The universal menace of mental health illnesses is a global issue that requires solicited mitigation efforts by all countries across the planet. Factors attributed to the occurrence of mental disorders are viewed from sociocultural, individual, and interpersonal perspectives. An estimate by the World Health Organization (WHO) reveals that more than 450 million people in the world are affected by the global burden related to mental disorders (Marangu, Sands, Rolley, Ndetei, & Mansouri, 2014). However, the challenge of addressing mental illnesses is worsened by the presence of healthcare disparities, increased healthcare costs, shortages of care providers, including nurses and physicians, the poor history of mental health that still has a negative impact on psychiatry, and moral challenges. Fortunately, different regulatory guidelines have been established to control the delivery of mental healthcare and improve health outcomes in patients. Therefore, it is critical to understand different aspects of global mental health such as historical perspectives, the significance of care disparities, relevant regulatory guidelines, global healthcare moral issues, economic and health productivity costs related to the disease burden, and the availability of healthcare providers.
Historical Perspectives: Global Health Learning in Nursing
The issue of mental health is as old as the ancient times, and numerous transformations experienced throughout its history resulted in modern psychiatry. According to Videbeck (2013), people had strong beliefs that any sickness was a consequence of the displeasure of the spirits and gods who punished sinners and wrongdoers; thus, the mentally ill were either demonic or divine, depending on the behaviors they displayed. Contrary to the ostracized, burned, or punished demonic members of the society, divine individuals were worshipped and adored. Jutras (2017) reiterates that ancient history reveals that mental disorders were attributed to demonic possession and supernatural powers, resulting in traditional and primitive treatment approaches such as trepanning to release evil spirits. Similarly, early Christianity was associated with superstitions, which led to blaming the occurrence of diseases on demons with the mentally ill being viewed as possessed individuals (Videbeck, 2013). Priests and other religious leaders performed exorcisms to rebuke evil spirits; a failure resulted in punitive measures that included flogging, starving, and dungeons. Therefore, mental health in the ancient times was attributed to supernatural forces with divine people taking the role of healthcare providers and patients being punished if treatment failed.
However, research and learning resulted in the formulation of theories that helped to transform this specialty from the barbaric to the modern perspective. Videbeck (2013) reports that Aristotle was the first individual to attempt to relate mental illnesses to physical disorders before developing a theory that stated that the amounts of body water, black and yellow bile, and blood controlled emotions. These humors, which were believed to control the level of calmness, sadness, anger, and happiness, were the causes of mental illnesses if imbalances occurred. As a result, treatment of these conditions was aimed at restoring the imbalances through starving, purging, and bloodletting; these treatment modalities were utilized into the 19th century (Videbeck, 2013). This understanding of the cause of mental illness seems barbaric in the current world due to the marked improvements in modern medicine.
After that, the period of enlightenment, establishment of mental health institutions, and scientific study followed, paving the way for modern medicine in psychiatry. By 1775, institutions were founded in Europe for the mentally ill; they acted as tourism centers in which visitors paid for viewing and ridiculing sick inmates since they were seen as less human (Videbeck, 2013). After the European visit, Dorothea Dix attempted to reform the treatment of mental disorders in the United States (US), which resulted in the opening of state hospitals that offered asylum to the sick. Through advocacy, Dix believed that the society was obliged to provide the mentally ill with warm clothing, nutritious food, and shelter. Later, Sigmund Freud's studies marked the beginning of the period of scientific study. He formulated the theory of psychodynamics followed by behaviorism of John Watson, which was a breakthrough in understanding mental illnesses and their treatment in modern medicine (Jutras, 2017). By challenging the society to view humans objectively, the study, diagnosis, and treatment of mental disorders transformed from traditional to modern scientific approaches. Therefore, the study of mental health in nursing is strongly based on the contribution of many personalities, including Dix, Freud, and Watson.
