A Fieldwork on Mental Illness

Prevention of mental health

Date Activity Location and
contact

Hours Relevance to
topic

Windshield
Survey

10 Topic selection
activity
Cultural survey 5 Topic selection
activity

Demographic
information

5 History of
Westchester
county

Focus group
interviews

15 Answering and
discussing the
health concern
Questionnaire 20 Filling
questionnaire

Data preparation
and assembling

10 Recording

Data processing 10 Mental health
strategies
Data analysing 5 Evaluation of
the problem
Data reporting 3 Presentations

Data
dissemination

7 Ensuring
accuracy,
disseminating
information

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Assessment of Mental Health Prevention

Introduction

Mental health is a state of wellbeing where every individual realizes their own
potential, able to cope with normal life stresses, can work fruitfully and productively and are
able to make contribution to the community. It includes our psychological, emotional and
social well-being affecting the way we act, think and feel (“Mental Health Promotion: A
Report from WHO”, 2005). About 450 million people suffer from behavioural and mental
disorder worldwide. Neuropsychiatric conditions account to 13% of total Disability
Adjustment Life Years (DALYs) and have been estimated to increase to 15% by 2020.
Mental illness in the United States the highest of all diseases being one of the
common cause of disability. In 2004, 1 in 4 adults in USA had a mental health disorder in the
previous year- most commonly depression and anxiety-and 1 in 17 had a serious mental
illness. Mental disorders have increased in children and adolescents with an alarming rate, 1
in 5 children in USA had a mental disorder in 2010 making the disorders to be one of the
primary causes of disability among the youths. The common disorder in children and adults is
attention deficit hyperactivity disorder (ADHD). 10.7% of adolescents in 2013 aged 12-17
years were found to have a major depressive episode (MDE) in the past year. In the specific
demographic categories, several population groups had the lowest MDE rate in the past year
including Alaska Native and American-Indian population, males and adolescents aged 12-13
years.
The health concern is still an issue in county and the world at large. The Westchester
county data on mental illness according to 2020 target is still worse calling for need for
intervention. In order to reduce the mental health burden, the most effective way is

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prevention. Human rights violation, stigma and discrimination of families and individuals
affected with the disorders are pervasive and intense.
Effective prevention can alter the perception and change the way mental disorder is
viewed by the society. Most of the preventive measures will be harmonious with the
principals of; equal opportunity, social equity and vulnerable groups care in the society.
Statistics shows that one adolescent in a group of five has been diagnosed with a mental
health disorder, making the disorders to be one of the primary causes disability among the
youths. Nevertheless, different studies have identified children and adolescents who have
mental health disorder fail to seek for the required services (Westchester County, 2016). The
goal of this study is to provide recovery, prevent mental disorders, promote mental well-
being, promote human rights, enhance recovery and reduce the morbidity, mortality and
disability of person with mental disorders.

Community Description and Assessment
Community Description

Westchester County community is located in New York City south-eastern side. It
occupies 430.50 square mile piece of land with 69.50 square mile of water surface. From
2010-2014 census population, it recorded a 962,319 population, a growth rate of 4.21% from
2000 census report, with a population density of 1924 people per square mile. The growth
rate is higher compared to the state average rate that hits 3.26%, which is lower than national
average rate of 11.61%. The county dominating race is the whites who represent 66.53% of
the total population.
The economy of the county reveals that the region is progressing well. Consider the
household income of $83422 between the years 2010 and 2014, an increase of 31.20% since

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2000. However, the state average rate (35.25%) is higher than the growth rate of income and
      the national average rate (27.36%) (U.S Department of Commerce, 2016). The median house
      value in Westchester County is $509200 between the years 2010 and 2014. The value grew
      by 56.29% since the year 2000. The growth rate in the value of houses in the region is lower
      than the state average rate of 90.79% but higher than the national average rate of 46.91%.
      The CPI inflation rate during 2010-2014 is 26.63%, a figure that is not so bad for a struggling
      economy (Sisti, Caplan, & Rimon-Greenspan, 2013)

Comparison of Community Data to HP2020

The following section includes a study on three health concerns, as they relate to the
2020 Westchester’s Community to Healthy People objectives.

Summary of All Six Assessment Tools; Population Economic Status
The tool is used to measure the economic status of the households in the region. Some
of the variables considered include the rate of employment, wages and average salaries, and
economic development. The population of the region using the 2010 census report was
949113 units with a density of 807 per square mile.

