Assessment and Recovery from Mental Distress - Essay Example

?Assessment and Recovery from Mental Distress: Appraising the concepts of ‘Recovery’ Introduction Mental distress is one of the least understood cases or situations where an individual himself or herself feel so helpless about his/her feelings. What makes it worse is the understanding of others about the situation. Mental distress is described as the case of a person who experience problems in their internal life such as in the way they think, feel or behave which is out of the normal. Their life attitude is often expected to result into trouble, confusion, and misunderstandings (Carey, 2011) which in the end also negatively impact on their relationships, their works, and their quality of life (Carey, 2011). The common causes of mental illness and distress are chemical imbalances in the brain, stress and everyday problems, and exposure to severely distressing experiences such as loss of a relationship, job, death of a family member, sexual assault, killings, and violence, among others. However, some mental health experts claim that mental illness can also be inherited. There are different types of mental distress: anxiety disorders, post-traumatic stress disorder, depression, manic depressive distress, borderline personality disorder, schizophrenia, and many more depending on gravity and description. People who suffered from these distresses were seen with various symptoms. The person could experience upset, feeling restless, sleeplessness, tremors, nightmares, extreme sadness or despair, loss of interest in doing anything, loss of appetite, irritability, impulsiveness, depression, inability to perform daily tasks, hopelessness, sense of guilt, extreme mood swings, feeling worthless, sense of guilt, extreme mood swings, violence, and suicidal tendencies (Borg and Kristianssen, 2004). Being mentally distressed is difficult. Some even deny they have such illness because of the prejudice and discrimination of people around them. But, having the illness is not anybody else’s fault or a sign of weakness and not something to be ashamed of (Mental Health Commission, 2007). It has been suggested that the treatment must not be delayed in order to prevent it into more severe stage. However, it has been found that conventional or traditional treatments had not been successful for many patients. If a person is seen with early stage symptoms of mental distress, it is not only a prompt treatment that must be provided to be able to recover the patient more quickly but the proper one and, there could be similar or different methods for every patient’s case. It should be noted, however, that early detection and treatment helps the patient to restore his/her respect, dignity, and confidence, and live a full, quality life (Borg and Kristianssen, 2004). Those mentally distressed can recover, provided they seek and provided the appropriate treatment and support. The treatment can be medication, therapy, support and counseling, lifestyle adjustment, support group meetings, and, provision of an inner strength that “…can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship,” (Carey, 2011, P 8). Discussion A. Mental Health Nursing Mental health nursing was described as “an ‘artistic’ interpersonal-relations tradition which emphasizes the centrality of nurses’ therapeutic relationships with ‘people’ ‘in distress’ and a ‘scientific’ tradition concerned with delivery of evidence-based interventions that can be applied to good effect by nurses to ‘patients’ suffering from ‘mental illness’,” (Norman and Ryrie, 2009, 1537). The task employs two different methods that are either integrated or complementary in order to deliver quality care to patients. It should be noted that one method is free and independent of any outlined procedure while the other is systematic and depends on evidence for its implementation. It should be also highlighted that a third factor is the “interpersonal relations” where patient takes a central figure in order for an effective delivery. This was promoted since the 18th century by William Tuke and his Retreat in York, and further by Hilda Peplau’s Interpersonal Relations in Nursing (Peplau, 1991). Peplau reinforced the role of the nurse as a medium to promote health and develop patients’ ability to engage with people around them. Recent developments accepted the role of the nurse on mentally distressed patients as dependent both on evidence-based models as well as the need to consider multi-disciplinary approaches that reflect a closer reality of nursing. In addition, nurses now occupy roles previously relegated to doctors and psychologists in delivery of evidence-based interventions, as well as evaluate effectiveness of these roles through scientific methods (Norman and Ryrie, 2009). A milestone in the care of mentally distressed was the health policy towards promotion of social inclusion and recovery with the goals to reduce the stigma associated with mental health as well as meet patient-centered results. Recovery is defined