Chapter 1/2: Psychiatric Mental health Nursing, Stigma, and Recovery

Foundations of Psychiatric Mental Health Nursing (PMH)

Definition: specialized field blending evidence based science with the art of therapeutic relationships

Scope: care provided at individual, family, community, and societal levels

Primary Goal: promoting well being, quality of life, and positive health outcomes

Core Principals of PMH

Purpose Use of Self: The nurse-pt relationship is the central tool of care

Holistic Approach: Rejects mind-body dualism; treats the patient within their environmental context.

Evidence-Based Practice: Synthesizes research, clinical expertise, and patient preferences.

Versatile Application: From acute crisis management (violence/suicide) to community health.

Florence Nightingale

early foundations

advocated for holistic views and therapeutic communication

Linda Richards

1882- early foundation pioneer

1st trained US nurse

opened Boston City Hospital Training School

Harriet Bailey

1920- early foundation pioneer

authored the 1st psychiatric nursing textbook

Hildegard E. Peplau

1952- modern pioneer

published Interpersonal Relations in Nursing defining the therapeutic relationship

ANA

1967- modern pioneer

published the 1st statement on psychiatric nursing practice

Modern PMH Milestone

2003

formal delineation of the Psychiatric-Mental Health Nirse Practitioner Role

Evolution of Mental Health Care

Ancient & Medieval: Mental illness attributed to evil spirits, sin, or environmental contamination. Treatments included trepanation and exclusion.

The Shift: Recognition of mental disorders as treatable illnesses.

"Moral Treatment": Emphasized kindness, compassion, and pleasant environments.

Key Reformers of Mental Health Evolution

Philippe Pinel (France), William Tuke (England), Dorothea Dix (US)

Philippe Pinel

removed chains

introduced physician led care

William Tuke

established the York Retreat (sympathetic care)

Dorothea Dix

crusaded for public funding and state hospitals to replace inhumane conditions

Institutionalization

1900-1955

forced confinement in large, self contained facilities

lead to social isolation, inhumane care, and negative pt outcomes, overcrowding

women faced harsh conditions and fewer rights

Deinstitutionalization

1963-present

Psychopharmacology revolution, community Mental Health Centers Act, National Mental Health Act

National Mental health Act

1946

established MNH

Psychopharmacology

1950s

intro to chlorpromazine (Thorazine) which calms symptoms, making community living possible

Mental Retardation Facilities and Community Mental Health Centers Constitution Act

1963

goal was to replace long stay hospitals w/less isolated community services

Implementation Challanges

populations dropped but infrastructure was insufficient

resulted in revolving door effect, homelessness, and trans-Institutionalization

Surgeon General’s Reports

1999/2000, modern framework

validated treatment efficacy

focused on children’s services

New Freedom Commission

2003, modern framework

shifted system toward a consumer and family centered recovery model

Mental Health Parity Act

2008, modern framework

required equal coverage for mental health/substance use and medical/surgical benefits

Affordable care Act

2010, modern framework

banned exclusions for preexisting conditions

expanded Medicaid

CARES Act

2020, modern framework

response to COVID 19 impact

$425 million to SAMHSA and $250 mil for Certified Community Behavioral Health Clinics

Mental health

state of well-being where one realizes abilities, copes w/stress, and works productively

not just absence of disease

Mental Illness

significant disturbances in cognition, emotion, or behavior

defined by cluster of behaviors, thoughts, and feelings

not just biological anthology

person can have diagnosed mental illness and still experience high lvls of wellness and person w/o diagnosis can have poor mental well being

8 Dimensions of Well-Being

Emotional- coping effectively w/life

Financial- satisfaction w/current and future situations

Social- connection, belonging, support systems

Spiritual- sense of purpose and meaning

Occupational- satisfaction and enrichment w/work

Physical- activity, diet, sleep, nutrition

Intellectual- creative abilities, expanding knowledge 

Environment- pleasant, stimulating environments

Recovery Model

Paradigm Shift: Moving from paternalistic medical care (symptom management) to a collaborative partnership where recovery is realistic goal

process of change to improve health and wellness, live a self-directed life, and strive for full potential

includes 4 pillars of recovery

4 Pillars of Recovery

Health- managing disease/symptoms emotionally and physically

Home- safe, stable place to live

Purpose- meaningful activities, independence

Community- relationships, social networks

Trauma Informed Care

includes Adverse Childhood Experiences (ACEs) and 6 principals of care

goal is to actively resist retraumatization

Adverse Childhood Experiences (ACEs)

traumatic events (0-17 yrs old) like abuse, neglect, or household dysfunction

strong link to mental disorders

64% of US adults report at least one ACE

6 Principles of care

Safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, cultural, historical and gender issues

Social Determinants of Health (SDOH)

conditions in the places where ppl live, learn, work, and play

SDOH often outweigh genetics or access to care in determining health outcomes

Key areas: economic stability, education access, healthcare access, neighborhood environment, social context

racial/ethnic groups face higher unmet needs due to cost, mistrust, and lack of culturally competent care

Stigma

barrier to treatment, recovery, and social integration leading to discrimination

Public Stigma

Stereotypes leading to prejudice and discrimination (housing, employment) 

Reinforced by media

Self Stigma

Internalizing negative stereotypes 

Pt agrees w/- view leading to low self esteem and why try attitude

Label Avoidance

Refusing to seek treatment to avoid mentally ill tag

Stigma Consequences: Social and Economic

reduced access to jobs and independent living

loss of social relationhsips

Stigma Consequences: Barrier to care

providers may minimize pt complaints

withholding of meds

reduced likelihood of pts pursuing help

Stigma Consequences: Psychological

reinforces hopelessness and SI

diagnostic labels (DSM), while useful for resources, can reinforce negative stereotypes

Populations With Special Needs: Women (FAB)

Vulnerable to power inequities and discrimination

Reproductive health restrictions linked to increased emotional stress

Populations With Special Needs: LGBTQ+

Higher rates of depression and anxiety due to minority stress, social stigma, and denial of civil rights

Populations With Special Needs: Racial and Ethnic Groups

Significant gap in service utilization

Barriers: language, systemic mistrust, and limited provider diversity