Special Population Presentation: Community Health Nursing

¶ … Interventions for Mentally-Ill Adolescents Mental illness is a serious health concern in America today. The National Alliance on Mental Illness (NAMI) estimates that one in every four adults in America, which translates to approximately 61.5 million people, suffer some form of mental illness in every given year (Duckworth, 2013). Worryingly, 13% of children aged between 8 and 15 and 20% of youth aged between 13 and 18 experience some severe mental disorder in any given year (Duckworth, 2013).

These statistics are disturbing, particularly because mental illness has been shown to be a significant risk factor for chronic medical conditions, and low life expectancy. It is estimated, for instance, that adults living with serious mental conditions die 25 years earlier than their counterparts in the rest of the population (Duckworth, 2013). Currently, the burden of mental disease takes away approximately $193.2 billion from the economy in lost productivity every year (Duckworth, 2013).

This is why there is need for stakeholders to come together to fight mental illness and reduce the annual burden that it imposes on the already-overburdened taxpayer. Community health nurses have a fundamental role to play, which is to increase the community's awareness in the issue of mental illness so that the burden of mental illness becomes one shared by all primary stakeholders.

The subsequent sections present a hypothetical two-part awareness program that could be used in identifying the best interventions for mentally-ill adolescents, particularly through increasing the involvement of family members. The Program Part One: Criteria for Identifying Suitable Interventions for the Special Population Special Population This program specifically targets mentally ill adolescents (aged between 10 and 18).

Its main aim is to increase awareness of issues of mental illness among adolescent patients and those people close to them with the aim of reducing the stigma and eliminating the negative stereotypes associated with mental illness. As already mentioned, 53% of adolescents aged between 8 and 18 experience some severe mental disorder in any given year (Duckworth, 2013).

Most of these cases, as the National Alliance on Mental Illness shows, result in either suicide or school drop-out -- suicide, for instance, has been named the third leading cause of death among teenagers and adolescents, often times recording higher rates than homicide (Duckworth, 2013). Disturbingly, 90% of teen suicides are mental illness-related (Duckworth, 2013).

Researchers agree that the main reason why the prevalence rates of mental illness for this particular population have remained relatively high is because stakeholders have failed to transfer knowledge on mental health problems from one generation to the next (Lauritzen & Reedtz, 2015). This has created a knowledge dearth that has made it increasingly difficult for families to take an active role and provide effective care for those suffering from mental illness.

Having no information to rely upon, families with mentally ill individuals have been forced to base their care on common stereotypes that have been built by society over time, some of which have no empirical basis (Canadian Center for Addiction and Mental Health, 2001).

Three common stereotypes, for instance, which lack empirical basis but still inform society's perceptions are that (Canadian Center for Addiction and Mental Health, 2001): i) Mentally ill persons have nothing tangible to contribute ii) Mentally ill persons are, to some extent, responsible for their mental conditions iii) Mentally ill persons are all dangerous and violent These misconceptions result from the fact that communities have not been adequately educated, and therefore lack the requisite knowledge to deal effectively with the issue of mental illness.

Worryingly, such misconceptions add to the stigma that mentally ill persons face and prevent them from receiving the necessary care from those closest to them (Canadian Center for Addiction and Mental Health, 2001). Strengths, Weaknesses and Resources in the Special Population It is recommended that therapists identify the strengths, weaknesses and resources inherent in their special population so that they are able to choose the intervention strategies that best meet the characteristics and needs of the selected population.

Strengths: these are the specific qualities of the population that make it better-placed to respond effectively to specific treatment interventions. Our special population (adolescents aged between 10 and 18) belongs to the Millennial generation, whose members have been found to be more inclined to work effectively in teams than the generations before them. Towards this end, therapists could maximize their health outcomes by using group therapy as opposed to individual therapy, and this basically means that a greater proportion of patients are attended to.

A second strength inherent in this population is that they are tech-savvy, having been born in a digital era characterized by rapid technological advancement. This means that the therapist an make effective use of m-health platforms, where group meetings are held through video conferencing and mobile apps are used to monitor progress and seek clarification. Resources: having not attained the age of majority, most members of our special population still live with their parents/guardians or are under some form of community care facility.

Family and the community are, therefore, among the most crucial resources that these individuals possess (Xie, 2013). Therapists can, therefore, maximize this group's health outcomes by taking in input from family members and the community, and using leverage from the community to develop informal support systems such as self-help groups, where patients can share with, and learn from each other (Xie, 2013).

