The Role of Nurses in the Assessment and Treatment of Mental Health Patients - Essay Example

Explore how the role of mental health nurse may be enhanced by understanding the sociological, political and economic factors that influence mental health care. Introduction Mental health is defined by the WHO as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". It is necessary for the well being and effective functioning for an individual and for a community. It can be said that mental, physical, and social functioning are interdependent. There are multiple social, psychological and biological factors interacting to determine health (WHO Summary Report 2004). Nurses play a major role in the assessment and treatment of mental health patients. Nurses, by virtue of their proximity to the patients develop a sense of empathy and caring feeling which comes naturally to them and thus are able to promote the emotional well being of the patient. Mental health nurses work with people suffering from various types of mental illnesses. Their role includes caring for these patients, assessing the problems of the patients, providing reassurance, building relationship to encourage trust, listening to patients and interpreting their needs, monitoring the route and dosage of drug intake, determining the response to treatment, preparing and maintaining records, assessing risk responding to a distressed patient appropriately in an unthreatening manner, participating in group and one-to-one therapy sessions, encouraging patients to take part in recreative and rehabilitative measures, organizing social events aimed at developing patients social skills and coordination with other organizations like legal services and police (Mental Health Nurse, Prospects). Besides the knowledge of the mental diseases and treatments, to pursue their functions efficiently, it is important for the mental health nurses to understand the various factors which influence mental health of people. Some of the major factors which play a major role in the mental health of individuals are described below. Role of economic factors Poverty and deprivation have a significant effect on mental health. Poor people in any society are vulnerable to mental illness because of insecurity, hopelessness, rapid social change, risks of physical and mental abuse and increased physical morbidity (WHO Summary Report 2004). The association between poverty and mental illness is universal. It occurs in all societies whether, developed, under developed or developing. According to World Health Organization, "Mental disorders occur in persons of all genders, ages, and backgrounds. No group is immune to mental disorders, but the risk is higher among the poor, homeless, the unemployed and persons with low education" (Cited in Kuruvilla & Jacob 2007). Poverty is associated with lack of opportunity, reduced availability and accessibility to resources and increased chances of experiencing difficult events. These can lead to distress which can manifest as low mood, sadness, frustration, discontentment or physical illness without organic cause (Kuruvilla & Jacob 2007. Common mental disorders like anxiety and depression are prevalent more commonly amongst the lower social economic group, especially those with the lowest material standard of living (Kuruvilla & Jacob 2007. The factors which contribute to these manifestations are financial hardship, lower education, unemployment, stress, and unfulfilled ambitions expectations at work (Manoranjitham 2005). Of all these, stress is the most important factor and is often correlated with suicidal tendencies. Suicidal rates are infact higher in communities with poverty, deprivation, unemployment and poor education. According to the Epidemiological Catchment Area Study (Religare et al 1993), the lowest economic groups are twice at risk for Major Depressive Disorder than the higher strata. However, as far as bipolar affective disorder is concerned, its incidence is more in the upper class. Psychiatric illness also leads to poverty. This can be explained by the drift hypothesis. According to this hypothesis, psychiatric illness can result in deterioration in functioning to such an extent that the affected individual is drifted down to the lower socio-economic status. Drifting is most commonly seen in schizophrenia when compared to other psychiatric illnesses. Goldberg & Morrison (1963) reported that schizophrenia affected the economic status of the persons affected. Also to consider is the fact that mental illnesses pose a heavy financial burden on individuals, their families, society, community and nation. This can be either due to expenditure for medications, consultations, in-hospital admissions or any other form of utilization of health services. Medications constitute an important source of expenditure because most of the patients with mental disorders need long -term medication, many of which may not be covered by insurance companies. In some developing countries like India, the poor do not have health insurances. Long term medications can also lead to side effects like elevated lipids and sugar which may further increase the cost of treatment (Kuruvilla & Jacob 2007). Also, those employed may not be able to attend to work properly, thus leading to absenteeism. Those who continue to attend to work may show poor performance. Absenteeism and poor performance can lead to loss of productivity. Major psychiatric conditions like schizophrenia and mood disorders are at risk for physical disability due to poor lifestyle and self-neglect. Treatment of these physical conditions further adds up to the cost (Kuruvilla & Jacob 2007). Dissatisfaction with ones lot in life in comparison to that of others is known as relative poverty. Relative poverty occurs as a result of inequality in the society and is commonly seen in developing companies where rapid social and economic changes are seen and