Mental health and mental illness

Mental health and mental illness

• We all have mental health and all of us experience mental health challenges

• The two terms do not have the same meaning. See page 123 of your text for further elaboration.

• Mental health nursing skills enable us to help others with mental health concerns and also to help ourselves to consciously care for our own mental wellbeing

Mental Health

‘A state of well being in which an individual realises his or her own abilities, can cope with

the normal stresses of life, can work productively & is able to make a contribution to his or

her community’ (WHO, 2010 cited in Happell, Cowin, Roper, Lakeman & Cox, 2013 p. 183).

‘A state in which an individual has a positive sense of self, personal & social support with

which to respond to life’s challenges, meaningful relationships with others, access to Mental health and mental illness

employment & recreational activities, sufficient financial resources & suitable living

arrangements (Elder et al. 2013, p. 477).

Mental Illness

• Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (2013)

International Classification of Disorders (ICD-10)

• Mental Illness is defined legally and is regulated by relevant Mental Health Acts in each Australian State.

• Mental illness – is characterised by a clinically significant disturbance of thought, mood, perception or memory

• a person must not be considered to have a mental illness merely because of any one or more of the following: Mental health and mental illness

(a) holds or refuses to hold a particular religious cultural, philosophical or political belief or opinion (b) member of ethnic or ‘racial’ group (c) economic or social status (d) sexual preference or sexual orientation (e) sexual promiscuity (f) immoral or indecent conduct (g) takes drugs or alcohol (h) intellectual disability (i) antisocial behaviour or illegal behaviour (j) involved in family conflict (k) previously been treated for mental illness or previously subject to involuntary assessment or

treatment (Queensland Government 2017, p. 5).

Definitional dilemmas

Recognise that ideas of health and therefore, definitions of health and illness, are social constructs (i.e. created by people).

Social, political, economic, cultural and historical factors influence definitions of illnesses (diagnosis) and treatment

Definitions and treatment are susceptible to changes in values in society (e.g. homosexuality as a mental illness). Mental health and mental illness


Mental Health Continuum

Wellness Illness

when becoming unwell or not coping we begin to lose function in one or several of the following areas – occupationally, intellectually, socially, psychologically, physically

when we are well we function at our usual levels or in our usual way occupationally, intellectually, socially, psychologically and physically

The mental health continuum

• minor symptoms to severe psychotic disturbances

• shades of human experience that lie between extremes

• the capacity for health status to shift between mental health and mental illness

• we all shift along the continuum

• any one of us could develop a mental illness at any time

• our own experience helps us to empathise with others …health professionals, including nurses, are of course also service users

• challenges ‘us and them’ ideas Mental health and mental illness

• those diagnosed with a mental illness can become well


Prevalence of Mental Illnesses – (Slade et al. 2009)

• 45.5% of the total population experienced a mental disorder at some point in their lifetime • 20% of Australians aged 16-25 experienced a mental disorder in the previous year (i.e. almost 3.2

million people) • 14.4% suffered anxiety disorders • 6.2% suffered mood disorders • 5.1% suffered substance use disorders – men represented twice the number of women. • The prevalence of mental disorders declines with age from 26.4% in the 16-24 year age group to

5.9% in the 75-85 years group. • 11.9% of the population used health services for mental health problems in the previous year and

almost 20% had lifetime disorders • Women are much more likely to access services than men

The Stress Vulnerability Model

• A theory of causation of mental illness (Zubin & Spring, 1977) • the interaction between a person’s vulnerability, their coping ability, and the

stressors they are exposed to will determine whether a mental illness will develop or not.

Harmony, calm, peacefulness

What are vulnerabilities?

• Genetic predisposition • Country of birth? • Family of birth (as an adverse interpersonal environment; learned behaviour) • Presence of physical conditions/disease • Learning difficulties • Substance use/abuse

The Stress Vulnerability Model • Stressors challenge our ability to adapt. • Internal factors – developmental challenges, toxic substances, infection

responses, pregnancy, physical responses to external stressors; and • External factors – for example, bereavement, promotion, marriage,

work/study pressure • Holmes & Rahe Social Readjustment rating Scale (1967). e.g.

The Stress Vulnerability Model

• The more vulnerability, the less stress is required to trigger the symptoms of a mental illness.

