LOOKING AT LONG-TERM CONDITIONS
Depression and mental health in the community and the role of the nurse Aysha Mendes discusses the risk of depression in patients who live alone, are elderly, or who are coping with physical illness, and the importance of community nurses quickly and correctly diagnosing any symptoms
T
oday, as many as one in three people suffer from a mental health problem (NHS Careers, 2015), and the majority of mental health services within the UK are based in the community (mentalhealthcare.org.uk, 2014). These services may cover conditions such as depression, anxiety, eating disorders, drug and alcohol problems, and dementia among many others (NHS Choices, 2013). However, awareness of the importance of mental health and a person’s risk of developing mental illness is paramount among community nurses, particularly in light of the inseparability of mental and physical health. Further, the patients often seen by community nurses, such as people living alone, those who are ageing, and those who are coping with physical illness, are at a higher risk of depression than the average healthy adult (Graham et al, 2011). Equally, people with depression are at higher risk of other long-term conditions such as heart disease, for which their risk is nearly doubled (Graham et al, 2011).
© 2015 MA Healthcare Ltd
Mental–physical connection One in four older people in the community have symptoms of depression, and with the frequency of comorbidities in later life, this risk is increased further (Graham et al, 2011). Over 4 million people in England living with physical long-term conditions also have mental health problems, often resulting in significantly poorer health outcomes and a reduced quality of life (Naylor et al, 2012). It is estimated that the cost to the NHS for poor mental health and wellbeing in people living with longterm conditions is £8 billion to £13 billion in England alone (Naylor et al, 2012). Being diagnosed with a long-term condition, not to mention several, can be extremely frightening and can lead to depression that is associated with grieving the loss of a younger, healthier, more active social and independent life, together with the thought of lifelong treatment and impending mortality. For example, depression is three times as common in people with end-stage renal failure, chronic obstructive pulmonary disease, and cardiovascular disease, and more than seven times more common in people
British Journal of Community Nursing May 2015 Vol 20, No 5
with two or more chronic physical conditions (Graham et al, 2011).
Recognition, resources, and support The symptoms of various mental health conditions vary widely, but community nurses’ effective communication, warm and compassionate care, and empathetic psychological support can make patients feel comfortable and safe in sharing any symptoms or emotional struggles, particularly given the stigma that still surrounds mental illness. Listening to patients or recognising symptoms, such as fatigue, withdrawal from social activities, trouble sleeping, or lasting feelings of sadness and hopelessness, can help to identify mental health conditions and signpost patients to the appropriate community services for help and support. It may sometimes be difficult to open what may feel like a ‘can of worms’ in the short time allotted to see a patient. However, if a community nurse suspects a patient of having depression, he or she can take a moment to ask two simple questions (National Institute for Health and Care Excellence (NICE), 2009): w Has the patient often been bothered by feeling down, depressed, or hopeless in the last month? w Has the patient often been bothered by having little interest or pleasure in doing things? Should the answer to either of these questions be ‘yes’, the patient can then be appropriately referred for a mental health assessment (NICE, 2009). Charity organisations are also an immense resource with a wealth of information, expertise, and support for both nurses and patients.
