Mental Health Nursing: Stress & Vulnerability Model

Stuart outlines the Stress & Vulnerability Model and explains how understanding it could help you in your role.

Topics Covered In This Article

Introduction

Defining Mental Health

Understanding The Cause

What Is The Model?

Coping Is Important

What Can Be Done?

Validation

What Is Recovery?

Conclusion

Introduction

Hi, my name's Stuart Sorenson and I'm a mental health Nurse and trainer.

In this video I'd like to talk about different interpretations of mental health and disorder, how they vary, and how we as Mental Health Nurses can use the stress and vulnerability model to cut through the disagreements and focus upon the distress that brought the person into our care in the first place.

Mental health is difficult to define in any meaningful way.

Like total physical health, total mental health is probably unattainable.

The World Health Organization definition for health includes the notion of well-being, and not merely the absence of disease.

Because health isn't just about symptoms but because there's no definition of perfect mental health, it's impossible to define without considering symptoms.

The definition of mental health varies from culture to culture and era to era. This is why things such as same sex attraction used to be evidence of mental disorder in UK, but now it's seen as perfectly acceptable.

Defining Mental Health

One definition of mental health then maybe to live within societies norms, but that also creates problems because it can stifle growth and individuality.

In practice, it's often best to avoid these considerations altogether and focus upon the individual's experience and levels of coping, versus distress.

Throughout history, mental disorder has been seen in different ways from God's curse to an imbalance of the four humours.

People had holes drilled into their skulls, burned at the stake, burned, stabbed, bled, imprisoned, exorcized.

Today, we like to think we're more enlightened than that, but that's not necessarily the case.

People diagnosed with serious and enduring mental disorders are regularly condemned wholesale in the media.

And those with less serious disorders report widespread prejudice and an attitude of “pull yourself together.”

If it was that easy, they'd have done it.

The concept of social drift makes it very clear that people diagnosed with any form of mental health problem are far more likely to lose their jobs than they are to gain one.

Understanding The Cause

We still don't even agree in the modern world about the causes of mental disorders.

Doctors might tell you it's all biological.

Hence, the use of biological medications.

Social workers might concentrate upon the effects of attachment, culture, and society in general, while psychologists focus upon thinking style.

Interestingly, exorcism of people with mental disorder is currently on the rise throughout the UK and the wider world, resulting in several deaths due to the physical stresses of some exorcism rituals.

Fortunately, there is a way to make sense of this situation, and even include elements of all the other conflicting theories, even though many of them are magical explanations tend to be seen as psychological or cultural, rather than real spiritual influences.

What Is The Model?

Welcome to the stress and vulnerability model of mental health and disorder, a much more inclusive way of thinking about mental health problems.

There really is something here for everyone.

People become ill when the stress they face becomes more than they can cope with.

Also, people's ability to deal with stress, therefore, their ability varies, so problems which one person might take in a stride could cause another person to become mentally ill.

People with low vulnerability need a great deal of stress to become unwell, whereas those with high vulnerability need only a small amount of stress to tip them over the edge.

So, what causes the difference in people's vulnerability?

What makes one person more vulnerable than another?

Evidence from family studies, particularly studies involving twins seem to show a strong genetic element.

It seems in one aspect of a person's vulnerability is related to their genetic makeup.

However, this isn't the whole story.

Other biological factors and stressors include poor diet, overwork, exhaustion, sleep deprivation, the use of substances, illicit and prescribed, infection, and other illnesses, inadequate oxygen supply, and even constipation.

We're biological organisms, and as such we're extremely vulnerable to stresses that interfere with normal biological function.

Coping Is Important

Coping style is important too.

Good coping, effective coping, involves maintaining relationships and supportive friendships, not driving them away.

It also involves being open to experience and learning how best to deal with situations as they arise.

People who use effective coping skills seem to deal with stress better than those who don't.

They can handle much more stress before they develop symptoms of mental disorder.

