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Course: Mental Health Nursing

Topic: Mental Wellness

The Nurses International Community

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Module Goals

Learners will be able to:

Define mental wellness as it relates to individual health, family and community health.
Explain the nurse's role in the promotion of mental health wellness and disease prevention.
Identify mental health concerns as they relate to culture, barriers to treatment and stigma.

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What Is Mental Health?

The World Health Organization (WHO) states that mental health is

“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” (WHO, 2018)

““…mental health implies fitness rather than freedom from illness” (WHO, 2004, p.14)

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What Is Mental Health?

The Singapore Association for Mental Health (n.d.) puts it this way:

“Being mentally well means that your mind is in order and functioning in your best interest. You are able to think, feel and act in ways that create a positive impact on your physical and social well-being.”

Singapore Association for Mental Health, n.d.

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Mental Health Demographics

Mental health issues affect 1 in 4 people in their lifetime
Majority of people who struggle with mental health will not seek care,
Those struggling with mental health issues have reduced life expectancy

20 years for men and 15 years for women
More than 700,000 people die due to suicide every year

Compared to other aspects of healthcare, mental health has fewer financial resources

Lower income countries proportionally budget the least % of healthcare dollars for mental health

Asanbe et al., 2018

WHO, 2021

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(Mental) Health Rights and Entitlements

"The right to health contains both freedoms and entitlements. Freedoms include the right to control one’s health, including the right to be free from non-consensual medical treatment and experimentation. Entitlements include the right to a system of health protection (i.e., health care and the underlying determinants of health) that provides equality of opportunity for people to enjoy the highest attainable standard of health.”

Asanbe et al., 2018

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Mental Health: Determinants

As with all of health, there are actions that individuals can take to improve (promote) their mental health.
These can be affected by the social context in which the individual lives.

Avoid drug/alcohol abuse
Develop close relationships
Be involved in serving others
Understand one’s own needs
Reach out for help when needed
Take care of one’s physical health

Singaporean Association of Mental Health, n.d.

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Determinants of Mental Health

There are also factors that affect mental health that are out of one’s control:

Biological factors
Culture
Family environment
Poverty: associated with mental disorders across all global societies.
Trauma: can be as specific as a traumatic brain injury for an individual or more widespread as in communities affected by war.

WHO, 2018

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Determinants of Mental Health (Continued)

Loss (grief)

Person: especially loss of a close family member.
Function: (for example, an individual who has had an amputation or lost a job)

Moral injury (for example, someone who has participated or been affected by something that they feel is against their moral code)

UCSF Department of Psychiatry and Behavioral Sciences, n.d.

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What Would the Nurse Do?

A 35-year-old woman is seen in clinic for non-specific abdominal pain. The nurse notes that she looks pale and tired and asks about her appetite and her sleeping habits. She states that she hasn’t slept well since her husband died 6 months ago. Without his income she has had to move in with her sister’s family but their home is crowded and stressful.

Aside from further evaluating her abdominal pain, what would the nurse do?

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Mental Health In The Family

Robinson et al., 2008

If one partner in a relationship has mental disorder, there is a higher than average chance that the other partner will also suffer from a mental disorder.
Strain of caregiving for someone with a mental disorder.
Children growing up with parents with a mental disorder may suffer a more stressful home environment.
Family members are often the caregivers for those with mental health issues.

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Cultural Impacts on Mental Health

“Mental illness is considered the product of a complex interaction among biological, psychological, social, and cultural factors. The role of any one of these major factors can be stronger or weaker depending on the disorder.” (US Department of Health and Human Services, 2001)

Widespread lack of knowledge about the biological basis for mental illness.
Some cultures attribute mental disorders to supernatural forces.
In some cultures a mental disorder is seen as a weakness.
Some cultures perceive mental illness as bringing shame on the family.

Tan et al, 2020

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Cultural Impacts on Mental Health

Though cultures around the world differ greatly, specific mental health disorders, like depression, share similarities across all cultures

Culture affects

How clients describe their disorders
Ability to cope with mental health issues
Family response to mental health issues
Adherence to treatment

Mental Health First Aid USA, 2019

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Cultural Impacts On Mental Health

Poverty

More stressful environment
Less access to resources for help

Rural environment

Less anonymity leading to fear of stigma
Fewer resources
Transportation difficulties

Immigration

Disruption in lifestyle
Fear of deportment

Rural Health Information Hub, n.d.

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Stigma

Attitude of avoidance, discrimination, or fear toward someone with a mental illness.
Fear of stigma prevents individuals with mental health issues from seeking treatment.
May lead to family rejection.
Perception is influenced by culture.
Affects self-esteem of those with mental illness as well as their family members.

Corrigan et al., 2014

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Stigma

Corrigan et al., 2014

	Public	Self	Institutional
Stereotypes & Prejudices	People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable	I am dangerous, incompetent, to blame	Stereotypes are embodied in laws and other institutions
Discrimination	Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care	These thoughts lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy of good health."	Intended and unintended loss of opportunity

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What Would the Nurse Do?

A school nurse has a 9-year-old student who visits her office frequently with complaints of not feeling well, but has no symptoms of illness. When the student is alone with the nurse, she often cries but, when asked, won’t explain the reason for her tears.

What would the nurse do?

