Category: Mental health

Persons with severe and persistent mental illnesses (SPMI) are at higher risk for medical problems as they are having inadequate access to primary care and preventive services and often do not have their general medical needs adequately addressed. Reports suggest that both urban and rural British Columbia (BC) has a severe shortage of mental health services, and access to resources is minimal. Literature reviews reveal that mental illness occurs at higher rates among the incarcerated population than in the overall U.S. population. Though the majority of people with mental disorders voluntarily get admitted to hospital, it is experienced that a large number with serious mental disorders refuse to accept psychiatric treatment, and under such circumstances, the Mental Health Act provides ‘authority, criteria, and procedures for involuntary admission, at the same time protecting individual freedom. Collaborative Mental Health Care Network (CMHCN) developed by Ontario College of Family Physicians is considered as the suitable model for implementing mental health programs in British Columbia. A more structured, evidence-based approach to mental health care and systematic follow-up of patients to assess clinical status and/or medication adherence are crucial for improving clinical outcomes.

Persons with ‘severe and persistent mental illnesses (SPMI) are at higher risk for medical problems, such as hypertension, coronary heart disease, and diabetes, and have ‘significantly shorter life expectancy than persons without mental illness. They are having inadequate access to primary care and preventive services and often do not have their general medical needs adequately addressed. Since people with chronic mental illness generally present themselves to the primary care providers, integrating mental health into primary care settings brings the care to the patient’s doorsteps, which will improve “the treatment of the “whole” patient with concomitant improvement in outcomes and reduced utilization”( Integration of mental health/substance abuse and primary care, 2008, p. 18). “The Report of the President’s New Freedom Commission on Mental Health identified the need for better coordination between primary care and mental health care and called for the dissemination of evidence-based models to improve care at the interface of general medicine and mental health.” (Butler, et al, 2008, p.9). Under such circumstances, the traditional practice of separating mental and physical health care should be replaced with integrated models of care, as it has the potential to improve access to treatment and improve quality.

British Columbia scenario of mental health services

Reports suggest that both urban and rural British Columbia (BC) has a severe shortage of mental health services, and access to resources is minimal, which results in an increased burden to society. The first major attempt to assess mental health issues and needs in rural British Columbia was conducted in 1970 under a government-funded research project. Researchers held extensive structured interviews with mental health staff, local medical practitioners, and social organizations impacted by mental health. A detailed survey was also conducted to determine the performance of existing services in meeting the specific needs of the particular community and areas, as wells as the level and type of mental health needs of communities without specific services. The study found that most of the existing mental health centers were providing “adequate service for their local communities but were lacking in outreach services, travel being a significant problem.” (Maddess, 2006, pp.172-173). Even though there was the highest need for mental health services in British Columbia (BC) access to service was extremely low, and the only resource was a local general practitioner. A general practitioner is allowed to bill four 20-minute sessions per year for anyone patient at $ 48.57 per session, which is inadequate even to discuss the problem. It is worth noting that most of the people in rural areas do not have any coverage and cannot afford to pay privately. The situation is further exacerbated with limited access to psychiatric facilities and those psychiatrists located in rural BC have to travel much with limited support. All these factors contribute to inadequate attention to mental health issues that make the degree of disorder and dysfunction often becoming unmanageable. It is suggested that adequate government funding, the establishment of “GP psychotherapy” that exists in other provinces in Canada, and covering registered psychologists by the medical plan would provide “a broader interdisciplinary service to a much larger population” (Maddess, 2006, pp.172-173).

Mental health problems among the incarcerated population

According to the Bureau of Justice Statistics (BJS), U.S jails process “an estimated 12 million admissions and releases each year,” and the “lives of many who cycle in and out of jail are unstable” because of substance addiction, ,job and housing instability, mental illness, and host of health problems are day-to-day realities of the majority of this population (Solomon, et al, 2008). With the increasing awareness about the effects of reentry on public safety and community well-beisocially-orientednted practitioners recognize that jail reentry programs and strategies with active collaboration of community-based organizations will help transform the situation. “Collaboration across disciplines and jurisdictional boundaries is the core of jail reentry” because collaboration among these disciplines could lend “support to programmatic interventions and also serve to reduce victimization” (Solomon et al, 2008, p. xv). However, it is worth noting that “even when individuals receive adequate training, treatment, and care during incarceration, they often face limited access and insufficient linkages to community-based resources and treatment services upon release” (Hemmet et al, 2001 cited by Solomon et al, 200, p. 15).

Literature reviews reveal that mental illness occur at higher rates among the incarcerated population than in the overall U.S. population. It is evidenced that “homelessness, unemployment, substance abuse and dependency, and histories of physical abuse are more acute among inmates and prisoners with mental health problems, and serious mental illness is correlated with higher rates of violence and longer criminal histories” (James & Glaze, 2006, cited by Solomon et al, 2008, p.16). Inmates with mental health problems encounter ‘limited access to continuity of care’ and a period of incarceration create void in Medicaid eligibility leading to interruption in access to prescription drugs that put individuals at high risk of relapse. An interruption in medication of jail inmates with mental health illness after release may result in relapse and instability that may promote recidivism. This issue is addressed by ensuring adequate supply of medication at the time of release that will last till their first appointment in the community.

British Columbia Mental Health Act

“All Canadian provinces and territories have legislation to treat and protect people with severe mental disorders and to protect the public,” and the British Columbia’s ‘Mental Health Act’ (the Act) became law in 1964. (Obtaining copies of the mental health act, regulations and forms, 2005). Its purpose is to ensure “…the treatment of the mentally disordered who need protection and care…” and the Act helps provide treatment and care for people with mental disorders when they are not willing to accept it. Though majority of people with mental disorders voluntarily get admitted to hospital, it is experienced that a large number with serious mental disorders refuse to accept psychiatric treatment, ‘causing significant disruption and harm to their lives and the lives of others.’ Under such circumstances the Mental Health Act provides ‘authority, criteria, and procedures for involuntary admission,’ at the same time protecting individual freedom by ensuring that ‘the provisions of the Act are applied in an appropriate and lawful manner.’ Involuntary patient admissions are made to ‘designated facility’ that include inpatient ‘Provincial mental health facilities,’ ‘psychiatric units,’ and ‘observation units’ and no other hospital or health care facility has legal authority to hold or admit an involuntary psychiatric patient. Adults and young persons 16 years of age or above can voluntarily seek admission to a designated facility after signing in prescribed forms and get treatment and may discharge themselves “just like non-psychiatric patients admitted to a hospital under the Hospital Act.” (Obtaining copies of the mental health act, regulations and forms, 2005). Children under age 16 may be admitted by their parent or guardian, and such children be admitted under the Mental Health Act, rather than the Hospital Act, because “Mental Health Act provides direction on admitting children and youth and protects their rights by providing for regular reviews and access to Review Panel” (Obtaining copies of the mental health act, regulations and forms, 2005).In the case of emergency and when a person is acting in a manner likely to endanger their own safety or that of others police should be called, who will determine that “the criteria under section 28(1) of the Act are met and the police would return the person to a designated facility, and Medical Certificate may be issued “(Obtaining copies of the mental health act, regulations and forms, 2005). The Medical Certificate provides authority for the police, paramedics or others to apprehend and transport the person to a designated facility. Only a “physician licensed to practice medicine in British Columbia may complete a Medical Certificate” that allows the person to be in involuntary admission for up to 48 hours. (Obtaining copies of the mental health act, regulations and forms, 2005). Under extraordinary circumstances in which it is impossible for physician or police to intervene for arranging involuntary admission of a person with apparent mental disorder judicial intervention is permissible under the Act. Mental Health Act also defines treatment as “safe and effective psychiatric treatment and includes any procedures necessarily relate to the provision of psychiatric treatment. Section 8(a) states that the director: “…must ensure that each patient admitted to the designated facility is provided with professional service, care and treatment appropriate to the patient’s condition and appropriate to the function of the designated facility and, for those purpose, a director may sign consent to treatment forms for a patient detained under Section 22, 28, 29, 30 or 42…” (The Act, 2005, p. 18). Thus, people with mental disorders can be provided with the treatment and care they need, even when they are not willing to accept it, by procuring a judicial order under the provisions of Mental Health Act.

Intervention model suitable for British Columbia

Randomized controlled trials and high quality quasi-experimental design studies conducted by Butler and colleagues (2008) observe that “in general, integrated care achieved positive outcomes; there is strong body of evidence to encourage integrated care, at least for depression; and efforts to implement integrated care will have to address financial barriers.”

“Financial barriers are a major impediment, primarily because many activities associated with integrated care, such as many management functions, consultations, and other communication activities between providers, and telephone consultations with patients, are not rationally reimbursed under typical “fee-for-service care” (Butler et al, 2008, p.3). Systematic review of trials designed to improve general medical care in people with mental addictive disorders by Butler and colleagues (2008) had also found that “collaborative care” models demonstrated intermediate to high levels of involvement by primary care providers, with regular contact between medical and mental health staff. The development of “shared care models of collaboration between family practitioners and psychiatrists” is considered as most viable approach to improve communication between disciplines and increase access to psychiatric care and consultation. (Rockman, et al, 2004) Considering the fact that family physicians (FPs) are the primary contact for patients with mental disorders and approximately one third of visits to FPs are for mental health problems Rockman et al (2004) argue that partnerships between FPs and psychiatrists could relieve the burden of day-to-day responsibility of providing primary mental health care. Collaborative Mental Health Care Network (CMHCN) developed by Ontario College of Family Physicians, launched in 2001, is cited as a successful model for meeting the challenges from difficult-to-treat conditions of mental health illness. CMHCN is a “unique mentoring program using General Practice (GP) psychotherapists and psychiatrists to help its FP members provide mental health care to their patients.” (Rockman, et al, 2004, p.398). Objectives of the program among other things include “improving collaboration between FPs and specialists in exchange of information and knowledge; enhancing mental health care as defined by the goals of the program, to increase physician’s satisfaction with collegial relationships; improving patient’s adherence to treatment; reducing time to consultation, and providing optimal treatment and relief to patients’ symptoms”(Rockman, et al, 2004). For better assessment and management of patients with mental health problems, it is suggested that physicians should be involved in continuing medical education (CME) sessions. However, this collaborative approach also had barriers and limitations, particularly communication barriers, in implementation. Major barriers identified in CMHCN were: “FPs and mentors preferring different modes of communication, being in different geographic locations, and not having access to the internet and email services” Rockman, et al, 2004).