Aysha Mendes
Freelance journalist specialising in health, psychology and nursing Email: [email protected]
253
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
LOOKING AT LONG-TERM CONDITIONS
Treatment interventions Some nurse prescribers in the community may even find themselves prescribing medications for mental health conditions. However, it is worth noting that for mild-to-moderate depression, for example, talking therapies, such as cognitive behavioural therapy, self-education, and exercise or social interventions, can often make a world of difference (NICE, 2009; NHS Choices, 2013). Of course, for more severe cases of depression, antidepressants may be necessary, but even then, their use may be in combination with therapy as a solution for helping patients to find a balance so that they can resume activities in their lives and perhaps begin to address some of the underlying causes of their depression (Mind, 2013). Many medications come with side effects, which may differ greatly across patients. Some may interact negatively with the medication the patient is already taking, and some may be associated with other issues, such as an increased risk of falls. There have been cases of patients put on an antidepressant for anxiety, only to then have the side effect of panic attacks, and to have such side effects misdiagnosed for other conditions, for which they are then prescribed further medications (Mendes, 2015a). Therefore, although medications are often necessary and beneficial, they must be prescribed with caution and often, non-pharmacological approaches are a healthier and safer alternative where possible. Of course, there are cases of severe mental illness where medications are used to control symptoms for the rest of the patient’s life, and these can become long-term conditions in themselves. For example, people diagnosed with schizophrenia will receive tailored treatments, such as antipsychotics combined with cognitive behavioural therapy, and will likely receive day-to-day support from a community mental health team to ensure all of their needs are met (NHS Choices, 2014b). When symptoms are well managed and people with mental health conditions can remain in control of their lives, for example, in many cases of obsessive compulsive disorder (OCD), this is often seen as recovery in itself (Mental Health Foundation, 2015). However, mental health conditions do not always need to become long-term conditions, as people can also recover completely from conditions such as schizophrenia (NHS Choices, 2014a) and obsessive compulsive disorders (NHS Choices, 2014b), particularly when their condition is diagnosed and treated early. However, they may still experience periods of symptom relapse, and it is important to note
that medication alone cannot cure mental illness (Mayo Foundation for Medical Education and Research, 2014).
Promise in the community Mental health issues are common and are also often a reason behind patients’ non-adherence to treatments for other conditions, or decreased likelihood of engaging in positive self-care (Mendes, 2015b; Witters and Wood, 2015). There are some systemic barriers to providing the most ideal care to patients in the community, such as the fragmentation and variability of services, a lack of continuity of care, and a great ongoing divide between health and social care. However, there are still many actions individual community nurses can take to increase the quality of services delivered, patients’ adherence to therapies, and the likelihood that patients in the community will live well. BJCN Graham CC, Campion J, Kaiser P, Edwards K (2011) Management of depression in older people: why this is important in primary care. http://tinyurl. com/oeumcgo (accessed 23 April 2015) Mayo Foundation for Medical Education and Research (2014) Treatments and drugs. http://tinyurl.com/lfr98bn (accessed 23 April 2015) Mendes A (2015a) Person-centred prescribing: Lessons learned from an expert patient story. Nurse Prescribing 13(5). [In Press] Mendes A (2015b) Holistic care of the heart and mind. British Journal of Cardiac Nursing 10(2): 57 Mental Health Foundation (2015) Recovery. http://tinyurl.com/644r854 (accessed 23 April 2015) mentalhealthorg.uk (2014) Mental health services. http://tinyurl.com/ lwmwkpm (accessed 23 April 2015) Mind (2013) Depression. http://tinyurl.com/kcevja4 (accessed 23 April 2015) National Institute for Health and Care Excellence (2009) Depression in adults: The treatment and management of depression in adults. https:// www.nice.org.uk/guidance/cg90 (accessed 20 April 2015) Naylor C, Galea A, Parsonage M, McDaid D, Knapp M, Fossey M (2012) Long-term conditions and mental health. The cost of co-morbidities. http://tinyurl.com/ncaql99 (accessed 23 April 2015) NHS Careers (2015) Mental health nursing. http://tinyurl.com/bztkcje (accessed 23 April 2015) NHS Choices (2013) Clinical depression – Treatment. http://tinyurl.com/ p6djgkb (accessed 23 April 2015) NHS Choices (2014a) Schizophrenia. http://tinyurl.com/plpf2qs (accessed 21 April 2015) NHS Choices (2014b) Obsessive compulsive disorder (OCD). http://tinyurl. com/bml7o4m (accessed 21 April 2015) Witters D, Wood J (2015) Heart attacks and depression closely linked. http:// tinyurl.com/ Lkwqnsg (accessed 23 April 2015)
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www.magonlinelibrary.com/toc/bjcn/current 254
© 2015 MA Healthcare Ltd
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British Journal of Community Nursing May 2015 Vol 20, No 5
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
Depression and mental health in the community and the role of the nurse Aysha Mendes discusses the risk of depression in patients who live alone, are elderly, or who are coping with physical illness, and the importance of community nurses quickly and correctly diagnosing any symptoms
T
oday, as many as one in three people suffer from a mental health problem (NHS Careers, 2015), and the majority of mental health services within the UK are based in the community (mentalhealthcare.org.uk, 2014). These services may cover conditions such as depression, anxiety, eating disorders, drug and alcohol problems, and dementia among many others (NHS Choices, 2013). However, awareness of the importance of mental health and a person’s risk of developing mental illness is paramount among community nurses, particularly in light of the inseparability of mental and physical health. Further, the patients often seen by community nurses, such as people living alone, those who are ageing, and those who are coping with physical illness, are at a higher risk of depression than the average healthy adult (Graham et al, 2011). Equally, people with depression are at higher risk of other long-term conditions such as heart disease, for which their risk is nearly doubled (Graham et al, 2011).
