Mental disorders are relatively common and tend to have early ages. Adults, age 18 to 26 years, can be considered the healthiest time of life. But young adults are more possible to experience anxiety, mood and eating disorders than other age group (Nizette, 2013). Men are more likely to die at this age than women, the reason includes car accidents and suicide (World Health Organization [WHO], 2014). According to the New Zealand [NZ] statistical results of the Ministry of Health [MOH] 2016 show that 47% of all mental health problems start at the age 14 to 18 years. 3.6% of adults have been diagnosed with mental illness, such as Schizophrenia, depression, anxiety and bipolar disorders (Mental Health Foundation [MOF], 2016a). This essay will explain about opportunities and barriers for the adult aged between 18 to 26 years with mental illness for inclusion in to the community. As well as describe the ‘Tidal Model’ of recovery and how the recovery model effects this age group’s well-being. It also discusses about NZ government initiatives, strategies to support young adults. Finally, the essay evaluates how a nurse can help recovery and improve the social inclusion of the adults in NZ.
The age of life between 18 to 26 years, also called emerging adulthood. Early adulthood is a key stage in life since, it presents unique opportunities and challenges, for setting up health outlines for later adult life (Clark et al.,2014). According to Erikson, adulthood is a time of greater vulnerability to mental illness than middle or later adulthood. People in this age group with severe mental disorder, face life expectancy of up to 30 years less than other individuals, because of their increasing medical conditions and other medical complications (Meyer et al.,2017). According to MHF, 50% of New Zealanders will experience a mental health problem in their lifetime.
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Adults with the mental illness, experiences number of social inclusion in community life (MHF, 2018a). According to theorist Erik Erikson, the developmental stage of mental disorders in an individual is influenced by their behaviour, environmental factors, social context and relationship. There are many opportunities in our community to bring up a mentally healthy generation (Elder, Evan, & Nizette, 2017a). People with mental illness should be provided with the support, opportunities and self-direction to achieve and get back to their standard life in community, work place and family. Interpersonal Social Rhythm Therapy (ISRT), provides opportunities to include them in the community and social activities. It also offers counselling, relationship support, recovery, education, employment, good housing, support for income, and boost their self-esteem (Mental Health Commission, [MHC], 2011). The family has an overwhelming impact on the healthy lifestyle of adulthood. According to (MHF, 2018a) Family Focused Therapy (FFT) and the family can offer hope and encouragement, help deal with difficulties in life. Family support services offers counselling in family circumstances like death, divorce, breakups and help to reconnect with family members. Another opportunity is the Workplace and Relationship with co-workers that play a major role in adult life. Work can provide financial stability and help to balance their life and responsibilities as parents without having financial worries. Through work adults can meet different individuals and engage in social activities (Cheer, 2009). Mental health foundation research shows that introducing five actions (Connect, Be Active, Keep Learning, Give and Take Notice) into daily life at work and at home can boost resilience, improve mental health and wellbeing, thus lowering the risk of developing mental health problems (MHF,2017).
Young adults in our community face number of challenges such as unemployment, low income, low social economic status, broken family relationship, lack of education and physical challenges. These act as barriers, contributing to mental illness, anxiety, stress and depression (Meyer, 2017). According to MCH (2011) 84% of the adult with mental disorders are not employed in any workplace. Young adults are subjected to an incredible amount of pressure in workplace. They are facing issues such as the relationship with colleagues, bullying and peer pressure with co-workers, body image issues. Young adults face barriers like financial worries, lack of education, responsibilities as young parents, drugs and alcohol addiction and sexual relationship (MHF, 2017). MHF studies shows 77% young adults use drugs, smoke and drink alcohol. Social isolation and loneliness are other significant barriers in mental illness. Adults with mental illness are socially disadvantaged and face social exclusion. Social isolation arises from loss of job, poor self-image, disabilities, anxiety and financial problems. They experience physical barriers like, transport to the health care system and access to services (Russell., & Lloyd., 2004). According to Russell and Lloyd, 64% adults age between 18 to 26 facing isolation in their community due to these barriers.