CMHCN program encountered certain limitations derived from a “perceived need to better match physicians and mentors by geographic locations”, a need for “mentors to reach out to cultivate mentoring relationships,” slow response by physicians and mentors, and a “lack of formalized FP and mentor expectations” (Rockman, et al, 2004). Since British Columbia has many geographic barriers and lacks of IT assisted communication facilities implementing the CMHCN program may encounter more challenges. Recruiting mentors located in geographically close proximity, increasing the number of small group sessions that comprise case discussions, videoconferences, and teleconferences, as well as efficient use of Network funds will help overcome these hurdles. Eliminating “face-to-face meetings” and introducing more telephonic and email communication between mentors and GP psychotherapists will permit “greater geographic flexibility” and “increase access to mental health expertise.” (Rockman, et al, 2004)

Conclusion

Mental health providers encompass not only psychology and psychiatric professionals, but also nursing and care management providers, whose professional roles focus on the mental health needs of patients. A more structured, evidence-based approach to mental health care should be multifaceted and target other elements of care process. A multifaceted approach of educating the patients about the nature of disorder and self management, introduction to evidence-based guidelines for care, providing new therapies in primary care settings, and systematic follow-up of patients to assess clinical status and/or medication adherence are crucial for improving clinical outcomes. Through restructuring of personnel and workflows, as well as connecting administrative functions, clinical records management, financing and claims processing, and disease management programs at the organizational or systems level will facilitate clinical integration.

References

1. Integration of mental health/substance abuse and primary care: Chapter 1 introduction: overview. (2008). AHRQ. 18. Web.
2. Butler, Mary., et al. (2008). Integration of mental health/substance abuse and primary care.Minnesota Agency for Healthcare Research and Quality: Evidence Report Technology Assessment. 1. Web.
3. Maddess, Rapph, J. (2006). Mental health care in rural British Columbia. BC Medical Journal, 48 (4), 172-173.
4. Obtaining copies of the mental health act, regulations and forms. (2005). British Columbia Ministry of Health. 4.
5. Rockman, Patricia, et al. (2004). Shared mental health care: Model for supporting and mentoring family physicians. Canadian Family Physicians, 50, 398.
6. Solomon, A.L., et al. (2008). Life after Lockup: Improving reentry from jail to the community. Washington: Urban Institute. Web.

Introduction

Mental health refers to the state of human cognitive and emotional condition. This refers to the feelings and behaviour of individuals. Mental health can also refer to the absence of a mental illness. Mental health is a concept that was clearly defined during the 19th century by William Sweetzer. He was the first to define mental hygiene that laid the ground for advances in mental health. Eugen Bleuler is credited for having come up with the term “Schizophrenia” during the second decade of the 20th century (Kyziridis, 2005).

Nonetheless, it has to be remarked that Emil Kraepelin came up with various categories of mental disorders. There is no doubt that schizophrenia is not a new disease. This is because symptoms that are associated with schizophrenia were witnessed in the formative years of human history.

In the early years, signs related to the disease were said to be resulting from possession of evil spirits. There has been debate on whether schizophrenia is a biological or social condition (Jablensky, 2010). This paper strives to give a critical analysis of schizophrenia and provide a position on whether the condition is biological or social.

Historical analysis of Schizophrenia

The term “Schizophrenia” is relative new in medical circles. Notably, the word was coined by Eugen Bleuler in 1911. In this regard, it can be observed that the term has only been in existence for barely a century now. In the first description of schizophrenia, Emile Kraepelin categorised the condition as “dementia praecox” in the year 1878.

Nonetheless, schizophrenia has been associated with humans since the ancient times. There is evidence indicating that schizophrenia was recorded in ancient Egypt since the year 2000 BC. Notably, psychotic symptomatology and symptoms related to schizophrenia characterised the ancient communities.

This is evidenced by the skulls belonging to the Stone Age humans that have holes drilled in the skulls. Research has indicated that the holes in skulls were drilled while the individual was alive to give a throughway for the evil spirits to leave the head. This mode of treating schizophrenia has become to be known as trepanning. In the ancient communities, schizophrenia was explained through supernatural understanding (Kyziridis, 2005).

Incidents of schizophrenia are clearly described in the Book of Hearts. In ancient Egypt, the heart and mind were seen as being similar. Psychical illnesses were considered to be symptoms resulting from blood vessels, faecal matter, poison or evil spirits. In most instances, the people of ancient Egypt regarded the mental disorders as being physical illnesses. Among the Hindu community, mental disorder descriptions can be traced to the year 1400 BC.

It was believed that health was derived from the balancing act of the Buthas and the Dosas. An imbalance resulting from the two elements was argued to lead to madness. Among the Chinese, symptoms related to schizophrenia were described in an ancient text about 1000 BC. It was believed that psychotic behaviours were caused by an individual being possessed by evil spirits (Kyziridis, 2005).

The history of development in respect to mental health can be traced to antiquity. Nonetheless, there are those individuals who stood out in defining the term schizophrenia. Notably, in the early 18th century, there was an emphasis on accurately detailing and describing mental abnormality. Philippe Pinel, who is regarded as one of the pioneers of modern psychiatry, emphasized on the need to incorporate medico-philosophical approach in understanding psychological disorders.

He went further to distinguish a worsening psychosomatic “dementia” from other conditions such as idiocy, mania, and melancholia. The other individual who contributed to the development of psychiatry is Jean Etienne Esquirol. He offered the definition of hallucination that is relatively similar to the modern definition.

During the 1860s, Benedict Augustin Morel used the term “dementia praecox” for the first time in his “Treatise on Mental Illness”. There are other individuals whose contribution to the field of psychiatry cannot be ignored. Such individuals include Kahlbaum who referred to the pattern of abnormal motor tension as “katatonia” or “catatonia” (Kyziridis, 2005).

During the nineteenth century, there were major developments related to the aspect of body and mind. There were indications that mental disorders were caused by an illness in the brain. This was after it was discovered that syphilis and insanity were closely related. During this time, organic aetiologies related to mental disorders were approved, and different illnesses were approved. This period was characterised by numerous descriptions defining what is now referred to as schizophrenia.

Emil Kraepelin came up with the various categories of mental disorders in 1878. Notably, he referred to the disorders with symptoms similar to those observed in schizophrenia as “dementia praecox” (Klosterkötter, Schultze-Lutter and Ruhrmann, 2008). On the contrary, during the early years of the 20th century, Eugen Bleuler coined the term “schizophrenia” for the first time in the history of mental disorders.

Bleuler was critical of the term “dementia praecox” arguing that there was the lack of evidence to support a worldwide dementing process. The term schizophrenia is derived from a Greek words “schizo” and “phone”. In Greek, schizo means “split” while “phone” is the “mind” (Kyziridis, 2005).

Though Bleuler was the first to coin the term schizophrenia, the term has undergone numerous changes to suit the definition of certain mental disorders. It is worth noting that Bleuler and Kraepelin divided schizophrenia into various categories relying on the elaborate signs and diagnosis. Individuals in the modern times have continued to categorise schizophrenia into various types. In this classification, there are five categories defined in the DSM-III. They include the “disorganised, catatonic, paranoid, residual, and undifferentiated” schizophrenia (Kyziridis, 2005, p. 45).

In defining schizophrenia, Bleuler noted that the disorder was characterised by positive and negative symptoms. According to Bleuler, the positive symptoms of schizophrenia are those that are regarded as additional to the normal human behaviour. Such symptoms include hallucinations and delusions (Moskowitz and Heim, 2011).

Hallucinations can be described as sensations that occur in without the individual experiencing a stimulus. The perceptions may seem to be realistic; however, they are just a creation of the brain. On the other hand, delusions refer to unfounded beliefs indicating abnormality in the thought process. The negative symptoms of schizophrenia are those that relate to loss of normal behaviour. Such symptoms include social withdrawal and apathy or lack of interest for certain things (Kyziridis, 2005).

It has been found that schizophrenia develops during early adulthood in most instances. In essence, most individuals begin showing signs of schizophrenia during their early twenties. It has also been observed that women take between five and ten years to peak more than men. During the initial stages, an individual appears not to be having any goals in life. The individuals thus become weird and lack motivation in life. Depression has strongly been associated with schizophrenia.

In this regard, depression is closely witnessed in patients suffering from schizophrenia. Kraepelin used the affective symptoms in differentiated praecox from manic-depressive illnesses. Kraepelin recognised the significance of depression in schizophrenia and came up with various subtypes of the disease (Mulholland and Cooper, 2000).

There has been a major debate on whether schizophrenia is a biological or a social disorder. Most people assume that the social causes of schizophrenia have been rendered ineffective due to the development of biological theories. Nonetheless, it can be asserted that both these aspects can be considered in the analysis of mental illnesses such as schizophrenia. Notably, it has been noted that biological factors may be critical in the development of schizophrenia; however, social factors also are critical in the development of schizophrenia.

Biological Construct of Schizophrenia

Biological and genetic aspects play a critical role in the development of schizophrenia. In this respect, numerous theories have been put forth to provide a biological explanation of schizophrenia. Among these theories include the dopamine hypothesis; glutamate hypothesis; genetics; and substance/drug/alcohol abuse.

In respect to the dopamine hypothesis, it is argued that schizophrenia is caused by the excess dopamine in the brain. This is because patients suffering from schizophrenia are having more dopamine in the brain than normal individuals. The increased level of dopamine causes symptoms related to schizophrenia (Moghaddam, 2003).

In regard to the glutamate hypothesis, it is argued that schizophrenic patients have a deficiency in a receptor found in the brain. In essence, it has been established that glutamate, which also serves as a transmitter, is a chemical found in the brain. This chemical is secreted into synapses and enhances the propagation of nerve impulse.

It is noted that, when the receptors in question are compromised, an individual becomes schizophrenic. The receptors, N-methyl-D-aspartate (NMDA) receptors are argued to be the main subtype of glutamate receptors facilitating slow excitatory postsynaptic potentials. This is important for the expression of complicated behavioural observations that get distorted in schizophrenic patients (Moghaddam, 2003).