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The racial makeup was as follows:
Race %
Non-Hispanic White 57.4%
African American 15.6%
Native American 0.4%
Asian 5.4%
Pacific Islander 0.1%
Other races 7.6%
One or more races 13.5%

The rate of unemployment in Westchester is 4.6%, a reduction from 5.2% in 2013. The rate
of employment; however, is also reducing though with an insignificant value.

Regarding wages and average salaries, the rate is increasing by 20.1% reaching $24.2
billion. The current minimum wage for one adult is $8, poverty wage of 5%, and a living
wage of $12. The economy of the region is being run by the industrial, financial, and

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professional sector. The manufacturing sector also has recorded a high average salary of
$93640, a reflection of the high-tech focus industry in the region (Khan, 2015).
The economic development in the region has different programs that help in
improving the living standards of the locals. The region has constructed 10000 units for the
low and middle-income earners by 2015. Besides, there was the project in New Rochelle for
developing $40 million residential houses. The development will include 66 townhouses for
single families and 102 units for the seniors (Westchester County, 2016).
Context of Local Data with State and National Data

The windshield survey tool was used to examine physical and social environment of
the county. It is a scientific methodology used to collect information in communities. Based
on the tool, I was able to gather information about Westchester County on mental health care
by the sense of seeing (Khan, 2015). I gathered information through observing disabilities
forms served in the mental health including; medically fragile patients, emotional or
psychiatric conditions, hearing impaired, development disabilities and the traumatic brain
injured serving the age of 22 years and over. The Westchester County community had a
beautiful onsite, with a rocky Long Island Sound Shore, that is interspersed with marshes,
tidal mud flats and wetlands. The region also has different sand beaches that make it very
beautiful a private parks offering access to beaches, nature preserves and waterfront
recreational facilities.
According to 2020 Westchester’s Community to Healthy People objectives, mental
health is a high priority issue as the status is getting worse. The suicidal rate due to the
condition as 2007 was11.3% and as 2010 it increased to 12.1% which is against the 2020
target 10.2%. Similarly, adolescents with major depressive episode as 2008 were 8.3% and
by 2012 it was 9.1%, it is against the 2020 target of 7.5%. Nationally, the suicidal rate has

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increased from 10.4 to 12.3 per 100000 population varied by age, ethnicity and race to 18.3%
between 2000 and 2011. In 2013, 2.7 per 100 students were reported to have suicidal attempts
that required medical intervention for a year, it varied based on race, ethnicity and sex
(Westchester County, 2016). According to the study, the females’ adolescents were more
prone to suicide than their male age mates.

Target Population and Health Disparity

The target population is the youth, this is because, and 1 adolescent in 5 has been
diagnosed with a mental health disorder, making the disorders to be one of the primary causes
of disability among the youths. According to estimates, 60% to 90% of the youths
experiencing mental health disorders never receive the required treatment. Several factors are
linked to mental health including, age, gender, income, ethnicity, geographical location,
sexual orientation and educational level. Other social conditions like, employment
opportunities, and work, housing quality, social support, family, and community dynamics
interpersonal, and school conditions- influenced mental outcomes and risks both positively
and negatively. For example, in positive way, safe shared places for people interaction like
churches and parks supported mental health.in order to improve mental health disparity in the
county; it calls for a need to understand the factors, how they interact and their impact in
promoting mental health well-being.
The population at risk in the community is children and youths but as for the research
it will be the youths. The reason for that are the things they do and the drugs they take. These
are some of the factors that affect the mental capability of a person. The injury related to
intake of drugs is closely connected to mental health problems as the consumption affects the
cognitive development of a person. The youths suicidal rate is higher 17.2% compared to the
adults 10.5% thus the need for a detailed assessment on mental health in youths.

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Health Disparities

Despite the available resources, these youths fail to get the requirement basically
because of various reasons: missed opportunities, poorly coordinated services, restrictions by
the insurers to cover certain services, lack of education, policy limitations, stigma, and
shortages of staff members with the required expertise. In addressing the concept of mental
health cases, emphasis will be placed on the healthier communities with the changes in the
field of healthcare policy, focus, and financing being a primary concern (Khan, 2015).
One major disparity in the community is lack or inadequate knowledge in mental
illness identification. Majority of the individuals, 80% could not distinguish mental illness
disorders. Some of the mental illness disorders like depression were hard to identify, this led
to many affected people not to seek medical advice as it was viewed as a normal condition.
Discrimination of families and individual affected led to majority of them not seeking
medical attention in mental health services. The adolescents were the most affected group,
they were rebellious and their families did not associate it with mental illness, this could be
the leading factor in suicidal attempts. Many residents have less access to mental health
services in the county.

