Mental Health Assignment: Critical Discussion On Women’s Health

Question

Task: For assessment 3 you have a number of tasks to complete. The assignment does not have to be written in essay format - it is recommended that you structure your assignment as a series of short answer questions (not bullet points) using the numbered questions provided. Please note that a large amount of the word count for this assignment should be used to address tasks 3 and 4 and references should be used to support this assessment.

Task 1: Identify and briefly describe a specific area of your practice in which you have a particular interest or where there is uncertainty/ differing opinions about the provision of care.

Task 2:

1. Develop a specific searchable question using the PICO format or similar based on the area of practice described in task 1.
2. Conduct a search for the highest levels of evidence that you can find to answer your question (refer to levels of evidence models/frameworks). The 3 highest pieces of research evidence found should be selected. Succinctly describe your search process and provide justification of the resources that you chose to search, and the evidence selected (discuss where your evidence sits within a levels of evidence model/framework). Attach the abstract/s or summary/summaries of the high level evidence to your final assignment.

Task 3: Compare and contrast the findings from the high-level evidence to current practice in your clinical setting. Your discussion should highlight the level of evidence and strength of the recommendations and clearly discuss any differences that exist between the evidence-based recommendations and current practice in your clinical setting. If you are unable to find high level evidence and/or clear evidence-based answers to your question then this should be discussed, including reasons why you think this evidence does not exist or is poorer quality evidence.

Task 4: Discuss the barriers to EBP that may exist in your specific clinical setting, and how these barriers may be overcome, and/or strategies that promote EBP within your practice setting.

Answer

Introduction:
Task 1:
It has been observed by several types of research conducted on the mental health assignment that, women with mental health disorders are most likely to get pregnant and give birth to children. The researches focus on the mental health of the mothers and the risk factors associated with the health and parenting of the children. Women suffering from mental health disorders getting pregnant are a matter of concern for the family as they have a conception that the unborn child may also develop with some mental health disorder. This misconception mentioned in the present context of mental health assignment has always been affecting the treatment and recovery of the mother and the child during their conception period. A child will have a risk of attaining mental disorder from the mother only if the mother has a genetic or hereditary history of mental illness (Sivaraman et al., 2018).

It is important to conduct gender-based mental health services and treatment as it varies in men and women. There are conditions where the mother is not in a state to make an appropriate decision on getting pregnant and giving birth to a new-born, yet they are witness conception and giving birth to children whom they are no able to take care of. In the early years, it was observed that women with mental health conditions had less rate of conception, but as the year are passing the rate of conception are increasing. While preparing mental health assignment, the research considers several cases where a patient with mental health condition witnesses abuse and assault which leads them towards pregnancy and childbirth (Nguyen et al.,2017). This creates a condition of unaware and critical pregnancy for the mothers, as it lacks the situation of effective decision making.

It becomes a matter of risk for the mother and child during the pregnancy as it takes a lot of treatment and medication to help overcome and individual from their mental health condition. Medication administration may not be a suitable measure in such a condition as it may have its toxic effect on the unborn child (Gressier et al., 2017).

Several challenges take place within this mental health assignment while addressing a patient with severe mental health, the incident of pregnancy increases the risk factor and complexity in the treatment and assessment process. Thus, it is necessary to develop and apply strategies ad interventions which will be beneficial in attaining better health and recovery for these pregnant mothers and the child.

PICOT Question:
Task 2a:

PICOT question: Does the pregnancy of women with severe mental illness creates a matter of concern and how effective is the interventions available for the safety of the mother and child during the pregnancy and motherhood?

Task 2b:
The literature review of mental health assignment has a major part in providing a comprehensive understanding of the information and data which exists regarding the research topic that needs to be investigated. It provides an in short idea about the whole article which needs to be addressed. In order to attain already existing information and data about the research topic, it is important to first find out the appropriate articles with adequate information. It is important to plans the exploration of the appropriate article which can be conducted using search strategies. Search strategies help in breaking down the process of finding into the smaller division which makes it easier to locate the exact article for the literature (Ho et al., 2016). The research finding of mental health assignment demonstrated that the condition of preconception and childbirth in women with severe mental illness requires advanced and critical treatments to provide safety and recovery to both the mother and the child.

