Understanding Mental Health and Mental Illness: A Case Study Analysis

This report aims to develop understanding regarding mental health and mental illness by evaluating the case study of Mary, a 41 year old patient with depression and critically evaluating the relation between mental and physical health to provide appropriate care to the client.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
Mental illness is associated with complex symptoms and adverse impact on physical
health of affected individuals. Due to this, recovery is often perceived as a complex and time
consuming process. To successfully engage in addressing mental illness in primary care
setting, it is necessary to take into account complex psychological, medical, social and
cultural factors leading to the condition. Current research emphasizes use of personal
recovery model in mental health as it helps to address various factors contributing to mental
illness in patient. This is essential to address all needs of mentally ill patient and promote
recovery of patient by addressing all factors that leads to deterioration of symptoms (Grover
et al., 2016). This report aims to develop understanding regarding mental health and mental
illness by evaluating the case study of Mary, a 41 year old patient with depression and
critically evaluating the relation between mental and physical health to provide appropriate
care to the client.
Analysis of mental health and mental issues:
Mental health is the state of complete well-being where an individual is able to cope
with stressors of life and work productively to contribute to the community. It can also be
defined as a state of complete mental, physical and social well-being (World Health
Organization, 2014). In contrast, mental illness is a disorder that affects the way people think
and behave with others. The impact of mental illness on overall well-being and normal
functioning is evidenced from the review of case study of Mary, a 41 year old woman who is
experiencing symptoms of depression currently. The key symptom indicative of depression
for Mary included lack of interest in simple activities like eating and dressing, poor mood,
being tearful, poor personal hygiene and feelings of worthlessness. The impact of the
depression on her behaviour is seen from the change that has occurred in her life post

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developing these symptoms. For example, earlier she looked smart and took showers on a
daily basis. However, now her family has notices that she sits in the same gown and take no
care of personal hygiene. Her condition matched with the common symptoms of depression
as defined by DSM-V criteria for depression (Schmidt & Tolentino, 2018).
The review of the prevalence of mental illness or mental disorders today indicates
depression, anxiety, post-traumatic stress disorder and schizophrenia are the most common
mental disorders who incidence is high in the contemporary world today (Charlson et al.,
2019). Among mental disorders, depression is turning out to be the most commonly occurring
mental health issues because of drastic changes in modern life circumstances and change in
demand of modern workplace. The issue of depression has been found for Mary too and the
case study reveals that she had previous history of depression too. She was diagnosed with
depression two years ago and prioritizing appropriate care is important to prevent risk to her
health. However, to ensure that appropriate care is provided, it is necessary to consider
holistic care needs of Mary which will be done by adapting personal recovery model during
care planning.
Relationship between mental health and physical health:
Mental health is directly linked to physical health and well-being of an individual.
Mary is suffering from recurrence of depressive symptoms. She was diagnosed with
depression at the age of 39 and she is experience the symptoms again now. Some clues from
the case study that shows impact of Mary’s mental illness on her physical health includes
lack of proper nutrition, poor personal hygiene and sleep problems. All these are factors that
can have direct impact on physical health of the client. For example, poor personal hygiene
and diet are factors that can expose patient to risk of infectious disease and malnutrition
respectively. Olivan-Blázquez et al. (2018) argues that poor diet in patients with major

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depression is associated with metabolic changes in the body which interacts with cerebral
functions to have adverse effect on patient. Hence, unless diet and poor hygiene related issues
are resolved, it can result in poor outcomes for patients like Mary. Therefore, addressing
mental health is important to maintain optimal physical health too.
There is strong link between physical health and mental health. Research literature
gives several evidences regarding the mental health and physical health is interlinked to one
another. Kim et al. (2012) explains mental health as a major risk factor for poor physical
conditions. This implies that the likelihood of experiencing chronic disease is high in patients
with serious mental illness. In addition, the opposite effect is also seen as odds of having
mental disorder increase with the number of chronic physical illness affecting an individual.
Stein et al. (2019) links mental illness with various non-communicable disease such as
cancer, cardiovascular disease, diabetes, cancer and respiratory illness. Heart disease is most
common in patients with depression and the research by Palacios et al. (2018) reveals that
depression and anxiety are most indicators of poor outcome in coronary heart disease
patients. The negative impact that heart disease and depression together have on an individual
is understood from the fact is that it is associated with long term poor health and increased
medical cost too. For this reason, while treating patients with depression, it is critical to
consider and address all morbidities associated with the condition too. Hence, the above
discussion signifies the need to address both mental and physical health issues of Mary to
minimize risk of complication and reduce cost associated with costly treatment. All the
factors such as poor diet, sleep difficulty and hygiene needs must be addressed to prevent risk
of other illness.

