Understanding Mental Health Practice

Mark Haith, Author

• Publisher: Learning Matters
• Year: 2017
• Print ISBN: 9781473966543, 9781473966536
• eBook ISBN: 9781526417367
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Mental health is a vast and fascinating subject but knowing where to begin can be challenging. This book focuses on the fundamentals of mental health care. It is packed full of 'need-to-know' information that will help students understand what is meant by mental health and wellbeing, be aware of the common mental health problems, as well as the typical interventions and treatment options available. The book focuses in on the most essential knowledge providing the ideal starting point for anyone looking to gain an initial understanding of mental health.

Chapter 1

Mental and physical health and wellbeing

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 1: Professional values

3.1 Mental health nurses must promote mental health and wellbeing, while challenging the inequalities and discrimination that may arise from or contribute to mental health problems.

Domain 3: Nursing practice and decision-making

8.1 Mental health nurses must practise in a way that promotes the self-determination and expertise of people with mental health problems, using a range of approaches and tools that aid wellness and recovery and enable self-care and self-management.

NMC Essential Skills Clusters

This chapter will address the following ESC:

Cluster: Organisational aspects of care

9.16 Promotes health and wellbeing, self-care and independence by teaching and empowering people and carers to make choices in coping with the effects of treatment and the ongoing nature and likely consequences of a condition including death and dying.

Chapter aims

By the end of this chapter you will be able to:

• recognise factors indicating mental health;

• understand the falsity of assuming that “mental health” and “mental illness” are the same thing;

• describe the relationships between physical health and mental health, and between physical illness and mental illness.

Introduction

Case study: A poorly designed mental health unit

My first experiences of a mental health unit were shocking. This wasn’t because of the types of patients that I met, or the nature of their conditions, but the environment within which they were treated. The ward consisted of a series of small rooms branching off a long corridor, making it dark and emphasising its cramped nature. Because the lines of sight were entirely restricted, some nursing staff patrolled the ward to ensure they knew where the patients were, and what they were doing. Other staff took a different approach, isolating themselves in the nursing office. The most striking thing about this treatment centre was the complete lack of consideration for stimulation provided for patients. Walls were plain without pictures or other decoration. There was a lack of organised activity for patients, resulting in the few events of the day gaining disproportionate significance. Beyond meals and drug rounds, patients spent their time smoking, drinking tea, eating junk food and sleeping. The atmosphere fluctuated from subdued to aggressive depending on how boredom affected the patient group at the time.

This case study depicts a mental health unit that is anything but healthy. Although the situation described occurred many years ago, and there are examples of much better approaches to inpatient mental healthcare, this type of unhealthy psychiatric setting remains far from exceptional. Advances in mental health treatment have been significant over recent years, in particular through the recognition of psychological therapies as a vital form of treatment, but physical wellbeing remains undervalued in mental health practice. Starting with the right physical environment is critical to providing treatment that is physically and mentally healthy.

Modern health services typically treat mental and physical health issues in isolation from each other. This is despite interlinking cause and effect widely recognised between them. Poor physical wellbeing is a major cause of mental ill health; therefore improving physical health is critical within effective mental health treatment (Sanna et al., 2013; Tansella et al., 2014).

This chapter highlights the importance of treating both aspects of health as one interlinked care package. It begins by exploring psychotherapeutic perspectives of mental health, then considers the predominance of mental illness within health services. The relationship between physical and mental illness is discussed, followed by physical and mental wellness. Through understanding the differences between these widely interchangeable terms, a more informed approach to mental and physical health is possible.

Defining mental health

An influential definition of mental health comes from the World Health Organization (WHO), suggesting it is:

… a state of wellbeing 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.

(WHO, 2001, p. 1)

Although it has some worth, there are a number of issues apparent with this definition, warranting further investigation. Fully realising our abilities is rare for any individual; where it occurs, it is transient rather than permanent. Mental health defined by these factors would therefore also be rare and transient, making it an unrealistically high standard. Conversely, an ability to “cope with the normal stresses of life” seems an unrealistically low standard. Not being able to deal with normal stresses may indicate mental illness, but coping with everyday occurrences seems insufficient to signify mental wellness. Productivity at work could occur in a mentally well person, but its absence does not exclude mental health. Not every person needs or desires to work; if we instead extend the term “work” to cover constructive activities, a more useful understanding emerges. The idea of contribution to community suggests that mental health occurs through successful social interaction; this is probably the case most, but not all, of the time.