The first important step mentioned in the mental health assignment in the search strategy is to articulate the search and find the keywords which will help in extracting the articles from the database such as google scholar. The Centre for Reviews and Dissemination (CRD) provides an outline which helps in developing the keywords and also the variation in spellings, abbreviations and alternative word were taken into account. As the article utilized in the mental health assignment focuses on motherhood for women with severe mental health. The keywords that were used are “severe mental illness”, “pregnancy” and “motherhood”, “pre-conception” “mental health” and “women” (Ho et al., 2016). These words were combined with each other using “or” and “and” and were transferred to the database for the result. The bibliography of the articles was also analysed to obtain a better article with appropriate information that is required for the study.

Literature review:
Task 3:
According to the words of Sandoz et al., 2019 applied in the case of mental health assignment, the majority of the women who have been dealing with severe mental illness tends to get pregnant and have a child, either they are willing to have a child or not. Severe mental health condition makes an individual incapable of making the appropriate decision in life which makes them vulnerable to take care of themselves and the child during their pregnancy. There are several cases where women with severe mental illness witness’s pregnancy due to sexual assault or harassment. It makes the health condition of the patient much more severe and critical to handle.

There are several factors that are involved with the condition of mental health patients getting pregnant and witnessing motherhood. There are cases where the mental health conditions of these women are misused and they end up getting pregnant. In such conditions, the women are not in a state to take wise or appropriate decisions for themselves of the child. Such cases develop a critical condition for the physical and mental health of the patient along with risking the life of the unborn child. There are several studies basis the case scenario of mental health assignment that demonstrated that many women lack awareness about their state of pregnancy and end up risking the lives of them. Often it has been observed that the families of the patient have the misconception of the transfer of the mental illness (Khan et al., 2016). They often believe that the mental illness of the mother will get transferred to the unborn child and the child will be the same illness throughout life. It causes a situation of careless and unfair pregnancy for women.

According to Dolman, Jones & Howard, (2013), treatment, and safety for the women and the child become a matter of concern for the healthcare professionals and the family. Thus, it becomes necessary to provide the mother and the child with appropriate safety and treatment intervention to endure better health. There are several studies where it has been discussed that medication administration may have a negative effect on the child during pregnancy. The administration of medications for the mental health conditions of the mother may end up causing a toxic environment for the child.

Depression and fluctuating mood are the common signs, one witness, during pregnancy, but it creates a situation of the critical outcome when a woman will severe mental illness goes through pregnancy signs. It increases the complexity of their mental health condition. As provided in this part of mental health assignment, it is important to provide appropriate interventions and management plans for the better outcome of the mental health of the women and the pregnancy. One of the most important and non-pharmacological interventions for addressing issues of mental health and pregnancy in women is counselling. Women with severe mental lines need advocacy, education, and awareness regarding their health, their pregnancy, and the fact of motherhood (McCauley et al., 2019). It will not only help them during their pregnancy but even after childbirth and decision making in child care. Counselling in a process of guiding people with mental health to control and manage their feelings, anxiety, depression, and overcome it with a good mood, happy environment, and positivity. It helps in boosting an individual moral and helping them overcome their deprived state of mind. Pregnancy includes several feelings such as guilt, sadness, depression, and anxiety (Jaiswal et al., 2017).

Counselling in women with mental illness has a special role in helping them control their illness and proving a safer and liveable environment for their child. The patients need education and awareness regarding their phases of pregnancy and the child they are going to give birth to. It is important to make them understand the importance of the child in their life and what good the child may bring to their life (Ramezani et al., 2017). There are certain cases where the father after pregnancy fights for the custody of the child as the mother witnesses’ mental health condition. It is important for the mother to attain appropriate interventions and treatment to control the state of mind in order to attain custody of the child after birth (Jones & Jones, 2017).

According to the words of Pan et al., 2019 considered in the mental health assignment, meditation has a major role in calming the cells and functioning of the brain. It helps in increasing the functionality of the body and reduces negativity and toxicity from the body. Meditation has been one of the interventions which are directed to women during their pregnancy for better health and safety of the unborn child. As medication administration is harmful in cases of pregnancy, it becomes essential for the healthcare assistants in providing counselling and meditation as a source of treatment for the women attaining motherhood during her severe mental health condition (Hall et al., 2016). It is argued on this mental health assignment that meditation has been helping several individuals to attain a healthy and better state of mind. It reduces stress, anxiety, and depression and is proven to be better than any of the antidepressant medications and drugs. Pregnancy and meditation have a long connection, as it has been practiced since very long and has provided positive feedback for the mother and the child (Abdi-Malekabadi, Tavakoli & Farzanfar, 2019).