as an approach that goes beyond managing symptoms, rebuilding people, and even helping patients to retain a valued if not satisfying lives (Perkins and Repper, 2009). B. Assessment Process for Mental Patients The United Kingdom’s Department of Health (1994) mandated that, “Psychiatric nurses work with individuals suffering from varying degrees of mental illness…They have a wide variety of roles, but the main focus of their work is to assess a specific individual’s needs and recommend the appropriate treatment, therapy or care package,” (p 11). Assessment is considered the first stage of the nursing process where patient’s needs are identified. An assessment of mentally distressed patient encompasses an evaluation of the condition of someone or something of which a judgment can be made about them. Assessment is considered as the first step in treating diagnosed mental distress patients. It is a process in which a person who seeks mental help is being evaluated based from the results of a structured interview and tests (Assessment and diagnosis 2011). The aim of assessment is part of diagnosis in order to recommend the most appropriate treatment with the goal to prevent the condition from become more severe. The assessment process involves multiple tests such as neurological tests, psychological tests for the behavior and attitude, and examinations on how the person interacts with people (Borg and Kristianssen, 2004). Personal information and medical history are also included in order to possibly trace the triggering or contributing factors that cause such illness to the patient (Harkreader and Hogan, 2003). The mental health assessment process is conducted by trained professional psychologists or other mental health practitioner. Technically, it starts the moment the patient sought the help of the doctor for conditions that are bothering him / her, or other people around him. It is highly possible that the person actually involved may be reluctant or deny seeking a professional due to the stigma attached to mental illness, and a third or another person induced the assessment to happen (Harkreader and Hogan, 2003). The process includes an interview of the patient in order to gather personal information; problems of the patient, history of his/her present illness, his professional career, work, engagement or family background. The next steps involve administration of various psychological tests. Currently, mental illness is detected through the use of psychological inventories with the mst common ones being the Beck Depression Inventory, Anxiety Scale, Firestone Assessment of Self-Destructive, and Hopelessness Scale. These are used to measure the anxiety and depression levels, current and recent mood states, and suicide ideation (Borg and Kristianssen, 2004). Another method to assess mental problems is through the neuropsychological tests. These tests check for the impairments in memory and recall, cognitive functioning, recognition, processing speed, and spatial abilities. These tests may include the CDR Computerized Assessment System or the Dean-Woodcock Neuropsychological Assessment System (DWNAS). The doctor can also detect the patient with mental problems through mental status examination (mse). This may include the patient’s appearance, attitude, behavior, mood, thought processes and perceptions. The doctor can also obtain information through observing his/her patient’s response during the consultation or in the way he/she responses or acts with questions (Borg and Kristianssen, 2004). After getting all the necessary information, the results of the tests and interviews will be reviewed and studied in order to make an assessment whether or not the patient is having mental health problems. A study on the nurses’ observations in an acute inpatient setting, it was found that assessment practices of nurses “were rich in situated assessment detail and a powerful strategy for producing civil conduct among patients…nurses deliberately obscured their practice of observation, in order not to provoke patients…such discreet practice is productive for everyday clinical work,” (Hamilton and Manias, 2007). C. Concepts of Recovery Recovery is a process by which individuals rebuild and develop new personal, social, environmental and social connections, and adjust their attitudes, feelings, perceptions and goals in life. It is a process of self- discovery, self-renewal and transformation (Gendreau, 2009). In mental health care, recovery may be expected through a multidisciplinary assessment, planning, treatment and evaluation process focused on the patient’s particular problems and potentials (Marks-Moran, 1992). Recovery is often referred to as a process, outlook, vision, and conceptual framework or guidance towards a positive and healthier direction. The concept of patient recovery is by keeping their life in control despite their mental health condition. Recovery it not just treating or managing the symptoms but rather on focusing care on supporting recovery and building the resilience of the patient