Week 1: Foundations of Psychiatric–Mental Health Nursing

Mental Health

A state of emotional, psychological, and social wellness characterized by satisfying relationships, effective coping, and positive self-concept.

Mental Illness

Disorders affecting mood, behavior, and thinking (e.g., depression, schizophrenia) that cause distress or impaired functioning.

Factors Influencing Mental Health

• Individual: Biological makeup, autonomy, self-esteem, and resilience.

• Interpersonal: Communication, intimacy, and social support.

• Social/Environmental: Access to resources, social inclusion, and exposure to violence or discrimination.

DSM-5-TR

• Purpose: Published by the APA, it provides standardized nomenclature and diagnostic criteria for mental disorders.

• Scope: Aids in identifying psychiatric disorders, medical conditions, and psychosocial problems.

• Global Context: The ICD-11 is the international standard, though many countries adapt DSM-5-TR principles.

Historical Perspectives of Mental Illness

• Ancient/Early Christian Times: Mental illness was often viewed as divine or demonic; treatments included bloodletting or exorcisms (Aristotle's fluid balance theory).

• Renaissance: Distinction between "harmless" and "dangerous" led to the creation of institutions like St. Mary of Bethlehem.

• Enlightenment (1790s): Philippe Pinel and William Tuke advocated for asylums as safe refuges.

• US Reform: Dorothea Dix established 32 state hospitals focusing on moral treatment.

• Scientific Era: Freud (psychoanalysis), Kraepelin (classification), and Bleuler (schizophrenia) shifted focus to clinical study.

Recent Trends and Changes

• Psychopharmacology (1950s): Introduction of Chlorpromazine and Lithium enabled shorter hospital stays and improved outpatient outcomes.

• Deinstitutionalization: The 1963 Community Mental Health Centers Construction Act shifted care to community settings, though many planned centers were never built.

• Current Challenges:

  • Revolving Door Effect: Frequent, short hospitalizations without full stabilization.

  • Dual Diagnosis: Co-occurring mental illness and substance misuse.

  • Disparity: Only about half of adults with mental illness receive treatment; it remains a leading cause of disability for people aged 15-44.

Managed Care and Standards

• Managed Care: Aims to control costs through case management and "need-based" care.

• Mental Health Parity Act (1996): Eliminated dollar limits for mental health care in large companies, though state-level coverage varies.

• Nursing Standards: The ANA and APNA establish professional practice standards to ensure safe, competent care.

Pyschiatric Nursing Practice

• Pioneers: Linda Richards (first psychiatric nurse); Hildegard Peplau (Interpersonal relations theory); June Mellow (psychosocial needs).

• Therapeutic Role: Shifted from purely physical care to focusing on trust, rapport, and interpersonal dimensions.

Student Considerations

• Common Fears: Fear of saying the wrong thing or personal safety concerns are normal but usually dissipate after client interaction.

• Relationship Building: "Just talking" is a valid therapeutic intervention; listening and interest are more valuable than a "perfect" response.

• Safety & Confidentiality: Mentally ill individuals are more likely to self-harm than harm others. Maintaining client privacy is paramount.