Support For the Mentally Ill
Support in Mental HealthLacey HastingsStenberg CollegeAcute Psychiatric Nursing TheoryDon TuffordAbstractUntreated mental illness can have serious impacts on a person’s mood, thinking or behavior, their functioning and ability to cope. People often feel isolated and hopeless. Social support and relationships are strongly connected to mental health, without the love and support of family and significant others and the interactions within social groups, there is lack of companionship, leading to loneliness and isolation which has serious impacts of the individual’s mental state. Individuals suffering with mental illness need the support of health professionals; they benefit greatly from the therapeutic relationships and fail to move forward without. Income and unemployment also greatly affect individual’s mental state and contribute to the suffering of the mentally ill. They need financial support, appropriate housing and social assistance to maintain a healthier lifestyle and well-being. There are ways in which nurses can contribute to the many ‘supports’ needed for those suffering, including being mindful of the importance of and incorporating all forms of support into care and discharge planning. Support in Mental HealthMental health is essential to a person’s well-being, healthy family and interpersonal relationships, and the ability to live a full and productive life. Therefor people with untreated mental illnesses are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior, and suicide (Healthy People. 2013). Mental illness has a serious impact on a person's ability to function effectively over a long period of time and may cause serious disturbances in thinking, mood or behavior (Health Canada, 2006). They may not be able to cope with the simplest aspects of everyday life and most need help in regaining balance in their lives. However many seem to suffer in silence, not getting the support they need; left confused and isolated. Mental health disorders can have harmful and long-lasting effects—including high psychosocial and economic costs; with lack of financial support (Healthy People, 2013). People with untreated mental illness can often feel vulnerable and helpless. This writer believes that those suffering with mental illness need support to get back on their feet and maintain a healthy life, they need social support (including emotional), financial support and the support of health professionals; without this support there is devastating consequences, including the worsening of their mental state. As such, this writer will review and analyze relevant literature to support my claim.Social SupportMany types of scientific evidence show that involvement in social relationships benefits health (Umberson & Montez 2011; Thoits, 2011); these social relationships or social ties refer to connections to and contacts with other people through membership in primary and secondary groups. Primary groups consists of family, friends and relatives, they tend to be ‘significant others’ in which one has emotional ties (Thoits, 2011). Secondary groups tend to be larger groups, less personal and are more ‘formal’; religious groups, work, support groups, peer groups, etc. For these relationships to have benefits on health they need to include ‘support’; social support is defined as “a social network’s provision of psychological and material resources intended to benefit an individual’s ability to cope with stress”(Thoits, 2011, p.149). Substantial evidence has accumulated over the past few decades showing that social ties and social support are positively and causally related to mental health, physical health, and longevity (Berkman1995; Cohen and Janicki-Deverts 2009; Cohen and Wills 1985; Ertel, Glymour, and Berkman 2009; House, Umberson, and Landis 1988; Hughes and Gove 1981; Kessler and McLeod 1985; Kessler, Price, and Wortman 1985; Seeman 1996; S. E. Taylor 2007; Stroebe and Stroebe 1996; Thoits 1995; Turner and Turner 1999; Uchino 2004; Umberson and Montez 2010; as cited in Thoits 2011). Typically social support refers to functions performed for the individual by significant others or secondary group members, generally these functions include emotional, informational, and instrumental support (Thoits, 2011). Significant others’ emotional support (concern and caring, love, valuing, companionate presence) and instrumental coping assistance should sustain the individual’s sense of mattering, self-esteem, and belonging, which in turn should reduce his or her physiological arousal and emotional distress. Their instrumental support can also lessen the burdens or demands of the problematic situation directly, decreasing the degree of perceived threat (Thoits, 2011). Significant to this is mattering, belonging and companionship. It is suggested that meaning in life comes from a sense of mattering to others, our self-esteem we get from relationships relates positively to life satisfaction and happiness and Companionship produces positive effects, which in turn enhances physical and psychological well-being (Thoits, 2011).Therefor what does this mean for individuals without social support, without belonging and companionship? Lack of companionship, often described as loneliness (a gap between one’s desired and actual ties to others), has been