Thinking style, how a person thinks about themselves or the world around them seems to make a major difference to their level of vulnerability and stress.

This is more than simply being optimistic or pessimistic.

There are certain thinking methods which help people to cope better than others.

The way a person deals with stress and the options they have are often related to their environment.

Anything, from the state of a person's home, to the neighbourhood they live in can make a difference.

This is true, even at the most basic level, the environment in which we live has a huge impact upon our mental health and can certainly contribute to a range of psychological problems.

Then, there are social skills, let's not overlook those.

The better a person's social skills, the easier it is for them to get other people to help them when things get too much for them to handle alone.

People with lots of supportive friends tend to do better at time of crisis than people with fewer, or perhaps no other people to turn to.

What Can Be Done?

So, what can be done?

Well, often we can reduce the amount of stress people find themselves under.

It's surprising how much can be achieved by making a few relatively simple lifestyle changes.

And this can have a huge impact upon the risk of further episodes of illness.

Learning disability isn't a mental disorder, but it can increase vulnerability.

Because learning disabilities make it more difficult to develop and manage coping strategies, at least it can.

It's not that it will necessarily, by the way.

In the simplest terms, by the way, mental disorder's really only a combination of three types of symptom: anxiety, physical, and psychological arousal, depression, that's physical and psychological de-arousal, and psychosis, which is hallucinations, delusions, and thought disorders.

All mental disorders, except the dementias which also include memory and orientation problems, are made up of combinations of these three types of experience or people's vulnerability to them.

Personality disorders are diagnoses based upon the way people usually think and behave could be here for their susceptibility to anxiety, depression, and psychosis.

That there's a major link between high expressed emotion from other people and mental disorder.

Expressed emotion falls into three categories: aggression and hostility, criticism, and emotional over-involvement.

Workers who understand and work towards eliminating these interruptions with service users, especially the over-involvement part, can have a major positive impact upon their well-being.

Validation of the person as an individual with their own rights, choices, and values is extremely important, especially when, arguably, invalidation is just the American restatement of high expressed emotion.

Validation

Devised by Marsha Linehan in Seattle, validation is one of the core concepts of dialectical behaviour therapy.

Originally designed for use with people with borderline personality disorder, it's proving extremely useful for people with widely differing problems. Both expressed emotion and validation complement Bowlby's original work on attachment.

What Is Recovery?

So, what's recovery?

Well, this doesn't mean perfection.

Nobody ever achieves that anyway.

It simply means being as good at coping as the average person, that's good enough.

Based upon this there are essentially three types of recovery.

It's what's known as the tripartite model of mental health recovery.

We have medical recovery, an absence of symptoms.

Social recovery, the person has a value placed in their society.

And psychological recovery, the person has developed effective coping strategies and isn't distressed by their experiences or symptoms.

Many would argue that any two out of the three are enough.

Mediums who claim to converse with spirits, religious people who see visions or communicate with guardian angels, hear voices that other people don't.

But they're accepted by society in spite of, and sometimes because of their experience.

According to Roman Asher's research, around 10% of the population hear voices, but they're not at all distressed by them.

They have psychological and social recovery.

Actually, many of these people would argue that they haven't recovered at all. They'll tell you that the were never ill in the first place, only different.

We can see then that there are many different ways to think about the experiences we call mental disorders.

And they're not always to do with anything much about the distressed person, so much as their experiences and circumstances.

Conclusion

So, rather than concentrate too much upon the definition of symptoms, although that's important, the real trick is to focus upon how the distress a person feels.

And work with them to find ways to overcome it.

That involves identifying the stressors, which can be biological, psychological, social, environmental, or developmental.

And then working to mitigate the stresses, their fears, at the same time as helping them to learn new ways to deal with the unavoidable.

That way we as Nurses really can be person-centred and holistic in our work.

My name's Stuart Sorenson, I'm a mental health Nurse and trainer; thank you for watching.