• Zubin & Spring (1977) argue that episodes of psychosis can arise for anyone under the right conditions (e.g. refugee detention). Mental health and mental illness

• It is important that we consider all of the factors interacting to potentially cause illness for a person (including ourselves).

The Water Tank Metaphor

The water tank represents our genetic makeup, which is predetermined. Some people are born with bigger tanks than others and they therefore have the capacity to hold more water and greater influxes before overflowing. ned/Risk_and_protective_factors/risk_objective_2/ind ex.html


The Water Tank Metaphor

The inflow pipe represents the external stressors (risk factors) which are often beyond our control. For example, rain often falls heavily and gutters fill quickly during a storm. This is equivalent to being overwhelmed by stressors – lots of stress all at once. At other times rain is minimal – not much stress. At other times rain may be regular and predictable – chronic but manageable stress.

The Water Tank Metaphor The outflow pipe represents personal (protective) factors such as habits and learnt coping strategies, or external protective factors like social support and employment. People with good coping strategies or strong external supports can control their outflow effectively to manage the water level in the tank, even when inflow is rapid and unpredictable. Others, particularly those with smaller tanks, might not be able to control their outflow and water levels will rise and cause overflow. Mental health and mental illness

The protective factors differ for all of us

• Good physical health • Social support • Strong family relationships • Problem solving skills • Mindfulness skills/stress management skills • Sense of belonging • Internal locus of control • Little or no community violence • Also see p. 502 of your text for a comprehensive list of risk and protective factors.

Perspective is everything

Stop. Think. Respect. Racial discrimination and mental health.

• (2 mins 7 sec)

Stigma and Discrimination

Stigma, stereotyping and labelling

• negative attitudes, shaming & discrimination from others – experienced by most people with mental illnesses

• being treated by others as if one is disgraced Mental health and mental illness

• an attitude that is deeply discrediting

• people get labelled by their illness and are stereotyped

• people accept the world view and engage in self-stigma

Labelling and disempowerment

• Feeling diminished by the diagnostic label (2 mins 40 sec)

How society contributes to distress

• What are some common stereotypes of those experiencing mental health problems?

• What are some myths about those experiencing mental health problems?

• Stereotyping is often revealed in insulting names & terms.

• Can you think of any?

Perceptions/attitudes to mental illness might be shaped by…

• personal experience

• ignorance, misinformation, no information, misunderstanding information Mental health and mental illness

• modelling by family, peers and society such as through media – social; digital, electronic and print; film; music

• personal and societal values


What is person-centred mental health care?

The person is central to the process of mental health care

Recovery from mental illness is always possible

Recovery as a philosophy for practice

• “is a person-centred approach, underpinned by principles of social justice and equity, which

challenges an exclusive biomedical model of focusing mainly on symptom identification and

treatment” (Muir-Cochrane, Barkway & Nizette, 2014, p9).

• Provides a way of organising your thoughts about working with people with mental illness.

• Opens up possibilities for people with serious mental illness that were never understood only 30-

40 years ago.

Critical Factors in Recovery

• “Just one person who believed in me” • Friends • Pets • Medications (for some) • Personal goals • Self-will • Professionals (Curtis, 1997).

Core Elements of Recovery

• Hope – the belief that change and a better way of life is not only possible, but also attainable. • Personal Responsibility – not counting on others to solve one’s problems or cure the disorder,

but relying on one’s self with help from others. • Self-Determination – re-establishing control over one’s personal life, rights, and responsibilities. • Relationships – assistance from friends, family and professional health/mental health care givers. • Understanding – learning about the disorder, one’s self, what can be done, what is available to

help (Stanton, Tooth & Champ, 2017). • Identity – developing a sense of self beyond a diagnostic label (Palmer & Halpin, 2017). Mental health and mental illness

A Recovery Focused Mental Health System

• Professionals do not hold the key to recovery, people with mental illness do. The task of professionals is to facilitate recovery while the task of people who are unwell, is to recover.

• Recovery can occur even though symptoms reoccur. The episodic nature of severe mental illness does not prevent recovery.

• Recovery changes the frequency and duration of symptoms. Symptoms interfere with functioning less often and for briefer periods of time.

• Recovery involves growths and setbacks, periods of rapid change and little change. The recovery process feels anything but systematic and planned.

• Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself (e.g. stigma and discrimination) (Anthony, 1993) Mental health and mental illness

Also check: Integrating Evidence-Based Practice