Question:

Selecting one mental condition or illness will allow you to critically examine how mental health service users are supported in recovery and treatment. This includes private providers, third sector support organisations, and mental health services.

Answer to Question: B760 Mental Health Nursing

Introduction

Mental illness is a major cause of disability and is a major health problem worldwide.

Major depressive disorder is the second most common cause of disability. This is due to its contribution to suicide risk and ischemic heart disease. (Mental health statistics: UK, worldwide 2017).

MDD, a major depressive disorder, is one that causes depression and sadness for at least 2 weeks.

MDD patients experience poor hygiene and weight loss.

MDD is also known for depressed mood, anhedonia, loss of enjoyment in activities, psychomotor agitation and insomnia.

These symptoms can cause problems in relationships, suicide attempts or substance abuse, which can then lead to productivity losses and disruptions (Snyder (2013)).

Unfortunately, there is little information available about the pathophysiology behind MDD.

While some evidence supports the interaction between neurotransmitter availability/receptor regulation as the reason for MDD, others support the possibility of a role in the underlying pathophysiology (Schmaal. 2016).

There are many treatment options for MDD. This review critically examines the role and responsibilities of mental health professionals, private providers, third sector organizations and mental health workers in treating depression and supporting recovery.

Critical Evaluation of Mental Health Services’ Role in the Treatment of People with MDD

A common treatment for depression is maintenance antidepressant. This treatment is recommended by mental health professionals to those who are at high risk of developing depressive symptoms again.

This medical treatment has limitations, including a moderate efficacy rate, high remission rates, slow onset and compliance problem.

Berwian, et al. (2013). Anti-depressants have a negative effect on sleep and can cause disruptions in bodily rhythms. 2017).

The development of new therapeutic options for people with severe depression was made possible by mental health services.

Mindfulness-based cognitive treatment is currently a popular alternative for those with MDD.

The effectiveness of this treatment was demonstrated in a randomized controlled trial that compared it with antidepressants for preventing recurrences in depression patients.

The study included adult patients who had experienced at least three major depression episodes and were taking antidepressants.

Randomly, participants were assigned either to maintenance depressants treatment or cognitive therapy.

The main outcome for the study was the time to relapse from depression. It was found that psychosocial treatments had no positive results in comparison to the control group.

The treatment is most effective for people with the highest chance of depressive relapses (Kuyken et. al. 2015.

Patients who are at highest risk of harm can be protected with this intervention.

The current mental health service approach is to select intervention based upon patient commitment and cost.

One new approach to major depression treatment in mental health services is the religiously-integrated cognitive behavioral therapy (CBT).

Patients find this therapy beneficial because it promotes their spiritual well-being.

Chronic illness patients are more likely to experience depression. For this reason, religiously integrated psychotherapy has been developed.

CBT focuses on the analysis of thought pattern, emotion and behavior in order to modify cognitive process and behavior.

Due to depressed patients’ interpretation and perception, this assessment may not be accurate.

Therefore, CBT integrated religious belief by specifically analyzing patients’ religious beliefs to replace their negative thoughts.

Pearce and colleagues found that patients can find motivation in religious beliefs to improve their resilience against depression. 2015).

This intervention is provided by mental healthcare services in 10 sessions. It begins with assessment of client and continues to reinforce the treatment rationale for patients. After that, it identifies unhelpful thoughts of patient.

Clients learn how to cope with their emotions and maintain motivation.

During the intervention process, clients were informed about the many benefits of gratitude and altruism to help them find meaning in their lives and achieve positive outcomes (Koenig et. al. 2015).

The patient’s faith tradition can be used to help reduce depression symptoms. It is also useful in helping clients with different cultural backgrounds in mental healthcare.

Numerous online services are also available to help young people suffering from depression.

Young people are more likely use online services to get help for their mental health. This is why it is crucial to assess its effect on the mental health of people.

An evaluation of the performance of these online mental services revealed that they were poor quality and that only a few people used them for help-seeking.

Although there are many online services that can help with depression, only a small number of participants have reported that they got the correct information.

A barrier in help-seeking behavior was another factor that caused some limitations in service.

These barriers included a lack of awareness of online services, lack trust in online information as well as greater preference for face to face services. 2014).

The online mental healthcare services need to be improved by further research into identifying improvement areas.

An alternative way to bring face-to–face services into the online environment is to direct people to service in their area through the website.

Efficacy and effectiveness of private providers in treating people with MDD

Private providers are expanding their mental health services due to increased trust in them and the ability to provide high quality and efficient health care.

Because of additional mental disorder burden and inability to find cost-effective and affordable interventions, the government’s spending on mental illness is limited.

