Archive for the ‘Mental Health’ Category

In some cases, conventional remedies are not an adequate solution. A recent study done in the United States indicates that increasingly more people with allergies are turning to alternative medicine remedies to relieve symptoms.

There are many valid treatments to treat allergies – nasal decongestant or antihistamines. Always the doctor may indicate appropriate treatment. The survey found that alternative medicine has proved successful for people who resorted to it in order to treat allergies.

Acupuncture – Acupuncture can reduce the number of allergy-related immune cells, balancing reactions in front of allergens. The procedure involves placing acupuncture needles in certain points of the body to stimulate specific areas, thus stimulating the body’s reactions to antigens tame. Allergic people who tried this method have said that after the acupuncture sessions have rarely resorted to traditional medications to control symptoms and specific allergies.

One of the theories circulating is that acupuncture make the brain to release more endorphins and other chemicals that control blood pressure, so will reduce nasal congestion.

Supplements – Supplements can also be used to relieve the symptoms as long (carefully!) As doctor approves it.. Natural supplement extracted from burdock (herb known as the bur, buedea-plague, captalan, Gula-the-lake, grayling, skid-high) was found to produce the equivalent effect of an antihistamine.

Flavonoids also are useful for people with allergies, are found in various fruits and vegetables such as apples, bananas, onions, oranges, flavonoids reduce inflammation that leads to sinus problems.

Another component of diet that can help, refers to omega-3 fatty acids found in fish and other foods. The study shows that some of the symptoms of fever are reduced when the omega-3 fatty acids are consumed.

Homeopathy – therapeutic method that uses some highly diluted substances to produce disturbances similar to those presented by the patient – is another way to relief allergies.

One and Other-Mental Health

Image by Feggy Art
Mental health on the Fourth Plinth (One and Other) performance art in Trafalgar Square, London.

I am standing on the plinth to represent people whose voices so often go unheard, either because they don’t have the necessary support, or they are socially isolated, or they are quite simply desperately marginalized: people with mental health issues.

According to the World Health Organisation, depression will be the second most costly health problem worldwide, coming second only to heart disease and ahead of cancer.

Despite this, however, and despite the fact that around one in four adults will experience them at some point in their lives, mental health problems are still surrounded by ignorance, fear and prejudice.

Research has shown that prejudice against people with mental health issues is actually increasing, despite social attitudes regarding sexuality, ethnicity and other similar issues improving.

There is a lot of prospect in community-based mental health careers both in the state of Maryland and all over the country. This is because for years now, there has been a lot of emphasis on prevention and reduction of inpatient hospitalization for all illnesses, including mental illness. This might primarily have been intended for cost control, it has also facilitated quality and access. The second reason why career prospects in community mental health are many is that there is currently a severe shortage of mental health workers in all sectors. The 2007 Maryland Mental Health Workforce White Paper revealed that the number and complexity of mental health problems experienced by children and their families have increased over the past decade. It further said, “At least one in five children and youth, or 20%, experience a mental health disorder. The crisis of mental health in the United States is such that 75-80% of youth with mental health diagnoses receive no services, and services received are often inadequate”. Thirdly, there is inadequate diversity among the few mental health workforce. For example, 28% of Maryland population is of ethnic minority but only 12% of mental workforce is of ethnic minorities. Furthermore, there is an acute shortage of African American males in mental health workforce.

 1. Outpatient Mental Health Clinics (OMHC)

Outpatient mental health clinics provide therapy, counseling, medication management, social skills teaching, and case management services to individuals with severe and chronic mental health problems. Career prospects available in OMHC include:

Therapists and Counselors: New regulations require therapists and counselors in OMHC to have a minimum of a Masters degree and a license (such as LGSW, LCSW, LCSW-C, LGPC, LCPC, RNC, APRN/PMHN) in nursing, social work, psychology, counseling, or psychiatric rehabilitation. Also, an RN without a Masters degree but with an RNC from ANCC can be employed as a therapist. Salaries are very attractive.

2. Psychiatric Rehabilitation Programs (PRP)

PRP programs are an extension of the services provided to the patient in the OMHC. A PRP may stand alone or be an additional service to an OMHC. The purpose of PRP is to promote the rehabilitation, integration and improved quality of life for the patient at home, school, work and community. It aims at helping the patient to function at his or her optimum best in life. The counseling can be done at the Program office (onsite) or at the patient’s home (offsite). PRP counseling could be about a wide range of topics, including anger management skills, social skills, assertiveness skills, medication compliance, coping with symptoms, managing peer pressure, taking a bus, determining bus route, drug and alcohol, gang prevention, sex education, STD education, accessing community resources such as food stamps, affordable housing, bus pass, ID card, driver’s license, job search, preparing for job interview, keeping a job, improving attention in school, completing homework and school projects, respect of authority, etc.     

Even though a mere one-year work experience in a mental health setting or having an AA degree qualifies one to be a PRP counselor, PRP programs prefer to employ persons with a BS degree in any health or mental health related field such as nursing, social work, counseling, psychology and rehabilitation. PRP counselors are usually paid  or more per counseling session. Each client receives 2 to 8 counseling sessions per month.

