continuum of mental health concept

The Mental Health Continuum

Mental health

While there is no official definition of mental or emotional health, these terms generally refer to our thoughts, feelings and actions, particularly when faced with life's challenges and stressors. Throughout our lives, mental health is the foundation of our thinking and communication skills, learning, emotional growth, resilience and self-esteem. In general, a person is mentally healthy when he possesses knowledge of himself, meets his basic needs, assumes responsibility for his behavior and for self-growth, has learned to integrate thoughts, feeling, and can resolve conflicts successfully. In relation to others, a mentally healthy person maintains relationship, communicates directly with others, and respects others. Lastly, a mental healthy person adapt to change in his environment. These characteristics provide a description of mental health but do not fully define mental health. Person who are mentally ill often possess many of the characteristics of well person, and mentally healthy person not infrequently experience symptom similar to those of mental illness. The difference between sickness and health can be quite arbitrary and is often based on the degree to which characteristic or behaviors affect a person functioning, above all, the mentally ill show deficits in functioning it is usually these deficits that bring them to the facilities when you will encounter them. Depending on the circumstances in your life at any given time, your state of mental health may be located at any point along the continuum below.

On the continuum, states of mental health are differentiated by the amount of stress/distress and impairment involved. The lines differentiating states of mental health are not precise because it is not clear at which exact point a concern becomes a problem, or a problem becomes an illness.

Most of us, most of the time, will be somewhere on the left half of the continuum – experiencing reasonably good emotional health and negotiating life events that, while stressful, do not feel unmanageable. In this state of well-being, the stress and discomfort caused by the everyday ups and downs of life do not impair daily functions such as eating, sleeping, or problem-solving. Generally we resolve these stresses ourselves, without seeking professional help.

But when major negative life events occur, or more serious or prolonged problems arise, coping becomes progressively more difficult. During these times you may experience what are identified on the right side of the continuum as “mental health problems.” Within the category identified as “mental health problems,” there are two major mental health states: emotional problems and mental illness.

Emotional problems or concerns: When emotional discomfort or distress begins to noticeably impair your daily functioning (e.g., changes in appetite or sleeping habits, lack of concentration), you are experiencing emotional problems. This experience may be commonly referred to as a “rough patch”, a “low point”, or “the blues.” Some people in this area of the continuum may be diagnosed with mild or temporary medical disorders such as “situational depression” or “general anxiety.” Self-care strategies and the support of friends and loved ones can be especially helpful during these times. In addition, many people experiencing this level of distress and impairment seek professional counseling to help them return to a state of emotional well-being.

Mental illness: The most serious type of mental health problem, located at the right end of the continuum, is a diagnosable “mental illness.” Mental illness is characterized by pronounced or prolonged alterations in thinking, mood, or behavior. Though they don’t take up a large amount of space on the continuum, mental illnesses are common: it is estimated that one in five Americans will personally experience a mental illness in their lifetime. Mental illnesses include relatively common disorders such as depression and anxiety as well as major disorders such as schizophrenia. Individuals with mental illness typically experience chronic or long-term impairments that range from moderate to disabling in nature. Like physical illnesses, mental illnesses are treatable. Professional help in the form of counseling and/or medication can lead to recovery or successful ongoing management of the condition.

Mental illness occurs when an individual is not able to view erself clearly or has a distorted view of self, is unable to maintain satisfying personal relationship, and is unable to adapt to her environment. The American Psychiatric Association defines mental disorder as “clinically significant behavior or psychological syndrome or pattern that occurs in an individual and is associated with present distress or disability or with a significantly increased risk of suffering, death, pain, disability or an important loss freedom’. The accompanying display present possible sign of mental illness sign, taken in isolation of the individual and his context or life experiences, necessarily indicates the presence of mental illness. These sign, however, assist a nurse to begin to understand the nature and experience of mental illness.

Causes of Mental Health Problems

Mental health researchers and professionals have developed several theories to explain the causes of mental health problems (including addiction), but they have reached no consensus. One factor on which they agree is that the individual sufferer is not responsible for the condition, and cannot simply turn it on or off at will. Most likely several factors combine to trigger a condition.

Environmental Factors: People are affected by broad social and cultural factors as well as by unique factors in their personal environments. Early experiences, unique to individuals, such as a lack of loving parents, violent or traumatic events, or rejection by childhood peers can negatively impact mental health. Current stressors such as relationship difficulties, the loss of a job, the birth of a child, a move, or prolonged problems at work can also be important environmental factors.Cultural factors such as racism, discrimination, poverty and violence also may contribute to the causes of mental illness. Poverty is especially significant: according to the U.S. Department of Health and Human Services, people in the lowest socio-economic status are two to three times more likely than those in the highest strata to have a mental illness.