Because poor countries spend less on mental healthcare, it is more difficult to move to community care.

Private providers can play an even greater role in helping to overcome the inefficiency, inequity, and scarcity of government-based mental care services.

Private providers have made significant strides in ensuring equitable distribution of services and making it more accessible to those most at-risk.

They have worked to remove stigmatization and improve the technical efficiency of managing mental health services. 2007).

Private providers play an important role in meeting patients with depression’s clinical needs.

Resource-oriented therapies can improve patient’s therapeutic relationship, resilience, coping and recovery capacities.

The effectiveness of the intervention was evaluated and showed that techniques and stabilizing resources were effective in securing a therapeutic relationship between patient and therapist.

Steinert et.al. reported that in these situations there was no barrier to patient-therapist communication. This resulted in increased compliance. 2017).

Depression is one contributor to world disease burden. A high level of discrimination is another factor.

This form of experience is a major obstacle to social participation as well as integration into the vocations for mental health.

It was essential to take a long-term approach to stigmatization in this situation (Lasalvia et. al. 2013).

Private providers have improved many treatment options for this group. One example was the telehealth-problem solving therapy for depressed older adult.

Participants were provided with this intervention, and their treatment evaluation inventory scores was high (Choi et. al. 2014).

This has a great impact on those older adults who cannot access treatment in a mental healthcare setting because they are at home.

Critical Assessment Of The Role of Third Sector Organizations in Supporting People With Anxiety and Depression

Third sector organizations are not-for-profit non-governmental organizations that play a significant role in community development.

Non-profit organizations, charities, and self-help groups play an important role in treating mental health issues such as anxiety and depression.

They serve as a middleman in the continuum of healthcare, offering both self-help and specialist services.

These organizations are a great resource for primary health care professionals.

The third sector is capable of identifying and managing common health issues in people, and this perspective must be reexamined by mental health professionals (Dowric and Martin 2016, 2016).

It will be possible to gain insight into how this sector can assist in the management of mental disorders, apart from primary care providers.

A third sector organization assists with mild to moderate depression via web intervention and mobile phone.

Study with 49 depressed people evaluated the effects of these resources.

It used the mental well-being self-efficacy measure (MHSE), which measures people’s ability and confidence to manage their mental health problems.

Participants’ MHSE scores were sensitive to changes. The use of web-based and mobile phone intervention was shown to increase their sensitivity.

This shows that MHSE has been associated with decreased depression and better social functioning.

This type of intervention is helpful in improving the self-efficacy and self-worth of those with depression.

It is important in improving the skills and motivation of patients in managing mental health symptoms. (Clarke and al. 2014).

When mental health service partners with third sector organizations, they can assist them in increasing the therapeutic potential and clinical efficacy of online interventions for people suffering from mental illness.

As a self-help program for patients suffering from depression, third-party organizations often offer cognitive behavioral selfhelp.

This self-help package included a CD and a book on the management of depression.

The self-help program stated that all participants needed to work on the intervention 4 days per weeks up to 4 weeks. Very minimal coaching was provided.

The coaching consisted only of a telephone call to provide support and to motivate participants to improve their self coping skills.

The results of the study after 4 months showed that self help intervention was effective in reducing anxiety levels and depression.

They also had a higher level of coping self-efficacy than the participants in the control groups.

Garnefski et.al. cited another significant benefit of the intervention: patients can be followed-up by mental health services. 2013).

This type of program can also be delivered via the internet or postal mail by third parties.

This allows for a greater number of patients to receive support and eliminates the need to seek psychological treatment.

This is a significant practical result considering the high incidence of depression.

Although third party involvement in mental care is not yet supported, many feel that it is impossible for non-specialists to provide the appropriate care.

Mendenhall, et al. examined the acceptability of mental health workers who are not specialists in order to provide care.

Mendenhall et. al. (2014) studied the acceptance of task-sharing mental care services by different stakeholders. These included community members as well as public health workers and policy makers.

Task-sharing was seen as an innovative approach to improving access to mental services by the majority of participants.

Task sharing can be difficult because of a lack of community preferences, infrastructure, workload, and awareness.

It was important as it revealed the fundamental requirements for task-sharing in mental health care services.

If the task sharing role is clearly defined it can significantly reduce the burden placed on private and community health workers who are responsible for treating patients.

Conclusion

The report assessed the effectiveness, in terms of reducing depressive symptoms among patients with MDD, of both mental health providers and private providers.

As they are placed in different parts of the continuum of care, the roles of these groups can be very different.

Although private and public providers of mental health care are the formal providers, third-party involvement is essential to ensure that the service is integrated more effectively and provides better health outcomes for patients.