3. Expanded School-Based Mental Health (ESBMH)

In addition to the school clinic, some schools also have an ESBMH clinic. A therapist assigned from an OMHC manages each of such clinics. Apart from providing therapy to troubled kids sent to the therapist’s office from the class or principal’s office, the therapist also serve as a resource person to the school staff regarding particular children, issues or topics related to mental health. 

4. Crisis Response Programs (BCRI, BCARS)

Mental health professionals are also needed in crisis centers where services are provided for anyone in mental health crisis. The two main centers in Baltimore are Baltimore Crisis Response, Inc. (BCRI) and Baltimore Child and Adolescent Response System (BCARS). For employment inquiries, please call 410-433-5255. There are positions that do not need a Masters degree.

BCARS website provides the following information about what they do: 

BCARS is a mobile crisis response service that provides emergency contact with mental health professionals throughout the city. Dedicated crisis clinicians staff the program as part of a continuum of clinical care provided by the Catholic Charities.  The Johns Hopkins Division of Child and Adolescent Psychiatry provide psychiatric consultations to the program.  BCARS assists children and families facing psychiatric and psychosocial crises by providing hospital diversion and immediate intervention and respite. For information or assistance, please call the BCARS hotline (410) 752-2272. It is available 24-7. 

BCRI web site provided the following information: about what they do:

HOTLINE: The telephone crisis “hotline” (410-752-2272) is available 24 hours a day and is staffed by trained counselors who have the ability to provide information and referral to the network of human services in the Baltimore metropolitan area. The counselors also provide supportive counseling, dispatch emergency assistance and link callers with more intensive BCRI services.  In FY 2004 – 34,852 and FY 2005 – 30,257 calls were received on the Hotline.

MOBILE CRISIS TEAMS: Mobile crisis teams are comprised of mental health professionals including psychiatrists, social workers and nurses who can be dispatched to community locations to provide immediate assessment, intervention and treatment. Teams operate from 7:00am till midnight seven days per week. Currently the teams average over 2000 responses per year.

IN HOME SUPPORT: Persons experiencing a mental health crisis can often be maintained in the community through regular visits from the BCRI mobile crisis teams. An average of 350 people a year is cared for in this manner.

RESIDENTIAL CRISIS BEDS: Baltimore Crisis Response, Inc. operates 18 psychiatric crisis beds. Crisis beds are not new to Maryland. However, since its inception, BCRI has operated with an average length of stay of 4.5 days compared with the historical statewide average of 16.5 days.

PUBLIC EDUCATION AND TRAINING: BCRI provide public and professional education and training on a wide range of mental health related topics including: suicide prevention, crisis intervention, mental illness, and stigma.  Training has also been provided to members of the Baltimore City Police Negotiation Team, over 3,000 patrol officers, Housing Police and Sheriff’s officers. Through special grants and contracts, BCRI has provided training to Baltimore City Public School teachers and guidance counselors, clergy, 911 operators, shelter care staff and others.  Public education is also provided via a cable television program called “Mental Health Matters”.  This program provides practical information regarding mental health issues and community resources.  BCRI has also offered professional training conferences, workshops and symposia.

ADDICTIONS SERVICES: In response to the growing need for addictions treatment services BCRI has expanded and now provides a 10-day residential detoxification program for chemically addicted and dually diagnosed persons.  There are currently 16 beds operated for this purpose.

5. Group Homes

Direct care staff and counselors are needed in group homes to manage, care and support the residents in the areas of activities of daily living, behavior management, life progress, and community living. Employment preference is usually given to individuals who have a degree related to health or mental health. Salary rates are very attractive. New regulations now mandate each group home especially for children to be managed by a Program Administrator (PA) who must possess at least a BS degree in any field but preferably in a health or mental health related field. Program Administrators are very well paid, depending on their education and experience and the size and intensity of the group home. 

6. Private Practice

There are a lot of prospects for licensed mental health professionals with at least a Masters degree to establish their own private practice. The practice could be in the area of clinical, research, educational, or consultancy.

One and Other-Mental Health

Image by Feggy Art
Mental health on the Fourth Plinth (One and Other) performance art in Trafalgar Square, London.

I am standing on the plinth to represent people whose voices so often go unheard, either because they don’t have the necessary support, or they are socially isolated, or they are quite simply desperately marginalized: people with mental health issues.

According to the World Health Organisation, depression will be the second most costly health problem worldwide, coming second only to heart disease and ahead of cancer.

Despite this, however, and despite the fact that around one in four adults will experience them at some point in their lives, mental health problems are still surrounded by ignorance, fear and prejudice.

Research has shown that prejudice against people with mental health issues is actually increasing, despite social attitudes regarding sexuality, ethnicity and other similar issues improving.

What’s with the sticking the tongue out routine? Whenever I photograph someone, they have to lunge the lingua.

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges Mental health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform. .

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental health and substance use performance measures that will be used to improve delivery of mental health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental health and substance use services and include mental health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

Find More Mental Health Articles

This article focuses on the need for mental health nurses to promote sexual health. As a mental health nurse I have observed that during practice, nurses are encountering problems dealing with sexual health issues in mental health. Clients have experienced sexual health needs that nurses failed to meet and many nurses have experienced that they are out of depth.

