What is Mental Health? Essay
What is Mental Health?
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A desire to be in charge of our own lives, a need for control, is born in
each of us. It is essential to our mental health, and our success, that we take control.
– Robert F. Bennett (1933- ); USA Senator
A definition of the concept of mental health must be comprehensive to include a sense of balance and harmony in well being and community functioning. Social, physical, spiritual, emotional needs, desires, expectations and responses that complement the setting and relationships illustrate “good mental health”. Navigation of the social-physical environment demonstrates active choice-making; research and casual observation support the need for agency to ensure good health. Thus, how we perceive ourselves, others and the meaning of life’s events will determine one’s sense of balance and ability to function in a healthy manner. Depression is often the result of poor mental health, as are experiences of anxiety (overwhelmed) and a need for control (manipulation) over the external environment.
Alternative definitions for mental health have existed across the ages. Today, mental health as a concept is recognized to be culturally determined, and multi-faceted in definition depending on circumstances. National and international standards of what is considered low functioning mental can be found in the DSM-IV TR for psychopathologies. Cognitive and emotional well being is the emphasis of positive psychology or holism to account for enjoyment of life and resilience skills.
The World Health Organization (WHO) has not adopted a standard definition of mental health.
Cross-cultural variances, the subjective nature of the evaluations and the myriad of theories as to how to define mental health constrain developing a solitary instrument of inquiry. For this reason, the mental disorder schizophrenia will be concentrated on for this paper as an illustration of low mental health functioning.
This paper will demonstrate that mental health can be defined as a continuum of enjoyment, contentment, sense of belonging and active contribution to the community. A brief description of schizophrenia will be provided. Literature in the area of mental health will be reviewed to identify gaps, needs and insights to develop a scale instrument to measure mental health. A diverse number of professional disciplines will be investigated to un-pack the complex inter-relationships of factors contributing to “mental health”.
It is anticipated that this research will contribute to the knowledge base about mental health, well being and measurement to develop better interventions.
The diagnostic criteria for schizophrenia as determined by the DSM-IV-TR are as follows;
Characteristic symptoms (two or more dramatically in one month): delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, affective flattening, alogia, or avolition.
N.B. bizarre delusions or ongoing auditory/visual hallucinations require only one such symptom
Social/Occupational dysfunction: since onset, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior.
Duration: continuous signs of the disturbance persist for at least 6 months.
Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive Episode, Manic Episode, or Mixed Episode have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
Substance/general medical condition exclusion: is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Relationship to a Pervasive Developmental Disorder: if there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
Pharmacology is an important aspect of mental health. It has been found that service users find nursing and other human service workers lacking in knowledge about common side-effects of medication (Bell, 2004; Marks, 2002; McGavock, 2003). One reason for this may be inadequate preparation at university about the relationship between bioscience and mental health (Jordan, Philpin, Davies, & Andrade, 2000). Curriculum needs to be informed based on service user needs and expectations. It is thought that modifications to the excitation of glutamatergic signaling in areas of the brain may be involved in the state of mental health of those with schizophrenia (Kristiansen, Huerta, Beneyto, & Meador-Woodruff, 2006). The N-methyl-d-asparate (NMDA) receptor and intracellular NMDA receptor-interacting proteins of the glutaminergic synapse appear to be dysregulated in schizophrenia (p. 48). Hence, the gateways of glutametergic pathways may be disrupted in schizophrenics.
General observation of the literature shows that research into mental health is dearth despite the known numbers of those experiencing a dysfunctional lifestyle. WHO estimated that 12.3% of people across the globe were experiencing mental illness (Thorncroft, 2002). However, less than 5% of clinical trials are in the Cochrane Controlled Trials Register.
Schizophrenia is an example of low mental health functioning. The Cochrane Schizophrenia Group undertook a survey in 2000 and found that the literature mostly reported hospital-based drug trials in Northern America (Wykes & Marshall, 2004). Of concern is that regardless of the long-term nature of schizophrenia, 50% of the trials only went for 6 weeks, and one-fifth went no longer than 6 months. Low power (sample number) was evident in 3% of the trials, so that they could not identify a clinically significant change if it did exist. The small-scale and short-term nature of most psychiatric trials makes it difficult to address questions of clinical relevance. These confounds also make it difficult to define what is good mental health for a person experiencing schizophrenia. Small samples do not give interventions and measurement instruments a chance to reflect their true reliabilities and validities, making generalization of results difficult.
