Mental health refers to any mental condition that interferes with ones feelings, thoughts, and behavior. Mental illness on the other hand represents a mental condition that affects ones feelings, thoughts and behavior to a great extent. This paper has used the case study of Mary who is suffering from depression. Management of depression should be holistic and based on patients unique identity. However, recovery depends on the ability to manage stigma in the society concerning mental illness and promotion of physical health since there is an association between physical and mental health.
Healthy lifestyle is a critical aspect of ones wellbeing and development. Attainment of a healthy lifestyle implies that ones wellness is holistic and integrates all aspects of health including mental health, physical and social self. This paper considers the case of Mary, a 41 year old lady living with her husband and three children aged 17, 14, and 10 years respectively. Mary occupies a senior position in a large organization and has a supportive husband with whom they have been married for 18 years.
In this paper, Marys case and experience is used to explore and discuss the meaning of mental health, mental illness and principles of recovery while illustrating the relationship between mental and physical health. This approach is based on the understanding that mental health often has an impact on physical health. On the other hand, physical health and wellbeing may also affect ones mental health status. In order to assess this two-way correlation, the paper identifies and explains the needs of people with mental illness. Most importantly, the paper highlights some of the effective strategies for supporting such individuals using the case and experience of Mary. This paper will also reflect on the knowledge of how practice in the sphere of mental health can influence my future work as a health professional in the area of nursing.
Mental Illness, Mental Health and the Principles of Recovery
Meaning of Mental Illness
Mental illness is a term that is broadly used in reference to any health problem that greatly affects a persons feelings, thinking, behavior and social relationships. The medical conditions that can easily disrupt ones thoughts, feelings and reduce his/her ability to interact with other people in his or her social environment are generally referred to as mental illness. Mental illness is, therefore, a condition of the brain that affects or interferes with ones normal cognitive functions such as thought processes, behavioral aspects such as feelings and social aspects like relationships and interactions.
Meaning of Mental Health
A person is described as mentally healthy if he or she has good emotional and social well-being and is capable of coping with changes and challenges in his or her social environment (Barlow 2008, p. 61). Mental health thus has great semblance with mental illness. However, there is a slight distinction between the two conditions based on the severity of ones status. Although mental health shares some of the characteristics used to classify one as mentally ill, mental health issues are not as severe as mental illness.
Presentations of Mental Health in Relation to Marys Case
With this distinction spelt out, it is imperative to shift the focus to Marys case in the context of the discourse of mental health and illness. Mary was diagnosed with clinical depression at the age of 39 and was hospitalized for five weeks. Depression is a mental illness related problem that seems to be a family problem in Marys family. Her own mother lived with depression for 35 years. The medical and developmental history of Mary shows that she has been physically healthy and has had no medical history. She does not consume alcohol or smoke neither does Mary have any drug use history. She has also appropriately achieved the developmental milestones throughout her life from childhood to adulthood. When she got diagnosed with clinical depression, Mary was given antidepressants which she stopped taking after feeling that the drugs were no longer necessary. From this background information, it can be loosely argued that Marys depression is not a consequence of any medical history, sickness or use of drugs and alcohol.
Stigmatization of People with Depression
People diagnosed with depression often become victims of social stigma in their society. There are various forms of stigmatization that victims of depression like Mary often experience. People like Mary who have been diagnosed and confirmed to be suffering from depression are often victims of stigma from their social environment. Sometimes such stigma originates and is sustained by the family members, caregivers and significant people around the patient. Some of the elements of stigma that people like Mary easily become victims of include the perceptions that depressed people are just weak and really sick in the actual sense. There is a likelihood that even the family members of people suffering from depression may not understand or believe in the reality of depression.
The perception and generalization that people with mental illness are generally dangerous is also a source of stigma for people like Mary. There is a biased generalization that all people with mental illness such as depression are unusually crazy and dangerous and can easily commit murder. This implies that such people are likely to be shunned, isolated and left as lone rangers because of the perceived risk of associating with the mentally ill. They are considered crazy and people associating with them are also likely to be branded as crazy. This is likely to transcend into social exclusion as friends shy away from being close to the mentally ill. This may make it difficult for the people diagnosed with any form of mental illness to disclose their condition.
There is also self-implicated stigma that emanates from the patients diagnosed with mental illnesses such as depression. People like Mary are likely to feel guilty, ashamed and embarrassed of their conditions. This may make them retreat and hide away from the public out of the embarrassment and shame of being associated with mental instability. Although the feeling of guilt and shame originates from ones self, it is compounded by the manner in which the people in ones social environment interact and relate with the person, who already feels insecure and mentally inadequate. Thus these forms of stigma often accelerate mental deterioration, feeling of desperation and solitude on the part of people suffering from mental illness and other mental health conditions like Mary.