Field Partners and Community Resources

Westchester County has many community resources and partners including. I worked
closely with some of the organisation like Department of Community Mental Health which
offered residential services which are licensed by OPWDD that provide housing and related
services. Medicaid Service Coordination (MSC) that helped adults and children with
developmental disabilities originating from mental disorders. The family support which
offered community and home-based services that assisted siblings, parents and other relative

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in caring for family members with developmental disorders staying at home. I visited the
Westchester district schools who offered transition services.
Fieldwork Experience

The transition from classwork to the field was important, enjoyable, served as
learning experience and had its setback. This field research gave a first-hand experience and
knowledge about events, people and the processes in mental health. It gave a clear
understanding of social context and shaped my life and experience. This study has uncovered
group interaction and people experiences that I was not aware of prior the study. A good
percentage of the respondent was cooperative and gave consent to the interviews.
Based on the collected information, it is clear that the region is vulnerable to the
mental health care condition. However, the effects might not be averse to affect the economy
of the region considering that it is a stable economy with positive growth prospects. The
demographics of the region reveal a healthy nation though with some issues that emerges
from the environmental degradation. The birth and death rate is very low with the rate at
which mental health conditions were affecting the vulnerable parties being low
Most of the respondents were more than willing to participate although they feared
being identified and after believing in confidentiality, the gave their information The birth
and death rate is very low with the rate at which mental health conditions were affecting the
vulnerable parties being low. Based on the epidemiology that I collected, the following were
the health status indicators. The prevalence of the self-reported better health among adults
was gathered to be 67.8%. The rate is not bad considering that it is a community that is
struggling with their economic status.

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The following is a data published ON 2013 by Healthy People 2020, on the expected
results of improved Mental Health and Mental Disorders (MHMD).
2020
Baseline
(year):
11.3
(2007)
2020
Baseline
(year):
11.3
(2007)

Desired Direction:

Year 2009 2010 2011 2012 2013
Total 11.8 12.1 12.3 12.6 12.6 Decrease desired:
2020 Target: 10.2

Source: Healthy People 2016
There was a disparity of youths brought up by single mothers to those raised by both
parents. In a family system of father and mother, the individuals are less affected but this was
different and prevalent to youths whose fathers or mothers abused drugs. Divorce which is
highly prevalent in the US was identified as major source of stress to youths. Many of the

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affected raised the concern of crying nights, turned to alcohol and drug abuse, dropped school
and joined groups that they felt appreciated them. Family instability according to the study
has led to many young adults affected, stressed, depressed and later may lead to mental
ailment.
Based on the health care coverage, most of the people in my community used
coverage either through health insurance or the government health plans. Most of them had
the government health plans like the Medicaid and Medicare. The prevalence of the adults
having health-care coverage was 72.4%. In the same line of action, I gathered information
about the preventive practices that are used in my community. There is a recent routine
check-up where people visit hospital for a general physical examination. Most of the people
in my region reported to visit a doctor for the routine check-up in the past 12 months.
The prevalence rate of the young adults was 55.5%. Another preventive practice was
the influenza vaccination. In my community, the rate was 85.5% for the people who receive
an influenza vaccination. The current asthma prevalence in the region was recorded to be
3.8%. General, the prevalence of the adults who were above 18-years with good or better
health for my county was 91.9%.

Unaddressed Aspects

Many members of the community could not recognise specific disorders. The
community had little knowledge on mental health, its causes and the negative attitude in
mental illness may be fuelled by lack of knowledge. Early identification of disorders and
intervention measures were not well distributed. The respondents could not differentiate if
their teenagers were acting normal, weird or abnormal. Many youths are engaged in drug and
substance abuse without their parents realising it. Many parents termed the teenagers physical
separation to be caused by their rebellious ways and high tempers without considering drugs.

