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Course: Mental Health Nursing

Topic: Social & Legislative Influences on Mental Health

The Nurses International Community

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Module Goals

Learners will be able to:

Discuss the social influences on the prevalence and management of mental health.
Discuss the legislative influences on management of mental health.
Detail the global perspectives related to identification management, diagnosis and treatment of mental health.
Describe the nurse’s role in advancement of mental health identification and treatment in communities.

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Social Influences on Mental Health

World Health Organization, 2014

Begin before birth and continue across the lifespan.

Maternal mental health effects on the fetus.

Throughout childhood

Access to proper nutrition
Parental mental health disorders
Low family income
Environmental factors

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Social Influences on Mental Health (Continued)

Throughout adulthood

Job-related factors- stress, unemployment
Socioeconomic level
Social identities

Older adults

Economic, political, and social living arrangements
Levels of social protection
Education level

World Health Organization, 2014

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Social Determinants of Mental Health (Continued)

World Health Organization, 2014

Interacting factors that influence mental health and wellbeing.

Exist within social groups, i.e.

Age
Gender
Ethnicity
Socioeconomic status
Sexual orientation

Inequalities in social groups increase the likelihood of mental illness.

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Stigma and Discrimination

Arise from lack of knowledge of mental illness

Cause significant barriers to managing mental illnesses

Delay of care in early stages
Prevention of treatment entirely

Can lead to social exclusion, further suffering, and poor outcomes

Wainberg et al., 2017

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Critical Thinking Question

What is the perception of mental illness in your country or region?

What area do you think you could make a difference as a nurse to increase understanding of mental illness?

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Legislative Influences

Mental Health Legislation

Government-enforced objectives for mental health.

Can improve mental health and lower disease burden when implemented properly.

Affects access to health services.

Population coverage rates vary greatly between high and low income countries.

Zhou et al., 2018

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Legislative Influences (Continued)

Affect populations from multiple levels of authoritative bodies

Global

United Nations

Principles for the protection of persons with mental illness
Treaties (United Nations and Regional)

World Health Organization (WHO)

World Health Organization, n.d.

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UN treaties: Convention on the Rights of Persons with Disabilities (CRPD), International Covenant on Economic, Social and Cultural Rights (ICESCR), International Covenant on Civil and Political Rights (ICCPR), Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT), Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), Convention on the Rights of the Child (CRC)

Regional treaties: African Charter on Human and Peoples' Rights, American Convention on Human Rights, Additional protocol to the American Convention on Human Rights in the area of Economic, Social and Cultural Rights, Inter-American Convention on all Forms of Discrimination Against Persons with Disabilities, Inter-American Convention to Prevent and Punish Torture, European Convention for the Protection of Human Rights and Fundamental Freedoms, European Convention for the Prevention of Torture and Inhuman or Degrading

Treatment or Punishment

WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health- focuses on priority countries to increase access to quality and affordable mental health care

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Legislative Influences (Continued)

Mental Health America, n.d.

Federal and local governments

Regulate health systems
Manage and allocate funding
Protect client rights

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Critical Thinking Question

Review the WHO Special Initiative for Mental Health (2019-2023).

How does your country or region compare to the WHO guidelines for interventions and services?

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Global Perspectives

Mental illness as a global issue

Leading cause of disability along with substance use disorders.

>70% of those who need care cannot access it

Creates a “gap” in care worldwide

Wainberg et al., 2017

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Mental Health Treatment Gap

Contributing Factors

Mental health care worker shortage
Lacking capacity for research
Stigma
Need for integration in health care services

Wainberg et al., 2017

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Mental Health Treatment Gap (Continued)

Mental health care worker shortage

High disease burden with insufficient health care workforce.

No “quick fix” to meet the need.

Stigma may dissuade many from entering the profession.

Task sharing- support of non-specialist health workers to increase access to care.

