MH Week 1
• Weekly Overview
• Overview of Mental Health Foundations
• Assignments: Reading, In-class Activities, Quiz
• Learning Objectives: Discuss mental health concepts, DSM-5, legal and ethical issues.
• Mental Health and Illness Foundations
• Historical and Contemporary Perspectives
• Definitions: Mental Health, Mental Illness, Disorders
• Examples: Anxiety, Schizophrenia, Eating Disorders.
• Diagnostic Tools
• DSM-5 Purpose and Classifications
• Mental Health Continuum
• Diathesis-Stress Model.
• Social Determinants and Stigma
• Life Course and Community Factors
• Effects of Bias and Stigma: Public, Self, Institutional
• Types of Bias: Implicit, Explicit.
• Legal, Ethical, and Regulatory Standards
• Ethics in Mental Health Nursing
• Key Laws: Mental Health Parity Act, Addiction Equity Act
• Types of Admission: Voluntary, Involuntary, Emergency.
• Client Rights and Consent
• Privacy and Confidentiality
• Informed and Implied Consent
• Capacity vs. Competence
• Psychiatric Advanced Directives.
• Documentation and Nursing Responsibilities
• Standards of Care
• Documentation: Legal Considerations, Client Progress
• Advocacy and Ethical Standards.
• Therapeutic Relationships
• Phases and Building Trust
• Professional Boundaries: Transference and Countertransference
• Milieu Therapy: Physical and Healing Environments.
• Trauma-Informed Approach and De-escalation
• Principles: Empathy, Cultural Considerations
• De-escalation Strategies: Clear Communication, Safe Environment
• Least Restrictive Measures and CMS Guidelines.
• Restraints and Debriefing
• Types: Physical and Chemical
• Principles: Client Safety, Liberty
• Debriefing to Improve Quality of Care.
• Week1:
Mental Health and Illness Foundations
Legal, Ethical, Regulatory Standards and Principle of mental health Patients
Therapeutic communication/Relationships
• Exemplars
• Stress
• Coping
• Changing Perception
• Restraints
• Therapeutic self
• Weekly Overview
• ATI Mental Health Nursing eBook
• Ch 1, 2, 3, 4, 9
• Engage Mental Health
• Foundations of Mental Health Nursing
• Foundational Concepts of Mental Health Nursing
• Client and Mental Health Team Member Safety: Legal and Ethical Considerations
• Evidence-Based Practice in Mental Health Nursing
• Building Nurse-Client Relationships
• Building Therapeutic Relationships
• Assignments
• Engage Mental Health
• Complete listed Reading Modules and tests prior to class (by Thursdays at 8:30 am)
• In-class Activity handed out in class, upload at end of class.
• Quiz 1
• Due Sunday after class.
• Learning Objectives
• Discuss mental health, mental illness, and mental health disorders.
• Explain mental health, mental illness, and the continuum of care for clients experiencing mental health issues.
• Identify the effect of bias and stigma on mental health care and treatment.
• Discuss the Diagnostic and Statistical Manual of Mental Disorders,
5th edition (DSM-5) classifications of mental health disorders.
• Explore the legal, ethical, and political issues related to mental health care and treatment.
• Mental Health and Illness Foundations
• Mental Health, Mental Illness, and Mental Health Disorders
• Historical Perspective
• Notably stigmatized
• Isolation of the individual
• Contemporary Perspective
• Diagnosis, pharmacology, legal policy
• From institutionalization to community-based care
• Goal includes quality of life and well-being
(Gopalkrishnan, 2018; Ogundare, 2020; U.S. Department of Health and Human Services, n.d.)
• Mental Health
• Foundational for
• Emotions and emotional well-being
• Thinking and learning
• Communication
• Resilience and self-esteem
• Relationships
• Daily functioning
(American Psychiatric Association, 2018)
• Mental Illness
• Results in change in
• Emotions
• Thinking
• Behavior
• Associated with distress/problems in daily functioning
• Social and family relationships
• Work or school
• Factors associated with increased risk
(American Psychiatric Association, 2018)
• Mental Health Disorders
• Diagnostic term
• Categorized by group of clinical manifestations
• Examples of mental health disorders
• Neurodevelopmental disorders
• Neurocognitive disorders
• Schizophrenia Spectrum disorders
• Anxiety disorders
• Eating disorders
(Medline Plus, 2021)
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• Purpose
• Defining and diagnosis of mental health conditions
• Common diagnostic language
• Classifications of mental health disorders
• Mental Health Continuum
• Five Zones of Mental Health Continuum
• Diathesis – Stress Model
• Diathesis
• Stress
• Impact
• Social Determinant of Mental Health
• Contributing Factors
• Life course
• Household
• Community
• Local services
• Community and global factors
• Effect of Bias and Stigma on Mental Health
• Stigma
• Public
• Self
• Institutional
• Bias
• Stereotyping
• Prejudice
• Discrimination
• Types of bias
• Implicit
• Explicit
• Legal, Ethical, Regulatory Standards and Principle of mental health Patients
• Ethic for Mental Health Nursing Practice
• Ethics: system of moral principles governing conduct
• Cultural norms
• Personal morals or values
• Values of the profession
• Mental Healthcare Act of 2017
• Code of Ethics for Nurses
• Code of Ethics for Nursing
• Purpose
• Guidance for practice
• Commitment and duty to society
• Decision-making
• Ethical dilemma
• Nursing obligation
(ANA, 2015; Haddad & Geiger, 2021
• Laws Specific to Mental Health Nursing
• Nurses are ethically and legally responsible
• Client safety
• Protection of the client
• Ensuring the quality of care
• Expectation
• When is a nurse legally liable?