The genetics hypothesis notes that schizophrenia is caused by the prenatal environment in the DNA of the child before it is born. In this regard, schizophrenia is considered to be a hereditary disease in which schizophrenic genes are passed from the parents to the child. It has been asserted that individuals inherit genes from the parents, which are critical in brain development.

If an allele of a gene that is critical in the brain development of the child is subjected to mutation, then the child stands a high chance of being born with a mental disorder. Notably, somatic mutation is common at the time of intense cell division and thus the chance of a child developing schizophrenia is limited to critical moments during neurodevelopment (Guidry and Kent, 1999).

There has been an association between schizophrenia and abuse of substances (Kosten, and Ziedords, 1997). Several studies have demonstrated that schizophrenics tend to indicate high rates of drug and alcohol abuse. Notably, individuals suffering from schizophrenia are said to be susceptible to negative consequences of drug abuse. It has also been indicated that use of drugs and alcohol leads to developmental issues in the brain. This has been noted to cause schizophrenia (Smith and Hucker, 1994).

Treatment of Schizophrenia

Individuals suffering from schizophrenia cannot experience a comprehensive remission of symptoms. Nonetheless, schizophrenia can be managed by combining medication and psychosocial therapies. The treatment of this condition can be directed by a psychiatric who manages the biological and medical needs of the patient.

The mental health professionals and social workers develop a strategy that is geared towards helping the schizophrenic patient integrate into the society. It can be noted that drugs are effective especially in the control of the positive symptoms. Such drugs enable the schizophrenic patients to live outside institutional care centres normally (Cheadle, Freeman and Korer, 1978).

Schizophrenia can be described as a condition that brings together thought, mood, and anxiety disorders. Also, the use of drugs is critical in the management of positive symptoms associated with schizophrenia. These drugs enable schizophrenic individuals to lead a relatively normal life outside the institutional care. The treatment of schizophrenia demands a combined effort from various medications. Such medication includes antipsychotics, antidepressants, and antianxiety drugs (Plasky, 1991).

Though these medications have proved to be helpful, most individuals on drugs do not continue using the drug prescribed after some time. This is especially when the side effects are intolerable. It has been indicated that about three quarters schizophrenic patients stop taking medication once they leave the institutional centers.

To ensure that patients adhere to the prescription, it is important to have follow-up programs in place that will monitor the progress of the patients in taking medication. Apart from the side effects that are associated with the medication, it has been realised that some schizophrenic patients do not respond to the drugs positively. Approximately, 30% of the patients do not respond to medication (Kramer, et al, 1989).

Several drugs are used in treating schizophrenia. These drugs include Clozapine, Seroquel, Risperdal and Zyprexa. The antipsychotic drugs assist in the normalisation of the biochemical imbalances that lead to schizophrenia. The traditional antipsychotic drugs include haloperidol, chlorpromazine, and fluphenazine, which help in the treatment of positive symptoms.

Also, there are the new antipsychotic drugs such as the Seroquel, Risperdal, Zyprexa and Clozoaril used in treating both positive and negative symptoms of schizophrenia. The new antipsychotic drugs also do not have numerous side effects as the old antipsychotic drugs (Carpenter and Koenig, 2008).

Social construct

Apart from the drug therapy, there are the psychological therapies used in treating schizophrenia. For instance, there is the cognitive behaviour therapy that is used in the management of schizophrenia. It is believed that the social environment in which an individual live can affect Cognitive behaviour therapy identifying what triggers and sustains schizophrenia and how strategies can be developed in managing the symptoms related to schizophrenia (Turkington, Dudley, Warman and Beck, 2006).

Notably, family intervention is one of the strategies used in enforcing the cognitive behaviour therapy. Family interventions are meant to change interaction patterns within family groups. This is aimed at stopping a relapse of schizophrenia symptoms among the patients who leave the institutional care centers (Carpenter and Koenig, 2008).

Training in social skills is also critical in helping schizophrenic patients cope with normal life. In social skills training, interpersonal skills are taught by breaking the complex behaviours into individual elements. These skills are demonstrated in role play where the schizophrenic patients are given a role to play while practising the skills.

Social skills training is rooted in conditioned reflex therapy, psychotherapy, and social learning theory. Social skills training help schizophrenic individuals to learn new skills, which they can maintain for quite some time. It also helps in improving social functioning, as well as quality of social life of patients. Social skills are critical in enhancing social functioning, quality of life, and adjustment of the patient to normal, community life (Mueser and Bellack, 2007).

Schizophrenia and Culture

Schizophrenia cuts across all cultures across the globe. In this regard, ethnographic studies have indicated that schizophrenia is found in virtually all communities around the world (Kyziridis, 2005). Therefore, it has to be noted that the various world communities devised different ways of dealing with this mental condition. In essence, some societies used to drill holes in the skull of individuals who were schizophrenic. It was believed that the individuals were possessed by evil spirits and thus drilling a hole provided a way through which these spirits left the brain (Insel, 2010).

Various cultural beliefs have developed over centuries aimed at the treatment of schizophrenia. Such cultural aspects include hydro baths, electroshock, and lobotomy. In hydrotherapy, there were various treatments in which water was used in treating schizophrenic patients. This required a doctor’s prescription and an attendant was assigned the duty of ensuring that the patient underwent all the necessary procedures in hydrotherapy.

Electroshocks were also used in the treatment of schizophrenia. In this respect, electric shocks are used to generate nerve-wracking convulsions in the treatment of schizophrenia. This treatment began in the 18th century and took root during the 19th century. Lobotomy treatment of schizophrenia entails the drilling of holes in the human skull. This is an ancient method of treatment, which has been revamped to minimise the dangers associated with it in the modern days.

Initially, lobotomy was thought to be only effective in treating patients with depression, as opposed to those with acute schizophrenia. However, this assertion has been disapproved, and numerous lobotomies have been carried out around the world. During the second decade of the 20th century, the Nazi advocated for the extermination of the schizophrenic individuals.

They advocated for euthanasia in which the unfortunate individuals were viewed as being a burden to the society. It can be remarked that the T4 program that was occasioned during the holocaust saw thousands of mentally challenged individuals being killed. The society has moved away from the archaic methods of treating schizophrenia to embrace humane means of treatment.

Schizophrenia is also associated with religious aspects. In the ancient societies such as Mesopotamia, any form of sickness was associated with spirits. Many religious groups handled schizophrenia in various ways. Plato, a Greek philosopher who lived during the 4th and 5th centuries, categorised madness into two. The first category had a divine origin whereas the other one had a physical origin. Among the Christians, exorcism was conducted to remove the evil spirits or demons from the individual.

It was believed that schizophrenia resulted from an individual being possessed by demons. During the 16th century, witchcraft was practiced among some societies to cure schizophrenia. Individuals suffering from schizophrenia were believed to be bearing the wrath of the gods. Therefore, a witch doctor was called to intervene and heal the patient (Jablensky, 2010).

Conclusion

Schizophrenia is a condition that has characterised the human society for many years. From the onset, individuals have struggled with ways to deal with the condition. However, development that has been realised in the medical field has seen the discovery of new and advanced medication to treat this condition. Notably, it can be asserted that schizophrenia is a biological condition since it concerns the composition of the chemicals in the brain. Nonetheless, social aspects also play a role in the development of schizophrenia.

Reference List

Carpenter, W. and Koenig, J. (2008). The evolution of drug development in schizophrenia: past issues and future opportunities. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 33(9), 2061-2079.

Cheadle, A. J., Freeman, H. L. and Korer, J. (1978). Chronic schizophrenic patients in the community. British Journal of Psychiatry, 133, 221–227.

Guidry, J. and Kent, T.A. (1999). New genetic hypothesis of schizophrenia. Med Hypotheses, 52(1):69-75.

Insel, T. (2010). Rethinking schizophrenia. Nature, 468(7321), 187-193.

Jablensky, A. (2010). The diagnostic concept of schizophrenia: its history, evolution, and prospects. Dialogues In Clinical Neuroscience, 12(3), 271-287.

Klosterkötter, J., Schultze-Lutter, F., and Ruhrmann, S. (2008). Kraepelin and psychotic prodromal conditions. European Archives Of Psychiatry And Clinical Neuroscience, 258 Suppl 274-84.

Kosten, T. R. and Ziedords, D. M. (1997). Substance Abuse and Schizophrenia: Editors’ Introduction. Schizophrenia Bulletin, 23(2):181-186.

Kramer, M. S., et al. (1989). Antidepressants in ‘depressed’ schizophrenic inpatients. A controlled trial. Arch Gen Psychiatry, 46: 922.

Kyziridis, T. C. (2005). Notes on the History of Schizophrenia. German J Psychiatry, 8: 42-48.

Moghaddam, B. (2003). Bringing order to the glutamate chaos in schizophrenia. Neuron, 40(5): 881-4.

Moskowitz, A. and Heim, G. (2011). Eugen Bleuler’s Dementia praecox or the group of schizophrenias (1911): a centenary appreciation and reconsideration. Schizophrenia Bulletin, 37(3), 471-479.

Mueser, K. T. and Bellack, A. S. (2007). Social skills training: Alive and well? Journal of Mental Health, 16(5): 549 – 552.

Mulholland, C. and Cooper, S. (2000). The symptom of depression in schizophrenia and its management. Advances in Psychiatric Treatment, 6: 169-177.

Plasky, P. (1991). Antidepressant usage in schizophrenia. Schizophrenia Bulletin, 17, 649–657.

Smith, J. and Hucker, S. (1994). Schizophrenia and substance abuse. Br J Psychiatry, 165(6): 836-7.

Turkington, D., Dudley, R., Warman, D. M. and Beck, A.T. (2006). Cognitive-Behavioural Therapy for Schizophrenia: a review. Focus, 4(2), 1-11.

The information was obtained from Mrs. B., a 24 years old female. The psychiatric-mental health assessment is necessary in this case because the patient is viewed as insecure about her appearance by members of the family. She frequently throws up after meals and is anxious about her weight most of the time. A survey was used to assess the patient’s mental status (Goroll & Mulley, 2014). She has got the highest possible score, and it is a significant factor because it indicates that no significant mental issues are present. No problems with self-esteem were noted. It is noticeable that she has frequent mood swings and tries to draw attention to herself. Overall, it is evident that she has a distorted perception of her body.