with mental health problem. Recovery also means giving hope to the patient that despite his/her serious mental condition, he/she still can regain a meaningful and quality life (Mental health Foundation). In order for the patient to recover, he /she must undergo appropriate medical treatment, gain self-esteem, increase his/her comfort level by accepting his/her real self. The family and friends of the patient also play significant roles in his/her fast recovery by accepting his/her condition, securing love, support and sense of belongingness, inspiring him/her and by showing his importance in the family or group (Froggat, year, p1). Froggat (year, pp 3-4) stated the fundamental components of recovery as a step-by-step approach of which the patient needs first to identify where he /she begins. After identifying where to start, his/her next moves are concerned on self-empowerment, self-direction, being person centered, non-linear and strengths-based. These encompass inclusion of self-respect, gaining responsibility and hope, and providing peer support (source, year). If the patient aims to recover from his/her mental problem, he/she must help himself/herself. He/she must have the will and determination to overcome it because whatever treatment he/she undergoes and he/she refuses to, then the concept of recovery is useless and meaningless ((source, year). One concept that has permeated in mental health nursing is the use of Individualized Patient Care of IPC principle. Concepts, ideas, and methods collectively revolve around IPC as self-actualizing nature of human nature wherein the nurse is an enabler (Choi, 1989). The concept of recovery is being optimistic that the illness is curable; that there are good clinicians or therapists who are willing to discuss the patients’ hopes and dreams and suggest the steps they need to take. Their family and peer groups will support them and should be committed throughout the process (Froggat, 2011, 3-4). The concept of recovery can be used to manage symptoms, reduce psychosocial disability, and improve role performance (Froggart, 2011). D. The Recovery Model for Mental Distress Nurses have played important roles in the recovery of process of mentally distressed patients. Some efforts have focused on containment measures (Bowers et al, 2007), access to nurses in such conditions (McEvoy and Richards, 2007), as well as computerized education intervention (Gega et al, 2007). The recovery approach in mental health care emphasizing on hope, meaningful activity and empowerment has also placed service user and their lived experience n the center of decision-making about treatment and care (Lloyd, Waghorn, and Williams, 2008). Lloyd et al (2008) emphasized that “Belief that there is hope for a better life is a large part of the recovery orientation,” (325). In the perspective of one service user subject to a study, “it’s…as if…you struggle to survive and put your point across: ‘And this is what’s happening to me, do you understand me? Do you know what I’m doing? Do you know what I’m talking about?.. A person’s got to work through emotion. They’ve got to work through stress. They’ve got to be able to work through voices and things that are disturbing and destructive to their lives,” (quoted from Happell, 2008, 124). The recovery approach not only includes a clinical recovery wherein correct assessment and optimal treatment is enough implementation of care (Lloyd et al, 2008) but encompass as well supporting methods with the individual patient as center of the process. Davidson, Shahar, Lawless, Sells, and Tondora (2006) suggested that recovery oriented care elicits, flesh out, and cultivate the positive elements of a person’s life including interests, assets, aspirations and hopes. Here, the views of the user or patient is integrated in the review of existing programs, approaches and future decision-making although it cannot be totally described as encouraging naive unrealism (Shepherd et al, 2008). The Mental Health Commission (2007) acknowledges that in recovery approach, each patient’s journey to wellness is unique and individual and can be achieved through active participation in treatment goals and plans. Goals lead to fulfilled lives even if challenges with mental illness. The method encourages hope, trust in self, positive self-image and identity, the patient’s resourcefulness, confidence, control, and the right of the patient to be heard and respected (Mental Health Commission, 2007). One the methods used in recovery approach is the encouragement of an individual’s personal inclinations to therapeutic activities such as engagement in the arts and crafts, including music. Practitioners believe that central to the well-being of the patient is the need to have meaning contact and relationship with others (Odell-Miller, 1995). Through these therapy sessions, the patient is reoriented towards a more person-centered way through his or her journeys while respect and empathic relationships are fostered between the patient, fellow individuals engaged in the activity, and