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Psychiatric-Mental Health Nursing

26.1 Barriers to Recovery

Psychiatric-Mental Health Nursing26.1 Barriers to Recovery

Learning Objectives

By the end of this section, you will be able to:

  • Recognize barriers to recovery from mental illness
  • Discuss adjunctive treatments for recovery
  • Explain the nurse’s role in adjunctive treatment

Many factors can hinder the recovery process for individuals with mental illness. One significant barrier is stigma, which refers to the negative attitudes, beliefs, and stereotypes associated with mental health conditions. Stigma can lead to discrimination, social isolation, and reduced access to health-care services, impeding individuals from seeking help and adhering to treatment. Lack of access to quality mental health care, including shortages of mental health professionals, particularly in certain geographic regions, limited availability of specialized services, and financial constraints pose additional barriers. Systemic barriers also exist, such as inadequate insurance coverage, fragmented health-care systems, and long waiting periods for treatment that can further slow the recovery journey. Personal factors like low self-esteem, poor self-efficacy, and lack of social support likewise can impede recovery. Nurses must remain aware of the influence of culture and religion on health-care decisions. Recognizing and addressing these barriers and factors is crucial for promoting recovery and improving the overall well-being of individuals with mental illness.

Challenges in Recovery

Primary care is often the initial access to mental health treatment and therefore plays a pivotal role in the provision of mental health services. Several challenges exist that complicate the effective and efficient delivery of these services. One of the main challenges is the underdiagnosis of mental health issues in primary care settings. Primary care practitioners may not have the necessary knowledge and skills to recognize and treat complex mental health issues. Additionally, time constraints and high client load can lead to mental health concerns being overlooked or minimized (Ng et al., 2020).

Another challenge lies within the referral system to secondary mental health services, which means specialist care or hospital admission. Fragmented health-care systems can complicate the process of referring clients, with often long waiting times for specialized services and gaps in communication between primary and secondary care providers (Evans-Lacko et al., 2018). This fragmentation creates access issues for clients in need of the services. It is the responsibility of the primary care practitioner to understand and properly refer the client with mental health concerns to the appropriate provider.

The stigma associated with mental illness also poses a barrier to care and can lead to clients not seeking or adhering to mental health treatments. Despite significant progress, many clients may still feel uncomfortable discussing mental health issues in a primary care setting or may fear the potential implications of a mental health referral (Thornicroft et al., 2016).

Lack of Compliance

Client compliance, also called adherence, is a critical factor in mental health-care treatment success, yet it presents a significant challenge in the management of mental illnesses. Nonadherence to psychiatric treatment has been estimated to be as high as 50 percent (Malik et al., 2020). Various factors can contribute to this issue, including the complexity of treatment regimes, medication side effects, lack of client insight into their illness, and poor therapeutic relationships with care providers (Malik et al., 2020).

The negative impact of nonadherence on treatment outcomes, including relapses and hospitalizations, adds to the complexity and costs of managing mental health conditions (Velligan et al., 2017). Strategies to improve adherence can be multifaceted, encompassing client education, treatment simplification, side effects management, therapeutic collaboration enhancement, and stigma reduction programs (Velligan et al., 2017).

Residual Symptoms, Side Effects, and Stigma

Psychiatric medications are pivotal in managing mental illnesses but may not entirely alleviate symptoms. Some individuals may experience residual symptoms while adhering to their medication regimen. Such residual symptoms, including persistent depressive mood, anxiety, cognitive deficits, and insomnia, can severely affect an individual’s quality of life and functionality (Semahegn et al., 2020) and can lead to clients discontinuing treatment.

Medication side effects are another significant concern in psychiatric treatment, often contributing to residual symptomatology. These side effects may include metabolic changes, sexual dysfunction, or neurological effects, which can compound individuals’ challenges with mental health conditions (Montejo et al., 2018).

The stigma associated with taking psychiatric medications can exacerbate these challenges. Many individuals feel societal pressure and self-stigma associated with the need for psychiatric medication, which can lead to feelings of inadequacy, shame, and isolation. This stigma can have far-reaching consequences, impacting adherence to medication, social relationships, self-esteem, and overall treatment outcomes (Malik et al., 2020). Stigma associated with mental illness is a pervasive issue that has manifested in various ways across societies. Historically, mental illness has been misunderstood, leading to fear, misconceptions, and negative attitudes toward those experiencing mental health challenges. This stigma manifests in society through discrimination, social exclusion, and harmful stereotypes, which can impede individuals’ willingness to seek help and receive appropriate care. Stigma exists due to a combination of factors, including lack of education, cultural beliefs, and media portrayals that often depict mental illness inaccurately or negatively (Subu et al., 2021).

