Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units
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Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units
Mental health refers to “a state of well-being in which the individual realizes his or her
own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and
is able to make a contribution to his or her community” (World Health Organization [WHO],
2001, p. 1) in (Lee, J., & Thyer, B. A. 2013 ). Music therapy has been proven to relieve anxiety
and decrease depression when it is combined with Therapy as usual (TAU) and thereby reducing
incidences if emergency crisis whereby patients end up in restraints, on physical hold or
chemical restraints. ““Music initiatives offer innovative modes of supporting young people to
address identity in the process of recovery (Solli 2014), since young people frequently engage
with music for constructing identity in everyday life (McFerran 2010; Tarrant, North, and
Hargreaves 2002)”, in Hense, C., & McFerran, K. S. (2017)”. The purpose of this paper is to
compare the effects of music therapy and journaling to journaling alone in the behavioral unit
milieu, reducing incidents of emergency crisis and to research guidelines and protocols to
implement music therapy at a behavioral unit for young adults and adults.
The Significance of the Problem
“With 75% of mental illnesses presenting before the age of 25, mental health is one of the
most important issues facing young people today” (Patton et al. 2014). Early screening and
treatment is crucial in reducing mental health illnesses, however in those that are unfortunate to
need in-treatment it is important that as healthcare workers we practice evidence-based practice
to deliver the best care. ““Approximately 26.2% of Americans ages 18 years and older suffer
from a mental disorder in a given year, which is about 57.7 million persons. Moreover, nearly
half (45%) of those have two or more mental disorders”. (Kessler, Chir, Demler, & Walters,
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
2005), which can complicate and prolong treatment””, (Lee, J., & Thyer, B. A. 2013). The milieu
in behavioral health units varies with the population at any time. If there are several
schizophrenic patients actively responding to voices and seeing things, it can affect the other
patients and increase anxiety, depression and other symptoms. Anxiety causes irritability and
increases incidences of crisis. Availability of music therapy especially after the Therapy as usual
will reduce anxiety, reduce depression and create a calm milieu. I have noticed patients who
have bee actively calmed by music. Research has proved that music therapy has significant
positive outcomes, “Participants articulated that music therapy can facilitate a patient’s ability to
self-disclose, socialize, and communicate and is therefore able to shift a patient’s frame of
reference from internal to external”, Silverman, M. J. (2018). With respect to nursing practice,
information literacy is the ability to identify information needed for a specific purpose, locate
pertinent information, evaluate the information and apply it correctly.
Questions Addressing Research
Emergency crisis is a disruption and can create chaos and decreased morale among
patients and staff and in a behavioral unit. The first question was whether Music Therapy as an
added intervention reduces anxiety, depression and improve the mood in a behavioral unit where
patients are vulnerable to crisis as they are exposed to different conditions that can trigger crisis?.
“Music therapy seems to reduce depressive symptoms and anxiety, and helps to improve
functioning (e.g., maintaining involvement in jobs, activities, and relationships)”, ( Health People
2020). There still ongoing research on music therapy and its effects in mentally ill patients.
“Music therapy is a well-established non-verbal treatment method in psychiatry and
psychosomatic medicine. However, empirical data of its impact on emotion modulation
processes and personality dimensions are still sparce”, (Gebhardt, S. 2018).
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
The second question, Is therapy as usual less effective in depression, schizophrenia, and
anxiety compared to adding music therapy to the regimen. “Participants receiving music therapy
plus standard care showed greater improvement than those receiving standard care only in depression
symptoms (mean difference 4.65, 95% CI 0.59 to 8.70), anxiety symptoms (1.82, 95% CI 0.09 to 3.55) and
general functioning (74.58, 95% CI 78.93 to 70.24) at 3-month follow-up”, (Jaakko, E., et al 2011).
Music therapy has been proven to balance the ratios of oxygen and blood in the brain thus
regulating blood pressure and respiration. Adding relaxation exercise and music therapy
improves treatment in the multidisciplinary treatment of schizophrenia, “ Even
though)pharmacological treatment)is the first option in the treatment of)schizophrenia, it has
limitations as a result of the chronic progress of the disease and patients' relapses, deficiency
of)insight)and cognitive losses; indeed, in some cases,)patients experience ongoing)negative
symptoms)despite medication (Ventura, Wood, Jimenez, & Hellemann , 2013 ”, in (Kavak, F.,
Ünal, S., & Yılmaz, E. 2016).
The third question,‘(1) How do various mental health hospital staff and administrators
perceive music therapy? (2) Why might they consider music therapy a contributing component
of the inpatient treatment milieu for inpatients on an acute care mental health unit?”, as
structured in Silverman, M. J. (2018). Staff and Administrators’ Perceptions of Music Therapy
with Acute Care Mental Health Inpatients. In this study, staff verbalized the effectiveness of
music therapy and how it makes it easier for patients to open up and discuss their fears, strength
and expectations of therapy. “I think it’s definitely calming for patients who are very agitated.
Music therapy is time to relax and calm them down. There’s something about teaching the
coping skill and using it and seeing it affects their mood and calms them down, that they can take
that when they leave the hospital and see it as a coping or soothing strategy”, (Program Director)
in (Silverman, M. J. 2018).
