Mental Health Disorders Textbook PDF

Mental Health and Mental Health Disorders A mental health disorder, which can be caused by a combination of genetic, biological, personality, and environmental factors, is a disturbance in a person’s ability to cope with or adjust to stress; as a result, the person’s thinking, mood, and behaviours...

Mental Health and Mental Health Disorders A mental health disorder, which can be caused by a combination of genetic, biological, personality, and environmental factors, is a disturbance in a person’s ability to cope with or adjust to stress; as a result, the person’s thinking, mood, and behaviours are affected, and functioning is impaired. Twenty percent of Canadians (one in five) will personally experience a mental health disorder during their lifetime.1 Mental health disorders affect people of all ages, cultures, and educational and income levels. Many people may be uncertain whether they have a mental health disorder (see BOX 37.1 on page 859). The onset of most mental health disorders occurs during adolescence or young adulthood. The terms mental illness, mental disorder, emotional illness, and psychiatric disorder all refer to mental health disorder. Mental health is a state of mind in which a person copes with and adjusts to the stressors of everyday living in socially acceptable ways. It is influenced by three factors: (1) inherited characteristics, (2) childhood nurturing, and (3) life circumstances. With good mental health, a person can cope with life’s difficulties and challenges and can “bounce back,” or recover, from difficult situations. People who are mentally healthy may feel anxiety, sadness, grief, and loneliness from time to time, but they can handle normal amounts of stress and are able to express and control their emotions appropriately. They feel capable and competent, know their own needs, can form stable and satisfying relationships, and lead an independent life. Impact of Mental Health Disorders More than one million Canadians currently live with a severe or persistent mental health disorder. Even if not affected personally, most Canadians in their lifetime will have a family member, friend, or co-worker affected by a mental health disorder, ailment, or addiction:1 The statistics regarding mental health disorders are staggering:1 20% of Canadians will personally experience a mental health disorder during their lifetime. Schizophrenia affects 1% of the population in Canada. Anxiety disorders affect 5% of the population. About 8% of adults in Canada will experience a major depressive disorder in the course of their lives.  Suicide rates in some Indigenous communities are among the highest in the world: five to seven times higher than the national average for First Nations youth and 11 times the national average for Inuit youth. Anxiety disorders are the most common of all mental health issues. It is estimated that 1 in 10 Canadians is affected by them. COVID-19 has impacted all Canadians. The Canadian Mental Health Association (CMHA) has stated that the pandemic is continuing to cause pronounced mental health concerns, including suicidal thoughts and feelings, in many segments of the population, particularly among isolated individuals and older persons.2 Mental health disorders are costly to the individual, the family, the community, and the health care system. Mental illness currently costs the economy at least $50 billion. If nothing changes in public programs, policies and investment, business practices, and health care practices, by 2041 there will be over 8.9 million people in Canada living with a mental illness. At the same time, the costs of mental health challenges and illness will grow sixfold over the next 30 years to $306 billion. The present value of the cumulative total cost over the next 30 years will exceed $2.5 trillion.3 Causes of Mental Health Disorders The causes of mental health disorders are complex, as there are numerous contributing factors, including the following: Biological factors. Chemical imbalances in the body can cause mental health disorders. Some disorders run in families, which suggests that they can be inherited (passed from parent to child). Childhood experiences. Childhood traumas or conflicts, particularly when memories of them are repressed, can cause mental health disorders. Repression means the keeping from the conscious mind of (or “burying of”) unpleasant or painful thoughts. For example, a client who was sexually abused during childhood has no recollection of the abuse. Social and cultural factors. These include poverty, discrimination, and social or physical isolation. Stressful life events. Although stress is a fact of everyday life, too much stress can cause serious health concerns, especially if it is not dealt with in a healthy-lifestyle manner. Family situations and workplace pressures can be stressful. Change is also stressful (see Chapter 8), especially when associated with loss (such as the death of a loved one or a divorce), and can lead to physical and mental health issues.  