Wainberg et al., 2017

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Mental Health Treatment Gap (Continued)

Lacking capacity for research

More researchers → more studies → more progress

Need for research initiatives globally

Wainberg et al., 2017

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Mental Health Treatment Gap (Continued)

Stigma

Inhibits many from seeking mental health care

Results in a downward spiral and worsening disease burden

Can deter professionals from specializing in mental health

Wainberg et al., 2017

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Mental Health Treatment Gap (Continued)

Need for integration of health care services

Mental health care must extend beyond psychiatric institutions

Into primary care and community health settings.

Geographic limitations in rural areas.

Increased effectiveness when treating mental illness and non-communicable chronic diseases together.

Wainberg et al., 2017

Ngo et al., 2013

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Critical Thinking Question:

List the four factors leading to “gap” in care.

Mental health care worker shortage
Lacking capacity for research
Stigma
Need for integration in health care services
Media portrayal of mentally ill

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Nurse’s Role

Primary Prevention

Client education

Healthy lifestyle habits across the lifespan
Risk factors for mental illness

Awareness of community resources

World Health Organization, 2018

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Nurse’s Role

Secondary Prevention

Use of screening tools

Safety, violence, abuse

Assessment skills

Client interviews
Physical assessments

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Nurse’s Role

Tertiary Prevention

Caring for clients with mental illness

Knowledge of disease processes
Disease-specific interventions
Client advocacy

Abbasinia et al., 2019

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Nurse’s Role

Acting as change agents in legislation and health policy

Nurses are important stakeholders in health care policy development.

Should be consulted and involved in the policy process.

World Health Organization, 2007; Abood, 2007

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What Would the Nurse Do?

In what ways can nurses advocate for political change in your country/region?

What is one step you could take as a nurse to make your voice heard in the legislative arena?

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References

Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2019). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141-151. https://doi.org/10.1177/0969733019832950

Abood, S. (2007). Influencing health care in the legislative arena. OJIN: The Online Journal of Issues in Nursing,12(1). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.html

Mental Health America. (n.d.). The federal and state role in mental health. https://www.mhanational.org/issues/federal-and-state-role-mental-health

Ngo, V. K., Rubinstein, A., Ganju, V., Kanellis, P., Loza, N., Rabadan-Diehl, C., & Daar, A. S. (2013). Grand challenges: Integrating mental health care into the non-communicable disease agenda. PLOS Medicine, 10(5), 1-5. https://doi.org/10.1371/journal.pmed.1001443

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References

Skärsätera, I., Keogh, B., Doyle, L., Ellilä, H., Jormfeldt, H., Lahti, M., Higgins, A., Meade, O., Sitvast, J., Stickley, T., & Kilkku, N. (2018). Advancing the knowledge, skills, and attitudes of mental health nurses working with families and caregivers: A critical review of the literature. Nursing Education in Practice, 32, 138-146. https://doi.org/10.1016/j.nepr.2018.07.002

Wainberg, M., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y., Bradford, J. E., Oquendo, M. A., & Arbuckle, M. R. (2017). Challenges and opportunities in global mental health: A research-to-practice perspective. Curr Psychiatry Rep., 19(5), 1-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553319/

World Health Organization. (2007). Nursing matters: Developing nursing resources for mental health. https://www.who.int/mental_health/policy/services/Nursing%20Matters%20Infosheet.pdf?ua=1

World Health Organization. (2014). Social determinants of mental health. https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf

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References

World Health Organization. (2018). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

World Health Organization. (‎2019)‎. The WHO special initiative for mental health (‎2019-2023)‎: Universal health coverage for mental health. https://apps.who.int/iris/handle/ 10665/310981.

World Health Organization. (n.d.). International human rights instruments relevant to the rights of people with mental disabilities. https://www.who.int/mental_health/policy/legislation/Key%20UN&Regional%20HR%20Instruments%20relevant%20to%20MH.pdf

Zhou, W., Yu, Y., Yang, M., Chen, L., & Xiao, S. (2018). Policy development and challenges of global mental health: A systematic review of published studies of national-level mental health policies. BMC Psychiatry, 18. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1711-1

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