NURS3003 Proposal Assessment

NURS3003 Proposal Assessment

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Cover Page under Assessments

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Tick the boxes regarding Generative artificial intelligence. It is OK to have used GenAI to do research, but please do not use GenAI to write whole sections. You should declare any use of GenAI. Team members should let the team representative know.

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The Impact of Social Integration on Discharged Involuntarily-Admitted Patients in India: A Qualitative Design

Angel Donina (21484465)

Jane Graham-Helwig (18834695)

Trishia Antoinette Cordon Bandoy (21482317)

Page 3 onwards

Adam Edwards (20311821)

Use the headings below:

Background/Literature Review

Background
Involuntary admission of mental health patients in India remains a controversial practice that raises significant questions about its long-term impact on patients' social reintegration. While it is often seen as necessary to ensure patient safety, particularly when individuals are considered a danger to themselves or others, involuntary admission results in several unintended consequences. These include heightened stigma, emotional distress, and challenges in regaining a sense of autonomy and trust in ones social environment after discharge. Despite the increasing prevalence of involuntary admissions, the impact on patients' reintegration into their communities has not been sufficiently explored in the context of India, where mental health care has long been hampered by limited resources, significant societal stigma, and a lack of community-based services.

India's Mental Healthcare Act (2017) was designed to provide stronger protections for individuals with mental health conditions, ensuring their rights and promoting a shift towards community-based care. However, the gap between policy and practice remains, with significant barriers to proper implementation. In particular, patients who are involuntarily admitted may face long-lasting consequences when attempting to reintegrate into society, where mental illness is often seen through a lens of prejudice and fear (Gowda et al., 2017). It is essential to understand how involuntary admission affects social integration in order to develop appropriate interventions that support these patients as they transition back into their communities.

While research has explored the clinical effects of involuntary admission, there is a clear gap in understanding the social challenges patients face once they are discharged (Veerendra et al., 2025). Few studies have focused specifically on the barriers to reintegration in India, where cultural factors, stigma, and limited community support systems play a crucial role. This research will fill that gap by exploring how involuntary admission impacts patients ability to reconnect with their communities, focusing on stigma, family dynamics, and community support.

Literature Review
Involuntary admission and its effects on social reintegration has been addressed in various international contexts, but remains underexplored in the context of a sample population in India. Rsch et al. (2014) explored the emotional consequences of involuntary admission, noting that patients often experience increased social stigma after their discharge. This stigma, in turn, intensifies feelings of shame and reduces self-esteem, delaying the recovery process and making it difficult for patients to rebuild relationships and reintegrate into their communities. Rsch et al. (2014) found that patients perceptions of their involuntary hospitalisation were often associated with negative emotional outcomes, including social isolation and self-stigmatization. These findings align with those of Xu et al. (2019), who reported that the psychological impact of involuntary admission often lingers, affecting long-term recovery and social reintegration.

In India, cultural attitudes toward mental illness further complicate the social reintegration of discharged patients. According to Hegde et al. (2022), societal views on mental health in India are shaped by a complex interplay of age, education, and geographical location, with rural and tribal areas particularly holding traditional views that stigmatise individuals with mental health conditions. As Hegde et al. (2022) emphasises, these deep-rooted cultural beliefs can lead to discrimination and social exclusion, posing a significant barrier for patients discharged after involuntary admission. In these settings, patients may struggle to find acceptance, making reintegration a lengthy and difficult process.

Family involvement plays a crucial role in the recovery and reintegration of mental health patients in India. Gowda et al. (2017) highlighted families' significant role in supporting patients through treatment and recovery. However, the stigma associated with involuntary admission can place a strain on familial relationships, leading to isolation and reduced support for the patient. As Gowda et al. (2017) argue, the involvement of families in the care process is essential. Still, the experience of involuntary admission often results in a breakdown of family dynamics, making reintegration even more challenging.

The lack of comprehensive community-based mental health services in India is another significant factor that impacts social reintegration. Veerendra et al. (2025) reported that, despite the passage of the Mental Healthcare Act of 2017, the transition from institutional to community care has been slow, and many areas of India still lack the foundation to support patients after discharge adequately. This service gap leaves many discharged patients without the necessary support systems to ease their reintegration. Veerendra et al. (2025) noted that the success of reintegration hinges on the availability of local mental health services, which can provide patients with ongoing care, social support, and opportunities for employment and social engagement.

To summarise, the social integration of discharged mental health patients in India is significantly affected by involuntary admission. The stigma associated with involuntary hospitalisation, intensified by cultural attitudes towards mental illness, familial strain, and inadequate community-based services, creates considerable barriers for patients trying to reintegrate into society. While policy changes, such as the Mental Healthcare Act of 2017, are steps in the right direction, more efforts are needed to bridge the gap between legislation and practice, ensuring that discharged patients receive the support they need to reintegrate into their communities successfully.

Research Question: What is the impact of involuntary admission on the social integration of discharged mental health patients in India?