The patient’s current diet may be described as unreasonable. She has suffered an enormous loss of weight over the last few years that should not be disregarded. Mrs. B. avoids certain foods and prefers fruits and vegetables in most cases. It needs to be said that laxatives are also frequently used. She does not have a history of drug use, and it is a significant factor because it could worsen the situation. It is also imperative to note that the process of eating is viewed as something terrifying by the patient and often causes discomfort. The fact that she is not physically active is significant because her muscles may be severely weakened as a result of such eating behavior.

Mrs. B. immigrated approximately six years ago. The patient has noted that she thinks that the treatment may not be complicated by issues that are associated with culture and traditions. She does not use traditional medicine and views it as extremely ineffective.

The patient has reported issues in the family. The primary issue that causes conflicts and disagreements is that most are not satisfied with her eating behavior. Husband often criticizes her actions, and he does not agree with her beliefs that she should lose weight. Mrs. B. has noted that nobody else in her family thinks that she needs to lose weight.

She currently works as an accountant for a local corporation and has plans for career development. It needs to be said that her current condition may be an issue because the employer may view her as mentally unstable because of her eating behavior.

The patient has issues with sleep and frequently wakes up in the middle of the night. It is paramount to note that nightmares are quite common. She struggles to fall asleep quite often because she has paranoid thoughts about her weight. The patient has also noted that she often feels sleepy during the day, and it negatively affects her overall performance in the workplace.

It needs to be said that teaching is a significant issue in this case because the patient does not view opinions of others as important and does not trust health care providers. SSRI antidepressants may be used to make sure that the patient can maintain healthy weight for her height (Yager et al., 2014). It is a major problem that needs to be addressed because it is entirely possible that she is at risk of development of numerous severe conditions. Overall, she should be educated about the dangers that are associated with unhealthy eating, and complications that may occur.

References

Goroll, A., & Mulley, A. (2014). Primary care medicine: office evaluation and management of the adult patient (7th ed.). Alphen aan den Rijn, NL: Wolters Kluwer Health.

Yager, J., Devlin, M., Halmi, K., Herzog, D., Mitchell, J., Powers, P., & Zerbe, K. (2014). Practice Guideline for the Treatment of Patients with Eating Disorders, 3rd Edition. FOC, 12(4), 416-431.

Introduction

The authors wrote this article to report the findings of a study they conducted at the Australian College of Mental Health Nurses Inc. In this study, the authors aimed at determining the type of patient characteristics used to decide whether a patient would be admitted to a mental hospital or not. In addition, they aimed at finding out what normally happens to those patients who are admitted to these hospitals. Secondly, the researchers hoped to find out whether high levels of risk of admission in psychiatric hospitals are some of the factors that predict the length of stay, seclusion, or readmission of a patient within four weeks.

Analysis

The authors’ perception of the problem can be analyzed based on a critique of the introduction and background sections. Here, it is evident that the researchers hypothesized that such factors as conditions of a patient during admission are likely to determine the possibility of admission in a psychiatric section. In addition, the authors suspected that the length of stay in a mental hospital and the probability of readmission within one month are determined by the patient conditions during admission and the dangers they pose to the public. Moreover, they suspected that several factors determine the probability of admission in a psychiatric hospital as opposed to a normal hospital. To develop a concise background, the researchers conducted an in-depth review of the literature to determine some of the reasons why people are admitted to mental hospitals. Among the major findings were the dangers a patient poses to the public, deficits in self-care, and respite for caretakers.

Opinion

Supportive evidence: Arguments developed in this article support some theoretical findings in other studies. I agree with the authors because, in most hospitals, admission into mental health hospitals is a way of reducing patients’ contact with the public. This is especially common in cases where a patient displays some antisocial behaviors that could be a threat to the public. In addition, the researcher’s argument that there is a high rate of seclusion and readmission to a mental hospital is genuine and concise with the actual phenomenon in Australian societies. Perhaps, the reasons behind this could be due to a decrease in the number of mental hospitals and an increase in social and economic stress among Australian communities. Although the researchers did not attempt to find the reasons behind the increased rates of readmission and seclusion, one would agree that social problems could be some important factors.

Conclusion

The researchers’ way of developing the article is quite commendable because it has been developed according to the conventional scientific format. First, a brief but informative abstract provides the readers with an overview of the entire research and contents of the article. Secondly, the introduction provides an in-depth background to the study and study problem, which shows the significance of the present research. However, the researchers have emphasized statistical aspects of the phenomenon to an extent that it could be biased, especially in case of an arithmetical error. Moreover, it is worth noting that the methodology section is brief and to the point, which may mislead the readers as they attempt to determine the credibility of the findings. In their conclusion, the researchers have admitted that there is a need for further studies to determine the best strategies for reducing the high rates of readmission and seclusions in mental health hospitals.

Reference

Hunt, G. E., O’Hara-Aarons, M., O’Connor, N., & Cleary, M. (2012). Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome. International Journal of Mental Health Nursing, 21, 145–153

The COVID-19 pandemic has been affecting people around the world for a year now. Statistics show that in Virginia, there were 7,152 newly reported COVID-19 cases on Dec 17, 2020 (“Virginia Coronavirus Cases and Deaths”). Unfortunately, this has a profound effect on people not only physically but also psychologically. People are forced to remain in quarantine, but patients continue to fall ill and die around them. Thus, maintaining mental health during the pandemic is no less important task than treating the virus (Singh et al., 2020). The purpose of this paper is to discuss resources for dealing with psychological difficulties during this period.

Hampton Roads currently has insufficient resources to maintain the mental health of the population. All the forces of medical institutions are thrown into the fight against COVID-19, so they do not have the opportunity to pay much attention to healthy people. The first resource that could help the population is psychological education. Society was not prepared for this stress and does not know how to cope with it (Xiong et al., 2020). Hence, people need brochures, websites, and other resources with information on how to stay calm during this period. Short, cheap, or even free psychological counseling can also be helpful. With their help, people will better understand what is happening to them and more calmly survive the pandemic.

The main cultural complications that arise during the pandemic are the socialization habits of people. Americans are used to spending time together, visiting interesting places, and communicating with each other. Now they cannot do it at the moment, so their life is changing dramatically. This aggravates their psychological state and harms their mental health. Therefore, it is vital to consider this aspect of behavior and develop new ways of interaction, such as online events.

Fortunately, Americans do not have a genetic predisposition to either the COVID-19 virus or psychological issues. However, mental problems are caused by the peculiarities of modern society based on the Internet and media. Therefore, the reduced consumption of media content could help people in this situation. They need more communication with each other, involving hobbies, and self-development. On the contrary, absorbing news and nonsensical content flooding the Internet increases anxiety and depression. This is a global trend that should be eradicated.

Various potential behavior changes could help people with mental problems. One of them is following a specific structure of life. This applies to both the organization of time and the organization of space. People who work and study at home need a particular time and place for different activities. This will allow the brain to get used to the new lifestyle and calmly switch from work to rest (Serafini et al., 2020). Thus, people will not feel locked up and will be able to abstract themselves from problems. They will not “live at work” and willfully exist even during the period of restrictions.

Maintaining mental health during the pandemic is one of the crucial tasks of all humankind. People need to stay strong and aware and stick together. Fruitful communication, competent distribution of forces, and time management will help create a comfortable psychological climate. Avoiding constantly reading the news will save people from anxiety and unnecessary worries. This way, by the end of the pandemic, people will remain as healthy as they were at the beginning and will return to their past life schedule. Plus, they will develop healthy habits that will stay with them forever and make them more conscious.

References

Serafini, G., Parmigiani, B., Amerio, A, Aguglia, A., Sher, L., Amore, M. (2020). The psychological impact of COVID-19 on the mental health in the general population. QJM: An International Journal of Medicine, 113(8) 531–537.

Singh, S., Roy, D., Sinha, K., Parveen, S., Sharma, G., & Joshi, G. (2020). Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry research, 293, 113429. Web.

Virginia Coronavirus Cases and Deaths. USA Facts. Web.

Xiong, J., Lipsitz, O., Nasri, F., Lui, L., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., & McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders, 277, 55–64.

Abstract

The purpose of this study was to find out the longitudinal impact of inter-household caregiving on adult children’s mental health. The research question formulated was the wear and tear of the adult children’s mental health (the longer the care given the greater the psychological impact). The samples subjects were chosen from 112 households that had elderly impaired parents and care was provided by an adult child in that family. The study was done for a duration of 14 weeks. The parameters used to measure mental health were depression, subjective caregiving stress, and subjective caregiving effectiveness. At the end of the study, it is suggested that more research should be done based on other types of caregivers.

Introduction

The research done by Townsend et al, clearly states the purpose of the study as it seeks to examine the effect of caregiving by adult children caring for their elderly parents. The longer a person is involved in caregiving, the more the effect it has on their mental health. This is important since the results of the study can be used in implementing different health policies that relate to caregiving in various households. This research paper reviews previous studies that have been done and is a review of a paper presented at the Annual Psychological Association, New York in August 1987(American Psychology Association, 2009). Other previous researches include research done by Harris (2005) on the mental health of spouses that were taking care of elderly people with Alzheimer’s disease.

The study is appropriate because there has been a lack of data on longitudinal research on this issue. There has been cross-sectional but not longitudinal research on the mental health of adult children taking care of their elderly parents. The hypothesis has been clearly stated in this particular research. It states that the wear and tear of the mental health of an adult caregiver are increased with longer periods of giving care to the impaired parent. To support the hypothesis, the study shows that the mental deterioration of the caregiver increases with time and is occasioned by depression and reduced immunity (Seyle, 1976). It also shows that the amount of stress at the initial stages increases with the duration it has had an effect on the caregivers. To counter the hypothesis, some studies show that after a long period of taking care of the impaired parent, the caregivers adapt and have reduced stress and strain. The hypothesis, therefore, explains the uncertainty being solved and also the purpose of the study.

