Mental health and physical health are intrinsically linked with each other. They are fundamentally related to each other, and there exist multiple associations between the chronic physical conditions and mental health which impact the lives of people and their quality of lives in a significant manner. These associations also affect the demands on the health care and other funded services-publicly and also generate consequences for the society as well (Dare et al., 2019). It is instated by the WHO, that “there exists no health without mental health” and that health is a state of complete social, physical and mental well-being (WHO). Going by the associations, it is observed that people who are suffering from any serious mental health issue or disorder are at a greater risk of developing any kind of mental disorder or a state of poor mental health (Canadian Mental Health Association, 2019). Also, poor mental health becomes a significant risk factor for the development of chronic physical conditions and in cases where people are suffering from serious issues with their mental health, they become more prone to experience chronic physical diseases or conditions as well. In this article, this association between physical and mental health will be discussed and how it is important in nursing practice.
There exists no area where the relationship between mental health and physical health is as evident as co-morbidities and chronic conditions. The various social determinants of health are impacting both the physical and mental health of the patients equally (Canadian Mental Health Association, 2019). There is increasing prevalence of both, mental and physical diseases and its co-morbidities which has reached epidemic levels in most countries and it has been grossly underestimated in most countries. It has become a norm to have the simultaneous presence of more than one disease at a time, especially in the age group of 60 and above. This co-morbidity is also increasing at younger ages where there are negative consequences of these conditions which are as numerous as the ones occurring at a higher age as well (Dare et al., 2019). Co-morbidity does not involve separate routes and trajectories for the diseases, instead it means that the presence of multiple diseases will affect and worsen the prognosis of all the diseases that are present and cause increasing complications and difficulties in treatment of all the diseases. This association between the psychological and physical co-morbidities is complicated and the casual relationship established for one disorder- mental or physical might not be true for another disorder (Sharma, 2016).
Also, what happens is that, in cases of co-morbidities, certain diseases are often over-looked, usually the mental disorders. This occurs with the understanding that the general practitioners or any non-psychiatric doctors focus on the physical diseases they know about and can treat, most often ignoring the associated mental condition or disease that might have developed along with the physical illness. On the other hand, psychiatrists tend to do the same with physical illnesses, where they mostly tend to deal with the mental illness that they have the experience and expertise to treat, often missing or under-treating the co-morbid physical illness. Both practitioners might skip the required physical examination or mental state examination to check for both, physical and mental illness and co-morbidities. The co-morbidities have a huge burden on the people living in developing nations. The mental health disorders are often un-prioritised in these countries, which should be focused more upon, given the increasing burden of non-communicable diseases and the fact that there exists no health without mental health (Dare et al., 2019). Strong cross-effects between physical and mental health have been found even after the cofounders are controlled. However, very little, exact knowledge about the probable pathways that affect the mental and physical health are known to each other and vice-versa (Ohrnberger et al., 2017). A mediation analysis studying the pathways showed that previous mental health has a major impact- both direct and indirect on the current physical health state which is mediated by social interactions and lifestyle choices of the people. It also showed that the relationship between past physical health and current state of mental health is only mediated by the rate of physical activity in the past (Ohrnberger et al., 2017).
This model is a complete, person-centred approach to mental health care and has gained momentum and importance in the past decade and is becoming the basic, standard model of mental health care as well. It involves a holistic view towards the idea of recovery for a person suffering from mental illness and focuses on the entire person, and not just his/her symptoms. It argues that a recovery like this is possible and it is a complete journey, instead of a destination. It does not mostly talk about returning to the previous level of functioning and asymptomatic phase, that is before the morbidity. Nor does t talk about a linear way of progressing towards recovery, but a phase of recovery that might happen in phases and various ups and downs (Jacob, 2015).
The model promotes the idea that, people might not have complete control over their own conditions and symptoms, but they can have a control over their lives. It aims to help people suffering from any kind of mental illness to look beyond mere existence and survival for the sake of surviving. It encourages the people to move ahead in life and set new aims and goals for themselves. It also supports the point of view that people suffering from mental health issues should get on with their lives and do and develop things and relationships that helps them give some meaning to their lives. Both practitioners and nurses are responsible for the provision of mental health care to patients. However, it is observed that nurses alone cannot adopt a recovery model of mental health and they require support from the medics in provision of care like this , instead of a symptom based approach to care which only focuses on particular symptoms at a time and not holistic care (Cusack et al., 2017).
Looking at the concept of how learning to deal with mental health issues and the adoption of the recovery model of care is an important aspect of nursing practice irrespective of the speciality of the nurses or their career trajectory, it is found that they may have to deal with patients who show explicit signs or are at a risk of developing mental health issues (Goman et al., 2020). A more holistic model of care needs to be implemented in terms of nursing care because of the increasing co-morbidities and associations between the mental and physical illnesses. The holistic mode involves breaking down the barriers and stigmatisation associated with mental health conditions and necessitates the future health professionals and nurses to be educated in mental health nursing and care irrespective of their own specialisation and career plans (Santangelo et al., 2018).
Nurses need to increase their knowledge and expertise in the provision of over-all care , including mental health care because sometimes patients suffering from chronic traumatic disorders or patients in emergency care can have triggered mental health issues such as anxiety and depression, amongst other mental health disorders. Hence, it becomes imperative for nursing professionals to be able to identify, examine and provide care for the same (Goman et al., 2020).