Poor physical health or disability. People with serious illnesses, injuries, or disabilities are at risk for certain mental health disorders. Supporting Clients and Their Families It is now known that mental health disorders can be treated successfully in the vast majority of circumstances. Until the 1960s, many people with chronic or severe mental health disorders lived in psychiatric facilities. Today, only those who are severely ill live in facilities. Unfortunately, a few people with mental health disorders end up living on the streets, as they are too ill to hold a job or apply for financial assistance, may fear receiving treatment, or are not aware of their own illness. Most people with mental health disorders are able to live in the community, where they may be offered treatment as well as assistance with life skills and employment. For example, once depression is recognized, treatment and support can make a difference for 80% of people who are affected, allowing them to get back to their regular activities.1 People with chronic or moderately severe mental health disorders are able to live in their homes, in group homes, or in assisted-living facilities, depending on their needs. Support workers provide valuable care and support to clients with mental health disorders and to their families in a wide variety of settings. The Importance of DIPPS While you are caring for and providing support to a person with a mental health disorder, your actions should always focus on respect for and acceptance of the client and their family. It is important to remember that the client is not defined by their diagnosis. Remember the principles of DIPPS (see the Providing Compassionate Care: Supporting Clients With Mental Health Disorders box on page 858). BOX 37.2 lists the principles that govern health care workers’ care and support for clients with mental health disorders and for their families. Mental health disorders affect people in different ways, and people with mild disorders tend to have fewer challenges than those with more pronounced mental health issues. Severe mental health disorders, however, almost always cause distress not only to the affected individuals but also to their families. The individuals with the disorder may be unable to function, and their behaviours may become disruptive at times. The support worker often provides the needed reassurance and support to these clients and to their families. Because they might have been exposed to negative attitudes in the past, your clients and their families may be particularly sensitive to any verbal or nonverbal signs that indicate disapproval of them or stigmatization of people with mental health disorders. Therefore, you need to pay particular attention to your body language and verbal language and make every attempt to convey to them that you are respectful, nonjudgemental, and accepting of their behaviours. Principles of Mental Health Care 1. Follow the care plan. Tell your supervisor if support measures are not working. 2. Do no harm. Provide a safe, comfortable setting for the client. You need to provide both safe care and protection from harm at all times. A safe, quiet, and neat setting can calm the client. You should remember to act as the client’s advocate whenever necessary to ensure the client’s safety (see the Think About Safety box on page 861). 3. Accept each client as a whole person. You should be accepting of the client and refrain from making any judgements. 4. Be patient and supportive. Speak calmly; avoid speaking in a loud or sharp tone of voice. 5. Develop mutual trust. Remember to do what you say you will do. Being on time, providing the care as promised, and explaining all procedures will promote trust and reduce your client’s anxiety. 6. Explore behaviours and emotions. Many clients will share with you what they are feeling and thinking if they trust you and if you take the time to listen to them. 7. Observe the client carefully. Observe for any changes in the client’s behaviour, mood, and thinking, such as signs and symptoms of fatigue, stress, anxiety, fear, and frustration, as well as signs and symptoms of illness. Report and record all of your observations, according to employer policy. 8. Encourage responsibility. Taking responsibility for their own actions helps clients build self-worth, dignity, and confidence. 9. Encourage effective adaptation. Clients who are mentally stressed may behave in socially unacceptable ways or may be harmful to themselves or others. It is often your responsibility to intervene when this behaviour happens and to help clients find better ways of coping.  