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Nursing Role in Mental Health

WHO, 2007

Worldwide, nurses are the primary providers of mental health care.
Mental health should be integrated into the primary care setting.
Nursing education in mental health care is vital.
Nurses should be involved in policy development.

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Nurse’s Role in Mental Health: Practice Settings

Substance abuse disorder treatment
Child abuse clients
Dementia clients
In or outpatient group therapy sessions
Residential mental health facilities
Suicide prevention advocacy
Disaster settings

WHO, 2007

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Nurse’s Role in Mental Wellness

Practicing Therapeutic Use of Self

Focus entirely on the client
Set boundaries in the relationship
Listen and clarify one’s understanding
Maintain unconditional positive regard for the client

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Nurse’s Role in Mental Wellness (Continued)

Screening for mental health and/or substance use disorders
Counseling
Teaching self-care
Coordination of care
Advocacy for clients’ care and human rights

Birmingham City School of Nursing and Midwifery, n.d.

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Mental Health Support Network

Specialized mental health care services staffed by mental health professionals
Primary healthcare clinics
Human services such as housing or economic support, religious groups
Voluntary support network, for example self-help groups

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What Would the Nurse Do?

A nurse at a post-traumatic stress disorder group therapy is tasked with teaching mental wellness self care.

What are some things the nurse should include?

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There are many ways one can enhance their mood, build resilience, and get more enjoyment out of life.

Learn to be at peace with themself

Get to know who they are and what makes them happy
Acknowledge what they can and cannot change about themself
Identify their abilities and weaknesses, accept them, build on them, and do the best with what they have

Pay attention to their needs and feelings

Express thoughts through a journal or blog to understand more about themselves

Work towards their objectives

Set SMART goals (Specific, Measurable, Achievable, Relevant, Time-limited)

Maintain a healthy lifestyle

Take balanced meals
Exercising regularly
Limit alcohol consumption
Avoid cigarettes and other harmful substances

Build strong relationships

Make time for family and friends, and share life’s joys and sorrows with them

Create a financial budget

Avoid overspending and focus on ‘needs’ instead of ‘wants’

Volunteer for a cause

Being involved in the community gives a sense of purpose and satisfaction

(https://www.samhealth.org.sg/understanding-mental-health/what-is-mental-wellness/)

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What Would the Nurse Do?

A client in a primary care clinic tells the nurse that he doesn’t see any reason to go on with life. On further questioning, she finds that he owns a weapon and intends to use it to take his life. What would the nurse do?

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Red Flags

Nurse should be aware of signs and symptoms of physical and mental abuse at each clinical visit.

The nurse should be aware of signs of depression and suicide at each clinical visit, especially after major life stressor events.

Postpartum women should be observed for postpartum depression.

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References

Asanbe, C.B., Gaba, A., & Yang, J. (2018, December). Mental health is a human right. American Psychological Association. https://www.apa.org/international/pi/2018/12/mental-health-rights

Birmingham City School of Nursing and Midwifery. (n.d.). What do mental health nurses do?. Retrieved on November 10, 2021 from https://www.bcu.ac.uk/nursing-and-midwifery/about-us/school-blog/what-do-mental-health-nurses-do

Corrigan, P.W., Druss, B.G., & Perlick, D.A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in The Public Interest, 15(2),37-70. https://journals.sagepub.com/stoken/rbtfl/dDpyhM2zRi.Fg/full

Mental Health First Aid USA. (2019, July 11). Four ways culture impacts mental Health. National Counsil for Mental Wellbeing, Missouri Department of Mental Health. https://www.mentalhealthfirstaid.org/2019/07/four-ways-culture-impacts-mental-health/

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References

Robinson, E., Rodgers, B. & Butterworth, P. (2008). Family relationships and mental illness: Impacts and service responses. Australian Family Relationships Clearinghouse. https://aifs.gov.au/cfca/publications/family-relationships-and-mental-illness-impacts-and-service-responses

Rural Health Information Hub. (n.d.). Barriers to mental health treatment in rural areas. Retrieved on November 10, 2021 from https://www.ruralhealthinfo.org/toolkits/mental-health/1/barriers

Singaporean Association for Mental Health. (n.d.). What is mental wellness. Retrieved on November 9, 2021 from https://www.samhealth.org.sg/understanding-mental-health/what-is-mental-wellness/

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References

Tan, G.T.H., Shahwan, S., Goh, C.M.J. et al. (2020). Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry. BMC Psychiatry, 20(422). https://doi.org/10.1186/s12888-020-02823-6

US Department of Health and Human Services. (2001). Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health. In: Mental health: Culture, race, and ethnicity. https://www.ncbi.nlm.nih.gov/books/NBK44243/

WHO. (2007). Nursing matters. Developing nursing resources for mental health. Retrieved on November 10, 2021 from https://www.who.int/mental_health/policy/services/Nursing%20Matters%20Infosheet.pdf?ua=1

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References

WHO. (2018, March 30). Mental health: strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

WHO. (2021, June 2017). Suicide. Retrieved on November 10, 2021 from https://www.who.int/news-room/fact-sheets/detail/suicide

World Health Organization. (‎2004,)‎. Promoting mental health : concepts, emerging evidence, practice : summary report / a report from the World Health Organization. Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. World Health Organization. https://apps.who.int/iris/handle/10665/42940

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