The recovery model is essential in improving the quality of life for people with mental illness in all ages [MHF,2017a]. Phil Barker and Poppy Buchanan and their colleagues developed the Tidal model in mid-1990s. This model is the one of the most effective recovery model used in mental illness age between 18 to 26 years (Mental Health Commission, 2017). The recovery model focuses on person-centred care and the continuous process of changes in mental illness people. The tidal model leads people to find their own experiences, emphasizing the importance of their own voice and wisdom through the power of metaphor and aim to empower people to lead their own recovery rather than being directed by health professionals (Elder, Evan, & Nizette, 2017a). The Tidal model has developed based around three Domains. Self-Domains, World Domains, Other Domains, which can be applied to any age groups. These three Domains also provide the theoretical basis for the key individual and group-based process. It deals with holistic assessment, one to one sessions, personal security plan and group work. These domains lead to discovery, solutions and information sharing, help the young adult to recovery from depression, anxiety and other mental illness.
According to Tidal Model, the process of recovery should start when mental illness is identified or when a person is admitted to any kind of psychiatric health sector. This way the recovery will be faster, and the treatment can be continued in their everyday life in the community (Barker, 2001). The adults who are affected with mental illness can access the recovery model through their GP or Nurses, from home-based care, addictions centres, and rehabilitation units (Elder, Even, Nizette, 2013). The Tidal model recovery is person-centred rather than clinical recovery. The Tidal model has Ten Commitments, which are the key guidelines for the nursing practice. These Ten commitments are organized into three waves. The waves are ‘Value the voice’, ‘respect the language’ and ‘develop curiosity’ (Barker, & Buchanan-Barker, 2005). These commitments are empowering nurses to understand the problems that patients face in their daily living and help them to provide their basic needs, support and well-being. The therapeutic relationship builds trust between health workers and the patient, this results in consistency and continuity in recovery within hospital and community (Barker, & Buchanan-Barker, 2008). Interpersonal relationship and ten commitments help young adults to learn how to deal and cope with their mental health illness in the best way (Barker, & Buchanan-Barker, 2010).The study on mental health recovery models, which included mental health patients, cares and nurses from mental health service in Australia and NZ resulted that, The Tidal Model concept of mental health recovery brought about a major shift in the traditional philosophical views of many mental health systems. This study shows the significant emphasis for placing the person’s centre care in the recovery process as crucial (Munro, & Taylor, 2014).
The NZ government and mental health services have established various strategies, initiatives and reports to provide and ensure that services are best placed to respond to the changing needs of the population they serve. One of the significant strategies for adulthood is Rising to the challenge: The Mental Health and Addiction Service Development plan 2012 to 2017 developed by the NZ government to encourage social inclusion (MOH, 2012). The propose of the strategy is to increase national consistency in access, services, quality and outcomes for people, who use services for their families and for their community. Young adults are most commonly affected by addiction, for example, alcohol, tobacco, cannabis (MOH, 2012).The MOH has increased support for the involvement of families and whanau in service planning and delivery. The development of a range of primary mental health and addiction initiatives throughout the country and a focus on supporting recovery for people with the highest needs. While there has been significant growth and development in services, there is some negative impact which needs to be improved, for example, a variable waiting time for access to Mental health and addiction services and in the quality of specialist inpatient facilities (MOH, 2012a).
Second important strategies for all age group in NZ Suicide Prevention Action Plan 2013-2016. This submission is made by Mental health foundation of NZ. The main core focus of this strategy is working with families, communities and professionals to provide safe and effective suicide prevention activities, create support and social inclusion for people experiencing distress and develop positive mental health wellbeing (MHF, 2017a). People with Suicide ideation, suffer from one or more mental disorders such as depression, schizophrenia, bipolar disorders. The records show a total of 668 suicide deaths noted in 2017/18, the highest In NZ since records began in 2007/08 year (Getz, 2018a). The outcome of this strategy, helps to decrease suicide-related behaviours in NZ by 10% in 2014. However, the drawback of this plan is the increased number of suicide rates in the last few years because of issues such as access to service, geographically rural areas, low income, social isolation and so on. These government strategies are developed to address the rising mental health problems and focusing more on services to improve health outcome (Getz, 2018a).
Mental health initiative is established by MOH, NZ. There are 26 initiatives in the youth mental health project (MOH, 2015). SPARX: is a free online service for young adults. SPARX is a self-help, e-therapy resource that explains young adults, the key skills required to help battle with depression, anxiety and other mental health illness. SPARX focuses on young adult. This is a free online website and can be accessed anytime from anywhere. The helpline or free text and trained counsellors provide support for people 24/7 and 365 days year. E-therapy programme and mood quiz on the website provide a source for young people to find information on where to find help. The youth-friendly game format teaches how to cope with harmful thoughts and feeling, and to think in a more balanced way (MOH,2015). On the flip side of this initiative, not all mental illness people can access the internet and other online setup.