the service providers (Mental Health Commission, 2007). The emphasis is on strength, resources, and potential of patient as well as collaboration and equal relationships instead of the problems or conflicts (Gold et al, 2005). It was suggested that healthy resources are highlighted and rediscovered through active and reflective listening in music therapy while it also facilitates empowerment to ensure quality care (Rolvsjord, 2010). Borg and Kristiansen (2004) also acknowledged that providers and their health care team should be characterized with the “willingness and ability to shape services to the needs and preferences of each individual service user,” (493). A great advantage of using the recovery model in patients with mental distress is that it provides opportunities for patients who may have difficulties in joining therapeutic services or those who have problems in social relations. It has been indicated that patients with severe and enduring mental illness showed negligible attrition level (Grocke et al, 2008) but this has been successfully addressed in the musical therapy implemented by a practitioner whose patients attended the services regularly with improvement in self-care, dressing-up (McCaffrey, Edwards, and Fannon, 2011). McCaffrey et al’s study (2011) which focused on musical therapy of patients concluded that focus “on the resources and strengths of clients; gently and gradually building their confidence and capacities through regular supportive sessions over time. Whilst music making requires a unique kind of mental organisation that is difficult to account in simple terms, it is important to consider music’s distinctive capacity for the promotion of self-organisation and self-regulation. In conjunction with another person, playing music together mirrors all the capacities for relating that verbal interaction requires; including listening, responding, and initiation,” (p 188). Tatsuki et al. (2003) proposed key aspects of the psychological recovery process: return to normalcy, struggle for meaning, and retreat. Return to normalcy is based on Berger and Luckman’s (1966) sociological where’s patient’s view of how everyday life is constructed. Recovery occurs as individuals internalize the negative events or thoughts and return a new reality as normal life. It is highly recommended that focus should be to help patients normalize their lives as quickly as possible and considered a key mental and psychosocial effort for the health care team and the individual (Chakrabhan et al., 2005). Some individuals in mental distress may retreat or refuse to cooperate in the process and this is expected due to the traumatic condition that they may have gone through. This may be called as post-traumatic avoidance (de Mel, McKenzie and Woodruff, 2007). The struggle for meaning and acceptance usually changes a person’s outlook for life although this stage may decline over time as individuals recover from their negative experience (de Mel et al, 2007). Marsha Linehan who developed the dialectical behavior therapy or D.B.T. is another proponent for mental distress recovery model where she has emphasized “… real treatment would have to be based not on some theory but on facts: which precise emotion led to which thought led to the latest gruesome act. It would have to break that chain — and teach a new behavior,” (Carey, 2011, 2). Linehan is a therapist but herself a victim of borderline personality disorder, who designed a recovery model emphasizing on hope for the individual. In includes commitment, day-to-day skills, as well as “opposite action, in which patients act opposite to the way they feel when an emotion is inappropriate; and mindfulness meditation, a Zen technique in which people focus on their breath and observe their emotions come and go without acting on them,” Carey, 2011, 3). This method has helped mainly suicidal cases and now practiced worldwide (Carey, 2011). Conclusion The nurse’s role in the assessment and recovery of a mentally distressed patient is as crucial as that of the psychologist or psychiatrist. While a clinical model requires accurate assessment in order to optimize treatment, recovery model requires not only an assessment but also cooperation with the patient’s requirements, needs, and personal input about how and what he or she may hope to be. Patient-centeredness has been widely accepted in all fields of heath care and this should be more emphasized in mental distress cases due to the nature of the need which has been identified since the 1800s. Providing the patient a sense of importance as well as voice for his own treatment not only reflects an actualization of patient centeredness but also a development towards a holistic approach to mental distress care and treatment. Reference: Berger, P., & Luckman, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. New York: Anchor Books. Borg, M., & Kristiansen, K. (2004). Recovery-orientated professionals: Helping relationships in mental health services. 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