Nursing and Mental Health Care

An introduction for all fields of practice

Steve Trenoweth, Terry Docherty, Joseph Franks, Reuben Pearce

• Publisher: Learning Matters
• Year: 2011
• Print ISBN: 9781844454679
• eBook ISBN: 9781844457847
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Improving mental health for all is increasingly important in nursing as more people suffer from mental health issues, ranging from stress through to diagnosed illnesses. It is crucial that all nurses, not just mental health nurses, are aware of mental health problems and the impact these have on patients, families and carers. This book gives a clear overview of mental health in nursing, relevant for all fields of practice. It explains the core features of the mental health nursing field, and explores aspects of mental health that every nurse should understand in order to provide holistic care to their patients.

Chapter 1

Understanding mental health and ill health

Steven Trenoweth

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies: Domain 1: Professional values 2. All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care. 5. All nurses must fully understand the nurse’s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations. Domain 2: Communication and interpersonal skills 4. All nurses must recognise when people are anxious or in distress and respond effectively, using therapeutic principles, to promote their well-being, manage personal safety and resolve conflict. They must use effective communication strategies and negotiation techniques to achieve best outcomes, respecting the dignity and human rights of all concerned. They must know when to consult a third party and how to make referrals for advocacy, mediation or arbitration. 5. All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. 6. All nurses must take every opportunity to encourage health-promoting behaviour through education, role modelling and effective communication. Domain 3: Nursing practice and decision-making 2. All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. 3. All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. 4. All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. 7. All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. Domain 4: Leadership, management and team working 4. All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation.

NMC Essential Skills Clusters

This chapter will address the following ESCs: Cluster: Organisational aspects of care 9. People can trust the newly registered graduate nurse to treat them as partners and work with them to make a holistic and systematic assessment of their needs; to develop a personalised plan that is based on mutual understanding and respect for their individual situation promoting health and wellbeing, minimising risk of harm and promoting their safety at all times. By the second progression point: ix. Undertakes the assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk factors by working with the person and records, shares and responds to clear indicators and signs. By entry to the register: xii. In partnership with the person, their carers and their families, makes a holistic, person centred and systematic assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk, and together, develops a comprehensive personalised plan of nursing care.

Chapter aims By the end of this chapter, you should be able to: describe how nurses, regardless of their specialist fields, can understand the mental health of their patients; understand the use of terminology in describing mental ill health; highlight various models and theories of mental distress; consider unifying framework(s) for understanding mental distress.

Introduction

In this book we consider the impact of mental ill health on the well-being of individuals. Assisting people to achieve a state of overall well-being is undoubtedly an important goal of nursing care. In our attempts to assist people to overcome adversity that might be affecting the mental health of people we care for, we must understand the nature of mental distress. This is the starting point of the nursing care process – we need to understand the patient’s experience and needs before we can intervene and provide care. This is often very complex.

You might think that mental health issues are the responsibility of mental health nurses who specialise in the care and treatment of people who experience mental distress. However, as we shall see in this chapter, the nursing profession as a whole is moving towards delivering more holistic care, and there are expectations that all nurses, regardless of field, will be able to respond to the mental health needs of their patients. In the same way, mental health nurses must be able to respond to the health care needs of their service users, whether they are children, whether they have a comorbid physical illness, or whether they have a mental health problem and a learning disability.

In this chapter we will first explore the different meanings that may be attributed to mental health and mental ill health. This is important as, regardless of the field of nursing you are studying, you will encounter many perceptions about mental health and mental ill health in your studies and in practice, and you will come to realise that how one perceives a phenomenon is often related to how one responds to it. We will explore what using terminology means, before looking broadly at what mental health and what mental ill health is. We will then explore the various theories and models of mental health and ill health, and look at the complex relationship between them, and how a holistic viewpoint can help all nurses, regardless of their field, to help patients to improve their mental health.

Clarifying terminology

As we have already touched on in the introduction, the words that we use in our lives can be a subtle way of communicating perceptions and biases. Words can act as symbols for a larger set of often otherwise unstated assumptions and ideologies. Look at the example given in the case study.

