Care of Participants with Mental Illness

Introduction

This module will cover the important topics of mental health and mental illness. We will start by learning what mental health is and how mentally healthy people cope with stressors in their life. We will then discuss what mental illness is, what causes it, and signs of mental illness. You will learn about specific mental health issues such as anxiety, depression, and schizophrenia. We will explore how mental illness is treated to help a person suffering from mental illness recover from their disease. Finally, we will discuss the role of a Home Health Aide/Personal Care Aide in working with patients who suffer from a mental illness.

What Is Mental Illness?

Similar to any physical disease, mental illness is a disease. Mental illness disrupts a person’s thinking, feeling, mood, ability to relate to other people and to function at home, work, or school. People with a mental illness are often unable to effectively cope with stressors. Mental illness may cause inappropriate behavior. It may cause a person to be confused and disoriented towards others and events around them. Mental illness may cause people to be agitated and could cause aggressive or depressed behaviors.

It is important to remember that a person with a mental illness did not do something wrong to get the mental illness. They cannot control having the mental illness just as a person with cancer cannot control having cancer. They cannot just “get over” their disease. Mental illness does not discriminate. Mental illness affects people of all ages, cultures, religions, socioeconomic status, and gender. It is important to know that while mental illness can cause great disruption to a person’s life, it is treatable. Recovery is possible.

Mental illness includes depression, anxiety, schizophrenia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), phobias, and bipolar disorder. According to the National Alliance on Mental Illness (NAMI, 2013) 1 in 4 adults will experience a mental health disorder each year, which means about 60 million Americans! One in 17 Americans lives with a serious mental illness such as schizophrenia, bipolar or major depression (NAMI, 2013). Suicide, a serious problem related to mental illness, is the 10th leading cause of death in the United States (NAMI, 2013). As you can see, mental health disorders affect many people and can have serious consequences!

Mental health disorders are not specific to just the United States. Mental health disorders exist throughout the entire world. According to the World Health Organization (WHO, 2015), depression affects about 350 million people globally. Bipolar disorder affects about 60 million people worldwide (WHO, 2015). Schizophrenia affects about 21 million people worldwide (WHO, 2015)!

Mental health disorders can have devastating consequences. Suicide is a very real threat, particularly for those who suffer from a mental health disorder. According to the WHO (2009), 1 million people commit suicide worldwide per year, which is one death every 40 seconds. The 10-24-year-old age group is the highest risk group for suicide (WHO, 2009).

Within the United States and throughout the world, there exist differences in cultural and religious beliefs, lived experiences, expression of mental health issues, and the actual treatment of mental health disorders. Stigma, or viewing people with a mental illness in an unfavorable or negative way, is not specific to the United States. This can lead to people with mental illness not reporting symptoms and not wanting to seek treatment.

According to the World Health Organization (2015), approximately 76% to 85% of people who suffer from a mental illness in low to middle income countries do not receive treatment, while 35% to 50% of people in high income countries do not receive treatment. Many people do not receive the treatment they need due to lack of resources, poor quality of care, lack of social support, and stigma toward people with mental health disorders. Home Health Aides/Personal Care Aides can work to treat all people with respect and learn to identify the signs of mental health disorders to assist the people with whom they work receive the care they need.

What Causes Mental Illness?

There are many factors that contribute to mental illness. There is no one specific factor that causes mental illness. However, mental illness can be caused or made to become worse by physical factors, environmental factors, heredity, and stress (Leahy, Fuzy & Grafe, 2013).

Physical Factors

Physical illness, disability or even the aging process can cause or make mental illness worse. Substance abuse or intoxication from alcohol or other drugs may mask mental illness. This means that people who abuse alcohol or drugs on a regular basis may have a mental illness and not even know it. This is because some of the signs and symptoms of mental illness are similar to the behavior of an intoxicated person.

According to NAMI (2015), about one third of all people experiencing a mental illness and about half of people living with a severe mental illness also have a substance abuse problem. A person who has had a traumatic brain injury (TBI) (suffered damage to the brain from a trauma) may also end up with changes in their personality, cognition, mood, and behavior. Chemical imbalances in the brain can cause mental illness. The brain has naturally occurring chemicals called neurotransmitters. It is thought that changes in neurotransmitters may cause mental illness. Changes in hormone levels can also cause mental health disorders.

