Mental Health 3 CH 9-12

Legally assisted or mandatory outpatient treatment

the requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital into the community.

restraint

direct application of physical force to a person without their permission to restrict their freedom of movement

seclusion

s the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visual monitoring

least restrictive environment

-Face-to-face evaluation within 1 hour and then
every 8 hours (every 4 hours for children)
- Physician’s order every 4 hours (every 2 hours
for children)
-Documented assessment by nurse every 1 to 2
hours
- Close supervision of client, one-to-one
monitoring for the first hour
- Debriefing session within 24 hours after release
from seclusion or restraint

M’Naghten rule

the defendant did not know the nature or quality of the act or did not know it was wrong because of a mental disease or defect.

Irresistible impulse

the defendant could not control their conduct owing to mental disease or defect.

Substantial capacity test

the defendant lacks substantial (but not total) capacity to appreciate their conduct as wrong or cannot conform their conduct to the law.

Durham

the defendant’s criminal conduct is excused when it is caused by a mental disease or defect

ethics

branch of philosophy that deals with values of human conduct related to the rightness or wrongness of actions and to the goodness and badness of the motives and ends of such actions

Utilitarianism

the greatest good for the greatest number.

which action would produce the greatest benefit for the most people

Deontology

decisions should be based on whether an action is morally right with no regard for the result or consequences.

grief

refers to the subjective emotions and affect that are a normal response to the experience of loss OR CHANGE

grieving or bereavement

refers to the process by which a person experiences the grief.

Anticipatory grieving

when people facing an imminent loss begin to grapple with the possibility of the loss or death in the near future.

mourning

outward expression of grief.

Rituals include having a wake, sitting shiva, holding religious ceremonies, and arranging funerals.

physiological loss

Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility

safety loss

Loss of a safe environment is evident in domestic violence, child abuse, or public violence.

Loss of security and a sense of belonging:

The loss of a loved one affects the need to love and the feeling of being loved. Loss accompanies changes in relationships, such as birth, marriage, divorce, illness, and death; as the meaning of a relationship changes, a person may lose roles within a family or group

loss in self esteem

Any change in how a person is valued at work or in relationships or by themself can threaten self-esteem. It may be an actual change or the person’s perception of a change in value.

loss related to self-actualization

An external or internal crisis that blocks or inhibits striving toward fulfillment may threaten personal goals and individual potential. A person who wanted to go to college, write books, and teach at a university reaches a point in life when it becomes evident that those plans will never materialize or a person loses hope that they will find a mate and have children. These are losses that the person will grieve.

legal guardian

person who assumes many responsibilities for the person, such as giving informed consent, writing checks, and entering contracts (marriage, mortgage)

conservator

refers to a person assigned by the court to manage all financial affairs of the client.

human restraint

occurs when staff members physically control the client and move them to a seclusion room

mechanical restraint

devices, usually ankle and wrist restraints, fastened to the bed frame to curtail the client’s physical aggression, such as hitting, kicking, and hair pulling.

duty to warn questions

Is the client dangerous to others?

Is the danger the result of serious mental illness?

Is the danger serious?

Are the means to carry out the threat available?

Is the danger targeted at identifiable victims?

Is the victim accessible?

insanity

has a legal meaning but no medical definition

Disenfranchised grief

grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Circumstances that can result in disenfranchised grief include the following:

A relationship that has no legitimacy

The loss itself is not recognized

The griever is not recognized

The loss involves social stigma

Kübler-Ross’s Stages of Grieving

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

rando’s 6 Rs of grieving tasks

1. recognize

2. react

3. recollect and re-experience

4. relinquish

5. readjust

6. reinvest

recognize

Experiencing the loss, understanding that it is real, and that it has happened

react

Emotional response to loss, feeling the feelings

Recollect and reexperience

Memories are reviewed and relived

relinquish

Accepting that the world has changed (as a result of the loss) and that there is no turning back

readjust

Beginning to return to daily life; loss feels less acute and overwhelming

reinvest

Accepting changes that have occurred; reentering the world, forming new relationships and commitments

acculturation

altering cultural values or behaviors as a way to adapt to another culture)

5 dimensions of grieving

-Cognitive responses (Questioning, trying to make sense of loss. Attempting to keep lost one present)

-Emotional responses ( anger, sadness, anxiety)
-Spiritual responses
-Behavioral responses
-Physiologic responses (physical, insomnia,angia)

complicated greiving

a response outside the norm, occurring when a person is void of emotion, grieves for prolonged periods, or has expressions of grief that seem disproportionate to the event.

Susceptibility to complicated grief

Low self-esteem

Low trust in others

A previous psychiatric disorder

Previous suicide threats or attempts

Absent or unhelpful family members

An ambivalent, dependent, or insecure attachment to the deceased person

dependent attachment

one partner relies on the other to provide for their needs without necessarily meeting the partner’s needs.

ambivalent attachment

at least one partner is unclear about how the couple loves or does not love each other. For example, when a person is uncertain about and feels pressure from others to have an abortion, they are experiencing ambivalence about their unborn child

insecure attachment

usually forms during childhood, especially if a child has learned fear and helplessness (i.e., through intimidation, abuse, or control by parents

Inadequate emotional regulation

focusing exclusively on negative emotions; not taking a break for more soothing or calming pursuits; and ignoring regular routines for eating, sleeping, activities, and social contact

Dysfunctional behaviors

avoiding all reminders of the deceased person or immersing oneself in the lost loved one’s possessions and pictures and daydreaming about being together to the exclusion of any other coping strategies

Maladaptive thoughts

rumination, catastrophizing, and worrying about doing the right thing, to the exclusion of problem-solving, positive thoughts, or cognitive reappraisal

Anger

a normal human emotion, is a strong, uncomfortable, emotional response to a real or perceived provocation. Results when a person is frustrated, hurt, or afraid.

Hostility

verbal aggression, an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

physical aggression

behavior in which a person attacks or injures another person or destroys property

catharsis

supposed to provide a release for anger.

However, can increase rather than alleviate angry feelings. may be contraindicated for angry clients

triggering phase

incident or situation that initiates an aggressive response

acting out

immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than through reflection or feelings

impulse control

the ability to delay gratification

crisis

During an emotional and physical crisis, the client loses control

recovery

The client regains physical and emotional control.

post-crisis

client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents.

escalation

The client’s responses represent escalating behaviors that indicate movement toward a loss of control.

Five-Phase Aggression Cycle

1. trigger

2. escalation

3. crisis

4. recovery

5. post-crisis

Abuse

the wrongful use and maltreatment of another person

intergenerational transmission process

patterns of violence are perpetuated from one generation to the next through role modeling and social learning

cycle of abuse/ violence

Violent episode → honeymoon period → tension-building
phase → violent episode