Impact of Stigma on Care and Response to Treatment of Depression
Perceived stigma has far-reaching impact on the care and response of patients to depression treatments and interventions. There is evidence that people who suffer from depression and perceived stigma resulting from their condition are likely to shun seeking medication or therapeutic interventions. This is due to the biased and subjective perception that everyone will stigmatize them and may not be in a position to offer any support apart from blaming them for their mental health status. This in turn is an important factor contributing to the poor health-seeking behavior and early treatment discontinuation, especially among adults. This notion can be used to explain why Mary had stopped taking her antidepressants after sometime, although she was still suffering from depression. Her report shows that she no longer felt that it was necessary to continue taking the drugs. The reality of stigma among people diagnosed with depression makes them engage in cost benefit analysis to ascertain the perceived social costs and benefits of seeking medication and treatment of mental illness.
While stigma affects health-seeking behavior of people diagnosed with mental illnesses such as depression, this phenomenon also affects the actual treatment of such conditions. The perceived social costs associated with stigma may hinder the adherence of people suffering from depression to the strict schedules of treatment. This has significant impact on the response of the patients to the treatment and medical interventions that are offered to them. Besides, the lack of trust and confidence in the professionals and caregivers may make the patients reserved and reduce their chances of recovering from their condition.
Principles of Recovery for Patients with Depression
Recovery is a concept used to refer to a change that enables people to overcome depression or register positive improvement in health and wellness status. Such improvement enables people to live a self-directed life and actualize their full-life potential. The principles of recovery are diverse. However, in the case of Mary who is suffering from depression, specific principles would be suitable. These include the principle that recovery as a process originates from hope. This principle is strongly embedded on the understanding that people can overcome mental challenges and cognitive barriers that they encounter. Perception of hope by the patient originates from the internalized messages of hope fostered by the family members, peers, care providers and the significant others. Hope thus stimulates recovery. Mary threw away the antidepressants suggesting that they were no longer necessary. She also feels hopeless and desperate as she sees no chance of making it through to the next day.
Whereas the principle of hope is pivotal, it is complimented with another principle that recovery is person-driver. Patients must understand that they determine their own recovery through self-direction. In the case of Mary, she needs to capitalize on her autonomy to influence, control, and use support services that assist in recovery. Mary can be helped to understand that her recovery greatly depends on her ability to mobilize personal strengths and be in charge of her own recovery process. Recovery is also a holistic process that depends on not only social, personal, psychological and medical interventions. For one to recover from mental illness there is a need for an integrated holistic support to the person that addresses the issues of the mind, body, spirit and communal support. In the case of Mary, this principle would involve attending to self-care issues like personal hygiene, family support, employment challenges, clinical treatment and other interventions. The complementary nature of these areas of support and services enables an individual to recover. Exclusive focus on one area may limit the pace of recovery.
The duration of recovery is reduced through treatment of psychological trauma associated with the mental illness. Traumatic experiences are likely to push one to severe forms and levels of mental illness like depression in the case of Mary. Fostering of mental health and safety services are critical to the progress of the recovery process. While the treatment of trauma associated with mental illness is critical, another principle of recovery that cannot be ignored is that the whole process of recovery emanates from individual, family and community strengths and responsibility. Marys family, especially her husband has been very supportive to her. She also has a social network with the church which she regularly attends. These are key sources of strength that form the foundation for Marys recovery. However, these foundations cannot be successful without Mary pulling the strings of her personal responsibility and strength in the recovery process. Based on this principle, Marys family needs to be close to her, share thoughts with her, and discuss her recovery. She should in turn develop a positive attitude and confidence that she is on a progressive path to recovery, which is critical to the success of all the other interventions aimed at promoting recovery.
The Significance of Mental Health Assessment
Careful, systematic and holistic assessment is critical for determining the mental health issue that a client is going through. Such assessment integrates as many variables as possible in order to achieve the optimal level of success that can inform intervention. The cues for mental illness that are evident in Mary include reduced confidence and declined sense of personal hygiene. Although Mary has a supportive husband and family, she shows social withdrawal and exclusion symptoms. She is hopeless and feels that she is a burden to her family. Mary lacks the motivation to eat and dress and lacks the energy to move to her bed. Mary also has difficulty with sleeping as reported by her husband and frequently wakes up early in the morning to stare at the window. These cues suggest that Mary can be classified as a person suffering from persistent depressive disorder.
Some of the symptoms of this form of depression are changes in appetite and sleeping patterns, hopelessness, low sense of self-worth, and problems with concentration and making the right decisions. Most of these symptoms are evident in the changed personality and behavior of Mary. These behaviors meet the criteria for classifying her condition as depression. There are various approaches that can be adopted to respond to Marys condition and promote recovery. These include medical treatment, group therapy, face to face sessions and education of the carers and the network involved in the supporting system. Early assessment and intervention would be instrumental in the treatment and onset of recovery for Mary.