Lomas (2009) carried out a survey with at least 283 mental health professionals of which half of them were nurses.  Evidence from the research showed that even though 80% of the participants were in support of the idea that sexual health promotion was a vital part of their role, only 30%, representing less than half the participants regularly discussed sexual health with mental health patients, (Lomas 2009).   A revelation also made by Lomas (2009), survey suggested that 92% of respondents had no clue that people with schizophrenia were at an increased risk of contracting HIV than the general population, 72% were not even convinced that they were more likely to engage in high-risk sexual behaviour.   From the participants, 14%  felt uncomfortable discussing sexual health issues with mental health patients, gay and lesbian issues was a very uncomfortable topic for 13% of them.  This queries whether mental health nurses are well equipped to promote sexual health, (Lomas 2009),

Through this, mental health nurses must  learn to appreciate the clause from the National Midwifery Council (2004) stating that health care professionals are expected to continuously update knowledge and skills throughout our working life and regularly take part in learning activities that develop our competence and performance.  In support to this, Higgins et al (2006)suggested that individuals with `severe’ mental health problems will most likely end up engaging in high-risk sexual activities creating the susceptibility to sexually transmitted infections.  In Higgins et al (2006)literature review from 1980 to 2005 focusing on sexual health education and sexual dysfunction emanating from prescribed medication, it was confirmed that sexual health education programmes were beneficial.   Education proved to produce a reduction in sexual risk activities compared to complete cessation. This undoubtedly highlights the issue that mental health professionals should make an effort to deliver holistic care that includes sexual health promotion (Higgins et al 2006)

In a similar study conducted but this time it included Glove-wearing Hughes and Gray (2009) states that only 61% of the participants reported wearing gloves whilst administering an injection.  Hughes and Gray (2009) continue to say that the nurses are also risking infection by not wearing gloves.

Bahrick and Harris (2009) emphasises that antidepressants are a popular cause for sexual dysfunction.   This suggests that reassurance and advice from nurses becomes a necessity.  Having an understanding of sexual health would make it easier for nurses to offer appropriate advice because sometimes this becomes debilitating for the mental health clients and therefore requires intervention Bahrick and Harris (2009).  Hughes and Gray (2009) mentioned that the lack of awareness and knowledge of sexual health does not only leave the clients disadvantaged by not having reasonable access to sexual health services or relevant information on sexual health.  Hughes and Gray (2009)   goes on to say that by this level of lack of knowledge, the mental health nurses continue to place themselves at risk.

In a study conducted by Cochran and Mays (2000), evidence was transparent that there was an escalated risk of suicide symptoms among homosexually experienced men.  Cochran and Mays (2000), further explains that some gay men also reported the risk of recurrent depression as slightly increased.  This again makes it a necessity for mental health nurses to be aware and well equipped w ith sexual health knowledge in order to be able to holistically assist their clients in a non judgmental manner. (Cochran and Mays 2000)

Interestingly MIND (2008) highlighted another good reason for mental health nurses to be aware of sexual health issues.  MIND (2008) explained that the distress experienced by some lesbians, gay men as well as bisexual’s mental distress is not due to their sexuality instead it is seen as the impact of heterosexism and homophobia,  MIND (2008).  As a result of this, many lesbians, gay men as well as bisexual’s find it a daunting task for fear of being seen as abnormal as well as not being understood.  MIND (2008) confirms that there is evidence that these concerns or worries are not baseless as homosexuality used to be seen as a psychiatric diagnosis in 1993.  Although nowadays there is an improvement in the awareness in the mental health field, it would be more beneficial for mental health nurses to be well equipped to deliver sexual health to clients with serious mental health problems (Mind 2008)

 

Implications for practice

This exercise has made it possible to identify gaps in service provision.  From my own experience, I have witnessed situations were mental health clients bring contraceptive pills on the ward and the nurses role is to administer them.  This questions whether these clients suffering from severe mental illness are aware of other sexual health issues other than pregnancy.  In support to this, The Royal College of Nursing (2001) has highlighted that contraception alongside teenage pregnancies and sexual infections are some of the significant issues that have a great impact on health care practice. The Royal College of Nursing (2001) has highlighted that “sexual health is about the holistic care of patients and clients”, it was also brought to attention that Clinical practice, Clinical education practice and Clinical policy development are essential in ensuring holistic care in sexual health. This has proved that evidence based practice is essential in delivering successful holistic care.  This includes sexual health for mental health patients facilitated by mental health nurses.  In support to this, Dawes et al (2005) emphasises that evidence based-practice ensures that individual health professionals practice based on sound research and successful outcome.  Every registered nurse needs to consider the evidence-based for practice in a multitude of areas as this is a requirement of Nursing and Midwifery Council (NMC 2004).

Having a good knowledge base on sexual health promotion will not only help to educate mental health clients on sexual health but when health promotion is carried out by mental health nurses, it could become cost effective.  This will also be supporting the Government in fulfilling its pledge in the NHS Plan to make progress in the amelioration of ill health.  The Royal College of Nursing (2001).

