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Weeks 1-10
Define mental illness.
People suffering from a disturbance of thought, mood volition (motivation), perception, orientation, or memory that impairs their judgement or behaviour to a significant extent.
What are some criteria that excludes people from being diagnosed with a mental illness if they only display one of these points?
Holding/refusing to hold a particular religious, philosophical or political opinion or belief
Sexually promiscuous or has a particular sexual preference
Engages in immoral or indecent conduct
Has an intellectual disability
Takes drugs or alcohol
Demonstrates antisocial behaviour
Describe some characteristics of being “mentally healthy”.
Functioning independently and autonomously
Holds a positive attitude towards themselves
Takes life disappointments in stride
Remains healthy even if under high levels of stress
Adapts to difficult experiences
Experiences a wide range of emotions
Perceives reality clearly
Explain the importance of mental health care.
Provides early detection and proactive responses to individual needs
Decreases stigma from lack of HCP understanding
Prevents long term impacts from undetected illnesses (malnutrition, poor management, poor access to services)
Reduces premature death in patients with severe mental illness conditions (from a preventable physical condition)
Define consumer participation.
An essential part of care and service delivery, involving facilitating consumer input into care and service delivery.
Define therapeutic relationships.
Focuses on creating trusting interpersonal alliances between HCPs and patients, considering the needs and goals of patients.
Define personal recovery.
People with mental health conditions can still dream, hope and thrive in life, even when they are symptomatic.
Define strengths-based models.
Concentrates on a person’s strengths rather than their deficits to encourage active participation in healthcare and personal recovery.
Define trauma-informed care.
It’s based on principles that aim not to re-traumatise people when they receive mental health treatment and care from service providers.
Describe some factors influencing stigma.
Blame, stereotypes, poor knowledge, contact and experience, media portrayals, race, ethnicity, and cultural beliefs.
Define stigma.
A “mark of disgrace” associated with a particular circumstance, quality or person.
Define a mental state examination.
A standard format for documenting mental health observations, providing insight into someone’s mind by objectively uncovering subjective experiences and determining someone’s mental state at a particular moment in time.
What are the components of an MSE?
Appearance, behaviour, mood/affect, speech, thought form, thought content, perception, cognition/intellectual functioning, insight/judgement, and risks.
Describe criteria for appearance.
Note distinctive features (scars, tattoos, wounds), clothing (appropriate for the weather), hygiene/grooming (clean, unkempt, dishevelled, body odour), body type (skinny, medium, obese).
Describe criteria for behaviour.
Consider attitude, cooperativeness, rapport with HCP, engagement, responses and interaction, body language, gestures, eye contact, posture, psychomotor activity (hyper or hypoactive), compulsive/bizarre behaviours (describe them), sleep patterns, eating, ADL compliance, relationships, and family issues.
Describe criteria for mood/affect.
Affect - The outward expression of emotion, observed by facial expressions, voice tone, body language, and posture.
Mood - Describes pervasive/sustained emotional state (subjective), rate on a scale of 1-10 (10 being the highest mood).
Describe criteria for speech.
Consider quantity (talkative, monosyllabic, mute), quality (slurred, whispered), rate (rapid/slow), tone (monotone, deep, regular), and volume (loud/soft).
Describe criteria for thought form.
Assess how they put ideas together (behaviour, speech, idea expression), consider amount of thought, rate of production, continuity of ideas, language disturbances, direction of conversation, derailment, tangentiality (irrelevant replies), thought blocking, flight of ideas, neologisms, word salad, speech poverty, and circumstantiality (indirect/long-winded speech).
Describe criteria for thought content.
Note the themes of conversation, consider delusions (fixed, not changed with reasoning), control from external forces, suicidal ideation, intent and plan, preoccupations (persistent topics), obsessions, and phobias.
Describe criteria for perception.
Describe any voices, strange sounds or unusual behaviour cues they exhibit, shared experiences, sensory distortions and misinterpretations, heightened or dull perception, intensity, hallucinations, and external stimuli influence.
Describe criteria for cognition and intellectual functioning.
Consider if the person is alert and oriented to person, time and place, aware of surroundings, can concentrate, can recall immediate, recent and remote memory, can read/write, exhibits abstract thinking (consider the mini-mental state examination to screen cognitive functioning).
Describe criteria for insight and judgement.
Note their degree of awareness, understanding of the origin of their problems and its meaning (partial, absent, or complete awareness), knowledge of symptoms and treatment. Observe the extent to which symptoms influence decision making, ability to act safely, and awareness of associated consequences.
