Post by marion on Nov 20, 2007 13:17:50 GMT
;DHi everyone
As some of you may remember I have done an essay on PNI for my foundation degree course. I thought some of you may be intereseted in reading it (or maybe not as it does go on a bit) so I have posted it below. Enjoy!!!!!!!!!!!
Marion Hawker
What is Health?
When looking at health, both physical and mental, it is important to define what it means. Generally it can be seen as a state of well being where you are free from disease or mental illness. The Department of Health (2004) describes how the Government is committed to ensuring “Good health for everyone in England”. Seedhouse(1986) suggested that “Health is a commodity. That is something – albeit an amorphous thing – which can be supplied. Equally it’s something that can be lost”. He suggested that we could buy health (for example health insurance) and loose health (in an accident). He suggested it was just another commodity we all have access to.
Talcott Parsons (1972) suggested that each of us has a role in life, which contributes to our health. These roles are such things as mother, father, sons, lecturer, student, doctor, nurse etc and if we could perform these roles successfully then we were healthy.
A Marxian definition was provided by Kelman (1975) who suggested that a community is healthy if the money we pay into the health service is les than or equal to the amount of money we get from having a healthy workforce.
The Black Report (1980), published by the Department of Health and Social Security, stated that although health had improved since the introduction of the welfare state, there were still widespread health inequalities and problems. The problems were caused by issues such as poverty and the gap between the upper and lower classes which must be reduced to combat these problems.
In 1948 the World Health Organisation (WHO) defined health as a 2state of complete physical, mental and social wellbeing”. This was later updated to include the ability to lead a “socially and economically productive life”.
What is Mental Health?
Mental illness is very common and 1 in 4 people will suffer from it at some point in their life. Mind (2005) suggests there is a lot of controversy into what causes it and how people can be helped to recover. People’s relationships can be affected by mental illness as it affects the way people think, feel or behave. Therefore Mind believes mental illness is a difficult condition to deal with not only for the sufferer but for family and friends as well.
Mind goes onto state that mental illnesses are the least understood conditions in society and they still have some social stigma attached to them. People may face prejudice and discrimination but Mind believes people can still lead fulfilling lives with the appropriate medical intervention and support. This can take the forms of drugs but for others cognitive treatments are more effective.
Medical treatment may only be a small part of what helps a sufferer to recover. Mind says that “seeing someone’s problems solely as an illness that requires medical treatment is far too narrow a view.” It is important to look at the other factors in someone’s life that influence their thoughts and feelings. These too can cause their mental distress. Many non-medical treatments are available but sufferers do not generally explore these.
What is Postnatal Depression?
A survey from the Royal College of Midwives where 500 people were surveyed suggests that twice as many mothers suffer from postnatal depression (PND) as previously realised. Once in five mothers suffers from the conditition which comes at a very difficult time in their lives. Mind (2006) describes how having a baby is thought to be a great source of happiness but it brings with it a great source of anxiety. PND is a depressive illness according to Netdoctor that occurs after having a baby. PND usually develops within the first few months of having a baby but when PND stops and ordinary depression starts is unclear.
The Guardian estimates that 10% of new mothers suffer from some sort of depressive illness but in a new study 20% needed treatment for PND. This survey of 500 women by the Royal College of Midwives found that new mothers living in the Midlands (23%) and the North (21%) were most likely to get PND compared to just 16% of women living in the South of England.
Baby Blues
PND should not be confused with ‘baby blues’ according to Babyworld (2005). The physical and hormonal changes in the body women go through when returning to a non-pregnant state can cause periods of weepiness in the immediate post natal period. This period normally comes 2-4 days after the birth.
Doctor’s suggest that the weepiness may be due to the hormone levels and is so common that it is classed as normal Mind says that although it can be distressing medical professional do not take it seriously and it’s seen as a normal part of having a baby.
Baby blues rarely lasts for long but if the depression lasts for longer or gets worse it may be turning into PND.