The basic purpose of assessment and care planning for a patient and individual is to provide a comprehensive assessment and examination of the individual in order to provide best-possible holistic care to him/her which will include both-physical and mental health as well. Mental state examination is a part of the holistic care examination and is beneficial and important for the comprehensive assessment of the patient. The aim of the mental state examination is to obtain a comprehensive, complete, cross-sectional description of the mental state of a patient’s mental state, which in combination with the biographical, physical and historical information of the patient’s history of health and psychiatry, helps the clinician to make an accurate and specific diagnosis, necessary for a coherent, holistic planning of treatment. It is a structured method of observing and then providing a description of the psychological condition of the patient at a given point of time, under the headings of attitude of the patient, physical appearance, mood, behavior, speech, judgment, cognition, content of thought process and perception (Fernando, 2016). Even though it is said to be practically unreal to perform a comprehensive mental state examination at every visit of the patient, incorporation of major components of a formal MSE whenever it is sensed by the health care professional that something is not right with the patient can help in the identification of psychiatric illnesses and help in the provision of the required extensive evaluation and referrals as well. It helps in identification of the mental co-morbidity that the individual might be suffering from along with his/her mental condition as well.
The duty of the nurse is to provide holistic care and that will include addressing the mental state of the patient. All registered nurses are not prepared in proper psychiatric training, but they still owe the responsibility of providing care for the mentally ill patients and also help the patients in obtaining treatment for any kind of mental and psychological distress. Irrespective of the specialty, nurses have to deal with patients who either show signs and symptoms of, or at a risk of development of mental illness (Bekhet et al., 2018). Menyal illness patients can display a range of symptoms including aggression, violence and despondency.
Nurses should be aware and prepared that a troublesome, sad or sullen patient maught just be showing signs of any kind of mental illness. The following strategy can be applied by the nurses in case of dealing with a patient of mental illness: Assessing the mental state of the patient, establishing good communication with the patient, building a trusting relationship with him/her, using language that displays concern and consideration, provide care which is sensitive and patient-centered and oriented, consulting with mental health professionals and referral, if required to the community services (Lambert, 2018). Nurses have a responsibility of provision of medical and nursing care and support to individuals suffering from a range of mental health conditions.
Mental health patients require significant sensitivity and compassion to be displayed towards them along with great communication skills as well that will help them deal with challenging conditions. Nurses working in mental health settings are required to give verbal instructions to make the patients feel more empowered in situations where the patients feel, they can exercise some control. It is essential to understand what is the right thing to say along with the volume and tone of voice and the appropriate, associated body language as well which is essential to care for the patients in a number of situations. One such significant technique is therapeutic communication which is a part of a lot of mental health nursing tasks, including the teaching and problem-solving techniques as well. It requires the use of appropriate and focused strategies which help in encouragement of the patient to be able to express his/her feelings and ideas which convey respect and acceptance. It helps in developing focused interactions which are non-judgmental that take place between the nurses and the patients and make him/her feel safe (Lambert, 2018). It involves the nurse to influence the patient in a better way to come to a better understanding by way of both- non-verbal and verbal communication. Other skills such as specialized assessment skills, along with proper treatment planning and evaluation can help improve outcomes for patients with co-morbid physical and mental health issues, both.
The other important skill required is therapeutic relationship building by the nurses, which involves the usage of specific clinical techniques along with displaying personal attitudes as well when interacting with the affected individuals. Such relationships between the nurse and the patient are more- oriented towards patient care and are majorly directed to improve learning, and healing of the patients along with improved health outcomes as well. (Bekhet et al., 2018).
There is a definite relationship between the physical health and mental health and the associations are direct and significant where any change or effect in one state of the individual might produce changes on the other. There is greater proof of increasing co-morbidities between both, the physical and mental health. This increase in co-morbidities necessitates the acknowledgement and practice of mental health and ways to handle mental health issues to help in provision of complete care to the patients. The practice of nursing is focused on the complete, holistic well-being of patients and providing support for the same which is inclusive of their mental health as well. Nurses should continue their education to learn more about identifying mental illness in patients and how to help them get the psychiatric care they need. With assistance and empathy from nurses, patients can overcome the stigma associated with mental illness.
Bekhet, A. K., Zauszniewski, J. A., Matel-Anderson, D. M., Suresky, M. J., & Stonehouse, M. (2018). Evidence for psychiatric and mental health nursing interventions: An update (2011 through 2015). Online Journal of Issues in Nursing, 23(2), 1-28.
Canadian Mental Health Association. (2019). Connection between mental and physical health. Canadian Mental Health Association: Mental Health For All.
Cusack, E., Killoury, F., & Nugent, L. E. (2017). The professional psychiatric/mental health nurse: skills, competencies and supports required to adopt recovery‐orientated policy in practice. Journal of Psychiatric and Mental Health Nursing, 24(2-3), 93-104.
Daré, L. O., Bruand, P. E., Gérard, D., Marin, B., Lameyre, V., Boumédiène, F., & Preux, P. M. (2019). Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: A meta-analysis. BMC Public Health, 19(1), 304.
Fernando, I., & Carter, G. (2016). A case report using the mental state examination scale (MSES): A tool for measuring change in mental state. Australasian Psychiatry, 24(1), 76-80.
Goman, C., Patterson, C., Moxham, L., Harada, T., & Tapsell, A. (2020). Alternative mental health clinical placements: Knowledge transfer and benefits for nursing practice outside mental health care settings. Journal of Clinical Nursing.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian Journal of Psychological Medicine, 37(2), 117.
Lambert, K. D., & Salmon, N. (2018). Caring for patients with mental health disorders. USA: AMN Healthcare Education Services
Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195, 42-49.
Santangelo, P., Procter, N., & Fassett, D. (2018). Mental health nursing: Daring to be different, special and leading recovery‐focused care?. International Journal of Mental Health Nursing, 27(1), 258-266.
Sharma, M. (2016). Comorbidity of mental and physical disorders. Indian Journal of Medical Research, 144(5), 786-786.
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