Therapeutic Approaches for Managing Mental Illnesses: A Literature Review

This literature review explores the different therapeutic approaches used to manage mental illnesses. It covers psychosocial and social approaches, legislation, ethics, compassion, care, and therapeutic communication. The article also provides information about the subject, course code, course name, and university.

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WHAT ARE SOME OF THE THERAPEUTIC APPROACHES USED TO MANAGE
MENTAL ILLNESSES?
Literature Review
By (Name)
Course
Professor’s name
University name
City, State
Date of submission

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Table of contents
Abstract............................................................................................................................................3
Introduction......................................................................................................................................4
Search Strategy................................................................................................................................5
Table 1: Literature Search.......................................................................................................................5
Inclusion Criteria.....................................................................................................................................5
Exclusion Criteria....................................................................................................................................6
State of Literature............................................................................................................................6
Wellness, personal responsibility and dignity of risk...............................................................................6
Social justice and Human rights..............................................................................................................8
Buddhists perception on mental illnesses................................................................................................9
Legislation, ethics, compassion and care.................................................................................................9
Therapeutic communication..................................................................................................................10
Therapeutic modalities..........................................................................................................................11
Discussion......................................................................................................................................14
Conclusion.....................................................................................................................................15
References......................................................................................................................................15

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Abstract
Importance of the project: Diagnosis of mental illnesses is usually missed in a lot of
patients who actually suffer from it. Without proper diagnosis, therapeutic interventions cannot
be initiated. Treatment approach towards mental illnesses in not only limited to drugs but also
methods like psychosocial and social approaches. This is holistic in ensuring the affected patient
recovers and assume nearly normal condition.
Methods: Different databases were accessed for literature review on the subject. They
include PubMed, Google Scholar and online google searches. Mental health related journals and
books were also accessed to give more insight on available interventions for mentally ill patients.
Papers and other sources not focusing on therapeutic interventions were excluded from the
review. Some of the studies were Meta analyses and systematic reviews.
Results: A total of 24 articles met the search criteria. Most of the studies focused on
therapeutic approach of bipolar disorders, schizophrenia and anxiety disorders. Results were of
mixed type due to application of both quantitative and qualitative data methods by the reviewed
research papers.
Conclusion: More rigorous research is required in the field of mental health to provide
data and information that can be used to guide policy making actions for better mental health
care. Providing this evidence will also help determine the effectiveness and gaps in each of the
aspects of care, for better patient management.
KEY WORDS: Mental health, psychosocial, dignity of risk

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Introduction
Mental health is one of the few disciplines that keen interests have not been taken
especially in the developing countries (Healthtalk.org, 2018). This is an exception to developed
countries because of the difference in lifestyle and presence of an ageing population alongside
good diagnostic capabilities, although much efforts still need to be put in ensuring early
diagnoses are made. Because of this, many times diagnosis of mental illness in a patient is
missed thus no proper interventions initiated. It is only with proper diagnoses that enough data
about people suffering from a particular illness can be established. This forms an evidence based
tool for more health financing and reform towards the condition, in this case mental illness.
With mental disorders being one of the leading cause of morbidity worldwide and
widespread across industrialized countries, health care personnel need to improve the detection,
diagnosis and management of this condition, in a multidisciplinary approach (Healthtalk.org,
2018). General Practitioners form part of primary care for mental disorders. However, this alone
is not enough. Other psychiatric interventions like social and psychosocial methods need to be
added to the primary physical care.

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Search Strategy
Search terms Database Articles Retrieved # Articles selected #
Therapeutic
modalities in mental
health
NCBI 22 7
Buddhists
perspectives
Online google search 30 6
Social justice and
human rights
Google Scholar 17 7
Legislation and ethics
in mental health
BMJ 9 2
Dignity of risk Research gate 13 2
Total 91 24
Table 1: Literature Search
Inclusion Criteria
Papers viewed fulfilled the following inclusion criteria. They were written in English
language, of full text and peer reviews. Scholarly articles published in the last ten years with
relevance to interventions in mental illness were selected.

