Continuum of Mental Health Concept.Mira

CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS

Mental health professionals are faced with the problem of defining mental illness and mental health. The term mental illness was applied to behaviors. Described as strange and different. That deviated from an established norm. There are people who show extremely abnormal behavior and are characterized as mentally ill who are far more like the rest of us than different from us. In fact, all human behavior lies somewhere along a continuum of mental health and mental illness.

A helpful approach in defining mental illness and mental health is based on evaluating individual behavior in two dimensions:

1. On a continuum from adaptive to maladaptive

2. On a continuum from constructive to destructive

Along the adaptive-maladaptive continuum, behaviors are assessed to the degree that they contribute to or are detrimental to the individual’s psychological well-being.

Maladaptive behavior allows a problem to continue and often generates new problems, interfering significantly often over an extended period of time with an individual’s ability to function in such important areas of life as health, work, love, and interpersonal relationships. On the other hand, adaptive behavior solves problems in living and enhances an individual’s life.

Destructive behavior not only results in failure to deal with a problem and thus is maladaptive but also undermines or destroys the psychological and often biological well being of the individual and others. Such behavior whether it occurs once or repeatedly may seriously undermine health. Significantly increase chances of (or actually bring about) death, or drastically affect psychological functioning in the individual or other. On the other hand. Constructive behavior contributes to psychological growth and biological well-being. It improves the health and positively influences the psychological functioning of the individual and others.

SIGNS OF MENTAL HEALTH

SIGNS OF MENTAL ILLNESS

Happiness · Finds life enjoyable · Can see in objects, people, and activities their possibilities for meeting one’s needs Control Over Behavior · Can recognize and act on cues to existing limits · Can respond to the rules, routines, and customs of any group to which one belongs Appraisal of Reality · Accurate picture of what is happening around one · Good sense of the consequences, both good and bad that will follow one’s acts · Can see the difference between the “as if” and “for real” in situations Effectiveness in Work · Within limits set by abilities, can do well in tasks attempted · When meeting mild failure, persists until determines whether or not one can do the job A Healthy Self-concept · Sees self as approaching one’s ideals, as capable of meeting demands · Reasonable degree of self-confidence help in being resourceful under stress

Major Depressive Episode · Loss of interest or pleasure in all or almost all usual activities and pastimes · Mood as described by person is depressed, sad, hopeless, discouraged, “down in the dumps”. Control Disorder, Undersocialized, Aggressive · A repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated Schizophrenic Disorder · Bizarre delusions, such as delusions of being controlled · Auditory hallucinations · Delusions with persecutory or jealous content Adjustment Disorder with work (on Academic) Inhibition · Inhibition in work or academic functioning where previously there was adequate performance Dependent Personality Disorder · Passively allows others to assume responsibility for major areas of life because of inability to function independently · Lacks self-confidence, e.g., sees self as helpless, stupid

Consepts of mental health

Psychiatry’s definition of normal (mental health) changes over time and reflects changes in cutural norms, society’s expectations adn values, professional biases, individual differences, and the political climate of the time (Sadock & Sadock, 2003). For example, criticisms have come from various groups who believe that they were or are stereotyped (and unfairly) in the psychiatric community. Their concerns include the way in which the psychiatric community places an emphasis on the group’s psychopathology rather than on health attributes. The psychology of women and the issue surrounding homosexuality are two very important examples but are by no means the only ones. This topic is discussed in more detail in the section on the DSM-IV-TR axis system later in this chapter.

We are taught to evaluate our clients with mental health issues to identify their strengths and their areas of high functioning. You will find many attributes of mental health in some of you clients with mental health issues. It is these strengths that we build upon ang encourage. By the same token, those who are “normal” or “mentally healthy” may have several areas of dysfunction at different times in their lives. We are all different, have different backgrounds (even siblings), and reflect different cultural influences even within the same subculture. We grow at different rates intellectually and emotionally, make different decisions at different times in our lives, choose or choose not to evaluate our behaviors and grow within ourselves, have deep-seated spiritual beliefs or not, and so on. Understandably, then, there can be no one definition of mental health that fits all. However, there are some traits that mentally healthy people share and that contribute to a better quality of life. Some of these traits of mentally healthy people are depicted in figure.

Some attributes of mental health

· Accurate appraisal of reality

· Ability to love and experience joy

· Capacity to deal with conflicting emotions

· Ability to live without (undue) fear, guilt, or anxiey

· Ability to take responsibility for one’s own actions

· Ability to control one’s own behavior

· Think clearly: problem solve, use good judgment,reason logically, reach insightful conclusions, be creative

· Relate to other: form relationships, have close, loving, adaptive relationships, experience empathy toward others, manage interpersonal conflict constructively

· Attain self-defined spirituality

· Negotiate each developmental task

· Ability to work and be productive

· Maintain a healthy self-concept and self-value

· Ability to play and laugh

EPIDEMIOLOGY OF MENTAL DISORDERS

Applications of Epidemiology

Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Once the distribution of mental disorders has been determined quantitatively, then epidemiologists can identify high-risk groups and high-risk factors. Study of these high-risk factors may lead to important clues about the etiology of various mental disorders.