The antidepressant has also been proven to be safe for women who are going through pregnancy, as they don’t have any negative effect on the child. But there is a condition where antidepressants may collaborate with other medical treatments provided to the mother and create a situation of toxicity for the child (Rai et al., 2017). There are several studies considered to support the readings of mental health assignment that demonstrated that mental health can be restored by meditation and counselling and it shows equal effectiveness as that of any medication (Saini, 2018). Medication administration may have its effect on the patients, but in cases of pregnant women, it becomes a matter of risk to provide medicine to the mother as it may end up affecting the child (Frayne et al., 2017).

Thus, it makes meditation and counselling a safer process to provide treatment to women with severe mental health illness during their phase of pregnancy. The research conducted has provided the idea that it is important to provide advocacy, education, support, and awareness to these women as it helps them go through a safer and healthier pregnancy period and motherhood in the future (Muthukrishnan et al., 2016). Childbirth has always provided these mothers with mental illness a new hope and happiness for better health which reflects on the mental health of the mother. Parenting and motherhood have helped reduce the complexity of mental illness in women and provided a path for better recovery and life (Boukakiou et al., 2019).

What is the main barrier in the practice outlined in the present context of mental health assignment?
Task 4:
It is evident in the present context of mental health assignment that one of the major needs during pregnancy for women with mental illness is the family and peer support. It is important for the patient to have a feeling of support during such a critical period of life. There are cases where it has been observed that, after pregnancy, the patients’ health starts getting worse. It is because of the pressure and criticism the patient witness from the peer and family reading their ability to take care of the child and upbringing. The state od critic develops a barrier in the process of treatment and pregnancy for these women. They start attaining depression and anxiety on the fact that whether they will be capable enough to take good care of their child and give them a safer life (Boukakiou et al., 2019). Often it has been seen that women due to criticism and lack of support give their child for adopting things that they will not be a good mother for their child.

There are several barriers as outlined in the mental health assignment that keep the nursing staff devoid of providing evidence-based practice. These general barriers are present in every field of healthcare practice such as lack of time, lesser knowledge about the database and evidence tools, awareness and understanding of the importance of the practice as well as stick rules of the healthcare settings. It is important to incorporate evidence-based practice in a healthcare setting to provide the patients with appropriate treatment and care to focus on the diversity of health condition and treatment (Genovez et al., 2018). In order to provide interventions and strategies regarding the treatment and recovery of a patient with mental illness during their pregnancy, it will be necessary to attain vast knowledge and understanding regarding the matter and available information. It is important that the involvement of the healthcare facilities and family be equal in cases where medication and other critical treatments cannot be provided to the patient.

It is important that the treatment that is provided to these patients has its effectiveness and better outcome ion the patient. Thus, analysis and understanding of the interventions will be required to attain success. One of the major barriers discussed in this section of mental health assignment that take place is lack of knowledge regarding the non-pharmacological treatment for these patients which creates a matter of unsure for the families of the patient. According to the families, medication only has a better effect on the mental health of the patient but they lack the understanding that it will also harm the health of the child. Thus, it is important to generate awareness and education among the health care facilities and families of the patient to provide counselling and meditation for the patient with mental health condition during their pregnancy (Genovez et al., 2018).

Thus, the readings obtained from the analysis on mental health assignment signify that it is important that every needs and requirement of the strategy implication are met in order to provide the patient and family with assurance and safety regarding the child and the mother. The intervention that is analyzed to be effective such as counselling and medication has its effects on the mother and the child along with the families. This strategy provided in the mental health assignment has its effectiveness for the long run of parenting and motherhood, as the guidance and knowledge provided to the patient will remain constant and will prove beneficial for the up brining of the child and restoring the mental illness of the patient. The process of counselling and meditation has been providing affective outcomes among people with mental health and has positive outcomes on pregnant women and children. These interventions have provided safer and healthier motherhood to women who have been living with the severe mental health condition.

Conclusion:
To conclude the overall discussion on mental health assignment, it can be stated that, mental health in one of the health conditions which affects an individual and the people associated with the person. Women often witness stress, depression, and other mental health condition while they go through pregnancy. But the majority of the women with severe mental health illness go through pregnancy and witness childbirth. The condition of pregnancy in women with severe mental health occurs due to sexual abuse and assault, lack of judgment, unstable health conditions, and poor decision-making capability. Women in such a scenario lack family support and care which makes them vulnerable to effective treatment. Medication and drug administration to these women may show a negative effect on the women and the child’s health. Thus, it increases the risk factors associated with the health of the patient. It becomes important to provide them non-pharmacological treatments and interventions to continue a healthy and safe pregnancy and motherhood.

