While the workplaces around the country are becoming widely diverse, the workforce in the United States nursing setting has historically been, and remained, predominantly white and female (Villarruel et al., 2015). Researchers advocating improved environments in the nursing setting call for more racial, ethnic, and gender diversity among nurses as one of the tools to facilitate care quality improvement and reduce disparities (Togioka et al., 2022). Even though growth is positive, its rate is not enough to reach the needed diversity indicators.
Significance
The problem of the lack of diversity in the nursing profession is significant because the general population has diversified immensely. While the proportion of nurses from racial and ethnic minority groups has increased in the recent two to three decades, the growth has been only from 15% to 20%, while the percentage of men increased from 8.7% to 10.7% (Villarruel et al., 2015). In nursing, diversity is critical because of the opportunity to build close relationships between nurses and patients within the sensitive context of care being provided (Maryville University, 2022). A nursing workforce that reflects the general population strengthens healthcare through the provision of culturally competent and quality healthcare.
Approach
The topic is likely to be approached from the perspective of barriers that prevent individuals from diverse backgrounds from entering the nursing workforce and becoming successful professionals in the field. It is necessary to determine whether the limitations in access to nursing education and training, as well as discriminatory environments, result in the absence of diversity in the nursing workforce. Besides, solutions to the problem will be provided; for example, the development of diversity initiatives to engage more diverse practitioners in the nursing field.
Topic #2: Mental Health Among Nurses Since COVID-19
Background
The COVID-19 pandemic has put a significant burden on healthcare providers who care for patients on a daily basis. Nurses have experienced negative consequences from the pandemic in the form of increased daily workloads, negative patient outcomes associated with the disease, as well as decreased access to social support systems (Riedel et al., 2021). Research has shown that the mental health of nurses has deteriorated significantly since the pandemic, with professionals reporting developing anxiety, depression, PTSD, as well as other mental health disorders (Riedel et al., 2021). The issue requires addressing because adverse mental health among nurses affects the quality of care and, subsequently, patient outcomes.
Significance
The significance of the issue to the nursing profession is linked to the fact that such mental health problems as PTSS, PTSD, and other mental health disorders make nurses less effective in completing their daily tasks within the care setting. As a result of COVID-19, nurses have reported having an increase prevalence of anxiety (23%), depression (28%), and insomnia (39%) (Pappa et al., 2021). Poor conditions of work in which nurses have found themselves during the pandemic and exposure to the disease on a daily basis have had a clear negative impact on providers’ mental health.
Approach
The topic will be approached from the perspective of finding solutions and recommending best practices to alleviate the burden of mental health challenges among nurses. Besides, it is important to look at preventive measures that could have reduced the adverse mental health effects during strenuous practice situations such as the pandemic. More considerations of mentally preparing nurses for emergencies such as pandemics and endemics are necessary, such as training and education for equipping professionals with more resources on handling stressful situations.
Topic #3: Implications of the Nursing Shortage
Background
The nursing profession continues to face shortages because of the lack of potential educators, high rates of turnover, as well as inequitable distribution of the workforce. The lack of nurses at facilities has been linked to such factors as the aging population, which requires more care, the aging workforce, nurses’ burnout, the lack of career growth, issues with the work-life balance, as well as violence in the healthcare setting (Haddad et al., 2022). The implications of shortages of nurses include a greater number of care errors, as well as higher rates of patient morbidity and mortality.
Significance
The issue bears significance to the nursing profession because, in settings with high patient-to-nurse ratios, professionals experience burnout, work dissatisfaction, and have higher failure-to-rescue rates compared to well-staffed settings (Haddad et al., 2022). The effects of the shortage of nursing professionals lead to long-term outcomes, such as the overall decrease in patient care quality, the need to pay “crisis” payments to nurses that work during understaffed shifts, and higher rates of mortality.
Approach
The topic will be approached from the perspective of recommending solutions to the problem of nurse shortages at healthcare facilities, in addition to discovering the implications of understaffing for nurses and the population for which they care. It is essential to develop a framework of solutions that could help address the challenge so that the quality of care improves and the general population does not face persistent public health challenges due to understaffing.
References
Haddad, L. M, Annamaraju, P., & Toney-Butler, T. J. (2022) Nursing shortage. StatPearls Publishing. Web.
Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2021). Corrigendum to “Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.” Brain, Behavior, and Immunity, 92, 247.
The COVID-19 pandemic presented urgent challenges to each aspect of the world, revealing the existing issues in the systems. The sector influenced the most by this pandemic is undoubtedly healthcare. The governments focused their response on the physical health of their citizens and containing the spread of the virus. However, mental health remained mostly unaddressed during the first waves of the disease (McCartan et al., 2021). Isolation and other phycological stress triggers exacerbated existing mental issues for many people (Kathirvel, 2020). Dealing with these issues is still difficult for most countries, considering varying mental health stigma levels (Lange, 2021). Moreover, the pandemic revealed a lack of funding and established mental healthcare structures. Therefore, for an effective action plan, addressing these fundamental issues and public perception is crucial. This proposal will limit the patient pool to adults suffering from mental health complications due to prolonged isolation to narrow the broad scope of the issue.
There are numerous suggestions for improved mental healthcare outcomes on the fundamental level. According to Lestari and Setyawan (2021), these foundational issues in healthcare can be separated into five categories, presenting five layers of society and ways to manage the solutions on each level. The first three categories relate to the type of patients needing help, including individuals, the elderly, and children (Lestari and Setyawan, 2021). For this analysis, only the policy and action recommendations for individuals or adults, in this case, will be considered. The solutions outlined by Lestari and Setyawan (2021) include hotlines, emergency services, online courses, and counseling. These objectives can only be properly accomplished on the governmental level with increased funding and reforms to guarantee the desired health outcomes.
Hospitals and other healthcare providers can also rearrange the use of their existing resources to maximize their effectiveness and provide more essential services to the patients if possible. Moreover, the public and medical professionals should be united in their goal of raising awareness of this issue to bring the attention of the government and medical organizations. In other words, the first step of the action plan is to find or establish the resources for the patients.
The next step of the action plan is to manage these resources efficiently. According to Lestari and Setyawan (2021), the following layer is healthcare workers. In particular, the role of general practitioners (GP) and nurses is important for this step. They need to be able to not only be aware of the issue but to intervene effectively and educate the public on the problem and existing solutions and resources. Therefore, according to Turabian (2020), the first step for healthcare professionals is to assess the patient’s situation in the context of their mental health struggles and isolation effects. In other words, professionals need to know about the pandemic, its effects, and other background factors. They can identify the risks and maladaptive behaviors more accurately and consequentially be able to provide care for these patients. A contingency plan for the crisis intervention based on the monitoring mentioned above is crucial for saving patients’ lives. Thus, the measures, including phycological monitoring of the at-risk populations, can be implemented by GPs and nurses.
Moreover, up-to-date knowledge allows them to educate the patients and the public on mental health and available resources. For at-risk patients, timely information can save their lives and improve mental health outcomes. One of the more general education efforts is bibliotherapy, suggested by Turabian (2020). In other words, medical staff and organizations can provide the public with free copies of books on the subject with possible commentary and reading guides. Some healthcare workers and companies took their educational content to social media to achieve the same awareness goals. It can be even more effective as social media is not only the most popular medium of information among adults recently but contains the most inaccurate data concerning health. Thus, medical professionals can share accurate information on the issue, possible solutions, resources, and prevention measures or healthy activities in isolation.
The solutions can also include a more personalized approach, including telecare. Telecare is an essential tool for GPs to administer care in the condition of social distancing and isolation. The GPs can also engage in the closer and more personal monitoring of the patients for maladaptive behavior and potential risks. Moreover, they can directly educate the patient and recommend more customized measures for recovery while recording the progress and effects of the changes. It leads to the necessary and basic counseling procedure, a follow-up, which is especially important during these times of increased mental health issues.
Overall, an effective action plan involves every part of society: from the healthcare workers to the public. Thus, every stakeholder should work together for the betterment of the mental health situation. The first step is establishing resources and structures for the working healthcare system. The second step is managing these resources to deliver care and accurate information to the patients, ranging from general solutions to more personalized ones. It includes monitoring the situation, providing the data and recommendations, administering cirisis intervention based on the monitoring results, and more personalized care, including telecare.
Interprofessional practice is a collaborative process that pulls together medical professionals from various fields with the stated aim of helping improve the health outcomes of a particular patient. To be effective interprofessional practice must involve all stakeholders including government agencies for funding, healthcare associations, and healthcare regulatory systems (Golom, & Schreck, 2018).
Discussion
A prerequisite for any collaboration remains that healthcare professionals must be enough to cater to everyone (Reeves, et al, 2018). A collaboration between medical doctors, therapists, nurses, and pharmacists to implement a personalized plan of care to improve the health outcomes of a patient is an example of interprofessional practice, Within the interprofessional practice, mental health nurses complement the efforts of everyone involved.
Interprofessional practice collaboration has advantages for patients, mental health professionals, healthcare systems, and healthcare organizations (Dahl, & Crawford, 2018). Efficient collaboration among mental health professionals leads to multiple benefits. Some of these benefits include reduced clinical errors, improved patients’ health status, and enhanced quality of care that ultimately lead to increased patient satisfaction (Reeves, et al., 2017). Collaboration also increases work motivation and satisfaction while reducing underlying tensions and promoting teamwork in problem-solving.
Conclusion
Collaboration is also known to reduce staff turnover and promote the creation of a conducive work environment. There are also indications that collaboration could lead to reduced healthcare costs as healthcare organizations improve their service quality and efficiency due to collaboration.
References
Dahl, B. M., & Crawford, P. (2018). Perceptions of experiences with interprofessional collaboration in public health nursing: A qualitative analysis. Journal of Interprofessional Care, 32(2), 178-184.
