Chapter 1

Mental Health & Mental Illness

Mental Health

A state of well-being in which individuals reach their own potential, cope with the normal stressors of life, work productively, and contribute to the community. It provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

Mental Illness

All psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfnctions that may be related to developmental, biological, or psychological disturbances in mental functioning.

Mental Health Continuum

• Mental health and mental illness can be conceptualized as points along a mental health continuum

• One end is mental health: may experience stress or discomfort resulting from problems of everyday life, they experience no serious impairments in daily functioning

• Mild impairment in functioning: problems in this category tend to be temporary but individuals with mild depression, GAD, and ADD may fit in as well

• Other end is Mental Illness: altered mood, thinking and behavior; chronic and long-term impariments that range from moderate to disabling

Individual Atrributes

Characterisitcs that are both inborn and learned that make us who we are — unique ways of managing thoughts & feelings, navigating pressures, respond to and participate in social scenarios

Factors That Influnece Mental Health

• Socioeconomic: increased stress can trigger disorders, family life, support system, education

• Biological: prenatal exposure to alcohol, oxygen deprivation at birth

• Genetic: huge predictors of mental health and are implicated in nearly every psychiatric disorder

• Environmental: political climate, culture (beliefs, attitudes, and practices), access / lack of access to water, safety service, transportation, healthcare

Resilience

The ability and capacity for people to secure the resources they need to support their well-being. It does not mean being unaffected by stressors; effective at regulating their emotions and not focusing on negative, self-defeating thoughts

Culture-Bound Syndromes

• Syndromes that seem to occur in specific sociolcultural contexts, and people ein those cultures easily recognize them

• Ex.

  • Southeast Asia: “Running amok” —> a person usually male runs around engaging in indiscriminate violent behavior

  • US/Europe/Australia: anorexia nervosa was almost unheard of in third world countries

Stigma

The belief that the overall person is flawed with a mental illness, that it is “all in their head” and is characterized by social shunning, disgrace and shame

Diathesis-Stress Model

Diathesis represents biological predisposition and stress represents environmental stress or trauma is the most accepted explanation for mental illness

• Most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors

Recovery

• Old: that some people, even those with the most serious mental illnesses, can recover

• Newer: Evolved into a consumer-focused process. It is a process of change through with individuals improve their health and wellness, live a self-directed life, and strive to reach their full potentioal

• Recovery: emerges from hope, is person drive, occurs through many pathways, is holisitc, is supported by peers & allies, is supported through relationships & social networks, is culturally based & influenced, is supported by addressing trauma, involves individual, family and community strengths and responsibilities, is based on respect

Epidemiology

As it applies to psychiatric-mental health is the quantitative study of the distribution of mental disorders in human populations

• helps to ID high-risk groups and risk factors associated with onset, duration and recurrence of an illness

Comorbidity

The presence of two or more disorders can occur at the same time or in sequence. The interactions between the ilnesses can often worsen the course of both

Incidence

Conveys information about the risk of contracting a disease. It refers to the number of new cases of mental disorders in a healthy population within a given period of time, usually annually

Prevalence

Describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill

Clinical Epidemiology

A broad field that examines health and illness at the population level. Studies use traditional epidemiological methods and are conducted in groups usually defined by the illness or symptoms or by the diagnostic procedures or treatments given for the illness or symptoms

• Includes: studies of the natural history (no treatment, problems runs its course) of an illness, studies of diagnostic screening tests and observational and experimental studies of interventions used in treatment

Diagnositic and Stastical Manual (DSM)

A publication of the American Psychiatric Association, first published in 1952 and last published in 2013 (5th edition — DSM-5). Identifies disorders based on specific criteria and as a tool for collecting epidemiological statistics about diagnosing disorders

• Disorder Categories: Neurodevelopmental, Schizophrenia Spectrum, bipolar & related, depressive, anxiety, Obsessive-compulsive, trauma & stressor related, dissociative, somatic symptom, feeding & eating, elimination, sleep-wake, sexual dysfunction, gender dysphoria, disruptive, impulse control & conduct, substance-related & addictive, neurocognitive, personality, paraphilic, & other

International Classification of Diseases, Tenth Revision (ICD-10)

Another major classification system that is gaining global popularity.

• US has adopted it with “clinical modifications” —> ICD-10-CM

Psychiatric-Mental Health Nursing

Promotes mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders

• Qualified to practice at basic and advanced levels depending on education

Phenomnea of Concern for Psychiatric-Mental Health Nurses

• Promotion of optimal mental & physical health & well-being

• prevention of mental & behavioral distress & illness

• Promotion of social inclusion of mentally & behaviorally fragile individuals

• Co-occurring mental health & substance use disorders

• Co-occurring mental health & physical disorders

• Alterations in thinking, perceiving, communication, and functioning related to psychological and physiological distress

• Psychological & physiological distress resulting from phsycial, interpersonal and/or environmental trauma or neglect

• Psychogenesis and individual vulnerability

• Complex clinical presentations cofounded by poverty & poor, inconsistent, or toxic environmental factors

• Alterations in self-concept related to loss of physical organs and/or limbs, psychic trauma, developmental conflicts or injury

• Individual, family, or group isolation and difficulty with interpersonal relations

• Self-harm & self-destructive behaviors including mutilation and suicide

• Violent behavior, including physical abuse, sexual abuse and bullying

• low health literacy rates contributing to treatment nonadherence

Basic Level RNs

Professional who have completed a nursing program, passed the state licensure exam, and are qualified to work in most any general or speciality area

Psychiatric-Mental Health Registered Nurse (PMH-RN)

A nursing graduate who possesses a diploma and chooses to wrok in the specialty of psych-mental health. At the basic level, nurses work in various supervised settings and perform multiple roles. AFter 2 years full-time, 2000 hours in a psych setting, and 30 hours of continuing education may take a board to demonstrate clinical competence in psych-mental health and become a RN-BC

Psychiatric-Mental Health Advanced Practice RN (PMH-APRN)

Licensed RN with a master’s or higher in psychiatric nursing and will have varying levels of autonomy depending on the state

Cultural Competence

Nurses adjust their practice to meet their patients’ cultural beliefs, practices, needs and preferences

Electronic Healthcare

Healthcare services provided from a distance. Telepsychiatry is an effective way to reach underserved populations and those who are homebound