Reference:
Abdi-Malekabadi, F., Tavakoli, S. M., & Farzanfar, A. (2019). The Effectiveness of Mindfulness Training on Self-Compassion, Sexual Satisfaction, and Pregnancy in Pregnant Women. Mental health assignment International Journal of Body, Mind and Culture, 6(3), 160-167.

Boukakiou, R., Glangeaud-Freudenthal, N. M., Falissard, B., Sutter-Dallay, A. L., & Gressier, F. (2019). Impact of a prenatal episode and diagnosis in women with serious mental illnesses on neonatal complications (prematurity, low birth weight, and hospitalization in neonatal intensive care units). Archives of women's mental health, 22(4), 439-446.

Dolman, C., Jones, I., & Howard, L. M. (2013). Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of women's mental health, 16(3), 173-196.

Frayne, J., Nguyen, T., Bennett, K., Allen, S., Hauck, Y., & Liira, H. (2017). The effects of gestational use of antidepressants and antipsychotics on neonatal outcomes for women with severe mental illness. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(5), 526-532.

Genovez, M., Vanderkruik, R., Lemon, E., & Dimidjian, S. (2018). Psychotherapeutic treatments for depression during pregnancy. Clinical obstetrics and gynecology, 61(3), 562-572.

Gressier, F., Guillard, V., Cazas, O., Falissard, B., Glangeaud-Freudenthal, N. M., & Sutter-Dallay, A. L. (2017). Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. Journal of psychiatric research, 84, 284-291.

Hall, H. G., Beattie, J., Lau, R., East, C., & Biro, M. A. (2016). Mindfulness and perinatal mental health: a systematic review. Women and Birth, 29(1), 62-71.

Ho, G. J., Liew, S. M., Ng, C. J., Shunmugam, R. H., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. Mental health assignment PloS one, 11(12).

Jaiswal, K. V., Jaiswal, K. M., Jaiswal, K. J., & Jaiswal, J. (2017). Evaluation of Knowledge, Attitude and Practice of Transcendental Meditation in Pregnant Women. Int. J. Life. Sci. Scienti. Res, 3(6), 1462-1466.

Jones, S. C., & Jones, I. (2017). Pharmacological management of bipolar disorder in pregnancy. CNS drugs, 31(9), 737-745.

Khan, S. J., Fersh, M. E., Ernst, C., Klipstein, K., Albertini, E. S., & Lusskin, S. I. (2016). Bipolar disorder in pregnancy and postpartum: principles of management. Current psychiatry reports, 18(2), 13.

McCauley, M., Abigail, B., Bernice, O., & Van Den Broek, N. (2019). “I just wish it becomes part of routine care”: healthcare providers’ knowledge, attitudes and perceptions of screening for maternal mental health during and after pregnancy: a qualitative study. BMC psychiatry, 19(1), 279.

Muthukrishnan, S., Jain, R., Kohli, S., & Batra, S. (2016). Effect of mindfulness meditation on perceived stress scores and autonomic function tests of pregnant Indian women. Journal of clinical and diagnostic research: JCDR, 10(4), CC05.

Nguyen, T., Hauck, Y. L., Pedruzzi, R. A., Frayne, J., Rock, D., & Dragovic, M. (2017). Sexual health and sexual trauma in women with severe mental illness: An exploratory survey of Western Australian community mental health services. Health care for women international, 38(7), 705-714.

Pan, W. L., Chang, C. W., Chen, S. M., & Gau, M. L. (2019). Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood-a randomized control trial. Mental health assignment BMC pregnancy and childbirth, 19(1), 346.

Rai, D., Lee, B. K., Dalman, C., Newschaffer, C., Lewis, G., & Magnusson, C. (2017). Antidepressants during pregnancy and autism in offspring: population based cohort study. bmj, 358, j2811.

Ramezani, S., Khosravi, A., Motaghi, Z., Hamidzadeh, A., & Mousavi, S. A. (2017). The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women. Journal of reproductive and infant psychology, 35(2), 172-182.

Saini, P. (2018). Benefits of Meditation during Pregnancy. Skin.