Environmental Factors

There has been some research indicating that exposure to certain viruses, chemicals, or alcohol in the womb may also be linked to a person having a mental illness. Traumatic life experiences such as being in combat or experiencing sexual abuse or rape may also lead to a mental illness.

Genetic Factors

Genetic factors, or genes which we inherit are also thought to have a role in mental illness. Mental illness has a strong genetic basis, which means that it tends to run in families. People are more likely to have a mental illness if their parent or close relative also has a mental illness. This does not mean that if your mother or father has a mental illness that you will also have one. It just means your chances are higher than if a person does not have a parent who has a mental illness. It is believed that environmental factors and stressors may trigger these inherited genes to result in mental illness.

Stress Factors

Mental illness may be brought about by stressors, such as traumatic events or poor interpersonal relationships with loved ones. A difficult break up, the death of a partner or child, or other loss such as loss of a job or pet can lead to mental illness. People may have difficulty coping during stressful situations and display signs and symptoms similar to those that people with mental illness display. In many cases after the initial reaction to the traumatic event and after the person receives help, the signs and symptoms go away.

Effects of Mental Illness

Individuals

People who suffer from mental illness experience many different effects. While there are similarities among people who experience depression or schizophrenia for example, no two people will have the exact same experience. Each person who suffers from a mental health disorder has a unique experience. People who suffer from mental illness may have: difficulty relating to others, mood swings (go from one mood such as happy to another mood such as depressed), may have negative thoughts about themselves, hear voices or see things that are not there. They may withdraw from the people they love and no longer have an interest in doing the things they used to love to do. They may have suicidal thoughts, meaning they have thoughts about wanting to die. People who suffer from mental illness will have trouble functioning in at least one area of their life: work, school, or home.

Families

Families of people who suffer from mental illness are also greatly affected. Since people with mental illness may have difficulty relating to others or experience changes in their mood, this affects the people around them. Families may have trouble understanding why their loved one does not want to spend time with them or seems to be angry or depressed all the time. Families may feel helpless and not know how to make things better. Children of parents who suffer from a mental illness may be neglected as their parent is unable to focus on providing their care. Finances of the family may also be affected if a person with a mental illness has trouble at work and loses their job.

Types of Mental Illness

Anxiety

Anxiety disorders are a group of disorders in which people feel anxious, frightened, distressed, or terrified to an extent that is more excessive than would be considered appropriate to the situation. They can interfere with a person’s life so much that the person with anxiety has trouble functioning in their everyday life. Anxiety can lead people to become depressed, have low self-esteem, abuse substances, and have suicidal thoughts. About 41 million Americans live with an anxiety disorder (NAMI, 2013). Anxiety disorders are very common and also very treatable.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is when people have anxiety every day for at least six months, which interferes with their ability to function in their everyday lives. They may feel constantly worried, afraid, and feel physical symptoms such as heart palpitations, trouble breathing, nausea, and headaches. Most of us worry and have anxiety at one time or another. The difference is that we can use positive coping skills to deal with our worries. People with GAD do not necessarily worry about something in particular and they are unable to use positive coping skills. GAD can lead to depression, substance abuse, loss of employment and relationships, and suicidal thoughts.

Phobias

Phobias are a type of anxiety disorder in which a person has an abnormal fear about something in particular. For example, some people may have a fear of germs, spiders, heights, being outside the home, crowds, closed in spaces, water, or animals. Most people have fears about many of those things, but the difference is that they are able to function when faced with their fear. A person with a phobia has an irrational fear, which is a fear that is not reasonable. They become unable to function in the face of these fears. In some cases, there may not be a reason for the fear, and in other cases, the person may have had a bad experience which has led to the excessive fear about the particular situation.

Obsessive-Compulsive Disorder

Obsessive–compulsive disorder (OCD) is a type of anxiety disorder in which the person has repetitive thoughts (obsessions) and repetitive behaviors (compulsions). These repetitive thoughts and behaviors impede (interfere with) the person’s ability to function in their everyday life. For example, a person who has a fear of germs may obsess (think continuously) about getting germs and spend excessive amounts of time washing their hands (compulsions). They may wash their hands for hours, leading to missing work and raw and bleeding hands.