Biological Factors: Scientists believe that the brain can produce too many or too few of certain chemicals, resulting in changes in how we perceive and experience things around us, as well as changes in behavior, mood and thought. While causes of fluctuations in brain chemicals aren’t fully understood, physical illness, hormonal change, reaction to medication, substance abuse, diet and stress have been identified as contributing factors.

Genetics: Researchers have found that there appears to be a hereditary pattern to illnesses: individuals with particular disorders tend to have had parents or other close relatives with the same illnesses. Research has shown that the likelihood of inheriting disorders varies, but scientists aren’t clear which genes are involved.

MENTAL ILLNESS AND THE MENTAL HEALTH CONTINUUM

Insures In 1996, the Mental Health Parity Act was passed by Congress. This legislation required insurers that provide mental health coverage offer benefits al the same level provided for medical and surgical coverage. In 2000, the Government Accounting Office found that, although 86% of health plans complied with the 1996 law, 87% of health plans that complied with the law imposed new limits on mental health coverage. On April 29, 2002, President George W Bush endorsed parity and established a new mental health commission. In February 2003, the senator Paul Wellstone Mental Health Equitable Treatment Act was introduced into the Senate and the House OF Representative. In July 2003. The president New Freedom Commission on Mental HEALTH also endorsed parity. The legislation became stalled in Congress IN 2003 AND 2004. Passage of this legislation would require full insurance parity for the most severe, biologically based mental illness, that is mental disorders caused by neurotransmitter dysfunction, abnormal brain structure, inherited genetic factor, or other biological causes. Another term for such an illness is psychobiological disorder.

These biologically influenced illness include:

• Schizophrenia.

• Bipolar disorder.

• Major depression.

• Obsessive-compulsive and panic disorder

• Posttraumatic stress disorder.

• Autism.

Other severe and disabling mental disorder include the following:

• Anorexia nervosa.

• Attention deficit hyperactivity disorder.

Thus, many (not necessarily all) of the most prevalent and disabling mental disorder have been found to have strong biologically influences. Therefore, we can look at these disorders as “disease “. It is helpful to visualize these disorders along the mental health continuum. This continuum is used each of the clinical chapters to identify the severity of biologically influenced disorders. See Figure 1-2 for a conceptualization of biologically based disorders on the mental health continuum.

The DSM-TV-TR cautions that the emphasis on the term mental disorder implies a distinction between “mental” disease and “physical” disorder, which is an out-dated concept, and stresses mid-body dualism, “there is much physical in mental disorders and much mental in physical disorders”(APA, 2000, p.xxx)

As nurses, we do not treat diseases; we care for people by providing effective nursing care using the nursing process as a guide. If we believe that human beings have biological, psychological, social, and spiritual components and need, than we believe in holistic nursing. Our task as nurses is to assess and plan care for the whole individual under our care. Nurses and physicians are two parts of multidisciplinary team that, when well coordinated, can provide optimal care for the biological, psychological, social, and spiritual needs of clients.

There are many factors that can affect the severity and progress of a mental health illness, biologically based or otherwise, and these same factors can affect a “normal” person’s mental health as well. Some of these factors include available support systems, family influences, developmental events, cultural or sub-cultural beliefs and values, health practices, and negative influences impinging on an individual’s life. If possible, these influences need to be evaluated and factored into an individual’s plan of care. Figure 1=3 identifies some influences that can have an impact on a person’s mental health. In fact, the DSM-IV-TR states that there is evidence suggesting that the symptoms and causes of a number of disorders listed in the DSM-IV-TR are influenced by cultural and ethnic factors(APA, 2002).

CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS

One approach to differentiating mental health from mental illness is based on what a particular culture regards as acceptable or unacceptable. In this view the mental ill are those who violate social norms and thus threaten (or make anxious) those observing them. This definition seems partly true. For example, the callous psychopathic person fits the definition, as does the sometimes wild manic person and schizophrenic person who is displaying strange behaviors. However, this definition explicitly makes mental illness a relative concept. Many forms of unusual behavior can be tolerated, depending on the prevailing cultural norms. The difficulty with defining mental illness through a particular behavior that is unacceptable to society is that it does not tell us what behavior a society should accept. Some totalitarian governments, to serve their own repressive goals, have classed all political dissidents as “mentally ill”.

Mental health professionals are faced with the problem of defining mental illness and mental health. Agreement on the definition of mental illness and mental health has been elusive throughout history in the past, definitions have used statistical measures. The term mental illness was applies to behaviors, described as strange and different, that deviated from an established norm. however, such criteria are in adequate because they may suggest that mental health is based on conformity. If such definitions were used nonconformists and independent thinkers, such as Abraham Lincoln, Mahatma Gandy, Socrates, and Martin Luther King Jr, would be judged mentally ill.

