Introduction: Hospitalization and illness, not only affects physical health, but also the mental health of patients, caretakers and family members. Many patients experience fear and stress that affects their day to day activities and relationship with others. Mental strength is required for adapting to changes caused by illness. A healthy mind helps the body cope up with the stress caused by one’s illness. Certain medical conditions can affect different aspects of one’s life: personal, professional and social life. Though it is normal for a patient to worry about his diseases; it is not normal to feel hopeless or worthless. These extreme feelings are signs of mental problems. Mental problems arise as a result of the brain working in the wrong way: causing wrong thinking, perception, emotion, signaling, physical and behavior changes. As a result of these changes, the person expresses several symptoms that help identify the mental problem.
The symptoms of mental diseases are not very specific and can vary from patient to patient. While some have problems focusing and paying attention, others have sleep problems or feel emotional highs and lows. When these symptoms begin to disrupt normal life, then mental health and disorder are suspected. Mental disorder is not only a consequence of a physical sickness, but can also occur as a consequence to the patient environment and genetic makeup. Though stress can aggravate mental disorders, only in very rare circumstances, stress can be the sole cause of mental problems. The cause of many mental diseases seen in the society lies has its roots in the person’s childhood.
Theories of mental health: According to Freud’s theory of psychosexual development, all human behavior is motivated by their subconscious thoughts and feeling. Analysis of these thoughts are important part of treating them. Freud is credited for explaining the concept of ego, and the behavior of the person defending his ego employing mechanisms like: denial, displacement, fixation, projection, rationalization and reaction formation. ("Psychiaric and Mental Health Nursing - Nursing Theory", 2016)
Erickson is a psychological theorist, who proposed the eight stages of psychosocial development. The society and the biological maturation process, forces the individual to go through eight stages of psychosocial development. Failure to resolve problems in any stage, can result in psychosocial problems. According to Sullivan, personality development is affected by environment and interpersonal relationship. As humans are social beings, any unsatisfactory relationship will result in psychological problems. Thus society and community have an important role to play in the wellbeing of the individual. The theorist Maslow, based his theory on factors that promote mental health, rather than on factors that cause mental illness. A mentally healthy person is tolerant, welcomes uncertainty, creative, open, self-accepting, caring, and has a good sense of humor. According to the basic need pyramid model, there are five needs that have to be met for ideal mental health. The fundamental of need in the pyramid are physiological needs. Following this, other needs like security, love, self-esteem and self-actualization, helps the person achieve mental wellbeing. ("Psychiaric and Mental Health Nursing - Nursing Theory", 2016)
According to Skinner’s learned behavior theory, all behaviors are learned. Rewarding a positive behavior will encourage its frequent expression Providing balancing factors, realistic perceptions and adequate coping mechanism can help achieve successful results. The lack of mental balancing factors, coping mechanism and distorted perception are the cause of most health problems. The ego defensive mechanism provides psychological protection from stress factors that topple the mental equilibrium. These mechanisms do not eliminate the root cause of stress; they only help to alleviate the symptom of the diseases. Unlike defensive mechanisms, coping mechanisms are conscious efforts that will help the patient overcome the root cause of the mental problem and gain psychological health. Coping mechanism may not remove the root cause, nevertheless, it can at least help in the defensive mechanism and bring more positive results. ("Psychiaric and Mental Health Nursing - Nursing Theory", 2016)
The ability of a person to live a socially acceptable life, in spite of being placed in a stressful or traumatic situation is called resilience (Bonanno, 2008). Factors like social support, hardiness, self enhancement, moral values, cognitive skills, positive attitude, help a person develop resilience (Bonanno, 2008). Cognitive behavioral skills training, can help reduce pessimism and enhance optimistic outlook towards life. Developing and nurturing relationships will help attain the necessary social support that will help overcome stress. Avoiding self-blaming and practicing self enhancement, can motivate people and is a form of coping. Cognitive abilities help solve problems and manage solutions. Moral values and principles make life meaningful and worth living. Cognitive flexibility helps the patient and family members to find a good, even in adverse situation and this can enable them to remain flexible enough to solve their problems. Sedgeman in his “The Power Behind Willpower”, identifies mind, thought and consciousness, as the three principles of innate health. Innate health affects all aspects of health, and thus, it is important for the health care provider and the consumer to know its importance.