Describe criteria for risks.
Consider what the person is vulnerable to, how HCPs can protect the people they are responsible for (may include risk of suicide, self-harm, absconding, reputation, sexual exploitation, falls and more).
How are MSE findings beneficial for HCPs?
They identify the nature and severity of symptoms and risks, creates an impression of the person and an objective set of data about them, their perceptions of problems and how it relates to their life.
Define protective factors regarding risks.
Things that can reduce a person’s risk to themselves or others (eg. partners, pets, children and support items with calming effects on the person).
Define anxiety.
Excessive, persistent worry that isn’t proportional with the situation. People have trouble controlling it, causing restlessness, poor sleep, feeling of being on edge. It can be generalised anxiety disorder (GAD), social anxiety disorder or a specific phobia like OCD.
Define a panic attack.
A sudden, intense episode of fear or anxiety. People experience 4+ of the following symptoms: shortness of breath, heart palpitations, chest tightness, trembling/shaking, sweating, nausea, or lightheadedness.
Define generalised anxiety disorder (GAD).
When someone experiences constant worry about a variety of life aspects. It’s hard to control, causes considerable stress/impairment to normal functioning, and a withdrawal from social support, pacing, irritability, poor sleep, difficulty maintaining eye contact, and fixations on events.
Define agoraphobia.
Fear, anxiety or avoidance of 2+ situations/places: open spaces, enclosed spaces, crowds, waiting in lines, being away from home alone, public transport. Escape is hard/embarrassing in these situations, helps isn’t easily accessible should panic symptoms occur. Some are house bound from fear.
Define social anxiety disorder.
Social interactions cause irrational anxiety, causing avoidance disrupting daily life, needing long-term treatment/support. It causes withdrawal from social support, panic in large social events, avoiding crowds, fear of judgement, and difficulty forming/maintaining relationships with others.
Define obsessive compulsive disorder (OCD).
Unreasonable thoughts/fears leading to compulsive behaviours, interrupting daily functioning. It can involve obsessive cleaning/handwashing, constant counting, specific behaviour patterns/rituals, and intense fear of bad outcomes if checks aren’t done.
What are 3 treatments for anxiety?
Medications - Manage symptoms (benzodiazepines), only for acute settings or crisis, not for long term situations (addictive).
Talking therapy - Long term, explores cause of anxiety to resolve it, builds coping strategies, warning signs/trigger awareness.
Exposure therapy - Good for specific fears, only done when the person is ready (not likely in inpatient or acute settings).
Discuss some nursing interventions for anxiety patients.
Provide emotional support, reassurance, validation of feelings
Provide PRNs to manage increased anxiety levels
Participate in their checks (OCD), reassure that they are safe
Empower patients to recognise their own triggers/warning signs
Define depression.
Diagnosed with the DSM-5 tool where a person must experience 5 out of the 8 symptoms during a 2-week period to receive a diagnosis. At least one should be either depressed mood for most of the day or loss of interest and pleasure in their activities.
What are the 8 possible criteria for a depression diagnosis?
Depressed mood, most of the day, nearly every day
Low interest/pleasure in all/most activities, most of the day, daily
Major weight loss when not dieting, weight gain, appetite changes
Slowed down thought, reduced physical movement (seen by others)
Fatigue or loss of energy nearly every day
Feeling of worthlessness, excessive/inappropriate guilt nearly daily
Diminished concentration abilities, indecisiveness nearly every day
Recurrent thoughts of death/suicidal ideation without plan, or a suicide attempt/specific plan to attempt suicide.
Define unipolar depression (major depressive disorder).
It doesn’t cycle through other mental states like mania but they may experience brief remission periods with no low mood, then relapse.
Define bipolar depression (bipolar affective disorder).
When a person experiences periods of depression but also periods of mania (elevated mood), often requiring further intervention.
Define post-natal depression.
Occurs after childbirth, may be linked to large hormonal changes. It includes loss of identity, sleep deprivation, responsibility changes. It should be screened for by primary health GPs and community nurses.
Define adjustment disorder.
Situational depression, short lived depression after a stressful event. Symptoms do not last longer than 6 months.
Define grief.
The loss of a loved one, or other major stressor. If it is complicated by suicidality, prolonged, or severe in nature, it requires intervention and treatment.
What are 3 treatments for depression?
Antidepressants (many types) - Takes weeks/months to reach full effect, some have negative side effects like weight gain.
Talking therapy - Long term, needs active participation from patient, costly, helps change thought patterns, coping mechanisms.