Through undertaking a literature review, this has also provided guidance that will enable us as mental health nurses to be keen on development and evaluation of sexual health education programmes that will be beneficial for our service users.  However, this also enlightens us to the fact that mental health nurses need to prioritise sexual health training and practice development or make an effort to make it part of their personal development plan in order to bridge the theory and practice gap. It should also be noted that they are also some hindrances. It is obviously a rather daunting task after considering the financial issues faced by the government as a result of the recession.   The Royal College of Nursing (2001) has highlighted that a lack of interest to develop knowledge in sexual health has been one of the hindrances.  On the other hand, another advantage brought about by continuing professional development is that resources are utilised more effectively. This is confirmed by the Chartered Institute of Professional Development (CIPD 2010), continuing professional development makes staff become more productive and work with efficiency by focusing on their own learning through reflection, (CIPD 2010).

The health care delivery system is plagued by lack of resources. Updating knowledge and skills ensures that the best use of these resources is put into practice. A continuing professional development allows the individual to work out what area of practice requires development in this case sexual health promotion by mental health nurses, This will be made possible through highlighting gaps in their knowledge and experience.therefore giving the individual a chance to compare what knowledge and skills they possess, and what is expected at their level of professional practice, (CIPD 2010).

Sexual health skills are required or desirable to meet the demands of the promotion of sexual health.  It also serves as a way of improving one’s competences to ensure satisfactory performance during sexual health promotion.  Enhancing knowledge and skills for mental health nurses allows the individual to engage in evidence based practice. Simpson and Dodds (2004).  This promotes conventionality minimising ambiguity and rendering information shared between health professionals and clients.  Improving teamwork this way reflects a climate that best supports a therapeutic environment (Simpson and Dodds, 2004).  Another vital point to make is that this form of practice could be useful to bridge the theory – practice gap as research evidence have proved that mental health nurses certainly need to be better equipped to promote sexual health.  Hughes and Gray (2009) argue that it is essential for policies to improve in order to extend on the achievements of the National Service Framework for Mental Health. The New Horizons programme is a programme that was launched by the Department of Health in 2009; this is a 10-year strategy to continue to improve the mental health services offered by 2020. However, this does not mention sexual health, (NHS Choices 2010)

The Royal College of Nurses (2001), states that health promotion policies that dispel inequalities in sexual health should be put in place and utilised. In addition to this, Gray et al (2002) pointed out that the sexual health policies of several mental health NHS Trusts are completely out dated, Gray et al (2002) further says that most of these policies simply states that patients are not permitted to have sex whilst on the ward.  Gray et al (2002) gave as an example a policy from a mental health Trust that simply states that ‘Sexual activity involving patients on hospital premises is not an acceptable form of behaviour’.

Developments and improvements in practice need to be made.  In order to achieve safe effective nursing practice, it is paramount to be able to enhance knowledge, skills, values and attitudes towards professional practice. This could be done through staff training and adopting a learning culture. However, time and duties need to be well managed in order to make this a success.  In addition to this, Nurse Week (2005), points out that nurses tend to spend most of their time in administrative and managerial duties which prevent them from spending time engaging in more therapeutic work with patients.  A learning culture is a practice of a ‘no blame’ approach to management which according to Collier (2005) generally translate theory and directives into practice in a meaningful way.

Conclusion

In conclusion, this article has demonstrated the relevance of mental health nurses having a good knowledge base of sexual health and the benefits of it and substantiated it with evidence   The literature used during this exercise highlights the need for mental health nurses to have sexual health knowledge and how much the mental health patients will benefit from sexual health education.  It has also proved that with sexual health education, evidence shows that they can be a reduction in sexually transmitted infections.   It is important to state finally that this exercise has given me a clear understanding of the importance of mental health nurses being able to promote sexual health.    It is clear that clients with mental health problems are more likely to experience problems with their sexual health.

The experience I had made me realise that knowledge is power and when faced with situations were mental health clients have sexual health needs they do not have enough knowledge on.  Health promotion is also identified among the seven pillars of clinical governance initiative (DOH, 1998), in which I will be expected to engage in my professional practice as a registered nurse.  In order to practice ethically and to empower clients to live an independent life, mental health nurses need to have knowledge about how to respond to the needs of people with mental illness in an ethical, honest, and non judgemental manner and this includes sexual health.

By Beatrice Kungwengwe

Related Mental Health Articles

Mental Health: Stress and Work

Image by xeeliz
Cover of an old 1969 Mental Health magazine from the UK I found in one of my old boxes – I used to work in mental health years ago, and these were being thrown out – they were old and out of date when I got them and now they are a curious historical record of a time before platform shoes, before disco, before Thatcher, before yuppies, before the internet – before Paxil, Zoloft and Prozac (yes there was a time before Prozac!)

Health Education as a core course for Teachers’ Education: to enhance the Mental Health of students

By

Akintunde, P. G. (Ph.D)

Department of Vocational & Special Education

University of Calabar

Calabar, Cross River State, Nigeria

And

Olanipekun, O. Fola

Olabisi Onabanjo University

Ago-Iwoye, Ogun State, Nigeria

 

Abstract

This paper is primarily concerned with the role of teachers in enhancement of mental health of students. It discuses the factual picture of the functions of the teachers in a changing social and education environment, identifying the social community in the actualization of the human need (mental health) that are otherwise ignored. It highlights the complex expectation of the public from the role of teachers. The expectation makes the duties of teachers diffused; they in some measures serve as social workers and perform in addition to duties other than classroom teaching. Their responsibilities for social training in a changing environment, particularly in the misconception of mental health are discussed and recommendation made.

