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Preface
Mental Health Nursing for Individual, Community and Organisational Benefit
Nicholas G Procter
Associate Professor, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide SA
Article Text
The contents of this volume reflect enthusiasm among clinicians and scholars for mental health care being 'everyone's business' underpinned by quality, sustainability and health for all, and the creation, application and communication of care delivering individual and community benefit. At the same time there is a commitment from the Journal to ensure ongoing strong links with professional education and practice fostered through international peer reviewed publication.
In developing the volume, the editors set about trying to address the dynamic nature of mental health nursing across the lifespan. The importance of mental health nursing is highlighted by knowledge that neuropsychiatric conditions account for 13% of the total Disability Adjusted Life Years lost due to all diseases and injuries in the world and are estimated to increase to 15% by the year 2020 (WHO 2004). Mental ill health represents not only an immense psychological, social and economic burden to society, but also increases the risk and complexity of physical illnesses. Hickie and colleagues (2005) identify the following national trends across Australia
- People aged between 25 and 49 years account for 56% of all suicides in Australia, and rates were highest in men aged 25 to 29 years (31.1 per 100,000);
- More than half of all health-related disability costs in 15-34 year-olds are attributable to mental health problems;
- 27% of all years lived with disability in Australia are attributable to mental disorders;
- Less than 40% of people with mental disorders receive any mental health care in a 12-month period compared with almost 80% for other common physical health problems;
- 75% of mental health care is provided in the primary care sector, with limited access to specialist support;
- Almost 50% of people with mental disorders are not recognised by their general practitioner as having a psychological problem;
- A majority of psychotic disorders (greater than 50%) commence before age 25, and there can be a delay of 2-8 years before first presentation for treatment; and
- Up to 60% of cases of alcohol or other substance misuse could be prevented by earlier treatment of common mental health problems.
Given the current limitations in effectiveness of treatment modalities for decreasing disability due to mental disorders, the only sustainable method for reducing the burden caused by these disorders in prevention.
In clinical practice this means early identification of symptoms and warning signs of mental ill health, improved nutrition, physical activity, housing and social connectedness have the potential to promote mental positive health and prevent mental illness. Such factors also provide substantial insight into the role of risk and protective factors in the developmental pathways to mental disorders and poor mental health. High co-morbidity among mental disorders and their interrelatedness with physical illness and social problems stress the need for integrated public health activity that will target clusters of related problems, common determinants, early stages of multi-problem trajectories and populations at multiple risks. The multi-outcome interventions of nursing and health care should be examined for their psychological benefits for improving positive mental health, the way they contribute to better physical health and generate social and economic benefits. Such investigations should be culturally sensitive and use both qualitative and quantitative research methods.
At a service level grass-roots pressures reflect an increasing incidence of mental disorders in young people, increased numbers of presentations for care and more disturbed behaviour, often in association with alcohol or other substance misuse problems. Most likely, the incidence of mental illness across Australia will continue to increase, particularly among younger people, partly because of the adverse effects of current social and environmental factors, as well as ineffectiveness of current treatment modalities (Andrews 2005). These include increased family breakdown, decreasing participation in and sense of belonging to community-based structures such as churches, sporting and recreational associations and social clubs, and increased exposure to substances such as cannabis and illicit stimulants. The prevalence of mental disorders among elderly people is likely to rise due to the increasing incidence of vascular, degenerative and other brain disorders (Hickie et al 2005). At the same time community demand for appropriate and accessible mental health services is likely to grow over the coming years due to increased aging plus increasing incidence of mental disorders in young people (Mental Health Council of Australia and the Brain and Mind Research Institute 2005).
The editors believe this volume both applies and contributes to human knowledge and civil society. In making this claim we have put the contents to the test by asking the fundamental questions raised by Ernest Boyer (1990).
- How can knowledge be responsibly applied to consequential problems?
- How can it be helpful to individuals as well as institutions?
These scholarly works identify a continuing need to improve access and availability of services and makes a series of recommendations to help achieve this aim. Such an enlargement of focus is important as mental health services within communities are delivered to population groups defined by population need, staff availability and funds available. Such services also tend to be established and sustained around key local service providers such as a senior nurse, community mental health service, community health service, visiting mental health worker, local hospital facility and/or local non-government supports and family support. Pathway access to hospital care varies throughout the world due to the amount of infrastructure support, the episodic nature of mental illness, staff availability, bed availability and transport arrangements. The pathway for access to hospital treatment for marginalised and disenfranchised groups is a particular concern as is access to appropriate services upon discharge in the wider community. Access and availability of services such as crisis assessment teams, respite and supportive accommodation, recovery and psychosocial rehabilitation programs upon discharge from hospitals and community treatment centres are crucial and in constant demand.
Finally, the launch of this volume is in tune with the principals of the forthcoming World Health Report 2006. In response to World Health Assembly resolution WHA57.19, the WHO Director-General declared the 'health workforce' to be the theme of the World Health Report 2006. The Report will offer scientific and policy support for the 'Day and the Decade'. The Day will energize relevant constituencies to celebrate health workers around the world. The follow-up activities of the Decade will focus on implementing and evaluating policies and strategies for workforce development. Both the Day and the Decade will emphasize collaboration, partnership and global responsibility for health workforce issues.
Irrespective of practice setting clinical mental health care requires teamwork. This is due to the social and biological determinants of mental ill health, the episodic nature of mental illness, differing approaches to care and availability of resources. Assessment and treatment of mental ill health requires a collaborative systems approach ensuring that care is experienced by clients in a consistent and connected manner. This requires service providers to communicate their assessment of clients and expectations of other service providers and promote continuity of care. The editors hope that the papers of this volume reflect these guiding principals.
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