Y khoa, y dược - Chapter 13: Preconceptions and the reality of mental illness

Chapter 13Preconceptions and the Reality of Mental IllnessIntroductionIn all practice settings nurses will encounter patients with mental health problems. This presentation considers societies’ misconceptions and encourages the student to question and examine their own views, feelings and attitudes towards mental illness. Acquiring an awareness of the different ways that mental illness can manifest itself is essential if nurses are to work effectively and provide the most appropriate treatment for an individual. Developing empathic and non-judgemental attitudes are a central part of nursing practice, consistent with the role of advocate, stated within the professional nursing Code of Conduct (NMC, 2004). BackgroundAt any one time a significant number of the adult population experience mental illness and the majority live within the community. Despite being so widespread mental illness is still frequently misunderstood and often the subject of stigma. Government policy has been to promote social inclusion of people with mental health problems (DoH, 2004).It is vital that modern nursing not only understands how mental illness affects people but also promotes positive values and non-discriminatory practice. Effects of Mental IllnessThere are a wide range of mental illnesses, which can affect people in different ways: Physically PsychologicallySocially This presentation considers what constitutes mental illness in relation to consent and the law. A brief overview of common mental health problems, Care in the community and the NSF for Mental Health will then be considered (DoH, 1999). Common Preconceptions of Mental Illness within Society Mental illness is a common feature of everyday life for many people. Mental ill health can affect one in six people of working age. It is estimated nearly half of all women and a quarter of all men will experience depression before they reach seventy years of age.Despite being a major part of daily life for so many, mental illness is commonly misunderstood. Society has intolerant views, for example, people with a mental illness are regarded as malingerers who ought to “pull themselves together”. At the other extreme people who are acutely mentally ill are viewed as: homicidal and unpredictable individuals who represent a danger to society. Mental Illness within SocietyWhile some people with mental health problems do commit acts of violence and murder, statistics suggest the risk is no more prevalent than with any other sector of the population.Instead of violence towards others, the more frequent risk factors associated with people with mental health problems are the likelihood of them committing suicide, self-harming or being a victim of violence and abuse. The stigma surrounding mental illness causes discrimination and a lack of opportunities for employment and meaningful occupation.Suffers frequently have low incomes and socio economic status; these factors can exert a detrimental effect on their mental health. Defining Mental Illness Defining mental illness is complex, as it exists on a continuum with mental health. Identifying physical illness is not a problem, when we are unwell we receive a diagnosis and treatment for a particular problem or undergo investigations to locate the cause. In contrast mental illness covers a range of disorders with various origins these include social, psychological, genetic, biological and chemical causes.Mental illness under the Mental Health Act (1983) is defined as including one or more of the four elements:Incomplete development of the mind Psychopathic disorder A disturbance which prevents normal development A mental disturbance which interferes with normal behaviour and daily life Consent to Treatment, Mental Health & the Law A person who is mentally ill may require treatment for a period of time in an in-patient setting. Individuals may agree and be “informal” admissions. When acutely mentally ill individuals may be reluctant to accept help it may become necessary to detain them for compulsory treatment – “formal” admission. The Mental Health Act is the only statute outside of the criminal justice system, which allows individuals to be legally detained against their will. Informed ConsentThe person must not be under coercion The person must understand the procedure to which they are consentingThe person must be legally of an age to give consent and mentally competent, or capable of giving consent There are numerous different sections of the Mental Health Act (1983), which are suitable to be used for various aspects of patient care. Identify which sections are used within your clinical areas and who is responsible for enforcing them.Provisions of the Mental Health Bill 2006 To make provision for people with serious and ongoing mental health problems to receive necessary treatment, and to maintain their safety and that of the public. To widen the range of healthcare professionals able to perform roles identified in the 1983 Act. To protect the rights of people who do not have the capacity to provide consent and whose circumstances are not covered by the 1983 Act. Controversy & the Mental Health BillThe most controversial measure in the Mental Health Bill is supervised Community Treatment Orders (CTOs) CTOs are recommended for use in circumstances where service users present a risk to their own safety, or that of the public and are intended to promote compliance with treatment and prevent relapse. CTOs do not diminish the service users’ rights. Where treatment is refused it may be necessary to return a service user to hospital for treatment. Types of Mental Health Problem Functional mental health problems are subdivided into; psychotic disorder schizophrenia and mood disorders other affective disorders depression, anxiety, obsessive-compulsive disorder, phobias, anorexia nervosa and bulimia nervosa.Organic mental health problems are due to the effects of physical causes on the action of the brain; including dementia type illnesses, infectious causes and also alcohol and substance misuse. Other types of mental health problems include personality disorders where a person’s attitudes and choices of behaviour lead them into making chaotic life choices.Scenario Dave experienced a myocardial infarct