MAY IS MENTAL HEALTH MONTH

MAY IS MENTAL HEALTH MONTH

A Call to Nursing Awareness and Action

By Carson Easley, MS, RN, Director of Nursing, The Harris Center for Mental Health and IDD, Chair, TNA Mental Health Workgroup

RECOGNIZED IN THE UNITED STATES SINCE 1949, Mental Health Month (May) was initiated by Mental Health America (MHA) and is promoted by MHA and its affiliate associations across the country. MHA remains a recognized resource for mental health awareness education, programs, and tools geared toward community education.

At the time of the initiation of Mental Health Month, psychiatr ic/mental health (PMH) nursing practice was considered a specialty whereby nurses received training post licensure. In the mid-1950s, PMH concepts became a requirement for all nursing education programs. However, nursing education has not been consistent in the availability of either clinical learning opportunities or experienced PMH faculty.

For the purpose of this article, the impact of unrecognized/untreated depression will be explored. Depression is often comorbid with chronic disease states, meaning that patients experiencing mental illness also have medical diagnoses such as heart disease, hypertension, diabetes, obesity, cancer, etc. Those experiencing mental illness in conjunction with another diagnosis die at an earlier rate than the general population with these diagnoses, and this is especially true for those diagnosed with schizophrenia.

Many times patients do not recognize that the feelings of sadness, loss, and/ or hopelessness may be stemming from depression. More often than not, persons with chronic medical conditions, who may also have symptoms of depression, are not assessed for depression. It is safe to say, if it is not assessed, it is not addressed.

The American Psychiatric Nurses Association (APNA), the organization that represents PMH nursing, has published a position statement, “Whole health begins with mental health” (2017). The statement declares that health is more than an absence of illness and that mental health is foundational to overall health and well-being. This aligns with the Robert Wood Johnson Foundation's pioneering efforts to advance a culture of health. The action framework for this work is based on the World Health Organization's (WHO) definition of health as “a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity” (WHO, 1948). Mental health is an essential element of whole and complete health.

Missed opportunities occur when members of the healthcare team fail to actively engage and identify patients presenting with depression or who may be at risk for suicide. (See sidebar discussion of a practice innovation implemented by Parkland Hospital to screen patients for suicide risk at multiple entry points into the healthcare system with the goal of suicide prevention.)

An alarming nationwide trend is the increased rates of suicide, a public health issue that impacts society for all ages, races, and ethnicities. Statistics show that annual suicide rates are more than two times the rate of homicides. Many of the persons who die by suicide have come in contact with a healthcare professional in the year preceding death. Depression is often undiagnosed, untreated, or unreferred for consultation in acute healthcare settings. Rarely does the discharge plan include recommendations for follow-up with a mental health professional.

When untreated, depression has a high correlation with suicide — both attempts and deaths. For those who unsuccessfully attempt suicide, an opportunity arises in hospitalizations that may result in life-changing outcomes that impact individuals, families, and communities.

The Healthy People 2020 project re- leased by the U.S. Department of Health and Human Services outlines health issues that are high risk to the public’s health. It is noteworthy that suicides and adolescent depression are listed as two of the 26 Leading Health Indicators (LHIs) that pinpoint determinants of health promotion, quality of life, and healthy behaviors. This falls under mental health, which is one of the 12 topics identified as high-priority health issues.

For many healthcare systems, it is assumed that once physical medical symptoms are under control, the patient’s affect will improve. Healthcare literature regarding patients with heart disease finds there is a strong correlation between cardiac heart disease and depression. Patients with chronic health conditions are discharged from acute care settings and often have not been asked during or at the end of their stay any questions reflective of their mental health status or their feelings regarding their condition, feelings of sadness, or if they are hopeful for the future. Reports in the medical literature reveal that these patients often return to the acute care setting with their medical condition symptoms worse than at discharge. Someone experiencing depression may have challenges adhering to a medical regimen such as taking medications as prescribed, exercising, making and keeping follow-up medical appointments, and following an eating plan that supports an improved state of health. Maintaining a healthy lifestyle is not an easy task even with the best of intentions, but becomes more difficult when dealing with symptoms of depression.

Hospitals are recognizing the financial impact of recidivism for patients who fall into this category. The situation above is a prime example of the impact of a mental health condition on symptom management and quality of life for a person experiencing a physical medical condition. The concept of mental health as foundational to all health as stated by APNA requires nurses in all practice settings to have the skills, knowledge, and abilities that enable them to gain competency and become comfortable with integrating PMH concepts and content as part of their assessment and intervention tool kits.

New nursing graduates rarely identify PMH as a practice choice within the first two years post-graduation. In Texas, less than 8,000 of the approximate 280,000 registered nurses self-identity their primary practice setting as PMH. Advanced Practice Registered Nurses whose primary focus is PMH number less than 600.

The numbers are daunting in terms of the quantity of nurses with a primary practice focus in PMH, but this can also be seen as a call to action for every nurse in practice to improve their literacy regarding PMH in the areas of assessment, interventions, and knowledge of community resources for patients in any settings.

WHAT CAN NURSES DO?

Become advocates for treating/engaging the whole person. Here are some suggested actions:

• Become informed and knowledgeable regarding the presence and types of mental illnesses prevalent in your community.

• Research suicide rates locally and nationally and the populations most at risk — in other words, know the stats for your community and the population served.

• Review current screening tools and comprehensive nursing assessments in use to ascertain if the data collected provides the necessary information to determine if there are underlying symptoms of depression with a risk for suicide.

• Become knowledgeable regarding standardized rating scales for depression that are populationspecific and can be employed in a variety of healthcare settings. Such tools can be found for child/adolescent, adult, and geriatric patients.

• Establish an information database for resources and PMH tools.

• Engage nursing leadership to develop a plan of action.

• Initiate training programs to increase awareness and knowledge of mental health issues and methods for practice integration.

• Establish an organizational cultural norm for all patients to be screened and assessed for depression and suicide ideation. When it is the norm, just like taking blood pressures, stigma is reduced.

• Gain knowledge regarding what other healthcare entities are doing, such as the Parkland Algorithm for Suicide Screening (PASS) initiative.

• Develop community partners who can collaborate and support the initiative and may be employed for consultations in-hospital and post discharge.

• Engage members of the healthcare team and stakeholders at all levels of the healthcare system. Inform them of the public health issue and community impact of deaths by suicide as well as the role the system can take in prevention.

Nurses have the training, but like with any skill, if not used, the knowledge becomes stored away. A few of the many attributes for which the profession is recognized are communication skills, patient education abilities, and most importantly, patient advocacy. So you are more than halfway there in taking the lead in your practice setting to support equity for mental health as a driver for treating the whole person so that overall health and wellness can be fostered. i

MENTAL HEALTH MONTH RESOURCES

Department of State Health Services Texas Suicide Prevention Information on suicide prevention for youth and adults.

Mental Health America Advocacy group for mental health focused on early treatment.

National Council for Behavioral Health Information on mental health first aid.

Suicide Prevention Resource Center Comprehensive prevention resources, including the Zero Suicide initiative to prevent deaths by suicide in health care and behavioral health care systems.

American Foundation for Suicide Prevention The American Foundation for Suicide Prevention funds research, provides resources, and raises awareness of suicide prevention.

American Psychiatric Nurses Association Information and resources for psychiatric mental health nurses and nurses in any practice setting who encounter persons with mental health conditions.