Therapeutic Approaches For Managing Mental Illnesses

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Discuss About The Some Therapeutic Approaches Used To Manage.

Mental health is one of the few disciplines that keen interests have not been taken especially in the developing countries (Healthtalk.org, 2018). This is an exception to developed countries because of the difference in lifestyle and presence of an ageing population alongside good diagnostic capabilities, although much efforts still need to be put in ensuring early diagnoses are made. Because of this, many times diagnosis of mental illness in a patient is missed thus no proper interventions initiated. It is only with proper diagnoses that enough data about people suffering from a particular illness can be established. This forms an evidence based tool for more healthcare financing and reform towards the condition, in this case mental illness.

With mental disorders being one of the leading cause of morbidity worldwide and widespread across industrialized countries, health care personnel need to improve the detection, diagnosis and management of this condition, in a multidisciplinary approach (Healthtalk.org, 2018). General Practitioners form part of primary care for mental disorders. However, this alone is not enough. Other psychiatric interventions like social and psychosocial methods need to be added to the primary physical care.

Papers viewed fulfilled the following inclusion criteria. They were written in English language, of full text and peer reviews. Scholarly articles published in the last ten years with relevance to interventions in mental illness were selected.

Articles not fulfilling the topic of interest above were excluded from the literature review. Others included articles published more than ten years ago, those that talked about interventions but not specific to mental illnesses and those that did not provide in depth analysis of the topic.

The risk of developing a mental illness is not limited to the population outside health care. Mental illness does not discriminate. A study conducted by (Daskivich et al. 2018) show that physicians who are being trained are prone to develop depression, while their colleges in training are more likely to commit suicide than in the general population. Part of the objective of the study was to promote a national policy that would increase awareness of stress at workplace so as to reduce the chances of depression. However, the definition of wellness in relation to mental health still remains a problem, therefore it is difficult to develop interventions to alleviate it. An abstract published in PubMed by Manderscheid (2018) shows an evolving definition of wellness. There has been a shift from diagnosis based definition to individual focused one and away from “absence” of disease to that which focuses on the psychological function for mental health. There are numerous stressors that predispose one to mental conditions and they form part of wellness. Without these stressors and environmental predisposing factors, the population would be free of mental illness.

Wellness, Personal Responsibility, and Dignity of Risk

Proper mental health recovery process depends on personal responsibility (R, 2018). It is assumed that people are responsible for their own choices and behaviors, factors that determine their health status. Health is a personal responsibility (Hughes 2017). management is capable to have a perfect health and mental health adjustment if they consider their personal responsibility. Personal responsibility raises a paradox in the context of mental health care. People often present in a way that does not correlate with the ideals of responsible end user. They are excluded from irresponsible behavior. This irony is looked into keenly by health care workers. Taking personal responsibility has been implicated to lead to sense of freedom from being victimized. A balance is always established between blaming the disorder and taking personal responsibility. People who blame the disorder tend to stay more with their conditions than those who take responsibility to solve them. The nature of personal responsibility and how the characteristics of it can conflict with policy and professional responsibilities to protect others.

For people with mental illness and any disability, the dignity of risk is a powerful concept. Dignity of risk is defined as the concept of self-determination and the right to take risks that are necessary for self-esteem and dignity. This concept applies to a vast group of people like the elderly, disabled and in this context people with mental disabilities. Mentally ill people are free to make informed decisions as others. This help in developing personality and an individual’s character (Disability News, Opinion & Discussion by My Disability Matters 2018).  Dignity of risk conflicts with the duty of care. It is said that when patients being taken care of are allowed to take risks, they can be in a conflict with their care givers. Therefore balancing between these considerations is hard when developing guidelines for caregiver (En.wikipedia.org, 2018).When a patient with mental illness is overprotected, a feeling of low self-esteem and underachievement can ensue because their expectations are lowered. A dignity of risk research project by (Hadland and Lambert 2014) shows the policy and perceptions to make decisions. The journal explores barriers in the concept and some of them include conflict between resident need and legal authorities, lack of experienced staff and mental disabilities.

Social justice is a key virtue for guiding health workers into creating institutions that determine what is good for the patient. It dwells on personal responsibility to ensure multidisciplinary approach to a patient and improve the working conditions around an institution (Breuer 2012). According to World Health Organization (WHO), health is a fundamental human right. Mental health patients are entitled to the highest level of health without being discriminated because of their condition (World Health Organization, 2018). Social justice goes with economic justice, which run on the principles of distributive, participative and social justice. For instance, a mentally ill individual should be treated equally as other members of the society. It is about having equal opportunities in social outcomes and recovery (Breuer, 2012). Other forms of social justice to these patients include proper housing, employment and improving their living standards in the community.

