Studying and Promoting Mental Health - Essay Example

? MENTAL HEALTH PROMOTION PROJECT This report is an attempt to document the outcomes of a Mental Health Promotion project that was carried out by thePsychiatric Assessment Ward for a 35 year old male patient who had been diagnosed with Clinical Depression. It documents the assessment, the objectives set for treatment, the interventions chosen to meet those objectives and the evaluation of the success obtained via the said interventions. Studying Mental Health Mental health has been found to mean different things for different people, given the cultural backgrounds and the periods in time. The World Health Organisation (WHO) (1948) has defined mental Health as a state of complete physical, mental and social well-being. This definition does not focus on the mere absence of illness or disease; but also on the presence of wellness on multiple factors. This concept is in opposition to the way in which many clinicians view the concept of health. Often the emphasis is on the absence of symptoms of illness; and medical professionals forget to attend to the presence of wellness. While this may or may not be as significant with illnesses of a purely physical nature; such a narrow perspective may not be adequate when dealing with problems that affect mental health. While House (2002) and Seeker (2005) claim that focusing on the symptoms and pathology helps keep a focus on resolution of symptoms and encourages a curer's approach; it needs to be mentioned that a person who is diagnosed and receiving help may be feeling better in part due to the fact that he or she is experiencing being cared for as against someone who is not receiving care. Squire (2002) has noted that someone who does not share the competencies with the rest of the population could be termed as unhealthy; something that is rather unfair. A better definition is that of the Health Education Authority (HEA) (1997) which includes emotional and spiritual resilience. This is the factor that allows one to enjoy the experience of life and cope with pain (Squire, 2002; Jeanette, 2009). We may say that the WHO (2004) definition that mental health is a state of wellbeing is a more positive definition that focuses on the ability to cope with normal stressors and the ability to work in a fruitful and productive manner and to contribute to the society around them. Promoting Mental Health. Barry and Jenkins (2007) have found that a focus of developing mental health has helped in reducing the number of people diagnosed with mental disorders. It also has the positive impact of increasing the number who recover (Friedli, 2009). Promoting mental health can thus be defined as “Any action to enhance the mental well-being of individuals, families, organizations or communities (DH 2001).” The national service framework of 1999 has established certain standards of care that are designed to enhance the recovery experience of patients. Over time, the focus has been on not only reducing the extent and number of symptoms seen; but also on the growth of a wellness principle. This principle is one that guides the treatment and carer actions such that the emphasis is on overall recovery and health. Most policies for health care are aimed at the working population. This has many reasons; from the density of this population; to the contribution they make towards the running of the significant services, including the health services. The working population is also the population which contains the parents of minors – a population whose overall wellbeing is to some extent contingent on the wellbeing of the adults who influence their lives. Any country functions best when its working population is well and functional in that they participate in meaningful activities and have healthy relationships with people and elements of their lives. The ‘Quality Framework for mental health promotion (Health Education Authority, 1997) was put in place in order to ensure that mental health promotion projects are effectively planned, consistently delivered and properly evaluated. This framework addresses both risk and protective factors; and does so in two ways. These are Reducing the barriers that people face when accessing mental health. It does this by increasing education about resources and reducing the amount of discrimination that any particular group may experience. Strengthening the community experience. This is done by increasing the amenities available; and by making a self help network more accessible to all members of society. (DH 2001, HEA 1997) Profile of Patient Studied The patient being studied at this point is a 35 year old male. In order to protect his privacy in accordance to the Nursing and Midwifery Council (2008); the patient shall henceforth be referred to as Mr. T. Mr. T is a professional, and has a hectic day schedule at work, and often spends extra time in office. He is married; but has been having some issues with his wife over finances and life choices. He has been reluctant to go for couple’s therapy although this was suggested to him. They do not have any children. Recently, he has been experiencing more than usual stress at work, and has been irritable at home due to it. Mr. T was raised by parents who had an amicable, but distant relationship and who constantly required high standards of functioning from him. A few months back, Mr. T started having reoccurring pains in different parts of the body. The GP he visited found nothing wrong, and recommended an exercise routine. But Mr. T claims that this only increased the pains he was experiencing, and so he gave it up. The pains continued, as did the irritability. In the last two months, Mr. T has been finding it difficult to keep up the quality and quantity of work in office. He has found himself making mistakes and forgetting things quite often. He has also found himself unable to cope with social situations and reports getting tired easily. On a recent visit to the GP, he was recommended for psychiatric evaluation. The test results showed that he was clinically depressed. He was recommended for a short hospitalisation in order to observe him and understand his condition better. The nurses observed that Mr. T was unable to sustain any vigorous activities for more than a short period. The first Multi-Disciplinary team review was held; and it was felt that it was necessary that Mr. T get regular medication and rest for the initial period, and that he should be regularly observed for mood and activity patterns. Mr. T was suggested to that he should avail of one – on – one discussions with a member of the nursing staff in order to build up a comfort zone. The staff member was to actively listen to him, observe his conduct of the day and his method of interacting and probe empathetically for information that could help with establishing the treatment objectives (Rigby and Alexandra 2008). According to Reynolds (2009) such a therapeutic relationship is key to helping the patient explore and achieve health outcomes. Over a period of observation and conversation, it was found that Mr. T was