Objectives:

1. To explore the social integration experiences of discharged mental health patients who were involuntarily admitted.

1. To identify the challenges faced by these patients in their social reintegration.

1. To assess the effectiveness of current support systems in aiding their social integration.

1. To provide recommendations for improving social integration support for these patients.

Significance

The body of literature around involuntary patient admission (IPA) fails to provide a comprehensive analysis of the psychosocial challenges that involuntarily-admitted patients face post-discharge (Iudici et al., 2022). Additionally, the studied prevalence and experiences around IPA have been set within Western contexts and additional empirical studies are required for their Asian counterparts (Wang et al., 2019). The implications of this study fulfil literature gaps and hold significance for clinicians and policy-makers, in order to improve out-patient care for those involuntarily admitted (Pridham et al., 2018).

Design

Qualitative design

This is appropriate but limited, as qualitative research focuses upon investigating subjective experiences of time or change (Audulv et al., 2022). Whilst it uses various methods of gathering data, its primary aim is to collect rich, descriptive information regarding the studys research area (Hjelm, 2024). However, qualitative study designs can have many elements, including: traditions, retrospective or prospective view points, and variations in data collection points (Audulv et al., 2022; Merriam & Grenier, 2019).

Additional points:

Qualitative research can be conducted in various different ways, such as either longitudinal or cross-sectional. In this study, a longitudinal methodology may be beneficial to monitor and identify trends months to years after patients have been discharged from their involuntary admission (Audulv et al., 2022). Additionally, qualitative research can also centre around a specific tradition, such as ethnography or grounded theory (citation). Our study also reflects upon past experiences with involuntary admission, and tracks their changing perspectives after discharge, therefore drawing upon both retrospective and prospective designs.

Sampling strategy

Copilot suggests A purposive sampling method will be used to select participants who can provide rich, detailed information about their experiences. The target population includes patients who were involuntarily admitted to mental health facilities in various regions of India.

This approach is appropriate as purposive sampling allows for the selection of individuals who meet the specific criteria relevant to the study (Valerio et al., 2016). However, Copilots suggestion is limited as it does not provide a description of the inclusion criteria, exclusion criteria or sample size of the targeted population.

Additionally, the snowball sampling method will be employed to recruit family members of participants in the study. This data triangulation approach will help gather diverse perspectives of the social integration of individuals facing mental health challenges following involuntary admissions into mental health facilities. (Cite)

Sample size determination

• Sample size will be determined by data saturation.

Inclusion Criteria

• 18-65 years of age.

• Individuals must be able to communicate effectively and be able to understand the studys requirements.

• Individuals must have been admitted to the Institute of Mental Health and Hospital (IMHH) in Agra, India.

• Individuals must have been admitted involuntarily.

• Individuals must be employed and return to work to explore the relationship between work and their mental health recovery.

Exclusion Criteria

• Individuals without access to the internet or phone access, as digital communication will be necessary for follow-up and data collection.

• Individuals who have experienced voluntary admissions to reduce bias, ensuring the study sample is homogeneous.

• Individuals who have a history of non-compliance with treatment or research protocols will be excluded to ensure the reliability and validity of the data collected.

Recruitment strategy

Copilot suggests Collaboration with Mental Health Facilities: Partner with psychiatric hospitals and mental health clinics to identify potential participants who have been discharged after involuntary admission. These facilities can help in reaching out to eligible patients and explaining the study's purpose.

This is appropriate but limited as it fails to state how information will be delivered to patients regarding details of the study, nor does it clarify who will be responsible for approaching eligible patients. Additionally, while the suggestion to collaborate with mental health facilities aligns with the study, it would be too broad without a more specific description of mental health facilities involved.

Alternative recruitment strategy (if Copilots suggestion is inappropriate):

• Support groups

• Participant referrals

• Incentivisation

Additional details:

• IMHH will receive the study criteria and collaborate with the study research coordinators to recruit eligible participants.

• Research coordinators will collaborate with leaders from support groups identified during participants discharge planning.

• Family members will be recruited through referrals from consenting participants.

• To incentivise participation, the study will offer $10 gift cards (either physically or via email) as a token of appreciation for their time and contribution to the study.

Data collection and Analysis

Copilot suggests a qualitative research design that utilises triangulated data collection methods will be implemented to study the effects of social integration on patients who were involuntarily admitted and then discharged in India. After discharge, patients will be interviewed using semi-structured methods to understand their personal experiences and identify their challenges and support networks. The technique provides comprehensive personal stories and demonstrates success in examining caregiver views on involuntary mental health admissions (Wells et al., 2024). Understanding reintegration processes will deepen through focus group discussions with patients and family members who share their social and cultural experiences (Solan et al., 2015). The analysis of hospital documents, including discharge summaries and care plans, provides insights into institutional practices and care continuity based on research conducted in Indian hospitals (Humphries et al., 2020).

Experienced mental health researchers will collect data familiar with qualitative interviewing and the Indian psychiatric care context. Interviews and focus groups will occur 36 months post-discharge, either in community mental health centres or via telehealth, and audio recordings will be securely encrypted. Anonymity and confidentiality will be strictly maintained.

