There has been quite a lot of discussion amongst the members of Nurse Uncut about having to manage difficult patients and their relatives. The focus has been mainly in Aged Care and I guess that’s because it’s becoming the biggest sector of people who are unable to care for themselves and/or their relatives are unable to care for them either. It’s under these stressful circumstances that undesirable traits and behaviours are much more evident.
I think many of these difficult people may have had undiagnosed (or diagnosed but not adequately managed) mental illnesses most of their lives. Statistics show that 1 in 5 Australians will experience a mental illness sometime in their life. Globally, mental illness is expected to be the 2nd biggest health issue of the 21st century!
As people grow older, their capacity to cope with their mental illness or disorder diminishes and they can no longer hide or manage their anger, depression, anxiety, paranoia or compulsive behaviours. It takes a person a lot of emotional and mental energy to manage untreated mental illness and most people towards the end of their lives just get too tired. Those traits and behaviours then become more evident and florid and so it falls upon our health system and nurses to care for these people. It’s then often labeled as dementia; and dementia is not a label – it’s a sentence!
So does it have to be that way? I don’t think so, I think we just need more education and understanding about mental illnesses.
Mental illnesses, like all illnesses, have complex origins. No single “thing” causes a mental illness or disorder. It is usually caused by a “hot-pot” concoction of genes, brain chemistry, learned behaviours, certain parenting styles, social, financial and geographic circumstances, personality type, personal and environmental stressors, childhood relationships and attachment style. All of these factors may come together to place a person at risk of developing a mental illness. Some people will never develop a mental illness even if they have lots of risk factors, but others will and why they do or don’t is still being researched very carefully.
Another factor about mental illness is that it is often termed “generational” which means that families often exhibit the same disorders and/or illnesses and these are passed down from generation to generation just like heart disease, diabetes and other familial disorders. It’s also in our family that we learn behaviours like resilience and coping, identifying and managing emotions and self esteem.
Many mental illnesses begin early in life. Here is a very simplistic example: (and – for ease of language I will use mother but it may be any caregiver father, foster carer, granny, grandad etc) If a mother experiences an undiagnosed and untreated ante or postnatal depression this mental illness may effect the way she cares for and relates with her baby. This is turn may effect the way the baby attaches and relates to his mum, lessens his resilience to coping as well as managing his emotions and normal stresses. This in turn can predispose the growing child/adolscent to behavioural disorders as well as depression/anxiety in later life. The cycle then continues.
Mental illness may present masked by many physical signs and symptoms, not just “crazy behaviour”. Headaches, rashes, fatigue, tummy and bowel troubles, palpitations and sweating are just some. Undiagnosed and untreated mental illnesses have an enormous impact on providing health services because many people present to health services with these types of physical complaints that can be investigated and treated over a long period of time as other organic illnesses. The primary presenting mental illness is therefore easily missed by health workers who haven’t had any training or experience in mental illness. When a mental illnes is missed and untreated it may become chronic and like all chronic illness it is much more difficult to treat.
Mental illnesses affect the way people think about their world. Left untreated, these thinking patterns become habitual and hard to change and become part of everyday thought patterns and expectations. These people’s conversations sound as if they always expect the worst, and speak about things in global terms (ie “people always do mean things”) or catastrophise (my whole life is a disaster).
Another less understood aspect is that when a mental illness is recurring, and is treated appropriately the patient will go into remission periods which may last for years. However, the illness in remission can’t be ignored and ongoing monitoring by health professionals is essential, as well as teaching the patient and family how to recognise warning events and symptoms to prevent or quickly treat a relapse.
If it sounds serious and complex that’s because it is and that’s why all nurses in all specialties need education and training in recognition and referral of people with suspected mental illness so that they can get help early. A program called “Introduction to mental health” should become mandatory training for nursing staff – just like we do child protection, CPR and manual handling mandatory updates. This is also called “increasing mental health literacy” part of the mental health state and federal plans.
As for those patients and their difficult relatives? Watch them carefully. They may, because of their stressful surroundings and predicaments, be displaying symptoms of a mental illness. What can you do? Well just by understanding the symptoms, behaviours and reasons for mental illnesses and people’s responses to intense stressors, enables you to engage with and better manage people.
We need to normalise Mental illness and think about it as you would any other illness. Remember how scary caring for someone is when you don’t undersand what’s wrong with them then you – once you know and you have guidelines and a road map you can calmly get on with caring for your patient and their relatives
Many of the new practices that are being introduced in health such as “working in partnership”; “relationship-based work”; and “psycho-social screening” are all based in mental health research. These practices help us to understand and attend to the emotional and mental wellbeing of our patients as well as their bodies.
I began this piece by referring to the difficulties of Aged Care Nursing because that has been a “hot topic”. However, my nursing practice is in perinatal mental health right at the other end of the nursing specialty spectrum. And, I wrote this to provide a basic introduction to “mental health”, and also because I firmly believe that if we are going to make an impact on mental illness, we have to start right at the beginning of life and during the critical period of mothering. Perinatal Mental Health is an extremely new, interesting and rewarding nursing specialty and one where my ongoing education helps me understand the many troubles of the lifespan and be able to make a sustained difference in the long term to all my clients whether they are new born or 100.
Do you have any questions, stories, or concerns that are related to mental illnesses? Do share them with us.
Image source: ihazacheeseburger.
mental illness Great Blog .Mental health whether in the AGED CARE SECTOR or dealing with young mums needs a lot more attention and funding.