Sandoz, V., Deforges, C., Stuijfzand, S., Epiney, M., Vial, Y., Sekarski, N., ... & Porcheret, K. (2019). Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START). BMJ open, 9(12).

Sivaraman, S. V., Thippeswamy, H., Philip, M., Desai, G., & Chandra, P. S. (2018). Is maternal-fetal attachment affected in women with severe mental illness. Mental health assignment Journal of Prenatal and Perinatal Psychology and Health, 32(4), 306-317.

Appendix:
Search strategy:
There was a set of inclusion and exclusion criteria which is mentioned below within this mental health assignment, on the bases of which the articles were selected and omitted for the literature review. The research articles obtained in the Google scholar database were later filtered based on their year of publishing, language, and involvement of the keywords. The first priority on the basis of which the articles were listed in and out was the language they were published in. the articles which were published in the English language were selected and the others were removed from the list. The articles used to develop this mental health assignment that were selected were al published from 2016 till 2020, and the articles which were published before the year 2016 were omitted from the list. After the selection and omission based on year articles with appropriate topics and information were selected for further analysis and selection. The articles utilized in the current mental health assignment which discussed pregnancy and mental health of women was selected for the study. Later, the articles which were reviewed by the peer were taken for the study, and rest were omitted from the process.

Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness
Dolman, C., Jones, I., & Howard, L. M. (2013). Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of women's mental health, 16(3), 173-196. https://doi.org/10.1007/s00737-013-0336-0

Abstract
The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis presented in the mental health assignment was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven databases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified in this mental health assignment that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes included the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.

Psychotherapeutic Treatments for Depression During Pregnancy
Genovez, M., Vanderkruik, R., Lemon, E., & Dimidjian, S. (2018). Psychotherapeutic treatments for depression during pregnancy. Clinical obstetrics and gynecology, 61(3), 562-572. https://doi.org/10.1097/GRF.0000000000000388

Abstract:
Depression during pregnancy is a significant public health problem that is associated with adverse consequences for women and children. Despite the availability of treatment options, depression during pregnancy is often undertreated. Most pregnant women prefer nonpharmacological interventions over antidepressant medications. We review the evidence base for psychotherapeutic treatment approaches to depression during pregnancy. Treatments reviewed include interpersonal therapy, cognitive-behavioral therapy, behavioral activation, and mindfulness-based cognitive therapy. We review both traditional face-to-face delivery and digital interventions in order to develop this mental health assignment. We conclude with recommendations for treatment preferences, collaborative decision-making, and strategies to improve uptake of such services among prenatal women

Effect of Mindfulness Meditation on Perceived Stress Scores and Autonomic Function Tests of Pregnant Indian Women
Muthukrishnan, S., Jain, R., Kohli, S., & Batra, S. (2016). Effect of mindfulness meditation on perceived stress scores and autonomic function tests of pregnant Indian women. Journal of clinical and diagnostic research: JCDR, 10(4), CC05. 10.7860/JCDR/2016/16463.7679

Abstract
Introduction
Various pregnancy complications like hypertension, preeclampsia have been strongly correlated with maternal stress. It is presented in the mental health assignment that one of the connecting links between pregnancy complications and maternal stress is mind-body intervention which can be part of Complementary and Alternative Medicine (CAM). Biologic measures of stress during pregnancy may get reduced by such interventions.

Aim
To evaluate the effect of Mindfulness meditation on perceived stress scores and autonomic function tests of pregnant Indian women.

Materials and Methods
Pregnant Indian women of 12 weeks gestation were randomised to two treatment groups: Test group with Mindfulness meditation and control group with their usual obstetric care. The effect of Mindfulness meditation on perceived stress scores and cardiac sympathetic functions and parasympathetic functions (Heart rate variation with respiration, lying to standing ratio, standing to lying ratio and respiratory rate) were evaluated on pregnant Indian women.

Results
The results found from the analysis done in the mental health assignment depicts that there was a significant decrease in perceived stress scores, a significant decrease of blood pressure response to cold pressor test and a significant increase in heart rate variability in the test group (p< 0.05, significant) which indicates that mindfulness meditation is a powerful modulator of the sympathetic nervous system and can thereby reduce the day-to-day perceived stress in pregnant women.

Conclusion
The results of this study provided in this mental health assignment suggest that mindfulness meditation improves parasympathetic functions in pregnant women and is a powerful modulator of the sympathetic nervous system during pregnancy.