This essay will explain the meaning of biopsychosocial model (BPS), and link it to a particular service user being cared for during placement. It will also analyse the biopsychosocial factors that influences the health and well-being of the service user and the holistic nursing care that was provided for him. The essay will starts with the service user’s brief history, explaination of the biopsychosocial factors and necessary nursing interventions.
In accordance to the Nursing and Midwifery Council (NMC) guidelines (2015), service users must have confidence regarding their information being shared amongst healthcare professionals which must not be released to the public without their consent or authorization. As a result of this, due to confidentiality act under the Nursing and Midwifery Council (NMC) (2015), the service user will be known as Steve which is a fictitious name.
Steve is a 50years old man, who has diagnosis of depression (ICD-10, 2016) with long history of drug misuse. He was referred to the Community Mental Health Team (CMHT) by his general practitioner (GP) following concerns raised by his wife and daughter regarding his sudden aggressive behavioural change. When the CMHT met with Steve, he appeared unkempt and he could not keep a straight eye contact. He told the team about his severe low mood which he reported that sometimes it lasts for weeks. His wife told the team about his withdrawn behaviour and how he locks himself in his room complaining about how fed up he was about life.
Steve has long family history of depression, his father and grandfather both committed suicide due to severe depression. Steve has been unemployed for the past three years and according to him he lost his job due to taking plenty time off during his many depressive episodes, he mentioned that he started taking cannabis as a result of his low mood to get him stable, he also made mentioned of having suicide thoughts and ideation at times.
In accordance with the World Health Organisation (WHO) (2012) and the Royal College of Psychiatrists (2015), depression is defined as a mood disorder with several explicit indicators, such as loss of interest and pleasure, hopelessness, helplessness, poor concentration, low self-worth or low self-esteem, being fed up with life, sad, sleep disturbance and also tiredness. WHO (2012) also stated that over 350 million people suffer from depression worldwide. In addition, Lelja et al. (2006), stated that depression result in adverse effects on cognitive function and it affects people of all gender, age, ethnicity and race. However, the root causes of depression is said to be mostly multi-dimensional.
There are many ways that can be used to explain Steve’s health associated problems and also offers solutions to explain his illness which are developmental, behavioural, and biomedical and psychology. Engel (2012), explained that the biomedical model focuses mainly on the biological factors and it excludes the psychological, environmental and social factors. According to Parsons (1951), a functionalist who invented the ‘sick role’ theory highlighted that good health and effective medical care provision are both very important for smooth functioning of the society in general. Parson added that service users must perform the “sick role” in order to be labelled as truly ill, which will exempt them from their daily duties. The physician-service users’ relationship is hierarchical; therefore, the instructions are provided by the physicians and must be obeyed by the service users. According to Engel (1997) a major Critics of the Biomedical model who argued that the model does not inculcate the psychological and behavioural dimensions of ill health, he gave example that the biomedical model does not explains why pain do not stop when tissue damage is no longer present in chronic pain or phantom pain.
In accordance with Engel (1997), who emphases that the biopsychosocial model concentrate on good and ill health, and the interaction between the biological (hormone changes, evolution, genetic makeup) the psychological (self-esteem, coping skills, stress, trauma) and the social factors (cultural expectation, social support, family circumstances, peers).Moreover, the biopsychosocial model promote the interdependence of the three factors on one another, For example, with the believe that what affects the mind also affects the body and vice versa. Ghaemi (2009) a critic of the biopsychosocial model argues that physicians who adopted this model are likely to lose clear boundaries in regards to their knowledge and expertise
The Biopsychosocial model was defined by the WHO (2018) as a state of complete physical, mental and social well-being with the absence of infirmity or disease. During placement the writer noticed that Steve’s diagnosis of depression has a great impact on his physical health due to lack of interest and motivation for him to enjoy many of the things like before. According to Faris (2014) who highlighted that serotonin works like a ”feel good ” chemical which allows communication between the brain neurons. However, an imbalance serotonin could lead to mood disorders, obsessive-compulsive disorder and panic attacks if not treated. In addition, Norman and Ryrie (2013), stated that depressed people are often disturbed with regards to endocrine hormone, immune, and neurotransmitter system functioning in the brain.
According to Carlsson et al (1999) which stated that there is a biological reason for depression, more so, there are some brain chemicals and neural pathways which are responsible for regulating mood. However, Norman and Ryrie (2013) Stated that the biological causes of depression are related to abnormalities in the delivery of the most important neurotransmitter in depression which is serotonin.