can contribute to emotional distress, anxiety and depression (Kuruvilla & Jacob 2007). Financial deficiency and restricted standards of living in those who are employed is known as working poverty. This is associated with insecurity of income flow and unmet mental health needs. Working poverty can contribute to suicidal tendencies (Kuruvilla & Jacob 2007). Also, acute change in socioeconomic status and sudden financial loss is associated with acute and extreme distress, suicidal ideation and suicidal attempts (Kuruvilla & Jacob 2007). Proper economic structure is necessary for family functioning and child mental health (WHO Summary Report 2004). Childs mental health is dependent on parents employment and education status, family size, maternal mental health, relationship between parents, safety of the living environment and parenting nature of the parents (Kuruvilla & Jacob 2007). In a study by Tao et al (2002), they reported that occupation of the parents, education of the parents, interest in the major studied, body image and gender had significance influence on the the psychological adaptation of college students in China. Chronic deprivation in children leads to behavioural problems and poor cognitive performance. Children tend to have higher levels of depression and anti-social behaviour. As they grow into adulthood, they may engage in substance abuse and crime. Some may develop externalized behaviours like defiance, impulsivity, hyperactivity and aggression. Some others, especially girls may develop internalized behaviours like withdrawal, dysphoria and anxiety (Kuruvilla & Jacob 2007). Culture, race and ethnicity All forms of medical care including mental health involve interaction between two or more people and hence an understanding of how social factors influence treatment will assist the nurse in developing skills. In mental illness, social factors play an important role in a persons decision to seek treatment (Goldman 2000). Major mental disorders like schizophrenia, bipolar disorder, depression, and panic disorder are found world wide with no racial, ethnic or traditional barriers. According to the Surgeon General Report (1999), the overall incidence of mental disorders in the United States has been estimated to be about 21 percent in adults and children. Amongst individuals living in communities, no difference has been noted between the prevalence of mental disorders amongst whites and mental disorders in minority groups. However, the report states that there is difference in prevalence rates amongst individuals in vulnerable, high-need subgroups such as persons who are homeless, incarcerated, or institutionalized. In vulnerable societies where minorities are over-represented, according to the same report, individuals faced with these circumstances especially the minority do suffer from more mental illnesses. It has been estimated that the prevalence of mental disorders is higher among African Americans than among whites and that this difference is due to socioeconomic differences rather than racial causes. This is because when socioeconomic factors are taken into account, the prevalence is same in both the communities (Community Alliance, Mental disabilities). Factors implicated in the development of mental disorders in these ethnic minorities are decreased availability of mental health services, decreased access to mental health services, poorer quality of mental health care, under-representation in mental health research and barriers deterring minorities from reaching treatment (Surgeon General Report 1999). Some of the barriers include, cost involved in the treatment, fragmentation of services, societal stigma toward mental illness, mistrust and fear of treatment, racism and discrimination and differences in language and communication (Surgeon General Report 1999). Minorities do not trust mental health services. They suspect clinician bias and stereotyping (Surgeon General Report 1999). Asian Americans are very unlikely to seek help for mental health problems. This is due to various factors like the cultural belief that mental health is stigmatizing, language communication problem, different cultural explanations for the problems, and an inability to find culturally competent services. On the other hand, Asian Americans born in United States have similar rates as that of the Whites. Hispanic Americans have different mental health problems and help-seeking behaviours. Many Hispanic families think that mental health disorders are a family issue and that should not be discussed in the community (Community Alliance, Mental disabilities). African Americans and Hispanics are more likely to be diagnosed with schizophrenia than with affective disorders and bipolar disorder (Soreff, 2007). Suicidal tendencies are more common in white race (Bhalla 2006) and infact, depression is less common in the black population (Bhalla 2006). In bipolar disease, no racial predilection exists (Soreff, 2007) It is important for the nurse to know these aspects so that these individuals can be seriously addressed and any disparities encountered in the treatment can be remedied. Communication is an important aspect of health care because mental disorders affect thoughts, moods, and the highest integrative aspects of behavior, and diagnosis and treatment of these mental disorders is largely dependent on communication and trust between the patient and the health professional (Surgeon General Report 1999). Culture, race, ethnicity and society have wide-ranging roles in mental health, mental illness, and mental health services. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. It is important to understand these aspects so that services that are specific to the needs of the racial and ethnic minorities can be provided. