Health Research

Table of Contents

Introduction.

Nexus between mental health and physical health relating to co-morbidity.

Model of recovery.

Understanding of the mental state examination.

Exploration of the skills required to engage and support a person with mental health needs.

Conclusion.

Reference List

Introduction to Dimensions of Physical and Mental Health

In order to develop nursing skills and knowledge’s it is required for the nurses to reflect upon their own experiences and learning. This study aims at reflection of thoughts and feelings regarding the mental health and addictions for enhancing knowledge and skills so that effective care can be delivered to the individuals that are suffering from mental illness. In order to achieve the same the current study will follow the steps such as description of the event, emotion of the nurse experiencing the situation, related thoughts, learning’s from the experience and application of those skills and knowledge to reach to conclusion. Bill, who has a long history of mental health crisis, has been discharged from acute inpatient metal health word. He looks dishevelled and cold and yelling at the nurse.

Nexus Between Mental Health and Physical Health Relating to Co-Morbidity

It is evident that mental and physical health is dependent on each other. The physical disorders are likely to deteriorate the overall health condition of a patient making their life more difficult for surviving. As per the views of Romain, Marleau & Baillot (2018), co-morbidity dos not only enhance suffering of a patient; it also increases the cost of treatment of the patient suffering from mental illness. The current case study does not provide clear understanding of the mental illness along with the co-morbidity of bill. However, it can be identified that Bill has alcohol dependence and a long history of mental health disorder. Along with this, focus can also be given to the lack of self care and dishevelled condition of the patient.

The access to care becomes difficult and the quality of care also reduces due to the stigma attached to the mental healthcare. These contribute to the probability of increasing complications of physical illnesses. The likelihood of complications increases due to discrimination and stigma attached to the mental health care and self-neglects (Vinall et al., 2016). Therefore, it can be stared that the link between the mental health and physical conditions such as in the case of Bill is required to be understood effectively so that the underlying health conditions can be treated for achieving better mental and physical health outcomes. Additionally, here is a common co-morbidity among both the sexes can be identified in the Australian context is substance use disorders in combination with anxiety disorders (0.8% in females and 1.3% in males). On the other hand, Department of Health (2020) found a highly significant relationship between substance abuse and anxiety disorders which worsen the condition of the patient with regards to his or her recovery from the mental illness. Similarly, in the current case, alcohol abuse can be a reason fir difficulty in treating the mental health issue of bill due to which he is suffering for a long period.

Model of Recovery

Recovery model of healthcare has been developed based on a person-cantered and holistic approach and considered as a standard model of healthcare. According to Ellison et al., (2018), there are two basic premises of this model such as “it is possible to recover from a mental health condition” and “the most effective recovery is patient directed”. As per this model, the perspective of the individual affected by mental illness is gaining and retaining hope is the sign of recovery. Apart from that, understanding a person’s abilities and disabilities and engaging in the active life, social identity, personal autonomy, meaning and purpose of life and positive sense of self are also the meaning of recovery.

One of the principles of recovery is considering the uniqueness of the individual. As per this principle, apart from caring for the person it is required to ensure that the person has opportunities for choices and his or her life is meaning to him or her (Department of Health, 2020). It is required to accept that the outcomes of recovery are personal and unique to the person and focus should be given upon quality of life and social inclusion. Putting the same into personal practice I would prioritise the individual and his sense of recovery and ensure that the life of that individual is meaningful as per their perspective.

It is evident that the individual independence of choices helps in creating meaning of life. This approach is covered in the principle of Real Choice. Under the model of recovery individuals are required to be empowered and supported for making their own choices and to be allowed for exploring the choices in creative manner. As per my viewpoint, it is required to follow the clinical practices and inputs from the physician along with psychiatrist (Frost et al., 2017). Applying both into the practice, it can be sated that the focus should be given both on the clinical instructions and individual choices to make the client live an independent and empowered life.

The principle ofattitudes and rights is oriented towards providing care support that is embedded with active listening and acting upon communication, giving the patient with meaning of life by developing social, recreational, occupational and vocational activities that are meaningful to the individual (Ashford, Brown & Curtis, 2018). The individual’s human rights and citizenship rights are also required to be protected during care practices. As a learner I could only focus on the promotion of individual health, however, I have developed understanding that I need to protect the rights of the patient’s also which I can perform by empowering the individual through providing education about human rights and how those can be protected. 

Another principle of recovery is dignity and respect. It is important to mention here that the health care practitioners are required to be courteous, honest and respectful to the patients to promote recovery (Department of Health, 2020). If the patient can be surrounded by sensitivity with respect to their beliefs, values and culture the discriminatory behavior and chances of stigmatization can be reduced. In the current practice setting I would focus on developing understanding about the beliefs and values of a patient before starting the clinical support practices so that dignity and respect can shown to the client.