Golom, F. D., & Schreck, J. S. (2018). The journey to interprofessional collaborative practice: are we there yet?. Pediatric Clinics, 65(1), 1-12.
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6).
Reeves, S., Xyrichis, A., & Zwarenstein, M. (2018). Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice. Journal of interprofessional care, 32(1), 1-3.
The brief discusses the mental health issues that arise as a result of the pandemic. Such policies have been essential for creating healthy societies for over thirty years (Browne et al., 2018). Since one in five people living in political or social conflict settings has a mental health condition, millions of people struggle with it due to global uncertainty caused by the pandemic (United Nations [UN], 2020). Thus, the author proves his opinion by pointing out that many people fear the injections and deaths around them, worrying about it whenever they are isolated from their loved ones. Many women and children become victims of domestic violence caused by quarantine and constant contact with abusers. Such stressors trigger people’s nervous system and result in harmful coping methods such as alcohol and drugs. Therefore, the author insists on mental health treatment and recovery from the pandemic by teaching people to cope with multiple stressors.
The presented brief is informative and thorough, providing detailed research and links to policy initiatives connected to COVID-19. The UN defines the issue’s nature and globality through statistics demonstrating mental health deterioration worldwide as the successful implementation of Mintrom’s first key step (Mintrom, 2012). Providing charts and avoiding vague statements are the best ways of utilizing metrics to quantify the problem (Bardach & Patashnik, 2020). However, it fails to emphasize the role of government in solving mental health problems. For example, it could include how governments reduce the effect of mental health conditions through a range of expenditure measures (Mintrom & O’Connor, 2020). Unfortunately, the brief does not include the roles and duties of street-level bureaucrats or mental health professionals who deliver their services to patients (Lipsky, 2010). It is disadvantageous as therapists do not know how to improve their approaches.
In contrast, it includes the UN’s action plan, such as attracting UNESCO, UNFPA, and UNHCR, but overlooks governmental engagement (UN, 2020). Brief’s other advantage is proposing alternative solutions for the problem as it mentions how countries like Lebanon, New Zealand, and the Bahamas adopted other solutions. Still, the policy brief does not identify the main criteria for the most successful option and does not consider outcomes for each alternative.
I agree with most of the policy brief because the text clearly defines the problem and proposes an action plan. Its concern with the global approach to protecting mental health and strengthening social cohesion and solidarity are the focus areas of the brief. However, the universality of the proposed solutions should be doubted as it does not consider personal reasons for neglecting psychological health. Some public policies do not succeed because they require a change in human nature but do not facilitate it (Mazmanian & Sabatier, 1983). For example, people do not attain therapies because they fear judgment and the unknown (Bennett, 2019). Therefore, the lack of mental health support centers and poor financing are not the only reasons for the problem, as the brief’s authors suggest.
The brief should include many more policy tools because it is impossible to resolve mental health issues without them. The UN indeed considers some governing instruments that help to achieve its goals and treat marginalized people. These tools involve various social actors in constant discussions with each other (Bali et al., 2021). For example, technology is a tool necessary to provide remote mental health care for isolated people (The UN, 2020). Meanwhile, substantive policy instruments are required to deal with resource nature, variety, quantity, and delivery (Werdiningtyas et al., 2020). However, the UN does not mention any substantive tools to allocate recourses when dealing with the problem. It would be better if the brief elaborated more on health care benefit packages and insurance schemes that include mental health care.
References
Bali, A. S., Howlett, M., Lewis, J. M., & Ramesh, M. (2021). Procedural policy tools in theory and practice. Policy and Society, 40(3), 295-311.
Bardach, E., & Patashnik, E. M. (2020). A practical guide for policy analysis (5th edition). Sage.
Browne, J., Coffey, B., Cook, K., Meiklejohn, S., Palermo, C. (2018). A guide to policy analysis as a research method, Health Promotion International, 34(5), 1032–1044.
Lipsky, M. (2010). Street-level bureaucracy. Russell Sage Foundation.
Mazmanian, D. A & Sabatier, P. A. (1983). Implementation and public policy. University Press of America.
Mintrom, M. (2012). Contemporary Policy Analysis. Oxford University Press.
Mintrom, M., & O’Connor, R. (2020). The importance of policy narrative: Effective government responses to Covid-19. Policy Design and Practice, 3(3), 205-227.
Werdiningtyas, R., Weib, Y., Western, A. (2020). Understanding policy instruments as rules of interaction in social-ecological system frameworks. Geography and Sustainability, 1(4), 295-303.
Globally, depressive disorders substantially contribute to a degree of overall disease burden. Thus, prioritizing depression treatment and prevention represents a significant healthcare priority. In terms of its prevalence, depression frequently occurs in adolescents, with conservative estimates that approximately 12% of a 12- to 17-year-old population experience symptoms of major depressive episodes (Clayborne et al., 2019). Adolescence is a critical developmental period characterized by building and understanding healthy relationships, exploring personal interests, developing essential skills for life and the workplace, and eventually transitioning to further education or the labor force. Depression experienced during this period can disrupt these processes, ultimately affecting an individual’s long-term socioeconomic standing and peer-to-peer, familial, and romantic relationships.
Disease Burden – Comorbidities
Furthermore, experiencing depression in early life can be associated with various poor outcomes in addition to depression’s possible recurrence. For instance, there is an increased risk of type 2 diabetes – 5% cumulative incidence – and obesity – 12% incidence in confirmed depression cases (Clayborne et al., 2018). Another example is an increased risk of other mental health disorders, including substance use disorders and anxiety, with a p-value lesser than 0.5 (Clayborne et al., 2018). Apart from that, there is evidence of links between early-life depression and many poor psychosocial outcomes, such as lower perceived social support, lower educational performance, and unemployment.
Disease Burden – Costs
Costs due to adolescent depression span from direct medical costs related to the use of medication and inpatient and outpatient care to indirect costs related to work absence, early retirement, and premature death. Direct medical costs caused by adolescent depressive disorders are substantial – 3.10 million USD annually per single age group – differing between the clinical depression subtypes (Ssegonja et al., 2020). In turn, indirect societal costs accrue from increased education needs, criminality, and increased social welfare dependence (p<0.05) due to poor performance in the labor market (Ssegonja et al., 2020). In this context, indirect costs of depression more significantly contribute to depression-related costs than direct costs.
Barriers and Challenges
Contemporary adolescent depression research faces many barriers and challenges. The mechanisms of how different interventions work are still not broadly understood (Cuijpers et al., 2020). Over the past decades, approximately 500 randomized trials have studied the antidepressant effects, whereas over 600 trials have focused on the effects of psychotherapies for depression (Cuijpers et al., 2020). However, only 20% of drug trials and less than 30% of therapy trials display low bias risk, making the outcomes uncertain (Cuijpers et al., 2020). Consequently, there is a barrier represented by a lack of clarity regarding depression boundaries and heterogeneity on the one hand and a scarcity of reliable research on the other.
Spontaneous Recovery & Placebo
Another notable challenge is the high rates of spontaneous recovery and placebo effects. In a meta-analysis including 177 studies and 44 240 patients, 54% responded to antidepressants, 54% to psychotherapies, and 38% responded to a placebo (Cuijpers, 2018). In this context, patients with depression who did not receive care showed comparable results. These findings pose a challenge that a substantial part of patients treated with psychotherapy or medication might have recovered with placebo or without treatment. In other words, for most patients who respond to treatment, the time investment in psychotherapy and the potential adverse effects of medications might not be necessary to get better.
Nonresponse and Relapse Rates
In contrast to the response to drug or placebo, a large group of patients is difficult to treat or do not respond to treatment. Although patients may respond to another drug after failing to respond to an initially prescribed drug, the chance of a successful response is almost halved with every new treatment (Cuijpers, 2018). One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment (Cuijpers, 2018). Another challenge is that treatment effects are probably overestimated because of the high relapse rates, estimated at 50% (Cuijpers, 2018). Thus, there are concerns about long-term effectiveness and biases regarding publications and sponsorships.
Solutions to Current Challenges
The treatment challenges are partly addressed with preventive interventions. They include approaches such as cognitive behavioral therapy, interpersonal therapy, and coaching. These interventions are usually delivered in schools, healthcare centers, and other community settings by teachers, clinicians, and other trained personnel. In particular, interventions focused on cognitive behavioral therapy (CBT) have demonstrated significant value. It showed 0.14 statistically significant evidence of successful prevention and 95% cost-efficiency compared to non-treatment (Ssegonja et al., 2020). These interventions aim to equip adolescents with skills to be able to recognize certain life stressors (triggers or thoughts), develop alternative thinking patterns and ultimately employ appropriate behavioral responses to them.
Universal Collaboration
Another solution to the challenges posed by depression is to draw attention to the matter, promoting collaboration at different societal levels. An example of such a promotion is the Healthy People organization, which took responsibility for mapping the desired outcomes of healthcare field development. In terms of adolescent depression, it issued several objectives, such as MHMD‑06 increasing the number of treated adolescent depression cases and EMC‑D04 focusing on anxiety and depression treatment among children and adolescents (Healthy People 2030, n.d.). The former aims to increase the current rate of 43.3% to 46.4% cases, whereas the latter is yet to be developed. The desired effect is achieved through the federal support and scholarly attention these objectives receive.
Mental Health Benefits Legislation
In the meantime, the Community Preventive Services Task Force (CPSTF) promotes mental health benefits legislation to improve financial protection and increase the proper use of health services by people with mental health conditions. Particularly, CPSTF recommends legislation that helps ensure no greater restrictions for mental health coverage than physical health coverage (Healthy People 2030, n.d.). In addition, CPSTF found evidence supporting that mental health benefits legislation is frequently associated with increased diagnoses of mental health conditions, increased care accessibility, reduced suicide rates, and prevalence of poor mental health.