Electroconvulsive therapy (ECT) - Electric current passes through the brain, controlled, causes a seizure (hormone release, improves mood). Only used when many medications are unsuccessful, needs 6-12 sessions as an inpatient (long-term, top up sessions needed).
Describe some nursing interventions for depression.
Give them PRNs as available
Encourage a stable routine and good sleep habits
Provide psycho-education
Allow them to express thoughts and feelings, validate them
Challenge negative thought patterns
Provide support in finding protective factors and a sense of hope
Describe care planning.
Consider active patient participation, the patient’s wants and needs, and strategies to engage them in planning to ensure adequate self-management occurs in community settings after discharge.
Define childhood, and common mental struggles with this age group.
Someone 10-19 years old. Mental illness doesn’t occur in isolation to other parts of life and anxiety/depression/self-harm are most common. Developmental milestones impact mental state (eg. puberty and emotional regulation, decision-making increases isolation, risk-taking social pressures).
Define risk-taking.
Part of identity exploration (drinking, smoking, drugs, risky sexual activity, reckless driving). They can be harmful to those with predisposing genetics, can become maladaptive coping strategies for those in emotional distress.
What are some indicators of potential mental health struggles?
Duration/intensity of adverse emotions
Sudden changes to sleep, eating, emotions
Isolation and withdrawal, persistent fear/worry
Regression (reverts to outgrown behaviours)
Excessive concern with appearance, perfectionism
Self harm or suicidal thoughts
Extreme reactions, refusing to go to school
Define older adults and common mental struggles with this age group.
Anyone 65+. Low willingness to discuss mental health, co-morbidities and pain, loss of independence, isolation, link to mental health issues. They can have schizophrenia, bipolar affective disorder, depression, anxiety, or other cognitive impairments.
Describe bio-psychosocial factors affecting older adults.
Retirement, death of family members, outliving others, changing physical health, worsening mental health (depression, grief), lower social interaction (family live far away, friends have their own lives).
Define schizophrenia in older adults.
Severe psychiatric diagnosis indicating the presence of both positive (delusions/hallucinations) and negative (social withdrawal, poor sleep) symptoms (similar to young adults). Consider effects of long-term antipsychotic use (causes increased risk of stroke and cardiac illness).
Define bipolar affective disorder (BPAD) in older adults.
Mood disorder causing extreme mood changes with depressive/manic phases. Long term mood stabiliser use (lithium) leads to low renal function.
Describe depression, anxiety, and suicidal ideation in older adults.
Stems from grief or a sense of despair from experiences of loss (of loved ones, health, mobility, independence) or major life changes (retirement, finances, care facility transitions). It affects one’s sense of purpose.
What are some risks related to older adults?
Older males are most likely to complete suicide (more certain, more lethal means used). Medications used for mental health illnesses have long term effects, their bodies have a low ability to process meds, can cause increased sedation leading to increased falls.
Describe cognitive impairment vs. dementia.
Cognitive impairment - Poor performance on objective assessments, decline in performance.
Dementia - Evidence of significant difficulty in daily life interfering with independence, caused by cognitive impairment. Alzheimer’s is most common (brain cell death in outer layer, involved in memory/language/judgement).
Define apraxia and aphasia.
Apraxia - Difficulty with movement.
Aphasia - Difficulty with speech.
Define anomia, agnosia, and amnesia.
Anomia - Difficulty word-finding (recognises but can’t relay the word for it).
Agnosia - Difficulty identifying people or objects.
Amnesia - Difficulty with memory.
What are some communication strategies used for patients with cognitive impairments?
Simple, short sentences, only a few choices, one person talks at a time, consider tone, body language, personal cues (hunger, thirst, toileting, pain), touch requirements (needing help or comfort).
What is the onset/duration, progression and related signs/symptoms of dementia?
Slow deterioration over months/years, slow and progressive cognitive decline, causes wandering, agitation, difficulty with word-finding, symptoms fluctuation at times.
What is the onset/duration, progression and related signs/symptoms of delirium?
Sudden onset within hours/days, short and fluctuating progression, reversible when cause is treated. It causes restlessness, fluctuations in agitation, hallucinations, mood changes, and disorganised thinking patterns.
What is the onset/duration, progression and related signs/symptoms of depression?
Mood changes over 2 weeks, may be linked to a certain event, causing fluctuations but reversible with treatment. Causes hopelessness, withdrawn nature, low appetite, concentration changes.
Define paraverbal communication.
It includes tone, pitch, pace, awareness of how speech impacts others. Speak at a pace that allows easy following of the conversation, give time to respond (consider how you say what you say).
