The Role Of Nutrition And Exercise In Mental Health Care For Regional And Rural Settings

The Burden of Mental Disorders

Mental illness or disorders are one of the leading causes of Disability And Morbidity worldwide. The burden of mental disorder is growing and it continues to have major impact on health and social outcomes. Recent research evidence supports the role of nutrients and physical activity in the treatment and prevention of mental illness in different population groups. However, there is a need to further explore how nutrition and exercise have a major impact on the symptoms of mental illness (Dalle Grave, 2020). The aim of the essay is to discuss about the role of nutrition and exercise in the provision of mental health care in regional and rural settings. The essay will give an insight into the use of nutrition and exercise modality in the management of stress and other conditions such as depression.  In addition, the role of nurses in supporting patients and families to maintain regular nutrition and exercise will be discussed.

Mental health is an important criterion for health and well-being. According to the survey by Australian Institute of health and Welfare (2020), around one in every two Australians experienced mental disorders in their lifetime. Among these, anxiety disorders were the most prevalent type of disorders followed by affective disorders and substance use disorders. With the increase in ageing population in Australia, it has become a major health concern for older people with disability and frailty issues too (Amare et al., 2020). In addition, the prevalence of mental illness is similar in rural and remote Australia compared to cities. The problem is more complex for rural Australians as access to mental health services is limited and the rate of self-harm increase with remoteness (NRHA, 2017). It is important to interpret the problems and challenges for this population group as such understanding would help to identify evidence for baseline resource allocation (Amare et al., 2020). Some of the contemporary theories of mental health and illness that aids in identifying the concerns and needs of the population are the psychodynamic theories, cognitive theories, behavioral theories. Psychodynamic theory focuses on ego psychology, self-psychology and attachment theory. The basic principles of this theory are that mental life is unconscious and childhood experiences shape the personality of an adult (Ribeiro, ÂRibeiro & von Doellinger, 2018). Thus, the psychodynamic therapist plays a role in developing a sense of uniqueness. In addition, the Jean Watson’s theory of human caring gives insight into how nurses for patients and identified the carative factors needed to build caring relationship with patients. It is based on altruistic values, kindness, nurturing behaviour and creating of a healing environment for patient. Mental health nurses often face unique challenges in their work due to aggressive patient behaviour, burnout and insufficient staffing. By adapting the Jean Watson’s theory in mental health, nurse’s perception of the care environment can be changed (Rosa et al., 2020).

The Role of Nutrition in Addressing the Symptoms of Mental Illness

Balanced nutrition is recognized as one of the key components for good physical health. However, there is great controversy regarding the role of diet and nutrition on the management of mental illness and health problems. Strategies on diet changes and nutritional intervention are often ignored during the treatment for mental health conditions too. However, many evidence exists for the effectiveness of nutrition and diet on addressing the symptoms of mental illness. Diet intervention has been implemented on patients with anxiety and depression, attention-deficit hyperactivity disorder (ADHD) and those with autism (Granero, 2020). A meta-analysis of randomized trials by Firth et al. (2019) reported about the effectiveness of dietary improvement on depression and anxiety patients. Diet was identified as a factor that influenced the onset of mood disorders and depression. By the review of 16 eligible randomized controlled trials, the study revealed that the delivery of dietary intervention was associated with a significant impact on depression symptoms. A healthy diet contains many bioactive components that interact with pathways such as immune function, neurotransmission and stress response. The evidence clearly indicated the role of nutrition in the treatment and self-management of depression.

Current treatment for depression mainly focuses on biological and psychological pathways and ignores the role of lifestyle factors. However, evidence shows the role of diet in reducing the risk of depression. The provision of diet in the treatment of depression has been convincing proved by Francis et al. (2019) who investigated about the role of a brief diet intervention on symptoms of depression in young adults. The samples for the study included young adults with depression and those who consumed a poor diet. The participants were randomly allocated to a 3 week diet intervention and a habitual diet control group. After completion of the study, good compliance with diet intervention was found. In addition, the diet group had lower self-reported depression symptoms. The study gave insights into the provision of diet composition on depression in young adults. Similarly, in the context of schizophrenia, diet modification was found to be associated with improvement in various health domains such as psychosis symptoms, cognition and quality of life. Thus, it is evident that dietary intervention could emerge as an emerging modality. However, gaps in studies were found regarding the study of compliance (Aucoin et al., 2020). This needs to be explored while using nutritional intervention as a modality for treatment of mental health in regional areas.

The Role of Exercise in Preventing the Symptoms of Mental Health Disorder

Similar to nutritional intervention, exercise is an important treatment modality for health and well-being. In UK, mental illness is the single cause behind disability in the UK. Evidence has particularly revealed the benefits of physical activity in preventing the symptoms of mental health disorder (Bell et al., 2019). The study by Bell et al. (2019) identified no strong evidence for relationship between physical activity and mental health disorder. However, the study by Harris (2018) found strong positive correlation between physical activity and increase in mental well-being. The study explored the relationship between physical activity and mental well-being by recruiting physically active individuals in the study. Based on the analysis of outcomes, strong relationship between physical inactivity and mental well-being outcome was found. The number of participants who reported increase in activity levels increased and increase in mental well-being was observed.