Quality Improvement
Using clinical registries is crucial to the systematic measurement of clinical outcomes in achieving better patient value. A clinical or patient registry is an organized system using observational studies to collect clinical data as structures, processes, and outcome measures to evaluate specific outcomes for a population characterized by a certain condition, disease, or exposure (Kampstra et al., 2018). The goal of measuring outcomes includes guiding clinical decision-making, benchmarking, monitoring, initiating improvement interventions, public accountability, and scientific research. Structurally measuring outcomes and using them to determine possible improvements contributes to achieving higher service value for patients.
Collaborative Care Model
For example, one study applied a web-based disease registry to track patients with symptoms of depression to support treatment management in primary care. The Breakthrough Collaborative Model (BCM) was used to create a cycle of structured conference sessions during which depression outcomes were studied and interpreted, and variations in work processes were discussed. Moreover, the model was used as a tool to facilitate insights and improvement efforts into data. Additionally, evidence-based depression management training was provided to primary care providers. As a result, the majority of patients experienced relief in depression symptoms (p<0.01) (Kampstra et al., 2018). Thus, the experiment led to a meaningful improvement in depression management.
Predictive Machine Learning
However, traditional clinical risk assessment tools sometimes do not demonstrate enough accuracy to identify high-risk patients. This is why machine learning approaches have been applied to EHR data to predict suicide risk in adult and adolescent populations (Su et al., 2020). A combination of patient demographic characteristics, procedures, diagnoses, laboratory tests, and medications was used to construct machine-learning models to predict the risk of suicide attempts – a five to 10-fold improvement – among patients receiving care in a children’s medical center (Su et al., 2020). The results observed from the proposed models constitute greater accuracy in suicide attempt prediction compared to the base rate.
Future Implication – Challenges
A thorough analysis of topics associated with adolescent depression provides a lot of information for future implications in nursing care. The fact that the particular treatment’s success can vary depending on each individual case prevents overgeneralization by providers. Additionally, the issue of statistical significance sets a milestone for researchers, emphasizing future research requirements. In the meantime, the possibility of successful treatment without the use of antidepressants and psychotherapies provides an opportunity to avoid adverse medication effects and potential time loss. Finally, high relapse rates foster critical thinking in healthcare professionals regarding the medication and possible bias around it.
Future Implication – Solutions
The acknowledged solutions and practices in terms of depression treatment add significance to evidence-based practice. For example, the success rate of depression prevention in comparison to depression treatment motivates providers to pay increased attention to regular screenings. In turn, the collaboration initiatives and their ability to provide aid, both professional and informational, ensure a qualitative delivery of services and safeguard less-experienced practitioners. Lastly, governmental support covers the areas where local and individual efforts might not be enough to achieve desired targets. Consequently, it unties the hands of professionals, making their services accessible to a more significant number of people in need.
Future Implication – Improvement
The tendency for performance measurement and quality improvement increases the quality of life not only for patients but for practitioners as well. The use of clinical records allows for increased data transparency and accessibility to healthcare professionals, contributing to the speed and accuracy of disease diagnosis and treatment. In this context, the practices, such as BCM, have a diversified purpose of technology implementation, quality improvement, and interdisciplinary collaboration promotion. Meanwhile, the ability to further implement technological advances such as machine learning can save a great amount of time and effort for practitioners and simultaneously improve service quality.
Ssegonja, R., Sampaio, F., Alaie, I., Philipson, A., Hagberg, L., Murray, K., & Feldman, I. (2020). Cost-effectiveness of an indicated preventive intervention for depression in adolescents: A model to support decision making. Journal of Affective Disorders, 277, 789-799.
Kampstra, N. A., Zipfel, N., van der Nat, P. B., Westert, G. P., van der Wees, P. J., & Groenewoud, A. S. (2018). Health outcomes measurement and organizational readiness support quality improvement: a systematic review. BMC health services research, 18(1), 1-14.
Su, C., Aseltine, R., Doshi, R., Chen, K., Rogers, S. C., & Wang, F. (2020). Machine learning for suicide risk prediction in children and adolescents with electronic health records. Translational psychiatry, 10(1), 1-10.
Depression, anxiety, and dementia are just some of the mental health issues that have been shown to correlate with head trauma. A mental health professional examining a patient with a head injury may encounter a wide range of symptoms that are difficult to pin down. For instance, a person with a history of head traumas may exhibit indications of a mental condition such as forgetfulness or inability to focus. Sleep issues, mood swings, and irritability can all be side effects of a head injury that may be misdiagnosed as the result of a mental health condition (Theadom et al., 2019). To establish a correct diagnosis, mental health professionals should be aware of the possible connection between head traumas and mental health issues.
An ever-growing body of evidence links head injuries to various mental health issues, from anxiety and depression to Alzheimer’s disease. A mental health practitioner may be deceived or confused by a patient’s presenting symptoms after a head injury, which might compromise the accuracy of their assessment (Hong & Rao, 2020). This holds truer still if the patient has sustained catastrophic brain damage. Those unaware of a person’s history of brain damage may incorrectly diagnose symptoms of mental illness, such as forgetfulness or inattention, as being caused by the individual. People who have suffered from previous head traumas may find it difficult to focus or recall information.
Concussion symptoms may be mistaken for those of a mental illness. It is not unheard of for someone with a concussion to exhibit symptoms like irritability, sleeplessness, and mood swings. In order to accurately identify their patients, mental health practitioners should be aware of the link between traumatic brain injury and mental health issues. Having a concussion is associated with a higher risk of developing depressive symptoms (Hong & Rao, 2020). Depression after a concussion can manifest in various ways, but the most common ones include a heightened emotional response, melancholy, anger, anxiousness, and weariness. People with depression had worse results than those without the disorder. Suicidal thoughts and suicide attempts were also substantially correlated with the self-reported history of sports-related concussions.
Mood swings are one of the symptoms of brain injury. Depending on how severely these changes occur, they might cause anything from a temporary increase in irritation to full-blown depression (Kelly et al., 2018). Having problems falling asleep or staying asleep during the night is a common complaint among adults. This may be unpleasant for someone attempting to get some shut-eye. Brain injuries can severely reduce a person’s vitality, appetite, and desire to engage in sexual activity (Topolovec-Vranic et al., 2019). A person’s mood or degree of worry at any particular time may seem like it has nothing to do with the symptoms and signs of a mental disorder (Ilie et al., 2018). After a concussion, the injured person may experience dizziness, nausea, and headaches. These feelings might result from something more serious, such as a migraine or an ear infection. Symptoms of both diseases might sometimes overlap with one another. Seizures can be a side effect of brain injury, albeit they only happen in rare cases.
In conclusion, an incorrect diagnosis of a seizure as epilepsy, which can be fatal if the underlying cause is not addressed, is conceivable Mental health providers should be aware of the possible link between head injuries and mental health issues to make an accurate diagnosis. Mental health practitioners should always inquire about any history of head trauma, including concussions, while examining a patient (Ströhle, 2018). They should also be familiar with the symptoms of head traumas and how they may be misunderstood as the symptoms of mental illness. These symptoms are sometimes misinterpreted as caused by head traumas and can lead to mental health issues.
References
Hong, E., & Rao, A. L. (2020). Mental health in the athlete: Modern perspectives and novel challenges for the sports medicine provider. Springer Nature.
A job associated with public security and criminal justice often involves substantial risk to personnel’s mental health. According to a survey by Carleton et al. (2020), roughly 71% of police personnel respondents have experienced more than ten psychologically traumatic events in their practice. In addition, almost half of the respondents screened positive for mental health disorders, while a quarter reported either suicidal ideation, planning, or attempts (Carleton et al., 2020). There is substantial evidence that police officers experience various potentially dangerous depressive and anxiety symptoms. Thus, psychological support is imperative to aid officers in maintaining psychological well-being and performing their duties efficiently. In this context, numerous mental health training program categories exist, such as debriefing, peer support, critical incident stress management (CISM), Road to Mental Readiness, psychoeducation, mental health first aid, and many others (Carleton et al., 2020). However, existing research on their categorization and effectiveness is limited, which are the issues chosen for the current paper.
Literature Review
In current criminal justice practice, focusing solely on the law, arrest and control skills, and defensive tactics in officer training is insufficient. Consequently, the article by Blumberg et al. (2019) addresses how vital it is to prepare police officers for their future duty mentally as well. Unfortunately, despite providing solid coverage of skills addressed by psychological interventions, the article does not explicitly mention their proportional contribution to mental health resilience.
The study by Carleton et al. (2020) assessed police officers’ perceptions of access to professional and non-professional support and associations between mental health and training. Despite most participants reporting access to support, the majority would first access a spouse, while many would access professional support only as a last resort. In this context, the research by Velazquez and Hernandez (2019) was conducted to identify police officers’ mental health in relation to traumas and the stigma behind seeking professional treatment. Additionally, the article by Papazoglou and Tuttle (2018) studied several practice-based actions that clinicians may utilize to understand police culture and develop respective clinical support for officers suffering from work-related stress and trauma. The mentioned studies contain a rich overview of possible mental health interventions but, unfortunately, do not compare them in terms of efficiency.
Finally, the study by Chitra and Karunanidhi (2021) aimed to determine the efficiency of a resilience-training program by evaluating its effect on female officers’ job satisfaction, occupational stress, and psychological well-being. The results demonstrated that resilience training was practical, and the qualitative feedback was positive, supporting the empirical evidence for the resilience training program’s effectiveness. However, the study’s main weak point is the generalizability of the chosen sample both within and outside the gender criterium.
