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The importance of mental health in achieving overall wellness cannot be overstated. Mental health is defined as a state of physical, emotional, social, and psychological well-being in which the individual is productive, able to adapt to changes or adversity, able to maintain fulfilling relationships with others, and contributes positively to society. In the past 20 years, this nation has seen a steady and alarming increase in the number of people who cannot meet that description. The lack of access to treatment, along with a general need for education and decreased stigma around mental health have greatly increased the risk of undiagnosed or delayed treatment of depression and other mental illnesses. Exasperating the problem are low rates of health literacy and a reluctance to seek help due to lack of health insurance. Additional risks of depression include poverty, family history, trauma, poor education, and multiple losses.
The two populations most susceptible to this type of illness are the ones most inherently vulnerable and difficult to diagnose: adolescents and veterans. In these groups particularly, depressed individuals frequently deny the severity of their symptoms and seek bodily medical care, hoping a physical condition has caused their psychic discomfort. While the situation is dire, nurses are here to help. With a unique view into day-to-day patient experiences and clinical research, nursing leaders are in a distinct position to provide high-level direction on solving problems at scale. Our nation’s most vulnerable populations have plenty of challenges, but increased risk of mental illness is one nurses are making strides to alleviate.
Adolescents and Young Adults
In children and adolescents, depression may manifest through irritability, aggression, or poor school performance. As “digital natives” who have never lived in a world without high-tech forms of communication and social media as part of daily life, children and adolescents are more exposed to bullying and peer comparison than ever before. Additionally, this age group has seen increased sleep disturbance and adverse health outcomes related to high levels of screen time, affecting physical, cognitive, and behavioral health outcomes during this vulnerable stage of development. These prolonged periods of sleep disturbances have been associated with poor mental health, suicidal thoughts, and self-injury.
Suicide is an act of violence against self and for every successful suicide there are multiple survivors of attempts. Nurses both in hospital psych wards and in decision-making roles behind the scenes are leading the charge to reduce the rate of suicide and attempted suicide in teenagers and young adults. Jonas Scholar Alumni Kari McDonald, PhD, is a prime example of the power of nurses in making progress on behalf of at-risk youth communities, dedicating her research to LGBTQ adolescent mental health and suicide prevention. Additionally, public awareness campaigns that help the public and teens understand warning signs and train the primary care workforce to screen for suicide ideation, intent, and risk have the potential for significant positive impact.
Our Nation’s Veterans
Another especially vulnerable group is our veterans, who are disproportionally at risk for suicide. In 2017, The Office of Mental Health and Suicide Prevention at U.S. Department of Veterans Affairs reported that in 2014 on average 20 veterans died by suicide each day. Six of the 20 were recent users of VHA services and about 67% of veteran deaths were the result of firearm injuries. Due to the experiences they have been exposed to, veterans have a complex set of medical, social, and psychological needs, and require tailored solutions to their mental illnesses.
Jonas Scholar Alumni Cynthia Knight, a primary care nurse practitioner in the Home Based Primary Care Program at Veterans Affairs (VA), is part of the solution. In alignment with the VA’s plan to integrate mental health services into primary care, Knight explores the needs of the older adult veterans with depressive symptoms and assesses how to bridge gaps in care to improve health outcomes. It is the work of nurses like Knight that will lead to actionable breakthroughs in suicide prevention for this at-risk population.
Nurses are a critical workforce in helping form additional mental health training and infrastructure, which can expand access across the breadth of patient care from hospitals and primary care to communities and school-based health. The American Academy of Nursing recommends funding for research that supports developing and testing new interventions. It also encourages the training of nurses and other health care professionals committed to raising public mental health awareness about the dangers of sleep disturbance. Nurses not only play a critical role in providing timely, effective, and comprehensive services, but they are valuable advocates to those living with depression and mental illness. By utilizing nurses to help address mental health, we can promote prevention and promote mental health for people at all levels of risk.