linked to depression, anxiety, poor health habits, and ill health (Cacioppio et al. 2002; Stroebe and Stroebe 1996; Uchino 2004; as cited in Thoits, 2011). Seemingly if evidence proves that social support plays a major role in mental health; and that connecting with others in a healthy supportive manner is an important component of managing most mental health problems (CMHA, 2013), it is safe to say lack of social support contributes to the suffering of those with mental illness and decreases their chances of maintaining a healthy life. Social isolation of otherwise healthy, well-functioning individuals eventually results in psychological and physical disintegration, and even death- now how do we expect this to affect the already unhealthy, ill-functioning individuals.Professional SupportThere is an explicit professional expectation that psychiatric nurses maintain practice that reflects the valuing of a ‘collaborative and consultative approach to care’ (McCloughen, Gillies, & O’Brien, 2011). Nurses are expected to support patients with mental illness through the therapeutic nurse-patient relationship. The form characteristics and strength of this nurse-patient relationship impacts on mental health and therapeutic outcomes (McCloughen, Gillies, & O’Brien, 2011). Mental health issues and stressors can leave individuals feeling isolated, confused, helpless, and frightened; other accompany emotions such as poor self-image, poor self-esteem and difficulties with adherence to a treatment regimen can be significantly improved through a therapeutic nurse-patient relationship (LaRowe, 2004; as cited in Varcarolis & Halter, 2010).The support provided in the nurse-patient relationship has proven to be a significant variable in health care and it can enable people to cope more effectively with threats to their mental health (Barker, 2009). There are many aims, purposes and goals of the therapeutic relationship; which are all focused on enhancing the patient’s growth (Barker, 2009). The nurse should initiate supportive interpersonal communication in order to understand the perceptions and needs of the other person; support and encouragement are used to empower the person to learn, or cope more effectively with their environment; and the aim will be to aid the patient to resolve obstacles that stand in the way of full development and health (Barker, 2009). Significant to the therapeutic relationship is the therapeutic alliance, or ‘collaboration’ where the nurse and patient are partners, working towards the same goals. In other words ‘alliance not compliance’, the nurse works with the patient, supporting them.Therefor what does this mean for those mentally ill who do not receive support from their health professionals, who are not part of the therapeutic alliance, and do not gain the benefits of the therapeutic relationship? If they have cold encounters with their nurses, no comfort, encouragement or collaboration? Clearly those feelings of isolation, low self-esteem, and helpless will remain. The inabilities to cope, to function effectively and the self-destructing behaviors will remain; without the support, assistance and encouragement in the therapeutic relationship, the health professional is contributing to the worsening of their mental state. Financial SupportIncome is a key determinant of health; as income increases, mental well-being also increases- therefor there is a strong link between income and mental health (CMHA, 2013). Seeing how 70-90% of people living with serious mental disorders in Canada are unemployed(CMHA, 2013) , there is a major concern for their financial and over all well- being. People with mental health conditions generally rely on social assistance as a primary source of income, representing the largest disability group to receive social assistance (CMHA, 2013). However these income benefits fall significantly short of meeting the cost of living in Canada, rates are significantly lower than what is needed to cover the costs of basic necessities- food, clothing and housing (CMHA, 2013). Even when those with mental disorders get into the work force they often work for minimum wage, which is also insufficient to cover living expenses. Unemployment is one of many factors that influence health, other factors like housing, income and a lack of social support also have a huge impact on overall well-being. Essentially it all works in a circle, unemployment can lead to a low income, which can lead to poor housing, which can change social networks, which can limit access to social supports, and so on. All of these social factors are related to mental health (CMHA, 2013).It is evident that there is financial support needed, however the social assistance is hardly covering it; and it can be very hard for people to sign up for government assistance programs, so people who qualify may not get the help they need(CMHA, 2013). Without the proper supports, proper housing, food and clothing; how are these people to get on their feet, and maintain healthy lives? Decent, safe, affordable housing is one of the most important factors that affect our mental health (CMHA, 2013), therefor poor housing, or lack thereof leads to poor overall health; and can also make recovery from mental health or substance use problems much more difficult. BC has far fewer affordable