Research Question
Based on the mentioned literature, one might perceive several common features. Firstly, mental health interventions vary in terms of their provider and scope. Secondly, these interventions were assessed in terms of perceived appealability and qualitative characteristics rather than in terms of comparable efficiency. Therefore, the current research will fill the gap of generalizing and comparing mental health interventions by defining the most effective interventions applicable to the most significant number of police officers.
Data and Methods
To answer the stated question, this research will conduct a systematic review of existing literature specifically dedicated to the performance of mental health interventions for the police workforce. Given that the results’ validity and statistical significance are in direct relationship with the number of relevant studies used for the review, there is a need for a thorough and expansive search. Thus, the initial keywords to locate and identify literature concerning healthcare interventions would be mental health support, clinical intervention, mental health promotion, psychological resilience, and psychological well-being. Then, the subsequent search results should be additionally filtered by police mental health, police trauma, police stress, and police resilience to ensure that the studies are related to the topic of criminal justice. Finally, the located healthcare interventions will be compared in the framework of Comparative Effectiveness Research (CER). This research can identify what clinical and public health interventions perform best in improving health (Harvard School of Public Health, n.d.). In this context, interventions will be compared based on health-related outcomes.
Results and Discussion
The expected outcome of this study is a generalized classification of existing mental health interventions available for the police workforce and their assessment in terms of efficiency. Such a dualistic approach ensures the research’s value for psychology scholars and criminal justice policy and practice. Firstly, it will list the existing interventions regardless of their scope in one place. Secondly, it will provide their characteristics and performance evaluation. This way, both sides will receive information regarding current approaches’ strengths and weaknesses, allowing them to adjust their strategy accordingly. This research has two potential limitations: available resources and possible gaps in underrepresented interventions. The former mainly concerns the number of researchers involved and the time framework – the longer the research lasts, and the more people work on it, the more significant would be the systematic review. Regarding the latter, the uncovered gaps would present an opportunity for future research.
A mental disorder is a severe mental or behavioral impairment that interferes with a person’s functioning. With the rising awareness of mental disease and increased amount of research exploring the topic, it appears that mental illnesses are significantly more common than one would think. The Substance Abuse and Mental Health Services Administration (2018) reports that as many as 19.6% of adults in the US suffered from a mental health condition. 5.4% of adults could be categorized as having severe mental disorders (major depressive disorder, severe anxiety, severe post-traumatic stress disorder, and others) (Substance Abuse and Mental Health Services Administration, 2018). Living with a mental illness presents a wide set of challenges for affected individuals one of which is physical comorbidities.
The poor physical health of people with severe mental disorders is a complex transdiagnostic problem that permeates age, gender, and ethnicity. The Lancet Psychiatry commission state that individuals with mental illness are at a higher risk of physical disease (Firth et al. 2019). The situation is aggravated by impeded access to adequate, timely health care. The Lancet Psychiatry claims that the medical and scientific communities have long been observing significant physical disparities across the spectrum of mental disorders (Firth et al. 2019). The phenomenon allegedly manifests itself no matter the income category of the country of residence (Maura & de Mamani, 2017). Mental patients in both developed and developing countries were disproportionately susceptible to physical disease.
At present, a plethora of studies seek to pinpoint the most common comorbidities in people with severe mental illnesses. An example of such study is a meta analytical review put together by Janssen, McGinty, Azrin, Juliano-Bult, and Daumit (2015). The researchers discovered that mental illness is often accompanied by or aggravates such conditions as: (1) overweight; (2) obesity; (3) hyperlipidemia; (4) hypertension; (5) diabetes mellitus; (6) coronary heart disease; (7) congestive heart failure; (8) cerebrovascular disease; (9) overall cardiovascular disease; (10) chronic obstructive pulmonary disease (COPD); (11) kidney disease; (12) cancer; (13) hepatitis B; (14) hepatitis C, and (15) HIV.
The high rate of comorbidities accompanying mental illnesses seriously reduces the life expectancy of such patients (Firth et al. 2019). Aside from the report submitted by the Lancet Psychiatry commission, other recent studies on the subject matter also suggest the evidence of premature mortality in mentally ill individuals. For instance, Hjorthøj, Stürup, McGrath, and Nordentoft (2017) show that schizophrenia reduces average life expectancy by as many as 14.5 years across all continents. Besides, suffering from physical disease on top of handling a mental disorder puts a strain on an individual’s ability to function socially and economically (Funk, 2016).
The present literature review inquiries the causes of poor physical health of individuals with mental health disorders in community settings. The need for such a review is motivated by the prevalence of mental disorders and the grave impact of unaddressed comorbidities. Researchers seek to pinpoint the key factors contributing to the issue with the main focus on the United Kingdom. The paper provides a critique of six articles with both qualitative and quantitative methodology and discusses the implications of their findings.
Literature Search Strategy
The literature search for the study was based on electronic databases such as British Nursing Index (BNI), Cumulative Index for Nursing and Allied Health Literature (CINAHL), InterNurse, Medline, Science Direct, ASSIA, British Education Index, Education Abstracts and ERIC. Upon further investigation, the researcher discovered that CINAHL and BNI not only provided excellent primary sources but also were convenient and easy to access. Since the literature review was limited to six articles, there was no rationale for being superfluous in data search (Hart, 2018). However, the researcher still deemed it important to expand the scope of the literature search in the discussion section.
The researcher compiled a list of search and keywords based on the title of the study and the three research themes. Generic search using terms such as “poor physical health,” “severe mental illness,” “mental health patients,” and community returned the total of 1,876 articles. To overcome the difficulty of glossing over this body of evidence, the researcher decided to differentiate further. First, the results were narrowed to full text, peer review, written in English, and within the last 3 years (2016-2019). Second, the researcher used the common comorbidities found in mental patients (as discovered by Janssen et al. (2015)).
To make the search even more rigorous, the Boolean method was employed. it brought out the researcher’s imaginative skills for creation and use of words, terms, phrases and symbolic logical operators to arrive at broader but refined or fluid results. Some of Boolean logical operators/values includes the use of conjunction (and, &), inclusive/disjunction (or), negation (not), question marks (?) and asterix (*) to list but a few (Aliyu, 2017). Out of all these options, the most relevant to the chosen search strategy were question marks and asterisks. Further, the researcher read the abstracts of the studies left after the filtering. The writer critically assessed their validity and significance and jumped to the discussion section in some cases to evaluate how serious the limitations of the study were (Booth, Sutton & Papaioannou, 2016). Finally, the researcher was able to single out six articles that were recent and relevant to the topic. The literature search strategy is presented visually in the image below.
Image 1. Literature search strategy.
Literature Review
Underdiagnosing Comorbidities
The first step to effective treatment is making a sound diagnosis. unfortunately, it seems that it is not the case for many mental patients. Cook et al. (2016) argue that people with mental illnesses experience multiple health disparities and increased medical morbidity. The phenomenon persists in even in countries whose citizens enjoy universal access to healthcare. Cook et al. (2016) claim that there is not enough evidence about the prevalence of medical comorbidities in demographics with a mental health condition and receiving health services in outpatient settings.
The aim of the study conducted by Cook et al. (2016) was to calculate the prevalence of eight most common medical comorbidities: (1) obesity, (2) hypertension; (3) diabetes; (4) smoking; (5) nicotine dependence; (6) alcohol abuse; (7) drug abuse; (8) coronary heart disease. Apart from those conditions, Cook et al. (2016) deemed it important to assess self-reported health competencies, medical conditions, and health service utilization. The need for the study is validated by the danger of underdiagnosing comorbidities. The researchers state that without regular screenings, patients with mental illnesses might be unmotivated to seek treatment or take preventive measures.
The researchers recruited 457 (464 contacted in total, seven refused) mentally ill patients in four US states: New Jersey, Illinois, Maryland, and Georgia. The eligibility criteria included being of age, the ability to give informed consent, English speaking, and participation in a community mental health program. The diagnosis needed to be recognized by DSM and indicate a moderate to severe mental impairment. For the sake of the ethical rigor, the researchers ensured confidentiality and anonymity. They took measures to verify that participants’ mental health status did not interfere with their ability to make well-informed decisions. The latter was especially important since some mental conditions prevent affected individuals from making sound decisions. To avert such situations, Cook et al. (2016) inquired those who volunteered about their understanding of the purpose of the study.
During the screenings administered in the four aforementioned states, the researchers and invited medical staff achieved two goals. First, they made a differentiated clinical diagnosis for each patient; second, they measured participants’ attitudes toward their own health using a variety of questionnaires. Lastly, it was essential to not only identify issues at hand but also assess health risks, which was done through measuring body mass index (BMI) based on height and weight; blood pressure; blood glucose, and other metrics. The data was subject to descriptive statistical analysis (prevalence, means, medians, and others). Random regression analysis helped to pinpoint changes in participants’ pre- and post-screening attitudes.
The data analysis has yielded the following results with regards to the prevalence of the explored morbid conditions: obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). The results indicated a higher prevalence as compared to the official health information. This implies that patients with mental illnesses indeed suffer from insufficient diagnosing, which may be worsening their quality of life. As expected, Cook et al. (2016) noticed significant positive changes in how patients perceived their own health efficacy after participating in health screening. At post-test, participants reported higher evaluations of their degree of competence in performing health practices. Lastly, Cook et al. (2016) observed an enhanced degree of internal control over one’s health.
The study had some serious caveats: firstly, the sample was not representative of broader populations. Secondly, Cook et al. (2016) did not recruit a control group to truly measure the effect of the intervention. Despite the limitations of the study, the findings shared by Cook et al. (2016) are definitely of value for nurses working with mental patients. Probably, one major implication that practitioners should pay attention to is the effect of a simple health screening. The obvious positive consequence for patients is actually learning about their comorbidities. The less apparent impact is the encouragement they receive to maintain their health and address their issues.