Key Words: Health education for teachers’ education, educating teachers in mental health, health education a necessity for teachers.

 

Introduction

            The World Health Organization (WHO) (1946) adopts a definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”, at the International Health Conference, New York; 19-22 June, 1946 signed on 22 July 1946 by the representative of 61 States (WHO official records No.2 100). It enters into force on 7th April 1948, thereby declaring health as a fundamental human right.

The complex nature of public expectation of teachers’ duties necessitates the need for them to have a social training that will make them meet the challenge resulting from changing environment. School health education aims at constituting healthy learning experiences, healthy environment (physical and mental health) and positive interpersonal relationships between Teachers and students, students and students inside and outside the school environment.

 Healthful school living which consists of emotional health, healthful interpersonal relationships, among others provide a safe and healthful environment. The three fold goal of environmental school health education is healthy people in healthy communities in a healthy environment.

Health lies in the functional interaction of the individual and his environment and not determined in terms of the individual isolation. A clinical picture shows the interplay of psychological, physiological and structural factors. The moment a man falls ill, he regresses in an infantile type of psychological condition, a type of adoption neurosis which is normal part of the patient’s reaction to his illness (Canestrari, 1963).

However, understanding of mental health by individual teacher and the society at large would be helpful in the conversion of weird and wild experience at early stage to greatness and responsibility in later life. Teachers are expected to have motivational impact on their students. Teachers have more vital role to play in student stress management. Students need to be educated on the effects of stress on achievement, and understand human behavior and how it affects other people in the environment (Olanipekun, 2006).

Key Words: Health education for teachers’ education, educating teachers in mental health, health education a necessity for teachers.

 

Mental Health

Mental health is a term to describe either a level of cognitive or emotional well-being or an absence of mental disorders. It may include an individual’s ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience (About.com, 2006). It is regarded as expression of ones emotions which signifies a successful adaptation to a range of demands.

World Health Organization (2005) defines mental health as “a state of well-being in which the individual realizes his/her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community”. However, the organization recognizes the fact that a complete definition may not be available because of cultural, religion and general environmental influences on determination, recognition of mental health and disorders. World Health Research (2001) explains that definition of mental health depend on cultural differences, subjective assessments, and competing professional theories because they all affect how mental health is defined.

 

Mental Disorders

The definition of mental disorders is a key issue for mental health and for users and providers of mental health services. Most international clinical documents use the term “Mental Disorders” and some define it as a psychological or behavioral pattern associated with distress or disability.

Mental disorders are conceptualized as disorders of the brain circuits likely caused by development processes shaped by a complex interplay of genetics and experience. It is psychological or behavior pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture (Yolken and Torrey, 1995).

The recognition and understanding of mental health condition has changed over time and across culture, there are still variations in the definition, assessment and classification of mental disorders, although standard guideline criteria are widely accepted. Diagnoses are made by psychiatrists or clinical psychologists using various methods, often relying on observation and questioning in interviews. Treatments are provided by various mental health professionals.   

            Yolken and Torrey (1995) records that there are some diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or psychopath, which are defined by or inherently associated with conduct problems and violence. There are conflicting findings about the extent to which certain specific symptoms, notably some kinds of psychosis (hallucination or delusions) that can occur in disorder such as schizophrenia, delusional disorder or mood disorder, are linked to an increased risk of serious violence on average.

            Recently, the field of Global Mental Health has emerged, defined as ‘the area of study, research and practice that places a priority on improving mental health for all people’ (Patel and Prince, 2010). The mediating factors of violence acts, however, are most consistently found to be mainly socio-demographic and socio-economic factors such as age, gender, lower socioeconomic status and in particular substance abuse (including alcoholism) to which some people may be particularly vulnerable (Stuart, 2003).

 

Types of Mental Disorders

Mental disorders are in categories. There are many facets of human behaviors and personality that can become disorder. This paper sum them from the classifications given by Yolken and Torrey (1995), Kitchener and Jorm (2002) and Keyes (2002).

Anxiety disorder: when anxiety or fear interferes with normal functioning. This may include phobia, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsession, compulsive disorder, and post traumatic stress disorder.

Affective disorders: Affective (emotion/mood) process can become disorders. These are mood disorder (unusual intense and sustained sadness, melancholia or despair) known as major depression or clinical depression (milder but still prolonged depression can be diagnosed as dysthymia).

Bipolar disorders (manic depression): It involves abnormally “high or pressured mood states, known as mania/hypomania, alternating with normal/depressed mood. Yolken and Torrey (1995) states that whether unipolar and bipolar mood phenomena represent distinct categories of disorder or whether they usually mix and merge together along a dimension or spectrum of mood is under debate in the scientific literature.

Pattern of belief, language use and perception can become disorder. Examples are delusion, thought disorder, and hallucinations. These are referred to as psychotic disorders (schizophrenia and delusional disorder).

