Exam 1 - 334 Mental Health

week 1-3 of slides. things that are bolded are things to focus on more/mentioned to be important in class

What is mental health?

Emotional and psychological balance in the pursuit of wellness and a meaningful quality of life.

privacy rights

• conifidentiality and right to privacy

  • health insurance portability and accountability act

  • exception: a duty to warn - Tarasoff v. Regents of Uni of Cali (1974)

  • exception: suspected child or elder abuse

mental bill of rights:protection of patient rights

• Appropriate treatment: Care should be provided in the least restrictive setting possible.

• Personalized treatment plan: Patients should have an individualized plan that is regularly updated.

• Participate in decisions: Patients have the right to understand their condition and be involved in treatment decisions.

• Informed consent: Patients must voluntarily consent to treatment, except in certain emergencies or court-ordered situations.

• Refuse research: Patients can choose whether to participate in research.

• Freedom from restraint/seclusion: Used only when necessary, generally during emergencies, with proper documentation.

• Humane environment: Patients deserve safety, dignity, and privacy.

• Confidentiality: Patient information must be kept private.

• Access records: Patients generally have the right to review their medical records.

• Communication/visitors: Patients have rights to communication and visitation, with some treatment-related restrictions.

• ℹ Know their rights: Patients must be informed of their rights.

• File grievances: Patients can report complaints and have them fairly addressed.

• Advocacy: Patients can receive help understanding and exercising their rights.

• No retaliation: Patients cannot be punished for exercising their rights.

• Discharge referral: Patients should receive appropriate follow-up services when discharged

ethics

branch of philosophy that deals with systematic approaches to distinugishing right from wrong behavior

bioethics

principles when they refer to concepts within the scope of medicine, nursing, and allied health

Milieu therapy has been changed to what?

Short term approach to care and to outpatient treatment programs

Skinner’s seven basic assumptions of a therapeutic
community

◦ The health in each individual is to be
realized and encouraged to grow.
◦ Every interaction is an opportunity for
therapeutic intervention.
◦ Each client owns his or her own
environment.
◦ Each client owns his or her own behavior.
◦ Peer pressure is a useful and powerful
tool.
◦ Inappropriate behaviors are dealt with as
they occur.
◦ Restrictions and punishment are to be
avoided.

things that promote a therapeutic environ.

• basic needs are met

• physical facilites are conductive to acheivement of therapy goals.

• democratic form of self-government present

• client’s capabilites determine responsibilites given

• community and family are included

hildegarde peplau: nursing theorist

• Nursing is a therapeutic, interpersonal process between the nurse and patient that works toward a shared patient goal.

  • Help the patient identify their difficulties

  • Uses phases of the therapeutic process

  • The nurse takes on different roles during the relationship

  • Nurse and patient work together toward a common goal

  • Influenced by Sullivan’s interpersonal theory

social determinates of mental health

• level concerns of poverty, violence, crime, safety, abuse of civil and political rights and freedom

• access to safe, effective, quality care at all levels

Freud- Psychoanalytical

• unconscious could be accessed through dreams and free association

• consists of id, ego, superego

• transference and counter transference

difference between id, ego, superego

instincts, realtiy, morality

Do you have to be mentally healthy to be healthy?

Yes, its impossible to be healthy w/o being mentally healthy.

• exception: chronic mental disorder- you can be mentally healthy w one

Freud defense mechanisms

• unconscious strategies the mind uses to protect from anxiety, stress, or uncomfortable thoughts

  • the ontes that are conscious are suppresion and compresation

What is mental wellness?

A purposeful process involving individual growth and integration of experience, meaningful connections, valued goals, and personal strengths.

what things are involved in having mental wellness

• purpose in life

• being active in work/hobbies

• joyful relationships w people

• healthy body and environment

• being happy

ACEs stands for

Adverse Childhood Experiences

What is a mental disorder?

A condition involving altered thinking, mood, or behavior associated with distress or impaired functioning.

Mental disorders are described as

Syndromes

• meaning sets of symptoms that cluster together

• may have multiple causes or represent different disease states

Can a person have a chronic mental disorder and still be mentally healthy?