According to Steve’s wife and daughter, his father and grandfather committed suicide due to depression. In support McGuffin and Kartz (1989) stated that depression can run in the family gene from one generation passing it to the other. According to Zubin and spring (1977) who stated that people who have depression or stress finds it hard to handle the effects of stress efficiently due to the present of norepinephrinergic system .more so, Steve job lost May also be a contributor to his various depressive episodes. Steve is on antidepressant medication Risperdal consta depot IM injection 37.5mg every two weeks, according to the British National Formulary (BNF), (2018), Risperdal consta as an antidepressant which is linked to potentiation of serotonergic activity in the central nervous system which could result from its inhibition of the central nervous system neuronal reuptake of serotonin. According to the BNF must medications has side effect, the side effects of risperidone are weight gain, drowsiness, stiffness mouth drooling at night, anticholinergic symptoms and constipation (BNF 2018).
During Steve referral appointment with the CMHT for assessment as agreed. It provided a good opportunity for the team to establish a good rapport which could lead to a therapeutic relationship with him. More so, this will aid his recovery in accordance with the National Collaborating Centre for Mental Health (NCCMH) (2011). The lead nurse in the interview explained to Steve his diagnosis, his prescribed medications, and also the side effects he might encounter with the medications. Steve consented and agreed to take his medication, he promised not to relapse on them. Goodwin et al. (1999), promote the sought of consent in their qualitative analysis of the views of inpatient mental health services before medications are administered on service users. However, in accordance with the National Institute of Clinical Excellence (NICE 2009) on Choice, medication and stress, the lead nurse enlightened Steve with psychoeducation regarding stress and made sure he has insight into his diagnosis.
The team continued to visit Steve as agreed by both parties, during a follow up visit, Steve stated that his mood had improved as he complied with his medication and he is sleeping better now but experiencing some side effects like stiffness on his neck.
The side effect was discussed in the multidisciplinary meeting (MDT) , the consultant prescribed procyclidine for him to reduce his side effects (BNF 2018).Furthermore, Kemp et al (1997) emphases that successful collaboration between nurses and service users leads to valuable approach in improving medication compliance by service users. According to NICE (2012) advice should be provided to service users with depression about their high risk or potential of their agitation, anxiety and suicidal ideation to increase during the initial stages of treatment taking some of their medication. In addition, Barber and Robinson (2012) highlighted that service users’ needs to be reassured, the nurses are there to listen and talk to them especially if they wish to discuss any suicidal ideation or thoughts. During our discussion with Steve, the team discovered that the loss of his job which has led to constant argument with his wife made him to believe that he was useless and life was not worth living to him anymore. However, during our visit he did not express any further suicidal ideations or intentions all through our assessment. Beck et al (2007), explains that Steve’s negative thought relate with the cognitive theory of depression which shows the role of negative beliefs and thoughts which can help service users maintain low mood. Moreover, Schneider (2005) stated that there are three types of thoughts which lead to depression, they are thoughts of inadequate feelings, believed that all efforts will result in failure and having no hope for the future.
As Steve continues to show signs of withdrawal from social activities like he used to, Lewisohn (1974) explained the behavioural theory of depression and stated that depression could result from lack of positive re-enforcement of pleasurable and withdrawal from meaningful activities. The team notice the fact that Steve smokes a lot of cannabis, which he reported he knew, was not good for him but he uses it as a coping mechanism to deal with his current situation of low mood.
Coping mechanisms was classified by Folkman and Moskowitz (2000) into two which are, problem-focused coping methods and emotional focused coping methods. The Problem-focused coping strategies are used when the situation that causes stressful events are perceived to be amendable. While the Emotion-focused coping methods are peculiar in dealing with the effects of stress rather than eliminating or finding solutions to the problem that caused the stress. In regards to his smoking of cannabis, Chylova and Natovova (2012) and Chang (2012) both stated that heavy smoking of cannabis could cause mental health issue like depression and also psychological distress.
During the MDT meeting, the nurses’ intervention recommended for Steve was agreed on by the team and must be discussed with Steve and agreed by him, the team discussed the use of Cognitive Behaviour Therapy (CBT) and family intervention (FI).According to the NICE guideline (2009) stated that combination of medication and psychosocial interventions such as CBT have shown many evidence based results of effective recovery of service users suffering from depression and other mental illnesses. The team discussed with Steve and he agreed to commence on CBT as soon as possible. According to Driessen et al (2013), the major goal of CBT is to help service users replace their negative thoughts with positive thoughts. In addition, Wykes (2008) stated that CBT programme for depressive service user is effective when it corresponds with the symptoms experienced by the service user.