Schizoaffective disorder:  It is a term use for those individuals showing aspects of both schizophrenia and affective disorders.

Personality disorders: paranoid, schizoid and schizotypal, antisocial, borderline, histrionic/narcissistic, avoidant, dependent/obsessive-compulsive.

Adjustment disorder: This is an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated.

Eating disorder: anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating order.

Sexual disorder: gender identification disorder, dyspareunia, and ego-dystonic homosexuality.

Sleep disorder: insomnia

Tic disorder: Tourette’s syndrome, kleptomania, pyromania, gambling, substance dependence or abuse or addiction is in this category.

Conduct disorder: Inability to behave normally with expected discipline in the society. If this continues into adulthood, it may be diagnosed as anti-social personality disorder (psychopath).

 

Prevalence

            Mental disorders are common world wide. WHO (2000) records that one out of three people in most communities report sufficient criteria for at least one at some point in their life.

Sanfford (1978), states that many children have behaviors that conflict with a reasonable school environment which could not be described as a healthful one and invariably affects their performance and the adaptation of others to them. Carter, Briggs-Gowan, and Davis (2004) exclaims that many children exhibit a deviation from age appropriate behaviors which interferes with child’s own growth and development and/or the issue of others.

 

Causes of mental disorders

Mental disorders can arise from a combination of sources. In many cases there is no single accepted cause currently established. It is commonly belief that mental disorder results from genetic vulnerabilities exposed by environmental stressors.

WHO (2000) reveals that there is a strong relationship between the various forms of severe and complex mental disorder in adulthood and abuse (physical, sexual or emotional) or neglect of children during the developmental years. According to the report ‘children sexual  abuse’ alone plays a significant percentage of all mental disorder in adult females, most notable example being eating disorder and borderline personality disorder.

Jefferoate (1969) explains that environment can cause or trigger physical  or mental ill-health while psyche influences the development of organic disease in remote parts of the body, and illness begets anxiety and this in turn begets illness. The mental health of an individual depends on the continuous satisfaction of specials requisites in the pattern of his psychological stimulation, the opportunity to give and receive love and affection, to be dependent and be depended upon. When one or more of these is/are missing the level of mental soundness is altered resulting in mental illness.  

 

The following are considered as contributing factors or causes of mental disorder (WHO, 2000; Steadman, Mulvey, Monahan, Robbins, Appelbaum, Grisso, Roth, and Silver, 1998; and Kitchener and Jorm, 2002):

Studies have shown that genes often play an important role in the development of mental disorder, although the reliable identification of connections between specific genes and specific categories of disorder has proven more difficult.

Environmental events surrounding pregnancy and birth have been implicated.

Traumatic brain injury may increase the risk of developing certain mental disorder.

There has been some tentative inconsistent links found to certain viral infections, to substance misuse, and to general physical health.

Social influences have been found to be important, including abuse, bullying and other negative/stressful life experiences.

Wider community vices/problems such as unemployment/employment problems, socio economic inequality, and lack of socio cohesion have been attributed also to mental disorder.

.

Society response to mentally ill people

Response of people to mentally ill persons or people with nervous breakdown is pathetic and unhealthy. A study reported by Times Online (2009) note that assistance given by extended families that often help and supportive religious leaders who listen with kindness and respect often contrast with usual practice in psychiatric diagnosis and medication. Due to lack of proper education and ignorance on causes of mental illness and emotional problems, prevention approach and treatment, the public fail to understand the true nature of many of these mental illnesses and fail to seek the available services. Thus rather than helping to reduce/cushing the effect of the problem or the cause of the problem, the condition of the affected individuals are worsen. Some conditions are not as bad as people look at them and if they are well handled the situation may change for better.

Murray, Lopez, and World Health Organization (1996) reports:           

 

“The burden of mental illness on health and productivity throughout

the world has been profoundly underestimated. Data developed by

the massive Global Burden of disease study, conducted by the WHO,

the World Bank, and Harvard University revealed that mental illness,

including suicide, rank second in the burden of disease in established

market economics, … It further revealed that nearly two third of  all

the people with diagnosable mental disorders do not seek treatment. It

is believed that when people understand that mental disorders are not

the result of moral failings or limited will power, but are legitimate

illnesses that are responsive to specific treatments, much of the

negative stereotyping may dissipate”

 

They report further that the 10 leading causes of disability (counting lost years of healthy life) at age 15-44 were: major depression, alcohol use, road traffic accident, schizophrenia, self inflicted injuries, drug use, bipolar disorder, obsessive-compulsive disorders, osteoarthritis, and violence.

            Thompson (2010) in his study ‘Addressing Suicide: is treatment more important than therapist?’  reports a study by Dr. Marsha Linehan at the University of Washington who suggested that “type of treatment may make a big difference for people who have borderline personality disorder (BPD), a chronic condition associated with difficulty in effectively managing one’s emotions., multiple suicide attempts, physical self harm (e.g. cutting on oneself) and impulsive, often destructive actions.”

            Stigma remains a serious problem, with many cases of human rights violations like chaining or beating experienced by people with mental illness. Perpetrators are rarely brought to justice.Royal College of Psychiatrist reported that research has shown that there is stigma attached to mental illness.

