Mental Health Nurse In Training

Reflections, Musings and some Politics in the UK

Introduction to Mental Health

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What is Mental health? Why are some people more vulnerable to poor mental health than others?

Ok this may seem a little far in but we’ve talked a bit about the social constructions of mental health, and other ideas around it but what actually is mental health?

WHO says it’s “Mental health is a positive sense of wellbeing from which springs the emotional and spiritual resistance which enables us to survive pain”.

The most common mental health problems are :

Stress
Anxiety
Bi Polar disorder
Dementia
Depression
PTSD
Dementia
OCD
Psycosis
Addiction

Anxiety is a fairly normal response to stress, different people are able to cope with different things in different ways. The earlier the intervention the better management of the condition. To understand poor mental health you have to understand what is good mental health. Depression is being seen at an earlier age more and more. Anxiety is often the trigger for depression, as you have physical symptoms which cannot be explained, you worry about the return of these symptoms.

Worry and fear is a normal response, it’s a survival instinct. It’s only when these things overwhelm do they become life limiting and therefore a sign of poor mental health. Phobias are a sign of imbalance.

Good mental health is considered:

Behaviour within societal norms, but it’s important to remember that societal norms will change and evolve, think about homosexuality, once it was considered a mental health problem and now it fits societal norms. Slightly differently Cultural norms can often be seen as unusual outside of the culture but within its considered totally fine.

We should be careful not to project our understanding of “normal” on to our clients, some clients will consider their norms very different to our own but they are not dangerous, or necessarily unwell if they think differently to yourself. Can we work within their norms and still maintain mental health?

Well some stats for you:

1 in 6 working age people will experience mental ill health. 

Mental ill health accounts for 1/3 of all ill health in the UK.

It is estimated that half of all women and a quarter of all men will experience depression before the age of 70 

Men are much more likely to commit suicide than women.

1/10 people will have issues with anxiety. 

The statistics are difficult when it comes to women and mens reactions to mental health. Men are much much more likely to commit suicide, but  this is not because they feel the depression more strongly but because they are less likely to seek help and support from professionals, there is more pressure on them to behave in a certain way (strong, tough, emotionless), and they have less access to mental health advice through magazines etc. There is also the connection that females will have a closer bond with their family, and support, compared to men.

Its thought that some people are more predisposed to mental health problems, but that anyone can have problems when triggered by a certain event, a stressor, or when quality of life is so diminished that it leads to stress over a prolonged period of time.

There are a lot of models to help  us understand mental health and I will cover a few of them here.

So the continuum model works on the principal that our mental health will always be shifting from healthy to less healthy throughout our lives, there are things that will make us more vulnerable to the swing going more to the right.

There is also the idea of Continuity vs Discontinuity, Continuity theory considers dimensions/degrees of health, understanding individuals, social science, and nurture. Discontinuity looks at categories of illness, making diagnosis, biomedicine, and nature.

A good book is Hart (2000) The Continuity of Mental Health and Illness.

Then there is Brabben and Turkington (2002) “bucket” of stress vulnerability. The idea is that we all have a level of stress in our lives, in this example debt, something that nags at us but isn’t controlling, that’s the base load of water in the bucket. Then very often you’ll have an acute issue arise, in this example exams, generally short lived but a big stresser, so the bucket fills a bit more, then you self medicate your increasing stress with drinking and not sleeping enough so the bucket is even more full and you start to see physical signs of the stress on the body, then you could self medicate a little more to deal with the additional physical stresses from the previous self medication.

Stress Vulnerability Bucket

Suddenly the bucket is full and you find it very difficult to manage the physical and mental symptoms, and this is when mental illness is more likely to occur.

Why do some people suffer and others not? Initial thoughts are :

Coping Strategies
Resilience
Pre Disposition
Level of Stress Baseline
Quality of Life

There are biological sources of vulnerability such as an abnormal brain structure or environmental influences. Abnormal brain structure is usually centred around issues in the lateral ventricles. They tend to be larger in those with psychosis, levels of serotonin are often lowered during episodes of depression and individuals with psychopathy often have limited activity in the frontal cortex and the amygdala (a – mig – da-la). Environmental influences such as viruses or difficulties in birth have been considered but there is no conclusive evidence of anything but a casual link.

Psychological Vulnerability is considered when individuals have information processing disorders, there may be specific phenomena that might contribute to the development of mental illness. Impairments in perception, memory and attention are cognitive defect, they can be from a trauma, abuse or social isolation. In fact even 24 hours in isolation can cause trauma if the person is not accustomed to it. There is also a natural process that the majority of people have which means they pay more attention to some elements of information, memories or experiences. It’s natural if we believe something to find information to prove ourselves right, this is cognitive bias.

Stress Vulnerability is the idea that if you already have a layer of stress in your life continually then you are more vulnerable to mental health problems such as anxiety, depression, and even psychosis. It explains why people might suffer from mental health problems and others do not.

Zubin and Spring – Stress & Vulnerability – Why do some people become ill? (Good book)

Brabben and Turkington (2002) Stress Vulnerability Bucket

There are a lot of sources of stress, they generally fall in to three categories

Physical Stress

Late nights
Binge drinking
Illicit drug use
Lack of routine
Poor diet
Illness
Addiction
Over training
Dieting
Malnutrition
Physical abuse

Environmental

Poor housing
Social isolation
Unemployment
New Environments
Moving
Where You Live
Feeling Unsafe/Paranoid
Discrimination
Weather/Lack of Sunlight
Finances
War

Emotional Stress

Relationship issues
Peer pressure
High expressed emotion
Conflicting cultural values
Leaving home
Marriage
Parenthood / Loss
Financial pressures
Insecurity
Isolation
Bereavement 
Unrequited love
Carer / Young Carer
Social Standing
Single Parent
Conflict with Self
Social exclusion/Bullying
Lack of control

There are Chronic problems and Acute problems. Chronic conditions are continual, they build more and more and cause constant stress, Acute problems tend to be short term but very intense, most likely life events. 

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