After having some session of CBT Steve reported that he was quite happy with his progress of improvement and that he can now replace his negative thought with positive thoughts. Steve was also thought some coping skills during his CBT programme to distract his suicide ideation, such as watching TV, reading books, listening to the music and many others. Also Family Intervention is necessary as Steve lives with his family and as they are the first point of contact with him, they can identify early signs of change in his mental state and offer support through reassurance before help comes.
Steve was given necessary Leaflets and useful telephone numbers to our out of hours contact line and relevant services to avoid relapse regarding his mental health condition. During the initial assessment the team was able to identify other social factors which affecting him and led to his depression such as job lost.
In accordance with Lloyd (2012) a care plan was written in collaboration with Steve, taking into consideration his long-term goals and social needs and unemployment statues, Thus, Appleby (2007), emphases that financial, employment, social networks and housing were equally important in the treatment of mental health problems as were the biological and psychologically previously concentrated on by medical professionals. Brown and Birley (1996) stated that people can also be depressed because of social factors such as, divorce, experiencing traumatic situations, marriage separation and unemployment.
In Accordance with Meltzer and Stanfeld (2010), research report shows that stress can be triggered on and off, causing changes in brain functioning through social stressor which can lead to a physical cause of depression. Roger and Pilgrim (2003) and NICE (2009), both stated that unemployment and lack of provision of good accommodation could lead to social isolation by service users and this could lead to depression. Furthermore, there are some social factors that affect mental health which are: socioeconomic status, culture, religion and technology. After Steve lost his job he became low in mood and he took to taking cannabis as a coping mechanism for his depressive mood. This made him aggressive to his wife and children. These social factors placed Steve at risk of stress and contributed abundantly to his development of physical health issues. Steve lacks self-esteem and with very limited support from his family as he has become aggressive to them, so prefers to be alone in his room.
The nursing intervention agreed by the team in collaboration with Steve was both short and long-term, the team planned to support him to win his family back through counselling and support groups before thinking of the option of seeking employment.
Allicock et al (2014) emphases that family support has a positive effect on service users recovery journey, through offering positive emotional support such as helping them book an appointment with their GP and driving them to meet up for their scheduled appointment. In contrast, Vilsbal et al. (2017) and Rosalind et al. (2010), are both of the opinion that lack of family support can affect service users health negatively through blaming them for their mental illness which may lead to relapse. Moreover, Shawon et al. (2016) belong to the school of thought with the view that the support provided by family is vital in a service users recovery because family absence reduces the service users attitude, motivation, and efforts toward their self-care.
In conclusion, according to Huh and Ackerman (2012) biopsychosocial model empower mental health professional to support service users using all aspects their life. It emphases that the biological, psychological and sociological factors influence their lives by contributing to their overall recovery journey through offering a holistic way of care. The 6 C’s of nursing which are Care, Compassion, Courage, Communication, Commitment and Competence should be always adopted and tailored by health care professionals into all aspects of care thy provide. This essay also discussed all social issues affecting Steve such as the loss of job and how it effect on his health and well being
Allicock, M., Carr, C., Johnson, L.-S., Smith, R., Lawrence, M., Kaye, L., Manning, M. (2014). Implementing a One-on-One Peer Support Program for Cancer Survivors Using a Motivational Interviewing Approach: Results and Lessons Learned. Journal of Cancer Education?: The Official Journal of the American Association for Cancer
Barber, P. And Robertson, D. (2012) Essentials of Pharmacology for Nurses, 2nd edition. Maidenhead: Open University Press
Beck, A.T., Rush, A.J., Shaw, B.F. and Emery, G. (2007). Cognitive Therapy of Depression. New York: Guilford Press
BNF (British National Formulary) (2018) BNF63: March .London: Pharmaceutical Press
Carlsson, A., Hansson, L.O., Waters, N and Carlsson, M.L. (1999) A glutamatergic deficiency model of schizophrenia. British Journal of Psychiatry 174(sup.37):2-6
Chang, S. A. (2012). Smoking and type 2 diabetes mellitus. Diabetes ; Metabolism Journal, 36(6), 399-403. 10.4093/dmj.2012.36.6.399
Chylova, H. and Natovova, L. (2012) Stress coping strategies at university students – part I: Gender Differences. Journal of Efficiency and Responsibility in Education and Science, 5 (3), 135-147.
Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S., Westra, D., ; Dekker, J. J. (2013). The efficacy of cognitive-behavioural therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. American Journal of Psychiatry
Engel, G. (1997). The need for a new scientific model: A Challenge for Biomedicine. Science.196 (1), 129-136.