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Many of suicidal attempts were considered to be caused by stress; they did not relate stress as
a sign of mental illness.
There was a gap in the community knowledge on mental disorders, many related it to
major signs; this is the leading reason why many youths and other does not seek medical
attention leading to late identification. There was no association of youth’s sadness, anxiety,
hopelessness, crying often, excessive neglect of personal hygiene and appearance and illegal
and dangerous seeking behaviours with mental illnesses. More than half of the respondents
believed in mental illness as a special condition from other illnesses and victims to be treated
special. This act will raise stigmatisation to the affected as many called or referred mental
illnesses as madness. Majority of the respondents’ referred to a mental illness as genetic
based leaving all the other causes out.
It turned as a myth to the community as they did not associate mental illness with
babies. It was a known condition for young adults, adults and the elderly. Half of mental
health disorders give signs before 14years and a quarter before the age of 24 years. They
believed that the sign for mentally ill people was unpredictable behaviours and violence.
Most people with mental disorders are not violent and only 3-5% of violent act can be related
to serious mental disorders. On the contrary, serious mentally individuals are more likely
(10times) to be victims of violence.
There was a belief that mentally ill- even those under managed could not hold
employment. It should be known that these individuals are as productive as other employees.
Receiving medication of employees with mental illness, it can lead to; less absenteeism, more
productivity, low total medical cost and decreased disability cost. Most of my respondents
related mental illness to character flaws or personality disorders, and there is a belief that
individuals with mental illness can snap out of it by trying hard. The fact is mental illnesses

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do not arise from weakness or laziness and causative include; biological factors- physical
illness, genes, brain chemistry or injury, family history of mental problems and life
experiences like trauma.

Nursing Action Plan

The preventive intervention measures will focus on enhancing protective factors and
reducing risk factors that are associated with mental ill-health. It will aim at reducing;
prevalence, incidence, recurrence of mental disorders in a community. In order to improve
the mental health status, there is a need to reduce the incidence by 5% to achieve the 2020
mental health status target. This would be achieved through creating a community
empowering process, which will build a sense of ownership and increase community social
responsibility through a Community That Care (CTC) programme.
There is need to plans on reducing the harm from addictive substances. Using drugs
or alcohol triggers mental illness in some individuals, it also causes further problems while
taking other medications. People who use alcohol or drugs to relieve their stresses should
look for other stress management strategies yoga, exercise, music and others. While faced
with stress- major cause of suicide- individuals need to learn on ways to manage them.
Speaking it out, meditation, counselling and others strategies would be used. Stress cannot be
totally avoided but managing the stressors and situation is a advisable. Stress has been known
to be the leading cause of depression, anxiety and other disorders, it can lead to use of drugs
as reliever.
In order to reduce mental health by 5%, the youths need to be trained on stress
management and drugs and drug abuse. During adolescent, teenagers try out new things
including drugs- legal and illegal- they should be trained on dangers of substance abuse to
their bodies. Legal legislation also has a part to play in this, there should be set rule against

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substance abuse. These laws should be well enforced and verdict given to all abstracting the
law. Stress management and drug abuse should be recruited in the education system to
increase knowledge to the youths. The parents and the community should be included in
implementing preventive measures to the youths.
Nursing Action Plan

Mental health illness in youths is caused mostly by drug and substance abuse which leads to
suicide and attempted suicides. Divorce and family violence causes stress, depression and
other mental disorders. The increased rate of mental disorders and illness calls for integrated
mental health preventive and promotion measures. Community-based interventions are the
most effective strategies to reduce youth mental illnesses.
Population Focused Objectives

The goal of this study is to provide recovery, prevent mental disorders, promote
mental well-being, promote human rights, enhance recovery and reduce the morbidity,
mortality and disability of person with mental disorders. The objective of the study was;
strengthening information systems, research and evidence of mental health. The study should
lead to providence of integrated, responsive and comprehensive social care services and
mental health in a community based setting. Community empowerment where the community
are impacted with knowledge on causes, symptoms and preventive strategies, they should
own their own health.

Population Focused Nursing Interventions

Mental health intervention and strategies for prevention should be scientific based and
taking cultural consideration. The two nursing intervention tools to be used in the community
will be, community organizing and outreach.

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Community Agencies and Partners

The community health department of Westchester County will be one of the agencies
to help in the research.

Population Focused Nursing Intervention Time Frame

The appropriate time frame for the intervention should be six months followed by
outreach programs.