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Common Ground for Young People, whanau and friends is another important initiative. The initiative aims to delivers services through its website, telephone line and text counselling (MOH, 2017a). Family and friends have an important role in supporting young people through their difficult time of life. But often they do not find the mental health issue surfacing until a crisis point has reached (MOH, 2017a). The main aim of Common Ground is providing a central hub for parents, family, whanau and friends with easy access to information, tools and support to helps a young person who’s struggling (MOH, 2013a). The features of Common Ground are a series of video exploring the challenges faced by young people in a fictional community. Common Ground provides information for the young person and help them recognise and understand the tough times in their life and identify signs of the early stages of possible mental illness (MHF, 2017a). The outcome of the project is that, the young people get support in their lives to manage challenges and enjoy positive mental health and wellbeing.
Another beneficial initiative for young adult is Lifehack: A Youth approach to wellbeing 2013 to 2017, has developed through the social media. The innovation fund for the initiative is provided by the part of the Prime Minister’s youth mental health project (MOH, 2017a). The aim of the project is bringing young people together to collaborate on social media and promote wellbeing. It’s easy to access through online anytime, anywhere (Lifehack 2017a). There are several tools, which support the well-being of young people, with an emphasis on co-design, prevention and capability building. Mental illness person can get help from training, labs, workshops, capability development programmers (Lifehack, 2017a). These progress help person to get back to their community.
The diverse roles of a nurse promote social inclusion and recovery in all age group. The nurse promote education, awareness of mental illness and provides opportunity for the adult in their workplace and community (Evans, Nizette & O’Brien, 2017a). The important tool in nursing is establishing a therapeutic relationship with patients. Nurses work together in the best interest of patients by treating everyone with respect and dignity (MHF, 2016a). Nurses focus on a person-centred approach, tailoring services according to the needs of the patient. Nurses are practising different approaches for each patient and work in a way that encourage positive outcomes, highlighting on social inclusion, human rights and recovery. Thus, the patient is capable to self- manage in the community with or without mental illness (Walker, 2017).
Nurses need to develop mindful and purposeful engagement with patients. The nurse promotes wellbeing and independence for their patients. A nurse should have the right attitudes and communication skill to work with very vulnerable people. When nurses are working with illness patients, they need to understand their symptoms and provide help and support with the family for the self-directed recovery, health education for the patient (Evans, Nizette & O’Brien, 2017a). Communication, assessment, motivational interviewing techniques, and recovery planning can help individuals to make decisions about their health (Elder, Even, Nizette, 2013a).
The nurse can enable social inclusion through, acts as advocate for the patient, in advocacy patients have their rights. The main purpose of advocacy is power sharing in decision making, caring and ensure quality care (Evans, Nizette & O’Brien, 2017a). Nurses provides education on various recovery models, health and how to access mental health facility. The nurse provides comprehensive care to the patients in the hospital, community, and another healthcare setup (Evans, Nizette & O’Brien, 2017a). Nurses need to focus on collaborative partnership and meeting the needs of people with mental health issues, family and communities to promote opportunities (Duvetyn, 2018).
Nurses have a significant role in this recovery model (Duvetyn, 2018). Nurses are in a unique position to help people in assessing their personal health status and protecting their rights, values, culture and well-being. They facilitate various groups like psychoeducation groups, family groups, therapeutic groups. Nurses also act as a link with other discipline, agencies. Nurses help the patient with physical aspects of healing as same holistic care (Duvetyn, 2018).
Young adulthood (18 to 26 years) is the healthiest as well as the risk-taking time of life. During this age, if a person becomes ill it will continue until the end of their life. As a health report shows that, this age group are most affected with mental health illness (depression, schizophrenia, anxiety, eating disorders). But these cases are being undetected or untreated sometimes in the early stage, this leads to more complicated mental health problems in their later life. Therefore, the family, school, co-workers and nurses can help them with the recovery and bring them back to a healthy lifestyle. The MHF and MOH reports, strategies, initiative and community support organization are the navigators for the recovery of the person and their wellbeing. The opportunities promote the social inclusion in the community. The tidal model recovery help mental illness person to realizes his or her own potential, can cope with illness and get back to her or his community and have quality life. Nurses play central roles in patients’ life during their illness, which help them in recovery and promote healthy life in the community.
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