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Factors contributing to personal recovery from mental illness:
As Mary is currently suffering from recurrence of symptoms, it is necessary to
identify all factors that are crucial for recovery. This will require taking patient-centred
approach to care and adapting the personal recovery model during patient assessment and
care planning. Personal recovery from mental illness means addressing all the factors in
patient’s life that contribute to negative mental outcome (Grover et al., 2016). Jacob (2015)
cites that people with mental illness may have to recover from several issues such as
experience of stigma, poor self-esteem, negative side effects of work disruption or
unemployment or failure to meet certain dreams in life. Similarly to identify ideal
interventions for personal recovery of Mary, addressing these types of factors is crucial
during the care process.
For example, in the context of Mary, there are many daily life factors that is
influenced because of her depressive symptoms. Earlier she used to work in a large
organization. However, because of her current symptoms of depresses mood and lack of
interest in activities, she is on sick leave from work. Hence, addressing impact of depression
her work is important. In addition, due to depressive symptoms, her daily food intake and
nutritional needs has been affected. She lacks motivation to eat properly. So, this also gives
clues regarding the factors that are necessary to promote overall recovery of Mary. Apart
from this, her review of her social life shows that she goes to local church weekly. However,
depression would have affected her ability to meet spiritual needs. Hence, to promote
personal recovery of Mary, it is necessary to consider social, physical, behavioural,
nutritional, hygiene and relationship related needs too.

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Recognition and response to mental health needs of the client:
From the case analysis of Mary, several person-centred needs have been identified
that is crucial for her recovery. Firstly, based on review of depressive symptom, it is
necessary to prioritize meeting nutritional needs of clients. As Mary lacks motivation to eat
on time, there is a possibility that depression may lead to risk of malnutrition for patient.
Hence, to address the risk of malnutrition or under nutrition for Mary, it will be necessary to
monitor food intake of Mary and involve her husband in the care process to ensure that Mary
does skips her meal. Firth et al. (2019) justifies the need for implementing nutritional
intervention for patients with depression as poor diet is detrimental to mental health and
maintaining proper diet can have positive effect on depression and other secondary outcome
of patient too.
Another care priority for treating Mary is to reduce her symptom of depression and
reduce her symptom of low mood. This is critical because delay in addressing symptoms may
lead to persistence of symptoms of low mood, despair and feelings of hopelessness for a long
period and it can increase her risk of developing major depressive disorder. Another rationale
behind addressing her depressive symptom is that if it is not addressed, it can increase risk of
suicide ideation or suicide attempt in patient too. Lawrence et al. (2016) gives the evidence
regarding the prevalence of suicidal behaviour in patients with depression. Therefore, the key
response that is needed for a registered nurse to treat symptom of depression is to first
administer anti-depressive medication to patient as order by the clinician followed by
engaging in therapeutic communication process to address other factors like low self-esteem,
sleep problems and challenges in completing basic activities. Arroll et al. (2016) explains that
antidepressant is a crucial part of treatment as it relieves the symptoms of depression and
restores emotional balance for patient. Hence, for Mary, antidepressants will help her to get
back to normal life and address the problem of sleep, restlessness and suicidal thoughts too.

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The above discussion prioritizes the need for registered to enter into therapeutic
alliance with Mary. The main rationale behind this is that such communication style will help
to establish trust and rapport with the client which will eventually help to make individualize
care plan for Mary. As person recovery for Mary has been emphasizes, entering into close
therapeutic relationship with Mary will help to assess the client’s readiness for recovery and
identify other social needs and spiritual needs for her well-being. For example, the review of
personal life of Mary shows that she visits the church on a regular basis. Hence, one-on-one
interaction can help to understand how far depression has affected her spiritual needs and
identifies other spiritual needs that can facilitate recovery of Mary (Annoni & Miller, 2016).
This will be crucial as part of patient centred care approach.
In addition, depression has affected work performance and she is found staring at the
window most of the time. This issue signifies that Mary is at risk of social isolation and poor
social relationship too. If this aspect is not addressed, her personal relationship and
employment will be affected too. Hence, the important care priority is to address social needs
of Mary and this can be done by providing social support intervention to her. This
intervention will provide Mary the opportunity to engage in social activities and reduce risk
of social isolation. Dour et al. (2014) reveals social support to be effective in addressing
emotional and social outcome of patient and enhancing the efficacy of overall treatment for
depression. Small session of counselling with Mary’s husband will address her social
relationship related issue as this will help her husband understand the cause behind Mary’s
change in behaviour and respond maturely in such situations.
Implications for practice:
The review and critical analysis of challenges and health need of patient with
depression through the case study of Mary gives the implication for mental health