The various applications of epidemiology are dependent on three levels of investigation (Sadock & Sadock, 2003):

1. Descriptiveà studies that produce basic estimates of the rates of disorder in a general population and its subgroups

2. Analyticà studies that explore the rates of variation in illness among different groups, to identify risk factors that may contribute to development of a disorder

3. Experimentalà studies that test the presumed assumption between a risk factor and a disorder and seek to reduce the occurrence of the illness by controlling risk factors

MENTAL ILLNESS AND THE MENTAL HEALTH CONTINUUM

In 1996, the Mental Health Parity Act was passed by Congress. This legislation required insurers that provide mental health coverage to offer benefits at the same level provided for medical and surgical coverage. In 2000, the Government Accounting Office found that, although 86% of health plans complied with the 1996 law, 87% of health plans that complied with the law imposed new limits on mental health coverage. On April 29, 2002, President George W. Bush endorsed parity and established a new mental health commission. In february 2003, the Senator Paul Wellstone Mental Health Equitable Treatment Act was introduced into the Senate and the House of Representatives. In july 2003, the President’s New Freedom Commission on Mental Health also endorsed parity. The legislation became stalled in Congress in 2003 and 2004 (National Mental Health Association, 2004).

Thus, many (not necessarily all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, we can look at these disorders as “diseases”. It is helpful to visualize these disorders along the mental health continuum. This continuum is used in each of the clinical chapters to identify the severity of the biologically in fluenced disorders.

The DSM-IV-TR cautions that the emphasis on the term mental disorder implies a distinction between “mental” disease and “physical” disorder, which is an out dated concept, and stresses mind-body dualism: “there is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders” (APA, 2000, p. xxx).

As nurses, we do not treat diseases; we care for people by providing effective nursing care using the nursing process as a guide. If we believe that human beings have biological, psychological, social, and spiritual components and needs, then we believe in holistic nursing. Our task as nurses is to assess and plan care for the whole individual under our care. Nurses and physicians are two parts of a multidisciplinary team that, when well coordinated, can provide optimal care for the biological, psychological, social, and spiritual needs of clients.

Influences that can have an impact on an individual’s mental health

· Available support system: friends, family, community

· Spirituality religious influences

· Family influences

· Developmental events

· Personality traits and states

· Demographic and geographic locations

· Negative influences: psychosocial stressors, poverty, impaired/inadequate parenting

· Cultural/subcultural bellefs and values

· Health practices and beliefs

· Hormonal influences

· Biological influences

· Inherited factors

· Eviromental experiences

These levels interact in such a way that it is often difficult to separate the impact of each level. If a person’s neurotransmitters are not functioning correctly, that person may have great difficulty organizing his or her thoughts. Disorganized thinking may interfere with the ability to perform activities of daily living (ADLs). Because of poor hygiene and the inability to communicate clearly, this individual may be shunned by others. As the person becomes more isolated, there may be a further loss of contact with reality. If adequate community resources are not available, the person may become homeless. In some cases, disruption to mental health may begin at the cultural level. An example is the impact of sexism on the mental health of women. Cultural sexism allows men to treat women as less worthy members of society. This treatment contributes to low self-esteem. Negative thoughts about oneself alter the amount and function of the neurotransmitters. Disruptions can occur at any level; however, each level is so intertwined with the others that it is often difficult to pinpoint the original source of the distress.

Factors contributing to the mental health-mental illness continuum

Illustrates how personal, interpersonal, and cultural factors interact in ways that produce movement toward mental health or menta ilness. If there are more factors on the mental illness side of the continuum, the balance will shift toward that end of the continuum. Likewise, the presence of more factors associated with mental health will shift the balance toward mental health.

Movement toward the mental illness end of the continuum may begin with a sense of disharmony with aspects of living that may be distressing to the individual, family, friends, or community. Some aspects may be primarily distressing to the individual, such as feeling miserable, spending a great deal of time worrying, and suffering from multiple fears and anxieties. Other aspects may be distressing to family and friends, such as withdrawal from relationships, an inability to communicate coherently, manipulation, and emotional outbursts. Other aspects are distressing to society, such as violence and substance abuse and dependence. Contributing cultural factors include racism, classism, sexism, inadequate access to health care, and disenfranchisement of many individuals and groups. All these aspects are interdependent and interactive. They influence the development of disorders, clinical pictures, the course and prognosis of the disorders,and responses to therapeutic interventions (Abraham, Fox, and Cohen, 1992).

REFERENCE

Fontaine, Karen Lee. 1999. Mental health nursing 4th ed. Menlo park, California: Eddison wesley longman, Inc

Varcarolis, Elizabeth M. 2006. Foundations of psychiatric mental health nursing: a clinical approach, fifth edition. St. Louis, Missouri: Saunders elsevier Inc

Varcarolis, Elizabeth M. 1994. Foundations of psychiatric-mental health nursing 2nd Ed. Philadelphia: W.B Saunders company