Complexities in Mental Health Nursing

Introduction

The mental illness is referred to health condition which includes emotional changes along with changes in thinking and behaviour due to distress and problems in functioning in social, work and family-related activities (Druss, 2020). In this study, the mental illness of depression among adults is to be discussed. The nursing intervention available for the treatment of depression is to be critically analysed. Moreover, the tole of cultural factors and family or carers in care delivery for depression is to be explained. The NUCE guidelines along with local CCG information for treatment of depression among adults is to be discussed.

Overview of Depression in adults

Depression is referred to as the mood-disorder which influences deterioration of daily life of an individual out of their persistent feeling of loss and sadness (Di Florio et al., 2017). In the UK, it is considered as the second leading cause for disability years and most prevalent mental health problem that is faced by people of all ages. It is reported that 24% of women followed by 13% of men in the UK are considered to be diagnosed with depression (mhfaengland.org, 2020). In 2020, it is mentioned that 1 in 5 adults (19.2%) mentioned to be suffering from depression during the COVID-19 situation in June 2020 which is nearly double the numbers that are 1 in 10 adults (9.7%) as reported from July 2019-March 2020. Moreover, 12.9% among the depressed adults in this period mentioned their level of depression varied from moderate to severe (ons.gov.uk, 2020). This indicates that depression has further worsened during the pandemic in the UK due to which effective discussion regarding nursing intervention to reduce it is required for encouraging well-being and health of the individuals. The problem with current services regarding depression in the UK is seen to focus on providing anti-depressants in controlling the health condition which is not effectively adhered by most of the patients. This leads the patients to suffer from depression and develop worsen symptoms (Holvast et al., 2019). The NICE guidelines mention that the best form of nursing intervention for depression is cognitive behaviour therapy (CBT). This is because there are no side-effects like anti-depressants on the patients and it helps to enhance the emotion and mood of the patient in an effective way to resolve their depression (NICE, 2018).

Question 1

The Cognitive Behaviour Therapy (CBT) is referred to the short-term talking therapy in which a professional counsellor or therapist communicates with an individual to make them realise and identify their negative thinking and way to overcome them by changing their behaviour (Lopresti, 2017). It is effective in helping adults to cope with depression and is one of the important nursing interventions for the health problem as mentioned in the three following studies. In the study by Hauksson et al. (2017), the researchers aimed to determine if CBT is effective in helping individuals to cope depression who also had psychiatric co-morbidity. For this purpose, 18-month follow-up study was performed for 181 depressed patients who were randomly allocated in group CBT program (86) and individual CBT with treatment group (59). It was seen that the patient with individual CBT and treatment, as usual, expressed better coping with depression compared to the patients who were provided group CBT. This indicates that CBT followed by usual care is an effective nursing intervention addition to usual care for helping people cope with depression. In contrast, the study by Tanoue et al. (2018) aimed to determine the impact of nurse-led group CBT behaviour therapy on depression among adults. For this purpose, the researchers used 6-weeks group CBT program for which 25 participants were included who were suffering from depression. The depression score difference was calculated in the study through Beck Depression Inventory-II (BDI-II). At the end of the therapy, it was seen that the mean total BDI-II score improved to 23.1 from 12.4 indicating that group CBT is effective in managing depression symptoms among individuals. Further, the study by Rief et al. (2018) aimed to compared effectiveness of cognitive-behavioural analysis system of psychotherapy (CBASP), CBT with physical exercise (CBT-E) and CBT with pleasure, low-energy and mindful activities (CBT-M) for managing symptoms of depression. For this purpose, 173 patients along with 41 therapists are included in the study. In comparison to health response rate of CBASP, high response rate in patient who were provided CBT-E and CBT-M was seen. This indicates both the CBT were more effective than CVBASP. Therefore, CBT of any form is found to be effective nursing intervention in managing depression disorder or symptoms in adults as prevalent from the three studies.

