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Course: Mental Health Nursing

Topic: Mental Illness

The Nurses International Community

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Module Goals

Learners will be able to:

Define mental illness.
Describe mental illness disease classification according to the DSM-5 manual.
Discuss the role of stress as it relates to mental and physical health
Identify risk factors for mental illness.
Define the role of the nurse in the treatment and prevention of mental illness.

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What is Mental Illness?

According to Parekh (2018) in American Psychiatric Association website, mental illness is:-

“refers collectively to all diagnosable mental disorders — health conditions involving
Significant changes in thinking, emotion and/or behavior
Distress and/or problems functioning in social, work or family activities”

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Mental Illness

Medical condition just like heart disease or diabetes.
Mental illnesses are treatable.
Does not discriminate, may affect anyone regardless of age, gender, geography, income, race/ethnicity, etc.
Often people with mental illness hesitate to talk about it for various reasons, most frequently due to shame.

Parekh, 2018

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Burden of Mental Illness

In United States

1 in 5 adults experience mental illness each year.
1 in 20 adults experience serious mental illness each year.
1 in 6 youth aged 6-17 experience a mental health disorder each year.
50% of all lifetime mental illness begins by age 14, and 75% by age 24.
Suicide is the 2nd leading cause of death among people aged 10-34.

National Alliance on Mental Illness, 2021

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Global Burden of Mental Illness

Mental illness is one of the leading causes of disability.
Close to 1 billion people are living with a mental disorder.
3 million people die every year from the harmful use of alcohol.
One person dies every 40 seconds by suicide.

World Health Organization [WHO], 2020

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Categories of Mental Illnesses

Any Mental Illness (AMI)

Is defined as a mental, behavioral, or emotional disorder.
Can vary in impact, ranging from no impairment to mild, moderate, or severe.

Serious Mental Illness (SMI)

Defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.
Burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.

National Institute of Mental Health [NIMH], n.d.a

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Critical Thinking Question

Which of the following are real illnesses? (Select all that apply)

Irritable bowel syndrome
Anxiety
Depression
High blood pressure

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Diagnostic and Statistical Manual for

Mental Disorders (DSM-5 manual)

Authoritative guide to assessment and diagnosis of mental disorders.
Developed by American Psychiatric Association:

Inputs of more than 160 of top researchers and clinicians around the world.
Careful consideration of scientific advances in research underlying the disorder and collective clinical knowledge of experts.

Establish consistent and reliable diagnoses that can be used for

Research of mental disorders.
Aid in development of medications and other interventions.

American Psychiatric Association, n.d.

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Critical Thinking Question

Reflection:

Consider the significance of the DSM-5 manual in identifying mental disorders as illnesses.

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Risks Factors for Mental Illness

Social, environmental and economic determinants of mental health:

Lack of education, transport, housing
Work stress, Unemployment
Poverty
Neighbourhood disorganisation
Peer rejection
Poor social circumstances
Poor nutrition

WHO, 2004

Racial injustice and discrimination
Social disadvantage
Urbanisation
Isolation and alienation
Violence and delinquency
War, displacement
Access to drugs and alcohol

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Critical Thinking Question

Reflection:

Provide examples of how a pandemic may relate to mental illness and the determinants of mental health.

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Risks Factors for Mental Illness

Individual and family related risk factors for mental illness:

Academic failure and scholastic demoralization
Attention deficits
Caring for chronically ill or dementia patients
Child abuse and neglect
Low social class
Communication deviance
Elder abuse
Exposure to aggression, violence and trauma
Family conflict or family disorganization
Parental mental illness
Parental substance abuse

WHO, 2004

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Risks Factors for Mental Illness

Individual and family related risk factors for mental illness (continued):

WHO, 2004

Sensory disabilities or organic handicaps
Social incompetence
Loneliness
Stressful life events
Personal loss – bereavement
Perinatal complications
Early pregnancies
Substance use during pregnancy

Low birth weight
Medical illness
Chronic insomnia
Chronic pain
Neurochemical imbalance
Emotional immaturity and dyscontrol
Excessive substance use
Poor work skills and habits
Reading disabilities

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Critical Thinking Question

The nurse is caring for a client who has returned home from war and sustained the loss of both legs. He does not want to get out of bed in the morning or perform daily hygiene. He says he is “no good anymore” to his wife and family.