Yes. The slides distinguish mental health from mental disorder.

What is stress?

An individual's reaction to a change that requires an adjustment or response

What types of responses can stress produce?

Physical, mental, and emotional responses.

What does the stress response help preserve?

Internal biological stability, psychological self-identity, and self-esteem.

What is a stressor?

A biological, psychological, social, or chemical factor that causes physical or emotional tension which may contribute development of specific illness

who created the General Adaptation syndrome and what is the alternative name

Hans Seyle; fight or flight response

What are the three stages of General Adaptation Syndrome?

Alarm, resistance, and exhaustion.

What is the correct GAS sequence?

Alarm → Resistance → Exhaustion.

What happens in the alarm stage of GAS?

It is the initial stress response stage in the General Adaptation Syndrome sequence.

What is the resistance stage of GAS?

The stage that follows alarm as the body continues adapting to the stressor.

What is the exhaustion stage of GAS?

The final stage of GAS when continued stress has depleted adaptive resources.

Criteria for Diagnosis: DSM-5-TR

• contains subtypes to classify disorders

• no boundaries

• culture bound syndromes

  • ex: AMOK which is a dissociative episode; period of brooding w outburst of anger in Southeast Asian pops.

What is adaptive coping?

A response or behavior that maintains the integrity of the individual.

• viewed as positive w correlation to healthy response

What is maladaptive coping?

A response or behavior that disrupts the integrity of the individual.

• considered negative and unhealthy

What is anxiety?

Diffuse, vague apprehension associated with uncertainty and helplessness.

What is grief?

Subjective emotional, physical, and social responses to loss of a valued entity.

What are the five stages in Kübler-Ross's model?

Denial, anger, bargaining, depression, acceptance.

What does DABDA stand for?

Denial → Anger → Bargaining → Depression → Acceptance.

What is a defense mechanism?

An unconscious strategy used to protect against anxiety, stress, or uncomfortable thoughts.

Which defense mechanisms were specifically identified as conscious?

Suppression and compensation.

What is suppression according to the slide material?

A defense mechanism identified as conscious.

What is compensation?

A defense mechanism that can be conscious.

What is public stigma?

Stereotypes leading to prejudice and discrimination.

Examples public stigma stereotypes that lead to prejudice and discrimination

The slides give examples such as 'dangerous,' 'unpredictable,' 'unable to function independently,' 'weak,' and 'immoral.'

What is self-stigma?

The negative stigma experienced or internalized by a person with mental illness.

What is label avoidance?

Avoiding a mental-health label because of stigma.

How can media contribute to stigma?

Negative images in media and films can reinforce stereotypes about mental illness.

What is self-determination?

A fundamental right and need involving empowerment/free will to make moral judgments and choices based on personal goals.

• internal motivation to make choices based on personal goals

What principle is self-determination based on?

Autonomy.

What is autonomy?

Respect for the person's right to make decisions.

What is beneficence?

Taking action directed toward benefit.

What is non-maleficence?

Avoiding harm.

What is justice?

Fairness and equitable treatment.

What is fidelity?

An ethical principle identified in the legal/ethical material involving faithfulness to professional responsibilities.

What is veracity?

An ethical principle involving truthfulness.

What is the Patient Self-Determination Act related to?

Information about advance care documents and the patient's rights to complete advance directives and refuse treatment.

What advance-care documents are listed for mental health?

Living will, psychiatric advance directives, and durable power of attorney.

What is a psychiatric advance directive?

An advance-care document specifically relevant to mental health care.

What is a durable power of attorney?

An advance-care document identified in the patient-rights material.

What is informed consent?

A legal procedure ensuring the patient knows what can be done to their body/mind and the benefits and costs of treatment.

• complicated in mental health treatment because you need competency and decision making ability to give consent which is often compromised

Why can informed consent be complicated in mental health treatment?

Competency is necessary to give consent, and decision-making ability may be compromised in mental illness.

What does HIPAA relate to in the slides?

Confidentiality and privacy rights.

What is privileged communication?

A privacy/confidentiality protection identified in the legal material.

What is the Tarasoff exception?

A duty-to-warn exception to confidentiality identified in the slides.