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. Asian patients are likely to express psychological distress as physical complaints (Kramer 2002). Major depression may be presented as fatigue, imbalance, or neurasthenia in patients of Asian origin (Bhalla 2006). Culture also influences help seeking behaviour of the affected individual, what types of help they seek, their coping styles, the social support they get and the social stigma attached to the mental disorder. A person diagnosed with mental illness may be distanced socially (Lauber 2004). Each culture has its own style of coping with disorders which buffers some people from developing certain disorders. Cultural norms not only affect the way patients present with symptoms, they also affect the way a health professional views the symptoms of the patient. There can be difference in the views of the patient and the health professional which may affect the delivery of care, diagnosis of the condition, treatment instituted and organization and reimbursement of services. It is obvious that health professionals who are much influenced by these cultural norms and who are not aware of the patients cultural requirements and variations can not do a good job of health care provision (Surgeon General Report 1999). In many countries, though racism is a much avoided aspect, it does exist, and it leads to discrimination. Discrimination is stressful to the taker and it has adverse impact on the mental and physical health of the individual. Anxiety and depression are common mental disorders encountered in those at the receiving end of discrimination (Surgeon General Report 1999). Cultural factors have a lot of influence on the DSM categories and also on the assessment and diagnosis of clinical disorders. This is because individuals of poor communities and culturally diverse populations are exposed to a multiplicity of physical, social and psychological stressors. Many a times, individuals from such populations indicate behaviors that do not meet any one diagnosis but whose severity demand therapeutic intervention (Canino 2000). Mental health nurses should be aware of these aspects because other times these individuals behaviors are solely a reflection of the exposure to continuously environmental stressors and hence the diagnosis of a condition must be reserved for unresponsive political and social interactions (Canino 2000). It is also possible that these individuals truly suffer from emotional disorders with chronic symptoms and overlapping or multiple diagnoses. It is due to these complex factors associated with diagnoses that the nurse should indicate in his or her assessment any diagnostic uncertainty, address exclusionary criteria and also comment on the severity, significance, and course of the symptoms (Canino, 2000). The way that culture is understood and operationalized within the DSM diagnostic scheme becomes particularly germane to counselor identity. Culture serves as the nexus of counseling practice and as a fundamental theoretical construct in understanding the change process (Douthit, 2006). Political factors influence on mental health Like other health reforms, mental health is also associated with the way health system works. This includes rules of governments, health professionals and the lay public. Frankish et al (2002) studied the effects of political factors on health reforms in British Columbia, Canada. They opined that the qualifications, representation and selection of the health board members influence health reforms. Also, relationship and addressing the concerns of the stake holders has an influence on the implementation of health reforms. There is a disparity in state and federal programs with many areas underserved (Community Alliance, Mental disabilities). In some countries, there are no Mental Health Hospitals. The patients are admitted in general hospitals. There are also severely mentally disabled persons who are homeless and not taken care of, living on the streets, surviving from garbage can to garbage can (Community Alliance, Mental disabilities). Political factors have a major role in the mental health of refugees. This vulnerable group is also subjected to the influences of social and cultural factors. Refugees are displaced from their homes due to political violence, wars or related threats. Thereby they have restricted economic opportunity. In their own country they may be displaced internally or they may have to abide by the rules of the country they have sought shelter in. In a study by LeMoult (2005), he reported that refugees who were women, older, more educated and higher socioeconomic status prior to displacement had worse mental health outcomes. Also, those who were from rural residence or those supported in institutional accommodation suffered the worst. The impact of political violence on collective health and populations is well known. Political violence includes armed conflict and guerrilla warfare, combat, imprisonment, torture, rape and other war atrocities. Pedersen (2006) studied the effects of political violence in the Latin American and Caribbean region on mental health of the individuals. He reported that political violence lead to increased interpersonal violence like child abuse, homicide and women abuse, substance abuse, suicidal tendencies, anxiety, depression, acute stress disorder and posttraumatic stress disorder. Many benefits either financially or resources are provided for the health professionals dealing with physical ailments. Such encouragement is not seen much in mental health care services. Increased financial support in the form of increased ancillary staff salary, post-graduate allowance for general practitioners and medical reimbursement can enhance participation of health professionals in mental health services and increase quality of mental health services. In the long term, such changes can benefit mental health arena even among those currently not interested in mental health work. Preventive services in mental health can be enhanced by more