Post-Traumatic Stress Disorder

Post–traumatic stress disorder (PTSD) is a type of anxiety disorder in which the person has experienced a traumatic event such as sexual abuse, rape, a natural disaster, or combat and experiences severe distress afterward. The person may have flashbacks (replay the event in their mind) about the event, have insomnia (trouble sleeping), nightmares, and feel constantly on edge, irritable, scared, or angry. It is normal for people to experience these things right after a traumatic event. The difference is that a person with PTSD is unable to function in their everyday life, to cope with their thoughts and feelings in a positive way, and feel that no matter what they do, they cannot “get back to normal.”

 Depression

Depression is an extremely common type of mental illness. Depression may involve extreme sadness, insomnia, trouble concentrating, over or under-eating, substance abuse, guilt, and thoughts of suicide. Depression often results in a disruption of a person’s ability to function normally in their life. They may have trouble getting out of bed, performing self-care, caring for their children, or going to work. Mood disorders such as depression is the third leading cause of hospitalizations within the United States (NAMI, 2013).

Depression left untreated can result in suicide, which is the 10th leading cause of death in the United States (NAMI, 2013). In the elderly, depression is very common and is something a HHA/PCA should monitor when working with the elderly. Some people may have one episode of depression, while others experience recurrent depression, or depression that occurs periodically. It is important to assist a person with depression to seek help. Depression is a very treatable disorder with proper treatment.

Schizophrenia

Schizophrenia is a serious mental illness that impacts a person’s ability to think clearly, make decisions, have relationships with others, manage stress and emotions, and function in their everyday lives. About 2.4 million Americans live with schizophrenia (NAMI, 2013). People with schizophrenia have psychoses. Psychoses are a loss of contact with what is real. They can include delusions (abnormal thoughts) or hallucinations (seeing or hearing things that are not real). Delusions may demonstrate paranoia (thinking someone is out to hurt you).

Behavior may be bizarre. For example, a person with schizophrenia may not dress appropriate to the weather, become catatonic (motionless and not move any muscle or body part), have repetitive movements of body parts and speech that is disorganized (does not make sense).

A person with schizophrenia may also have sleeping and eating problems, an inability to relate to others, and trouble providing self-care. People with schizophrenia are at a very high risk of suicide. Most people with schizophrenia are not dangerous to other people. With medication, support from others, and the help of a psychiatrist and therapist, a person with schizophrenia can usually be able to regain their ability to function within the community.

Treating Mental Illness

It is important to know that while mental illness can have long-term effects on a person’s physical, psychological, and social functioning, many people can recover and lead normal lives. There are many types of treatment available. The most common types of treatment include medication and psychotherapy (counseling).

It is extremely important for a person with a mental illness to take their medication as prescribed. Home Health Aides/Personal Care Aides may come to observe patients who do not take their medication as prescribed. They should inform their supervisor and document their findings.

Sometimes a person who is suffering from a severe form of mental illness and who is unable to help themselves may need to be hospitalized for periods of time. Most people who suffer from a mental illness receive outpatient treatment, which is treatment outside of a hospital. Patients meet with a psychiatrist (a physician who specializes in treating mental health disorders) to discuss their thoughts and feelings and to obtain prescriptions for medications. Patients may also meet with a mental health therapist or social worker (specialists who focus on working with people with mental health issues by providing counseling) to talk about their thoughts and feelings and to learn better ways to cope with their stressors.

Some people go to individual therapy (therapy focused on one person) and others may go to group therapy (therapy where many people with similar problems meet with a therapist) to talk about and solve their problems. A common form of treatment is Cognitive Behavior Therapy. This treatment focuses on how a person’s thoughts, feelings, and behaviors are related. Patients are taught to recognize negative self-talk (what we tell ourselves in our head) and to turn these thoughts into more positive ones. More positive thoughts will lead to improved mood and behavior.

Mental Health, Mental Illness, And the Home Care Worker

Guidelines for Observing Behavior:

·        Describe the unusual behavior. When does it occur? How often does it occur? How long does it last? Does it seem to occur during certain situations?

·        Does the behavior indicate a change in the patient’s personality?