Weaknesses: the fact that members of the special population are tech-savvy is one of their greatest strengths; however, it also is the source of their most fundamental weakness -- since answers to queries are readily available on 'Google', 'Wikipedia', and other sites on the internet, this group of individuals has grown to appreciate things that provide instant gratification. They expect therapy sessions to yield immediate results and are likely to discontinue participation if they do not see any value within the first few sessions.

The therapeutic interventions chosen, therefore, need to be effective, and the therapist must provide platforms for constant monitoring and assurance to help keep participants in line and minimize the risk of relapse. Community Interventions for Health Promotion among the Special Population Based on the strengths and resources outlined earlier on, I would conclude that for mentally ill adolescents, maximum outcomes would be realized through a combination of biological and psychosocial interventions.

Biological Interventions i) Medication Based on the seriousness and type of mental condition, the therapist could prescribe one of the common medications used to treat mental disorders including anti-anxiety medication, mood stabilizers, antidepressants and antipsychotics (Canadian Center for Addiction and Mental Health, 2001). ii) Electroconvulsive Therapy (ECT) This is also referred to as 'shock therapy' and is commonly used on patients with acute depression (Canadian Center for Addiction and Mental Health, 2001).

In this case, a muscle relaxer and anesthetic is given to the patient before an electric charge is induced on the brain to create a small seizure (Canadian Center for Addiction and Mental Health, 2001). Psychosocial Interventions i) Psychotherapy This is a form of treatment achieved through talks between a patient and their therapist.

It could work perfectly with adolescents because adolescents often feel that their parents are not understanding or liberal enough; and hence, they may be more comfortable laying out their fears with a trusted third-party (Canadian Center for Addiction and Mental Health, 2001). The overriding aim of psychotherapy is to help patients relive stress by expressing their feelings and just having someone listen to them without judgment or criticism.

It could take any form, from individual to group psychotherapy -- however, in the case of adolescents; the latter would be preferred because of the degree of significance that they place on peers, social networks, and being able to identify with others. ii) Self-help groups Mentally ill adolescents could also use self-help groups as an alternative to psychotherapy.

Most of these groups are run by clients in the mental health system, and provide platforms for patients and their families to interact informally with other people who share the same issues and challenges (Canadian Center for Addiction and Mental Health, 2001). Such groups help to eliminate isolation issues and help adolescents to not only identify with other people with similar experiences, but also learn from their peers.

iii) Community Support Providing mentally-ill adolescents with access to family services, social support systems, effective housing, educational facilities and social services in addition to therapeutic treatment could also go a long way in maintaining their wellness. Moreover, they could be assigned to service clubs (such as Rotary), religious organizations and interest-based groups that allow them to make meaningful impact in the community and rebuild their self-esteem (Canadian Center for Addiction and Mental Health, 2001).

iv) Family involvement and support Family plays a crucial role in the mental health of members, and is actually a vital resource for this particular population. Getting family members involved in adolescent patients' health through informal settings could go a long way in maximizing their health outcomes, especially if family members are provided with adequate and accurate information on risk factors, potential triggers, and so on.

Part Two: Criteria for Increasing Family Awareness and Involvement The Role of Family Literature has shown that families, if properly-involved, could play a crucial role in the maximization of health outcomes for mentally-ill adolescents.

They, for instance, they could assist in the provision of crisis intervention, in system navigation, in advocating for their sick, in the providing vital information to mental health professionals, in ensuring that patients' adhere to treatment options, and in increasing rates of recovery, particularly if they understand the causes and risk factors of the same (Family Mental Health Alliance, 2006). Family members can, therefore, if effectively-utilized and adequately-educated, be a crucial resource in the treatment of mental illness.

This is particularly because they have had the privilege to live and interact with patients on a larger scale better than the mental health professional, and are better-placed to understand the causes of illness and the unique needs of patients. This program recognizes the fundamental role of family in adolescents' mental health. What needs to be Taught Patients and their families could be educated on three key concepts of mental health -- health, health promotion and the web of causality.

The nurse needs to have conducted thorough analyses and data review procedures beforehand, and clearly identified the statistics, as well as the said factors and their relevance to the selected population. The program, therefore, will simply be one of knowledge-transfer, where the nurse transfers the data and information gathered in initial processes to the special population (patients and their families) as a way of helping them better understand the causes and risk factors of mental illness among adolescents.

This could go a long way in maximizing the mental health outcomes of the target population. The Concepts of Health and Mental Health Health is defined as the state of being without illness or disability; and therefore, experiencing complete social, mental and physical well-being (WHO, 2005).