© 2015 MA Healthcare Ltd
Mental–physical connection One in four older people in the community have symptoms of depression, and with the frequency of comorbidities in later life, this risk is increased further (Graham et al, 2011). Over 4 million people in England living with physical long-term conditions also have mental health problems, often resulting in significantly poorer health outcomes and a reduced quality of life (Naylor et al, 2012). It is estimated that the cost to the NHS for poor mental health and wellbeing in people living with longterm conditions is £8 billion to £13 billion in England alone (Naylor et al, 2012). Being diagnosed with a long-term condition, not to mention several, can be extremely frightening and can lead to depression that is associated with grieving the loss of a younger, healthier, more active social and independent life, together with the thought of lifelong treatment and impending mortality. For example, depression is three times as common in people with end-stage renal failure, chronic obstructive pulmonary disease, and cardiovascular disease, and more than seven times more common in people
British Journal of Community Nursing May 2015 Vol 20, No 5
with two or more chronic physical conditions (Graham et al, 2011).
Recognition, resources, and support The symptoms of various mental health conditions vary widely, but community nurses’ effective communication, warm and compassionate care, and empathetic psychological support can make patients feel comfortable and safe in sharing any symptoms or emotional struggles, particularly given the stigma that still surrounds mental illness. Listening to patients or recognising symptoms, such as fatigue, withdrawal from social activities, trouble sleeping, or lasting feelings of sadness and hopelessness, can help to identify mental health conditions and signpost patients to the appropriate community services for help and support. It may sometimes be difficult to open what may feel like a ‘can of worms’ in the short time allotted to see a patient. However, if a community nurse suspects a patient of having depression, he or she can take a moment to ask two simple questions (National Institute for Health and Care Excellence (NICE), 2009): w Has the patient often been bothered by feeling down, depressed, or hopeless in the last month? w Has the patient often been bothered by having little interest or pleasure in doing things? Should the answer to either of these questions be ‘yes’, the patient can then be appropriately referred for a mental health assessment (NICE, 2009). Charity organisations are also an immense resource with a wealth of information, expertise, and support for both nurses and patients.
Aysha Mendes
Freelance journalist specialising in health, psychology and nursing Email: [email protected]
253
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
LOOKING AT LONG-TERM CONDITIONS
Treatment interventions Some nurse prescribers in the community may even find themselves prescribing medications for mental health conditions. However, it is worth noting that for mild-to-moderate depression, for example, talking therapies, such as cognitive behavioural therapy, self-education, and exercise or social interventions, can often make a world of difference (NICE, 2009; NHS Choices, 2013). Of course, for more severe cases of depression, antidepressants may be necessary, but even then, their use may be in combination with therapy as a solution for helping patients to find a balance so that they can resume activities in their lives and perhaps begin to address some of the underlying causes of their depression (Mind, 2013). Many medications come with side effects, which may differ greatly across patients. Some may interact negatively with the medication the patient is already taking, and some may be associated with other issues, such as an increased risk of falls. There have been cases of patients put on an antidepressant for anxiety, only to then have the side effect of panic attacks, and to have such side effects misdiagnosed for other conditions, for which they are then prescribed further medications (Mendes, 2015a). Therefore, although medications are often necessary and beneficial, they must be prescribed with caution and often, non-pharmacological approaches are a healthier and safer alternative where possible. Of course, there are cases of severe mental illness where medications are used to control symptoms for the rest of the patient’s life, and these can become long-term conditions in themselves. For example, people diagnosed with schizophrenia will receive tailored treatments, such as antipsychotics combined with cognitive behavioural therapy, and will likely receive day-to-day support from a community mental health team to ensure all of their needs are met (NHS Choices, 2014b). When symptoms are well managed and people with mental health conditions can remain in control of their lives, for example, in many cases of obsessive compulsive disorder (OCD), this is often seen as recovery in itself (Mental Health Foundation, 2015). However, mental health conditions do not always need to become long-term conditions, as people can also recover completely from conditions such as schizophrenia (NHS Choices, 2014a) and obsessive compulsive disorders (NHS Choices, 2014b), particularly when their condition is diagnosed and treated early. However, they may still experience periods of symptom relapse, and it is important to note
that medication alone cannot cure mental illness (Mayo Foundation for Medical Education and Research, 2014).