There are on-line psychiatric or mental illness self-diagnose available now stating the weekly changes in individual mental health and quality of life. Report has it that annual expenditure on health in Nigeria is less than 3% of Gross Domestic Product, amounting to per capita, mental health services received only a very small part of this total health budget.

 

Factors underlying people’ behavior towards mental ill people

Many factors have been attributed to uncaring attitude of people to the mentally ill people. These include:

Predisposition factors: The antecedents to behavior. What provide the rationale or motivation for the behavior (e.g. knowledge, beliefs, values, attitudes, confidence, and existing skills).
Enabling factors: The conditions in the environment that enable the motivation to be realized. These factors may be availability, accessibility to facilities for caring for the affected (finance, psychiatric care, etc).
Reinforcing factors: What follow the behavior (acceptance of the patient that he/she needs help).
Knowledge: It is necessary for a conscious action to take place; knowledge can be gained from information provided by health professionals, parents, teachers, books and mass medial or other sources through experience.
Belief: A conviction that a phenomenon or object is true or real. Most of them are derived from parents or other respected people in the life of the beholder.
Values: The value given to things tends to cluster within ethnic group and across generations of people sharing a common history and geographical identity.
Attitude: This reflects likes/dislikes towards certain categories of objects, persons/situation. It is sometimes based on limited experience. It may be formed without understanding the whole situation.
Relationships and morality: Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality, so much so that it is sometimes argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society.

 

            Tilbury and Rapley (2004) and Karasz (2005), agree that in clinical psychiatry, persistent distress and disability indicate an internal disorder requiring treatment; but in order context, the distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems. The poor economic situation has affected the standard of living of many people especially those we can class as poor.

The unchecked wide gap between the rich and the poor has resulted in some cases to family disintegration, with adverse effect on children who are being abused. These and other factors have led to increase in mental illness of many young ones within school age.

If their society cannot accommodate them, schools have no choice, and they cannot be discriminated against. Every child has right to education in Nigeria. Therefore schools should learn how to accommodate and integrate them into the system. 

 

Psychotherapy

            Psychotherapy involves a variety of treatment techniques, often used along with medication. There are many ways of treating mental disorders, some of which are stated below (general and specific):

General

Individual: involving only the patent and the therapist.

Group – involving two or more patient in the therapy at the same time. It gives them the opportunity to share experiences and learns and appreciates how others feel too.

Marital or couples: helping spouses and partners understand why their loved one has a mental disorder, what changes in communication, how behaviors can help and what they can do to cope.

Family/relation: Involvement of family or a close relation that has influence or has much information on the patient in improving the condition of patient is vital and recognized. They need to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

Specific

Psychoanalytic – the first approach, the patient’s thoughts are verbalized including free associations, fantasies, and dreams, from which the analysis formulates the nature of the unconscious conflicts which are causing the patient’s symptoms and character problems. It addresses the underlining psychic conflicts and defenses.

Behavior therapy/applied behavior analysis – focuses on changing maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others.

Cognitive behavioral therapy – It is based on modifying the patterns of thought and behavior associated with a particular disorder. It seeks to identify maladaptive cognition, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors.

Psychodynamic – a dept psychology with primary aim to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension. It gets its root from psychoanalysis.

Existential therapy – It is based on the existential belief that human beings are alone in the world. This association leads to meaninglessness, which can be overcome only by creating one’s own values and by meanings. It is philosophically associated with phenomena.

Systemic therapy or family therapy – a process where a net-work of significant others as well as an individual are addressed.

Humanistic Approach – a psychological approach that is a value oriented, holds a hopeful, constructive view of human beings and of their substantial capacity to be self determining, guided by a conviction that intentionality and ethical values are strong psychological forces, among the basic determinants of human behavior.

Eclectic/integrative approach – a combination of two or more therapy techniques for treatment of mental disorder.

Counseling and co-counseling – a psychological approach too but in this case advice and suggestion are given base on the observation and information available to the counselor(s).

Psycho education – This program provides people with the information to understand and manage their problems.

Creative therapies – This involves art works such as music and drama therapies.

Lifestyle adjustments and supportive measures – personal adjustment to situations.

 

School connection and nature of teachers’ duties

WHO (2000) reveals that there is a strong relationship between the various forms of severe and complex mental disorder in adulthood and the abuse (physical, sexual/emotional/neglect of children during the developmental years); and records that sexual abuse of children alone plays a significant percentage of the mental disorder in adult females, most notable examples being eating disorders and borderline personality disorder should be a thing of serious concern to our education institutions. There were records of various abuses of children in our environment, many of which could have been averted if they were well enlightened on how to relate in the society, the self protection or prevention of some of the vices in our society and even counseling for victims.

The socio economic and family problems has made many school children and even the grown ups exhibit some emotional and behavioral problems. Children are the life wire of schools. Therefore, identification and management of emotional and behaviorally disturbed children is very important since teachers are dealing with them directly in schools (Akintunde and Akintunde, 2010)). It is not economically possible for each school to have a psychiatrist as a permanent staff. This inability to have such specialist necessitates equipping teachers with essential knowledge capable of assisting in identifying and administering mental health problems to some extent (Akintunde, 2007).

