Exploring exploitation and mental illness in isolated communities

By Katherine Pachkowski
January 2017
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What you need to know

This research study is exploratory. It is designed to elicit data that will illuminate the scope and nature of exploitation of people with mental illness, particularly those people who do not live in an area where mental health services are easily accessible. It also elicits the challenges experienced by service providers who face these issues on a regular basis in their practice. These data will guide future research and ultimately serve to fill a gap in the literature and provide context for policy direction.

Why this research is important

Working with persons living with mental illness in rural, remote and isolated areas reveals that they are particularly vulnerable to various forms of exploitation. Research has demonstrated that they are more likely than the general population to be victims of criminal activity and abuse. They are stigmatized, frequently alienated from family, and members of society respond to them with fear and misunderstanding. Persons with mental illness in rural, remote and isolated areas also face challenges in accessing health care, legal assistance, and advocacy resources. These factors create conditions in which they are vulnerable to targeted exploitation.

Unfortunately, exploitation of persons with mental illness is surprisingly unrepresented in scholarly research, and few formal guidelines exist for government employees and health care workers who encounter this form of abuse among their clients. As an example of the latter, existing "required reporting" laws apply to children, youth, and people with developmental disabilities, and do not specifically address people living with mental illness. Naturally, the lack of formal guidelines cannot be safely addressed without accurate information from scholarly research. The current phase of this research is exploratory and involves gathering this necessary information. Future phases will use the gathered data to help develop adequate guidelines for identifying exploitation as a subtle but profoundly damaging form of abuse and developing policy direction around the obligations of mental health care professionals in identifying, reporting, and intervening in exploitation they encounter on a daily basis.

How the research is being done

Researchers have been conducting qualitative, key informant interviews with a variety of ‘front-line' mental health care providers. A key informant is a person who, by nature of their employment or position in a community, is considered a subject matter expert. The participants to date include community mental health workers, emergency room workers, long-term care providers, and peer support workers. Semi-structured interviews are largely conducted in person and are audio-recorded. Researchers ask key informants about the nature and prevalence of exploitation experienced by the people who they work with, and the challenges unique to this set of issues. They are also asked about the effect of isolation from services on these experiences, and about suggestions for improvement.

What the researcher found out

The initial thematic analysis reveals that exploitation of people with mental illness is highly prevalent. Key informants report that the more geographically or socially isolated an individual is, and the more visible a mental illness is, the more likely it is that a person will be ‘targeted' for exploitation by others. Exploitation can take many forms, from financial and sexual exploitation to exploitation of people for their services or property. Social engagement, transportation, and relationships are impacting factors. The ‘exploiters’ can be family members, people in the community, service providers, or even other people living with mental illness. There are patterns of internalization and perpetuation of exploitation. The key initial finding is that mental illness and isolation are creating preconditions for a person to be vulnerable to exploitation. Key informants also shared insights into ways in which mental health care systems are failing to provide resources needed to support adequate human rights of people with mental illness outside of urban areas. Key informants note that ethical resource distribution would include more than simply increasing funding to existing services, but in fact involve a fundamental reimagining of how resources are distributed and controlled in non-urban regions.

 

How this research can be used

The data from this study are intended to inform future research, fill a profound gap in current literature on this subject, and ultimately inform service providers and policy makers on these issues and ethical considerations for more equitable and appropriate resource distribution.

Acknowledgements

This research is funded by a New Researcher Grant from the Brandon University Research Committee. It has received ethics approval from the Brandon University Research Ethics Committee, as well as from the Prairie Mountain and Northern Health Regions. Kayla Kohinski, Research Assistant, has been instrumental in the success of this research project.

 

 

About the Researcher

Katherine Pachkowski, R.P.N., B.Sc.P.N., M.Sc.

Katherine Pachkowski is a registered psychiatric nurse and an assistant professor in the Department of Psychiatric Nursing at Brandon University. She graduated with a B.Sc. in Psychiatric Nursing in 2004 and a Master of Science (Bioethics Specialization) from McGill University in 2013. Her areas of specialty and research focus are mental health and ethics. She also takes a special interest in rural issues.

Keywords

  • abuse
  • exploitation
  • isolation
  • mental health
  • mental illness
  • remote
  • rural

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