In a cultural context, the perception and impact of stigma vary widely. Different cultures have unique beliefs and attitudes toward mental health, which influence how individuals perceive and respond to mental illness. Understanding these cultural considerations is essential for health-care providers, particularly nurses, who are often at the forefront of client care and advocacy. Nurses must be aware of the cultural nuances that influence their clients’ experiences of stigma and tailor their approach to care accordingly. Culturally sensitive care involves acknowledging and respecting clients’ beliefs, values, and experiences, and engaging in open, nonjudgmental communication to build trust and rapport (Ahad et al., 2023).

A more holistic approach to mental health care can help mitigate symptoms and stigma. Such an approach includes medication management, psychoeducation, psychotherapy, addressing lifestyle factors, and reducing perceived shame in securing treatment for mental health conditions. It also involves close collaboration between clients, health-care providers, and caregivers in shared decision-making processes (Laranjeira et al., 2023).

Cultural Context

Cultural Considerations in Mental Health Recovery and Adjunct Treatment

Cultural factors play a significant role in shaping the experiences and perceptions of individuals in mental health recovery and receiving adjunct treatments. Understanding these cultural nuances is crucial for health-care providers to deliver effective and compassionate care:

  • Beliefs and attitudes toward mental illness: Different cultures have distinct beliefs about mental illness, influencing how individuals perceive and respond to mental health challenges. For example, some cultures may view mental illness as a spiritual or moral issue, while others might see it as a medical condition. Recognizing and respecting these beliefs is essential in providing culturally sensitive care.
  • Stigma and discrimination: Stigma surrounding mental illness varies across cultures and can significantly impact a person’s willingness to seek help and adhere to treatment. In some cultures, mental illness may be heavily stigmatized, leading to social exclusion and discrimination. Health-care providers need to be aware of these cultural dynamics and work to reduce stigma in their interactions with clients.
  • Communication styles: Cultural differences in communication styles can affect how clients express their symptoms and concerns. Providers should be attentive to nonverbal cues and understand the cultural context of verbal communication. Open, empathetic, and nonjudgmental communication is crucial in building trust with clients from diverse cultural backgrounds.
  • Family and community involvement: In many cultures, family and community play a central role in supporting individuals with mental illness. Understanding the client’s family dynamics and community resources can enhance treatment plans and recovery outcomes. Involving family members in care planning and education can also improve treatment adherence and support.
  • Holistic and integrative approaches: Different cultures may have unique approaches to health and healing that can complement conventional mental health treatments. Traditional healing practices, herbal remedies, and spiritual interventions may be integral to the client’s belief system and can be considered in adjunctive treatment plans, where appropriate.
  • Language and interpretation services: Language barriers can impede effective communication and understanding between health-care providers and clients. Providing access to interpretation services and culturally appropriate educational materials is crucial for ensuring that clients fully comprehend their treatment options and can make informed decisions.

Health-care providers must continually strive to develop culturally sensitive care, which involves understanding and respecting cultural differences, engaging in continuous learning about diverse cultures, and applying this knowledge in clinical practice (Stubbe, 2020).

Access to Care and Need for Support

Despite the high prevalence and profound impact of mental health disorders, access to mental health care remains a significant challenge globally. Barriers to accessing care can be multifaceted, encompassing systemic issues, such as insufficient mental health resources, geographical distance from services, long wait times, and high costs, especially in regions with limited public health coverage (Werlen et al., 2020). Marginalized groups, including racial and ethnic minorities, low-income populations, and individuals in rural areas, face additional challenges in accessing mental health care due to systemic disparities (Subu et al., 2021).

Client support is integral to overcoming these barriers and improving mental health outcomes. Support can take many forms, such as providing client education, promoting mental health literacy, fostering a supportive therapeutic alliance, and engaging in shared decision-making (Aoki et al., 2022). Peer support groups can also be beneficial, cost-effective, and accessible, providing an environment of mutual understanding and empathy, sharing personal experiences and coping strategies, and reducing feelings of isolation (Bellamy et al., 2020).

Nurses play a crucial role in addressing systemic barriers to mental health care by advocating for policy reform, access to affordable services, and the reduction of stigma and discrimination associated with mental illness (Thornicroft et al., 2016). Nurses can influence mental health policy by participating in professional organizations, engaging with policymakers, and contributing to public discourse on mental health issues. For example, they can advocate for increased funding for mental health services, integration of mental health care into primary care settings, and policies that support evidence-based practices (Anders, 2021). Nurses can advocate for policies that ensure access to affordable mental health care for all individuals, regardless of their socioeconomic status. This includes supporting the expansion of insurance coverage for mental health services and advocating for enhanced mental health services in health-care coverage (Flaubert et al., 2021). Nurses can also help combat stigma associated with mental illness through education, community outreach, and by modeling compassionate, nonjudgmental care. They can also participate in public awareness campaigns and collaborate with advocacy groups to challenge myths and misconceptions about mental illness (Borenstein, 2020).