Define non-verbal communication (SOLER).
S - Sit squarely, face the person you talk to.
O - Open posture (don’t cross arms or lean away).
L - Lean in towards the person.
E - Eye contact (appropriate for the situation).
R - Relaxed posture (relax shoulders and face).
Describe principles to navigate difficult conversations.
Plan what you say beforehand, have facts readily available to answer their questions. Choose a good time and place to have the conversation and provide enough privacy while minimising environmental distractions.
Describe some principles to providing therapeutic communication.
Offer your time, empower others to take control of their own journey, advocate for their wellbeing, look after your own wellbeing, and connect people to other secure people to promote like-minded recovery.
Define trauma.
A distressing event causing a psychological wound/injury or a difficulty coping/functioning normally following the event. It can occur individually or collectively, can be passed through generations, causes serious long-term consequences varying based on past experience, support systems, and many other factors.
Define trauma informed care and name the 6 principles.
It is a holistic care model based on 6 principles that aim to create services that feel safe to staff and users, with a goal to avoid re-traumatising someone. The principles include safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment voice and choice, and cultural historical and gender issues.
Describe safety in trauma informed care.
Physical, sexual, psychological safety, environment is set up to promote safety. Locked doors, visibility into meeting rooms, duress alarms and frequent patient checks.
Describe trustworthiness and transparency in trauma informed care.
Decisions are made transparently with a goal to build patient/family/staff trust. Be open and honest, give warnings, expectations, and updates.
Describe peer support in trauma informed care.
Support from others with similar lived experiences to build stronger connections.
Describe collaboration and mutuality in trauma informed care.
Involve patients in care planning and decision-making, minimise power imbalances where possible.
Describe empowerment, voice and choice in trauma informed care.
Strengths, experience and resilience are recognised. Support patients in their ability to make their own choices to promote personal control over recovery.
Describe cultural, historical, and gender issues in trauma informed care.
Cultural safety, remove stereotypes and bias, be responsive to racial, ethnic, and cultural needs of those who access and work for health services.
Define deliberate self harm.
The intentional, direct injuring of body tissue without suicidal intent (cutting, scratching, hitting, head banging, burning, hair pulling, substance use). They may not be suicidal but may die through misadventure. It can be used to manage anxiety, ground themselves, feel physical pain (easier than emotional pain), form of self-punishment, sense of control, maladaptive strategy.
Define suicidal ideation.
The thoughts, ideas, or plans a person has about causing their own death.
Define predisposing, precipitating, and perpetuating factors.
Predisposing - Renders someone more prone to a certain behaviour.
Precipitating - Behaviour catalysts, can trigger actions.
Perpetuating - Supports behaviour continuation (manageable/controlled).
Describe social predisposing, precipitating, and perpetuating risk factors to self harm and suicide.
Predisposing - Family history of self harm/suicide, homelessness, childhood abuse, physical illness.
Precipitating - Entering care, divorcing parents, bereavement, unplanned pregnancy, sexual assault, significant financial stress.
Perpetuating - Being bullied, unresolved housing/employment/financial problems, availability of potentially lethal means of self-harm.
Describe psychological predisposing, precipitating, and perpetuating risk factors to self harm and suicide.
Predisposing - Family history of mental illness, low ability to regulate emotions, poor impulse control and low self-esteem.
Precipitating - Active mental illness, alcohol and drug use.
Perpetuating - Intoxication with alcohol/drugs, cognitive problems, belief that distress/problems are not being taken seriously by other people.
Describe interpersonal predisposing, precipitating, and perpetuating risk factors to self harm and suicide.
Predisposing - Conflict between parents, lack of supportive relationships, poor interpersonal problem solving skills.
Precipitating - Stressful situations involving others, relationship breakdowns, arguments or conflict with a significant other.
Perpetuating - Unresolved parental conflict, continuous negative experiences, ongoing difficulty accurately communicating feelings.
Define drug.
Substances that, when administered, affect mental processes like perception, consciousness, cognition, or mood/emotion. They can be depressants, hallucinogens, or stimulants based on their CNS action.
Why do people use drugs?
For enjoyment, relaxation, socialisation, curiosity, peer pressure, trauma coping mechanisms, or to avoid physical or psychological pain.
Describe the drug use spectrum.
People move along it both ways, and there is no evidence to show that one stage automatically leads to the next. There are risks at all levels.
Non use —> Experimental —> Recreational —> Regular —> Dependent.
Describe the 6 aspects of the cycle of change.