The primary method for data analysis will be thematic analysis according to Braun and Clarke's six-phase framework. The method finds extensive application in Indian healthcare research and creates a solid base for detecting significant patterns and social mechanisms (Mukherjee et al., 2024). The narrative analysis will examine individual interpretations of their psychiatric experiences and reintegration processes, focusing on stigma and identity aspects (White & Staniford, 2023). The NVivo software will support data management, while Cohen's Kappa will assess inter-rater reliability in applicable cases.

Ethical considerations

Copilot makes the following suggestions:

• Informed consent will be obtained from all participants.

• Confidentiality and anonymity will be maintained.

• Ethical approval will be sought from relevant institutional review boards.

This is appropriate/inappropriate because

Additional points regarding ethical considerations:

• Ethical approval will be sought from the Curtin University Human Research Ethics Committee

• where ethical approval will be sought? e.g. hospital, clinic, etc.

• how receive consent? e.g. paper/ electronic form, signature, etc.

• seek medical records??

• confidentialy & privacy e.g. participant number identification

• participation voluntary w/ participants being free to withdraw?

• (how you deal w/ adverse events e.g. participant upset, uncomfortable, distressed etc. = refer to appropriate support)

• reference = national statement on ethical conduct in human research 2023

• include words such as, beneficence, human dignity, justice, etc.

Rigour (validity/reliability or trustworthiness)

Copilot suggests:

This is appropriate/inappropriate because

Additional points regarding rigour:

use textbook in reading list ch17 table qualitative

assess credibility, dependability, confirmability and transferability (4 separate for each)

Certainly! Here's a structured research proposal based on the research question:

Title

The Impact of Involuntary Admission on the Social Integration of Discharged Mental Health Patients in India

Abstract

This research aims to investigate the impact of involuntary admission on the social integration of discharged mental health patients in India. By examining their experiences, challenges, and support systems, the study seeks to understand how involuntary admission affects their reintegration into society. The findings will inform policy recommendations and interventions to enhance social integration and support for these patients.

Introduction

Background

Involuntary admission to mental health facilities is often necessary for individuals experiencing severe mental health crises. However, the period following discharge is critical for their recovery and reintegration into society. Understanding the impact of involuntary admission on social integration can help improve mental health services and support systems[1][2].

Research Problem

The specific issue this research addresses is the impact of involuntary admission on the social integration of discharged mental health patients in India. This includes their challenges, support systems, and overall well-being during the transition back to their communities.

Objectives

1. To explore the social integration experiences of discharged mental health patients who were involuntarily admitted.

1. To identify the challenges faced by these patients in their social reintegration.

1. To assess the effectiveness of current support systems in aiding their social integration.

1. To provide recommendations for improving social integration support for these patients.

Research Questions

• What is the impact of involuntary admission on the social integration of discharged mental health patients in India?

• What challenges do these patients face during their social reintegration?

• How effective are the current support systems in aiding their social integration?

• What factors influence their overall well-being and reintegration into society?

Literature Review

The literature review will cover existing research on the experiences of involuntarily admitted mental health patients, focusing on their post-discharge social integration. It will also review studies on the effectiveness of support systems and the challenges faced by patients during their reintegration[1][2][3].

Research Methodology

Research Design

This study will use a qualitative research design to gain in-depth insights into the social integration experiences of patients.

Population and Sampling

The target population includes patients who were involuntarily admitted to mental health facilities in various regions of India. A purposive sampling method will be used to select participants who can provide rich, detailed information about their experiences.

Data Collection Methods

• Interviews: Semi-structured interviews with patients to explore their social integration experiences, challenges, and support systems.

• Focus Groups: Group discussions with patients and their families to gather diverse perspectives on social integration and support.

• Document Analysis: Review of discharge plans, follow-up records, and policy documents related to post-discharge care.

Data Analysis Techniques

• Thematic Analysis: To identify common themes and patterns in the qualitative data.

• Narrative Analysis: To understand the personal stories and experiences of patients.

Ethical Considerations

• Informed consent will be obtained from all participants.

• Confidentiality and anonymity will be maintained.

• Ethical approval will be sought from relevant institutional review boards.

Expected Results

The research is expected to reveal significant challenges faced by involuntarily admitted mental health patients in their social integration post-discharge. It will identify gaps in current support systems and suggest strategies to enhance social integration support.

Timeline

• Month 1-2: Literature review and research design.

• Month 3-4: Data collection (interviews, focus groups, document analysis).

• Month 5-6: Data analysis and interpretation.

• Month 7: Report writing and dissemination of findings.

Budget

A detailed budget will be prepared, covering costs for data collection, travel, personnel, and other research-related expenses.

Feel free to adjust any sections as needed. If you have any specific requirements or additional details you'd like to include, let me know

1. readmission rate?

Purposive sampling for participants ask participants for family involvement soon-after