The recovery model also considers that individuals are expert on their own lives due to which the principle of partnership and communication is required to be taken under consideration while planning and delivering care to the individuals (Nickel, Weinberger & Guze, 2018). The relevant information regarding the illness and treatment is required to be shared with the individuals and I would focus on helping the individuals to realize their own goals, hopes and aspirations. The recovery model also directs for evaluating the recovery plan. Here, I would implement regular care evaluation, recordings of progress, change process of recovery if aims are not achieved.

Understanding of The Mental State Examination

Understanding the state of the patient’s mind is essential in making any treatment related decisions as it guides towards less erroneous diagnosis and solid ground to support the treatment plan. Mental State Examination can be considered as a structured way of collecting information related to the mental condition of a patient such as mood, affect, behaviour, insight, thought content, perception, speech and others. There are several domains under which these conditions are recorded.

The appearance of a patient is likely to convey about the current condition and lifestyle of the person and indicates towards self-care abilities which includes distinctive features, clothing, hygiene, grooming, evidence of self-harm and others (Creavin et al., 2018). However, in the current condition, Bill has been observed to be dishevelled which indicates towards lack of self-care. Behaviours of patients can reflect their mental issues. Difficulties in eye contact, facial expressions, and motor activities related to mental process or psychomotor activities, gestures, body language, ability to follow requests are the behavioural assessments that help understanding the patient’s mental issues (Ciesielska et al., 2016). Speech is the reflection of a patient’s thought processes, therefore, assessing rate of speech, quantity of speed, volume and tone might indicate if there is any issue with thought process of the patient.

Bill has been observed to be shouting and yelling at everybody without any valid reason that can be an indication of issues in thought processes. Different mood disturbance along with difficult affects can create issues in mental wellbeing of a person. Therefore, assessing the mood and long term feeling such as anxiety, anger, depression, and irritability can be significant indicator of disturbances (Lawton et al., 2016). Additionally, assessment are also required to be done for understanding if the person’s thought process is coherent, linear, circumstantial or others. Mental illness affects logical thought, issues with perception, such as hallucination, delusion, and others which can be associated with different kinds of mental illness. As I observed Bill to yell at me and every other person, I felt surprised. I could not respond without knowing much about that person, however, I have started thinking what the underlying cause of this behaviour is. Apart from that, I also thought about how I could help that person.

 Therefore, in order to meet the needs of Bill, it is required to focus on his thought process and speech. It is required to promote his health by educating about self-care process. Along with this, Bill is also required to be empowered by providing information about his accommodation.

Exploration of The Skills Required to Engage and Support a Person with Mental Health Needs

Empathy

Considering the learning from the current reflection, it can be stated that it is likely for patients with mental illness to demonstrate high irritability, agitation, incoherent thoughts and behaviours (Crane et al., 2019). As a nurse, I need to empathise with the patient and understand how these issues are affecting the person. For instance, I will empathise with Bill and would try to comfort him first before assessing.

Following principles of recovery

Applying the principles of recovery I am going to treat Bill in respectful and dignified manner. Apart from that, my only focus will be empowering the person and ensure that he gets proper treatment and shelter (Rousseau & Frounfelker, 2019). His health condition is also required to be prioritised which can be achieved through training bill about taking care of self. I will also ensure that Bill is being engaged with any vocation training process so that he can meaningfully live his life.

Verbal and written communication skills

I have identified that Bill is facing mental health issues which have deteriorated his overall health and wellbeing. Apart from psychiatric intervention, Bill requires total healthcare support which can be achieved only through collaborative healthcare approach (McCann & Sharek, 2016). Therefore, I would try to collaborate with other healthcare professionals in order to develop a care planning that addresses both mental and physical health issues of bill along with proper diet plan, exercise, social support and empowerment will also be prioritised.

Unconditional positive regards

The patient is already facing issues that created difficulties in healthy living. I will provide care and support to Bill regardless of what he says to me or does (Ashford, Brown & Curtis, 2018). The care planning will be developed based on the patient’s preference as he is aware of his everyday life and his process of living his life more than any care provider. I will ensure that the person is treated in dignified manner at every point of healthcare journey.

Conclusion on Dimensions of Physical and Mental Health

In conclusion, it can be stated that Bill is facing mental health issues even after leaving the acute inpatient mental health ward. The behavioural aspects observable in the current scenario are the result of the issues he is suffering from. The current study has applied the principles of recovery based on which a patient is required to be kept in the centre of care process and care planning will be developed based on the choices of a person. Here the individuality of a person is respected and empowered for making personal decision. Apart from that a person is required to be supported with vocational and other skill development opportunity so that the life can be made meaningful to him or her. The learning from the current study will be applied in the case Bill where the patient will be provided integrated healthcare service where collaborative approach for improving mental and physical health will be taken under consideration.