experiencing a huge amount of stress from his job and the problems in his marriage; and he considered himself a failure at everything. He felt incapable of doing anything, and believed he would not succeed if he tried. Assessment of Needs Staying mindful of Parry-Jones and Soulsby's (2001) warning about the lack of a systematic structural approach to assessment, and in compliance with the Community Care ACT 1990 (DH, 1999); a fully detailed assessment was carried out. The results showed that Mr. T was truly being extremely hard on himself; and was not mindful of the irrationality of doing so. He blamed himself for all mistakes, however minor, and believed he had let everyone down. He felt that his illness was a punishment he was receiving for being unable to do things right. He was afraid he was going to lose his wife; and his job as well. After his concerns and fears were thus documented (Barker, 2009), the MDT, with his collaboration came up with a few interventions that were thought to be helpful in enhancing coping and reducing his tendency to blame self. Success in these areas would help develop a sense of competence and positivity; goals that are in accordance with the goals outlined by Barry and Jenkins (2007). It was found that Mr. T needed to feel more competent and worthy; and this was considered to be the fundamental objective to be reached. The DH (2001) recommends physical exercise as a means of preventing health problems. Faulkner and Biddle (2002) and Cripps (2008) have also documented the beneficial effects of exercise in recovering from mental illness and enhancing health; and so mild exercise was incorporated in to Mr. T's daily routine. In order to increase his self efficacy, a structured regime was planned with incremental goals. These were to be observed by the carers, so that there would be no repercussions. Along with the exercise, it was also recommended that Mr. T be involved in the hobby and activity workshops at the centre that he finds interesting. Creativity has been found to be important in enhancing worthiness and competence (Health, 1997). This works in two ways; for one, it provides a sense of accomplishment at having learnt a new activity; and secondly, it enhances the persons sense of worthiness when they realise that they have been able to create something by themselves. Objectives established: To attend the exercise sessions at the centre. To gain through the levels set in context to exercise sessions. To choose an activity to learn. To attend as many sessions as possible for the activity chosen so that genuine learning occurs. To reach a point of self – motivation in exercise and activity and be able to discuss how attending the sessions felt. Process Mr. T was encouraged to join the exercise class at the centre on a daily basis, and the instructor planned a 4 week regime such that there was an increase in intensity each week. Regular feedback was an important part of the structure planned; and the careers and the trainer ensured that honest but constructive feedback was given to Mr. T regularly. Ransford (1982) has suggested that, physical exercise could increase aminergic synaptic transmission in the nervous system by increasing serotonin levels. North et al.'s (2004) reviews the impact of exercise on depression and states that there are noted changes in the psychosocial aspects. Greenwood et al (2005) cautions us though that this hypothesis is derived from animal study models and should be treated with caution. The one on one sessions with the member of the nursing staff were conducted regularly, to help Mr. T revisit his beliefs about himself, and his activities. Examples from the objectives that were set up with his collaboration were used to help him see his own activities in a more positive light. Mrs. T was involved in the process of helping Mr. T regain a healthy perspective; and she was informed about the findings and taken into confidence about the concerns and stressors that Mr. T was dealing with. Firstly, meeting other people for exercise provides a basis of social interaction. Hedelin and Svenssion (2002) acknowledge the importance of social support in positive mental health. She was completely co-operative, and volunteered to get involved in the healing process. She and Mr. T attended couples dance classes outside the centre with the doctor's permission as a means of reconnecting with him. The dance classes were also judged to be a good activity for Mr. T to learn; and the feedback from the dance lessons and from Mrs. T were incorporated into the one on one sessions. The resulting positive feedback from Mrs Miller and the great improvement to her appearance indicated an improved self-concept (Mann 2004). Brown et al (1990 as cited in Mann 2004) suggested that low social support contributed to low self-esteem which is associated with various mental health problems.  Evaluation The evaluation on the success of the set objectives was made on the basis of the extent to which Mr. T met his goals; the extent to which he was able to take pride in what he was accomplishing; and on the basis of the feedback from other members of the team. The staff member with whom he had one on one sessions reported that Mr. T was slowly learning to take an active interest in his own wellbeing. He was able to accept his accomplishments, although he was still not taking much pride in the activities. On the basis of clinical assessment, it was believed that at the end of two months, Mr. T was ready to go home, though he was still required to com e in regularly for sessions and exercise reviews. After four months of regular sessions, exercise and joint activities with his wife, Mr. T was pronounced much better than when he was first admitted. He was more realistic in his approach to work and relationships; more appreciative of himself, and more aware of the effort that he was taking. Another breakthrough that occurred during this period was that Mr. T agreed to both, personal and couples counselling as an attempt to make sense of the issues that mattered to him the most. The support he received from his wife motivated him to return the favour by sorting out the issues that they had been happening. Feedback over the next few months showed that he was making constant progress by addressing his issues in a positive manner, and appreciating the good things in his life more. His depressive symptoms had reduced, and he was beginning to life a more healthy and fruitful life. References  Audit Commission. (2004). Older People : Independence and well-being. The Challenge for Public Services. London: Audit Commission.  Barker, P.. (2009). Assessment- The Foundation of Practice. In P. Barker, Psychiatric and Mental Health Nursing. The Craft of Caring. London: Arnold.  Barry, M. & Jenkins, R. (2009). Implementing Mental Health Promotion. Philadelphia: Churchill.  Callaghan, P. (2004). Exercise: A Neglected intervention in Mental Health Care. Journal of Psychiatric and Mental health Nursing.  Colbridge, M. (2005) Management of SSRI and Related Drug Overdose. 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