Hi class, this is Professor Gasparro and welcome to your first lecture on mental health nursing. In this lecture we're going to cover many topics all related to the foundational concepts of mental health nursing. So let's get right into it.
We're going to start by talking about the concepts of mental health and mental illness. So what is mental health? Mental health is an important and essential component of our overall health.
It affects how we think, how we feel, and how we act. Mental health is a state of well-being in which an individual realizes their own abilities, they can cope with the normal stresses of day-to-day life, they can work productively, and they're able to make a contribution to their community. When somebody is in good mental health, they are capable of rational thinking, they have good communication, they demonstrate resiliency, and they have good self-esteem. Now mental health is not a fixed state, but it is a continuum, so it can change over time based on what's going on in our life. Mental health is influenced by a variety of factors.
These include our biological and genetic history, our individual behaviors, our past experiences, our communication styles, the amount of support and the different relationships that we engage in, And it can also be influenced by social determinants of health, things like income status, education, employment, food security, and access to basic things like housing and access to health care. Mental health is important at every stage of life, so from childhood to adolescence, all the way through adulthood and even end of life. On the contrary, what is mental illness? Mental illness, let me just give you a little bit of background. It's pretty common in the United States.
Nearly one in five adults experience some form of mental illness in their life. One in 12 have a substance use disorder. About one in 24 have a serious mental health condition.
So you can imagine what kind of economic burden this really is on our on our healthcare system and how it affects just the daily lives of the people living in our country. Poor mental health increases the risk of chronic physical illness, such as heart disease, cancer, strokes. Poor mental health can lead to thoughts of suicide.
And we'll talk more about suicide, but this is a very common symptom associated with mental illness. And it's the second leading cause of death in Americans from 15 to 34 years of age. Now different cultures do have their varying definitions of what is mental illness and what truly is a mental disorder. However, overall we consider emotional problems being classified as mental illness when that individual's level of distress becomes significant and they may have moderate to severe impairment in their daily functioning at work, at school, or at home. Mental illness can include relatively common disorders such as depression and anxiety, as well as less common disorders like schizophrenia.
When somebody is having poor mental health or having signs of mental illness, we're noticing alterations in the way they think, in the way they behave, and in their mood or the way they feel. Mental illness can be ongoing, Over a lifetime, it can occur just over a short period of time, maybe based on certain events that happened in somebody's life. Or mental illness can be episodic, meaning these symptoms come and go.
The term serious mental illness refers to mental illness that causes disabling functional impairment. Okay, and this is substantially interfering with one or more of life's major activities, such as caring for oneself, even things like seeing, hearing, eating, sleeping, walking, standing. Some of these actions we take for granted, but in serious mental illness, individuals have trouble even performing just these very basic tasks.
Examples of serious mental illnesses that commonly interfere with some of these major life activities include major depressive disorder, schizophrenia, and bipolar disorder. Individuals with serious mental illness may experience long-term impairments ranging from moderate to disabling in nature, but many can lead productive lives with effective treatment. is treatable, okay?
It's not a choice. The majority of individuals with mental illness do recover and can function in their daily lives. Over time, this means that they've developed a process of change through which they were able to improve their overall health and wellness and live a more self-directed life and strive to reach their full potential. Now there are several theories to explain the causes of mental health disorders, but truly there is not one universal consensus.
One factor though that all researchers agree on is that an individual is not at fault for their condition. They simply cannot just turn on and turn off their symptoms when they want to. Remember there are likely several factors that combine to trigger a mental health disorder and those symptoms.
However, again, recovery is possible. So we look at a few different dimensions of recovery for people. Overall their health.
Are they overcoming and managing their disease? They're living in a more physically and emotionally healthy way. We look at their home life, so we know that having a stable and a safe place to live contributes to people's overall mental health. Their purpose, so we want them to participate in meaningful daily activities, and that can look like a lot of different things.
Maybe they hold down a job, maybe they're able to go to school, or they volunteer. Perhaps they take care of a family member, or maybe they started their own business. business or they're really into some kind of creative task or hobby, right? They are engaging in some kind of activity that is giving them purpose every day.
And then we also look at community. So are they enjoying relationships and do they have social networks that are providing them support, friendship, love, and hope? Taking a closer look at the mental health, mental illness continuum. We see that well-being is on the healthy range of the mental health continuum, and this is where individuals are experiencing a state of good mental health and emotional health. They may experience stress and discomfort resulting from occasional problems of everyday life.
However, they're able to cope effectively with these stressors, and they experience no impairments to daily functioning. On the other end of the mental health continuum are mental health problems and these are where individuals have progressively more difficulty coping with serious problems and stressors. Within this range you see that there are two categories. There are emotional problems and concerns and then there's mental illness. So for individuals experiencing emotional problems the discomfort has risen to a level of mild to moderate distress.
and they are experiencing some mild or temporary impairments in their functioning, such as insomnia, maybe they're having a lack of concentration due to anxiety, or even a loss of appetite. As that level of distress increases because their internal coping mechanisms and their support systems are not in place, they may eventually seek treatment. and they often start with visiting their primary health care provider for this.
Some of the individual factors that affect somebody's mental health include biological things like the imbalance of neurotransmitters. There are several neurotransmitters that affect the way our brain function and that includes dopamine, acetylcholine, GABA, norepinephrine, glutamate, and serotonin. And we'll talk a lot more about these, but overall imbalances in these neurotransmitters result in changes in behavior, mood, and thought. There's also a genetic link as well.