Changing trends and Promotion of mental health in clinical settings: Patient, family and community must appreciate that happiness is a goal that can to be achieved by making conscious efforts to remain happy. Current treatment trends promote ways to remain focused on the path of happiness as this will prevent people from straying away to unhappy and depressive thoughts. Happy people remain healthier and live longer. Happiness can be gained through sharing and learning. Good social relationships and self-confidence, helps build optimism. Leading a depressive and less satisfied life, increases the number of hospital visits, increases risk for chronic pain syndrome, accidents, heart problems, low productivity and poor relationships.
Community wellbeing depends on the mental wellbeing of its citizen. Increased suicide rates, crime rates, violence, divorce and depression rates, are signs of high prevalence of mental disorders. Antidepressant and sleeping tablets are among the commonly prescribed drugs in the market. Nature can have a positive impact on mental well-being, and a highly competitive industrialized community that moves away from nature may have the disadvantage of losing the benefits offered by nature. In addition, changes in social values, relationship, diet, diseases and other unknown stress factors in the environment, are suspected as causes for high level of depressive problems in industrialized countries. Though psychotherapy can help reduce misery, it cannot make a person happy. Positive mental health makes the person happy (Lindebaum & Jordan, 2012). All people are capable of being happier than what they presently are. Happiness helps people understand their potential and creates opportunities. According to a study conducted in Sweden, worrying increases the risk of Diabetes related complications (Bener, 2012). Positive mental health also helps reduce risk of breast cancer by 25% in young women (Peled, Carmil, Siboni-Samocha & Shoham-Vardi, 2008). Though the mechanism that links happiness to positive health is less understood, scientists suggest that happiness can result in positive changes in CNS and immune system that benefits health. The brain can be trained to remain healthy. Activities like volunteering, exercise, forgiveness, meditation, journaling can train the brain to remain healthy. Investments made in happiness can reduce expenditure made on treating diseases. According to Sellgman, authentic and long lasting happiness has little to do with pleasure. Social connections and services to others, can bring about a longer lasting and positive happiness. According to Fredrickson, behavior arising from negative emotions like anger, fear and despair is predictable, while behavior arising from positive emotions like curiosity, joy and contentment are not predictable (Fredrickson, 2003). Negative emotions enable survival, while positive emotions promote growth (Fredrickson, 2003).
In his book, “Quality of life therapy”, Michael. B. Frish, identifies 16 areas, which include health, self-esteem, spiritual goals, values, money and standard of living (Frisch, 2006). Intervention in the area of circumstances, attitudes, standards and values, can be beneficial in improving quality of life. Brainstorming was also identified as an effective way of changing people’s thoughts and attitude. While discussing about interventions in mental health, in his book The How of Happiness, Lynbomusk, identified that 50% of the cause of happiness is genetic, 10% are governed by circumstances, while the remaining 40% is under the person’s control. Intervention can be targeted at the factors that are under one’s control (Lyubomirsky, 2008). Counselling, medication and a combination of both have been used to treat mental disorder. Gratitude diary, gratitude visit, using personal strengths and relaxation techniques were also beneficial in many people.