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Exclusion Criteria
Articles not fulfilling the topic of interest above were excluded from the literature review.
Others included articles published more than ten years ago, those that talked about interventions
but not specific to mental illnesses and those that did not provide in depth analysis of the topic.
State of Literature
Wellness, personal responsibility and dignity of risk
The risk of developing a mental illness is not limited to the population outside health
care. Mental illness does not discriminate. A study conducted by (Daskivich et al. 2018) show
that physicians who are being trained are prone to develop depression, while their colleges in
training are more likely to commit suicide than in the general population. Part of the objective of
the study was to promote a national policy that would increase awareness of stress at workplace
so as to reduce the chances of depression. However, the definition of wellness in relation to
mental health still remains a problem, therefore it is difficult to develop interventions to alleviate
it. An abstract published in PubMed by Manderscheid (2018) shows an evolving definition of
wellness. There has been a shift from diagnosis based definition to individual focused one and
away from “absence” of disease to that which focuses on the psychological function for mental
health. There are numerous stressors that predispose one to mental conditions and they form part
of wellness. Without these stressors and environmental predisposing factors, the population
would be free of mental illness.
Proper mental health recovery process depends on personal responsibility (R, 2018). It is
assumed that people are responsible for their own choices and behaviors, factors that determine
their health status. Health is a personal responsibility (Hughes 2017). Everyone is capable to

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have a perfect health and mental health adjustment if they consider their personal responsibility.
Personal responsibility raises a paradox in the context of mental health care. People often present
in a way that does not correlate with the ideals of responsible end user. They are excluded from
irresponsible behavior. This irony is looked into keenly by health care workers. Taking personal
responsibility has been implicated to lead to sense of freedom from being victimized. A balance
is always established between blaming the disorder and taking personal responsibility. People
who blame the disorder tend to stay more with their conditions than those who take
responsibility to solve them. The nature of personal responsibility and how the characteristics of
it can conflict with policy and professional responsibilities to protect others.
For people with mental illness and any disability, the dignity of risk is a powerful
concept. Dignity of risk is defined as the concept of self-determination and the right to take risks
that are necessary for self-esteem and dignity. This concept applies to a vast group of people like
the elderly, disabled and in this context people with mental disabilities. Mentally ill people are
free to make informed decisions as others. This help in developing personality and an
individual’s character (Disability News, Opinion & Discussion by My Disability Matters 2018).
Dignity of risk conflicts with the duty of care. It is said that when patients being taken care of are
allowed to take risks, they can be in a conflict with their care givers. Therefore balancing
between these considerations is hard when developing guidelines for caregiver
(En.wikipedia.org, 2018).When a patient with mental illness is overprotected, a feeling of low
self-esteem and underachievement can ensue because their expectations are lowered. A dignity
of risk research project by (Hadland and Lambert 2014) shows the policy and perceptions to
make decisions. The journal explores barriers in the concept and some of them include conflict
between resident need and legal authorities, lack of experienced staff and mental disabilities.

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Social justice and Human rights
Social justice is a key virtue for guiding health workers into creating institutions that
determine what is good for the patient. It dwells on personal responsibility to ensure
multidisciplinary approach to a patient and improve the working conditions around an institution
(Breuer 2012). According to World Health Organization (WHO), health is a fundamental human
right. Mental health patients are entitled to the highest level of health without being
discriminated because of their condition (World Health Organization, 2018). Social justice goes
with economic justice, which run on the principles of distributive, participative and social justice.
For instance, a mentally ill individual should be treated equally as other members of the society.
It is about having equal opportunities in social outcomes and recovery (Breuer, 2012). Other
forms of social justice to these patients include proper housing, employment and improving their
living standards in the community.
Health rights for this group of people should be properly constructed to offer substantive
and justifiable claim to ensure equitable use of public resources. A study by Breuer (2012) on
definition of mental illness in the context of disability showed that 65% implications suggest that
disability contain mental illness, and that 64% of responses supported that the law prohibits
discrimination in order to promote social justice. However this is not being practiced in most
countries. Almost 41% of countries with ratified CRPD did not allow people with mental illness
to marry and about 12% of these countries allow divorce on the ground that one of the spouses is
mentally ill (Breuer 2012). Better research funding should be enhanced since human rights and
social justice for the mentally ill is an urgent need at both local, national and international level.

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Buddhists perception on mental illnesses
Of the major world religions, Buddhism is considered one of the most psychological ones
(Tariki Books and Papers 2018). Buddhist approach to mental health has been underpinned by
Buddha’s enlightens. To understand a Buddhist approach to mental illness, an in-depth analysis
of their teachings should be evaluated. Buddhism is based on three pillars namely Sila, Samadhi
and Prajna, each of which represents an element in mental health.
Sila represents a person’s ethical framework. Sila prescribed to a morally sound lifestyle,
with respect for living things and grounded in concern for others and sobriety. It cultivates a
healthy mental state. Samadhi represent someone who is spiritually grounded, calm, peaceful,
and full of meditation and concentration (Dailymirror 2018). Prajna means wisdom. One
experiences deep understanding of knowledge and insights of mental constructs. From these
three pillars, several aspects of well-being can be understood. Behavior that influence mental
states and the ability to view a lie at the root of mental state are some of the examples. Tariki
Books and Papers, (2018) also suggest that mental illness is an extreme version of the state
someone suffers from and that psychotic states are the end versions of mental states. Buddhism
in itself forms a therapeutic model for managing mental health conditions (Applied Buddhism
2018). Most of the modern therapeutic theories are rooted in Buddhist practices.
Legislation, ethics, compassion and care
Mental health has been conceptualized as global disorders with physical basis in the brain
and affects everyone without discriminating (Fernando 2017). By making mental disorders a
universal subject, attention to inequalities in the treatment gap has been identified by a push from