Engel, G. (2012). The need for a new scientific model: A challenge for biomedicine. Psychodynamic Psychiatry. 40(3), 377-396
Faris, S. (2014). Is depression genetic: Available: http://www.healthline.com/health/depression/genetic. Last accessed 02/02/2018
Folkman, S. and Moskowitz, J. T. (2000) coping: pitfalls and promise. Annual Review of Psychology, 55, pp. 745-774.
Ghaemi, S. N. (2009). The rise and fall of the biopsychosocial model. The British Journal of Psychiatry. 195 (1), 3-4.
Goodwin, I.,Holmes, G.,Newnes, C and Waltho, D.(1999) Aqualitative analysis of the views of in-patient mental health services users. Journal of Mental Health 8(1)
Huh, J., ; Ackerman, M. (2012). Collaborative help in chronic disease management: Supporting individualized problems. Paper presented at the 853-862. 10.1145/2145204.2145331
Kemp, R., Haywood, P. and David, A. (1997) Compliance Therapy Manual. London: The Maudsley Hospital.
Lewinsohn, P.M. (1974). A behavioural approach to depression. In R.J. Friedman and M.M. Katz (eds), The Psychology of Depression: Contemporary Theory and Research (pp. 157–178). Washington, DC: Winston-Wiley.
Lilja, L., Hellzen, M., Lind, I and Hellzen, O. (2006) the meaning of depression: Swedish nurses perceptions of depressed inpatients. Journal of Psychiatry and Mental Health Nursing 13:269-78
McGuffin, P., ; Katz, R. (1989). The Genetics of Depression and Manic-Depressive Disorder. British Journal of Psychiatry, 155(3), 294-304. doi:10.1192/bjp.155.3.294
NCCMH (National Collaborating Centre for Mental Health) (2011) Common Mental Health Disorders: Identification and Pathways to Care. National Clinical Guideline Number 123. London: NICE.
NICE (National Institute for Clinical Excellence) (2009) Depression: The Treatment and Management of Depression in Adults (partial update of NICE Clinical Guidance 23). London: NICE.
NICE (National Institute for Clinical Excellence) (2009) Depression: The Treatment and Management of Depression in Adults (partial update of NICE Clinical Guidance 23). London: NICE.
NICE (National Institute for Clinical Excellence) (2012) Depression: The Treatment and Management of Depression in Adults (partial update of NICE Clinical Guidance 23). London: NICE.
Norman, I.J. and Ryrie, I. (2013). The art and science of mental health nursing: principles and practice. Maidenhead: Open University Press; 3rd ed
Nursing and Midwifery Council (2015) Code of professional conduct. London: NMC
Pamungkas, R. A., Chamroonsawasdi, K., ; Vatanasomboon, P. (2017). A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behavioral Sciences, 7(3), 62.
Parsons, T. (1951) The Social System. Free Press, Glencoe, IL.
Pryjmackuk, S. (2011) Mental Health Nursing. Los Angeles: Sage
Rosland, A., Heisler, M., Choi, H., Silveira, M. J., ; Piette, J. D. (2010). Family influences on self-management among functionally independent adults with diabetes or heart failure: Do family members hinder as much as they help? Chronic Illness.
Roth A. ; Fonagy P. (2005). What Works for Whom: A critical review of psychotherapy research. Second Edition. The Guildford Press. London
Shawon, M. S. R., Hossain, F. B., Adhikary, G., Das Gupta, R., Hashan, M. R., Rabbi, M. F., ; Ahsan, G. U. (2016). Attitude towards diabetes and social and family support among type 2 diabetes patients attending a tertiary-care hospital in Bangladesh: a cross-sectional study. BMC Research Notes, 9, 286.
Schneider, F. W., Gruman, J. A., ; Coutts, L. M. (Eds.) (2005). Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Thousand Oaks, CA: Sage Publications.
Vilsball, T., Overgaard, D., Egerod, I., Munch, L., Rader, M. E., Bennich, B. B., Knop, F. K. (2017). Supportive and non-supportive interactions in families with a type 2 diabetes patient: An integrative review. Diabetology ; Metabolic Syndrome.
World Health Organisation (2018). Depression. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Last accessed 02/02/2018.
World Health Organisation. (2018). Mental Health: strengthening our response. Available: http://www.who.int/mediacentre/factsheets/fs220/en/. Last accessed 2 May 2018.
World Health Organization. (2017). Mental disorders. Online Available at: http://www.who.int/news-room/fact-sheets/detail/mental-disorders Accessed 2 May 2018.
Wykes T., Steel C., Everitt B. ;Tarrier N. (2008) Cognitive behavioural therapy for schizophrenia: effect sizes, clinical models, and methodological rigour. Schizophrenia Bulletin, 34(3), 523-537.
Zubin, J. and spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86(2), pp.103-126.