I received a message from Terrie Riley, Mental Health First Aid Instructor, a few weeks ago,replied and then filed it in my 'I'll think about what I can do about this' box. Then, this morning I was listening to a programme on the radio about the dilemma faced by people who have or have had a Mental Health illness. Firstly, Terrie's message which she asked me to pass on:
'Please could you show your support for Mental Health education by passing my contact details on to anyone you know who might be interested or is passionate about education of the populous regarding Mental Health issues. 1 in 4 of your friends, colleagues and family WILL be affected by mental health problems within the space of this year, the majority will not know how and when to get professional help so they can start on the road to recovery. The stigma associated with mental health problems mean that people do not ask for help soon enough therefore the misery that these people suffer goes on sometimes for years and can be a very distressing time. Mental Health First aid is designed to educate people as to the help out there and how to spot the early warning signs of mental illness.
In my opinion the only way to tackle the stigma and discrimination is to educate everyone whether they suffer from mental ill health or not the training programme is designed to facilitate discussions and give people the confidence to talk about difficult subject such as suicide. '
During my work as a nurse on various wards in a busy NHS hospital, I often come across patients who have a past history of Mental Health problems or a current overlay of a Mental Health illness. I consider myself a reasonably well educated nurse, keep up-to-date with current treatments and current health issues yet still react to the words 'suffers from depression' or 'schizophrenic' differently from the way I react to 'suffers from diabetes' or ' has diverticulitis' . I find myself expecting to find that the patient is somehow different , more anxious or less able to cope with their current illness which may have nothing to do with a Mental Health illness. They may be lying quietly in their hospital bed nursing a sore arm or a broken toe, in no way distinguishable from the patient in the next bed with a similar complaint .
Why does the brain and its vagaries still make us react with suspicion or make us feel that the person who has a Mental Health condition is somehow showing a weakness and should be able to 'deal with it like the rest of us'?
Terrie's use of the word 'stigma' holds the clue, I think. This was highlighted again on the radio programme this morning. The dilemma faced by people with a current or past Mental Health Illness in deciding whether to disclose this to an employer, for example. The expression 'damned if you do, damned if you don't' was used. If disclosed, the risk is that the employer will see the person as being unable to cope under stress and likely to need a lot of time off work. If not disclosed, the risk is that extra support - perhaps a quick catch-up occasionally to see if all is going well- will not be given.
I then started thinking about the English language needs of overseas nurses who care for patients with a Mental Illness, particularly during a crisis period. Do they need more langauge support to be able to nurse patients with a Mental Health illness. My conclusion is that the language skills are no different from any other patient exchange, that is:
- paying attention (active listening) to what your patient is telling you
- listening for the 'hidden message' - what your patient is not telling you but may be expressing in a non-verbal way
- being aware of differences in non-verbal communication - e.g less eye contact
- explaining procedures carefully so patients are aware of planned interventions ahead of time
- encouraging co-operation from patients in their own care -after all every patient has this right
- asking patients to explain to you if they feel they may have difficulties following treatment
- asking patients how they are feeling 'right now' - and following with 'what can I do to help'
- asking patients if they would like anyone (a support worker) to help them in hospital
I have a friend who recently re-trained as a Psychiatrist and started work in a small Mental Health unit. She was telling me that she brought in a new 'programme' with her clients. She explained to them that they were going to start going out into town for outings - going to the movies and going out for coffee. Firstly, she said, they were going to have a dental visit, go to the hairdresser's for a 'new look' and buy some new clothes (mostly at charity shops. She's a bit of a charity shop fan herself!) Her point was :'You are like everyone else. You have a right to look your best like everyone else. You have a right to go to the places everyone else goes to'. The programme continues and is going well . Not surprisingly the residents at the unit have started looking as if they have confidence and feel they had the right to go where ever they chose to go, just as other people do.
For too long we have believed that people with a Mental Illness look different. They may well look different if they are in the throes of a psychotic episode but then people in the middle of a hypoglycaemic attack or a stroke also look different from their normal selves. A patient suffering from reactive depression experienced because of the death of a loved one is placed in the 'acceptable' box where depression experienced as a Mental Health illness is viewed as suspicious. Why is it OK to suffer depression if there is a 'reasonable cause' but not if it is a part of a person's health status?
World Mental Health Day was celebrated this year on Oct 10 - to raise public awareness of Mental Health.
From the World Mental Health Day website
'Mental disorders affect nearly 12 percent of the world’s population – about 450 million or one out of every four people around the world – will experience a mental illness that would benefit from diagnosis and treatment. WHO statistics for 2002 showed that 154 million people globally suffered from depression, which is a form of mental illness. According to WHO, mental health is defined as a state of well-being in which people realize their own potential, can cope with normal life stresses, can work productively, and can contribute to their community.
Mental health services lack human and financial resources in many countries, particularly low and middle income countries. More funding is needed to promote mental health to increase people’s awareness of the issue. In response to making mental health a global priority, World Health Day was first celebrated in 1992 as an initiative of the WFMH, which has members and contacts in more than 150 countries. Each year the UN, through WHO, actively participates in promoting this event.'
So, what can we, as nurses, do to help?
- Treat all patients as people who need care and attention in physical, emotional, psychological and spiritual areas
- Look beyond the name of the illness and try to see what additional support a patient may need
- Spend time listening to patients to truly understand their needs
- Stop fearing Mental Health illnesses - most are treated as effectively as physical illnesses
I know I am going to keep trying to look beyond the diagnosis to the real patient . Are you?