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Where Is the Mental Health in Psychiatric Mental Health Nursing?

Posted on: Thursday, 29 September 2005, 03:00 CDT

By McCabe, Susan

I have been wondering lately, what happened to mental health in America? I have wondered about the role of psychiatric mental health nurses in addressing the mental health problems that seem to be everywhere. As a psychiatric nurse, I have always thought I knew madness. I thought I understood normal. I learned it contextualized in the nosology of disease, assessed and treated in the confines of healthcare settings. But as I find myself surrounded more and more by a world focused on terrorists and bombings, on violence and shootings, and on natural disasters that are as sudden as they are devastating, I am beginning to realize that I was wrong. Increasingly, as I watch the mental health of America turning on a color code of objectification of threat levels, as orange mutates to yellow and yellow is upgraded to red alerts, I realize the depth of mental health needs that surround us as psychiatric nurses. The ticker tape of mental health sorrows, with an endless replay of shootings and other disasters runs daily across the bottom of our TV view of the world, tallying the toll it all takes on our collective psyche, revealing that the mental footing I thought firm, the rules I thought I understood, the mental health I believed cloaked most of us are all changing in the blink of the eye of ideology and behavior I scarcely understand. The laws of gravity, of baseball and apple pie, are shifted in ways Newton never predicted as the mental health of supposed normal people crumbles in waves of devastating behavior.

We live in increasingly uncertain times surrounded by evidence of failing mental health for many people. One in four Americans report occasionally missing work because they have too much "stress" in their lives to function normally. It is estimated that 75% of visits to primary care providers in America are for stress-related concerns. Homicide is the second leading cause of death for American youth ages 10-24. Just over 75% of high school-age children report seeing or receiving disturbing levels of violent bullying. Some 77% of college juniors report feeling frequently or occasionally anxious and stressed, causing them decreased happiness, productivity, and resulting in lowered self-esteem. Last year, the parents of approximately 25,000 children voluntarily surrendered custody of them to the state because of the inability to deal with or to find help for their children's behavior. These facts (APA, 2004; NMHA, 2003) are eloquent evidence of the tip of an iceberg of mental health needs.

And the iceberg is growing, spreading a glacier cold chill over the comfort and the sense of health in our country, casting ripples that impact us all. This week alone, a church shooting killed seven, a courtroom shooting killed four, a mother killed her baby to "protect" it from a violent father, an immigrant who speaks no English, stressed and driving too fast to an illegal job, spun his car out of control, killing thirteen. The ripples of these mental health problems touch us all. These widely reported events were not behaviors of people with mental illness-none of the responsible people as far as we know suffered from psychiatric disorders. There were no diagnosable states, no labels that cling in descriptive, almost comforting ways, separating them from us, the healthy from the sick. They were what their neighbors called normal people, victims of failing mental health. They were a divorced father about to lose his job, insulted over words spoken at a sermon. They were a high school football star, a father and boyfriend, lost and reeling over criminal charges he denied. They were a parent, overcome by worry about the future and the quality of life her child would face. They were a recent immigrant, stressed by acculturation, trying to find a job and a home. They were people who made life-altering choices, people finding ways to deal with stress, individuals struggling to cope, to be flexible. The tie that binds them, that binds us to them, is mental health.

What do we do with the mounting mental health problems in our society? We are the specialists; we are experts in the world of mental health. It is in our very name, our very identity as professionals. We are psychiatric mental health nurses. The name is intentional, reflecting the past of our profession, the epistemological need for our name to reflect both disease and health. We are called psychiatric mental health nurses because mental health matters. We understand that mental health is dynamic, and needs to be nurtured and coddled in order to grow and be maintained. We know the quality of life is boundaried by the quality of our mental health, and as psychiatric nurses we know how much one's overall health is linked to the depth and strength of one's mental health. Mental health is a lived concept essential to health, essential to the collective psyche of a society, and is a concept that can no longer be taken for granted.

But I am increasingly wondering if we are living up to our name? The seismic vibrations of mental health problems are all around us, registering on the Richter scale of comprehension. We have all seen the effects of tsunamis, of post-9/11 angst, of anthrax, and war. But I find myself wondering; where is the collective, organized response from psychiatric mental health nurses? As individuals some of us have been active and invaluable time and efforts have been given, but as a professional discipline we have been largely absent. At a time when visibility of psychiatric nurses was possible, and when the value of what we have to offer was needed, we were absent. Where is our contribution to mental health?