The symptoms displayed by Mary are also close to another type of depression known as melancholic depression. This is a classic type of depression that is biological in nature. It is a more severe form of depression when compared to the other types that are non-melancholic. It is mostly known and associated with disturbances of the psychomotor processes such as slowed agitation of the physical movement and delays of the cognitive processes. This form of depression is not very common but affects 1-2% of the Western populations. Both men and women have an equal level of vulnerability. This condition responds well to physical treatment like the administration of antidepressants. However, interventions such as counseling and psychotherapy may work but to a lesser extent when compared to the physical interventions.
The Correlation between Physical and Mental Health
The relationship between mental and physical health has been studied and documented. People who are involved in consistent physical exercise have a boosted sense of self-worth. This in turn reduces stress and anxiety-related psychological wellness. Physical activity increases the chances of preventing and eliminating mental health crises like depression. Mary is reported to have no time for physical exercise. Physical exercise and activity have also been documented to reduce the risk of depression among 20-30% of patients, especially adults. People with depression and physical health challenges are likely to have more complications. Those with severe physical complications are likely to experience more psychological distress compared to those who are healthy.
There have been contentions that those with poor physical health are exposed to a relatively high risk of depression. Mild depression is likely to affect people who have consistent medical complications. Improvement of mental health can significantly contribute to the improvement of physical health. This is a key to reduced morbidity and mortality. On the contrary, those with severe physical conditions promote mental setbacks that reduce ones ability to cope with their daily physical activities. Interventions positively influencing peoples physical wellbeing such as scheduled and constant physical exercise improve ones mental health status and reduce the likelihood of chronic mental health complications.
The relationship between physical and mental health is evident in the life of Mary who has been diagnosed with depression. She has been a successful female in her career but lost confidence with the diagnosis of depression. Her physical health and wellness worsened which had an impact her normal life activities. The mental health condition of Mary has reduced her motivation to complete even minor activities like eating and dressing. She cannot even maintain her personal hygiene which has since deteriorated. It is evident that physical and mental health have two-way relationships. Physical health affects mental health while mental health also affects ones physical health and wellbeing.
Recognizing and Responding to Mental Health Needs of the Identified Person
The elements that contribute to Marys mental illness include but are not limited to family history. Her mother lived with depression for 35 years. Her husband and the family are very supportive to Mary while the church also provides social support. Mary was able to dress and maintain her own hygiene while she was unable to continue working leading to her decision to take leave. Having been hospitalized for 5 weeks, Mary has not had any further admissions. She has achieved optimal and appropriate developmental milestones, having no record of drugs and substance abuse and alcoholism. She manages her care by herself in collaboration with the grandparents. Her condition is more compounded by her depression.
The stakeholders in the care management in Marys case include the husband, children, fellow employees at the work place, church members and the professional counselors, medical doctors and physiotherapists. This network of support is critical to the treatment and recovery of Mary. This trickles down to the holistic and integrated approach to treatment and care of people with mental illness. The priorities for her treatment include social, psychological and emotional support. The family therapy sessions, for example, should involve all the people in ones environment. The recommendations of the doctors and physicians such as schedules for medication can be adhered to if all these players are involved in the treatment process. Marys decision to stop taking antidepressants is partly explained by the fact that the family members may have been left out in the treatment and medication process and have not been involved in decisions made by the doctors and physicians.
My Future Practice as a Health Professional
Mental health problems such as depression need understanding of the dynamics. My knowledge about depression, its symptoms and principles of recovery will help to offer better services to clients in my field of practice. Specifically, this knowledge will help me to confront the issue of stigma that has been a barrier to the health-seeking behavior of patients with depression. I will begin with challenging colleagues in my working environment to embrace clients with depression and join hands to overcome social stigma. The knowledge will also help me to engage the family members who form part of the stakeholders critical to the recovery of depressed persons. The fact that mental health is related to physical health is another factor that I will integrate in my practice. Particularly, I will sensitize the clients and their family members to strive to ensure that the patients are physically healthy to limit the complications of mental health that result from poor physical wellness.
Mental illness is a complex condition that is multifactorial in its causes, management and treatment. Depression in particular is one of the common mental illnesses that is compounded by stigma. Its management requires integration of different aspects including the patients strengths, family support, social networks and holistic approach that enlists even the input of professionals like doctors and counselors. The approaches that should be included in the treatment of depression include physiotherapy, family therapy and medical treatment. However, to manage depression, there is a need to consider factors of physical health of the patients since health status has bearing on mental illness. The recovery process for the case of depression can be enhanced through stigma eradication and management.