The WHO definition contains both useful and disputable points. This suggests that we need to consider alternative views on mental health. Practical approaches to achieving mental wellbeing are provided by the major psychotherapeutic modalities. A consideration of psychodynamic theory, cognitive behaviour therapy, the person-centred approach, brief solution-focused therapy and mindfulness approaches may provide a more helpful understanding of mental health than the WHO definition alone. As we will see, a lack of consensus exists within psychotherapeutic approaches regarding a definition of mental health.

Psychotherapeutic perspectives of mental health

The original purpose of psychotherapy was to reduce symptoms of mental illness. Modern approaches also address improvement of mental wellbeing in people without psychiatric symptoms. Psychodynamic theories remain highly influential in the diagnostic approach to psychiatry, defining specific mental illnesses through patients’ symptoms. This is a long-term approach, sometimes lasting for years. Symptoms of mental illness are viewed as the result of psychological complexes occurring during childhood. Mental wellbeing is viewed as the absence of mental illness within psychodynamic therapies.

Cognitive behaviour therapy (CBT) provides more balanced views of mental illness and mental health. It proposes objective, free-thinking decision-making as the basis of healthy emotions and behaviour. Conversely, subjective rule-based decisions cause emotional distress and unhealthy behaviours. The presence of habitual unhelpful thinking is due to conditioned (automatic) responses resulting from traumatic experiences. From a CBT perspective, mental wellbeing occurs through becoming aware of personal conditioned responses and replacing them with decisions based on realistic evidence. The process of reconditioning our thoughts, feelings and behaviour using a CBT approach is described within the following case study.

Case study: An example of mental health work using CBT principles

Yaz Husain has been working on improving her self-esteem for the last fourteen weeks with Mike, a community mental health worker. She has gained a great deal of insight through the process, recognising the impact her negative thinking has on how she feels about herself and other people. Through identifying situations that cause her distress, she has been able to plan strategies that allow her to cope more effectively with her fears. She recognises her negative thought patterns are part of the reason friends and family members are able to take advantage of her good nature; in order to avoid potential confrontation, Yaz offers childcare even though she feels this is unfair on her. Discussing her thoughts, feelings and actions with Mike has allowed Yaz to plan a new way of reacting to childcare requests, which is to politely refuse except in cases of emergency. Yaz recognises that early experiences of rejection have been highly influential in encouraging her to do what family members want in case they reject her again. By changing her actions, Yaz now appreciates that relationships do not end if she doesn’t put other people’s needs ahead of her own. As a result of this new understanding, she feels that her own mental health has improved.

The work undertaken by Yaz is an example of a mental health intervention creating behavioural change that influences her wider experience of life. Activity 1.1 asks you to consider aspects of your own conditioning.

Activity 1.1 Reflection

Consider the work Yaz has been undertaking using principles of CBT. Are there any areas of your own life where previous experiences encourage you to act in a manner that you don’t feel comfortable with?

Because this is a personal piece of reflection, a suggested answer is not available at the end of the chapter.

Recognising the influence of previous experiences on our actions allows us to appreciate the potential benefit of CBT on mental wellbeing. Where CBT seeks to develop a pattern of cause and effect between thoughts, emotions and behaviour, brief solution-focused therapy (BSFT) takes a simpler approach to behaviour change. It seeks to change perspective from focusing on the impact of a problem, to considering how solutions can realistically be achieved. Through encouraging action to make necessary changes, troubling situations become opportunities to achieve difficult challenges. Self-belief replaces self-doubt once the person has developed positive problem-solving skills. BSFT therefore demonstrates that good mental health requires an ability to achieve solutions for the difficulties we experience. Clay’s case study illustrates the use of BSFT principles in action.

