What is Mental Health?
This assignment will define mental health and mental illness, theoretically, from a clinical and from a legal perspective, and it will discuss the difference between mental health and mental illness and its relevance to my field of work. The assignment will chose depression as a type of mental illness and explain how this affected a particular individual, and the support I expect to give as a nurse. I have chosen depression due to a particular experience I had on placement when asked to support an African lady who was mute at the time. The assignment will use Gibbs reflective cycle as a model to reflect on my learning and develop an action plan for my continuous learning.
The relevance of mental health studies to my field of work is that it is an area where people in need of treatment will get support based on diagnosis of symptoms, assessment of problem, care planning to ensure the right service and support is given, and care delivery which, in the case of a mental health patient, will include the administration of clinically prescribed medication, counselling, education and rehabilitation to bring the person back to normalcy. This will involve professional multi disciplinary work from a GP, psychiatrist, psychologist and nurses. The assignment will briefly outline the contribution of these professionals in supporting patients with mental health problems.
The US National Library of Medicine (2009) defines mental health as how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, from childhood and adolescence through to adulthood. While Pritchard (2006) states that the word ‘health’ implies a search for well being that will enable a person to achieve their life goals. This mirrors the British NHS Act of 1948. Health care intervention will then incorporate all aspects of the person and serve the citizen at every stage of their lives. On the other hand Liberty, 2009 defines www.yourrights.org.uk/yourrights/rights-of-people-detained-under-the-mental-health-act/definition-of-mental-disorder.htmlmmm mental disorder as: mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of the mind. The WHO (2005) uses the term disorder to imply that there exists a clinically recognisable set of symptoms or behaviour associated in most cases with distress and interference with personal functioning. The term disorder is preferred by the WHO rather than illness or disease as it avoids inferences on causes outlining patterns of human behaviour and experiences found in all cultures. The World Health Organisation (WHO) successfully developed a clinical tool that can be used to standardise definitions related to specific diagnosis which are based on a patient’s symptoms and signs. The tool is called the International Classification of Diseases (ICD) which became an internationally recognised method (WHO, 2005). However, Wilson (2002) criticised this model because every human being is different, as our DNA shows.
In terms of the difference between mental health and mental illness, Bentall (2003) states that clinical psychologists would agree that mental illnesses are along a continuum of normality of psychological attributes or traits, and the individual moves along a functioning into a dysfunctioning and often self defeating state. Hence, we may all feel at times that things are against us (paranoia), and then at times we may feel good about ourselves and energised (mania). The Counselling Service ( 2009) sees the www.liv.ac.uk/counserv/self_help/mental_health/definition_mhealth.htmterm ‘mental health problems’ as that that encompass a range of experiences and situations, while mental health might usefully be viewed as a continuum of experience, from mental well-being through to a severe and enduring mental illness. We all experience changes in our mental health state influenced by social, personal, financial and other factors. Major life events such as a close bereavement, or leaving home, can impact significantly on how we feel about ourselves, for example, leading to depression and anxiety.
A minority of people may experience mental health problems to such a degree that they may be diagnosed as having a mental illness, requiring the involvement of specialist services and support. The majority of people will not experience mental illness, but will undoubtedly experience mental health problems at different times in their lives. Our mental well-being is an issue for all of us to consider all of the time, as we might consider our physical well-being (The Counselling service, 2009). Everyone feels worried, anxious, sad or stressed sometimes. But with a mental illness, these feelings do not go away and are severe enough to interfere with daily life. It can make it hard to meet and keep friends, hold a job or enjoy your life. (US National Library of Medicine, 2009)
According to Liberty (2009), mental illness is not defined in the Mental Health Act (MHA) and the courts have considered a definition unnecessary, suggesting that the test should be what the ordinary sensible person would decide on a case-by-case basis. The conditions which are generally accepted as falling under the category of mental illnesses include schizophrenia and mood disorders. Most admissions under the MHA requiring the category of mental disorder to be specified are admissions of individuals with a diagnosis of a mental illness.
The MHA defines three other forms of mental disorder: severe mental impairment: ‘a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.’ This is mental impairment in a less severe form. Psychopathic disorder: ‘a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’ (Liberty, 2009). The patient I worked with in my hospital placement suffers from severe mental health problems with suicidal ideation.
The terms used in the MHA are legal, not medical, categories. While recognising these terms have no legal meaning in the context of the MHA, many people, in particular people who use mental health services, prefer terms such as ‘mental health problems’ and ‘mental distress’ when describing their experience. Most admissions under the MHA requiring the category of mental disorder to be specified are admissions of individuals with a diagnosis of a mental illness (Liberty, 2009).