·        Is the behavior or thought extreme (bizarre and seem abnormal)? Is the behavior or thought appropriate to the situation, or does it seem out of the ordinary and abnormal?

·        Is the behavior harmful to the patient, to their love’s ones, or to the Home Health Aide/Personal Care Aide?

It is important to remember not to draw conclusions about the behaviors observed. The job of an CNA/PCA is not to diagnose or interpret behaviors or thoughts the patient expresses. Their job is to observe, record, and report what they see and hear.

Role of the PCA/CNA with Mentally Ill Patients and their Families

Home Health Aides/Personal Care Aides play an important role in helping a patient with mental illness and their family function normally and safely. They assist patients with medications as allowed by their state, agency, and the Care Plan. They observe, record, and report any changes in mood, behavior, or side effects from medications. They should take note of what is happening in the home. Is the home unkempt? Is the patient’s personal appearance unkempt? Are children neglected?

People who suffer from a mental illness may not be able to provide for their personal care needs or to maintain a clean and safe home. It is the responsibility of the HHA/PCA to assist them to complete their activities of daily living (ADLs). This includes assisting with bathing, dressing, toileting, and self-care. This also may include assisting with light housekeeping and helping to plan, shop, and prepare meals. A HHA/PCA may also be asked to observe whether a patient is compliant (follows) their treatment plan. Do they take their medications as ordered? Do they attend psychiatric appointments?

Home Health Aides/Personal Care Aides play an important role in providing emotional support and assisting a person with mental health issues to use positive coping strategies. They also work to support the family members during the process of recovery. They must use their communication skills to listen to concerns and provide emotional support and role model healthy coping skills and effective communication skills. Be aware of including the patient in the treatment plan. Respect their confidentiality. Just because they have a mental health issue does not mean that they lose the right for confidential and respectful treatment. Be patient, compassionate, kind, and respectful of the patient and family. Most importantly, always offer hope that people with mental illness may recover.

Maintain Safety

Home Health Aides/Personal Care Aides should discuss the Care Plan with their supervisor and treatment team on a regular basis to ensure that they are always following the directions outlined in the Care Plan. This is to ensure the safety of them and their patient, and to ensure that their patient receives the proper care. In some instances, patients may require very close supervision and constant attention. These patients may be at risk to harm themselves or others. Never leave these patients alone unsupervised.

Home Health Aides/Personal Care Aides should provide observations as asked and report any concerns immediately. Maintain careful documentation and accurately record observations. Remember not to include judgments within documentation. Do not include interpretations of behaviors such as, “Mr. Alman is talking to himself today. I think he needs a higher dose of medications.” Interpreting behaviors and making diagnoses is not the responsibility of the HHA/PCA. Maintain objectivity at all times. Only report what you see, hear, smell, and can touch.

It is important to always maintain safety within the home. Never leave a patient unattended if it is required, they receive constant supervision or if they have made statements to hurt or kill themselves. Help to keep the home environment clean and free of debris and pests. Provide personal care to the patient as directed in the Care Plan. People with mental illness may be unable to provide personal care for themselves and may rely on the HHA/PCA to help remind or assist them with these activities.

Observe and report noncompliance with medications and psychiatric treatment. Noncompliance means that a patient is not following the treatment plan or medical recommendations as directed. There may be many reasons for this. Some medications that people take to help them recover from mental illness may make them feel drowsy, not like themselves, have no energy, or even diminish their sexual drive. Patients may not like these side effects. Patients may also be non-compliant with treatment because they have difficulty remembering to take medications or to attend appointments. If Home Health Aides/Personal Care Aides notice noncompliance in their patient, they should try to ask them what may be happening to make them not want to take their medications or miss their treatment appointments. Whatever the reason may be record and report noncompliance and any reasons discovered. Without following the treatment plan, patients will be unable to recover from their mental illness and live a safe and functional life.

In the case of extreme, dangerous, or unsafe situations or behaviors, immediately call 911 or the emergency phone number in your area. Home Health Aides/Personal Care Aides should use their communication skills and appropriate telephone skills to accurately and calmly report the situation. Provide only the facts to emergency services and try to remain calm. Then, when it is safe, call a supervisor to report the situation. Never stay in a situation that is unsafe.