach to patient care. I heard countless stories from the participants about how people come from the neighboring villages, districts, or states to get these services. This experience is still etched in my senses. I feel the need for it whole over my country, as it is going through the pandemic, and many more waves of Covid are expected before it subsides.

CG: What is the biggest challenge in the field of psychiatric nursing in India?

VD: The biggest challenge in psychiatric nursing in India is to remove the stigma towards mental illness. India is a land of integration of many cultures and languages. It is the land of the 4^th highest number of spoken languages that is 447, and many sublanguages, which means there should be chaos, right? But no, India believes in "Unity in diversity." Moreover, this philosophy is taught to a child throughout their school life. I think it builds a tolerance in the people and a sense of acceptance towards others to accept as they are. Then, why stigma towards mental illness? Stigma is ingrained in the belief system and the country's past that defines it.

CG: How does stigma against people with mental health conditions impact the work of psychiatric nurses in India?

VD: India is the birthplace of Hinduism, Buddhism, Jainism and Sikhism. From ancient times people here have interacted and exchanged ideas with other civilizations. So as India got independent and the education system in India got developed, the people of India started building their idea of knowledge. But did it reach the masses (billions) that live here? No, the education system is still crawling to find its place; as the "Inverse Law in Equity" states, most services are concentrated in metropolitan areas, where it is least required. The services still need to reach the remote villages.  As the services reach the people, they will learn and understand the primary cause of mental illness. Until then, there will be a difference in society's reaction towards mental illness.

My experience led me to understand the cross-section at which the disease condition can lead to a stigma in society. Most often, diseases that are seen in the community develop stigma as it becomes apparent. When it is hidden, everything is fine. As it becomes apparent, opinions form conclusions without being backed by evidence. They become a construct that is then believed as a reason for the presence of the illness. Stigma has hindered society in reaching out to the services that are freely available in the community. I don't find the stigma related to other diseases as prevalent as it is for mental illness. 

CG: When you hear the term "Nurses Well-Being" what does that mean to you?

VD: For me, Nurses Well-Being is about being financially stable and taking care of themselves and their family and being respected for their contribution to the community.

CG: Is the concept of self-care among psychiatric nurses prominent in India? If so, what are strategies in place to promote self-care and well-being?

VD: Self-care of nurses in India for being resilient is intertwined with the self-care tradition of their family. Suppose the family is rooted in resilience and supportiveness. In that case, the nurse can get adequate support for many issues in personal and professional life. Nurses in India fall back on their families for emotional support. This all comes with how much they can support their family financially by contributing to their growth.

CG: How has the global pandemic affected the well-being of nurses in India?

VD: The global pandemic has affected everyone and broken the connectedness between the families, which is the backbone of the families and nurses In India. Presently, the shortage of nurses has affected nursing care, especially in the villages. India is a land of festivals, and people celebrate it with pomp and show. The pandemic has brought lives to standstill. Whenever people come back to normal and try to enjoy life, the covid wave surges and affects their lives, this, accompanied by ignorance and indecisiveness, has taken away many lives. It, in turn, has caused burnout among nurses. I hope things turn out better in the future with the roll-out of vaccines for a population of more than a billion. 

CG: How can addressing stigma against mental illness influence the well-being of psychiatric nurses in India and around the globe?

VD: Addressing stigma is the most critical discussion during this pandemic. Because of the numerous lives that have been lost and may lose in the future, there is an anticipation of a depression pandemic. Stigma has always been a barrier between mental health services and a community. Perception of mental illness can only be changed with education. It's a two-way process. Initiatives from the government and people to combat it can only help tackle and achieve health for all during this pandemic. These initiatives call for people-centric approaches that are upstream driven to reach the masses keeping in mind the functional inefficiency of the population they are trying to cater to.

CG: Can you tell us about the ISPN organization in India? Please define the acronym and the objectives of the organization. What motivated you to be involved with ISPN in India?

VD: ISPN is called the Indian Society of Psychiatric Nurses. I am privileged to be an active member of ISPN, and I had joined it to contribute scientifically to the growth of the society of like-minded professionals. A professional organization can only grow when adequate literature is published to create evidence-based functioning values. From its inception, it has created a rich body of literature that has guided and encouraged a lot of research-associated activities among nursing and other disciplines. Thus, helping the Indian nurses develop a sense of belongingness to the professional organization they belong to.

CG: How do you think ISPN and ISPN in India can work together to address the global mental health stigma and well-being of nurses worldwide?

VD: Suppose ISPN India and ISPN global get united. In that case, we would have a great team that would help fight stigma at the regional and international platforms. It would be mutually beneficial. India would get a foothold in the global arena. International nurses can conduct research activities by collaborating and understanding various issues in the South Asian population, diverse from other ethnic-origin societies.

CG: What are other ways the two organizations can optimize their partnership?

VD: I believe that both the organizations can contribute to research activities and share research ideas to help each other grow in their regional interests.

CG: Is there anything else you would like to add?

VD: I would say kudos to ISPN global for initiating this collaboration since it takes much effort to collaborate with an organization diverse in many ways.

CG: Thank you, Vinisha! I am so grateful for the opportunity to learn so much from you, and I look forward to the collaborative future of our organizations.