What other confidentiality exception is listed?

Suspected child or elder abuse.

What are criteria listed for admission to an inpatient mental health facility?

Danger to self or others, least restrictive environment, and ability to benefit from hospitalization.

What are the types of admission listed for Kentucky?

Voluntary, involuntary, and a 72-hour hold.

What is voluntary admission?

An individual makes an application to the institution for services and can stay as long as treatment is deemed necessary.

Can a voluntarily admitted patient leave at any time?

The slides state the patient may sign out unless it is determined they are harmful to themselves or others.

When should emergency commitment be sought?

When an individual displays behavior clearly and imminently dangerous to themselves or others.

What is true of emergency commitments?

They are time-limited and a court hearing must be scheduled to determine discharge or additional hospitalization.

What is involuntary commitment for treatment?

A legal process that may occur when a person with mental illness meets state criteria for needing treatment.

What general criteria for 'mentally ill' are described in the slides?

Unable to make treatment decisions, likely to harm self/others, or unable to fulfill basic personal needs.

What is involuntary outpatient commitment (IOC)?

A court-ordered process compelling a person with mental illness to submit to outpatient treatment.

What are examples of IOC eligibility criteria?

Repeated decompensation requiring involuntary hospitalization, likely deterioration requiring inpatient commitment, severe/persistent mental illness, risk of homelessness, violence, or suicide.

What does 'gravely disabled' generally mean in the slides?

Mental illness has left the individual in danger of serious physical harm because they cannot provide for basic needs.

What may happen if a person is determined gravely disabled?

A guardian, conservator, or committee may be appointed by the court to manage the person's affairs.

What is the right to treatment?

A hospitalized patient has the right to appropriate treatment for their diagnosis.

What is the right to refuse treatment?

Patients generally may refuse treatment, including medication, unless immediate intervention is required to prevent death or serious harm.

What is least-restrictive treatment?

The level of treatment that is effective without unnecessarily limiting the patient's freedom.

If a client can be adequately treated outpatient, what does least-restrictive care imply?

The client should not be hospitalized.

If a client is hospitalized, when should sedation/restraint/seclusion be used?

Only after less restrictive steps are unsuccessful, according to the slide material.

What is a mental health bill of rights?

A set of patient rights covering appropriate treatment, participation, consent, confidentiality, humane care, communication, grievances, advocacy, and other protections.

What is the right to a personalized treatment plan?

The patient receives a written individualized plan promptly after admission with regular reviews and updates.

What is the right to participate in care decisions?

The patient can be involved in treatment planning and receive explanations of condition, options, and risks.

What is the right to confidentiality?

Patient records must be kept confidential with limited exceptions.

What is the right to access records?

Patients may request access to their records, subject to some safety or third-party confidentiality limitations.

What is the right to file grievances?

Facilities must provide a fair and timely grievance process.

What is the right to advocacy services?

Patients may access services to help understand and exercise their rights.

What is the right to be free from retaliation?

Exercising patient rights should not result in denial of treatment or other reprisals.

What is the right to referral upon discharge?

Patients should be referred to appropriate services after leaving a facility.

What forms can restraints take?

Physical or chemical restraints.

What is seclusion?

The seclusion room is identified as a form of restraint.

When should restraint/seclusion be used?

For the shortest duration necessary and only after less restrictive measures have failed.

What are examples of less restrictive interventions?

Verbal de-escalation, redirection, PRN medication, and 'cool off time' in a calm, quiet environment.

What is required before seclusion/restraint?

A provider's order.

What are the slide time limits for restraint/seclusion orders?

Age 18+: 4 hours; age 9–17: 2 hours; age 8 and younger: 1 hour.

What happens if restraint/seclusion continues?

The provider must reassess the patient and rewrite the order every 24 hours, according to the provided slide.

What is the nurse's role during restraint/seclusion?

Assess behavior, safety, and physical needs; offer food/fluids; provide toileting; monitor vital signs/pain; and document the event.

How often does the slide specify documentation during restraint/seclusion?

Every 15–30 minutes.

What must be documented about behavior before restraint/seclusion?

Precipitating events and behaviors of the client.