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WHO and Movement for Global Mental Health (MGMH). A legal framework is necessary to
guard and promote the interests of those suffering from mental illnesses. This is according to a
paper on Ethical aspects of public health legislation in focus to Mental Health Care Bill of 2011
by (Thippeswamy 2018). The proposed bill puts into account the aspects of support for decision
making, consent and advance directive for those who are mentally challenged. This new bill that
was proposed under the United Nations (UN) Conventions on the Rights of Persons with
Disabilities should strengthen and facilitate mental health policy. When put into practice, it will
ensure that acceptable, accessible and equitable mental health care is provided (Mammot and
Allen 2014). Mental health legislation should have a room for respecting decision making (Doyal
and Sheather 2018).
With the advent of legislations guarding mental illness patient, compassion and care for
the same has been seen. This is according to a paper by Chadda, (2014). Studies showed that
those patients who were taken care of compassionately had good outcome and returned to their
pre-mental illness state quicker than those that were not given the same treatment. An
explorative study on self-compassion and resilience mechanisms in regards to mental health by
Trompetter, (2016) showed that there was intercorrelation between self-compassion,
psychopathology and positive mental state of an individual.
Therapeutic communication
Promoting well- being of a mentally ill patient needs a multidisciplinary approach. A goal
directed approach is used to help the patient gather resources to maintain and restore the perfect
mental health (M 2018). A pilot study by Webster and Debra, (2013) used students who engaged

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in an interaction with an actor that portrayed an individual with mental illness. The strengths and
weaknesses in therapeutic skills in psychiatric nursing were evaluated. The desired outcomes of a
good therapeutic communication were empathy, caring, addressing the patient’s values, beliefs
and preferences. The study concluded that students saw the importance of therapeutic
interventions. Gausvick et al. (2015) also show that communication improves patient and health
care worker satisfaction.
Therapeutic modalities
Treatment approaches toward mental illness include use of drugs (physical), social and
psychosocial (behavioral) therapy. Generally, a combination of these approaches are used and it
has been shown that it is more effective. Detailed discussion about each is provided below.
Physical approach
General principles of this method include initial evaluation of the condition, target of
symptoms, good choice of drugs while taking into consideration pharmacokinetic and
pharmacodynamics of the drugs and classification of the agents. A qualitative investigation by
(Fleury et al. 2018) shows that general practitioners employ pharmacotherapy to their patients.
The main conditions focused on in literature are bipolar disorders, anxiety disorders and
schizophrenia. The main condition in bipolar disorders is depression. Some of the anti-
depressants used include Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, and
tricyclic antidepressants (TCSs) like amitriptyline. They work by enhancing the activity of
noradrenaline and serotonin which are usually limited. Both of them have similar efficacy and
almost 60% of the patients respond in 6 weeks. Continued treatment is important since it
maintains the improvement. Mood stabilizers for bipolar disorders include lithium that has a

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narrow margin of safety thus not preferred, others are anti-epileptics like valproate and
antipsychotics like olanzapine. Anxiolytics include lorazepam, propranolol and buspirone among
others. Antipsychotics are the mainstream for managing schizophrenia and are classified into two
groups called typical like haloperidol and atypical for instance olanzapine.
Medical interventions come with their drawbacks. Atypical antipsychotics cause
pyramidal effects in the patients thus reducing drug compliance which can lead to worsening of
the condition and prolonged hospital stay. These drugs should also be given cautiously in special
groups like children, elderly, pregnant and in breastfeeding women. Other forms of physical
approach include electroconvulsive therapy (ECT). ECT is safe and effective for managing
severe depression (Healthtalk.org, 2018). Its use is limited because of the negative perception
people have about it. Psychosurgery is an ancient method used to manage depressive disorders
without informed consent as compared to ECT. However, ethical concerns about the method
over years limit its use by medical team.
Psychotherapy
Medical treatment requires interaction between the patient and the doctor. This is a
determinant of both patient and physician satisfaction. Psychological therapy is a byproduct of
this interaction. Some of the common methods include psychodynamic therapy, behavioral
therapy, cognitive therapy and cognitive behavioral therapy among others. Psychotherapy is
based on a principle of general therapeutic factors. The person providing thus type of therapy
should be credible, well behaved, empathic, interested and able to give hope to the patient. For
the intervention to be successful, one needs to select the right therapy for the right patient, do
adequate preparation and ensure that the therapy is available.