Social Justice and Human Rights

Health rights for this group of people should be properly constructed to offer substantive and justifiable claim to ensure equitable use of public resources. A study by Breuer (2012) on definition of mental illness in the context of disability showed that 65% implications suggest that disability contain mental illness, and that 64% of responses supported that the law prohibits discrimination in order to promote social justice. However this is not being practiced in most countries. Almost 41% of countries with ratified CRPD did not allow people with mental illness to marry and about 12% of these countries allow divorce on the ground that one of the spouses is mentally ill (Breuer 2012). Better research funding should be enhanced since human rights and social justice for the mentally ill is an urgent need at both local, national and international level.

Of the major world religions, Buddhism is considered one of the most psychological ones (Tariki Books and Papers 2018). Buddhist approach to mental health has been underpinned by Buddha’s enlightens. To understand a Buddhist approach to mental illness, an in-depth analysis of their teachings should be evaluated. Buddhism is based on three pillars namely Sila, Samadhi and Prajna, each of which represents an element in mental health.

Sila represents a person’s ethical framework. Sila prescribed to a morally sound lifestyle, with respect for living things and grounded in concern for others and sobriety. It cultivates a healthy mental state. Samadhi represent someone who is spiritually grounded, calm, peaceful, and full of meditation and concentration (Dailymirror 2018). Prajna means wisdom. One experiences deep understanding of knowledge and insights of mental constructs. From these three pillars, several aspects of well-being can be understood. Behavior that influence mental states and the ability to view a lie at the root of mental state are some of the examples. Tariki Books and Papers, (2018) also suggest that mental illness is an extreme version of the state someone suffers from and that psychotic states are the end versions of mental states. Buddhism in itself forms a therapeutic model for managing mental health conditions (Applied Buddhism 2018). Most of the modern therapeutic theories are rooted in Buddhist practices.

Mental health has been conceptualized as global disorders with physical basis in the brain and affects everyone without discriminating (Fernando 2017). By making mental disorders a universal subject, attention to inequalities in the treatment gap has been identified by a push from WHO and Movement for Global Mental Health (MGMH). A legal framework is necessary to guard and promote the interests of those suffering from mental illnesses. This is according to a paper on Ethical aspects of public health legislation in focus to Mental Health Care Bill of 2011 by (Thippeswamy 2018). The proposed bill puts into account the aspects of support for decision making, consent and advance directive for those who are mentally challenged. This new bill that was proposed under the United Nations (UN) Conventions on the Rights of Persons with Disabilities should strengthen and facilitate mental health policy. When put into practice, it will ensure that acceptable, accessible and equitable mental health care is provided (Mammot and Allen 2014). Mental health legislation should have a room for respecting decision making (Doyal and Sheather 2018).

Buddh

With the advent of legislations guarding mental illness patient, compassion and care for the same has been seen. This is according to a paper by Chadda, (2014). Studies showed that those patients who were taken care of compassionately had good outcome and returned to their pre-mental illness state quicker than those that were not given the same treatment. An explorative study on self-compassion and resilience mechanisms in regards to mental health by Trompetter, (2016) showed that there was intercorrelation between self-compassion, psychopathology and positive mental state of an individual.

Promoting well- being of a mentally ill patient needs a multidisciplinary approach. A goal directed approach is used to help the patient gather resources to maintain and restore the perfect mental health (M 2018). A pilot study by Webster and Debra, (2013) used students who engaged in an interaction with an actor that portrayed an individual with mental illness. The strengths and weaknesses in therapeutic skills in psychiatric nursing were evaluated. The desired outcomes of a good therapeutic communication were empathy, caring, addressing the patient’s values, beliefs and preferences. The study concluded that students saw the importance of therapeutic interventions. Gausvick et al. (2015) also show that communication improves patient and health care worker satisfaction.

Treatment approaches toward mental illness include use of drugs (physical), social and psychosocial (behavioral) therapy. Generally, a combination of these approaches are used and it has been shown that it is more effective. Detailed discussion about each is provided below.

General principles of this method include initial evaluation of the condition, target of symptoms, good choice of drugs while taking into consideration pharmacokinetic and pharmacodynamics of the drugs and classification of the agents. A qualitative investigation by (Fleury et al. 2018) shows that general practitioners employ pharmacotherapy to their patients. The main conditions focused on in literature are bipolar disorders, anxiety disorders and schizophrenia. The main condition in bipolar disorders is depression. Some of the anti-depressants used include Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, and tricyclic antidepressants (TCSs) like amitriptyline. They work by enhancing the activity of noradrenaline and serotonin which are usually limited. Both of them have similar efficacy and almost 60% of the patients respond in 6 weeks. Continued treatment is important since it maintains the improvement. Mood stabilizers for bipolar disorders include lithium that has a narrow margin of safety thus not preferred, others are anti-epileptics like valproate and antipsychotics like olanzapine. Anxiolytics include lorazepam, propranolol and buspirone among others. Antipsychotics are the mainstream for managing schizophrenia and are classified into two groups called typical like haloperidol and atypical for instance olanzapine.

