“There's nothing really wrong with him, it's just anxiety.” How many times have you heard someone say this—or said it yourself? Mental health problems are among the most marginalized health conditions in the United States. They're viewed as less “real” than physical illnesses; there's no tumor to be palpated, no abnormality to be spotted on an X-ray. Emotional and psychological problems are often thought to be under a person's control in a way that, say, multiple sclerosis or cancer is not. And because mental health problems can be construed as signs of weakness, sufferers may hide their symptoms. People who suffer from a mental illness need to feel comfortable seeking care and to trust that they'll be treated with skill, compassion, and respect. This is vital: studies consistently find that mental illnesses, particularly depression, take a terrible toll on health. Such illnesses have been associated with an increased risk of stroke, coronary artery disease, and dementia, as well as increased mortality in people with cancer, diabetes, or chronic kidney disease and following a myocardial infarction or coronary artery bypass surgery.
This month we introduce a new column, Mental Health Matters, which will appear several times a year. As author and column coordinator Donna Sabella states, its purpose is to “help you feel more comfortable around patients with mental health issues, and put an end to some of the stigma and myths that surround caring for these patients.” Sabella points out that almost half of all Americans will experience at least one mental health disorder during their lifetime. Therefore, it's likely that every nurse in every setting will care for patients with mental illnesses at some point.
In a recent integrative literature review, van der Kluit and Goossens found that many nurses have positive attitudes toward patients with mental illnesses. But when nurses had negative attitudes, these were often associated with a lack of knowledge and with limited experience in caring for such patients. As might be expected, nurses who worked in environments that afforded more contact with such patients tended to be more comfortable with them. For those of us who don't work in such areas, caring for someone in emotional or psychological distress can be discomfiting. The care needed isn't as straightforward as cleaning and dressing a wound or monitoring a heart arrhythmia. Adding to the complexities of providing care are the myths and misperceptions we may carry about “mental health patients.”
We need to change the culture around mental health issues—and nurses can take the lead. As in addressing any stigmatized condition, increasing awareness and knowledge are essential to improving the quality of care. Examining our own attitudes and biases is the first step. It's important to realize that it's never just anxiety or just depression; these disorders can have as many (and sometimes more) negative consequences as any physical ailment, affecting a person's health, quality of life, and longevity.
Mental health issues affect nurses personally, too. As Susan A. Letvak and colleagues note in this month's CE feature, “Nurses' Presenteeism and Its Effects on Self-Reported Quality of Care and Costs,” mental health issues are a major cause of nurses' presenteeism (reduced on-the-job productivity resulting from health problems). Nursing is a highly stressful occupation. We're called upon to help others through life-altering illnesses and injuries. Yet too often, we don't take care of ourselves or each other. Notably, nurses feel enormous pressure to show up for work no matter what; no one wants to be the reason colleagues are working on an understaffed unit. This needs to change. As Letvak and colleagues' research indicates, showing up while sick is neither wise nor helpful. They found presenteeism to have significant negative effects on the quality of patient care, and to cost the United States as much as $13 billion annually.
Administrators also have a role here. They must provide for safer staffing ratios and for adequate back-up staff when a nurse unexpectedly needs time off. Nurses should be encouraged to take the time they need to recover from illness, whatever its nature. These changes will benefit not only nurses, but also their patients, and save our health care system billions of dollars as well.