Perhaps some of our absence is explainable when one begins to delve into the concept, for where does one start when examining mental health. It starts as an abstract, a value transmitted in formal ways in our educational and professional acculturation. But from the abstract, it should move to our care practices and interventions in concrete ways. But therein lies the rub. While we realize mental health is important, we struggle to really identify what it is, to measure its presence or absence, or to know what nursing actions best enhance it. Most of us assume we know it when we see it, but from the perspective of concept development, we actually know very little about mental health. We do not even have a consensus definition of what it is. If we turn to our nursing textbooks, we see a wide array of definitions of mental health, open to many diverse interpretations, each rooted in the different values, judgments, ideology, and beliefs of illness versus health that exist within nursing. Some define mental health as the absence of, as the opposite end of the continuum from mental illness. Some define mental health as a subjective state of well-being. Still others refer to mental health as a totality, the sum of parts such as the individual's ability to cope, to maintain control, to respond effectively to life's demands, and to take responsibility for one's actions. Mental health is also defined in terms of functionality, as the ability to do productive activities, to establish and maintain fulfilling relationships, to master developmental tasks, and to cope flexibly with adversity. Most definitions of mental health discuss it as a relatively enduring state, implying a steady-state, an ability to adjust to a changing social environment without undue mental, emotional, or behavioral disruption.

While all these make intuitive sense, the definitions are not easily operationalized as interventions, remain elusive to measurement, and are not very predictive in identifying who will go to church with a gun. They are even less helpful in identifying preventative actions and few guidelines exist for psychiatric mental health nurse practices designed to strengthen mental health. A clear example of the absence of understanding related to the concept of mental health can be seen in a brief literature search. Type mental health screening into CINAHL and you produce a plethora of hits, yet fully two thirds of them are actually about screening for mental illness, and almost no actional literature can be identified.

We need to put mental health back into the heart of psychiatric mental health nursing. We need to begin to wrestle with the conceptual difficulties pertaining to mental health and begin to consider how it is conceptually different from mental illness. It is time for us to build on the small body of scientific extant literature that does exist on the concept of mental health; extending that work into clear nursing care actions. For more than 50 years, the National Mental Health Association (http:// www.nmha.org/may/index.cfm) has recognized May as mental health month. The NMHA's theme for this year's mental health observance is MIND Your Health, which focuses on mind-body connections and highlights the growing research on the link between mental and physical health. Perhaps this is a perfect time for us as psychiatric nurses to renew our commitment to mental health, to renew the energy and the efforts to think of ways in which to grow our understanding of the concept, and our ability to make direct nursing actions to improve mental health.

Mental health is an essential, integral phenomenon, a universal exigency of \humanness. Mental health is fragile, erudite; a lacy cloak that can be easily torn and tattered, momentarily displaced and forgotten. Some individuals are more rough and more forgetful than others with their mental health. Some wear the cloak of mental health tightly and wrap it about them in comforting ways. Others fold up their mental health, pushing it into a pocket or purse, scarcely remembering where they put it, or when they last used it. But no matter how it is treated, it is essential to overall health.

Events of our modern world are increasingly convincing me, helping me to come to know that psychiatric nurses matter, are essential healthcare providers, and will continue to be needed, oh so needed, in the weeks and months and years to come. Psychiatric nurses are positioned well to grow our understanding of mental health and to better identify the constructs and care practices that promote, strengthen, and protect the mental health of individuals and families. Perhaps May is the time to get back to mental health. Let's talk about it . . .

References

American Psychological Association. (2004). APA survey on mental health. Washington, D.C.: Author.

National Mental Health Association. (2004). Fast facts about mental health across populations. Alexandria, VA: Author.

Susan McCabe, EdD, APRN, BC

Associate Professor, Fay W. Whitney School of Nursing, University of Wyoming

Author contact: smccabe321@aol.com, with a copy to the Editor: mary@artwindows.com

Copyright Nursecom, Inc. Jul-Sep 2005

Source: Perspectives in Psychiatric Care

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