Symptoms of Postnatal Depression
PND can be different for everyone. However, according to Veritee’s PNI (postnatal illness) Website the can include some of the following:
• Anxiety and panic
• Some physical symptoms that are not usual such as chest pains, headaches, dizziness, some breathing difficulties
• Constant worrying about the health of yourself, your baby and your family
• Obsessive thoughts or repetitive, chanting thoughts or voices
• Thoughts that you will accidentally or deliberately harm your baby or another member of the family
• Fears you may physically or sexually abuse your baby
• Feeling of a ‘fuzzy’ or ‘muggy’ head
• Worries that everyday objects such as knives, stairs, cars could harm you and your baby
• Worrying about what could happen – ‘what if’ thoughts
• Feeling you are a bad mother or person
• Obsessions about yours and the families health and obsessions you could die
• Constant feelings of doom or dread – as if something dreadful will happen
• Having a constant need to revisit the birth because it was horrible and you felt out of control
• Not being able to talk about the birth
• Feeling of great sadness and that life is not worth living
• Feeling you are causing your family sadness by being there and they would be better off if you were not there
• Numbness and lack of emotion
• Lack of feeling for the baby
• Hiding how you feel
• Actual self harm or the feeling you would like to harm yourself
• Difficulty sleeping or waking in a panic
• Feeling tired all the time even when you get enough sleep
• Drinking too much or the abuse of recreational drugs
• Irritability
• Loss of appetite
• Thoughts of suicide
• Feelings of worthlessness or hopelessness
A mother may feel just some of these symptoms whilst suffering PND.
Who may get Postnatal Depression?
PND can hit any mother. It does not discriminate between social class, race or religion. However, those from socially deprived homes where mothers have other issues to contend with duch as financial worry may be under more strain when caring for her family. Certain ethnic families have more support at home due to extended family living in the house so the mother may have more support and help with her baby. She is therefore at less risk of developing PND. There are other factors which have been identified as common in sufferers.
Netdoctor suggests that PND is more common in mothers who have had previous episodes of depression. These mothers can be monitored especially throughout pregnancy and following the birth for any signs of depression and treated quickly.
It is also thought that genetic factors may prove a higher risk. If there is a history of depression in the family the mother is thought to be at a higher risk of developing PND.
PND is also more common in mothers who have problems during their pregnancy. As suggested by Netdoctor, this may be life events such as death of a loved one, physical problems with the mother linked to the pregnancy or problems at work or in home life. Women who do not have support at home are also in a higher risk group.
Health visitors and GP’s offer a valuable service to mother’s when they have just gad a baby. Again, the service you may receive depends on the area in which you live and your social class determines whether or not you can pay for private care, the support from which may help prevent PND from developing. Mother’s from higher social class may have a better care structure in place as they live in a better area and are financially better off.
According to the Guardian a survey of 500 new mothers came up with the following results. Mothers living as married or actually married (18%) were less likely to get PND than mothers who were single (25%) or widowed (27%) as they had more support and help with the new born baby. The survey by the Royal College of Midwives also found that 14% of women in full time jobs and 16% of women in part-time jobs suffered PND, possibly due to the extra work strain put upon them at an already difficult time. Dame Karlene Davis, the secretary of the Royal College of Midwives said “The survey indicates that postnatal depression could be a lot higher than previously estimated and the reality is that the incidence could be even higher, as many women hide their symptoms and are too afraid to ask for help.”
Causes of Postnatal Depression
Mind (2005) has found that PND can occur whether or not the baby is your first and whatever your family circumstances. Some women are fine with their first baby but PND may develop with their second. Many causes of PND have been indentified. Babyworld (2007) detail the following causes:
• Unhappy childhood leading to a bad relationship with your own parents
• The lack of a mother figure to provide a close relationship in your own life
• No one to turn to for practical/emotional support
• Mixed feeling towards the baby
• Problems during the birth
• Difficult pregnancy
• Breastfeeding difficulties leading to feeling a failure
• Stress factors such as death of a loved one, moving house, divorce or separation
• Poor social conditions such as poor housing or unemployment
• The shock of becoming a mother
• Hormonal changes
• Previous episodes of depression
• Poor diet, particularly during pregnancy
The above can all have an affect on the onset of PND. The Royal College of Midwives (2007) say that in a survey of 500 women 41% said that their birth was very bad. Only 9% said they had a good birth experience in the survey. Babyworld (2007) states “A general rule of thumb applies by psychiatrists is that the more severe the bout of postnatal depression, the more likely it is that the origins could be hereditary.”
Treatment of Postnatal Depression
The first point of contact for the mother is the midwife who may refer the mother to the GP. According to BUPA (2007) GP’s and midwives are now trained to spot PND but where there is any doubt a questionnaire called the Edinburgh Postnatal Depression Scale is often used to get rid of that doubt. Anti-depressants are often prescribed although the Government is investing more money in Cognitive methods of treatment such as talking therapies. In some cases of PND anti-psychotics are also prescribed in conjunction with anti-depressants and in very severe cases ECT (electro convulsive therapy) is used to aid mothers in their recovery.