Non Adherence to Medication
Another serious barrier to physical and mental health is patients’ compliance and commitment to the treatment plan. While being able to access medical service is integral to relief and recovery, the process is a two-way street. Medical professionals play an important role in enhancing patients’ quality of life; however, their best efforts to help may prove to be futile if the patient does not adhere to recommendations. Hickling, Kouvaras, Nterian, and Perez-Iglesias (2018) investigated exactly why some patients refuse to take medications even though the consequences of such a decision might pose a threat to their health. The aim of the study is to identify the association between the attitudes of patients with psychosis (independent variable) and their adherence level (dependent variable).
The study’s significance is validated by the impact that adherence and non adherence to medications have on patients’ health outcomes. Other researchers concur with the rationale provided by Hickling et al. (2018): for instance, Wouters et al. (2016) show that non adherence decrease the likelihood of a positive outcome in the long-term. Hickling et al. (2016) state that exploring the issue of non-adherence is especially important when it comes to psychosis. As a whole, antipsychotic drugs are highly efficient; however, attaining and maintaining adherence is challenging for both patients and healthcare workers (Hickling et al. 2016). The researchers explain that episodes of psychosis are disruptive to a person’s life and may lead to the neglect of physical health among other consequences.
Participants were recruited at random from COAST Early Intervention in psychosis service, South London and Maudsley NHS Foundation Trust (SLaM). Researchers approached patients attending the outpatient clinic in person. The eligibility criteria for an interview included being of age (18 years and older), having an official diagnosis (psychosis), and being prescribed antipsychotic medication. To ensure the ethical rigor of the study, the researchers reassured the participants that the data collected will not be accessible by their clinicians. Aside from that, the researchers ensured total confidentiality and anonymity as well as participants’ ability to provide informed consent. The project was approved by SLaM NHS Foundation Trust, a UK-based ethical board.
In order to measure the dependent and independent variables, Hickling et al. (2016) selected three externally validated questionnaires. Self-reported adherence was evaluated using the Selwood Compliance Scale that consists of four statements regarding medication taking behaviour. Based on the responses to the first questionnaire, patients were classified as whether adherent or non adherent. Beliefs about antipsychotic medications were measured with the Beliefs about Medicines Questionnaire (BMQ). The BMQ assesses two dimensions of medication use: personal (in terms of necessity and concern) and general (in terms of harm and overuse). Lastly, Hickling et al. (2016) explored whether patients with psychosis believed that they were provided with sufficient, exhaustive information using Satisfaction with Information about Medicines Scale (SIMS).
The data was analyzed using SPSS, and the following methods were employed: Student’s t-tests (for continuous variables) and Pearson’s chi-square and Fisher’s exact tests (categorical variables). To identify the main predictors of adherence to antipsychotics binary logistic regression was used. One-way ANOVA (analysis of variance) was administered to identify the effects of the BMQ categories (necessity, concerns, harm, and overuse) on adherence.
The results of data analysis were comprehensively demonstrated in tables and plots. Hickling et al. (2016) discovered that two-thirds (66%) of patients could be classified as adherent while one-third (34%) showed significant non-adherence. Interestingly enough, such factors as gender, employment, and living separately or with a family did not impact the likelihood of adherence (Hickling et al. 2016). However, what apparently made a difference is age: younger patients were more to ignore their treatment plan. As for the participants’ beliefs, one category that strongly correlated with adherence was concerns about one’s health. Lastly, adherent patients expressed more satisfaction with the information provided about antipsychotic medications as compared to non-adherent patients.
The study had some serious limitations: firstly, due to the study design, Hickling et al. (2016) were unable to pinpoint causal relationships. Another limitation concerns the major pitfall of any study that relies on self-reported data: there is hardly any way to check whether the participants were honest. Lastly, as Hickling et al. (2016) admit non-adherent patients are less likely to participate in research, therefore, the sample itself might have not been exactly representative. Despite all the aforementioned limitations, the study is still of value to practicing nurses who deal with mentally ill patients. One practical implication that they might want to use is that complete and comprehensive information about medication might promote adherence in patients. As a result, they will relieve their symptoms and will be able to take care of their physical health as well.
Stigma
For individuals with mental disease, timely intervention and self-care habits are essential for recovery or at least a relief of burdening symptoms. Mantovani, Pizzolatti, and Edge (2017) investigate the issue of stigma as one of the key barriers to receiving medical help and treating mental disorders. The researchers define stigma as an “attitude that is deeply discrediting (Mantovani, Pizzolatti & Edge, 2017).” Essentially, stigmatization is a psychological process of deriving the feelings of shame and inadequacy in individuals whose health status presents certain challenges for social functioning. Mantovani, Pizzolatti, and Edge (2017) explain that stigma occurs at two interconnected and mutually reinforcing dimensions: personal and social.
Self-stigma, or personal stigma, is internalized negative beliefs about individuals with stigmatized attributes. For instance, a person who was raised to believe that it is shameful to suffer from a mental illness may be confronted with an additional difficulty in battling the disease. Social stigma, on the other hand, is produced collectively and draws upon common, often misguided beliefs. An example of social stigma pertaining to the subject matter would be a stereotype that all mentally ill people are inherently dangerous. As one may readily imagine, once this belief becomes part of self-stigma, the affected individual might be extremely reluctant to seek help in order not to proclaim themselves “dangerous.”
In the United Kingdom, stigma reduction has become one of the public health priorities, which is even reflected in a number of policy documents. At present, eradication of mental health stigmatization is seen as a requirement for ensuring social justice and equality. The need for the study is also motivated by the importance of reaching out and contacting mental health specialists in the first place. Maintaining a good physical health is extremely difficult if a patient is struggling with the symptoms of his or her mental condition on a daily basis. For instance, Badcock, Davey, Whittle, Allen, and Friston (2017) write that having a major depressive episode may be compared to having a mild cognitive impairment. According to Badcock et al. (2017), an untreated mental disorder interferes with long-term planning, memory, and decision-making. These three mental faculties are essential to making healthy choices and upholding positive habits.
Mantovani, Pizzolatti, and Edge (2017) narrow down the scope of their qualitative research to African-descended communities in the UK. The aim of the study is to investigate the complex ways in which stigma influences help-seeking for mental illness in the said demographic cohorts. To achieve the research goals, Mantovani, Pizzolatti, and Edge (2017) recruited 26 African descendents from eight geographically adjacent faith-based organizations (FBOs) of different Christian denominations. The organizers from the said FBOs codesigned the information material explaining the purpose of the study to the respective participants and ensured confidentiality and anonymity.
The semi-structured interviews have shown that African communities in the UK indeed suffer from personal and social stigmatization of mental health issues. Among common themes identified in the collected text data were the themes of weakness and self-shame. Another common theme was the lack of acceptance in African communities and their ostracization of those in need of help for their mental disease. The obvious strength of the analyzed study is its novelty: it is arguably the first precedent of meta analysis on quite a narrow topic. The main limitation is the modest sample size and researchers’ inability to recruit individuals not from FBOs due to time constraints. Mantovani, Pizzolatti, and Edge (2017) are looking forward to more studies that could build on the methods and findings of the present study. Nevertheless, the study started an important discussion about the stigmatization of mental illnesses. Health practitioners need to be aware that both mental and physical recovery in patients with mental disorders start with their intention to get better and lack of shame.
Obesity
In their quantitative correlation study, Jonikas et al. (2016) explore the factors influencing the development of overweight and obesity in mentally ill persons. The researchers explain the importance of this research area by citing recent global statistics on obesity. Jonikas et al. (2016) state that the fact that one-third of the world’s adult population is either overweight or obese is indicative of global crisis. The authors refer to reliable sources showcasing the association of obesity and cardiovascular diseases that have become the number one cause of death in the majority of countries (Jonikas et al. 2016). It is argued that mentally ill individuals are more prone to being obese than general populations. Jonikas et al. (2016) speculate that severe mental disorders interfere with the maintenance of a healthy lifestyle and do not allow affected individuals take timely measures. The aim of the study by Jonikas et al. (2016) was to discover the association between obesity (dependent variable) and gender, clinical factors, and medical comorbidities (independent variables) in mentally ill patients.
The data was collected from 457 (464 contacted in total, seven refused) mentally ill patients in four US states: New Jersey, Illinois, Maryland, and Georgia. The eligibility criteria included being of age, the ability to give informed consent, English speaking, and participation in a community mental health program. The diagnosis needed to be compliant with DSM and indicate a moderate to severe mental impairment. The study can be recognized as ethically rigorous: the researchers ensured confidentiality and anonymity. They took measures to verify that participants’ mental health status did not interfere with their ability to make well-informed decisions.
Participants were invited to screening stations where they were administered the following tests: body mass index (BMI), blood pressure, non-fasting lipid profile, risk for alcohol and drug abuse, blood glucose profile, and some others (Jonikas et al. 2016). The validity of the data collection is verified by the fact that screening staff was specifically trained in methods for administering the aforementioned tests. The collected data was processed using hierarchical ordinary least squares regression analysis; the researchers made sure to control for psychiatric, smoking, health insurance, and demographic factors. Jonikas et al. (2016) presented the discovered multivariate associations in tables, stating the results for p<0.001, p<0.01, and p<0.05.
As a result, Jonikas et al. (2016) were able to confirm all the research hypothesis Namely, they discovered that women with mental illnesses were more likely to be obese as compared to their male counterparts. In the discussion section, Jonikas et al. (2016) provided a few possible explanations for this association. Firstly, it is possible that women with mental illnesses had lower levels of activity than men. Secondly, they might have gained weight due to hormonal transitions. Lastly, Jonikas et al. (2016) put forward the idea that since female mental patients had a higher likelihood of experiencing a childhood trauma, they might have developed an eating disorder leading to obesity. Some of the other associations discovered by the researchers concern not completing high school, diabetes, and hypertension.