So there appears to be a hereditary pattern to some mental illnesses. For example, individuals with major depressive disorder often have parents or other close relatives with the same illness. Behavioral factors include individual addictive behaviors, lifestyle choices surrounding nutrition and sleep, individual trauma resulting from an event, a series of events, or circumstances.
These are experienced as either physically or emotionally harmful, and these can have lasting adverse effects on an individual's functioning and their mental, physical, social, emotional, and even their spiritual well-being. Some of these serious traumatic events can include adverse childhood experiences, or you may see them abbreviated as ACEs. These would be childhood experiences like abuse, neglect, growing up in a household where there was a lot of violence, mental illness, substance misuse, perhaps the adults in the house, there was some incarceration, or even divorce, chronic stress from ACEs that can actually change the brain development in children and how their body is affected and responds to stress overall. So ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood.
Looking at some of the interpersonal factors related to mental health, this can include family and peer groups. They have a significant impact on development and mental health. Stressors such as relationship difficulties can have a negative effect on somebody's mental health. And there's also social factors to keep in mind. So exposure to racism, discrimination, poverty.
Violence. These can all contribute to poor mental health or the development of mental illness. Everybody deserves access to things like basic needs like health care, food, and water.
Let's look at some of those cultural considerations that we touched on a bit earlier. So first, let's define what a culture is. This is a collection of shared customs, social institutions, beliefs, practices, and values that influence an individual's behavior and thinking.
What is considered normal or abnormal depends on the specific cultural viewpoint. Every culture has a different perspective on mental health and most cultures have some kind of stigma surrounding mental health. Mental health challenges may be considered a weakness and something to hide, which can make it harder for those struggling to talk openly and ask for help.
So be aware of cultural stigma. An individual's culture may also influence how they describe their symptoms. It can affect whether somebody chooses to recognize or talk openly about their physical symptoms, their emotional symptoms, or both. So, for example, members of the Amish community, typically they are stoic and they endure physical and emotional pain without any complaints. We'll also consider the community support.
So cultural factors can determine how much support someone gets from their family and their community when it comes to mental health. Because of existing stigma, it can be challenging for individuals to find mental health treatment and support. And then there is also the availability of culturally sensitive resources.
When looking for mental health treatment, it can be difficult to find resources and treatment options that take into account a specific culture, their concerns, and their needs. So nurses can help clients by understanding the role that culture plays in their mental health, If potential signs of undiagnosed or poorly managed mental health disorders are present, nurses should make appropriate referrals for further assessment and follow-up. The nurse also needs to be aware of their own natural bias and generalizations. Now, these are internal subconscious processes that happen in all of us.
And it's a way for our brains to automatically categorize and group data based on characteristics, such as maybe an individual's age, gender, or race. So a natural bias, this is when the nurse's point of view causes them to notice some things but not others. An example of this might be a nurse providing extra attention to an individual.
who maybe reminds them of a late grandmother that they had a really positive relationship with. There's also generalizations that the nurse has to be aware of. Now generalizations, these are a way of organizing information in our brain. Generalizations arise from natural biases. They're a starting place for comparing typical behavioral patterns with what is actually observed.
So an example of a generalization may be all older adults are always confused. Now again, natural bias and generalizations, these are subconscious processes and as long as the nurse is aware of them, they can still lead to an overall open-mindedness of that care provider. But what we have to be really careful is that these don't turn into negative bias, stereotypes, prejudice, or discrimination.
These are things that we need to avoid. Now negative bias, this is a refusal to recognize other points of view. This negative bias can turn into stereotypes.
Stereotypes are essentially where in our minds we have an image that's frozen in time and this basically causes us to see what we would expect to see even when the facts differ from our expectations. Okay stereotypes can be favorable or unfavorable and both have the potential to cause harm. So one big stereotype in mental health is that those with mental illness are dangerous, that they're unpredictable, and that they're incompetent, right?
So this is a disrespectful attitude that labels this entire group of people. These can then lead to prejudice, which are irrational and negative feelings about people who are different from ourselves. This is an agreement with the stereotype that leads to a negative emotion. So if you agree with the stereotype that everybody with a mental illness is dangerous, now your negative emotion is that you fear them. If you agree that all people with mental illness are unpredictable, then your negative emotion or reaction is that you don't trust them.
All right. And then prejudice can lead to discrimination. And this is subsequent behaviors that are resulting in a loss of rightful opportunity for that group of people. So for example, the behavior that would lead from the stereotype, um, with the individuals with mental illness is now employers don't hire people with mental illnesses. Maybe then landlords would not rent to people with mental illnesses.
And in healthcare, this may mean that providers do not listen to their concerns and then provide care that is not acceptable, right? They provide worse care than they would to somebody else. All right, so some key take-home points here for caring for individuals that come from culturally diverse populations.
We have to learn to effectively advocate for culturally diverse groups. The nurse must understand their own internal biases and generalizations. They must remain sensitive on how their attitudes, values, and prejudices can affect their own nursing practice.
Communication is really, really important here. Caring for clients from diverse backgrounds and becoming culturally competent and confident in managing diversity requires practice and patience. Okay. This is a process that never ends. We're always internally...
looking for these unconscious biases so that we can provide the best care for our clients with mental illness.