The more teachers know about how to identify the children mental problems the better and easier for them to deal with such situations when they arise. Their relationship with the students and the community will improve and help tremendously in improving the performance of the students. They will even be in position to enlighten parents of these children and the public in general (Akintunde, 2007).

Educating student teachers on mental health through school health education will go a long way not to assist both students and teachers. Teachers are also part of our community; they also operate under the same condition as their students and people in the community. Therefore they are faced with many challenges as those in the community.

Teachers have their personal problems that stress them up upon which they are still expected to accommodate students’ problems most of which are related to mental health problems. In order to make their job easy, they should be armed adequately with enough skills to handle those problems (Sanfford, (1978)).  

Although a lay man look at teaching as a job that any man can handle, forgetting that it is a 24hours job, not ending in school hours but continues as carry over after closing hour, the teacher has to prepare for the next day job and also finish assessment/marking of any assignment given to students as home work. The same person has domestic responsibilities to attend to.

In fact he has little or no time for himself talk less of recreation to recuperate him. If he does not know how to manage the situation, he may end up a psychiatric patient. The knowledge of symptoms, identification, management and therapy of mental disorders or illnesses will help him cope and adjust.

The knowledge of mental health will enable the teachers to know how far they can push the students in terms of discipline, academic activities, co-curricular activities and what to do to assist or step down the effect of mental illness on students. There are times that the attitude of some teachers (especially the untrained or half baked ones) can be very tormenting to the life of students. This is getting worse now that teachers indulge in all sorts of corruptions in schools.

 

Problems associated with integration of children with mental disorders into school system

According to WHO (2000) virtually everybody seems to experience mental disorder at one time or the other. All agents of enhancement of mental health are equally affected mentally too either directly or indirectly. Stress which is a booster of mental illness strikes on everyone; thus, there is need for all and sundry to understand and know how to manage stress.

Guardians’ services render by teachers stops in school but students still interact with the environment outside the school where the school is not in the knowing of the nature of the interaction. What happen to the child after school is not under the control of the school. This condition is worse now that almost all schools are operating as day school except few private schools. There is every possibility of the effort of school being rendered useless by counter interaction of the larger society.

The problem in our society is too heavy for individual to carry; talk less of adding another person’s problem. As a result of this, there is insufficient value base for a committed ethic of care in our society. Thus committed teacher are rare to find.

The differences in background, ethnicity, culture and other attribute that makes individual unique couple with the general society concept and stigma associated with mental illness/disorders makes individual nature complex.

If teachers are to be carried along in alleviating the problem of mental illness in our society, it means a change in teachers’ training curriculum. This is always a problem because generally people do not give in to changes easily. Before you know it Government will also give excuse of lack of money to finance the little alteration the change in curriculum will bring.

Some teachers are bad examples to students and they rather add to the existing problem than solve or reduce it. Whoever cannot manage himself cannot manage others or be a brothers’ keeper. Those in this category needs attention themselves and schools should take appropriate step to help them out before they influence the students.

There is no problem without solution. Sanfford (1978) adopts and adapts some psychotherapy techniques to suggest the following ten aids for teachers to actualize a healthy school environment:

Objectivity – To be objective about self and what to do towards what the student does.
Sharing – To share problems and experiences regularly with colleagues, parents and administrators, through conference, formal and informal meeting.
Feedback – Obtain feedback from observation of the child and suggestions from parents, teachers and administration.
Consultation – Where necessary consult expert like psychologist.
Collaboration – Loan out the child for sometime with other teachers, class and environment, then collate feedback on particular trait being addressed.
Observation – Use some observational techniques such as feedback interaction, analysis and other objective recording system.
Be artistic – Literature, theatres, good films, music and art, may somehow become more meaningful to the teacher when it comes to the issue of their children. People in different community are gradually getting used to using these media as tools for integration and communicative models.
Sense of humor – Maintain sense of humor.
Be Professional – maintain a strict sense of professionalizing while remain the personality the teacher is.
Reinforce – Seek reinforcement and assurance from the children in order to provide them with assurance and solid ground to fall on.

 

Benefit of making health education a core course for teacher education

The awareness and ability to understand the causes and problems associated with mental disorders goes a long way to prevention, management and treatment of these problems, making teaching and learning conducive, effective and enjoyable. Therefore there are lots to benefit from introducing school health education with emphasis on mental health into teachers curriculum. The summary of the benefits are these:

Teachers will be able to discover themselves and relate well with their colleagues and students.

It will enable teachers to understand their students’ inadequacies and problems.

Teachers will find it easy to assist their students in reducing the effects of their problems on their academic and relationship with other people inside and outside the school.

Students will have confidence in discussing their problems with their teachers, sharing their dreams with them with the aim of getting valuable advice and support from them.

Relationship between teachers and students will be more cordial, helpful and effective.

Both teachers and students will develop the ability to come to terms with the environment, adjust to situations and blend with people, their inadequacies not withstanding.

All these are attributes that can improve on teaching learning and lay solid foundation for development of a whole man in a child to meet society expectation.

 

 

 

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