Ease of access to mental health care is a crucial factor in ensuring effective treatment and recovery. Several services and resources have been developed to address physical barriers to accessing mental health care. Telehealth services have emerged as a vital tool in providing mental health care, especially in areas with limited access to mental health professionals. Telehealth involves the use of telecommunications technologies to deliver health-related services and information. It allows clients to receive therapy, counseling, and psychiatric services remotely, which can be particularly beneficial for those living in rural or underserved areas (Gajarawala & Pelkowski, 2021). Moreover, community-based mental health services are designed to be more accessible and less stigmatizing than traditional psychiatric settings. These services often include community clinics, day treatment programs, peer support groups, and crisis intervention teams. Community-based services focus on providing comprehensive care tailored to the individual’s needs within their community, promoting recovery and integration into society (Singh et al., 2022). The internet also offers a wealth of online resources for mental health support, including informational websites, online support groups, and mental health apps. These resources can provide education, self-help tools, and peer support, making mental health information and support more accessible to a broader audience. Online resources can be particularly useful for individuals who are hesitant to seek face-to-face therapy or who prefer anonymity (Wong et al., 2018).

Adjunctive Modalities

Traditional treatment modalities for mental health conditions include psychotherapy and medication. Psychotherapy is a cornerstone in the treatment of mental illness, often used in conjunction with pharmacological interventions for optimal outcomes (Cook et al., 2017). This therapeutic approach involves talking with a mental health professional to understand and manage mental health conditions, with various types of psychotherapy suited to different mental disorders (American Psychological Association [APA], 2021). In mental health care, adjunctive treatments comprise a range of alternative treatments designed to enhance the impact of primary treatments, improving overall mental health outcomes (Lake, 2022). Some of these modalities include mindfulness-based therapies, biofeedback, art therapy, music therapy, animal-assisted therapy, and yoga (de Bruin et al., 2016).

For instance, mindfulness-based therapies have been shown to reduce symptoms of depression and anxiety and improve quality of life (Bhattacharya & Hofmann, 2023). Similarly, studies have found biofeedback to be effective in managing stress and anxiety disorders by giving clients a greater awareness of their physiological functions (Yu et al., 2018). Biofeedback is a therapeutic technique used in mental health care that involves training individuals to improve their health by controlling certain physiological processes that are typically involuntary, such as heart rate, muscle tension, blood pressure, skin temperature, and brain wave activity. In mental health care, biofeedback is used to help clients learn how to regulate their body’s responses to stress, anxiety, and other emotional states. By becoming aware of their physiological responses and learning techniques to control them, clients can develop better coping mechanisms for managing symptoms of various mental health conditions (Mayo Clinic, 2019).

Creative therapies, such as art and music therapy, can offer a nonverbal outlet for emotions and aid in expressing and exploring feelings. Engaging in music and art therapy can provide emotional expression, stress relief, and cognitive benefits. These therapies are used to help individuals cope with trauma and improve mental health (Shukla et al., 2022). Research has demonstrated that combining these adjunctive modalities with standard treatment approaches can result in more effective and holistic care, potentially leading to better client satisfaction, increased compliance, and improved therapeutic outcomes (Lake, 2022).

Nutrition and Activity

Nutrition and physical activity play significant roles in the treatment of mental illnesses and are often incorporated into comprehensive treatment plans. Certain nutritional supplements, including omega-3 fatty acids, vitamin D, and B vitamins, have been found to have positive effects on mood and cognitive function. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can also contribute to better mental health (Firth et al., 2020).

Physical activity likewise is a well-established adjunctive treatment for mental illnesses. Regular exercise has been shown to reduce symptoms of depression, anxiety, and stress and improve cognitive function (Mahindru et al., 2023). For instance, aerobic exercises, such as jogging, cycling, or swimming, have been found to stimulate the release of endorphins, serotonin, and norepinephrine, which can enhance mood and overall well-being (Basso & Suzuki, 2017). Yoga, which combines physical postures, breathing exercises, and meditation, has been shown to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). It promotes relaxation, mindfulness, and overall well-being (Laplaud et al., 2023).

Integrating nutritional counseling and physical activity interventions into mental health treatment plans can benefit clients and improve outcomes. These approaches should be personalized to each individual’s needs and abilities and should be used as additions to standard mental health treatments (Grajek et al., 2022). Quality sleep is also essential for mental health. Poor sleep can exacerbate mental health conditions, while good sleep hygiene can improve mood and cognitive function (Scott et al., 2021).