10. Provide consistency. Maintaining a routine promotes a sense of control. Consistency and reliability of your care will also provide security and stability for the client. This will, in turn, help reduce the client’s stresses and anxieties. Maintaining Client and Worker Safety It is not uncommon for clients in any setting to feel comfortable enough to share confidential information about themselves with their support workers. However, if the client shares an intention to do self-harm or to harm others, you must report this immediately to your supervisor or the appropriate person. You must then accurately record the conversation in the client’s records (see Chapter 26). Clients should also be informed that health care workers are obligated to report this information. When supporting a client, remember that your personal safety is also a priority (see Chapter 20). Remember to maintain a safe distance from any client who might strike you, intentionally or otherwise. Do not enter premises or leave them if there are unlocked firearms or weapons present. Always maintain a clear path by which to leave any premises suddenly, and immediately notify the appropriate person on your cell phone, according to your employer’s policies. Team Approach The care-planning process aims at addressing the needs of clients with mental health disorders, including their physical safety and emotional needs, and usually requires input from various members of the health care team. The physician may order medications, depending on the client’s disorder, signs, and symptoms, as a number of mental health disorders can be controlled effectively with medication. The health care team may include a family physician, nurse, occupational therapist (who helps the person learn or relearn skills for the performance of life tasks), social worker (who provides assistance such as helping a client resolve employment problems), support worker, and one or more of the following mental health specialists: Psychiatrists—physicians who specialize in mental health disorders and who can prescribe medications for treatment Psychologists and psychotherapists—health care providers educated in treatments for mental health disorders that do not involve prescribing medications  Indigenous mental health providers—elders, healers, and cultural counsellors, who are vital parts of many Indigenous mental health services, and other members of a treatment or mental health and wellness staff, who assist clients and provide services to Indigenous people and communities. Some practitioners use exclusively traditional Indigenous healing methods or a combination of traditional and Western health care methods. Treatment of mental health disorders often involves psychotherapy, which is a form of therapy in which a client explores thoughts, feelings, and behaviours with the help and guidance from a mental health specialist. The various forms of psychotherapy include the following: Psychoanalysis—explores the unconscious conflicts and reasons behind the person’s mental health issues. Behaviour therapy—attempts to change behaviour by using various techniques. The focus is on the behaviour, not on the underlying reasons for the behaviour. Cognitive behavioural therapy—a practical, short-term form of psychotherapy. It focuses on the challenges a person may face in day-to-day life and is problem-focused and goal- oriented. It teaches the client strategies and skills for coping.4 Group therapy—a group of people who meet regularly to discuss their concerns under the guidance of a mental health specialist. Family therapy—family members meet regularly with a mental health specialist to discuss their issues or conflicts. Stigma of Mental Health Disorders Chapter 6 included a discussion about how some people feel uncomfortable or fearful in the company of people with illnesses and disabilities. They may stare or avoid eye contact and may treat these people differently from others who are well or appear able-bodied. This altered treatment is commonly faced by people living with mental health disorders, who are often discriminated against because of a lack of understanding of mental health disorders. Some people fear being with a person with a mental health disorder; they do not know what to expect and may believe that the person is dangerous. Some may blame people with mental health disorders for their own difficulties. Such attitudes lead people to avoid and exclude persons with mental health disorders, often causing them to feel ashamed, rejected, and isolated. Stigma is social shame associated with a particular circumstance, quality, or person, such as “the stigma of a mental health disorder.” A report from the Mental Health Commission of Canada stated that for individuals with mental health disorders, stigma is a major reason for not seeking treatment, taking prescribed medication, or attending counselling.5 It also stated that stigma affects men more than it does women and influences the person’s successful reintegration into the family or into society in general. The stigma extends to the workplace, with employers often having concerns about the person’s ability to function at the level of other employees. Although it is against current human rights legislation to openly discriminate against people with mental health disorders, many employers still do. The Canadian Alliance on Mental Illness and Mental Health (CAMIMH) is an organization that represents mental health professionals and individuals concerned with mental health. The main goal of the CAMIMH is to prevent stigma and discrimination against people with mental health