List the risks the client has for mental illness.

What specific behaviors and statements by the client should the nurse be concerned about?

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Critical Thinking Question

A nurse would know which of the following clients is at risk of mental illness or disorder? (Select all that apply)

Teenager who has not completed homework due next day
Middle aged man who smokes a cigarette every evening after work
A mother who had surgery for ectopic pregnancy at 11 weeks gestation
An athlete scheduled to compete at finals in two days
80 year old suffering from memory loss

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Answer: c, e

Loss of pregnancy is a stressful life events for some mothers/families. These mothers are at increased risk for postpartum psychiatric illness.

Elderly people are at risk of mental illness such as depression due to various reasons such as loss of independence, loneliness/isolation, neglect, etc. Memory loss in elderly people can also be cause by depression. However, many of the signs and symptoms mental illness in elderly people are overlooked as being old age related.

Teenager who has not completed homework due next day or an athlete about to compete at finals might be stressed for short period of time but is not at risk of mental illness or disorder

Smoking a cigarette a day pose health risks to middle age to an individual at any age but not necessarily put them at risk of mental illness.

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Protective Factors for Mental Health

WHO, 2004

Protective factors of mental health in relation to social, environmental, and economic determinants:

Empowerment
Ethnic minorities integration
Positive interpersonal interactions
Social participation
Social responsibility and tolerance
Social services
Social support and community networks

Image from Clipart Library

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Risks Factors for Mental Illness

Protective factors of mental health in relation to individual and family determinants:

WHO, 2004

Good parenting: Positive attachment and early bonding, positive parent–child interaction
Problem-solving skills, life skills
Pro-social behaviour
Social/conflict management skills
Socioemotional growth
Social support of family/friends
Feelings of security

Ability to cope with stress
Ability to face adversity
Adaptability
Autonomy, self-esteem
Early cognitive stimulation
Literacy
Exercise
Feelings of mastery and control

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Macro Strategies to Reduce Risk of Mental Illness

WHO, 2004

Improve nutrition
Improve housing
Improve access to education
Reduce economic insecurity
Strengthen community networks
Reduce harm from addictive substances
Reduce smoking and use of other substances during pregnancy
Promote healthy start in life through interventions early in life targeted at child populations at risk, especially for families with low income and education levels
Reduce child abuse and neglect

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Macro Strategies to Reduce Risk of Mental Illness

WHO, 2004

Enhance resilience and reducing risk behaviour in schools.
Deal with family disruption.
Workplace interventions aimed at reducing work stress and unemployment/its aftermath.
Supporting refugees
Aging mentally healthy

Exercise interventions
Enhance social support
Early screening and intervention in primary care.
Support services for management of chronic conditions.

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Stress and Mental/Physical Health

NIMH, n.d.b

Mental Health Foundation, 2021

Stress is how the brain and body respond to a demand or pressure
Stress is triggered when one experiences:

Something new or unexpected
Threat to one’s sense of self
Sense of little control over a situation

All stress is not bad

Signals quick response to dangerous situations
Helps push through fear/pain (e.g.run marathon, deliver speech)
Return to normal after stressful event is over

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Stress and Mental/Physical Health

Physical changes takes place:

All functions aim for survival: increased heart rate/respirations, muscles tension, oxygen use.
Chronic stress can lead to heart disease, digestive problems, diabetes, sleeplessness, immune systems disturbance, etc.

Ability to cope with stress varies with the individual:

Withdraw from other people or be abrupt
Indecisiveness or inflexible, tearful
Smoke, drink alcohol or take drugs more than usual
Long-term/chronic stress may lead to depression and anxiety

NIMH, n.d.b

Mental Health Foundation, 2021

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Critical Thinking Question

Reflection:

Identify a risk factor for mental illness.
Identify three factors that may prevent illness

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Nurse’s Role in Prevention of Mental Illness

Be knowledgeable of risk factors and protective factors related to mental health and illness.

Assess risks for mental illness at every client encounter

Early identification and referral of those at risk for mental illness.

Using effective communication to build good rapport with the clients.

Recognize teachable and learning moments to work with client to promote mental health and prevent illness.