Case study Sandra is a service user with a long history of schizophrenia, which has had a devastating effect on her life. She is often very angry with mental health services, which she feels do not always meet her needs. She has complained that she feels she is not involved in her care. Sometimes she breaks off all contact. Unfortunately this has meant that she has been hospitalised six times in the last four years. Sandra manages to do some voluntary work in a local Age Concern charity shop when she feels able. She would like to find more permanent work but says she has been unlucky in finding a position. She is a qualified primary school teacher but would be willing to undertake any work. At present she is receiving state benefits. Recently, things have been difficult for her as she is struggling with the break-up of a long-term relationship. Sandra has been diagnosed with diabetes and is being seen by a diabetic nurse specialist with whom she recently had an argument. She felt that the nurse specialist ‘kept going on’ about her diagnosis of schizophrenia, which Sandra feels has nothing to do with her diabetes. Sandra is also under the care of a community psychiatric nurse (CPN) with whom she has a good relationship. Sandra relates the argument she has had with the nurse specialist: ‘She kept telling me I am mentally ill. She said “Because you are schizophrenic you need to remember to take your diabetes medication.” I asked her what she meant and she got defensive. She thought I was stupid. I asked if she was mentally healthy. I don’t know what good mental health is and she didn’t seem to know either.’

In this case study, Sandra asked what seem to be straightforward questions: What do you mean by mental illness? What is mental health? The concepts of mental health and mental illness are terms that are value laden – that is, they are imbued with more meaning than can be found by a dictionary definition. Such terms carry with them a set of personal, social and cultural assumptions. Sandra, for example, felt that the nurse specialist saw her as ‘stupid’ because of her mental health issue.

Activity 1.1

Reflection

Think for a moment and jot down any words you associate with the term schizophrenia. What does the term imply to you? How did you develop your ideas about the term? That is, where do you get your ideas from? What other terminology do people sometimes use to describe people who experience mental ill health? What effects might this have on individuals? An outline answer is given at the end of this chapter.

You might have thought that the term schizophrenia was a mental illness or a diagnosis. You might have even jotted down the term madness. You might have assumed that people with this diagnosis are dangerous or violent, or that they need long-term institutional care. It can be quite difficult to reflect on where our assumptions come from. Often they are transmitted by our parents, friends and siblings. Sometimes the media (books, magazines, newspapers as well as film and television) represents and reinforces a particular view about groups of people.

Symbolic interactionism is a sociological theory that seeks to account for such socially constructed ideas (Haralambos and Holborn, 2008). Put simply, the theory suggests that people construct their own social reality through culturally meaningful symbols such as words, uniforms, flags, social interactions and gestures. While such symbols can give people a sense of common identity, they can also lead to stigmas and stereotyping that can often go unchallenged. In nursing care it is vital that we are aware of such symbols and that our culturally imbued and socially constructed knowledge does not affect the quality of care that we provide.

In this book we use the broader terms mental health problems, mental ill health or mental distress as symbols that encompass the experience of all people with psychological difficulties rather than words that are medically bound, such as mental illness or mental disorder, which may convey or reinforce the view that mental health problems have a biological or psychiatric origin – as we shall see later, there are indeed many different interpretations of mental health and mental distress.

For this reason, the Working in partnership review (DH, 1994) suggested that the nurses who care for people with mental health problems should not be called psychiatric nurses but mental health nurses, to reflect the diverse nature of their work and to ensure they are not tied exclusively to a medical framework for their practice.

Furthermore, we must be careful to avoid the trap that may be laid by our culturally imbued ideas (see Chapter 3). For example, we must not assume that an individual’s problems centre solely on a medical diagnosis. This is called ‘diagnostic overshadowing’ where one diagnosis or condition is given pre-eminence over other health issues (Jones et al., 2008). Take, for example, a child who has been diagnosed with, and is receiving treatment for, cancer. This is very likely to be a time of considerable stress and distress for the child and their friends, siblings and parents. However, the nursing and other health care staff may be focused on treating the cancer and may not recognise or respond to the potentially long-lasting psychological distress experienced by the child and their friends and family. As such, nurses of all fields must recognise that anyone can experience mental distress, regardless of whether or not they have a diagnosed mental illness, and it is the duty of the nurse to provide holistic support to the person in need.

What is mental health?

Before continuing our journey exploring mental distress it is useful to pause to consider what is meant by mental health.

Activity 1.2	Reflection
What do you believe to be the essential features of mental health? Do you consider yourself to be mentally healthy? An outline answer is given at the end of the chapter.

The World Health Organization (WHO, 2010) defines mental health as:

a state of well-being in which the individual realises 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.

Health is, ...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Acknowledgements
• About the authors
• Introduction
• 1 Understanding mental healthand ill health
• 2 Clarifying your own personal values and beliefs
• 3 The policy context for mental health care
• 4 Mental and physical health care needs
• 5 Legal and ethical issues in mental health nursing
• 6 Communicating and relating
• 7 Assessing mental health needs
• 8 Helping the person with mental health needs
• 9 Improving your own mental health
• Glossary
• References
• Index