Pre-contemplation (educate, build trust, raise awareness)
Contemplation (motivational interviewing, express importance)
Preparation (set goals, identify support network, highlight barriers)
Action (problem-solve, peer pressure, manage craving, high-risk)
Maintenance (refusal, social settings, bad thoughts, alternatives)
Relapse (falling back multiple times into old behaviour patterns)
Define harm minimisation.
Building safe, healthy, and resilient communities by preventing, reducing, and responding to alcohol, tobacco and other drug related health, social, and economic harms. Done through demand, supply, and harm reduction.
Provide examples of demand, supply, and harm reduction.
Demand reduction - Prevent uptake, delay/reduce 1st use, support recovery.
Supply reduction - Control illicit drug/pre-cursor availability, lower access.
Harm reduction - Supervised consumption rooms, pill testing, smoke-free laws, take-home naloxone programs, standard drinks, drink/drug driving laws, provision of clean needles.
Define self care.
Taking an active role in protecting one’s wellbeing and happiness, includes a good sleep routine, nutrition, exercise, hobbies, and work life balance. Well managed stress enables compassionate care without increased anxiety, especially when commonly faced with traumatic events in work settings.
Give some examples of self care.
Trying new hobbies, good sleep, good food choices, practicing creativity, mindfulness/meditation, planning social activities, self-pampering, create career goals, declutter work bag, engage in routine preventative care.
Define self awareness.
Knowledge of your own character and feelings, achieved by asking for feedback, regular self-reflection, being proactive in ensuring you look after your wellbeing during periods of increased stress.
Define vicarious trauma.
Indirect exposure to traumatic events from first-hand accounts. It can lead to feeling overwhelmed, HCPs can experience similar feelings faced by trauma survivors in their care. It shifts their worldview, known as the cost of caring.
What are some signs of burnout?
Physical or emotional distress related to work, indifference towards patients, chronic fatigue, irritability, anxiety/panic, sense of dread before working, lack of joy, digestive problems, headaches, disrupted sleep, body aches.
Define resilience.
Positive adaptation to adversity, regaining wellbeing after periods of stress. It can be constructed as an interaction between a person and their environment, using personal skills (linked to emotional intelligence).
Define clinical supervision.
A professional relationship proving a place/platform to reflect on practice and seek feedback from a clinician in a similar role, either allocated or sought out and approached for clinical guidance.
Define cultural safety in healthcare.
Where cultural values, strengths, and differences are respected which helps people accessing services feel validated and safe. Strong relationships can be developed which encourages people to seek interventions.
Describe social and emotional wellbeing for Indigenous people.
Foundation of physical and mental health, holistic approach, considers connection to land, spirituality and culture. Barriers include intergenerational trauma, poor service availability, racism and unemployment. They risk isolation and foster “self-reliance” or reluctance to seek medical help.
How can cultural safety be improved in healthcare?
Include Indigenous people in decision making, consider use of Aboriginal Liaison Officers, continuous learning opportunities, self awareness, ask patients what they need and how you can create a more comfortable space.
Define violence.
Intentional use of physical force or power, threatened or actual, against oneself, another person or group. It results in or has a high chance of resulting in injury, death, psychological harm, maldevelopment or deprivation.
Define workplace violence.
Includes verbal threats, psychological distress, unintentional assault. Under reported because it is time consuming to report, fear of judgement or blame, experience deficit (new grads), stigma, or lack of effective leadership.
Describe verbal de-escalation.
Stay calm, use open body language, minimal language (less confusing), clear speech, risk assessments, consider the environment, plan Bs, consider the right person to lead (based on age, rapport, gender or other factors).
Describe an environmental risk assessment.
Consider items of risk, other people involved, exit locations, trip hazards, and duress alarms. Ensure your coworkers know where you are.
What are some causes or triggers of violence?
Active psychotic symptoms, withdrawal, inability to regulate emotions, frustration, lack of support, ongoing hospitalisation, medication side effects, diagnosis (eg. stroke) altering normal brain function.
What are the 4 aspects of the escalation cycle?
Anxiety (fidgeting, repetitive questions, reassurance, tearful)
Defensive (pacing, asking challenging questions, refusal)
Crisis behaviour (assault attempts, self harm, property damage)
Post-crisis exhaustion (isolation, apologising, tearful)
Define seclusion.
Confinement of a person being treated at an authorised hospital. Involves leaving them alone in a room or area where they cannot leave. It’s a last resort, not used for punishment or periods of active suicide/self-harm. Paperwork must be done, max 2 hours before MO review, visual checks every 15 minutes, verbal de-escalation continues throughout.