The field of mental illness is plagued by a host of myth and misconception. One myth is that to be mentally ill is to be different and odd. Another mis-conception is that to be healthy, one must be logical and rational. But many of those suffering from mental illness are not different odd, and no “healthy” human is fully logical and rational. There are characterizes as mentally ill who are far more like the rest of us than different from us. There is no obvious and consistent line between mental illness and mental health. In fact, all human behavior lies somewhere along a continuum of mental health and mental illness.

A helpful approach in defining mental illness and mental health is based on evaluating individual behavior in two dimensions:

1. On a continuum from adaptive to maladaptive.

2. On a continuum from constructive to destructive.

Along the adaptive-maladaptive continuum, behaviors are assessed to the degree that they contribute to or are detrimental individuals psychological well-being. For example, does the behavior widen or restrict the range of possible responses to problem of living? Does it raise or lower self-esteem? Does it create situations in which the individual or others more likely to experience relief of tension or stress?

Maladaptive behavior allows a problem to continue and often generates new problems, interfering significantly-often over an extended period of time-wiyh an individuals ability to function in such important areas of life as health, work,love, and interpersonal relationship. On the other hand, adaptive behavior solves problem in living and enhances an individuals life.

Table 1.1 identifies important aspects of mental health continuum. These aspect include degree of :

1) Happiness

2) Control over behavior.

3) Appraisal of reality.

4) Effectiveness in work.

5) Health of self-concept.

6) Satisfying relationship, and

7) Effective coping strategies.

Regarding the second dimension, behavior along the constructive-destructive continuum often affects others as much as the individuals. Destructive behaviors not only result in failure to deal with a problem and thus is maladaptive but also undermines or destroys the psychological and others. Such behavior whether it occurs once or repeatedly may seriously undermine health, significantly increase chances of (or actually bring about ) death, or drastically affect psychological functioning in the individual or others. On the other hand, constructive behaviors contributes to psychological growth and biological well-being proves the health and positively influences the psychological functioning of the individual and others.

Table 1.1 MENTAL HEALTH VERSUS MENTAL ILLNESS
SIGN MENTAL HEALTH
• Happiness
A. Finds life enjoyable.
B. Can see in objects, people and activities their possibilities for meeting one’s needs

• Control Over Behavior
A. Can recognize and act on cues to existing limits.
B. Can respond to the rules, routines, and customs of any group to which one belongs

• Appraisal of Reality
A. Accurate picture of what is happening around one.
B. Good sense of the consequences, boyh good abd bad that will follow one’s acts.
C. Can see the difference between the “as if” and “for real” in situation.

• Effectiveness in work
A. Within limits set by abilities, can do well in task attempted.
B. When meeting mild failure, persists until determines whether or not one can do the job.

• A Healthy Self-concept.
A. Sees self approaching one’s ideas, as capable of meeting demands.
B. Reasonable degree of self-confidence help in being resourceful under stress.


• Satisfying Relationships.
A. Experiences satisfaction and stability in relationships.
B. Socially integrated and can rely on social supports.


• Effective Coping Strategies
A. Uses stress reduction strategies that address the problem, threat (e.g.,a problem solving, cognitive restructuring)
B. Uses coping strategies in a healthy way that does not cause harm to self or other.

SIGN OF MENTAL ILLNESS

• Major Depressive Episode
A. Loss of interest or pleasure in all or almost all usual activities and pastimes.
B. Mood as described by person is depressed, sad, hopeless, discouraged, “down in the dumps”

• Control Disorder, Undersocialized, Aggressive.
A. A repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.

• Schizophrenic Disorder.
A. Bizarre delusions, such as delusions of being controlled.
B. Auditory hallucinations.
C. Delusions with persecutory or jealous content.

• Adjustment Disorder with Work (or Academic)
A. Inhibition in work or academic functioning where previously there was adequate performance.

• Dependent Personality Disorder.
A. Passively allows others to assume responsibility for major areas of life because of inability to function independently.
B. Lacks self-confidence, e.g.,sees self as helpless, stupid.

• Borderline Personality Disorder.
A. Show pattern of unstable and intense interpersonal relationships.
B. Has chronic feeling of emptiness.

• Substance Dependencies
A. Repeatedly self administers substances despite significant substance related problem(e.g., threat to job, family, social relationship)

referensi:
Barry,Patricia.1998.Mental health and Mental Illness.6th ed.Philadelphia:Lippincolt.
Frisch,Noreen Cavan.2005.Psychiatric Mental Health,3th.ed.Canada:Thomson.
Iyus,Yosep.2009.Keperawatan Jiwa.Bandung:Refika Aditama
Varcarolir,Elizabeth M.2006.Foundation of Psychiatric Mental Health Nursing.Philadelphia:Saunders.
Videbeck,S.2004.Psychiatric Mental Health Nursing.2ed.Philadelphia:Lippincot.