Medical interventions come with their drawbacks. Atypical antipsychotics cause pyramidal effects in the patients thus reducing drug compliance which can lead to worsening of the condition and prolonged hospital stay. These drugs should also be given cautiously in special groups like children, elderly, pregnant and in breastfeeding women. Other forms of physical approach include electroconvulsive therapy (ECT). ECT is safe and effective for managing severe depression (Healthtalk.org, 2018). Its use is limited because of the negative perception people have about it. Psychosurgery is an ancient method used to manage depressive disorders without informed consent as compared to ECT. However, ethical concerns about the method over years limit its use by medical team.

Medical treatment requires interaction between the patient and the doctor. This is a determinant of both patient and physician satisfaction. Psychological therapy is a byproduct of this interaction. Some of the common methods include psychodynamic therapy, behavioral therapy, cognitive therapy and cognitive behavioral therapy among others. Psychotherapy is based on a principle of general therapeutic factors. The person providing thus type of therapy should be credible, well behaved, empathic, interested and able to give hope to the patient. For the intervention to be successful, one needs to select the right therapy for the right patient, do adequate preparation and ensure that the therapy is available.

Behavioral therapy arise from the idea that adaptive behaviors can be learned and maladaptive behaviors can be dropped away. It is effective for managing anxiety disorders like phobias. Exposure is the mainstream to this kind of therapy. The patient is re exposed to the behavior they avoid. Graded exposure is used in a step by step manner and progress is reviewed.

Cognitive therapy aims to correct inaccurate ways of thinking so that it can be improved to a better standard, reduce anxiety and allow a return to normal behavior. The therapist obtains a detailed problem description while being keen to the thoughts. He or she provides an explanation afterwards of the role of the cognition perpetuating the problem to the patient. Patient is then taught how they can become aware of and challenge the negative cognitions and practice to think in more helpful ways. Techniques applied here include education on the role of cognition and their effects on emotions and behavior.

Cognitive behavioral therapy combines both elements of cognitive and behavioral therapies. Other hybrid psychotherapies include cognitive analytical therapy, interpersonal therapy, dialectical behavioral therapy, eye movement desensitization and reprocessing therapy and metallization based therapy. Group psychotherapy have been adopted to treat several groups at once. Family therapy is based on the theory that a family is the source of a problem.

Social factors play a major role in predisposing and maintaining psychiatric disorders. They also determine the environment in which therapy is initiated and its outcome. Acute social interventions include:

Psychiatric admission where community treatment is not feasible due to risk to the community itself or if the patients’ condition risks deterioration. A systematic study by (Webber and Fendt-Newlin 2018) show that social network gains are strongly supported by the community. The least restrictive method of admission should be obtained because patients become traumatized if detained under the mental act. Another method is crisis intervention by a specialist at home so that hospital admission can be prevented. These caregivers provide psychological interventions, medication, telephone support and home visits. Social approach also includes providing accommodation and financial solutions to the affected patient thereby reducing stressors that act as maintaining factors. Family support and education is also an important part of care. Social isolation can also be addressed by home visits and putting the person in a self-help group. Chronic psychiatric disorders can be managed by rehabilitation that will ensure there is social, occupational skills and self-confidence. These methods have limited evidence as suggested by (Webber and Fendt-Newlin 2018) therefore need more research and data on how to improve them.

Mental illnesses still affect a great deal of population in the developed and developing countries. By addressing the therapeutic options available and understanding theories behind them, the best type of care for patients can be examined and applied.

Much of the current literature focuses on a narrow spectrum of mental illnesses, leaving behind the rare and emerging ones. Limited research papers have been published on mental health awareness and management plans. The reviewed literature consisted of literature reviews from journals, pilot studies, and systematic reviews and cross sectional studies therefore there is need for much rigor in studies related to mental health. It was also noted that most of the studies lacked solid methodology and enough sample size. Clearly, it is evident that further research in the field of mental health is needed to act as a guide for supporting more funding by governments in managing mental illnesses holistically. This is despite the fact that some of the research published are still promising. More research needs to be done in the effectiveness of social and psychosocial care outcomes to inform on how much resources should be located to facilitate their use as one approach to manage mental health issues.

Conclusion

Most of the therapeutic approaches towards managing mental illnesses have not been explored by research papers to a great extent. Some of them include use of biological methods like drugs, ECT, psychosocial and social methods. Other aspects such as communication, the use of laws and legislations and also dignity of risks have been highlighted. More rigorous research is required in the field of mental health to provide data and information that can be used to guide policy making actions for better mental health care. Providing this evidence will also help determine the effectiveness and gaps in each of the aspects of care, for better patient management.