Mental health is, therefore, one of the fundamental aspects of health -- it is defined simply as the state of well-being in which an individual is able to make a contribution to their society, is able to work fruitfully and productively, and is able to cope with the normal stresses of life in realizing their maximum potential (WHO, 2005). When one is healthy (in the right state of physical, mental and social well-being), they are able to carry out their normal social roles effectively (WHO, 2004).

The Concept of Health Promotion The WHO defines health promotion as the process of improving the community's health by enabling people to have greater control over their own health (WHO, 2005). In order to achieve that state of complete social, mental and physical well-being, an individual must be able to cope with the normal stresses of life inherent in the environment, to satisfy needs, and to realize aspirations (WHO, 2005). This implies that health promotion goes against individual factors -- it is a function of both environmental factors and individual factors (WHO, 2005).

Health promotion, therefore, is not just the role of the health sector -- it is up to the individual to identify factors in the environment that have an effect on their health, and to understand how these interact with the individual factors (WHO, 2005). Only then will they be able to maximize their health outcomes.

This concept will be crucial in explaining to participants why they need to take part in the program, which acquaints them with knowledge on the specific individual and environmental factors that predispose them (as adolescents) to mental illness. The Web of Causality Concept Based on the WHO's definition of health promotion, the current program will focus on educating participants on the web of causality concept -- particularly, how illness and disease are caused by a range of interconnected factors in an individual's physical, physiological, economic, social, and cultural environment.

Biophysical Risk Factors Participants could be educated on the physiological factors that predispose adolescents to mental health issues including genetic diseases, cardiovascular diseases, chronic conditions such as HIV and diabetes, early pregnancies, overweight and underweight, physical disability, and so on. The nurse will explain how these could affect a child's perception about life and their self-esteem, eventually culminating in depression and suicidal thoughts. They will also explain how parents and guardians could identify the same, and how they ought to deal positively with any such discoveries.

Psychological Risk Factors In this regard, participants will be educated on the psychosocial factors that could provide breeding grounds for mental illness. Focus in this case will be given to such factors as hopelessness, low control and perceived power, self-blame, low self-esteem, lack of social support, and isolation. Teenagers and adolescents are at stage in life when perceived control and power are of utmost importance -- adolescents will often feel like they are old enough to make and stand accountable for their own decisions.

The thought, therefore, that one's parents or parenting techniques limit this perceived 'power and control' beyond what adolescents regard as 'acceptable' could be a breeding ground for rebellion, withdrawal and mental disturbances. Participants will be educated on such things, and parents will be provided with tips on how to take an active role in their children's lives without necessarily being too intrusive.

Environmental Risk Factors The nurse will, based on the specific environment surrounding the population, educate participants on the role of elements in the external environment that predispose adolescents to mental disease. The information presented in this regard will depend on the nurse's own analysis and evaluation of the environment.

Factors to be discussed in this case will include neighborhood characteristics in regard to substance abuse; poverty; low educational levels, discrimination by peers on the basis of age, sex, race, sexual orientation and so on; low economic and political power; poor housing, and inadequate access to basic amenities. Literature has shown unfavorable environmental conditions to be a fundamental risk factor for mental illness -- for instance, living in a neighborhood characterized by substance and drug abuse could be a breeding ground for addiction-related mental illnesses.

Behavioral Factors Participants will be educated on the effect of negative behavioral qualities that place adolescents at risk for mental illness. Factors to be discussed here include alcohol consumption patterns, drug and substance abuse, sexual tendencies, dietary habits, and sport/exercise tendencies. Irresponsible sexual behavior, alcoholism, and drug/substance abuse for instance, increases the risk of early pregnancies and sexually transmitted diseases, both of which have been shown to increase adolescents' risk of mental illness.

Moreover, literature supports the idea that exercise provides opportunities for relieving stress and depression; lack of the same, therefore, could be a potential risk factor for mental disturbances (Locker, 2011). Health System Factors The health system dimension focuses on the availability of systems that can adequately address the mental health needs of the community.

Having already conducted their analysis in the area, the nurse will educate participants on i) the primary (health promotion/exercise), secondary (for instance, screening and testing) programs; and preventive services available in the community, and which they could access to maximize mental health outcomes; ii) how accessible such platforms are for members of the public; iii) the types of services offered; and iv) how relevant such services are to the cultural values and heath needs of the population (Locker, 2011).

Socio-Cultural Risk Factors Socio-cultural factors have been shown to be a major determinant of mental illness (Locker, 2011). The nurse will be keen to educate participants on how the effect of subcultures such as the hip-hop subculture, the language spoken in the community, the dominant religion in the community, the typical family structure in the community, and the.