Method

Samples for this research were chosen by Margaret Blenkner Research Center at the Benjamin Rose Institute in Cleveland Ohio. The samples have been stated but it’s not clear especially concerning the elderly parents. However, the samples were taken from white family units with elderly (60 years and above) impaired parents. These parents needed at least assistance on 6 caregiving chores to qualify for this research. The sampling procedure used was personalized and individual interviews with the caregivers and elderly parents were done. There were also referrals from community agencies and informal community groups.

The study protocol dealt with the development of a study plan that was based on the research question. The outline of the study provides a detailed list of the elements of the study that acts as a checklist for the researcher. With this in mind, 160 families were selected and eligible at the start of the data collection but with various factors, only 112 remained on the criteria that they needed help for the next 14 months. Some were also eliminated on the basis that the elderly parents were institutionalized and no longer need their care in the course of the study. If no data was available at the first and second data collection, the families were disqualified. The instruments used in the research are well described and measured the content intended.

The instruments used were the social demographic data that classified the adult children’s characteristics and the elderly parents’ characteristics. With this information, one is able to determine what category of caregivers is affected by what level of impairment in the parents. Another measure used was parental care needs, and the parents who had limited functionality were said to have affected their other responsibilities. This instrument can be used to measure the mental health of the caregivers. The instruments used were able to measure the concepts they intended; these concepts are mental health of the adult children caregivers, duration of the caregiving and subjective stress & effectiveness. To measure mental health, the researcher used the Zung (1965) instrument which measures the frequency of depressive episodes in a person. The scores were lower at the 1^st point of data collection than the second. The investigators also used the Bradburn (1969) affect balance scale which measures the occurrence of positive and negative feelings that happen for long durations.

To measure the duration of care giving, the caregivers were asked to state how long they had being taking care of their impaired parents’ needs. Subjective stress and effectiveness measurements used the Klein & Hills (1979) model that seeks to establish the relationship between family problems and solving effectiveness was put into play. The need for care by the impaired parents is viewed as a family problem, and being able to meet the needs was subjective to effectiveness. The design selected is longitudinal research and was appropriate for the research of the wear and tear of the mental health of the care givers.

The design used in the study in the complex issue was based on the hypotheses that the research was seeking to investigate. The design of this study is appropriate as the mental health of the care givers is the dependent variable and the others being the subjective stress and effectiveness. The design selected is able to get the right answers which respond to the research question. During the study there were threats to internal and external validity inherent in the design of the study; there is the difference between the actual and intended a sample, where the sample group of 160 people was originally selected but with various reasons coming into play the number reduced to 112 and with more elimination based on various criteria. Another threat would be a wrong format of the questionnaires and that results in the subjects ticking the wrong boxes therefore providing the wrong information. There various errors that would also be a threat to the validity include random errors (caused by chances) and systematic errors caused by biases. The author of the research coped with the threats to internal and external factors by use of smaller sample sizes. Bigger sample sizes give bigger margins for errors.

Discussion

The researcher compares the present findings with previous works. Increased subjective stress levels increased depression which is consistent with a study done earlier by Montgomery et al, (1985) and Zarit et al, (1980).Other findings in the study were that; longer periods of care giving lead to more subjective stress, greater subjective effectiveness and more depression which was seen at the initial stages of data collection. Another group’s findings were that; longer duration of care giving didn’t mean deterioration in the mental health of the care giver in that some of these children actually adapt to the situation and their depression is greatly lowered resulting in good mental health. Duration of time spent care giving to the parents had little co-relation with the subjective stress level/effectiveness or mental health.

Some subjects experienced more subjective effectiveness and more depression with prolonged periods of care giving. The relationship between the care giver and the parent had no significant impact on the subjective stress levels, efficiency and mental health. It is clear that the purpose of the study was to test the wear and tear hypotheses of the mental health of adult care takers of impaired parents (Hulley, et al., 2006). The findings this particular study are related to the purpose of the study by viewing the data collected in relation to the set parameters of the study which are mental health, subjective stress and effectiveness.

The hypothesis is contrary to the findings in that the mental health of an adult care taker does not deteriorate with pronged care giving. In subjects, the stress levels increased but effectiveness decreased resulting to very poor mental health. To add on this is that, the implications of the research has been discussed in the paper.The answers to the research question show that caretakers need help at the beginning of the care giving since the findings show that initial stages have higher subjective stress levels. At the same time, the depression is decreased with prolonged periods especially when the caregivers are happy that they are able provide care to their elderly parents. They adapt to the situation and start to experience satisfaction for being able to meet the needs of the parent (Saunders, 2006)

Conclusion

The results of this research can be used in future research in various ways as explained here; the use of the wear and tear hypotheses while focusing on other categories of caregivers for example, spouses taking care of impaired spouses, since the study has established that most caregivers adapt and their stress decreases with increased effectiveness. A future research study could be done to show which factors that can cause variability in these care givers. Some of the caretakers may want to put their impaired parents in institutions.

Another thing to be noted is that the research has been consistent and there are no leaps of logic. The paper starts with the statement of the hypothesis thus one understands what the research is all about. After the establishment of the research question, there is the determination of the importance of the research followed by the design of the study while at the same time the outline and study protocol is established (Pan, 2008). To establish the hypothesis of the wear and tear on the longitudinal impact on adult children’s mental health of inter household care giving to impaired elderly parents, subjects are selected that fit the criteria of elderly impaired parent (above 60 years and beyond that require help with more than six personal care activities).

The criteria of the subjects also cover caregivers who are adult children of the elderly impaired and are either widowed or married parent. Sampling is done with the subjects being interviewed together or apart from each other and the researcher making his own observations for the duration of the study. After the gathering of the data the findings are analyzed and tested against the hypothesis which can be either for or against the hypothesis. In this particular research there where findings that were consistent with the hypothesis and others contrary to the hypothesis. These cases, previous works of similar studies are compared with the present findings and from the results of the study; future research questions can be generated.

References

American Psychology Association (2009).Publication Manual of the American Psychological Association. Washington DC: American Psychology Association.

Bradburn, N. (1969). The structure of psychological well-being. Chicago: Aldine Harris, R. A. (2005) Using Sources Effectively. Web.

Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D., & Newman, T. B. (2006). Designing clinical research. New York: Lippincott Williams and Wilkins.

Klein, D., & Hill, R. (1979). Determinants of family problem-solving Effectiveness: Contemporary theories about the family. New York Free press.

Montgomery, R., Stull, D., & Borgatta, E (1985). Measurement and the Analysis of burden. Research on Aging, Vol; 7, 137-15.

Pan, M. L. (2008). Preparing Literature Reviews. Web.

Zarit, S. Reever, K., & Bach-Peterson. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The gerontologist, Vol; 20 649-655

Zung, W. (1965). A self-rating depression scale. Archives of general psychiatry, Vol; 12, 63-70

The issues associated with alcoholism and mental health are among the ones that are the most difficult to cope with, partially due to the social stigma (Noronha, Cui, & Harris, 2014). Experiencing a problem associated with alcoholism and the ensuing mental health problems may become not only exhausting but also embarrassing for many people (Stimmel, 2014). Herein lies the significance of mental health self-support groups, which allow embracing the problem and addressing it accordingly. The mental health self-support group in question became the tool for helping around 100 people manage their alcoholism issues by changing their perception of the issue.

Named Long Beach Early Risers, the group was scheduled to meet every Saturday at 6.30 a.m. on Long Island Beach, in St. John’s Lutheran Church basement. The reason for choosing the identified group was based on the convenience principle – the meetings were held in the vicinity of my house (particularly, it took a 10-minute walk to get to the venue). Furthermore, the accessibility of the group should be mentioned among the primary reasons for me to attend its meetings. Discussing the topic of gratefulness, the participants shed a lot of light on the issue of alcoholism and the associated mental health problems that they either have been suffering from or may develop in the future.

The group was rather big, with a total of 100 participants. Although the attendance rates never actually reached 100%, there were still a lot of people to provide support and share their emotional experiences. Furthermore, there was a notable prevalence of male participants (approximately 70% of the total population). Therefore, there was a threat that the needs of women, who were in the minority (30%), might be overlooked. Nevertheless, all issues were addressed during the group meetings, with every category of the target population experiencing a gradual improvement in their attitude toward the problem. The age also varied greatly among the group members, 25 being the youngest group members and 70 being the oldest ones. Only 10% had a diploma, whereas 80% barely managed to graduate from school. All group members were white Caucasians.

The members of the group seemed to have succeeded in forming a bond with one another. There was a threat that, with the population so big and diverse, creating strong ties will not be a possibility. However, as implausible as the connection was, it, nevertheless, occurred. Sharing their stories and experiences, the participants managed to establish a strong emotional connection with one another.

The leadership issue played an important role in helping the people create a bond. With the active use of transformational and visionary leadership styles, the person in charge of the meetings created an environment in which change was viewed as not only a necessity but also an inevitable process. Thus, the recognition of the problem was the purpose of the group. The function thereof, in its turn, concerned the development of a coping strategy (Stimmel, 2014). Consequently, the 12-steps program meeting can be viewed as an efficient way of promoting change among the target population (Noronha et al., 2014).

Therefore, it can be assumed that the group managed to meet the set goals rather successfully. Every person attending the meeting recognized the significance of changing their lifestyle and attitude toward drinking. Furthermore, the importance of maintaining positive relationships with the family members was addressed successfully.

The identified experience was essential for me as a nurse. It helped gain a better insight into the needs of a person struggling with substance abuse issues. Furthermore, the detrimental effects that alcoholism has on mental health have been explored.

Helping the participants define their alcoholism-related issue and develop the framework that would help them suppress the craving, change their lifestyles, and rebuild relationships with their family members, the 12-step program served as the foundation for changing these people’s lives. Therefore, it can be assumed that the mental health self-support group helped the participants not only recognize their issues but also develop a responsible attitude toward the problem and adders it accordingly.

References

Noronha, A., Cui, C., & Harris, R. A. (2014). Neurobiology of alcohol dependence. New York, NY: Elsevier.

Stimmel, B. (2014). Cultural and sociological aspects of alcoholism and substance abuse. New York, NY: Routledge.