Treatment of PND varies according to the severity of the case. Where possible the mother is kept with her baby unless severely unwell when admission to hospital may be necessary. Even then, mothers may be admitted to a mother and baby unit so they can stay together but this is not always possible due to availability. Certain areas of the country do not have these units set up so admission may not be possible.
Birmingham and Solihull Mental Health Trust has a mother and baby unit set up at the Queen Elizabeth Hospital in Birmingham. The mother and baby unit provides care for both expectant mothers and mothers with their babies together. As with many other units throughout the country admission to the unit depends on where you live.
Once undergoing treatment the mother will be closely monitored by community health visitors and GP’s. Again, the level of care received depends on factors such as where the mother lives. Counselling may be arranged for the mother alongside the conventional treatments of anti-depressants. The mother and her treatment of the child will be observed until the mother feels she is well. Serives such as a Community Psychiatric Nurse (CPN) may be assigned to help the mother further.
The CPN visits the PND sufferer regularly as a follow up to what the dry/psychiatrist has done. The CPN visits sometimes weekly and reports back to the psychiatrist and rest of the team about the progress made. They can also pick up on any problems before they develop. The CPN is a qualified nurse who may have worked in mental health hospitals and have a good understanding of mental illness. They can be as good as a counsellor in some ways and work very closely with the sufferer.
Where admission to hospital has seemed necessary but is not possible, Mind (2007) details how home treatment may be used depending if it is available in that area. Home treatment consists of psychiatric nurses visiting patients on a daily basis and close liaison with the psychiatrist for ensuring that a good level of care is given in the home environment. This has been found to be very effective in treating mothers with PND as the mother is kept with the baby in the home environment.
PND can be a very debilitating illness for all concerned. Socially, having a baby can leave the mother very cut off from friends and support leading to the onset of the condition. Once in recovery it is essential to monitor the mother closely and keep the mother feeling secure and supported both through family and services to prevent relapse. Doctor’s stay heavily involved and work with support nurses such as CPN’s to ensure the mother stays well.
As some of you may remember I have done an essay on PNI for my foundation degree course. I thought some of you may be intereseted in reading it (or maybe not as it does go on a bit) so I have posted it below. Enjoy!!!!!!!!!!!
Marion Hawker
What is Health?
When looking at health, both physical and mental, it is important to define what it means. Generally it can be seen as a state of well being where you are free from disease or mental illness. The Department of Health (2004) describes how the Government is committed to ensuring “Good health for everyone in England”. Seedhouse(1986) suggested that “Health is a commodity. That is something – albeit an amorphous thing – which can be supplied. Equally it’s something that can be lost”. He suggested that we could buy health (for example health insurance) and loose health (in an accident). He suggested it was just another commodity we all have access to.
Talcott Parsons (1972) suggested that each of us has a role in life, which contributes to our health. These roles are such things as mother, father, sons, lecturer, student, doctor, nurse etc and if we could perform these roles successfully then we were healthy.
A Marxian definition was provided by Kelman (1975) who suggested that a community is healthy if the money we pay into the health service is les than or equal to the amount of money we get from having a healthy workforce.
The Black Report (1980), published by the Department of Health and Social Security, stated that although health had improved since the introduction of the welfare state, there were still widespread health inequalities and problems. The problems were caused by issues such as poverty and the gap between the upper and lower classes which must be reduced to combat these problems.
In 1948 the World Health Organisation (WHO) defined health as a 2state of complete physical, mental and social wellbeing”. This was later updated to include the ability to lead a “socially and economically productive life”.
What is Mental Health?
Mental illness is very common and 1 in 4 people will suffer from it at some point in their life. Mind (2005) suggests there is a lot of controversy into what causes it and how people can be helped to recover. People’s relationships can be affected by mental illness as it affects the way people think, feel or behave. Therefore Mind believes mental illness is a difficult condition to deal with not only for the sufferer but for family and friends as well.
Mind goes onto state that mental illnesses are the least understood conditions in society and they still have some social stigma attached to them. People may face prejudice and discrimination but Mind believes people can still lead fulfilling lives with the appropriate medical intervention and support. This can take the forms of drugs but for others cognitive treatments are more effective.
