HOW DO WE INCREASE MENTAL HEALTH?

by Gisli Kort Kristofersson

There are many ways to increase our overall mental health, some of them have mountains of data to back them up, while others are more individualized and have more indirect evidence. What is most important to remember, is that what works for one, does not necessarily work for someone else. All of us have different brains, different backgrounds, different goals and abilities. The best way to find what works for you is to try different things; what works for you, keep it going. What doesn't work for you; stop it and try something else. 

Simple, but not easy. 

Risk assessment

When deciding which steps are most beneficial to your own mental health,  it is important to follow the words of Hippocrates, the father of medicine, primum non nocere  (first: do no harm). He taught us to use only the most serious components in the most serious cases: That the risks of treatment should remain proportional to the severity of symptoms to be treated or prevented. 

Many psychiatric nurses deal with chronic work-related stress and thus need to mind their mental health particularly well. Prevention is always better than treatment, and better is never broken than healed. Although some of us that have been broken have healed pretty well… 😉

 The mental health toolbox contains examples of things that can have a protective effect on our mental health. But the most important thing is to remember that all of us are unique and all of us have different brains and personalities. Find what nourishes you: singing in a choir, psychotherapy, type of exercise (the walking counts too!), meditation approach, support system, or medications in consultation with your prescriber (if the problem is serious). Our psychiatric health is not in a box, it is a part of our overall health and just as important as our physical health. Taking responsibility for one is an essential party of taking responsibility for the other. 

Medications

Psychotropics are often enormously beneficial and many of them have excellent evidence in certain cases.  However, side effects and interactions for those suffering from chronic disorders that require complex medication are sometimes  troublesome. Psychotropics should therefore be used when the problem has become serious and/or other simpler and safer approaches have not been successful.

Psychotherapy

Is an extremely useful approach in many cases. In most cases the risk is fairly low compared to possible benefits, and interactions- and side effects are extremely rare. If one approach or psychotherapist is not suitable, you can always try a new psychotherapist or a new approach. When searching for a psychotherapist, we would recommend someone with a graduate degree and fairly extensive training and experience, e.g. psychiatric nurse, psychologist, psychiatrist or social worker. Do not be afraid inquire about the therapists credentials and training as well as their experience.  

Clinical supervision

Many psychiatric nurses find it helpful to receive clinical supervision from a trained psychotherapist, either from within or without of their profession. In some countries specific credentials exist for those who deliver such care but in many psychotherapy training should also prepare for the role of clinical supervision. It is important that psychiatric nurses receive regular clinical supervision and whenever possible include that as a component or benefit related to their employment. 

Exercise

Numerous studies have demonstrated the association between exercise and improved mental health. Find a way to move your body: thirty minutes three times a week is a good start. And remember, walking is a exercise too! Look not just at exercise as part of cultivating physical health, but your mental health too. 

Yoga: Yoga is slowly accruing evidence that it may help with various mental health symptoms such as symptoms of anxiety and depression. Most Yoga approaches are relatively safe and inexpensive and it is slowly becoming more and more accessible throughout Europe. Not much evidence exists for the protective effects of Yoga on mental health, although they are increasing. Yoga is both movement and meditation and considering the studies that exist in these two areas we do not need much imagination to assume that Yoga can have a positive impact on mental health in some cases. Serious adverse effects of Yoga are not very commonly seen in the literature if you are careful and interacting with other treatments is also very rare. 

Meditation

As with exercise, studies of meditation, especially mindfulness, have demonstrated increasingly more compelling evidence on the efficacy of meditative practices on mental health symptoms such as anxiety, sleep and milder types of depression. Mindfulness is the approach of meditation that has been used most in the research field in the last few years. 

Mindfulness is about noticing, in the the moment, without judging. A  large number of books and websites exist with good instructions, and exercises for mindfulness, but we can specially recommend the books of Thich Nhat Hanh and Jon Kabat-Zinn listed in the reference list below.

Social connections and relationships

We often forget how our connections with others are important to our mental health but the data is quite clear on that. The quality of our relations, of course, also matters. But for those who are under long term stress, the risk of perceived loneliness and social isolation is very real. So create and maintain nutritious relationships that are positive and supportive in nature. We can use various support groups, NGO´s, online forums and professional venues, for example with other psychiatric nurses to seek out and build nurturing and perhaps mututally supportive relationships. 