Mindfulness and meditation technique were found to increase happiness (Hollis-Walker & Colosimo, 2011). Mediation is a way of training the mind to stop wandering and to contemplate of the positive aspects of life like compassion and love. Studies indicate that student contemplating on compassion during meditation, showed a higher energy level in the frontal lobe of the brain (Hollis-Walker & Colosimo, 2011). Depressed people who were provided autogenic training in meditation, showed improved mental health and lower relapse rate. (Liou et al., 2009)
Mental health models, Diagnostic description of mental health and psychiatric disorder: People have varying degrees of mental health. While few score more towards the extremes of good mental health and ill mental health, many score in-between. The level of mental health in a person can also vary during different time periods of life. Every person is at risk of becoming mentally ill, if given the right circumstances for ill-health. Continuous model, grades mental health of all people on a scale as: healthy, adjustment reaction, neurosis and psychosis. Healthy indicates the positive extreme of mental health, and psychosis indicates the negative extreme mental health (Westerhof & Keyes, 2009). In discrete model, people are categorized as those without mental disorder and those with specific mental disorder. In most societies a mentally healthy person is defined as one who behaves like the majority and any person who deviates from the majority are identified as mentally unstable. However, this definition has serious flaws. Mental health cannot be measured objectively and is measured subjectively. The lack of laboratory test and body imaging to measure mental illness, make the diagnosis very difficult. DSM (Diagnostic and Statistical Manual of Mental Disorders) method helps to make the diagnosis of psychological disorder based on the concept of “symptoms as indicator of diseases”. This method has several limitations like it does not identify the diseases with the cause. (Middleton, 2008)
Coding system relating to diagnostic categories used in current mental health: The DSM criteria for diagnosing mental disorder was developed with the scope of providing a practical, flexible, and functional guide for practitioners, students and researchers, who want information on mental health and psychological disorder. ICD (International Classification of Diseases) was developed by the WHO to classify mental diseases. Both DSM and ICD are revised from time to time. Presently, DSM -5, ICD-9 and ICD-10 are adopted by Australian Government to diagnose mental diseases (Canady, 2015). Psychologist uses ICD and DSM code to diagnose and define mental disorders. In ICD-9 & 10, the diseases are coded as 3,4,5,6 and 7-digit number (Canady, 2015). Under DSM, diseases are organized into 5 Axis. Clinicians are required to report the diseases on the status of these 5 Axis. Axis I, II and III have codable information. (Middleton, 2008)
Ethic and medico legal issues: Very often the patient is admitted to psychiatric institutions involuntarily, as he poses a danger to himself and danger to others. Most legal commitments occur from schizophrenic patients. In order to lift the commitment, the patient is required to obtain clearance from the mental health provider and police, stating that he is no longer dangerous. There is a need to protect the patient from being committed wrongly. The staffing level of the facilities, the bathrooms, the size of the facility and other factors that affect quality of life of inmates in psychiatric institution needs to be monitored and taken care of. As per legal insanity law, a person cannot be held responsible for a crime, if he lacks the ability to control his action and is unable to understand the nature and consequence of his action. As it is very difficult to prove insanity, there is a possibility of a sane person, using the loopholes of this law to escape punishment. In some instances, the patient is incarcerated, but undergoes treatment for mental health while in prison. The patient is also provided the right to refuse treatment for mental problems, however, exceptions are made in the case of psychosis and delusion. The therapist also has the legal responsibility of warning friend, family members or any other potential victim about the potential of the client to cause harm. The therapist can also warn the police about the dangerous potential in the client. (Funk, Saraceno, Pathare & Minoletti, 2003)
Mental illness and individuals in Australian city: It would be interesting to understand how psychiatric disorders develop in the Australian society. Though most of the psychiatric research provides information of symptoms and treatment for mental diseases, there has hardly been any effort to understand the cause of mental diseases in Australia. The behavior that is treated normal in one culture can be deviant in another culture and thus there is a need for conducting cross cultural studies to understand people’s behavior. The psychological, biological and sociological perspective of the community will dictate the behavior of its people. Very often the cause of mental diseases is very complex, and a combination of biological and environment conditions trigger the disorder. The vulnerability of the individual in the Australian community, could be understood by knowing the prevalence of social stressor, social network and support. Poverty, dangerous neighborhood, overwhelming responsibilities, can take the person off his mental balance. In addition to this, unemployment, natural disaster, new environment and new roles can also lead to mental illness. (Pelling, 2015)
Conclusion: The number of people seeking help for mental distress has increased over the years. This paper looks into different domains that are pertinent to nursing care for mentally distressed individuals. A majority of the mental diseases can be alleviated or mitigated by proper care. Social stigma, exclusion and discrimination towards patients with mental disorder, prevent many from availing treatment. The information shared between a patient and a therapist is confidential, and the therapist is ethically bound to keep it confidential. One practical issue seen in current day clinical psychiatric nursing, is pseudoscience, where the therapist uses nonscientific treatment for psychiatric disorders. The explosion in self-help book and tapes, motivates people to use technique in those books without proper assessment.
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