US National Library of Medicine (2009), states that mental disorders will include depression, phobias, bipolar disorder and schizophrenia. Mental illness is common, and the milder conditions are very common. Even school-age children are also affected by these conditions. Severe and persistent mental illness, however, is less common. The vast majority of individuals with mental disorders continue to function in their daily lives, although with varying impairments. Overall medical care costs are driven up enormously by costs associated with unrecognized psychiatric syndromes (Healthy Minds, 2009).
In terms of bio science the exact causes of mental disorders are unknown, but there have been major growths in research. Certain inherited dispositions interact with triggering environmental factors. Poverty and stress are well-known to be bad for health which is true for mental health and physical health. In fact, the distinction between “mental” illness and “physical” illness can be misleading. Like physical illnesses, mental disorders can have a biological nature. Many physical illnesses can also have a strong emotional component (Healthy Minds, 2009). Fortunately, medicines and therapy can improve the life of most people with mental illnesses (US National Library of Medicine, 2009).
In terms of the socio – political setting the development of community based approaches has replaced the medical model, where people are encouraged to live in their own homes rather than long stay hospitals (Falloon and Fadden (1995)). Support is given to so that this will lead to rapid recovery of functioning and a healthy and productive lifestyle. A coordinated strategy will include assessing needs, setting goals, allocating resources, implementation reviewing progress and assessing outcomes.
While unskilled nursing staff are burdened with the care of the most disabled, highly skilled psychologists and psychiatrists spend more time on those that are less disabled. The filters through which patients pass to receive intensive mental health care from hospital based services begin from referrals to specialists by the GP (Falloon and Fadden, 1995). Psychiatrists / psychologists are responsible for making reliable and valid assessments of a mental disorder, GPs may recognise the signs that enable them to make the initial referral. Diagnostic classifications provide some guidance to the morbidity and quality of life experienced by people suffering from mental disorders.
The mental health illness this assignment will now focus on is depression. This illness has been chosen based on the experience I had on placement in a mental health ward where I supported a person suffering from manic depression. Depression is seen as a mood disorder which is a state of mind or feeling, where depressive episodes can range from mild to severe (Pritchard, 2006). There are two forms of depression, reactive (mild) results from external stressors such as divorce, serious illness or bereavement. The second is endogenous depression which arises from within but for no apparent cause, but there could be a mild trigger stress to the deeper pathological form of depression.
Psychiatrists will diagnose a person as suffering from depression when the person is feeling a sense of misery and can be added with low self esteem and poor appetite, and the symptoms last for up to two weeks. These feelings will interfere with the person’s sense of self, their interpersonal relationships and social interactions. They cannot rouse themselves from their all- pervading sense of misery. Depression is associated with deliberate self harm and the finality of suicide (Pritchard, 2006), and can begin at any phase of life and even affect children (Hill et al, 2004). Hankin et al (2005) states that it tends to occur in the later teens and peaks in the middle years (45 plus). Severe depression occurs where the person feels a sense of guilt and unworthiness progressing into delusional or even hallucinatory state. At the extreme, sufferers will become mute and withdrawn but will still be able to remember everything.
In terms of bio science depression is seen as being associated with a decrease in neuro- transmission. This means that the nerve cells do not communicate with the brain. These neuro- transmitters are serotonin, noradrenalin and dopamine. Therefore, anti depressant drugs such as Prozac are used to improve the levels of these neuro- transmitters. (Zaretsky, 2003, Baldwin and Birtwhistle, 2002). However, these still come with their added controversy so the best approach is a combined treatment of anti depressants and psychosocial input (Browne et al, 2000 and Hirschfeld et al, 2002). It is important to explain to the patient’s family the general progress of the syndrome, how it affects the person and its ramifications (Miklowitz et al, 2003).
The nurses’ training gives them the expertise to function as counsellors. Nurses are in a position to educate patients and families about their treatment and offer the patient crucial support through difficult illnesses in collaboration with other medical professionals (De Paulo, 2002).