housing options available now than in the past. As the number of affordable housing options drops, the cost of rent rises; which has harmful effects on people receiving government income assistance because the amount of assistance they receive doesn’t always match the real cost of housing (CMHA, 2013) Often times the portion of income assistance that’s meant to cover housing costs is much lower than the real cost of needs like food. Putting those already suffering with mental health issues into these situations, struggling to get by, struggling to find housing or food to eat; significantly affects their mental state and contributes to their suffering.How Can Nurses Help?We know the importance of social support and social relationships for mental health and recovery from mental illness; but how can we can we help the clients in our care? Well we need to continue to be mindful of this significance to our patient’s health, and make it a focus of our care/discharge plans. In our initial interactions and assessments with our patients we need to include evolving conversations about individuals’ current social contacts and supports; their leisure and social activities; their wishes and goals (Repper & Perkens,2001). How did they spend their time before their problems began? Who with? How often do they see friends and family? When we identify these social contacts, they can be involved positively in their support and care (Repper & Perkens, 2001). Often times families, friends and loved ones are excluded once the individual is in services, treatment, etc. For different reasons, maybe through fear or concern, or they’ve been pushed away by the individual; however it is evident that continued contact with family and friends is often a critical part of recovery, and given information and support, they are usually pleased to be involved (May 1999; Repper & Perkens, 2001). We can encourage the participation of the family and loved ones in supporting the individual, being involved in care and discharge planning and offer them referral to support groups/counseling for themselves as needed. To be supportive nurses we need to be in collaboration with our patients, be partners working towards common goals and the patients growth; and we need to maintain supportive, encouraging, and trusting therapeutic relationships. Our patients should feel comforted, understood and supported; this should be our goal. We should aim to break down feelings of isolation, helplessness, low self-esteem and confusion; thus contributing to their road to recovery, healing, and well-being.While in our care we can assist patients with financial support by referring them to the appropriate services, and agencies. We can assist them with seeking out financial support, and educating them on what is available. It is part of our job to know what is out there for supportive services, and what will fit our patient’s needs. We need to be knowledgeable of the many housing supports, such as licensed community care, supportive housing, semi-independent living, subsidized housing, shelters etc. We can encourage our patients who are capable, to get out into the workforce, and refer them to the appropriate community organizations and agencies that offer employment programs (CMHA, 2013). We know how income, housing and unemployment affect mental health, therefor this needs to be incorporated into care and discharge planning for the patients overall well-being.ConclusionWe have looked at the significance of social support and social relationships and the isolation and worsening mental state that can develop without it. We’ve looked at the importance of supportive health professionals, the need for the therapeutic relationship and the consequences for unsupported patients; and we’ve looked at the impact poverty can have on those with mental health concerns; and the need for financial support. Now it is clear that without these forms of support, those suffering will continue to suffer , and the idea of a healthier lifestyle and well-being will hang in the balance.ReferencesBarker, P. (Eds.). (2009).Developing therapeutic one-to-one relationships. Psychiatric and Mental health nursing: The craft of caring. (2nd ed.).(pp.313-318). London, UK: Hodder ArnoldCanadian Mental Health Association. (2013). Housing for People with Mental Health and Substance Use Problems. Retrieved from: Mental Health Association. (2013). Income. Retrieved from: Mental Health Association. (2013). Unemployment, Mental Health and Substance Use. Retrieved from: People. (2013). Mental Health. Retrieved from: Canada. (2006). Mental Health - Mental Illness: It’s Your Health. Retrieved from: , A., Gillies, D., & O'Brien, L. (2011). Collaboration between mental health consumers and nurses: shared understandings, dissimilar experiences. International journal of mental health nursing, 20(1), 47-55. Repper, J. Perkens, R. (2001). Mental health nursing and social inclusion. Royal College of Nursing. Article 530. 4, 5, 32-39. Retrieved from: , P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145-161. Retrieved from: , E.M., Halter, J.M. (2010).Therapeutic relationships. Foundations of psychiatricMental health nursing.(6th ed.). (pp.156-173). St. Louis, Missouri: Saunders –Elsevier ................
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