collaborative work practices, decisions on priorities for the team, close monitoring of the health and health needs of the client group and measures of their effectiveness (Newton 1994). There are many challenges encountered by the health professionals in the mental health and drug-abuse management faculty (Jones, 2003). One important stress factor is inadequate practical experience. Though the nurses are trained academically, they may not have real-life experience, making them more vulnerable to stress. Also, many de-addiction centers and mental health services do not have adequate staff because working in these units is highly demanding with fewer pay packets. Added to this, most of these services rendered are through government or non-profit making organizations and hence may not be funded appropriately. Also, of concern is the patient behaviour. The kind patients who come to these units have a wide range of mental problems and hence their behavior will be abnormal. Some may turn violent and others may use abusive language (Room, 2005). Another issue faced by the nurses is lack of resources (Annette, 2004). This is usually a problem in remote and rural areas. Due to the high stressful conditions which drains the nurses physically and mentally, the nurses themselves may go in for alcohol, anti-anxiety medications, etc. Some may develop depression. As such the staff themselves may require counseling and help (Happell, 1999). Gender and mental health It is important to understand the gender related demographics of mental health disorders so as to arrive at a correct diagnosis, assist appropriate treatment and take help of other organizations like medical and legal if necessary. In the demographic study on Community Alliance (Community Alliance, Mental disabilities), it has been estimated that the overall incidence of mental health disorders is similar among men and women, however, there does exist a difference in different diagnoses. Women are often at greater risk of mental ailments because of the multiple roles they fulfill in society and the stress they are prone to because of their roles. Women also are at the receiving end of not only gender discrimination and the associated factors of poverty, hunger, malnutrition and overwork, but also of sexual and domestic violence (WHO Media Center 2000). Women are most likely to be affected by anxiety related disorders and depression (Tao et al 2002). Infact, prevalence rates of depression and anxiety disorders as well as psychological distress are higher for women than for men. The lifetime incidence of MDD is 20% in women and 12% in men in the United states (Bhalla 2006). They are also prone to obsessive compulsive disorder, somatization disorder and panic disorder (WHO Media Center 2000). Bipolar disease occurs equally in both sexes. But rapid-cycling bipolar disorder (4 or more episodes a year) is more common in women than in men (Soreff, 2007). The lifetime risk of schizophrenia is equal for both sexes. However, the onset is earlier and the outcome is poorer in males than in females. Females have a better response than males to antipsychotic medications (Gerstein 2007). Antisocial disorders and alcohol abuse are more common in men. Suicidal tendencies are also more common in men than in women (Bhalla 2006). These differences between men and women are attributed to the biological and hormonal differences in the sexes, social causes, different ways in which women and men cope with distress, and different help-seeking behaviours of the sexes (WHO Media Center 2000). To provide appropriate service to womens mental health needs, it is important to understand the different factors which influence womens mental health. Women are at higher risk for common mental disorders like depression and anxiety. Women are considered to be more at risk because of single status in child rearing, multiple roles, unequal power relations with men, and sense of powerlessness (Kuruvilla & Jacob 2007). They suffer more from hopelessness, lack of education, insufficient employment and non-cooperation from family members. They are targets of social stigmas and beliefs (Kuruvilla & Jacob 2007). Women also suffer from physiological depression due to menstruation, pregnancy and lactation. Age and mental health It is important to know what disease is common at what age to facilitate proper diagnosis and care and also to identify the sources of distress. Also, some disorders like substance abuse at an early age can lead on to other disorders like schizophrenia and such aspects can be tackled with. Some mental illnesses are common in younger age group while others in older age. Suicidal tendencies are more common amongst the older age group (Bhalla 2006). In prepubertal children, boys and girls are affected equally in case of major depressive disorder (Bhalla 2006). But the incidence of clinically significant depressive symptoms increases with advancing age (Bhalla 2006). Also, in major depression, elderly persons present with more somatic complaints, cognitive symptoms, and fewer complaints of sad or dysphoric mood (Bhalla 2006). The mean age of incidence of bipolar disease is 21 years (Soreff, 2007). The peak age of onset of schizophrenia is 18-25 years for males and age 26-45 years for females. This disease onset before puberty is rare and older than 45 years is uncommon. The symptoms of schizophrenia improve gradually when they are middle aged and older (Gerstein 2007). Conclusion Mental health is affected by various sociological, economical and political factors, all of which are actually interdependent. Understanding these aspects helps a mental health nurse focus on certain underprivileged groups, retrieve information about despair, arrive at proper diagnosis, assess outcomes and arrange for other sources of help. References Annette, M., Nkowane, R.N., & Saxena, S. 2004. 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