In summary, this assignment has critically assessed different definitions of mental health and mental illness from a theoretical, clinical and legal standpoint, concluding that much research is still required to understand the biological causes of the illness. This has led to difficulties in coming up with clear definitions. The assignment discussed the difference between mental health and mental illness and its relevance to my field of work (nursing). It was demonstrated that these move along a continuum of normality of psychological traits of functioning (health) and dysfunctioning (illness). The assignment chose depression as a type of mental illness and explained how this affected a particular individual, and the support I am expected to give as a nurse through recovery and rehabilitation of the patient, recognising that mental health and depression has genetic and environmental causes. I have learnt that given support and information people experiencing mental health problems can make positive changes and improvements. Only a small minority of people do not respond to appropriate help and therefore need more specialist involvement.
The reflective model I have chosen will be based on Gibbs reflective cycle (1998) Gibbs identified a series of six steps (Description, feelings, evaluation, analysis, conclusion and action plan). To aid reflective practice, these elements make up a cycle that can be applied over and over, which is excellent as a means of continuous learning. Unlike many other models Gibbs takes in to account the realm of feelings and emotions which plays a part in particular events. This will help me focus on my internal perceptions around my beliefs and prejudices when I learn about anti oppressive and anti discriminatory practices (see Appendix one).
In applying the Gibbs model I will now give an account of an experience when I began my placement in the first week. Before my hospital placement, I had not worked with a person suffering from mental health problems. The person I was assigned to is called Regina Curtis (real name withheld in accordance with NMC (2008) code on confidentiality). I was asked to support her, which was quite difficult as she was mute. Regina is a 43 year old Anglo-Nigerian, who had spent all her life in the UK. (However, little did I realise she still maintains her cultural leaning), which I knew virtually nothing about. I was told that she had relapsed and taken to hospital, as she suffers from manic depression, and had earlier tried to commit suicide. Even though I was talking to her in the hope of encouraging her, I was not initially aware that she would remember everything I was saying even though she was not responding.
At the time I felt that as a fellow woman Regina can be quite vulnerable particularly as she suffers a lot from very low self esteem. This placed me in an uncomfortable position as I began to put myself in her place and was beginning to feel her vulnerability. At first I also felt helpless because she was not responding to anything I said or did.
However, after supervision with my mentor a registered mental health nurse, I felt better about the experience. As I kept talking to Regina despite her lack of response, my mentor said that this will eventually register with her, that someone was trying to help and support her. I felt I did very well in encouraging her that she can do much better than she thinks, and can still do adult education courses such as computers and take part in a fitness club to occupy her mind and body. Yet I knew that none of these will prevent her relapse.
In analysing my experience I felt that being able to prepare for the interaction was a good experience as I was able to read Regina’s file, and was briefed by other nurses about her. This enabled me to communicate with her, despite her lack of response. De Paulo (2002) said patients should be given something positive to think about. I have learnt to be careful about what I say to patients, even when patients have relapsed.
“This is important for the patient in terms of care delivery, I always tell patients, you’ll look better before you feel better. The inner symptoms of hopelessness and low self esteem take more time to recover than vitality and physical condition.” De Paulo (2002, p245).
With regards Regina, I was able to develop a good working relationship with her, because during the following week she began to regain normalcy and told me some of the things I was telling her. I had built a good working relationship with her as she enjoys communication and was fascinated that we were from different cultural background. She discussed her culture with me and the different types of food she likes to eat. I realised I had to consider my values in relation to the interaction I had with the patient. I utilised appropriate communication skills. I demonstrated sensitivity when interacting with and providing information to the patient. De Paulo (2002) stated that life events can cause the onset of depression (Regina said she was abused by her step dad before her first bout of depression at the age of 17 years old. There were further upsets such as the first pregnancy which led her slipping into depression, but due to family support the baby was well looked after).
In the hospital, I had learnt the core values of being a mental health nurse and some of its functions. The mental health nurses work with adults suffering from various types of mental health problems. The work involves helping people to recover from their illness or come to terms with it in order to maximise their life potential. The nurses liaise with psychiatrists, occupational therapists, GPs, social workers and other health professionals to plan and deliver care using a multidisciplinary client-centred approach. Some of the typical work activities include: ensuring that the legal requirements appropriate to patients are observed; caring for patients who are experiencing acute mental distress or have an enduring mental health problem; assessing and talking to patients about their problems; building relationships with patients to encourage trust, while listening to and interpreting their needs and concerns; ensuring the correct administration of medication, including injections, and monitoring the results of treatment; responding to distressed patients in a non-threatening manner and attempting to understand the source of distress; applying de-escalation to help people manage their emotions and behaviour; preparing and maintaining patient records; and producing care plans and risk assessments for individual patients. I was able to put into practice or observe all of these functions.