Reference List for Dimensions of Physical and Mental Health

Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Collegiate recovery programs: the integrated behavioral health model. Alcoholism Treatment Quarterly, 36(2), 274-285. Retrieved 22 August 2020, from https://www.researchgate.net/profile/Robert_Ashford4/publication/322079166_Collegiate_Recovery_Programs_The_Integrated_Behavioral_Health_Model/links/5a43b3070f7e9ba868a77dce/Collegiate-Recovery-Programs-The-Integrated-Behavioral-Health-Model.pdf

Ciesielska, N., Sokolowski, R., Mazur, E., Podhorecka, M., Polak-Szabela, A., & Kedziora-Kornatowska, K. (2016). Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol, 50(5), 1039-1052. Retrieved 23 August 2020, from https://www.psychiatriapolska.pl/uploads/images/PP_5_2016/ENGver1039Ciesielska_PsychiatrPol2016v50i5.pdf

Crane, L., Adams, F., Harper, G., Welch, J., & Pellicano, E. (2019). ‘Something needs to change’: mental health experiences of young autistic adults in England. Autism, 23(2), 477-493. Retrieved 20 August 2020, from https://discovery.ucl.ac.uk/id/eprint/10041364/1/Crane_What%E2%80%99s%20my%20normal_paper_R2.pdf

Creavin, S. T., Wisniewski, S., Noel‐Storr, A. H., Trevelyan, C. M., Hampton, T., Rayment, D., ... & Patel, A. S. (2016). Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews, (1). Retrieved 23 August 2020, from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011145.pub2/full

Department of Health, (2020). Mental disorder comorbidity. Retrieved 22 August 2020, from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-m-mhaust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-men\

Department of Health, (2020). Principles of recovery oriented mental health practice. Retrieved 23 August 2020, from https://www1.health.gov.au/internet/main/publishing.nsf/content/CFA833CB8C1AA178CA257BF0001E7520/$File/servpri.pdf

Ellison, M. L., Belanger, L. K., Niles, B. L., Evans, L. C., & Bauer, M. S. (2018). Explication and definition of mental health recovery: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 91-102. Retrieved 22 August 2020, from https://www.researchgate.net/profile/Marsha_Ellison/publication/308907940_Explication_and_Definition_of_Mental_Health_Recovery_A_Systematic_Review/links/5a5e6cf6a6fdcc68fa99288a/Explication-and-Definition-of-Mental-Health-Recovery-A-Systematic-Review.pdf

Frost, B. G., Tirupati, S., Johnston, S., Turrell, M., Lewin, T. J., Sly, K. A., & Conrad, A. M. (2017). An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC psychiatry, 17(1), 22. Retrieved 22 August 2020, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1164-3?optIn=false

Lawton, M., Kasten, M., May, M. T., Mollenhauer, B., Schaumburg, M., Liepelt‐Scarfone, I., ... & Ben‐Shlomo, Y. (2016). Validation of conversion between mini–mental state examination and montreal cognitive assessment. Movement Disorders, 31(4), 593-596. Retrieved 20 August 2020, from https://movementdisorders.onlinelibrary.wiley.com/doi/pdf/10.1002/mds.26498

McCann, E., & Sharek, D. (2016). Mental health needs of people who identify as transgender: A review of the literature. Archives of psychiatric nursing, 30(2), 280-285. Retrieved 20 August 2020, from https://www.researchgate.net/profile/Edward_Mccann/publication/287197399_Mental_health_needs_of_people_who_identify_as_transgender_A_review_of_the_literature/links/56e7d82108ae85e780d2652d.pdf

Nickel, W. K., Weinberger, S. E., & Guze, P. A. (2018). Principles for patient and family partnership in care: an American College of Physicians position paper. Annals of internal medicine, 169(11), 796-799. Retrieved 23 August 2020, from https://www.acpjournals.org/doi/pdf/10.7326/M18-0018

Romain, A. J., Marleau, J., & Baillot, A. (2018). Impact of obesity and mood disorders on physical comorbidities, psychological well-being, health behaviours and use of health services. Journal of affective disorders, 225, 381-388. Retrieved 20 August 2020, from https://www.researchgate.net/profile/Ahmed_Romain/publication/319245099_Impact_of_obesity_and_mood_disorders_on_physical_comorbidities_psychological_well-being_health_behaviours_and_use_of_health_services/links/5a2edae40f7e9bfe81700437/Impact-of-obesity-and-mood-disorders-on-physical-comorbidities-psychological-well-being-health-behaviours-and-use-of-health-services.pdf

Rousseau, C., & Frounfelker, R. L. (2019). Mental health needs and services for migrants: an overview for primary care providers. Journal of Travel Medicine, 26(2), tay150. Retrieved 20 August 2020, from https://www.sherpa-recherche.com/wp-content/uploads/Mental-health-needs-newcomers_Frounfelker-et-Rousseau.pdf

Vinall, J., Pavlova, M., Asmundson, G. J., Rasic, N., & Noel, M. (2016). Mental health comorbidities in pediatric chronic pain: a narrative review of epidemiology, models, neurobiological mechanisms and treatment. Children, 3(4), 40. Retrieved 21 August 2020, from https://www.mdpi.com/2227-9067/3/4/40/pdf

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