The journey to pursuing my master's started right after graduating from nursing school. My professor’s wisdom and mentorship inspired me to pursue further education with the intent of teaching future nursing students. At the start of the course, we were asked to create and describe a professional identity and identify obligations associated with our role within our chosen profession. I identified both my professional obligations and my role within the context of the health care system. I described my role as being collaborative and client-centred. In doing so, I failed to acknowledge the role I take as an advocate. It was my peers who pointed this out. As a registered psychiatric nurse, I repeatedly advocate on my client’s behalf. I advocate for access to services, medication, housing and even funding. This includes reaching out to family physicians, psychiatrists and other allied health care workers.
This semester, I chose to focus on mental health. Mental illness is often not considered a chronic illness. I would like to remind you that it is in fact a chronic illness. Those living with a severe and persistent mental illness are at an increased risk of developing chronic physical conditions and those living with chronic physical conditions are at risk of developing depression and anxiety (Canadian Mental Health Association, n.d.). Working in mental health and addiction, I am an advocate for both the profession and the population I serve. It is a field within health care that is not easily understood thus resulting in stigmatization. Negative attitudes and beliefs are common towards those with mental illness. Both fear and a lack of understanding lead to prejudice (The Centre for Addiction and Mental Health, n.d.). It is this discrimination that influences health outcomes and quite often for the worse. There have been many stories published in the news regarding stigma within the health care field. In some instances, this discrimination resulted in death. This course allowed me the opportunity to provide education on the challenges faced by those struggling with mental illness. It allowed me to discuss the effects of social determinants of health on the development of mental illness and even addiction.
Social determinants of health (SDH) are defined as the factors that influence an individual’s health and well-being. They are essentially the conditions to which someone is born and exposed too throughout their lifetime (Marsh, 2022). These conditions are often unfair yet modifiable (The World Health Organization, n.d.). Social determinants of health are known to have an impact on mental health. Alegria et al., (2018) identify precarious employment, unemployment, poverty, negative peer and family relationships, ethnicity, race and even geographical location as negatively impacting a person’s mental health. This brings up the question of how mental illness is both managed and prevented.
As we are all aware, mental illness is on the rise. It is the leading cause of disability in Canada (CAMH, n.d.). Evidence has shown the efficacy of harm reduction and recovery-orientated care. Harm reduction aims to reduce the negative impact of substance use while the recovery-orientated approach is used to empower those struggling with mental illness. Emphasis is placed on an individual's strengths. Care is non-judgemental, client-centred and most important of all it provides hope. Based on my observations, there is room for improvement in our current health care system. As of right now, we are responding to situations as they arise. Early intervention is not taking place. For example, harm reduction for substance use was not implemented until after the start of the opioid crisis, once the health care system was burdened by the cost of increased overdoses, overdose-related deaths and communicable diseases. This illustrates the importance of implementing a social-ecological model (SEM) of care.
The social-ecological model (SEM) identifies both the person, their environment and the effects that outside forces have on their health (Golden & Earp, 2012). These forces can be at the individual, community, organizational and societal levels (Early, 2016). It is important to note that these levels are often intertwined. One influences the other. Utilizing the SEM in the context of mental health we would identify concerns prior to them arising (i.e. early intervention). The use of SEM would allow for health care providers to understand the cause of health inequalities and mitigate them as needed. Health care providers would use the SEM as a foundation for both planning and evaluating (Golden & Earp, 2012). For example, trauma is often linked to mental illness. If we could both identify and intervene, health outcomes would improve. As we are all aware, promotion, prevention and intervention lead to positive health outcomes.
Health care is constantly evolving. In the mental health field specifically, there are new medications, treatments and even diagnoses. Research is being published daily. Since the start of COIVD-19, there has been an increase in mental illness. The global rate of anxiety and depression has increased by 25% (World Health Organization, 2022). Unfortunately, we cannot meet the demands. Globally, there is a chronic shortage of mental health resources. In Canada specifically, accessing services for mental health can be challenging. There are long wait times and even a shortage of trained professionals. As previously discussed, nearly half of the current nursing population is set to retire in 10-35 years (The Canadian Nurses Association, n.d.). So, what does this mean for the future? For me, the future of health care looks very different. The future means, accessibility, sustainability and inclusion.