Medical treatment may only be a small part of what helps a sufferer to recover. Mind says that “seeing someone’s problems solely as an illness that requires medical treatment is far too narrow a view.” It is important to look at the other factors in someone’s life that influence their thoughts and feelings. These too can cause their mental distress. Many non-medical treatments are available but sufferers do not generally explore these.
What is Postnatal Depression?
A survey from the Royal College of Midwives where 500 people were surveyed suggests that twice as many mothers suffer from postnatal depression (PND) as previously realised. Once in five mothers suffers from the conditition which comes at a very difficult time in their lives. Mind (2006) describes how having a baby is thought to be a great source of happiness but it brings with it a great source of anxiety. PND is a depressive illness according to Netdoctor that occurs after having a baby. PND usually develops within the first few months of having a baby but when PND stops and ordinary depression starts is unclear.
The Guardian estimates that 10% of new mothers suffer from some sort of depressive illness but in a new study 20% needed treatment for PND. This survey of 500 women by the Royal College of Midwives found that new mothers living in the Midlands (23%) and the North (21%) were most likely to get PND compared to just 16% of women living in the South of England.
Baby Blues
PND should not be confused with ‘baby blues’ according to Babyworld (2005). The physical and hormonal changes in the body women go through when returning to a non-pregnant state can cause periods of weepiness in the immediate post natal period. This period normally comes 2-4 days after the birth.
Doctor’s suggest that the weepiness may be due to the hormone levels and is so common that it is classed as normal Mind says that although it can be distressing medical professional do not take it seriously and it’s seen as a normal part of having a baby.
Baby blues rarely lasts for long but if the depression lasts for longer or gets worse it may be turning into PND.
Symptoms of Postnatal Depression
PND can be different for everyone. However, according to Veritee’s PNI (postnatal illness) Website the can include some of the following:
• Anxiety and panic
• Some physical symptoms that are not usual such as chest pains, headaches, dizziness, some breathing difficulties
• Constant worrying about the health of yourself, your baby and your family
• Obsessive thoughts or repetitive, chanting thoughts or voices
• Thoughts that you will accidentally or deliberately harm your baby or another member of the family
• Fears you may physically or sexually abuse your baby
• Feeling of a ‘fuzzy’ or ‘muggy’ head
• Worries that everyday objects such as knives, stairs, cars could harm you and your baby
• Worrying about what could happen – ‘what if’ thoughts
• Feeling you are a bad mother or person
• Obsessions about yours and the families health and obsessions you could die
• Constant feelings of doom or dread – as if something dreadful will happen
• Having a constant need to revisit the birth because it was horrible and you felt out of control
• Not being able to talk about the birth
• Feeling of great sadness and that life is not worth living
• Feeling you are causing your family sadness by being there and they would be better off if you were not there
• Numbness and lack of emotion
• Lack of feeling for the baby
• Hiding how you feel
• Actual self harm or the feeling you would like to harm yourself
• Difficulty sleeping or waking in a panic
• Feeling tired all the time even when you get enough sleep
• Drinking too much or the abuse of recreational drugs
• Irritability
• Loss of appetite
• Thoughts of suicide
• Feelings of worthlessness or hopelessness
A mother may feel just some of these symptoms whilst suffering PND.
Who may get Postnatal Depression?
PND can hit any mother. It does not discriminate between social class, race or religion. However, those from socially deprived homes where mothers have other issues to contend with duch as financial worry may be under more strain when caring for her family. Certain ethnic families have more support at home due to extended family living in the house so the mother may have more support and help with her baby. She is therefore at less risk of developing PND. There are other factors which have been identified as common in sufferers.
Netdoctor suggests that PND is more common in mothers who have had previous episodes of depression. These mothers can be monitored especially throughout pregnancy and following the birth for any signs of depression and treated quickly.
It is also thought that genetic factors may prove a higher risk. If there is a history of depression in the family the mother is thought to be at a higher risk of developing PND.
PND is also more common in mothers who have problems during their pregnancy. As suggested by Netdoctor, this may be life events such as death of a loved one, physical problems with the mother linked to the pregnancy or problems at work or in home life. Women who do not have support at home are also in a higher risk group.
Health visitors and GP’s offer a valuable service to mother’s when they have just gad a baby. Again, the service you may receive depends on the area in which you live and your social class determines whether or not you can pay for private care, the support from which may help prevent PND from developing. Mother’s from higher social class may have a better care structure in place as they live in a better area and are financially better off.