Currently, psychopharmacology and deinstitutionalization have gained popularity as a result of the improvements in the field of mental health following the attempt to improve care delivery. Videbeck (2013) reports that significant improvements in the treatment of mental illnesses occurred in the 1950s when psychotropic drugs were developed; lithium and chlorpromazine were the first antimanic and antipsychotic drugs respectively. Other drugs that were developed included haloperidol, benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitor antidepressants, among many others. These drugs have proven effective in reducing agitation, depression, and psychosis in mentally ill patients, making them the most appropriate treatment approaches compared to old traditional strategies (Videbeck, 2013). Professional healthcare providers such as nurses and physicians can now receive formal psychiatric training in colleges and universities before commencing clinical practice. Furthermore, psychiatric deinstitutionalization has remained a popular concept since the second half of the 20th century when most health systems and stakeholders realized that mental health expenses could be reduced by utilizing community-based outpatient settings (Jutras, 2017). Therefore, the use of these community-based services in this specialty results in reduced hospitalizations and better subsequent health outcomes.
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People with mental disorders are a disadvantaged group in the society due to the noticeable healthcare disparities. For instance, the majority of individuals with psychological and mental disabilities lives in abject poverty, has poor physical health, and is subject to the violation of human rights (WHO, n.d.). Besides, mental health issues cannot be isolated from areas of development such as employment, human rights capacity building, education, and emergency responses for which the mentally ill are underrepresented. For example, homelessness is a common occurrence in these populations due to individual and structural factors, which is attributed to the worsening of their mental health status. According to Weinstein et al. (2013), the US is one of the countries with the highest rates of homelessness among people with mental conditions; unfortunately, mortality rates among homeless people are 3-4 times higher than the rates among the general population, with individuals between the ages of 18 and 54 years being the most affected group. To make it worse, the mentally ill are subject to discrimination and stigma throughout their lives in addition to being vulnerable to different forms of sexual, psychological, and physical victimization (WHO, n.d.). Eventually, they encounter different restrictions, especially when exercising their rights to participate in civil and public activities.
Furthermore, mental disorders are associated with many co-occurring health conditions, which increases the morbidity and mortality rates among people with disorders compared to those without illnesses. Muirhead (2014) reiterates that those living with a serious mental illness (SMI) have higher morbidity and mortality rates than the general population as a result of respiratory, cardiovascular, and infectious diseases, as well as some types of cancer and diabetes. For example, hepatobiliary, urinary tract, and laryngeal cancer has a higher morbidity rate among mentally ill groups across the planet, which is a major disparity compared to the rest of the human population. In support of this assertion, Weinstein et al. (2013) explain that since a significant proportion of patients are homeless, they develop multiple disabilities that include chronic medical conditions, SMI, and co-occurring disorders associated with substance abuse. Consequently, the increase in mortality rates among these populations is high due to the subsequent risk of substance abuse and smoking that are equally the causes of mental conditions (WHO, n.d.). Therefore, mental health disparities manifest in the form of numerous health problems, including physical and mental diseases, the morbidity and mortality rates of which are higher than the rates among the general population.
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Finally, accessing care for the mentally ill is a challenge due to the effects of poverty, stigmatization, discrimination, and so forth. For example, the rates of SMI in American adults range from 4-6%, accounting for a minimum of 11 million people (Agency for Healthcare Research and Quality [AHRQ], 2015). Additionally, those with SMI are mostly undertreated or untreated, which worsens the disease condition. For example, less than 60% of SMI patients used different mental health services in 2007; besides, it is much likely that those who received treatment may have defaulted at one point or another (AHRQ, 2015). That notwithstanding, disparities in accessing high-quality mental healthcare occur along socioeconomic, geographic, ethnic, and racial lines with the poor and non-natives suffering the most. Therefore, much should be done to curb these disparities by increasing access to care, eliminating illiteracy, homelessness, and poverty, as well as addressing many other aspects associated with increased societal inequalities.
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Every state and nation has regulations to control high-quality care delivery. For example, New York has formulated its guidelines to help mental health professionals understand the regulatory and statutory language that defines their practice, including unprofessional conduct and professional misconduct (New York State Education Department, 2013). Healthy People 2020 is a set of temporary guidelines that will serve the US from 2010 to 2020 with the aim of improving the state of mental health in the country. These guidelines provide the strategies the nation should use to achieve desired mental health goals through disease prevention and increased access to high-quality care (Healthy People 2020, n.d.). Further, the renowned SAMHSA, which is also called the Substance Abuse and Mental Health Services Administration, provides many guidelines for controlling the delivery of care in this specialty. For instance, it has established federal regulations to protect information from patients; thus, health IT vendors, insurance companies, and healthcare professionals are guided to maintain confidentiality and security of patient information (SAMHSA, 2017). Many other regulations concerning different aspects of mental health across the world are in place at the state, national, and international levels.