References

Berwian I.M. Walter H. Seifritz E. Seifritz E. Huys Q.J.M. 2017

Predicting relapses after withdrawal of antidepressants-a systematic review.

Psychological medicine. 47(3). pp. 426-437.

Choi N.G. Hegel M.T. Marti C.N. Marinucci M.L. Sirrianni L. Bruce M.L.

Telehealth problem-solving for elderly homebound people who are depressed and low-income.

The American Journal of Geriatric Psychiatry. 22, pp.263-271.

Clarke J. Proudfoot J. Birch M.R. Whitton A.E. Parker G. Manicavasagar V. Harrison V. Christensen H. & Hadzi-Pavlovic D.

The effects of mental self-efficacy on the outcomes of a mobile phone or web intervention for mild–to-moderate depression and anxiety: secondary analysis of an randomised controlled trial. BMC psychiatry, 14(1), p.272.

Dowrick C. and Martin S.

Depression and Anxiety: A Role for the Third Sector.

In Mental Health and Older People 121-131).

Springer International Publishing.

Garnefski N. Kraaij V. Benoist M. Bout Z. Karels E. Smit A.

Treatment of depression, anxiety, and self-coping in people with rheumatic disease: The Effects of a Cognitive Behavioral Intervention.

Arthritis care and research, 65(7). pp.1077-1084.

Kauer S.D., Mangan C. & Sanci L. 2014 Do online mental health services improve help-seeking for young people?

A systematic review.

Journal of medical Internet search, 16(3) p.e66.Koenig, H.G., Pearce, M.J., Nelson, B., Shaw, S.F., Robins, C.J., Daher, N.S., Cohen, H.J., Berk, L.S., Bellinger, D.L., Pargament, K.I.

Rosmarin (D.H.), 2015.

A pilot randomized controlled trial to compare religious vs. traditional cognitive behavioral therapy in major depression for people with chronic illnesses.

The Journal of nervous disease and mental illness, 203(4) pp.243-251.

Kuyken W. Hayes R. Hayes B. Barrett B. Byng R. Dalgleish T. Kessler D. Kessler D. Lewis G. Watkins E. Watkins E. Brejcha C. Cardy J. Casley A.

An randomized controlled trial evaluating mindfulness-based cognitive therapies against maintenance antidepressant treatments in the prevention depressive relapses or recurrences (PREVENT).

The Lancet. 386(9988), P.63-73.

Lasalvia A. Zoppei S. Van Bortel T. Bonetto C. Cristofalo D. Wahlbeck K. Bacle S.V. Van Audenhove C. Van Weeghel J. Reneses B. Germanavicius A.

Global pattern in discrimination experienced and expected by major depressive disorder sufferers: cross-sectional research.

The Lancet. 381(9860), 55-62.

Mendenhall E. and De Silva M.J. Hanlon C., Petersen I. Shidhaye R. Jordans M. Luitel N. Ssebunnya J. Fekadu A. Patel V. Tomlinson M.

Acceptability and feasibility for non-specialist medical workers to provide mental healthcare: A survey of stakeholders from PRIME sites in Ethiopia (India, Nepal, South Africa) and Uganda (M., 2014).

Social science & Medicine, 118, pages 33-42.

Statistics about mental health in the UK and internationally 2017.

Mental Health Foundation. Retrieved 20 April 2017, from https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwidePearce, M.J., Koenig, H.G., Robins, C.J., Nelson, B., Shaw, S.F., Cohen, H.J.

King, M.B.

Religiously integrated cognitive behavioral therapy: A new approach to major depression treatment in patients with chronic diseases. Psychotherapy, 52(1), p.56.

Saxena S. Thornicroft G. Thornicroft M. Knapp M. Whiteford H.

Resources for mental illness: scarcity, inequity and inefficiency.

The lancet 370(9590), page 878-889.Schmaal, L., Veltman, D.J., van Erp, T.G., Samann, P.G., Frodl, T., Jahanshad, N., Loehrer, E., Tiemeier, H., Hofman, A., Niessen, W.J. and Vernooij, M.W., 2016.

Research from the ENIGMA major depressive disorder working group. Subcortical brain abnormalities in major depression. Molecular psychiatry, 21(6), pp.806-812.Snyder, H.R., 2013.

There are broad impairments in executive function neuropsychological measures for major depressive disorders: A meta-analysis.Steinert, C., Bumke, P.J., Hollekamp, R.L., Larisch, A., Leichsenring, F., Matthess, H., Sek, S., Sodemann, U., Stingl, M., Ret, T. and Vojtova, H., 2017.

Resource activation in the treatment of post-traumatic stress disorder and co-morbid conditions: A randomised controlled trial in Cambodia.

Psychological Medicine. 47(3). pp.553-564.