According to the Guardian a survey of 500 new mothers came up with the following results. Mothers living as married or actually married (18%) were less likely to get PND than mothers who were single (25%) or widowed (27%) as they had more support and help with the new born baby. The survey by the Royal College of Midwives also found that 14% of women in full time jobs and 16% of women in part-time jobs suffered PND, possibly due to the extra work strain put upon them at an already difficult time. Dame Karlene Davis, the secretary of the Royal College of Midwives said “The survey indicates that postnatal depression could be a lot higher than previously estimated and the reality is that the incidence could be even higher, as many women hide their symptoms and are too afraid to ask for help.”
Causes of Postnatal Depression
Mind (2005) has found that PND can occur whether or not the baby is your first and whatever your family circumstances. Some women are fine with their first baby but PND may develop with their second. Many causes of PND have been indentified. Babyworld (2007) detail the following causes:
• Unhappy childhood leading to a bad relationship with your own parents
• The lack of a mother figure to provide a close relationship in your own life
• No one to turn to for practical/emotional support
• Mixed feeling towards the baby
• Problems during the birth
• Difficult pregnancy
• Breastfeeding difficulties leading to feeling a failure
• Stress factors such as death of a loved one, moving house, divorce or separation
• Poor social conditions such as poor housing or unemployment
• The shock of becoming a mother
• Hormonal changes
• Previous episodes of depression
• Poor diet, particularly during pregnancy
The above can all have an affect on the onset of PND. The Royal College of Midwives (2007) say that in a survey of 500 women 41% said that their birth was very bad. Only 9% said they had a good birth experience in the survey. Babyworld (2007) states “A general rule of thumb applies by psychiatrists is that the more severe the bout of postnatal depression, the more likely it is that the origins could be hereditary.”
Treatment of Postnatal Depression
The first point of contact for the mother is the midwife who may refer the mother to the GP. According to BUPA (2007) GP’s and midwives are now trained to spot PND but where there is any doubt a questionnaire called the Edinburgh Postnatal Depression Scale is often used to get rid of that doubt. Anti-depressants are often prescribed although the Government is investing more money in Cognitive methods of treatment such as talking therapies. In some cases of PND anti-psychotics are also prescribed in conjunction with anti-depressants and in very severe cases ECT (electro convulsive therapy) is used to aid mothers in their recovery.
Treatment of PND varies according to the severity of the case. Where possible the mother is kept with her baby unless severely unwell when admission to hospital may be necessary. Even then, mothers may be admitted to a mother and baby unit so they can stay together but this is not always possible due to availability. Certain areas of the country do not have these units set up so admission may not be possible.
Birmingham and Solihull Mental Health Trust has a mother and baby unit set up at the Queen Elizabeth Hospital in Birmingham. The mother and baby unit provides care for both expectant mothers and mothers with their babies together. As with many other units throughout the country admission to the unit depends on where you live.
Once undergoing treatment the mother will be closely monitored by community health visitors and GP’s. Again, the level of care received depends on factors such as where the mother lives. Counselling may be arranged for the mother alongside the conventional treatments of anti-depressants. The mother and her treatment of the child will be observed until the mother feels she is well. Serives such as a Community Psychiatric Nurse (CPN) may be assigned to help the mother further.
The CPN visits the PND sufferer regularly as a follow up to what the dry/psychiatrist has done. The CPN visits sometimes weekly and reports back to the psychiatrist and rest of the team about the progress made. They can also pick up on any problems before they develop. The CPN is a qualified nurse who may have worked in mental health hospitals and have a good understanding of mental illness. They can be as good as a counsellor in some ways and work very closely with the sufferer.
Where admission to hospital has seemed necessary but is not possible, Mind (2007) details how home treatment may be used depending if it is available in that area. Home treatment consists of psychiatric nurses visiting patients on a daily basis and close liaison with the psychiatrist for ensuring that a good level of care is given in the home environment. This has been found to be very effective in treating mothers with PND as the mother is kept with the baby in the home environment.
PND can be a very debilitating illness for all concerned. Socially, having a baby can leave the mother very cut off from friends and support leading to the onset of the condition. Once in recovery it is essential to monitor the mother closely and keep the mother feeling secure and supported both through family and services to prevent relapse. Doctor’s stay heavily involved and work with support nurses such as CPN’s to ensure the mother stays well.