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Behavioral therapy arise from the idea that adaptive behaviors can be learned and
maladaptive behaviors can be dropped away. It is effective for managing anxiety disorders like
phobias. Exposure is the mainstream to this kind of therapy. The patient is re exposed to the
behavior they avoid. Graded exposure is used in a step by step manner and progress is reviewed.
Cognitive therapy aims to correct inaccurate ways of thinking so that it can be improved
to a better standard, reduce anxiety and allow a return to normal behavior. The therapist obtains a
detailed problem description while being keen to the thoughts. He or she provides an explanation
afterwards of the role of the cognition perpetuating the problem to the patient. Patient is then
taught how they can become aware of and challenge the negative cognitions and practice to think
in more helpful ways. Techniques applied here include education on the role of cognition and
their effects on emotions and behavior.
Cognitive behavioral therapy combines both elements of cognitive and behavioral
therapies. Other hybrid psychotherapies include cognitive analytical therapy, interpersonal
therapy, dialectical behavioral therapy, eye movement desensitization and reprocessing therapy
and metallization based therapy. Group psychotherapy have been adopted to treat several groups
at once. Family therapy is based on the theory that a family is the source of a problem.

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Social approach
Social factors play a major role in predisposing and maintaining psychiatric disorders.
They also determine the environment in which therapy is initiated and its outcome. Acute social
interventions include:
Psychiatric admission where community treatment is not feasible due to risk to the
community itself or if the patients’ condition risks deterioration. A systematic study by (Webber
and Fendt-Newlin 2018) show that social network gains are strongly supported by the
community. The least restrictive method of admission should be obtained because patients
become traumatized if detained under the mental act. Another method is crisis intervention by a
specialist at home so that hospital admission can be prevented. These caregivers provide
psychological interventions, medication, telephone support and home visits. Social approach also
includes providing accommodation and financial solutions to the affected patient thereby
reducing stressors that act as maintaining factors. Family support and education is also an
important part of care. Social isolation can also be addressed by home visits and putting the
person in a self-help group. Chronic psychiatric disorders can be managed by rehabilitation that
will ensure there is social, occupational skills and self-confidence. These methods have limited
evidence as suggested by (Webber and Fendt-Newlin 2018) therefore need more research and
data on how to improve them.
Discussion
Mental illnesses still affect a great deal of population in the developed and developing
countries. By addressing the therapeutic options available and understanding theories behind
them, the best type of care for patients can be examined and applied.

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Much of the current literature focuses on a narrow spectrum of mental illnesses, leaving
behind the rare and emerging ones. Limited research papers have been published on mental
health awareness and management plans. The reviewed literature consisted of literature reviews
from journals, pilot studies, and systematic reviews and cross sectional studies therefore there is
need for much rigor in studies related to mental health. It was also noted that most of the studies
lacked solid methodology and enough sample size. Clearly, it is evident that further research in
the field of mental health is needed to act as a guide for supporting more funding by
governments in managing mental illnesses holistically. This is despite the fact that some of the
research published are still promising. More research needs to be done in the effectiveness of
social and psychosocial care outcomes to inform on how much resources should be located to
facilitate their use as one approach to manage mental health issues.
Conclusion
Most of the therapeutic approaches towards managing mental illnesses have not been
explored by research papers to a great extent. Some of them include use of biological methods
like drugs, ECT, psychosocial and social methods. Other aspects such as communication, the use
of laws and legislations and also dignity of risks have been highlighted. More rigorous research
is required in the field of mental health to provide data and information that can be used to guide
policy making actions for better mental health care. Providing this evidence will also help
determine the effectiveness and gaps in each of the aspects of care, for better patient
management.

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References
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Breuer, S. 2012. Review of Mental illness, discrimination and the law: Fighting for social justice.
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Chadda, R.K., 2014. Caring for the family caregivers of persons with mental illness. Indian
journal of psychiatry, 56(3), p.221.
Dailymirror.lk. 2018. Towards a Buddhist Theory of Mental Illness. [Online] Available at:
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Daskivich, T., Jardine, D., Tseng, J., Correa, R., Stagg, B., Jacob, K. and Harwood, J. 2018.
Promotion of Wellness and Mental Health Awareness Among Physicians in Training:
Perspective of a National, Multispecialty Panel of Residents and Fellows.
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Doyal, L. and Sheather, J. 2018. Mental health legislation should respect decision making
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communication on interdisciplinary acute care teams improves perceptions of safety, efficiency,
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