Those experiencing schizophrenia often have difficulty understanding the non-verbal aspects of conversation, or of adhering to social norms during an interaction. The ability to express themselves can also be difficult for those with schizophrenia (Doherty, 2004). Talking to others about needs and desires can be stressful and or frustrating. As the external environment can be overwhelming, developing communication skills is important (www.schizophrenia.com). When, what and how are critical conversation elements. Need to role play or get out there and practice to become adept at reading and responding to verbal and non-verbal cues.
Partnership working requires inclusive decision making for all stakeholders and across government, non-government and volunteer agencies (Bell, 2004; Haralambos, 2004). Also, partnership with the pharmaceutical industry may be a useful and safe way to encourage good mental health. A project management approach is ideal. Team orientated training rather than one-to-one. Multi-disciplinary teams reflect real-world scenarios. Policy needs to embody an organizational culture of equality, acceptance, innovation and client-centeredness. A more comprehensive picture of the life and circumstances of a person can be viewed to inform intervention, support and lifestyle preferences.
Professional, Legal and Ethical
Clinical governance is the way in which an organization ensures the quality of care service that they provide to patients, by way of making the individual employees accountable for determining, maintaining and evaluating standards of performance (Henderson, 2002). As clinical care is becoming more complicated in regards to potential for litigation, it is necessary for medical professionals to develop extended networks of professional relationships (Department of Health, 1994). In the 21st century, where patients and their families are more informed of their rights than in previous years, and a time when the fallibility of the medical profession is well documented, a nurses’ awareness of their accountability is essential. In general, provision of high quality care requires that the nurse and hospital demonstrate its seriousness toward this issue by way of putting in place, and constantly evaluating, these standards (Department of Health, 1998).
The practice of nursing necessitates scientific and technical knowledge of clinical practice, but it is also essential that the nurse be aware of, and to be motivated to, practice ethical codes of conduct (Gross, 2001). Ethical codes of conduct make the nurse accountable for their decisions and actions in their delivery of patient care. As such, abiding with ethics enables the nurse to be guided through value-based judgments (Thompson, Melia & Boyd, 2000). Furthermore, these value judgments need to be evaluated in a critical manner in the same way that scientific information is critically analysed. Ethics is a generic word that reflects a set of standards for analyzing and understanding moral life. Hence, ethics requires that the nurse to go beyond the individual patient and to apply assumed universal laws (General Medical Council, 2001).
In summary, there is no solitary definition of mental health, and it appears to be culturally specific. A diagnosis of a mental disorder, such as schizophrenia requires the meeting of a list of selective criteria, such as that established internationally in the DSM-IV-TR. Publications such as this identify different forms of low mental functioning that are determined to be indications of poor mental health. There are many aspects to positive mental health, as illustrated by bioscientific, psychological, clinical, partnership working, professional, legal and ethical considerations. Ultimately it is important for the nurse to become familiar with what is considered to be mental health and what factors make up mental health.
Bell, R (2004) Mental Health Nursing: An Introductory Guide, Nelson Thornes,
Doherty, L (2004) The Royal Marsden Hospital Manual of Clinical Nursing
Procedures, 6th Edition, Blackwell Publishing
General Medical Council. (2001). Good medical practice. Retrieved June 3, 2006, from:
Gross, R. (2001) Psychology, The Science of Mind and Behaviour, 4th Ed, Hodder
Haralambos, M (2004) Sociology: Themes and Perspectives, 6th Ed, Pearson,
Jordan, S., Davies, S., Andrade, M., (2000) The biological sciences in mental health nursing:
Stakeholders’ perspectives. Journal of Advanced Nursing, 32(4), 881-891.
Marks, D. (2002) The Health Psychology Reader Sage Publications, London
McGavock, H. (2003) How Drugs Work, Radcliffe Medical Press, Oxon
Stanton, N (2004) Mastering communication, 4th Edition, Palgrave, Basingstoke
Thompson, I., Melia, K. & Boyd, K. (2000) Nursing Ethics 4th ed. Churchill.
Thornicroft, G. (2002) The global response to mental illness. BMJ, 325, 608 -609.
Wykes, T., Marshall, M. (2004) Reshaping mental health practice with evidence. The
Mental Health Research Network Psychiatric Bulletin, 28, 153-155.