Introduction

This paper outlines a treatment plan for Mr. Pall. Pall is suffering from a mental health condition instigated by the loss of his girlfriend and child. Mr. Pall is a 28-year old male with signs of hallucinations, suicidal tendencies and a strong sense of hopelessness. Pall also shows extreme signs of anxiety and exudes feelings of self-blame. These feelings have developed into visual and auditory hallucinations. However, Pall’s condition is a development of a mental health condition that he had for the past two years. Within this period, Pall unsuccessfully attempted three suicides. Pall has also had a poor history of compliance to medication, and it has been difficult to retain him in one form of employment. Part of this problem emanates from a lack of confidence and a strong sense of suspicion in his actions. This paper outlines a treatment and discharge plan for Pall, but before that, a mental status examination and an identification of Pall’s risk factors are analyzed.

Mental Status Examination

Pall’s mental status examination reveals a strong sense of social disconnect because he stays in bed most of the days without any meaningful social interaction. During the interview, Pall had an unkempt hair and an unsteady gait, which partially occurred from Pall’s inactivity. Pall was also extremely sad and disorganized because he thought very little of himself. He also blamed his girlfriend for his woes. These feelings caused him to have a flat affect, causing him to appear melancholic. Pall’s speech was however unpressurized, though it sounded a little hesitant and slow. Nonetheless, his speech was well articulated.

Pall’s thought analysis process revealed that he bore signs of suicidal thoughts, though it was difficult to identify the presence of a suicidal plot. It was also difficult to point out a strong sense of tangential or circumstantial speech in his auditory analysis because his arguments were well articulated. His thought process was also well organized and concrete because there was an absence of confabulation or flight of ideas. For instance, Pall was able to give short and informed answers during the interview.

However, amid this composure, Pall showed signs of perceptual disturbance, which bore signs of illusions and hallucinations. From this background, Pall seemed to have an impersonal sense of life. This observation couples with a strong sense of derealization. Illusions were a little difficult to detect but auditory and visual hallucinations were hard to ignore. For instance, during the interview, Pall occasionally moved his eyes towards the door as if to listen to some imaginary person who was out of the room. His impulse control was also weak because he failed to control his cries as he narrated about his son’s death. His sense of concentration was also weak because he could not respond to all questions, and when he tried to, he lost track of them. He could not count back his ideas. However, Pall still did not show signs of memory impairment though he showed a poor sense of judgment and insight into his depressive state. His poor sense of judgment showed from his failure to decide which clothes to wear. His mental analysis revealed several risk factors discussed below.

Risk Factors

Pall runs several risks if his mental status is not treated. Azue (2008) explains that, mental health illnesses may cause disabilities if they remain unchecked for a long time. However, this effect is nothing compared to the reduction in quality of life that a patient experiences. For instance, Pall runs the risk of poorly feeding himself because he already experiences episodes of skipping his medication. Pall also runs the risk of poor self-care and thought disturbances that have lead to increased episodes of hallucinations. These effects are part of the emotional, behavioral and physical health problems cited by Bosmans (2008) as part of the complications brought about by mental health problems. Comprehensively, Pall runs the risk of suffering any of the above risk factors though he also runs the risk of inflicting harm on himself (because the mental status examination revealed that he had suicidal ideas). These problems highlight the risk of suicide.

Nursing Goals

Butler (2008) explains that, the nursing goals of different mental health treatment plans often depend on the nature of the patient’s condition. However, there is a strong emphasis on the clear identification and ascertainment of nursing outcomes. Moreover, the nursing goals should also be easily identifiable by the patients (Elder, 2009, p. 12). The goals should also be realistic, and ideally, they need to be understood in behavioral terms (Butler, 2008). In the context of this study, the ultimate goal of the nursing care intervention is to influence Pall’s behavior to reflect positive health outcomes. Primarily, the main short-term goals of the nursing care plan will be to get Pall out of bed and participate in normal day-to-day activities. The second goal of the nursing care plan will be to see Pall sleep well at night. Lastly, the design of the nursing care plan intends to help Pall receive good nutrition and gain weight. These three nursing goals expect to materialize within one month. However, they depend on the effective implementation of the treatment plan.

Treatment Plan

Pall’s treatment plan derives its origin from the use somatic therapies to treat mental instability. The justification for this methodology is the strong association noted among mental disorders, suicide supports, and antidepressant use. However, since Pall is already on trycylic antidepressants such as Pamelor, Risperidone and Diazepam, this treatment plan will be sensitive to these medications. The treatment steps outlined in this plan work in sequential phases, as explained below.

First, it would be important to emphasize Pall’s physical self-care because it this has a significant bearing on his mental state (McGorry, 2005, p. 120). Here, issues such as Pall’s nutritional program, sleep plan, and exercise need addressing to ensure he has a stable mental status (Woolsey, 2008). Afterwards, Pall should undergo a long-term exposure to atypical antipsychotics because they have fewer side effects, when compared to typical antipsychotics. Moreover, since Pall’s mental condition is not at an advanced stage, the atypical antipsychotics will suit his treatment plan because of their minimal withdrawal symptoms. In addition, considering Pall is already under some atypical medications (such as risperidone); it is advisable to continue with the atypical medications to avoid mixed courses of treatment (Woolsey, 2008).

The first course of treatment is lithium salts, which acts as a maintenance treatment method to reduce the patient’s probability of attempting suicide (Regier, 1993, p. 85). The second drug in the treatment plan is Clozapine because it is a complementary treatment drug identified to reduce the probability of suicide (McGorry, 2005, p. 120). In addition, since Pall exhibits signs of extreme anxiety, his diazepam treatment will continue. The main aim of administering this drug is to ensure Pall remains calm. To guarantee the efficacy of this treatment method, Pall will take benzodiazepines drug because it reduces suicidal attempts as well (McGorry, 2005, p. 120). Though this treatment method is common for patients with borderline personalities, a high level of efficacy is expected.

Since Pall exhibits signs of inactivity, it will be important to introduce a structured and predictable program for undertaking his day-to-day activities (Osbourn, 2001, p. 329). Structure and predictability are crucial in motivating Pall to get off the bed and participate in productive activities. Furthermore, since Pall exhibits signs of extreme anxiety, it will be important to reduce the level of noise (or any environmental disturbances) in his surroundings. Medical studies support this proposal by explaining that, noisy environments tend to aggravate patients with mental instability (Osbourn, 2001, p. 329). This action would go a long way towards ensuring Pall remains calm. Nonetheless, this measure complements the continuation of Pamelor medications because the drug treats depression and mood disorders as well.

In the same spirit, it is important to give extra processing time to Pall (regarding his daily tasks). This action is crucial because Pall needs no pressure when undertaking his daily tasks, or else, he may crack under the pressure of the treatment plan and be excessively aggressive.

Whenever possible, it is crucial to expose Pall to natural lighting and not artificial lighting. Artificial lighting (or too much light) can make Pall’s anxiety levels to escalate, thereby prompting him to be aggressive or resistant to the nursing care plan. Pall should also avoid crowds because crowds aggravate mentally instable people. A calm and peaceful environment would be more appropriate for the patient as he develops better control of his impulses.

However, Pall should be aware about the consequences of his suicidal tendencies through role-playing (Pincus, 2005, p. 271). Due to this reason, Pall’s risperidone treatment continues under the new treatment plan because the drug reduces a patient’s chances of self-injury (Pincus, 2005, p. 271). Pall’s spiritual welfare also needs consideration at this point of the treatment plan because enrolling him in spiritual discussions where he is able to explore his spiritual side will go a long way to ensure he remains emotionally stable. Here, issues such as forgiveness, submission to a higher authority and similar issues need emphasizing. This spiritual framework aims to enlightening Pall about the repercussions of his suicidal behaviors. It is also at this point of the treatment plan where family and community support should be included in the treatment plan. The family and community elements of Pall’s treatment plan are support groups to help motivate him. Close family members and colleagues should also be encouraged to be proactive in Pall’s life to encourage him to be upbeat about his life. Positive self-perception and self-talk should be hereby encouraged to make Pall feel better about himself. This initiative will also minimize his probability of committing suicide. Through this intervention, Pall will feel cared for, and presumably, he will understand that his absence (death) will affect other people as well. Nonetheless, if these interventions fail at the implementation stage, Pall’s aggressive behavior may worsen, and he may cause harm or injury to himself or other people. His chances of breaking the law, killing, destroying property and similar vices are also high (Institute of Medicine, 2006, p. 2).

Discharge Plan

Pall’s treatment plan includes several aspects of his lifestyle after he leaves the mental health institution. Different aspects of Pall’s discharge plan that he cannot arrange for himself constitutes the majority sections of the discharge plan. For instance, Pall’s place of residence (after discharge) constitutes the provision for a stable housing environment. Preferably, it would be appropriate for Pall to reside in a place where there are people around him who love and care for him (Olfson, 2009, p. 848). A transportation plan arrangement constitutes part of the discharge plan if Pall lacks a reliable mode of transport to his residence. Thirdly, an aftercare referral program will be arranged for Pall after evaluating if he needs any clinical support after discharge. Also, the nearest clinical institution where Pall can be admitted will also be identified. Lastly, any resources (like medications, clothing and the likes) required upon discharge will also be outlined (Spann, 2004, p. 1). If possible, a job placement should be identified where pall can be accommodated and comfortably adapt to his new status.

Application of Mental health Act in Victoria, Australia 1986

The 1986 Victorian mental health act will be applicable in Pall’s mental health treatment plan because it will outline the boundaries and limitations of the entire treatment plan (Elder, 2009). Emphasis lies on the rights and requirements of the patient as well as the limits of the nursing care plan. Instances where the nursing care plan may interfere with the privacy, dignity or self-respect of the patient also outlines the mental health act requirements to ensure the treatment plan is implemented in the least intrusive manner and in the least prohibitive environment (Burke, 2000, p. 813). However, the1986 Victorian mental health act will be most applicable if Pall’s admission to a mental health institution is involuntary. The above dynamics of the 1986 mental health act will therefore be applicable in such a case.

Conclusion

Pall’s mental status examination reveals that his condition is not at an advanced stage. In this regard, timely nursing care is required to prevent the occurrence of severe mental instability, which may consequently lead to a long-term health illness (McGorry, 2008, p. 337). However, the importance of support groups (in the treatment plan) needs a lot of emphasis because mental patients need such supportive frameworks for long-term recovery. However, if the above steps outline the nursing care process, the desired nursing outcomes will be realized.

