Chapter 1 Foundations of Psychiatric–Mental Health Nursing

mental health is difficult to

define

influencing factors of mental health

-Individual (personal)

-Interpersonal (relationship)

-Social/cultural (environmental)

individual

personal, factors include a person's biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities

interpersonal

relationship, factors include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness

social

nonmedical factors that influence health, such as a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, education, employment, income and social protection, and food security

mental illness may alter

-mood

-behavior

-thinking

mental disorders often cause

significant distress and/or impaired functioning.

individual factors

-Biologic makeup

-Intolerable or unrealistic worries or fears

interpersonal factors

-Ineffective communication

-Inadequate social support

social/cultural factors

-Unwarranted negative view of the world

-Discrimination (stigma, racism, classism, etc.)

DSM-5-TR

-book for diagnosis

-Taxonomy published by the American Psychiatric Association

-Purposes:

-Standardize diagnosis criteria

-Present defining characteristics or symptoms

-Assist in identifying the underlying causes of disorders

DSM-5-TR Classification Allows the practitioner to identify

-all factors that relate to a client's condition:

-Major psychiatric disorders

-Medical conditions

-Psychosocial and environmental problems

Ancient times

-Sickness as displeasure of gods; punishment for sins; viewed as demonic or divine

aristotle

-Aristotle and imbalances of the four humors (blood, water, yellow, and black bile); balance restoration via bloodletting, starving, and purging

early christians

All diseases were again blamed on demons, and the mentally ill were viewed as possessed. Priests performed exorcisms to rid sufferers of evil spirits. When that failed, they used more severe and brutal measures, such as incarceration in dungeons, flogging, and starving.

in early renaissance

people with mental illness were distinguished from criminals. Those considered harmless were allowed to wander the countryside or live in rural communities, but the more "dangerous lunatics" were thrown in prison, chained, and starved

Period of enlightenment

-1790s

-created asylums: -moral tx of mentally ill came with this movement

asylum

a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill

who created asylums

Dorothea Dix

after a visit to tukes institution on england Dorothea Dix

-began a crusade to reform the treatment of mental illness -She was instrumental in opening 32 state hospitals that offered asylum to the suffering.

who studied mental illness treatment scientifically

sigmund freud

freud challenged society to view

-human beings objectively.

-He studied the mind, its disorders, and their treatment as no one had done before

development of psychopharmacology

-1950

-began with psychotropic drugs (drugs used to treat mental illness)

-drugs actually reduced agitation, psychotic thinking, and depression.

-Hospital stays were shortened, and many people became well enough to go home.

-The level of noise, chaos, and violence greatly diminished in the hospital setting.

-community mental health movement

community mental health move

-1963

-deinstitutionalized (bad tx inside)

-legislation for disability income supplemental security income (SSI) and Social Security disability income (SSDI).

-changes in commitment laws in the early 1970s (cant just lock somebody up against their will)

what happened after deinstitutionalization

-Community mental health centers served smaller geographic catchment, or service, areas that provided less restrictive treatment located closer to individuals' homes, families, and friends.

-These centers provided emergency care, inpatient care, outpatient services, partial hospitalization, screening services, and education.

-Thus, deinstitutionalization accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care.

how many adults in the United States have a mental illness

51.5 million

how many actually get tx for it

23 mil

how many children and adolescents are diagnosed with a mental disorder.

11 mil

what is the economic burden of mental health

-Economic burden of mental illness exceeds the economic burden of cancer

mental health is the leading

cause of disability for those 15-44 years old

only how many out of those diagnosed are actually treated

-in which pops is tx lagging

-only 1 in 4 adults

- 1 in 5 children and adolescents are treated.

-Treatment still lagging in homeless and those with substance abuse problems.

revolving door effect

-due to deinstitutionalization

-frequent fliers in ER

-you stabalize them they never follow up and come back

recidivism

revolving door effect

Which statement best reflects the current state of mental health and mental illness?

A. Mental health care costs exceed the costs for cancer care.

B. Most adults and children receive adequate mental health care.

C. Community resources for the homeless with mental illness are adequate.

D. Deinstitutionalization has reduced the revolving door effect.

A.Mental health care costs exceed the costs for cancer care.

Healthy People 2030 objectives:

-Reduce the suicide rate.

-Increase the proportion of children and adolescents who get treatment.

-Reduce the proportion of persons who experience major depressive episodes.

-Increase the proportion of adults with mental health disorders who receive treatment.

-Increase the number of homeless adults with mental health problems who receive mental health services

Lack of appropriate number of

community mental health centers to provide services

Development of community support programs

-Availability, quality of services highly variable

-Inaccurate anticipation of extent of people's needs

-Despite flaws, positive aspects make them preferable for treatment

Managed care movement

-early 1970s

-concept designed to purposely control the balance between the quality of care provided and the cost of that care

-were successful in populations of healthier people

development of utilization review firms/managed care organizations

-1990s

to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care.

Case management

-management of care on a case-by-case basis, represented an effort to provide necessary services while containing cost. -The client is assigned to a case manager, a person who coordinates all types of care needed by the client.

-In theory, this approach is designed to decrease fragmented care from a variety of sources, eliminate unneeded overlap of services, provide care in the least restrictive environment, and decrease costs for the insurers.

case management in reality

-expenditures are often reduced by withholding services deemed unnecessary or by substituting less expensive treatment alternatives for more expensive care, such as hospital admission.

Mental health care management through privately owned behavioral health care firms

-If no private insurance, reliance on counties of residence for payment

Health Care Finance Administration:

-Medicare- people over 65, kidney failure, certain disabilities

-Medicaid- low income families jointly funded by federal and state govs

Cultural Considerations

-Culturally diverse population

-Cultural differences influencing mental health and treatment of mental illness

-Changes in family structure

Is the following statement true or false?

Community-based programs are preferable for treating many people with mental illness.

true

first American psychiatric nurse

-linda richards

-treat them morally

First psychiatric nursing textbook

(Nursing Mental Diseases) was published in 1920.

Johns Hopkins:

first school of nursing to include psychiatric nursing course (1913)

National League for Nursing

(1950) requiring schools to include an experience in psychiatric nursing

H. Peplau:

therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice)

-SPEAK SOFTLY

-build rapport so it doesnt look like your going down a list

J. . Mellow:

: focus on client's psychosocial needs and strengths

Basic-level functions

-Counseling:first line

-Milieu therapy

-Self-care activities

-Psychobiologic interventions

-Health teaching

-Case management

-Health promotion and maintenance

-exercise

-non-pharm

Advanced-level functions

-Psychotherapy

-Prescriptive authority for drugs

-Consultation and liaison

-Evaluation

-Program development, management

-Clinical supervision