Role of cultural factors in care delivery

The cultural factors affect care delivery in case of depression is that they create stigma and wrong conception regarding the health issue which causes hindrance in reach of the care regarding depression among the adults. For instance, in Asian culture, the presence of any form of mental illness in the family or presence of mentally-ill family members is considered to be shameful for the family. This is because mental illness such as depression is considered as a personal weakness which makes the family or individual be overtly dependent for assistance on the society and become burden of care (Zhang et al., 2020). The stigma influences the family members avoid approaching to access care, in turn, making them avoid reaching the care delivery and develop deteriorated health condition without treatment (Dardas et al., 2017). In Chinese, depression is considered not as a health issues and reflected as person showing behaviour to attract attention (Smith et al., 2018). This cultural thinking create hindrance in care delivery as people suffering from depression do not feel the need to access care and does not come out to avail support.

Role of family or carers in care delivery

The role of the family caregivers or carers in care delivery is to act as integral and key part in supporting patient with depression overcome the symptoms. In care delivery regarding depression, one of the roles of the family caregivers is to show continuous support and encouragement to the depressed individual in adhering and accepting treatment or therapy to overcome the mental health issue. This is because positive support and motivation leads the depressed patients to show effort in accepting the treatment out of valued feeling that their health condition is understood by the family members and they are willing to show enhanced support in helping them recover instead of avoiding them (familyaware.org, 2019). The other role of the family caregivers in care delivery regarding depression is developing knolwdege and showing skills to support day-to-day struggles faced by depressed adults due to their mood disorder. This is because it indicates ultimately helping the adult to get treatment (familyaware.org, 2019).

Discussion of NICE guidelines

The NICE guidelines mention that individual self-help is to be provided as initial treatment for less severe depression to the patients. In this condition, the principles of cognitive behaviour therapy (CBT) is to be followed and physical activity programs are to be framed to both mentally and physical support people to overcome symptoms of depression (NICE, 2018). This is because self-help assists the people with depression realise the key cause of their mood disorder in turn making them understand which emotions are to be controlled to overcome depression. In addition, physical activity helps people with depression to develop greater concentration and focus in life out of feeling rejuvenated from the exercise (Dorscht et al., 2019). In case of severe depression, the NICE guidelines mention using anti-depressants medication along with psychological therapies such as CBT in heling patient gradually overcome the condition. The guidelines mention that treatment is to be initiated by prescribing SSRI or mirtazapine to the patients and later be provide TCA (Tricyclic anti-depressants) if they have history of poor response to SSRI (Selective serotonin reuptake inhibitors) (NICE, 2018). The need for future development in care for depression among adults require including care services and awareness campaign that allows resolving barriers of stigma that creates hindrance in care delivery for the health issue. Further, better research is required so that anti-depressants with less side-effects can be provided for effective control of severe depression. The local CCG informs regarding people with depression that the health issue is one of the major mental health problem which is required to be managed through treatment at the earliest so that it deteriorated impact on the health can be avoided (northeasthampshireandfarnhamccg.nhs.uk, 2020). In North East Hampshire, integrated care system (ICS) for managing depression is present for adults which is evident as the NHS North-East Hampshire is seen to act in partnership with The Source – Youth Support Services, Safe Heaven, Combat Stress and other local organisation in forming coordinate care services to plan in resolving depression among adult and others (northeasthampshireandfarnhamccg.nhs.uk, 2020). The importance of this ICS for depression in the area is that gaps in care regarding the health issue is effectively controlled and better outcomes for the patients is entertained (Goldstein et al., 2017).

Conclusion

The above discussion informs that depression is one of the leading mental health issues among adults in the UK. The key and effective nursing intervention for depression is cognitive behaviour therapy (CBT) apart from anti-depressants which are seen to create side-effects on the health of depressed patients such as dizziness, nausea and others. The NICE guidelines mention that self-help for less severe depression and psychological therapy for severe depression is required to be first line of support and nursing intervention.

References

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Dorscht, L., Karg, N., Book, S., Graessel, E., Kornhuber, J. and Luttenberger, K., 2019. A German climbing study on depression: a bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation–study protocol for a multicentre randomised controlled trial. BMC psychiatry, 19(1), pp.1-13.

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