References

Azue, M. (2008). The Potential to Reduce Mental Health Disparities Through the Comprehensive Community Mental Health Services for Children and Their Families Program. J Behav Health Serv Res, 35(3), 253–264.

Bosmans, J. (2008). Are Psychological Treatments for Depression in Primary Care Cost-Effective? Journal of Mental Health Policy and Economics, 11(1), 3–15.

Burke, J. (2000). The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients. Social Science and Medicine, 50(6), 813–828.

Butler, M. (2008). Integration of Mental Health/Substance Abuse and Primary Care. Rockville: Agency for Healthcare Research and Quality.

Elder, R. (2009). Psychiatric and Mental Health Nursing. Sydney: Elsevier.

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McGorry, P. (2005). International clinical practice guidelines for early psychosis. The British Journal of Psychiatry, 187, 120–124.

McGorry, P. (2008). Is Early Intervention in the Major Psychotic Disorders Justified? Yes. BMJ, 337, 695.

Olfson, M. (2009). National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry, 66(8), 848–856.

Osbourn, D. (2001). The Poor Physical Health of People with Mental Illness. Western J Med, 175(5), 329–332.

Pincus, H. (2005). Depression in Primary Care: Bringing Behavioral Health Care into the Mainstream. Health Affairs, 24(1), 271–276.

Regier, D. (1993). The De Facto US Mental and Addictive Disorders System. Arch Gen Psychiatry, 50(2), 85–94.

Spann, S. (2004). Report on Financing the New Model of Family Medicine. Annals of Family Medicine, 2, 1-21.

Woolsey, L. (2008). Excerpts from: Transitioning Youth With Mental Health Needs to Meaningful Employment and Independent Living. Journal for Vocational Special Needs Education, 31(1–3), 9–18.

The human psyche is a vulnerable system: the incredibly rapid rate of modern life often causes anxiety and stress, leading to various mental disorders. The emergence and prevalence of COVID-19 only worsen the situation: a feeling of isolation, fear for one’s life and health of relatives and friends, and risk of losing job and income weaken people’s nervous system. Therefore, it is possible to identify prevention and treatment of neurological and psychological ailments that negatively impact people’s lives as a current healthcare need that has to be met.

Mental Disorders As an Urgent Problem

Mental disorders affect people not depending on their age, gender, or race. Although in several cases, they can be explained by posttraumatic stress or genetics, ailments often choose their victims by chance, selecting the most emotional people. To date, mental disorders are one of the primary burdens of populations: “the prevalence of clinically significant levels of mental disorders increased from 18.9 to 27.3%” (Winkler et al., 2020, p. 1). They are “associated with severe personal suffering by patients and their relatives, considerable transgenerational transmission, huge economic costs, and increased levels of physical morbidity and mortality” (Cuijpers, 2019, p. 276). Since depression, obsessive-compulsive disorder, bipolar disorder, mania, and generalized anxiety disorder are more vital than ever, they have become an urgent problem in the healthcare sector. Millions of people worldwide try to pretend that they live full lives, in fact, daily suffering from anxiety, insomnia, and stress. Therefore, mental disorders are a pretty severe problem in the modern world.

At the height of the pandemic, many people suffer from symptoms of depression. As studies show, “the prevalence of both major depressive disorder and suicide risk tripled and current anxiety disorders almost doubled” (Winkler et al., 2020, p. 1). Patients with COVID-19 are at significant risk to obtain mental disorders as a complication of this virus. In addition, even those who have not been ill complain about anxiety, insomnia, melancholia, and constant fear. The oppressive changes always negatively affect a person’s psyche: COVID-19 has become one of the most crucial changes for the worse. People are forced to replace face-to-face interaction with text messages and video chats and refuse trips, visits to the cinema, walks, and economic stability. Thus, the pandemic is one more reason why mental disorders are so prevalent in modern society.

Mental Disorder’s Impact on Society

The mentally exhausted society cannot contribute to the state’s prosperity and be a community of socially responsible citizens striving for self-development and self-improvement. People with damaged psyches are feared and nervous, which negatively affects the quality of their lives. If patients’ mental problems are not solved, they can harm different age groups (Cuijpers, 2019). For instance, pupils and students with psychological ailments can face challenges with studying and interaction with coevals. Adults’ disorders can lead to family disruption, business collapse, suicidal thoughts, and even danger to others. Since those who have mental illness cannot make an appropriate contribution to society’s life, the community needs mentally healthy people to be a powerful element of the state.

APN and Its Role

Advance practicing nursing (APN) can play a significant role in the psychiatric-mental health care sector. The specialists of this sphere form a group of psychiatric mental health nurse practitioners (PMHNP) who can strengthen the human psyche and solve various mental problems of society (Horowitz & Posmontier, 2020). Although “the original PMHCNS role centered on forming a therapeutic alliance and providing psychotherapy services, its current focus shifted to a medical model with an emphasis on prescribing medications” (Horowitz & Posmontier, 2020, p. 351). Despite the shortage of high-quality psychiatrists, well-educated and licensed nurses are able to diagnose and treat diverse ailments. Due to the license, PMH APNs can prescribe medicine and set treatment methods. They also work according to a patient-centered approach that considers the patient’s needs. Thus, APNs’ impact in the psychological healthcare sphere is crucial.

Although it seems that absolute extermination of mental disorders is impossible, APNs’ work contributes to a successful search of the potential solutions to this problem and strengthens the population’s psyche. According to modern studies, “now is the time to embrace expanded models of education that endorse thoughtful integration of psychotherapy with medication treatment/management, informatics, and organizational leadership” (Horowitz & Posmontier, 2020, p. 354). APNs supply psychiatric evaluations, conduct psychotherapy sessions, prescribe drugs and determine the scheme of healing that can include medicine and elements of cognitive-behavior therapy. Thus, due to APNs, more people can get professional medical help even despite the lack of psychiatrists.

Conclusion

To date, the rapid rate of life, endless flow of information, and the pandemic make mental healthcare need one of the most urgent and requiring solutions. Psychological disorders negatively affect society’s existence and complicate the lives of millions of people worldwide. Advance practicing nursing’s impact on this problem is positive and quite powerful: APNs strive to help their patients fight against their ailments. Therefore, despite the disorders’ prevalence, it would be wrong to consider that they are absolutely unbeatable.

References

Cuijpers, P. (2019). Targets and outcomes of psychotherapies for mental disorders: An overview. World Psychiatry, 18(3), 276-285. Web.

Horowitz, J. A., & Posmontier, B. (2020). A call to action: Reclaiming our PMH APN heritage. Archives of Psychiatric Nursing, 34(5), 351-354.

Winkler, P., Formanek, T., Mlada, K., Kagstrom, A., Mohrova, Z., Mohr, P., & Csemy, L. (2020). Increase in prevalence of current mental disorders in the context of COVID-19: Analysis of repeated nationwide cross-sectional surveys. Epidemiology and Psychiatric Sciences, 29, E173. Web.

• Connected to suicide intentions (World Health Organization, 2017).
• Connected to non-lethal self-harm (WHO, 2017).
• Affects general psychological well-being (WHO, 2017).

Adolescent mental health constitutes a considerable public health issue recognized, among other things, as one of the 2020 Topics and Objectives on the Healthy People. Its importance is undeniable: according to the World Health Organization, it connects directly to suicide intentions as well as non-lethal self-harm. Apart from these, it also correlates to bullying, substance, abuse, and other issues faced by the youth on a regular basis. As a result, the general level of psychological well-being among adolescents is inseparable from the mental health issues encountered by this population group, and this problem needs to be addressed both promptly and effectively.

Focus Population: Why Adolescents

In the 2010s, developed countries face:

• Sharp increase in adolescent mental conditions (Gunnell et al., 2018).
• Sharp increase in adolescent self-harm (Gunnell et al., 2018).

While all population groups face mental health problems of their own, there are grounds to focus on adolescents specifically. To begin with, the World Health Organization stresses that adolescent mental health is often overlooked among other health risks faced by the youth worldwide. Apart from that, there are issues specific to developed countries. Throughout the 2010s, the first-world countries have witnessed a sharp increase in the number of mental conditions reported by adolescents. Apart from that, the cases of non-lethal self-harm, which are indicative of mental health issues, have become more frequent as well. Considering these developments, adolescent mental health deserves thorough attention of scholars and practitioners alike.

Racial Disparities

Black and Hispanic adolescents face:

• Higher degrees of polyvictimization (López et al., 2016).
• Slightly higher degrees of PTSD (López et al., 2016).

The negative effects of mental health issues among adolescents are not distributed evenly – on the contrary, there are notable disparities easily established with the use of several criteria. Race and ethnicity occupy a prominent place among these and account for the uneven distribution of mental health conditions among adolescents to a great degree. For instance, Black and Hispanic adolescents face much higher degrees of polyvictimization – that is, having experienced multiple victimizations – than their White counterparts. This tendency manifest in higher rates of several mental disorders – for example, research confirms that Black and Hispanic youths experience PTSD more often than the Whites.

Disparities by Gender and Sexuality

Sexual minority adolescents demonstrate:

• Significantly higher risks of suicide (Raifman et al., 2020).
• Slightly higher risks of anxiety (Durwood et al., 2017).

Race and ethnicity are not the only criteria that account for disparities in the distribution of mental health problems among adolescents. Gender and sexual orientation also play a notable role, although it is slightly less significant as that of ethnicity and race. There is evidence that sexual minority adolescents face notably higher risks of suicide. The risks of anxiety are also higher in this group, if only marginally so. The same applies to transgender adolescents whose gender identity does not correspond to their biological sex. Thus, the disparities by gender and sexuality are slightly less pronounced than those by ethnicity and race but are still notable and significant.

WHO and Adolescent Mental Health

Global Accelerated Action for the Health of Adolescents initiative offers:

• National programming frameworks for adolescent mental health (World Health Organization, 2017).
• Evidence-based approaches to adolescent mental health (World Health Organization, 2017).

The importance of adolescent mental health problems is further illustrated by the fact that the World Health Organization focuses on this topic. In its Global Accelerated Action for the Health of Adolescents initiative, the WHO recognizes mental health issues as an essential yet often overlooked part of overall health risks faced by the youth and urges to address them. In order to further this vision, the WHO develops and introduces national programming frameworks for adolescent mental health designed to suit different countries and conditions. Additionally, it outlines a broad range of evidence-based approaches applicable to addressing adolescent mental health.