Vitamins and Supplements

For those who deal with chronic occupational stress the use of certain vitamins and supplements can often be helpful. When it comes to positive affective effects on mood, vitamin D, Omega 3 oils and certain B vitamins have the best risk benefit profile. Some evidence is also accruing on the possible beneficial effects of certain probiotics on our mental health although we are still in the early stages of that development. It is important to consult with the appropriate healthcare professionals before any vitamins and supplements are used as side effects and interactions with other medications can occur, sometimes with serious consequences.

Omega 3 Essential fish Oils

The positive effects of Omega 3 on mood have long been maintained with leading experts in integrative mental health swearing by its efficacy and its anti-inflammatory effects making it an essential part of many nutritional recommendations regardless of their effect on mental health. Due to its beneficial risk/benefit profile many experts recommend supplementing ones diet with Omega 3 fatty acids, although mono-therapy for depression does not have significant clinical evidence behind it at this time. There are some indications that Omega 3 does have increased efficacy in depressed consumers with a comorbidity of anxiety disorders although this needs more study. Usually a combined dose of DHA and EPA should be about 1 gr. a day, with some studies using larger doses (3 grams a day or more of combined Omega 3 fatty acids). 

Vitamin D

Vitamin D supplementation has not been shown to reduce symptoms of depression directly but the benefits of physical health of rectifying Vitamin D deficiency might indirectly positively affect symptom of depression for those affected. Epidemiological studies have demonstrated a correlation between low Vitamin D levels and depression, so consumers with symptoms of depression should be screened for Vitamin D deficiency and if they are found to be deficient should be treated with supplements. Vitamin D deficiency is especially important to screen for if there is minimal exposure to sunlight, in inner city populations and in the elderly. If levels are low one can either load up with a once a week dose of 50.000 IUs of Vit D3 for a few weeks (6-7) or start taking a supplement daily, with doses ranging from 1000-5000 IUs a day depending on levels of deficiency.

B Vitamins

Vitamin B6 might reduce symptoms of depression of pre-menopausal women, although more evidence is needed on this. There is not clear evidence for other benefits of Vitamin B on mood. There is some evidence that indicates that adjunct therapy of Folate with SSRI does reduce symptoms of depression. Folate is a relative safe water soluble vitamin, and the evidence for its use as adjunct in addressing symptoms of depression are somewhat strong, although more studies are needed. Some experts recommend the taking Vitamin B12 with Folate as Folate can mask Vitamin B12 deficiency

Nutrition and Diet

The effects of nutrition and various dietary deficiencies on mood and overall mental health have long been established. Despite this we mental health professionals too often ignore the effects that malnutrition can have on mood. We should not hesitate to seek the aid of qualified professionals such as nutritionists as needed when it comes to assessing and addressing dietary issues with ourselves or our clients. But protein deficiency as well as lack of intake of certain vitamins and minerals can certainly lead to the exacerbation of specific mental health symptoms 

Spirituality

Cultivating and expanding their spiritual lives may prove to be helpful to many. Prayer and religious practice seem to be able to have a positive and protective effect on mental health in certain cases. A broad definition of spirituality that includes search for meaning and purpose can be helpful for others. 

Selected references that can be placed under each category.

Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., ... & Mead, G. E. (2013). Exercise for depression.  Cochrane Database Syst Rev, 9.

Dakwar, E., & Levin, F. R. (2009). The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders.  Harvard Review of Psychiatry, 17(4), 254-267. 

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis.  Journal of Psychosomatic Research, 57(1), 35-43. 

Hanh, T. N. (2008).  The Miracle of Mindfulness: The Classic Guide to Meditation by the world's 

most revered master. Random House.

House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health.  Science, 241 (4865),

540-545.

Kabat-Zinn, J., & Hanh, T. N. (2009).  Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Random House LLC.

Koenig, H.G. (2004). Religion, Spirituality, and Medicine: Research Findings and Implications for Clinical Practice. Southern Medical Journal, vol. 9.

Lake , J. ( 2009 ). Integrative Mental Health Care: A Therapist’s Handbook.  New York: W.W. 

Norton & Company .

Parhami, I., Fong, T. W., Siani, A., Carlotti, C., & Khanlou, H. (2013). Documentation of Psychiatric Disorders and Related Factors in a Large Sample Population of HIV-Positive Patients in California.  AIDS and Behavior, 17(8), 2792-2801.

Stuart, G. W. (2013) 10th ed. Principles and practice of psychiatric nursing.  St. Louis, Mo. : Elsevier