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
Fourth question, In comparison which scale would yield most effective and ideal results
for the setting?. Nine studies were done comparing Music Therapy to Therapy as Usual using
scales such as the Hamilton Depression scale, Thai Depression scale, Beck Depression scale,
and Emotional Anxiety Scale among others. “This trial has shown that music therapy added to
standard care helps people with mild, moderate or severe depressive episodes to improve their
levels of depression as well as anxiety and functioning” (Jaakko, E. et al 2011). The Hamilton
depression would be more suitable, the scale has been widely used in clinical practice and
becomes a standard in pharmaceutical trials, it has 21 questions and scoring is based on the first
17 questions. It has questions ideal for the study population.
The 5th question is formulating a protocol on how staff Nurses and Behavioral
Technicians will be effective in delivering music therapy. Most therapies start late morning to
early afternoon, having group music first thing in the morning is a good start to the day. In the
evening individual music like headphones whereby an individual listens to their ideal music is a
calming effect for the night. Most behavioral units have levels of merit and certain privileges are
rewarded every level. When admitted all patients are level 1 and with improved behaviors, they
can be level 2 whereby they can listen to their favorite music with headphones. Otherwise
satellite radio for everyone will yield results. “MA variety of neurophysiological findings of music
are known, e.g., impacts on the medial and dorsolateralMprefrontal cortex,Mamygdala,Mnucleus
accumbensMas well asMcortisolMmetabolism affecting both emotional and cognitive processes”,
(Gebhardt, S,. et al 2018).
PICOT Research Question.
The question for research focuses on reducing emergency crisis in behavioral units by
comparing the music therapy to therapy as usual alone, its effectiveness as an added intervention:
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
to reduce cases whereby patients end up in physical restraints, physical hold, seclusions or
chemical restraints after they have been on the unit for some time and had or had not exhibited
crisis behavior. How can nurses foster effective coping skills while patients are on the unit?
On admission most patients verbalize that music and journalling ease their anxiety but that
seems to be just a questionnaire and is hardly included in the Plan of Care.
In applying PICOT to the study:
P – the population is mental health patients with emphasis to bipolar depressive disorder,
anxiety, schizophrenia, and depression
I - the research aims to prove if music therapy reduces emergency crisis compared with other
therapies alone like journaling and therapy as usual
C – Compare depression and anxiety and incidents of emergency crisis in Patients doing
therapy as usual compared to the ones who will also do Music therapy
O – the aim of the study is to reduce incidents of emergency crisis in behavioral units by
reducing anxiety, agitation and depression.
T - does Music therapy decrease anxiety, depression and agitation in patients within 2-3 days
of admission to a behavioral unit.
Literature Key Word Search
In the study the words likely to result in relevant information/ articles on the PICOT
question are Mental Health, Music Therapy, Bipolar, Depression, Anxiety, Schizophrenia,
Journaling Therapy, emergency medication, Adults, and Young Adults. “The most effective
literature is recent, unbiased, high quality and it should be primary source that is it is written by
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
researchers who conducted the studies. The most high-level literature is the systematic reviews
these include filtered “…experimental or quantitative, studies and often include randomized
trial”, (Walden, 2018).
The search conducted through Walden University Library and the databases that would
yield the most credible, and that contain the high-level articles, authoritative articles were
selected and there were CINAHL Plus with Text, Cochrane Database of Systematic Reviews and
Joanna Briggs Institute, “The criteria for inclusion is usually based on research from clinical
trials and observational studies. Assessments are done based on stringent guidelines, and the
reviews are regularly updated”, (Walden University, 2012). Also used Medline with text for
RCT Randomized Control Trials and Cohort studies which have a lot of information on the topic.
The search is expanded using Boolean to get most articles for the question i.e. Music Therapy
was the first word, the second word was Mental health and the third word was alternated with all
the other words, “depression”, “anxiety”, “Bipolar”, “journaling”, “emergency medication
“schizophrenia” and “young adult”. For relevance and up to date research articles the search
narrowed to articles published within the last 8 years.
The study is set to prove the effects of Music Therapy reducing emergency crisis in
mental health units and get protocols in place before implementation. Of urgency and interest in
the study is the fact that my organization is building a new building for behavioral health and
involvement in the committee working on the new developments is crucial. Getting the relevant
people involved is of importance for the study i.e., Management, social workers, Nurses and
administrators and making sure the right education is available for everyone who will be
involved.
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
Conclusion
“Music therapy can be defined as “the professional use of music and its elements as an
intervention in medical, educational, and everyday environment with individuals, groups,
families, or communities, who seek to optimize their quality of life and improve their physical,
social, communicative, emotional, intellectual and spiritual health and well-being”. (Aalbers, S.
2017). M The study reveals that Music Therapy in combination with other therapies is effective in
reducing anxiety and depression in Mental illness. The cost is reasonable compared to
alternatives of emergency medication or the dangers of seclusion, restraints or hold downs. With
Depression affecting 300 million people each year worldwide and linked to about 800 000 deaths
by suicide, more research and alternative treatments are critical. The study shows that most
nursing staff required education and protocols on implementing music therapy as an intervention.
Management must be involved in looking at costs and benefits to the program and success in the
project will improve patient care and outcome.
Using Music Therapy to Reduce Incidences of Emergency Crisis in Mental Health Units.
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