Thomas et al., 2015

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Nurse’s Role in Prevention of Mental Illness

Provide supportive care to clients to help prevent mental illness.
Assist in early referral to appropriate specialist.
Be aware of different resources and services available in the community to refer clients for mental health promotion and supportive care for mental illness.
Promotion of good mental health in the practice environment

Using posters, videos and fliers to signpost local services and community assets.

Thomas et al., 2015

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Nurse’s Role as an Advocate

Works directly with clients, serve as a source of information for the physically and mentally ill.
Advocate and influence development of new policies for more funding for affordable ongoing care.
Impact greatly on the attitude of clients.
Assist clients to overcome stigma associated with mental illness.

Arkansas State University, 2017

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Client Education for Stress Reduction

Recognize problematic stress:

Difficulty sleeping, having low energy
Increased alcohol intake or other substance use
Easily angered, feeling depressed

Seek healthcare provider advice as soon as possible
Regular exercise, relaxing activities
Set goals and priorities: what needs to be done now, what can wait.
Be mindful of accomplishments.
Maintain social circle for emotional support and practical help.

NIMH, n.d. b

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What would the nurse do?

The nurse in a long term care facility is aware that a client becomes anxious when he experiences even minimal change. The facility wants to paint the rooms on his unit and the residents will be required to move temporarily to another unit. What is the nurse’s best response as an advocate?

Ask the physician to consider ordering a tranquilizer to help the client cope with the change.
Talk reassuringly to the client and explain the process and assure him he will return to his own room.
See if the painting can be coordinated with the client’s visit to his son’s for a wedding in the family.
Inform the client’s family about the work and encourage them to visit him more often when he is transferred to the temporary room.

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Cultural Considerations

Concept of mental health varies across cultures
Culture (Stigma)

There is stigma around mental illness
Considered a weakness, something to be ashamed of
Poses as a barrier for those struggling to seek help

Understanding of symptoms of mental illness varies across cultures

May recognize/describe symptoms of mental illness as something else.

Community support

Cultural factors can determine how much support someone gets from their family and community
Due to stigma, one may have to find/seek help alone.

Mental Health First Aid USA, 2019

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References:

American Psychiatric Association. (n.d.). DSM–5: Frequently Asked Questions. Retrieved on December 6, 2021 from https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions

Arkansas State University. (2017, April 4). How to Care for Patients With Mental Health Problems. https://degree.astate.edu/articles/nursing/caring-for-mental-health-patients.aspx

Mental Health First Aid USA. (2019, July 11). Four ways culture impacts mental health. https://www.mentalhealthfirstaid.org/2019/07/four-ways-culture-impacts-mental-health/

Mental Health Foundation. (2021, September 17). Stress. https://www.mentalhealth.org.uk/a-to-z/s/stress

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References:

National Alliance on Mental Health. (2021, March). Mental health by the numbers. https://www.nami.org/mhstats

National Institute of Mental Health. (n.d.a). Mental Illness. Retrieved on October 18, 2021 from https://www.nimh.nih.gov/health/statistics/mental-illness

National Institute of Mental Health. (n.d.b). 5 Things You Should Know About Stress. Retrieved on October 22, 2021 from https://www.nimh.nih.gov/health/publications/stress#part_6263

Parekh, R. (2018, August). What is Mental Illness?. American Psychiatric Association. https://www.psychiatry.org/patients-families/what-is-mental-illness

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References:

Thomas, S., Jenkins, R., Burch, T., Calamos Nasir, L., Fisher, B., Giotaki, G., Gnani, S., Hertel, L., Marks, M., Mathers, N., Millington-Sanders, C., Morris, D., Ruprah-Shah, B., Stange, K., Thomas, P., White, R., & Wright, F. (2016). Promoting Mental Health and Preventing Mental Illness in General Practice. London journal of primary care, 8(1), 3–9. https://doi.org/10.1080/17571472.2015.1135659

World Health Organization. (2020, August 27). World Mental Health Day: an opportunity to kick-start a massive scale-up in investment in mental health. https://www.who.int/news/item/27-08-2020-world-mental-health-day-an-opportunity-to-kick-start-a-massive-scale-up-in-investment-in-mental-health

World Health Organization. (2004). Prevention of mental disorders : effective interventions and policy options [summary report]. https://apps.who.int/iris/handle/10665/43027

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