approximately eighteen months ago. He is fifty-two and gave up smoking five years ago. Previously Dave worked as a building contractor which often involved living away from home, during these periods Dave’s diet was poor and he regularly drank large amounts of alcohol.After having the heart attack Dave began to feel low in mood, had difficulty sleeping, woke up early in the morning and generally lost interest in life. Dave describes himself before the heart attack as “happy go lucky”, but since his physical illness he has not worked, abandoned many former interests, lost contact with his friends and lacks motivation. Due to losing interest in eating Dave has become underweight and his wife is worried about his physical health.On several occasions recently Dave has had chest pain and attended the A&E department, no physical problems were found. Dave experienced this pain again during a weekend when his GP was unavailable so his wife drove him to A&E. Psychotic Disorders & Schizophrenia Psychosis leads the person to lose touch with reality and develop personalised or unusual meanings to events or phenomena. The causes of psychosis can vary from a response to traumatic events or problems at a particular time in life.Frequently people can experience an episode of psychosis and fully recover. A linked but separate mental health problem is schizophrenia.While the cause of schizophrenia is not definitely known it is felt some physical factors are active. Schizophrenia is a fragmentation of the person’s perception and grasp of objective reality.Symptoms of Schizophrenia Commonly people with schizophrenia experience sensory delusions and hallucinations Hearing voices is common and due to the influence of this phenomenon the person experiences difficulty thinking logically and acting appropriately in social situationsDelusions - abnormal beliefs that are not real. Hallucinations - the feeling of having an experience, which is not real. Disordered thoughts - which result from the delusions and hallucinations Abnormal behaviour - which occur through responding to the delusions, hallucinations and disordered thoughts Psychoactive Substance Misuse Substances, which can be misused, include nicotine, caffeine, alcohol and drugs The effects vary depending on the choice and in some cases a combination of these substances are used. Frequently people experience low mood, personality changes or impulsive behaviour or impaired judgement through using substances.Substance abuse commonly co-exists with mental illness as suffers seek relief from their conditions and society attitudes toward them.Self - Harm Self-harm frequently occurs as a method of relieving pent up feelings of emotion or anger.Other causes may be sexual, psychological or emotional abuse, neglect and bullying or harassment. Areas associated with self-harm include the wrists, upper thighs, inner arms and upper chest, although self-harm can also include skin picking and the deliberate breaking of bones. People who self-harm tend to be ashamed of their behaviour and conceal their injuries.Eating Disorders Eating disorders refer to a range of problems. In some cases the person does not eat because they mistakenly believe they are overweight and introduce a rigorous regime of dietary control and deprivation of food (anorexia nervosa). The person may binge eat large amounts of food and then purge through vomiting or using laxatives (bulimia nervosa). However these conditions, while varied on presentation, share some common characteristics.Identifying an eating disorder can be difficult due to societies’ preoccupation with weight and peer pressure, especially among women promoting certain expectations around body size and attitudes towards food. However eating disorders are linked with mental health and causes include loneliness, boredom, anxiety, abuse, low self-esteem, guilt and the need to feel in control Dementia Dementia is a group of symptoms which occur as a result of a number of different illnesses which all cause degenerative changes in brain tissue leading to a progressive decline in cognitive functioning.Typical changes are loss of memory, confusion, and change in personality, mood and behaviour. Examples of dementia type illnesses are Alzheimer’s disease and vascular disease.Cerebral haematomas or space occupying lesions can also produce similar symptoms to dementia. Care in the Community In the past mental health hospitals were discreetly located just outside major towns with average patient populations of up to 2,500. There was a consistently large amount of in-patients reaching a staggering high of over 151,400 in 1955. In 1961 the government chose to abolish long stay mental hospitals and reduce psychiatric in patient-bed capacity nationwide by 75,000. The consequences have had far reaching implications and while the number of inpatient beds reduced to approximately 50,000 by 1992, this was not a smooth transition. There was no planned development to provide for the needs of mental health patients re-provisioned within the community and there was no introduction of mental health services that could serve these patients. The National Service Framework for Mental Health The NSF for mental health was the first comprehensive statement of what was expected from mental health services in England.The vision of the government contained in the “NSF for Mental Health” (DoH, 1999) was to provide services, which are;Safe – to protect the public and care for those with mental health problems at the time care is needed. Sound – To ensure service users and carers are able to access a full range of services appropriate to their need when they need it. Supportive – Working together with service users, their families, carers and significant others to build healthier communities. ConclusionRegardless of whichever setting adult nurses specialise in, mental illness will be encountered within their clinical practice. You have now gained insight into some of the many causes of mental illness and numerous potential clinical manifestations. The presentation discussed how governments and public opinion influence healthcare. The role of the nurse is pivotal in promoting positive, patient centred care and is crucial in advocating for our patients and in supporting their recovery and optimum capacity for health.