disorders. Through educational programs, the organization promotes greater understanding and acceptance of people with mental health disorders.6 As a support worker, you must remember that all clients (and their families) have the right to caring, nonjudgemental support and the right to be treated with dignity and respect, as stressed throughout this textbook. Effect on the Family Often, family members of clients with mental health disorders must make difficult decisions about care, treatment, and housing. They may feel anxious about an uncertain future, and the financial burden of caring for a loved one who is ill may be significant. Some family members may feel guilty and blame themselves for the illness, and some others may be at risk for depression themselves. Family members are also affected by the stigma of mental health disorders. Friends and acquaintances who feel uncomfortable may not offer their time or social support. One woman described how differently people reacted to her husband’s physical illness than to her son’s mental health disorder: “When my husband had cancer, neighbours and friends were very kind. The phone rang constantly with offers to help. People brought over meals and sent flowers and cards. When my son was diagnosed with schizophrenia, everything was different. Nobody called. Nobody asked how we were doing. They pretended everything was fine. We felt very much alone.” Culture and Its Influence on Mental Health Disorders and Treatment The need for understanding cultural differences among clients receiving support care has been emphasized repeatedly in this book. As stated in Chapter 7, culture is not limited to ethnic background but can extend to any group of interacting individuals who share similar learned characteristics, such as families, groups of friends, or even people who have shared similar experiences in the past. Culture has a profound influence on understanding mental health disorders and their treatments. People in one culture may not find it hard to seek medical attention for their mental health disorder, while people in another culture may see it as a sign of weakness. Similarly, some family members may refuse to acknowledge a loved one’s mental health disorder, whereas others may readily be open about it. Some cultures distrust traditional medicine and prefer to consult their local healer for herbal treatments or other remedies. Interpretations of the signs and symptoms of what some call “mental illness” vary greatly from culture to culture and even from person to person. What may be appropriate behaviour in one culture or group of people may be considered “insanity” in another. For example, someone who has lived through severe poverty might be afraid or hesitant to throw anything away, even items such as rubber bands or paper clips; some, in contrast, may consider keeping these things odd behaviour (see the Supporting Mrs. Hill: The Effect of Past Experiences box). Understanding your clients’ cultural background before caring for them will help you show respect for their cultural differences and preferences as you provide care. Make sure that you follow the DIPPS principles. Mental Health Challenges Among Marginalized Populations Within Canada Marginalized populations within Canada that were identified in Chapter 12 as being at high risk for abuse may also be at increased risk for mental health challenges. Those marginalized persons include people who (1) are not fluent in an official language and so are less likely to seek assistance when needed, (2) belong to a visible-minority group (for example, members of Indigenous communities or some ethnic groups, or members of the LGBTQ2 community), (3) are geographically isolated, (4) live with a physical or intellectual disability, (5) live with a mental health disorder, (6) have (or had) a substance abuse problem, or (7) work in the sex trade and may therefore be shunned by mainstream society. Marginalized people can also include inmates and refugees. Refugees are people who had to escape from their former country, leaving their homes and families behind, to seek safe shelter elsewhere. Many refugees have seen or experienced imprisonment, torture, murder of loved ones, extreme hunger, and poverty. They must learn to cope with life in a new country, learn new customs and a new language, and adjust to the new country’s laws. Because of their particularly difficult circumstances, many marginalized people have a higher incidence of depression, anxiety, and stress and may be distrustful of the support care they are receiving. As a support worker, you should know when to report your observations to your supervisor. Providing Care and Support for Clients With Mental Health Disorders There are different types of mental health disorders, and this chapter briefly addresses the most common of these, paying particular attention to the role of the support worker in caring for clients with these disorders and for their families. Common mental health disorders addressed in this chapter include acquired brain injuries; schizophrenia spectrum disorders; bipolar and related