Evidenced-Based Approaches

• Intervention research knowledge management (Rith-Najarian et al., 2016).
• Collaborative design (Rith-Najarian et al., 2016).
• Developmentally sensitive training and supervision (Rith-Najarian et al., 2016).

There are several evidence-based approaches suited to adolescent mental health issues. One example is the intervention research knowledge management. Its importance lies in the fact that the body of knowledge and the number of possible solutions regarding adolescent mental health increase constantly, and intervention research knowledge management helps to standardize information for the practitioners’ benefit. Collaborative design is another evidence-based approach that focuses on bringing the right individuals together to address a particular case and design the most effective intervention under given conditions. Finally, there is also developmentally sensitive training and supervision that is designed to help health professionals in identifying and addressing mental health issues among adolescents as they emerge.

Evidenced-Based Approaches in Practice

Intervention Research Knowledge Management → Distillation and Matching Model (DMM).

Collaborative design → Interdisciplinary teams.

Developmentally sensitive training and supervision → Modular training.

Each of the three evidence-based approaches listed above has its own implications for practice. Intervention research knowledge management manifests in producing Distillation and Matching Models or DMMs. Unlike traditional knowledge synthesis approaches, such as literature reviews or meta-analysis, DMMs have a specific focus on identifying practice elements and establishing their frequency in successful programs. Collaborative design logically leads to establishing interdisciplinary teams of health professionals uniting their varied qualifications for achieving a common goal. As for the developmentally sensitive training and supervision, its practical application is modular training, as opposed to unidirectional and standardized programs. The modular structure of training would allow producing health professionals with a more diverse set of skills for addressing adolescent mental health problems.

Effects on Racial Disparities In Adolescent Mental Health

• Better analysis of adolescent mental health with regards to race and ethnicity (Rith-Najarian et al., 2016).
• Health professionals better equipped to address existing disparities (Rith-Najarian et al., 2016).

At least two of the evidence-based approaches listed above and their practical applications have direct importance for addressing racial disparities in adolescent mental health. Intervention research knowledge management and the DMMs it produces represent information in a highly standardized form. As a result, it helps to identify intervention better suited to address mental health issues among different groups of adolescents, including those distinguished by racial criteria. As for the developmentally sensitive training and supervision, modular training would result in more flexible training procedures. It would allow trainees to stress different practice elements, including those that promote understanding and addressing racial disparities in adolescent mental health.

Effects on Disparities by Gender and Sexuality In Adolescent Mental Health

• Better analysis of adolescent mental health with regards to gender and sexuality (Rith-Najarian et al., 2016).
• Health professionals better equipped to address existing disparities (Rith-Najarian et al., 2016).

The application of the evidence-based approaches to disparities by gender in sexuality is quite similar to their importance for addressing racial disparities. This similarity, however, is merely evidence of the universal applicability of said approaches to a broad set of disparities that exist within the topic. As in the latter case, the proper use of DMMs would allow identifying practice elements and interventions that are more and less effective in addressing different groups of youth. This knowledge would be a necessary first step to mitigating sexuality and gender disparities in adolescent mental health. Modular training would allow an emphasis on implementing this knowledge for the trainees most interested in the subject.

Education Proposal: Mental Health Trainee Facilitation of Sibling Support Groups

• Participants: mental health trainees in psychiatry, psychology, and social work.
• Essence: participants receive training as facilitators of sibling support groups in family-centered care.
• Goal: better prepared and motivated healthcare professionals (Damodaran et al., 2019).

Health education on adolescent mental health could benefit significantly from the mental health trainee facilitation of sibling support groups. It would involve mental health trainees from such fields as psychiatry, psychology, and social work. As suggested by the name, it would give the participants an opportunity to act as facilitators in sibling support groups for adolescents with mental health problems. Due to a specific focus on sibling support, this proposal would be a perfect fit for the family-centered health promotion. If properly implemented, it could affect the outcomes of adolescents with mental health issues and the education of health professionals in their respective fields at the same time.

Connection to Evidence-Based Approaches

The proposal is firmly based on the evidence-based approaches listed above. The program of facilitating sibling support groups for adolescents with mental health problems would naturally fit as a module in the education of mental health professionals. As a consequence, it corresponds perfectly to the modular training, which is, in turn, an extension of the developmentally sensitive training and supervision. As mentioned above, the proposal encompasses mental health trainees from the fields of psychiatry, psychology, and social work alike. This would bring the individuals with different perspectives on adolescent mental health and, by extension, facilitate the building of interdisciplinary teams. As mentioned above, such teams are a natural manifestation of such an evidence-based approach as collaborative design.

Results for Family-Based Care

• Better skills in family-centered care (Damodaran et al., 2019).
• Greater confidence in family-centered care (Damodaran et al., 2019).
• Stronger intention to practice family-centered care (Damodaran et al., 2019).

Apart from being rooted in evidence-based approaches and the practices that arise from them, the proposal is also beneficial for promoting family-based care for adolescents with mental health problems. Existing research suggests that the trainees who underwent a similar program, albeit with no emphasis on adolescent mental health specifically, demonstrate better skills in family-centered care. Apart from the objective increase in skills, they also showed greater subjective confidence as family-based care practitioners. Finally, the trainees who underwent the program expressed greater intention to practice family-centered care in their future careers as compared to their counterparts who did not. Thus, the benefits of the proposal for promoting family-based care for adolescents with mental health problems is evident.

Interdisciplinary Health Professional: Registered Nurse

• Role: provide education and counseling, refer patients to other healthcare practitioners.
• Significance: influence the patient’s first steps after contacting the healthcare system.

One type of interdisciplinary health professionals that could benefit from such a proposal is, obviously enough, registered nurses or RNs. Their role is multifold, and, among other things, they are responsible for providing education and counseling as well as referring patients to other healthcare practitioners. Doing so efficiently when encountering a problem related to adolescent mental health requires thorough knowledge and understanding of evidence-based practices used to address such issues in different youth groups. Since RNs often influence the patient’s first steps after contacting the healthcare system, their competence and qualification potentially impact the entire course of the following treatment. Therefore, RNs are essential for promoting mental health among adolescents, and greater awareness of adolescent mental health problems is sure to benefit them as interdisciplinary health professionals.

Interdisciplinary Health Professional: Social Worker

• Role: provide qualified assistance for groups and individuals facing specific issues.
• Significance: ensure effective labor division.

Another group of interdisciplinary health professionals that could improve their competency by facilitating sibling support groups for adolescents with mental health issues is social workers. Unlike registered nurses, who need a broad competency to perform their functions with the utmost efficiency, social workers concentrate on providing qualified assistance for groups and individuals facing specific issues. The significance of social workers as interdisciplinary health professionals lies in the fact that their efforts allow a more efficient labor division in an institution by relieving other professionals from the duties they would have to perform otherwise. Thus, proper training is essential for social workers, including those helping youths with mental health, and this proposal is likely to leave trainees better prepared to address corresponding issues and promote mental health among adolescents.

Resource #1 (national): American Academy of Pediatrics

• Guidance on screening for behavioral and emotional problems (Weitzman & Wegner, 2015).
• Specific emphasis on adolescent mental health (Weitzman & Wegner, 2015).

When addressing the issues related to adolescent mental health, a health professional may rely on a number of national resources. One such resource is the American Academy of Pediatrics or, more specifically, its guidelines for screening children and adolescents for behavioral and emotional problems. The obvious advantage of this resource is its focus on children and adolescents and practices that help a health professional to address mental health issues among the youths specifically. Since most mental disorders originate in adolescence, screening for behavioral and emotional problems in this age acquires twofold importance. Proper detection does not merely improve the outcomes for adolescents, but potentially lowers the rates of mental disorders later in life, and the guideline from the American Academy of Pediatrics is a useful resource for that.

Resource #2 (national): National Institute of Mental Health

• Wide array of materials on mental health disorders (National Institute of Mental Health, n.d.).
• Broad range of mental health disorders covered (National Institute of Mental Health, n.d.).

Another resource that can be utilized by a patient to promote adolescent mental health is the National Institute of Mental Health. It is one of the leading medical institutions studying mental health issues, including those faced by the youth, in the United States. The National Institute of Mental Health offers a wide array of materials useful for a patient. The range of the mental disorders covered in these materials is correspondingly broad and provides a wealth of relevant and up-to-date information. More importantly still, the materials cover their respective issues in a user-friendly style and are accessible through the Internet, making them a suitable option for adolescent patients.

References

Damodaran, S., Huttlin, E., Lauer, E., & Rubin, E. (2019). Mental health trainee facilitation of sibling support groups: Understanding its influence on views and skills of family-centered care. Academic Psychiatry. Web.

Durwood. L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially-transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2) 116-123.

Gunnell, D., Kidger, J., & Elvidge, H. (2018). The adolescent mental health in crisis. British Medical Journal, 361. Web.

López, C. M., Andrews, A. R., III, Chisolm, A. M., de Arellano, M. A., Saunders, B., & Kilpatrick, D. G. (2017). Racial/ethnic differences in trauma exposure and mental health disorders in adolescents. Cultural Diversity and Ethnic Minority Psychology, 23(3), 382-387.

National Institute of Mental Health. (N.d). Brochures and factsheets. Web.

Raifman, J., Charlton, B. M., Arrington-Sanders, R., Chan, P. A., Rusley, J., Mayer, K. H., Stein, M. D., Austin, S. B., & McConnell, M. (2020). Sexual orientation nand suicide attempts among US adolescents: 2009-2017.Pediatrics, e20191658. Web.

Rith-Najarian, L. R., Daleiden, E. L., Chorpita, B. F. (2016). Evidence-based decision making in youth mental health prevention. American Journal of Preventive Medicine, 51(4s2), s132-s139.

Weitzman, C., & Wegner, L. (2015). Promoting optimal development: Screening for behavioral and emotional problems. Pediatrics, 135(2), 384-95.

World Health Organization (2017). Global Accelerated Action for the Health of Adolescents (AA-HA!). World Health Organization.