Moral Issues in Global Healthcare
In mental health, care providers face serious ethical issues that may result in the dilemma of making choices that can promote better health of both the patient and significant others while upholding the professional code of ethics and legal provisions. According to Vyskocilova and Prasko (2013), the moral issues are related to four major ethical principles: non-maleficence, autonomy, beneficence, and justice. For instance, it is difficult for a clinician to choose between keeping and sharing information without consent when it concerns patients who threaten to harm others or themselves. The dilemma is made worse by the professional code of ethics that states that clinicians should keep patient information private and confidential unless consent is obtained. In such a case, Schneider (2016) argues that the professional codes only provide the standards of practice that are unclear and not straightforward, leaving care providers to weigh up before applying them. Besides, the decision of care providers should not hurt their patients, which may be difficult to uphold, especially when information about the disease status is shared, causing psychological harm. That notwithstanding, clinicians face the risk of violating the right of patients to make clinical decisions regarding their own care, particularly when they lack the insight into their health status (Schneider, 2016). Therefore, the field of psychiatry is full of moral issues that pose an ethical dilemma majorly due to the nature of mental disorders and their effects on individual patients.
Healthcare Productivity and Economic Costs
Mental illnesses are associated with massive economic costs due to the human and physical resources required for treatment and the subsequent reduction in human productivity. According to Razzouk (2017), the costs related to mental illnesses have an adverse impact on the GDP of different countries; it reduces the GDP by at least 2-4.4% in low-income economies. Direct medical costs are those attributed to rehabilitation and treatment such as drug, hospitalization, and outpatient costs while direct non-medical ones are those associated with non-medical costs like meal expenses during hospitalizations (Xu, Wang, Wimo, & Qiu, 2016). Conversely, indirect costs related to these diseases occur through increased mortality rates, seeking care, disabilities, early retirement, work absenteeism, sick leaves, and so forth. As for early retirement, Razzouk (2017) reports that income tax revenue is adversely affected; one study in Australia revealed that, due to early retirement, people with depression earned 78% less than their colleagues employed for the same job did. Furthermore, indirect costs exceed the direct ones; for instance, out of the US$2.5 trillion spent on mental illness economic and productivity costs, US$0.8 trillion was attributed to direct costs, which is much less than US$1.7 trillion spent on indirect costs (Trautmann, Rehm, & Wittchen, 2016). The costs of care provision and the reduction of productivity are great challenges to economic growth and development.
Availability of Healthcare Providers
The field of mental health is affected by severe and acute shortages of healthcare professionals, a situation that may worsen in the future years, especially due to the increase in the population in need of mental health services. Although primary healthcare providers can satisfy the demand for most of the care, mental health professionals such as psychiatrists, as well as registered and advanced nurse practitioners, are required to provide specialized care in addition to delivering essential services, including training, supervision, and support to non-specialists (WHO, 2015). Globally, 10% of the entire human race has mental health conditions; however, only 1% of the entire health workforce population provides care in this specialty; such a thing means that almost 50% of the population of the planet lives in countries with less than one psychiatrist and nursing professional per 100,000 people (WHO, 2015). Furthermore, the population of care recipients is growing, yet few nurses and physicians are entering the specialty, which will likely worsen the future status of provider availability. Therefore, appropriate actions are required to save the already debilitating situation.
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The field of mental health is enriched with history from the ancient times when mental disorders were perceived to be the influence of supernatural powers to the modern era of medicine. The historical transformations include enlightenment, the establishment of institutions of care, objectivity in research and study of disorders that helped to formulate theories of psychopathology and psychopharmacology, and subsequent movements of deinstitutionalization of patients, among others. Although the costly impacts of illnesses and health disparities adversely influence the world, regulatory guidelines are in place to facilitate the provision of cost-effective high-quality care. Unfortunately, moral issues and the inadequacy of healthcare staff shortages complicate the situation. Therefore, much should be done to address the challenges in this specialty.
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