References

Applied Buddhism. 2018. Can Buddhism Cure Mental Illness? [Online] Available at: https://appliedbuddhism.com/2014/04/23/can-buddhism-cure-mental-illness/ [Accessed 8 Jun. 2018].

Breuer, S. 2012. Review of Mental illness, discrimination and the law: Fighting for social justice. Psychiatric Rehabilitation Journal, 35(5), pp.413-413.

Chadda, R.K., 2014. Caring for the family caregivers of persons with mental illness. Indian journal of psychiatry, 56(3), p.221.

Dailymirror.lk. 2018. Towards a Buddhist Theory of Mental Illness. [Online] Available at: https://www.dailymirror.lk/40266/towards-a-buddhist-theory-of-mental-illness [Accessed 8 Jun. 2018].

Daskivich, T., Jardine, D., Tseng, J., Correa, R., Stagg, B., Jacob, K. and Harwood, J. 2018. Promotion of Wellness and Mental Health Awareness Among Physicians in Training: Perspective of a National, Multispecialty Panel of Residents and Fellows.

Disability News, Opinion & Discussion by My Disability Matters. 2018. The Dignity of Risk For People With Disabilities. [Online] Available at: https://mydisabilitymatters.news/evergreen/dignity-risk-people-disabilities/52675/ [Accessed 8 Jun. 2018]

Doyal, L. and Sheather, J. 2018. Mental health legislation should respect decision making capacity. En.wikipedia.org. (2018). Dignity of risk. [Online] Available at: https://en.wikipedia.org/wiki/Dignity_of_risk [Accessed 8 Jun. 2018].

Fernando, S., 2017. Globalising mental health or pathologising the Global South? Mapping the ethics, theory and practice of global mental health.

Fleury, M., Imboua, A., Aubé, D., Farand, L. and Lambert, Y. 2018. General practitioners’ management of mental disorders: A rewarding practice with considerable obstacles.

Gausvik, C., Lautar, A., Miller, L., Pallerla, H. and Schlaudecker, J., 2015. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, p.33.

Hackley, B., Sharma, C., Kedzior, A. and Sreenivasan, S., 2010. Managing mental health conditions in primary care settings. Journal of Midwifery & Women’s Health, 55(1), pp.9-19.

Hadland, R. and Lambert, N. 2014. The challenge of dignity in mental health. British Journal of Mental Health Nursing, 3(3), pp.132-136. Journal

Healthtalk.org. 2018. Managing mental illness and recovery | Topics, Electroconvulsive Treatment, Mental health, People’s Experiences | healthtalk.org. [Online] Available at: https://www.healthtalk.org/peoples-experiences/mental-health/electroconvulsive-treatment/managing-mental-illness-and-recovery [Accessed 7 Jun. 2018].

Hughes, K., 2017. Health as individual responsibility: Possibilities and personal struggle. In Mainstreaming Complementary and Alternative Medicine (pp. 25-46). Routledge.

M, S. 2018. Psychiatric nurses’ communication with psychiatric patients. – PubMed – NCBI. [Online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8697531 [Accessed 8 Jun. 2018].

Manderscheid RW, e. 2018. Evolving definitions of mental illness and wellness. – PubMed – NCBI. [Online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20040234 [Accessed 8 Jun. 2018].

Marmot, M. and Allen, J.J., 2014. Social determinants of health equity.

R, L. 2018. Paradoxes of Personal Responsibility in Mental Health Care. – PubMed – NCBI. [Online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27858512 [Accessed 8 Jun. 2018].

Tariki Books and Papers. 2018. A BUDDHIST PERSPECTIVE ON MENTAL HEALTH. [Online] Available at: https://buddhistpsychology.typepad.com/my-blog/a-buddhist-perspective-on-mental-health.html [Accessed 8 Jun. 2018].

Thippeswamy H, e. 2018. Ethical aspects of public health legislation: the Mental Health Care Bill, 2011. – PubMed – NCBI. [Online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22319853 [Accessed 8 Jun. 2018].

Webber, M. and Fendt-Newlin, M. 2018. A review of social participation interventions for people with mental health problems.

Webster, Debra. 2013. Promoting Therapeutic Communication and Patient-Centered Care Using Standardized Patients. The Journal of nursing education. 52. 1-4. 10.3928/01484834-20131014-06.

World Health Organization. 2018. Health is a fundamental human right. [Online] Available at: https://www.who.int/mediacentre/news/statements/fundamental-human-right/en/ [Accessed 8 Jun. 2018].

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