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professionals and registered nurse to incorporate personal recovery model in care planning.
Using this approach will help to address holistic care needs of client and maintain good
physical and mental health too.
Conclusion:
To conclude, the analysis of the case study of Mary, a patient with mental illness gave
the insight that mental disorder has impact on daily life behaviour and holistic well-being of
patient. By the analysis of key issues for Mary using personal recovery approach, various
priorities of care has been identified. This includes addressing nutritional needs, social needs,
and physical needs, physiological and behavioural needs of Mary. The key response
suggested addressing these care priorities can give future registered nurse the idea regarding
the way to deal with clients suffering from mental disorder.

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References:
Annoni, M., & Miller, F. G. (2016). Placebo effects and the ethics of therapeutic
communication: a pragmatic perspective. Kennedy Institute of Ethics Journal, 26(1),
79-103.
Arroll, B., Chin, W. Y., Martis, W., Goodyear-Smith, F., Mount, V., Kingsford, D., ... &
MacGillivray, S. (2016). Antidepressants for treatment of depression in primary care:
a systematic review and meta-analysis. Journal of primary health care, 8(4), 325-334.
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S.
(2019). New WHO prevalence estimates of mental disorders in conflict settings: a
systematic review and meta-analysis. The Lancet.
Dour, H. J., Wiley, J. F., Roy‐Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., ... &
Craske, M. G. (2014). Perceived social support mediates anxiety and depressive
symptom changes following primary care intervention. Depression and anxiety, 31(5),
436-442.
Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., ... & Sarris, J. (2019).
The effects of dietary improvement on symptoms of depression and anxiety: a meta-
analysis of randomized controlled trials. Psychosomatic medicine, 81(3), 265.
Grover, S., Hazari, N., Singla, N., Chakrabarti, S., Aneja, J., Sharma, S., & Avasthi, A.
(2016). Recovery among patients with severe mental illness: Factor analysis of
recovery assessment scale in Indian setting. Indian Journal of Social
Psychiatry, 32(2), 92.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to
psychiatric care. Indian journal of psychological medicine, 37(2), 117.

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Kim, Y. S., Park, Y. S., Allegrante, J. P., Marks, R., Ok, H., Cho, K. O., & Garber, C. E.
(2012). Relationship between physical activity and general mental health. Preventive
medicine, 55(5), 458-463.
Lawrence, R. E., Brent, D., Mann, J. J., Burke, A. K., Grunebaum, M. F., Galfalvy, H. C., &
Oquendo, M. A. (2016). Religion as a risk factor for suicide attempt and suicide
ideation among depressed patients. The Journal of nervous and mental
disease, 204(11), 845.
Olivan-Blázquez, B., Montero-Marin, J., García-Toro, M., Vicens-Pons, E., Serrano-Ripoll,
M. J., Castro-Gracia, A., ... & Garcia-Campayo, J. (2018). Facilitators and barriers to
modifying dietary and hygiene behaviours as adjuvant treatment in patients with
depression in primary care: a qualitative study. BMC psychiatry, 18(1), 205.
Palacios, J., Khondoker, M., Mann, A., Tylee, A., & Hotopf, M. (2018). Depression and
anxiety symptom trajectories in coronary heart disease: associations with measures of
disability and impact on 3-year health care costs. Journal of psychosomatic
research, 104, 1-8.
Schmidt, S. L., & Tolentino, J. C. (2018). DSM-5 criteria and depression severity:
implications for clinical practice. Frontiers in psychiatry, 9, 450.
Stein, D. J., Benjet, C., Gureje, O., Lund, C., Scott, K. M., Poznyak, V., & van Ommeren, M.
(2019). Integrating mental health with other non-communicable diseases. Bmj, 364,
l295.
World Health Organization (2014). Mental health: a state of well-being. Retrieved from:
https://www.who.int/features/factfiles/mental_health/en/

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