Behavioral, Peer, and Group Therapy

Behavioral therapy is a general term for treatment wherein the client partners with helping others to raise personal awareness of problematic behaviors. The goal of behavioral therapy, such as CBT, is to work toward further understanding and, ultimately, to modify the thoughts and feelings that drive the unwanted actions. Overall, the use of behavioral therapy in mental health treatment can be highly effective, but the specific modality and approach should be tailored to the individual’s needs and specific mental health condition (APA, 2021).

Peer therapy is a valuable adjunct treatment for mental illness, offering unique benefits that complement individual therapy and medication. Peer therapy involves support from individuals who have lived experience with mental illness, providing empathy, understanding, and practical advice based on personal experience. Peer therapy has been shown to enhance self-efficacy, empowerment, and engagement in the recovery process. It provides an opportunity for individuals to share coping strategies and learn from others’ experiences in a nonjudgmental setting (Shalaby & Agyapong, 2020).

Group therapy, on the other hand, typically involves a trained therapist leading a group of individuals who share similar mental health challenges. Group therapy offers the benefits of shared experiences, peer support, and the opportunity to develop social skills in a safe environment. It can be particularly effective for conditions such as depression, anxiety disorders, and substance misuse because it allows individuals to see how others deal with similar challenges and to receive feedback on their own experiences. Both forms of therapy foster a sense of community and support, helping individuals feel less isolated in their experiences (Malhotra & Baker, 2022).

Clinical Safety and Procedures (QSEN)

QSEN in Adjunctive Treatments for Mental Illness

Quality and Safety Education for Nurses (QSEN) underscores the importance of providing safe, effective, client-centered, timely, efficient, and equitable care. In the context of adjunctive treatments for mental illness, the following considerations should be taken into account:

  • Client-centered care: It is crucial to respect the clients’ unique experiences, values, and preferences. Collaborate with clients in developing their treatment plans, including adjunctive therapies, such as psychoeducation, cognitive behavioral techniques, or nutritional and physical interventions.
  • Teamwork and collaboration: Nurses should actively communicate and collaborate with the multidisciplinary team. This collaboration ensures comprehensive care, incorporating the perspectives of psychiatrists, psychologists, occupational therapists, social workers, and dietitians.
  • Evidence-based practice: Decisions about adjunctive treatments should be based on the best available evidence, clinical expertise, and client preferences. Stay informed about the latest research on the efficacy and safety of adjunctive therapies.
  • Quality improvement: Regularly evaluate client outcomes and processes to identify areas of improvement. Use this information to refine treatment plans and protocols, aiming to enhance the safety and effectiveness of adjunctive treatments.
  • Safety: Regularly assess clients for any risks or adverse effects related to adjunctive treatments. Monitor for any worsening symptoms, suicidal ideations, or adverse reactions to treatments. Maintain a safe and therapeutic environment.
  • Informatics: Leverage health information technology to support client care, decision-making, and communication among the health-care team. Electronic health records can provide timely access to comprehensive client information, enhance coordination of care, and support monitoring client progress.

The Nurse’s Role in Adjunctive Treatments

The nurse’s role in mental health treatment, particularly adjunctive modalities, is multifaceted and integral to comprehensive care. As trained health professionals, with respect to adjunctive treatments, nurses can provide psychosocial interventions, client education, and care coordination (Hurley et al., 2022). For instance, nurses can facilitate treatment delivery during CBT by reinforcing the skills taught in therapy sessions, providing support, and encouraging adherence to homework assignments (Tanoue et al., 2018). Nurses may also lead psychoeducational sessions, providing clients and families with crucial information about the nature of mental illness, medication management, and coping strategies (Matsuda & Kohno, 2021). Additionally, nurses may teach about the risks associated with nonadherence to treatments, and how to manage crises.

Nurses assist with complementary interventions, such as mindfulness-based therapies, physical activity programs, and nutritional counseling. They may guide clients through relaxation exercises, assist in developing an exercise regimen, or provide dietary advice to improve overall wellness. Through these roles, nurses enhance the effectiveness of adjunctive treatments for mental illness, contributing to better client outcomes (Ee et al., 2020). Nurses also play a critical role in risk avoidance during adjunctive treatments for mental illness, ensuring that clients are safe and well cared for. One of the key responsibilities of nurses is the ongoing assessment and monitoring of clients. Nurses must be vigilant in detecting any signs of adverse reactions to adjunctive treatments or changes in a client’s mental status and promptly reporting these to the treating physician. They also monitor for suicidal or self-harm ideations, which could be exacerbated by certain mental health conditions, ensuring that preventive measures are taken, and the treatment team is promptly notified (Nawaz et al., 2021).


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