The main strength of the study lies in the discovery of actual factors behind obesity in mental patients. However, there are certain limitations: the major threat to validity is the sampling method that resulted in recruiting participants that might not be exactly representative of broader populations. The second limitation undermining the value of the study is researchers’ inability to collect more background data on participants’ family history and dietary habits. Nevertheless, the findings of the study and especially the recommendations provided by Jonikas et al. (2016) may contribute positively to adult nursing practice. They suggest that optimal physical health promotion will require targeting populations at risk.
The Lack of Physical Activity
When discussing strategies to overcome the issue of poor physical health in mental patients, one may find it useful to focus on modifiable factors. One of such factors is physical activity that has been found integral to preserving heart health and preventing such conditions as hypertension and cardiovascular disease (Vancampfort, Stubbs, Venigalla, & Probst, 2015). In their quantitative cross-sectional study, Vancampfort et al. (2015) seek to pinpoint motivational problems in patients with mental illnesses that prevent them from doing sports and being active. The researchers explain the need for such a study by soaring rates of premature mortality in mentally ill individuals: both due to natural causes and cardiovascular disease. Vancampfort et al. (2015) argue that investigating motivational deficits might help health practitioners to reach out to more patients with mental disorders and convince them to make healthier choices. At the beginning of the paper, the researchers speculate that it might be the overbearing symptoms of mental disease that do not let patients make their physical health a real priority.
The data was collected from 257 patients residing in the United Kingdom; no pilot study was administered. The recruitment of participants took place in two waves: first, patients with bipolar and affective disorder were invited; second, patients with depression and schizophrenia. The eligibility criteria included: a) an official diagnosis in compliance with DSM; b) ability to concentrate for 20-25 minutes to complete the survey. Vancampfort et al. (2015) combined two widely used questionnaires: the Behavioral Regulation in Exercise Questionnaire (BREQ) and International Physical Activity Questionnaire (IPAQ). The participants were handled by trained psychiatrists who did not partake in research. Vancampfort et al. (2015) ensured the ethical rigor of the research by receiving approval of 15 local ethical committees. Aside from that, the researchers ensured confidentiality and gained informed consent before proceeding with the survey.
The collected data was explored using multivariate analysis of variance (MANOVA) for identifying the differences between diagnostic groups. Student’s t-test was administered for exploring the differences between men and women, various age groups, and individuals with varying educational background (Vancampfort et al. 2015). The findings have shown that patients with affective and bipolar disorders were more likely to have the so-called introjected motivation than patients with schizophrenia. Introjected motivation is a person’s drive to achieve something due to external pressure that becomes internalized over time. The researchers discovered that individuals had the most prominent motivational deficits at the early stages of change. Interestingly enough, such factors as age, gender, ethnicity, and education level did not influence how motivated people were. Another significant finding concerned with the impact of extrinsic and intrinsic motivation. Individuals with intrinsic motivation were more active while those motivated extrinsically were more likely to withdraw from physical activities. In summation, Vancampfort et al. (2015) were able to meet the research objectives and come to meaningful conclusions.
For all its advantages, the study was not devoid of significant limitations, which is why its findings should be treated with caution. Firstly, Vancampfort et al. (2015) state that both questionnaires (BREQ and IPAQ) are considered reliable and comply with the international standards. However, the participants might have submitted distorted information because the design of the study essentially implies self-reporting. The second limitation is the exclusion of such an important criteria as medication use, which might have also shaped participants’ motivational patterns. Lastly, Vancampfort et al. (2015) did not collect any background information on participants, for example, about their smoking habits. Despite the aforementioned limitations, health practitioners may still come to meaningful conclusions regarding the results of the study. As Vancampfort et al. (2015) state themselves, it is important to pay attention to a person’s motivation type when encouraging them to take up a healthier lifestyle. Health practitioners can gain insights into the nature of mental illness and motivation to better understand the unwillingness of some patients to do sports.
Smoking
Aside from neglecting physical exercise, another lifestyle choice that might be impacting mental patients’ health negatively is smoking. Szatkowski and McNeill (2015) explored the diverging trends in smoking behaviors with regards to the mental health status. The researchers claim that while the smoking habit has been on decline globally in the last ten years, individuals with mental disorders still show higher rates of smoking. The aim of the study by Szatkowski and McNeill (2015) was to understand the dynamics of smoking prevalence in two distinct groups of people: mentally healthy and mentally ill. The working hypothesis for the study was the following: the decline in smoking habits would be more pronounced in individuals without mental health issues as opposed to those who have them. The need for a study with such a design and research questions is motivated by the negative impact that smoking has on human health (Szatkowski & McNeill 2015). Apart from Szatkowski and McNeill (2015), other researchers spoke exhaustively about the adverse effects of smoking. Onor et al. (2017) and Kowalzciuk et al. (2017) enlist such conditions as lung cancer, COPD (chronic obstructive pulmonary disease), decreased male fertility, pregnancy complications and preterm birth as being associated with smoking.
Szatkowski and McNeill (2015) collected data from survey responses from adults (16 year and older) residing in England. Aside from the age, another key eligibility criteria for participating in the study was participation in the Health Survey for England from 1993 through 2011. As Szatkowski and McNeill state, the database gave them access to more than 11,000 profiles per year. The Health Survey allowed them to categorize the participants with self-reported longstanding mental illness and those who recently used psychoactive medication as mentally disordered. The data was analyzed using simple linear regression, which allowed Szatkowski and McNeill (2015) to quantify annual changes. Data analysis investigated the dynamics of the smoking habit, daily consumption as well as respondents’ readiness for smoking cessation. The results were comprehensively presented in tables that included correlation coefficients and confidence intervals.
The findings of the study confirmed the initial research hypothesis, which means that Szatkowski and McNeill (2015) were able to achieve their research goals. The main findings suggested that the respondents without a longstanding mental illnesses showed more pronounced declines in smoking prevalence (-0.5% annually at a 95% confidence interval). Aside from that, the mentally healthy study participants were more likely to decrease their daily consumption (-0.14% annually at a 95% confidence interval). The respondents who reported a mental disorder did not demonstrate similar tendencies: in fact, they continued their smoking habit with the same intensity throughout the years. Interestingly enough, those taking psychoactive medication to fight their disorder were able to control their habit and reduce their consumption. The last key result worth mentioning is the same level of desire to quit in both mentally ill and mentally healthy patients.
The conclusions made by Szatkowski and McNeil (2015) are of value for health practitioners dealing with mentally ill patients and can be translated into practice. Nurses should understand that patients with mental disorders are more likely to develop a smoking habit and have more difficulties quitting it. As Szatjowski and McNeill (2015) write, there are a few explanations for this phenomenon with the most widely recognized being that individuals with a psychiatric diagnosis might be using smoking as a coping strategy. In nursing practice, it is essential that healthcare workers pinpoint the actual reasons on a case-to-case basis. However, the findings of the study should be approached with caution. The researchers admit that there are a few limitations that might have been undermining to the study’s validity. Firstly, it was impossible to tell whether those who self-reported a mental illness had an actual diagnosis. Secondly, the design of the health survey made it impossible to single out specific groups, for example, schizophrenic patients, bipolar patients, and others.
Discussion
The literature review has demonstrated the complexity of the issue of poor physical health in patients with mental illnesses. It has become evident that the problem exists and persist at three levels: at the level of the healthcare system as a whole, medical staff, and patients themselves. The study by Cook et al. (2016) implies that mental patients are routinely underserved: they have multiple undiagnosed comorbidities that worsen their quality of life. Inferring the findings on the UK, one may also add that here the situation is aggravated by the politics of austerity that reduce social benefits (Stuckler, Reeves, Loopstra, Karanikolos & McKee, 2017). Stuckler et al. (2017) have shown that austerity has caused a search in mental disease rates and even correlated positively with suicide rates. This implies that the national healthcare system needs to undergo a transformation that would accommodate the most vulnerable demographics. The intervention conducted by Cook et al. (2016) could lay a foundation for the future change. Community-based screenings are not difficult to organize, and the positive effect lingers for a long time.
Gopee and Galloway (2017) and Pilgrim (2019) argue that top-down policies regarding promoting mental health would indeed be a solid step forward. Yet, they would not come to fruition without leadership and change management at the hospital level. Hayes (2018) highlight the need for flexibility to tackle the uncertainty in healthcare, for which it is imperative that health workers know how to react and respond adequately. Proctor et al. (2017) claim that health care is in dire need of evidence-based approaches: they that would translate the recent scientific findings like those cited in this paper into practice. Evidence-based medicine has a chance to be sustainable: it teaches medical staff critical thinking and creative problem solving. As mental health issues gain more traction in British society, healthcare workers shall stay on top of events and be able to address the issues in a timely manner.
The literature review helped the researcher once again realize the importance of therapeutic communication. As Brownie, Scott, and Rossiter (2016) write, the complexity of therapeutic communication in chronic care is explained by the exposure and vulnerability that patients experience when receiving medical help. A healthcare worker assumes a position in which they have enough power and leverage to motivate a patient to maintain a healthy lifestyle or give up on such attempts altogether (Ford, Thomas, Byng & McCabe, 2019). One of the best approaches is described by Schwartz et al. (2017): the authors claim that medical specialists need to look beyond the disease and see a unique person behind it. This mindset should serve as a foundation of the so-called patient-centered collaboration. Within this framework, a healthcare worker does not make top-down decisions for patients; instead, the latter are equally involved.