Evaluating Effectiveness of Nursing Plan

The rate of suicide in Westchester County should be reduced by 5% after a year. The
indicator will be the number of suicidal death per 100,000 populations per year. The mean of
verification will be routine registration of death due to suicide every month. The assumption
is that acquiring accurate suicidal death statistics will be difficult as other factors also cause
suicides and some may be unreported. The registered data will represent the number of
suicidal cases due to mental illness.
The outreach nursing plan would be evaluated through developing priority questions
that will identify community outreach target performance at all sites. On the other hand, the
community organizing will be evaluated, to help identify that what is said is what is done. It
also helps determine the impact of programs on the target population. Evaluation will justify
the replication of the study goals

Tools to Be Used

The following tools will be used in conducting the evaluation, drug and alcohol
screening tools, interviews and questionnaires.
Conclusion

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According to Healthy People 2020, successful mental function increases the
performance of an individual, which in return improves the state of community functionality.
It emphasizes on the integration of environmental, social and hereditary/ genetic factors
(CDC, 2015). In the whole, Healthy People 2020 points ‘Treatment Expansion’ as the key
underlying factor for Mental Health Status Improvement (MHSI) in Westchester County.
This includes increased number of health care facilities and primary care physicians in the
county to increase access to mental health care in the county (Healthy People 2020, 2016).
End results to these efforts include reduced cases of suicides and low count of Major
Depressive Episodes.
Regardless of sex, age, race, socio-economic status, sexual orientation or ethnicity,
following the principle of equity, mental disorder clients should access essential social and
health which help them achieve recovery and attain high health standards. Persons with
psychosocial disabilities and mental disorders should be empowered and involved in health
policy, advocacy, legislation, Planning, monitoring, evaluation and research
In conclusion, mental disorders cause 12-15% of today’s world disability which is
more than cardiovascular disease and worse twice than cancer. Mental health services should
be provided in all normal community setting while coordinating all mental health services,
private, governmental or non-governmental. There is need to lead and coordinate a strategy-
multi-sector which combines targeted and universal interventions for preventing mental
disorder and promoting mental health, reducing discrimination, stigmatisation and human
rights violations. The strategy should be specific to the youth problems and integrated to
national health promotion and mental health strategies.
Recommendations

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There is need to increase public understanding and knowledge on mental health
though campaigns and the media tom reduce discrimination and stigmatisation to promote
human rights. Reducing alcohol exposure to the youth, this is done through; implementation
measures that are included in the global mental health reduction strategy. There should be
early childhood programmes addressing the sensory-motor, psychosocial and cognitive
childhood development and promote parental relation. Early detection of the illness and
prevention will reduce youth mental illness statistics. Programmes should be implemented
that discuss domestic violence especially emphasize on violence from alcohol.
Many youths are facing stresses caused by parental violence and divorce leading to
depression and other conditions. Develop school based prevention and promotion including
programs that counter bulling an violence, raising health benifts awareness of risk of
substance use and early detection of children and adolescent exhibiting behavioural or
emotional problems. Enhance social support, self-help groups, community participation
opportunities and community network for people with psychosocial disabilities and mental
disorders. Evidence-based traditional practices for mental health prevention and promotion
such as meditation and yoga should be promoted.
In suicide prevention, national strategies should be implemented and developed with
special attention to the youths and other vulnerable groups like gays, lesbians, bisexual and
transgender. The access of means of self-harm and suicide should be restricted to the youths
like pesticides and firearms. Health systems should be improved in response to suicide and
self-harm. The youth should optimize psychosocial support they receive from available
community resources for affected individuals with suicide. Increase political, media and
public awareness of the youths on the magnitude of mental problem and availability of
effective preventive strategies.

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References
Centres for Disease Control and Prevention (CDC): STD Data and Statistics. Washington:
CDC; 2015 Nov.
Healthy People 2020 (2016), 2020 Topics and Objectives – Objectives A–Z
Retrieved on 30th April 2016 from < >https://www.youtube.com/watch?v=2l_eVdplODI
Khan, M. (2015). Western Governors University – BS Nursing. Retrieved April 10, 2016,
from http://meokhan.blogspot.co.ke/2015/04/western-governors-university-bs-nursing.html
Mental Health Promotion: A Report from WHO. (2005). International Journal Of Mental
Health Promotion, 7(2), 61-61. http://dx.doi.org/10.1080/14623730.2005.9721867
Sisti, D. A., Caplan, A. L., & Rimon-Greenspan, H. (2013). Applied ethics in mental health
care : an interdisciplinary reader. Cambridge, Mass.: MIT Press.
Westchester County (2016). Census and Statistics. Retrieved April 10, 2016, from
http://planning.westchestergov.com/census-statistics
Westchester County. (2016). Westchester County. Retrieved April 10, 2016, from
http://www3.westchestergov.com/