My experience with Regina challenged my perception of someone with a mental illness as clearly education has shown that more sympathy and support is needed to demystify the illness as stated in Edwards (2003). I would need to study the issue of discrimination and anti oppressive practices. Attitudes and misconceptions can get in the way (see appendix one).
I read that in 2002 the Department of Health released its paper on the National Suicide Prevention Strategy for England, laying out strategies to reduce suicide rates in England. This was preceded by the defeat depression campaign, which sought to reduce the stigma associated with depression. Both these reports focused attention on prevention through education so that depression can be diagnosed early and people who are depressive must be empowered to speak of their needs and experiences, and press for improved treatment and public awareness.
I will study legislation which protects people from unfairness such as at work, such as getting time off work for a depressive disorder. The action plan on Appendix one explains some of the actions I will consider to improve anti oppressive and anti discriminatory practices.
Baldwin, D and Birtwhistle, J (2002) Depression an Illustrated History, Blackwell Science, Oxford
Bentall, R (2003) Madness Explained: Psychosis and Human Nature, Allen, London.
Browne, G, Beck, A, Steer, R and Grisham J (2000) Risk factors for suicide in psychiatric outpatients: A 20 year prospective study. Journal of Consulting Clinical Psychology 68:371 – 7
De Paulo, J (2002) Understanding Depression: What we know and what we can do about it, John Wiley and Sons, New York
Edwards, V (2003) Depression: What you really need to know, Robinson, London
Falloon, I and Fadden, G (1995) Integrated Mental Health Care: A comprehensive Community Based Approach, Cambridge University Press, Cambridge
Healthy Minds (2009) Healthy lives, Mental illness, American Psychiatric Association
Hill, J, Pickles, A and Bryatt, M (2004) Juvenile versus adult onset depression: multiple differences imply different pathways. Psychological Medicine, 34, 1483 – 93
Hirschfeld, R, Montgomery, S, Amore, M and Versiani, M Partial Response and non response to anti depressant therapy: current approaches and treatment options (2002) Journal of Clinical Psychiatry 63: 826 –37.
Liberty (2009), definition of mental disorder, the liberty guide to human rights
Last update 20th Jan 2009
NMC (2008) Code of Professional conduct, Nursing and Midwifery Council, London
Miklowitz, D, Richards, J and Sacher, J (2003) Integrated Family and Individual Therapy for Bipolar Disorders: Results of a treatment development study. Journal of Clinical Psychiatry 64: 182 – 91.
Pritchard, C (2006) Mental Health Social Work, Evidence based practice, Routledge, London
The counselling service (2009) Self Help Mental Health, University of Liverpool, www.liv.ac.uk/counserv/self_help/mental_health/definitions
US National Library of Medicine, Bethesda.
Last updated 2nd December 2009.
WHO (2005) World Annual Statistics, World Health Organisation, Geneva
Wilson, E (2002) the Future of Life, Little Brown, London
Zaretsky, A (2003) Targeted psychosocial interventions for bipolar disorder, Bipolar Disorder 5 (Supplement 2): 80 – 7.
ACTION PLAN FOR FUTURE LEARNING
Practice in a fair and anti discriminatory way, acknowledging the difference in beliefs and cultural practices of individuals or groups
|HOW THESE WILL BE ACHIEVED||WHO WILL SUPPORT THIS||TIME ACHIEVED|
Demonstrate fairness and sensitivity when responding to patients, clients and groups from diverse circumstances
|· Training in equalities and diversity issues.|
· Knowledge of relevant legislation, policies and procedures involving equal opportunities.
· Support others to promote their culture and beliefs.
· Demonstrate a person centred approach in supporting those in need.
|· University / placement|
· Personal research / placement
· Placement / work
· Personal research / placement
Recognise the needs of patients and clients whose lives are affected by disability, however manifest
|· Recognise how my own beliefs and prejudices will have an impact on others.|
· Recognise the causes of disability / mental health and how this impact on the patient.
· Understand the socio-political and economic factors which may contribute to oppression and injustice.
|· Placement / work|
· Personal research / university
· Personal research / university
· Personal research / university
Challenge discrimination of all forms to preserve the rights and dignity of patients, clients and groups
|· Reporting incidences to the appropriate authorities.|
· Contributing to issues, activities and discussions in a multi disciplinary setting.
· Refer to policies, procedures and legislation.
· Empowering patients, clients and groups through education and confidence building.
|· Placement / work|
· Placement / work
· Placement / work
· Placement / work