Promise in the community Mental health issues are common and are also often a reason behind patients’ non-adherence to treatments for other conditions, or decreased likelihood of engaging in positive self-care (Mendes, 2015b; Witters and Wood, 2015). There are some systemic barriers to providing the most ideal care to patients in the community, such as the fragmentation and variability of services, a lack of continuity of care, and a great ongoing divide between health and social care. However, there are still many actions individual community nurses can take to increase the quality of services delivered, patients’ adherence to therapies, and the likelihood that patients in the community will live well. BJCN Graham CC, Campion J, Kaiser P, Edwards K (2011) Management of depression in older people: why this is important in primary care. http://tinyurl. com/oeumcgo (accessed 23 April 2015) Mayo Foundation for Medical Education and Research (2014) Treatments and drugs. http://tinyurl.com/lfr98bn (accessed 23 April 2015) Mendes A (2015a) Person-centred prescribing: Lessons learned from an expert patient story. Nurse Prescribing 13(5). [In Press] Mendes A (2015b) Holistic care of the heart and mind. British Journal of Cardiac Nursing 10(2): 57 Mental Health Foundation (2015) Recovery. http://tinyurl.com/644r854 (accessed 23 April 2015) mentalhealthorg.uk (2014) Mental health services. http://tinyurl.com/ lwmwkpm (accessed 23 April 2015) Mind (2013) Depression. http://tinyurl.com/kcevja4 (accessed 23 April 2015) National Institute for Health and Care Excellence (2009) Depression in adults: The treatment and management of depression in adults. https:// www.nice.org.uk/guidance/cg90 (accessed 20 April 2015) Naylor C, Galea A, Parsonage M, McDaid D, Knapp M, Fossey M (2012) Long-term conditions and mental health. The cost of co-morbidities. http://tinyurl.com/ncaql99 (accessed 23 April 2015) NHS Careers (2015) Mental health nursing. http://tinyurl.com/bztkcje (accessed 23 April 2015) NHS Choices (2013) Clinical depression – Treatment. http://tinyurl.com/ p6djgkb (accessed 23 April 2015) NHS Choices (2014a) Schizophrenia. http://tinyurl.com/plpf2qs (accessed 21 April 2015) NHS Choices (2014b) Obsessive compulsive disorder (OCD). http://tinyurl. com/bml7o4m (accessed 21 April 2015) Witters D, Wood J (2015) Heart attacks and depression closely linked. http:// tinyurl.com/ Lkwqnsg (accessed 23 April 2015)
BREAKING NEWS: ‘Like’ us on Facebook (www.facebook.com/communitynursing)
Follow us on Twitter (@BJCommunityNurs)
Join our community nurses group on LinkedIn (www.linkedin.com, then search British Journal of Community Nursing)
and stay in contact with us with your views or ideas ([email protected])
www.magonlinelibrary.com/toc/bjcn/current 254
© 2015 MA Healthcare Ltd
Community nurses, join in the conversation online
British Journal of Community Nursing May 2015 Vol 20, No 5
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