For people living in rural and regional regions, increase in psychological distress is a common concern for them. There are many factors that contribute to high mental health burden in Australia. It includes factors such as poor diet, social isolation, socioeconomic burden, high alcohol intake, lack of exercise, high rate of diabetes and obesity. The significance of the study by Brumby et al. (2011) is that it reported about the potential of exercise as a modality for treatment psychological distress in rural farmers of Australia. The research on this population group was significant as psychological stress and suicide rate is high among rural farmers compared to urban farmers. The study aimed to evaluate the effect of physical activity on psychological health and other outcomes such as obesity, impaired glucose tolerance and hypertension in farm men and women. However, the study was a protocol and the outcomes of the study are yet to be confirmed. Despite this, the study gives the insight that exercise and dietary intervention can be an emerging modality in treating mental illness in regional areas of Australia.

Research scholars have discussed about the scope of exercise and diet together to treat healthy eating habits in patient with dementia. Dementia is a type of mental disorder that is associated with significant defects in cognitive function. Mental illness patients are often exposed to problems such as decline in physical activity and nutritional problems such as malnutrition and weight loss issues. It has been found that healthy meal lower the risk of dementia in old age. In addition, combination of physical activity and nutrition education program has been associated with improvement in cognitive functions and other morbidities of patient. These are positive results that show that exercise and diet can be targeted for people with mental illness too. Such evidence gives implication for implementing a comprehensive health program that benefits mental health population in rural and regional regions of Australia (Cho & Kim, 2019).

Psychological Distress in Regional and Rural Regions

As rural residents have been found to have poor attitude towards physical activity and healthy diet, the nurses need to use their communication skills to educate them about its benefits. By means of health education, nurses can target knowledge barriers as well as motivate rural residents to take part in healthy diet and lifestyle change. Nurses have the expertise to work at community level and influence attitude change. They can implement health education on diet and physical activity by means of one-to-one counseling session, supervised lifestyle program or ongoing face-to-face support. Evidence has shown that healthy-eating education, weight management guidance, exercise supervision,   

Having balanced nutrition is crucial for healthy later life. Healthy eating involves changing consumption patterns and behaviors. However, people living in rural and regional areas of Australia are at risk of food insecurity issues because of low income, refugees and homelessness. Thus, access to healthy food is a major concern for the group and targeting dietary change will be the task of mental health professionals (Love et al., 2018). This will require change in attitude and the need to direct attention towards lifestyle intervention for mental health too. Indigenous groups in Australia mostly reside in rural and remotes areas of the country. Physical inactivity is identified as one of the major factors for Aboriginal and Torres Strait Islander groups and the reason for increase in disease burden. The physical activity in the group was influenced by various factors such as colonization, discrimination and dispossession (Dahlberg et al., 2018). Evidence also shows that Indigenous Australians are at three to four fold higher risk of depression, anxiety and substance use disorder (Nasir et al., 2018).  Hence, to use exercise as a modality to promote mental health in the group, there is a need for public health initiatives that have the longest impacts on communities. The essay will consider the role of nurses in encouraging families and patients in rural settings to adapt nutrition and exercise as part of lifestyle change.

Nurses can encourage citizens living in rural and urban areas to engage in healthy diet and physical activity by means of health education and use of communication skills. Interventions may include healthy-eating education, weight management guidance, advice on meal replacement and free supply of fruits and vegetables. Effective communication skill is vital in giving such training and education as through this skill, the education can be tailored to the needs of patient. In addition, verbal and non-verbal communication skills can support nurses to engage in culturally appropriate education. As the education needs to be implemented in the community, the nurse can implement education via one-on-one counseling session or through group based educational program in the community (Fergus, Seals & Holston, 2021). Nurses use motivational interventions like motivational interviewing techniques to promote adherence to nutritional care. This technique involves the use of four principles which resisting the reflex, interpreting patient’s motivation, listening with empathy and empowering the patient. Such method is associated with greater adherence to behavioral change compared to other interventions alone (Frost et al., 2018).

To conclude, the essay provided a detailed insight into the burden of mental disorders in Australia and the specific challenges for people living rural and remote areas of Australia. Apart from biological and psychological interventions, nutrition and exercise was found to be a major factor in reducing stress and other mental health symptoms. It prevent stress and metabolic syndrome, it can aid in recovery of patients. However, the main issue that has been found is that nutrition and exercise has been ignored in mental health treatment. Few evidences gave strong evidence for the effect of healthy diet and physical activity on depressive symptoms, cognitive functions and reduction in anxiety in mental illness patients. However, unique barrier to the use of nutrition and physical activity among rural Australians were identified. The essay discussed about the role of effective communication and lifestyle education in encouraging rural residents to take part in physical activity and healthy diet. Such initiative can minimize the burden of mental illness in the future.   

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