disorders; major depressive disorders; anxiety disorders; trauma and stressor-related disorders; obsessive–compulsive and related disorders; feeding and eating disorders; sleep–wake disorders; suicidal behaviour disorder; disruptive, impulse-control, and conduct disorders; substance-related and addictive disorders; and personality disorders. Disorientation, delirium, and dementia, which are conditions and mental health disorders of particular significance in older persons, are discussed in Chapter 38. Acquired Brain Injuries An acquired brain injury (ABI), which was introduced in Chapter 33, is any type of sudden injury or illness that causes temporary or permanent damage to the brain. It is also discussed in this chapter because clients who live with an ABI may be at increased risk for feelings of frustration, anxiety, mood swings, or depression (see Supporting Greg Wood: How an ABI Can Affect Behaviour, on the next page). Families of clients must learn to adjust to any new changes in personality or if the clients can no longer contribute to the family income as they used to. Some clients who have suffered an undiagnosed (or mild) ABI can be mislabelled, misdiagnosed, and misunderstood, which can increase their feelings of frustration or anxiety. Supporting Clients With Acquired Brain Injury (ABI) While providing support to clients with ABI, keep the following in mind:7 Follow clients’ care plans in reassuring them that what they are experiencing is a result of brain injury. Clients with ABI may have forgotten about the injury that occurred but may be aware that they feel “different” from before. One goal of the health care team is to teach and reinforce information about the reasons for their symptoms. Doing so will help to reduce the fear and anxiety that clients may feel.  Encourage clients to establish routines and structure in daily tasks. Being able to establish a routine when carrying out everyday tasks such as bathing, dressing, eating, or toileting will reinforce a sense of accomplishment and self-esteem. It can also reduce anxieties resulting from trying to decide what to do. Encourage clients to set both long-term and short-term goals. Goals help the client with ABI to focus on a specific task and can motivate the client to work toward reaching the goals. Goals should always be realistic and achievable. If a certain goal is not achieved, the client may need to be supported to accept the failure and to try again. Ensure that clients’ adaptive devices are within reach. If a client must use an adaptive device (such as a wheelchair, memory aid, or picture board) to assist with ambulation or communication, it should be easy for the client to reach and use. Encourage clients to “put the past behind them.” A client who focuses on lost abilities may refuse to participate in rehabilitation activities. Although this reaction is normal for a short period, if prolonged, it may prevent the client from reaching their full potential. Follow the steps in Supporting Clients With Anxiety Disorders, on page 868, and Supporting Clients With A Depressive Disorder, on page 872, if directed to do so by your supervisor. Observe for and report signs indicating alcohol or substance use. The client with ABI who is feeling depressed may wish to drink alcohol or take recreational drugs or substances and may lack the ability to reason that these substances may be harmful. Supporting Mrs. Hill: The Effect of Past Experiences After falling and breaking her hip in her backyard, followed by a lengthy hospitalization and rehabilitation, Anabelle Hill, 85, was finally discharged home for supportive care. As her support worker, Tina was assigned to assist Mrs. Hill with her daily bath and with leg exercises. On Tina’s first visit to Mrs. Hill’s home, she noticed the house seemed clean but overfull, with items everywhere. In the kitchen, there were boxes of empty plastic containers, egg crates, and items such as string, all neatly sorted and packed. Tina also noticed that Mrs. Hill used a handkerchief when she blew her nose, did not own any paper towels, and used clean, rewashed rags instead of toilet tissue. Trying to be helpful, Tina politely offered to put the boxes of items at the curbside for recycling. Mrs. Hill became upset and told her that it was “unnecessary to throw everything away.” Later, when Tina talked to her supervisor about what she saw, the supervisor told Tina that many people who had been very poor during the Great Depression tended to keep items that seemed useless to others and suggested that Mrs. Hill may be one of those people. The next time Tina went to Mrs. Hill’s house, she asked Mrs. Hill about her experiences during the Depression. Tina found out that Mrs. Hill’s family was homeless during that time and that they all survived by begging for food and living in a deserted shed on someone’s farm. Tina began to understand Mrs. Hill’s insistence on reusing items that Tina would have just thrown away. Tina then remembered another client who had also had many boxes of used items in his home and who had also survived a similar experience.