Case study: Using principles from brief solution-focused therapy to improve difficult situations

Clay has been unemployed for the last two years following more than 20 years in a senior industrial role. He is bitter about the means of his dismissal which he believes wasn’t through any fault of his own. He has been using his savings to maintain his lifestyle and is close to running out of money. He has been interviewed regularly for a number of promising jobs, but has repeatedly failed to be offered employment. He is concerned that he may have been “blacklisted” within the industry, and the anxiety he is experiencing to get a job is reducing his performance. His family are unaware of his present circumstances and he tends to avoid former colleagues, so has become isolated from other people. He feels that his mental health is the poorest it has been for a long time.

Due to his business background, Clay is aware of solution-focused approaches to challenging situations. Following his latest rejection for employment, he formally evaluates his options. By putting aside his bitterness towards his situation, Clay recognises that he remains attractive to the right employer, but that he has not yet found them. He also knows that even multiple rejections do not justify his fears that he is worthless as a person or employee. The options Clay identifies are: to continue applying for work within his own industry; to seek this type of work elsewhere; or to look at different jobs entirely. Clay decides to have one last try for a promising job elsewhere in the country before trying something entirely different. The match between himself and the employer is great and he is offered the job. After three years in post Clay feels this is the best job he has had in many years; he is settled and financially more successful than before, with prospects of further promotion. He can see that the problem with gaining employment did not come from him, but sits with the companies he applied to, who seem to value a less experienced and cheaper employee above an experienced person like himself. Clay feels mentally well and more compassionate for others undergoing workplace difficulties of this kind.

BSFT allows Clay to re-evaluate his approach to work and his life. Following his example, Activity 1.2 asks you to refocus on solutions for difficult situations within your own life.

Activity 1.2 Reflection

Consider a recent situation where you felt out of control. Concentrate on switching your thoughts from the emotional impact that the situation has on you, to considering what you can do personally to resolve the issue.

Is any sort of positive progress possible in your situation, and if so, how does this realisation affect you emotionally?

Because this is a personal piece of reflection, a suggested answer is not available at the end of the chapter.

Having considered Clay’s example and your own reflections, we can now examine the person-centred approach (PCA) to personal development. Clay’s example demonstrates BSFT in facilitating a change of focus from problem to solution. PCA shares BSFT’s emphasis on self-reliance, but provides a more developed theory of mental wellbeing. Accepting self-responsibility for poor mental health also means accepting personal ability to make changes to improve matters. Mental health is therefore achievable through individuals making the choices required to ascertain what they personally need. The PCA assists the individual to move from an incongruent (dishonest) way of being, to congruence in their thoughts, feelings and behaviour. Harmony between these factors enables the person to be mentally well. Conversely, a person avoiding expression of their real thoughts, feelings or behaviour is likely to experience psychological disturbance. The PCA suggests decision-making free from external influence, creativity and honest self-expression only occurs through personal congruence. The degree of congruence experienced by the individual is seen in the PCA as determining their mental health. An illustration of the development of personal congruence is given in the next case study.

Case study: Developing congruence using the person-centred approach

Juan began counselling using the person-centred approach after many years of unsuccessful treatment for depression using antidepressants. Through building a trusting relationship with Alan, a mental health professional with experience in counselling, Juan has been able to verbalise his feelings in an increasingly honest and clear manner. Alan’s role is not to advise Juan, but instead to accept his thoughts, feelings and behaviour without judgement. Over a number of weeks Juan was able to explain to Alan his regrets at being unable to express his sexuality freely because he fears upsetting his wife. Juan sees living separately as the only realistic way of being himself. However, he does not feel he has the right to divorce his wife because of the upset this will cause his family, who he loves very much. He has remained stuck in this way of thinking until breaking down in front of his wife and telling her openly about his feelings. Although difficult for her, she has accepted the reality of ...

Table of contents

• Cover Page
• Halftitle
• Advertisement
• Title
• Copyright
• Contents
• Transforming Nursing Practice
• About the Series Editors
• About the Author
• Acknowledgements
• Dedication
• Introduction
• 1 Mental and Physical Health and Wellbeing
• 2 Common Mental Health Issues
• 3 Suicide Risk and Mental Health
• 4 Mental Health assessment and Care Planning
• 5 Psychotherapeutic Approaches to Mental Healthcare
• 6 Psychopharmacology
• 7 Recovery from Mental Health Problems
• Glossary
• References
• Index