Figure 1 - Mental Health During COVID-19
(Statistics Canada, 2020)
The future of health care would mean an increase in both funding and programming. There would be increased access to training and specialized programming. An increase in funding would allow for universities to increase capacity in health-related programs. Further funding would be invested into mental health and addiction services allowing for needed changes in programming. These programs would be accessible, attainable, and inclusive for marginalized populations. Throughout the course, we spoke of the marginalization of specific populations. In Canada, there is both stigma and marginalization toward Indigenous Peoples. Data shows us that depression and suicide are higher among the Indigenous population (Here to Help, n.d.). The added training would combat both marginalization and stigma making programming accessible for those populations.
Figure 2 - Mental Health Impacts on Indigenous Peoples
(Statistics Canada, 2020)
Another improvement would be to the employee and family assistance program (EFAP). As previously mentioned, an individual can receive 2-8 sessions through EFAP. If they require more sessions, they must pay out of pocket. An estimated $950 million is spent yearly on private psychotherapists (Moroz et al., 2020). With the rising cost of living, many Canadians are barely meeting their basic needs. By not treating mental illness properly, we are further straining the system. Patients who could have been treated at the community level are now accessing emergency services.
A final improvement would be an increase in disability funding. As of right now, British Columbians receive $1358 a month. The average cost of a one-bedroom apartment in my community is $1000. As we are aware, poverty can lead to mental illness, addiction, diabetes and other chronic illnesses. If this is not mitigated early on, one can only hypothesize the outcome. While there are many areas for improvement, these are the ones that greatly impact my field of study.
I have spent the last three months reflecting on my practice. My understanding of the health care system has both increased and evolved. I now have a better understanding of the determinants of health and the application of multilevel models of care. My hope is for there to be further improvements in the delivery of mental health services and that I have active involvement in these improvements.
References
Alegria, M., NeMoyer, A., Falgas Bague, I., Wang, Y., & Alvarez, K. (2018). Social determinants of mental health: Where we are and where we need to go. Current Psychiatry Reports, 20(11). Retrieved April 1, 2022, from https://doi.org/10.1007/s11920-018-0969-9
British Columbia College of Nurses and Midwives. (2021). Code of ethics. Retrieved March 31, 2022, from https://www.bccnm.ca/Documents/standards_practice/rpn/RPN_CodeofEthics.pdf
Canadian Mental Health Association. (n.d.). The relationship between mental health, mental illness and chronic physical conditions. Retrieved April 2, 2022, from https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/
Canadian Nurses Association. (n.d.). Nursing statistics - canadian nurses association. Retrieved March 30, 2022, from https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-statistics
Centre for Addiction and Mental Health. (n.d.). Mental illness and addiction: Facts and statistics. CAMH. Retrieved February 22, 2022, from https://www.camh.ca/en/Driving-Change/The-Crisis-is-Real/Mental-Health-Statistics
Early, J. (2016, October 31). Health is more than healthcare: It's time for a social-ecological approach. Retrieved February 22, 2022, from https://www.imedpub.com/articles/health-is-more-than-healthcare-its-time-for-a-social-ecological-approach.php?aid=17440
Golden, S. D., & Earp, J. L. (2012). Social ecological approaches to individuals and their contexts. Health Education & Behavior, 39(3), 364–372. Retrieved February 22, 2022, from https://doi.org/10.1177/1090198111418634
Here to Help. (n.d.). Aboriginal mental health: The statistical reality. Retrieved April 3, 2022, from https://www.heretohelp.bc.ca/aboriginal-mental-health-statistical-reality
Marsh, M. (2022). The Mental Health & Addiction Crisis is Real: Utilizing the Social-Ecological Model as a Blueprint for Change. [Unpublished manuscript]. Athabasca University.
Moroz, N., Moroz, I., & D’Angelo, M. (2020). Mental health services in canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum, 33(6), 282–287. Retrieved March 20, 2022, from https://doi.org/10.1177/0840470420933911
Statistics Canada. (2020). Impacts on indigenous peoples. Retrieved April 3, 2022, from https://www150.statcan.gc.ca/n1/pub/11-631-x/2020004/s7-eng.htm
Statistics Canada. (2020). Mental health of canadians during the covid-19 pandemic. Retrieved April 1, 2022, from https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2020039-eng.htm
The Centre for Addiction and Mental Health. (n.d.). Addressing stigma. CAMH. Retrieved March 20, 2022, from https://www.camh.ca/en/driving-change/addressing-stigma
World Health Organization. (n.d.). Constitution. Retrieved February 5, 2022, from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
World Health Organization. (2022). Covid-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. Retrieved April 1, 2022, from https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
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