For instance, Hickling et al. (2018) discovered that one of the reasons why patients fail to stick to the treatment plan was that they were concerned about side effects and did not feel like they had exhaustive information about medication. Patient-centered collaboration proposed by Schwartz et al. (2017) could help to promote self-agency in patients. If they are informed about the effects of medication and benefits of therapy, they would allegedly feel more responsible for their health. Stevens et al. (2017) describe the social identity approach to health that akin to the patient-centered approach, puts an emphasis on the individual factors. Stevens et al. (2017) address the issue of low levels of physical activity in mental patients, which was also observed by Vancompfort et al. (2015). The researchers claim that low motivation un unwillingness to make healthier choices come down to cognitive factors, motivation, and attitudes. One solution to this would be to help mental patients to transition from their individual identity to group identity by joining exercise groups. Stevens et al. (2017) and Mendoza-Vaskonez et al. (2016) argue that the team spirit and leadership could make a difference for poorly motivated patients.
Another implication for healthcare workers is the need to tackle the issue of bad habits in patients with mental disease. As this literature review has shown, smoking remains prevalent in adults with mental disorders in the UK, despite the overall decline over the last two decades. Given that chronic obstructive pulmonary disease (COPD) belongs to the long list of severe comorbidities common in mental patients, smoking is a habit that needs to come to cessation. The question arises as to how healthcare workers could influence patients in a way that they would act on their intentions and commit to their promises to quit. Coronado-Montoya et al. (2016) show that mindfulness exercises could be used for successful mental health interventions. Mindfulness is a psychological concept that denotes a person’s ability to be conscientious, to know oneself, and be aware of one’s thoughts and feelings. In relation to bad habits, mindfulness could help patients to realize what triggers their urges to indulge. With time, they could come up with more sustainable pathways toward emotional gratification without harming themselves.
Lastly, the literature review implies that healthcare workers need to be good, evidence-based predictors. Jonikas et al. (2016) have demonstrated that some factors predispose mental patients to have poor physical health. Building on findings like those cited in this paper, nurses could try and develop their own strategies to singling out groups that are more at risk of having comorbidities. For instance, in alignment with what Jonikas et al. (2016) discovered, nurses could be more persistent with promoting physical activity in women with mental disease. Surely, promotion should not highlight the “otherness” of a group at risk as it might lead to stigmatization. In any case, healthcare workers need to rely on the key principles of therapeutic communication and treat patients with respect.
Summation / Conclusion with Recommendation
The present literature review has demonstrated apparent physical health disparities and increased premature mortality rate in patients with mental illnesses. It is evident that the issue of poor physical health is a complex one, with a plethora of underlying factors and reasons. Patients with mental disease are routinely underdiagnosed, which leads to the aggravation of existing comorbidities. Stigmatization, or discreditation of their physical and mental state, prevents them from reaching out to health specialists. On top of that, many mental patients show non-adherence to medications, which impedes their recovery. Lastly, some of the other factors responsible for poor physical health are obesity, lack of physical activity, and harmful habits such as smoking. The problem can only be solved if both sides – healthcare workers and patients – make a conscious effort to bring about the needed change. Regular screening should become the norm to prevent the development of comorbidities in mental patients. The latter in turn should be more conscientious about their health. The process needs to be mediated by healthcare workers who could encourage patients and provide them with necessary information.
Reference List
Aliyu, Muhammad Bello 2017, ‘Efficiency of Boolean search strings for Information retrieval’, American Journal of Engineering Research, vol. 6, no. 11, pp. 216-222.
Badcock, Paul B, Davey, Christopher G, Whittle, Sarah, Allen, Nicholas B & Friston, Karl J 2017, ‘The depressed brain: an evolutionary systems theory’, Trends in Cognitive Sciences, vol. 21, no. 3, pp. 182-194.
Brownie, Sharon, Scott, Robin & Rossiter, Rachel 2016, ‘Therapeutic communication and relationships in chronic and complex care’, Nursing Standard, vol. 31, no. 6, p.54.
Booth, Andrew, Sutton, Antea and Papaioannou, Diana 2016, Systematic approaches to a successful literature review, Sage, Newbury Park.
Coronado-Montoya, Stephanie et al. 2016, ‘Reporting of positive results in randomized controlled trials of mindfulness-based mental health interventions’, PloS one, vol. 11, no. 4.
Gopee, Neil & Galloway, Jo 2017, Leadership and management in healthcare, Sage, Newbury Park.
Firth, Joseph et al. 2019, ‘The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness’, The Lancet Psychiatry, vol. 6, no. 8, pp. 675-712.
Hart, Chris 2018, Doing a literature review: Releasing the research imagination. Sage, Newbury Park.
Hayes, John 2018, The theory and practice of change management, Palgrave, London.
Hayes, Josepth F et al. 2016, ‘Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: a UK population-based electronic health records study’, JAMA psychiatry, vol. 73, no. 6, pp. 630-637.
Hickling, Lauren M, Kouvaras, Stefanie, Nterian, Zaklin & Perez-Iglesias, Rocio 2018, ‘Non-adherence to antipsychotic medication in first-episode psychosis patients’, Psychiatry Research, vol. 264, pp. 151-154.
Hjorthøj, Carsten, Stürup, Anne Emilie, McGrath, John J and Nordentoft, Merete 2017, ‘Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis’, The Lancet Psychiatry, vol. 4, no. 4, pp. 295-301.
Janssen, Ellen M, McGinty, Emma E, Azrin, Susan T, Juliano-Bult, Denise & Daumit, Gail L 2015, ‘Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness’, General Hospital Psychiatry, vol. 37, no. 3, pp.199-222.
Jonikas, Jessica A et al. 2016, ‘Associations between gender and obesity among adults with mental illnesses in a community health screening study’, Community Mental Health Journal, vol. 52, no. 4, pp. 406-415.
Kowalczyk, William J et al. 2017, ‘Predictors of the perception of smoking health risks in smokers with or without schizophrenia’, Journal of Dual Diagnosis, vol. 13, no. 1, pp. 29-35.
Onor, IfeanyiChukwu O et al. 2017, ‘Clinical effects of cigarette smoking: epidemiologic impact and review of pharmacotherapy options’, International Journal of Environmental Research and Public Health, vol. 14, no. 10, p. 1147.
Proctor, Enola et al. 2015, ‘Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support’, Implementation Science, vol. 10, no. 1, p. 88.
Maura, Jessica & de Mamani, Amy W 2017, ‘Mental health disparities, treatment engagement, and attrition among racial/ethnic minorities with severe mental illness: a review’, Journal of Clinical Psychology in Medical Settings, vol. 24, no. 3-4, pp. 187-210.
Mantovani, Nadia, Pizzolati, Micol & Edge, Dawn 2017, ‘Exploring the relationship between stigma and help‐seeking for mental illness in African‐descended faith communities in the UK.’, Health Expectations, vol. 20, no. 3, pp.373-384.
Mendoza-Vasconez, Andrea S et al. 2016, Promoting physical activity among underserved populations, Current Sports Medicine Reports, vol. 15, no. 4, p. 290.
Pilgrim, David 2019, Key concepts in mental health, SAGE Publications Limited, Newbury Park.
Sendt, Kyra-Verena, Tracy, Derek Kenneth & Bhattacharyya, Sagnik 2015, ‘A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders’, Psychiatry Research, vol. 225, no. 1-2, pp. 14-30.
Schwartz, David D et al. 2017, ‘Seeing the person, not the illness: promoting diabetes medication adherence through patient-centered collaboration’, Clinical Diabetes, vol. 35, no. 1, pp. 35-42.
Stevens, Mark et al. 2017, ‘A social identity approach to understanding and promoting physical activity’, Sports Medicine, vol. 47, no. 10, pp. 1911-1918.
Stuckler, David, Reeves, Aaron, Loopstra, Rachel, Karanikolos, Marina & McKee, Martin 2017, ‘Austerity and health: the impact in the UK and Europe’, European Journal of Public Health, vol. 27(suppl_4), pp. 18-21.
Vancampfort, Davy, Stubbs, Brendon, Venigalla, Sumanth Kumar & Probst, Michael 2015, ‘Adopting and maintaining physical activity behaviours in people with severe mental illness: the importance of autonomous motivation’, Preventive Medicine, vol. 81, pp. 216-220.
Wouters, Hans 2016, ‘Understanding statin non-adherence: knowing which perceptions and experiences matter to different patients’, PloS one, vol. 11, no. 1.
To date, there are a number of problems hindering the development of the mental health industry. These include a lack of adequate level of coordination among practitioners, various disparate positions and qualifications that the patient does not understand, the cost of treatment, and a general lack of staff. However, the strategy to increase the number of physicians is obvious and long-term, so attention must be paid to the contributing factors. Several actions are suggested to optimize the industry, taking into account resource and financial issues that may arise in the process of increasing access to mental health care for patients.
Possible Financial and Resource Utilization Issues
Most of the challenges that arise in planning for industry improvement relate to the healthcare industry as a whole. These include compliance with new regulations and prohibitions, recovery from the COVID-19 pandemic, lack of qualified staff, and lack of funding (“2022 healthcare finance trends,” 2022). For the mental health field specifically, one should note the poor development and prevalence of local support services, non-profit community-based organizations, and emergency and online care for those suffering from mental health disorders.
Resource utilization implies an assessment of the extent and quality of the current set of resources. Accordingly, problems in utilization arise from inefficient or unproductive allocation (Stenmark et al., 2022). Among such problems to consider in developing a nursing program proposal is the possible mismatch of priorities in the disposition of resources or inadequate planning for the volume and current capacity of those resources. In addition, there is the issue of correctness and completeness of information about available resources, which is essential because of the sparse and heterogeneous nature of the industry.
Types of Resources Available
There are several types of division of resources into types, depending on categorization features. Thus, resources can be divided into tangible and intangible by the fact of physical existence, financial and human by generalized orientation, potential, available, or developed by timing. In addition, available resources in the format of mental health care can include various types of assistance to patients, formats of interaction, and feedback, for example, support groups, emergency care, contact centers, and direct treating physicians (Stenmark et al., 2022). However, in this case, it is most appropriate to pay attention to the division by orientation.