(ANA, 2021)
• Mental Health Laws and Legal Implications
• Focus on parity in services
• Federal laws and state laws
• Key federal acts/laws
• Mental Health Parity and Addiction Equity Act
• 21st Century Cures Act
• Comprehensive Addiction and Recovery Act (CARA)
• Children’s Health Act of 2000
• SUPPORT Act
• Patient Record Confidentiality
• Types of Admission
• Voluntary
• Request of client
• Client recognition of need for care
• Involuntary
• Danger to self
• Danger to others
• Unable to meet basic self-care needs
• Mental illness preventing recognition or need for care
• Emergency
• Temporary admission
• Client imminent danger to self or others
• For evaluation of mental illness
(NAMI, 2020; SAMHSA, 2019b: Disability Rights South Carolina, 2018)
• Client Rights to Privacy
• Clients’ Bill of Rights
• Confidentiality
• Privacy
• Exceptions to confidentiality and privacy
• Danger to self
• Duty to warn
• Evidence of abuse or client report of abuse
• Informed Consent
• Must include
• Description of the treatment
• Possible benefits from the treatment
• Possible risks involved in receiving the treatment
• Possible consequences of not receiving the treatment
• Alternative treatments available
• Client is unable to provide informed consent
• Deemed legally as mentally Incompetent
• Alternate decision-maker
(Schub & Schub, 2017)
• Implied Consent
• Occurs in an emergency situation
• Client unconscious
• Unable to provide informed consent
• Legal representative is unavailable
• Assumes client actions demonstrates willingness for treatment
(Schub & Schub, 2017; Wilson, 2022)
• Capacity and Competence
• Capacity
• Generally medical term
• Determining if cognitive processes are intact
• Determining if able to provide informed consent
• Determined by qualified medical provider
• Competence
• Legal term
• Global impairment
• Unable to make decisions
• Unable to provide informed consent
• Determined by judge
(Barstow et al., 2018; Libby, 2021)
• Psychiatric Advanced Directives (PAD)
• Legal Tool - Protecting client
• Self-direction
• Autonomy
• Provides plan if loss of capacity/incompetence determined
• Health care power of attorney
• Names surrogate decision-maker
• Advanced directives for mental health care
• Treatment choices
• Medication choices
• Choices of provider
(SAMHSA, 2019a)
• Documentation – Legal Considerations
• Evidence in lawsuits, including malpractice
• Record of client progress
• Record of nursing care
• Description of client behavior and response to care
• Detailed and accurate
• Nonjudgmental
(Wortham & Maag, 2019)
• Nursing Responsibilities
• Standards of nursing care
• Ethical standard
• Specific of each states nurse practice acts
• Regulatory standards
• Documentation
• Client advocacy
• Therapeutic communication/Relationships
• Phases of the Therapeutic Relationship (Peplau 1991)
• Building Client Trust and Rapport and Therapeutic Alliance
• Qualities that engender trust
• Honesty
• Transparency
• Respect
• Fidelity
• Understanding
• Barriers to trust include perceived differences in
• Gender
• Education
• Language/literacy
• Racial/cultural ways of being
• Socioeconomic status
• Maintaining Professional Boundaries
• Boundary blurring interferes with treatment goals
• Stay professional, therapeutic
• Transference (client displaces feelings toward nurse) and counter transference (nurse displaces feelings toward client) can lead to nurse being removed from the care team
• Milieu Therapy
• Therapeutic “milieu” – “healing environment”
• Organized and focused on healing
• Modification and Control of environment
• Develop life and social skills
(ANA, 2022a; Delaney, 2018)
• Developing physical healing spaces (physical environment)
• Ensure safety.
• Ensure healing.
• Creating a healing culture (psychosocial environment)
• Developing awareness and intention for healing with client and staff.
• Ensuring experiences for personal wholeness.
• Cultivating healing relationships.
• Applying collaborative therapies.
(Grech et al., 2020: Delaney, 2018)
• Trauma-Informed Approach
• Create a culture of empathy
• Restraints/seclusion perceived as assault
• Cultural considerations
• Previous experiences
• Consider psychological and emotional risk
• Least Restrictive Measures
• Centers for Medicare and Medicaid Services
• Audit restraint and seclusion use
• Validates least restrictive alternative attempted
• Principle of least restrictive alternative
• Client safety balanced with personal liberty
(CMS, 2008)
• De-Escalation Strategies
• Use verbal communication that is clear and calm.
• Ensure body language of staff is nonthreatening.
• Approach the client with respect by being supportive of their issue or concern.
• Respond to client issues or concerns creating a sense of trust.
• Set clear limits or boundaries.
• Ensure the physical environment supports a therapeutic milieu
• Reduced sound
• Lower lighting
• Calm activity
(The Joint Commission, 2019)
• Restraints: Physical and Chemical
• Physical restraints
• Chemical restraints
• Debriefing
• Debriefing purpose
• Avoid restraints/ seclusion
• To improve the quality for future responses
• Discuss the situation
• What occurred, actions taken
• What led up to situation
• Discuss feelings about situation
• Staff
• Client
(APNA, 2022; Hammervold et al., 2020)