Fiscal resources are part of the general concept of financial resources and relate more to the public distribution of money, reporting, financing, and taxation. General financial resources are undoubtedly an important factor that is considered in this paper because, without financial support and management, no industry can exist (Alegría et al., 2018). On the other hand, human resources include the personnel and related factors directly: the number, training, and education of employees, performance management, control over the quality of treatment provided and compliance with standards, planning, and development of human resources in the industry.
The current resources available are medical personnel, private and public clinics, public assistance organizations, medical supplies, facilities, equipment, and allocated funding. The purpose of managing all this is to diagnose, eliminate or alleviate the symptoms, causes, and manifestations of mental health disorders in order to cure people or at least improve their health status. Accordingly, all these resources must be adequately evaluated quantitatively and qualitatively to offer the most precise options for their optimal allocation in order to develop a nursing program proposal.
Strategic Decisions to Consider
The proposal recommends three strategies that have the potential to improve industry performance and leverage all available resources. The first is the increased adoption of technological innovation in diagnosing, treating, and preventing mental illness. According to Sporinova et al. (2019), such methods are already widely used by professionals. However, the level of their prevalence and development does not match the growth rate of society’s digitalization rate. For example, the expansion of videoconferencing can help normalize the distribution of specific specialists and save time and resources. Making a diagnosis in most cases is possible with virtual contact, especially if software analysis of patient characteristics is connected, which is another development in the industry and should be implemented further.
The second possible strategy could be defined as empowering those who are not fully licensed psychiatrists. For example, psychiatric assistants or nursing leaders with some training in mental health or who have taken a short course could assist in lighter or more preventive cases. Undoubtedly, supervision and general supervision should be done by a professional, but the benefits of such a move are likely. It is temporary and parallels the increase in the training rate needed by professionals. In the short-term format, it can threaten to reduce the burden on the industry with little or no additional financial. However, it is necessary to consider the overall workload of medical units and not deprive additional employees of time and opportunities to perform their primary duties.
The third strategy could be reinforcing the collaborative care already practiced in some places. The term implies the involvement of staff members from other medical units who have the most contact with patients to note their potential need for psychiatric care (Moreno et al., 2020). Although such a strategy requires increasing the staff of professional psychiatrists or implementing a second strategy, its main goal is to overcome the barrier between the community and psychiatry. Since the primary goal of the industry is to care for the health of the nation, this factor must necessarily be evaluated. People can rarely diagnose mental deviations on their own, and the reputation of psychiatric clinics, combined with prejudice, reduces the number of patients coming forward (Moreno et al., 2020). Including mental health and attitude normalization materials in citizen education programs is likewise possible.
Methods and Tools to Track the Strategic Impact
In the context of reviewing the outcomes of strategies, one can distinguish methods of Failure modes and effects analysis, Plan-Do-Study-Act, and quality assessment, including patient surveys. However, quality assessment methods and tools can vary widely due to the differentiated nature of the medical field and various unpredictable factors in the treatment of mental illness. Consequences and types of failures track changes over time, determining the effectiveness of processes by using tools to detect new emerging problems, their outcomes, and their solutions (Stenmark et al., 2022). PDSA involves subsequent cyclical adjustment of changes to achieve the desired outcome. Tools exist to track monthly and annual effects in the form of comparisons of patient data, budget costs, and overall patient and employee recall rates.
Project tracking tools can be used to develop a program that allows greater access to care for mental health. These tools can help to organize and manage tasks, set deadlines, and track progress on the program’s development. They can also be used to collaborate with team members, share resources, and communicate effectively throughout the development process. Some popular project tracking tools include Asana, Trello, and Jira. By using these tools, a team can effectively plan and execute a program that improves access to mental health care for individuals in need.
Conclusion
Thus, the proposed strategies have the potential to further improve mental health care outcomes in addition to the overall mandatory trend toward the development of the field and increased funding. If all available resources, opportunities, and risks are taken into account, the implementation of these strategies can be evaluated by means of evaluation methods and corrected if necessary. Actions in the sphere of mental health towards improvement are necessary today since the stereotypical perception of people of psychiatry and their unwillingness to interact complicate the care for the health of the nation.
Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., Cannon, M., Correll, C. U., Byrne, L., Carr, S., Chen, E. Y. H., Gorwood, P., Johnson, S., Kärkkäinen, H., Krystal, J. H., Lee, J., Lieberman, J., López-Jaramillo, C., Männikkö, M., … Arango, C. (2020). How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet. Psychiatry, 7(9), 813–824. Web.
When an individual is accepted as a refugee, they will be living in the new country for a long time, and this process could affect their mental health if it is not taken into account. The World Health Organization estimates that 18% of refugees have symptoms associated with depression or anxiety at any given time (von Werthern et al., 2019). This rate may be higher for some populations, such as Afghanistan and Sudan (von Werthern et al., 2019). These two nations are where post-traumatic stress disorder (PTSD) is prevalent in up to 80% of survivors (von Werthern et al., 2019). Mental health services are generally not accessible in refugee camps or exile communities which further contributes to existing mental disorders among these populations. Individuals facing hardship cannot always control their memories and emotions. Hence, they might start to give up hope and feel overwhelmed by the changes they have been going through (von Werthern et al., 2019). Many factors affect the mental health of refugees: displacement, cultural shock, the trauma of flight, and uncertainty about the future.
The main factor that affects the mental health of refugees is displacement. Displacement is the physical separation of a person from their community, culture, and identity. Displacement occurs when a person’s life is disrupted due to events such as war or natural disasters (Löbel, 2020). When people are displaced, they often form new relationships and create new meaning in their lives outside of their home country. Often people have to leave behind their homes, loved ones, jobs, and possessions (Löbel, 2020). This experience is one of the most traumatic events that can happen to individuals. The uncertainty associated with being displaced can be stressful and cause high anxiety levels, leading to depression or PTSD (Löbel, 2020). Many refugee families who flee from their country are separated during the flight or at first asylum camps, which can cause additional stress on those individuals who are separated from family members. Subsequently, displacement causes refugees to lose connection with their loved ones, leading to various mental issues such as stress.
Refugees are often affected by culture shock, which is a psychological response to the unfamiliar surroundings of a new place. Culture shock can cause many problems for these individuals, such as stress, depression, and anxiety (Kronick et al., 2021). Because these refugees have fled from their normal environment, which stresses them out, they may also suffer from culture shock because they are trying to adapt to their new situation, which can lead to depression and anxiety (Kronick et al., 2021). Refugee stressors include cultural issues such as religion, political attitudes and values, gender roles, language barriers, and individual strategies used to cope with their situation (Kronick et al., 2021). This transition can be difficult for those refugees who have known each other since birth and were raised in the same community or city. It is also common for refugees to have trouble adjusting to the new culture and language (Kronick et al., 2021). This can cause a lot of stress and make it hard for them to make friends with their culture because they feel more comfortable with people like them.
Additionally, each refugee camp has a different culture, which stresses refugees out because they might not get along with their new community. Refugees might feel isolated and find it difficult to become accepted by their community due to cultural differences (Kronick et al., 2021). Cultural issues such as food and hygiene problems are possible in these camps, which makes things more complicated for the refugees who are already feeling stressed (Kronick et al., 2021). For instance, many refugees have limited experience with food in their new homes, so they might have a bad experience eating new foods. Refugee camps lack good hygiene standards, and people can get sick from using the same water sources used by millions of people in their home country (Kronick et al., 2021). These cultural differences are among the factors that can lead to depression, anxiety, and stress among refugees.
The trauma of flight is another factor that affects refugees’ mental health. When refugees flee their country, they experience trauma, such as bomb blasts and the killing of loved ones. Refugees face danger when fleeing from their homeland to escape war and persecution (Löbel, 2020). After these traumatic events, many refugees experience severe psychological reactions, leading to PTSD, grief, or depression in adults and children (Löbel, 2020). Being separated from family members during a flight could affect children’s mental health (Löbel, 2020). For instance, children might develop fear, guilt, and confusion, leading to PTSD if their traumatic experience is not appropriately treated. Additionally, children may have difficulty adjusting to their new lives because they might face a new culture and language, which could cause stress, anxiety, and depression (Löbel, 2020). This means that even when these children go to school, they will have difficulty adjusting and playing with other kids. Hence, without proper care, such children could have various mental conditions that could worsen.
One of the most critical factors contributing to refugees’ mental health is uncertainty about the future. This fear of the unknown creates a lot of anxiety for those trying to adapt to their new life in a foreign land, and it can cause them to feel overwhelmed by everything around them (Kronick et al., 2021). For example, refugees might be worried about their future because they do not know whether or not they will be able to provide for themselves. Many refugees are also concerned about the well-being of their families in the camps, which causes a great deal of stress and anxiety (Kronick et al., 2021). This uncertainty can cause many problems for these individuals and make them anxious. One solution was to create a strategy to help refugees learn how to cope with their situation in a new country to reduce as much anxiety or depression.
In conclusion, refugees fleeing from their country have many mental health problems associated with their experience because of the trauma they endure. These individuals face many stressors, such as uncertainty about their future, the trauma of flight, culture shock, and more which can cause anxiety, depression, and PTSD. Because of this, many refugees have resorted to seeking refugee camp mental health services to cope with their situation in a new country and feel less stress. Many refugee camps are not well established and may lack proper medical care. Many refugees are unaware of where they can get mental health services and usually have no other options than clinics. Sometimes, the best option is to go to the clinic to which their camp has been assigned. However, many refugees do not have access to this service. Therefore, refugee clinics should help deal with trauma, culture shock, and other psychological issues affecting refugees, such as anxiety and depression. Taking care of refugees’ mental health is essential because it will help them prevent these problems from these issues.
