Key Concepts and Terms in Mental Health: Vocabulary Flashcards

Historical Perspectives on Mental Health Treatment

• Evolving concept of mental illness and mental health throughout history.

• Notable stigmatizations and cultural variations in descriptions and treatments; many variations rooted in religious practices.

• Post-World War II contributed to increased need for psychiatric services due to higher diagnosis rates.

• National Mental Health Act signed in 1946 by President Harry S. Truman; established the National Institute of Mental Health (NIMH).

• 1950s: rise of psychopharmacology led by chlorpromazine for aggression and psychosis; marked expansion of pharmacologic treatment.

• 1963: Mental Retardation Facilities and Community Mental Health Centers Construction Act (Kennedy administration) provided federal support for community mental health centers.

• Contemporary shift from asylums to community-based care; movement to limit institutionalization; driven in part by medications and broader reforms.

• Healthy People 2030 identifies priorities in mental health to improve clients’ health and well-being; goals include prevention, screening, assessment, and treatment; focus on quality of life and functioning.

• Areas of focus include increasing primary care visits for mental illness screening and reducing safety-related outcomes in adolescents.

Contemporary Perspectives on Mental Health Treatment

• Treatment has evolved from asylum-based care to community-based care and preventive approaches.

• Development of medications in mid- to late-20th century facilitated deinstitutionalization and outpatient management.

• Current public health framework emphasizes prevention, early detection, integrated care, and promotion of well-being.

• Policies like Healthy People 2030 guide priorities for mental health promotion, prevention, screening, and treatment to improve quality of life.

Mental Health and Mental Health Definitions

• Mental Health: described by the American Psychiatric Association as the foundation for emotions, thinking, communication, learning, resilience, and self-esteem; essential to relationships, well-being, and community contribution.

  • Ability to perform activities of daily living (ADLs) reflects mental health.

  • Mental wellness promotes optimal functioning in occupations, relationships, and developmental milestones.

• Mental Illness: defined by the American Psychiatric Association as health conditions involving changes in emotion, thinking, or behavior (or a combination), associated with distress and/or problems functioning in social, work, or family activities.

• Disability definition (ADA): “a physical or mental impairment that substantially limits one or more major life activities.”

• Over 44 million adults in the United States have a reportable mental illness, illustrating that psychiatric mental illness/disabilities are among the most common.

Mental Health, Mental Illness, and Related Concepts

• Mental health depends on successful emotion, thinking, and behavior management and interaction with others; disruptions can impair daily functioning.

• Mental illness arises from a combination of risk factors rather than a single cause.

• Factors include traumatic life events, biological/chemical imbalances, substance use, loneliness and isolation; no demographic discrimination in risk (income, culture, geography, race/ethnicity, gender).

• Mental illness covers a wide range of conditions impacting mental and emotional health.

Emotion, Thinking, and Behavior

• Multiple factors contribute to mental illness risk; no single cause.

• The range of factors includes traumatic life events, biological or chemical imbalances, substance use, loneliness, and isolation.

• These factors do not discriminate by income, culture, geography, race/ethnicity, or gender.

Social Determinants of Disability and Mental Health (ADA Context)

• Disability defined as a physical or mental impairment that substantially limits major life activities.

• Mental illnesses are highly prevalent; by some estimates, more than 44 million adults in the U.S. have a reportable mental illness, underscoring widespread impact.

Mental Health Disorders

• People experience stress daily: physical stressors (infection, metabolic imbalance) and psychological stressors (job changes, bereavement).

• In some cases, prolonged inability to cope with stress may manifest as a mental health disorder.

• Mental health disorders are diagnostic groupings for manifestations of mental health issues; recovery is the primary goal.

• Not all mental health disorders are preventable due to diverse etiologies.

• Common categories (symptom-based):

  • Anxiety disorders

  • Somatic symptom disorder, trauma- and dissociation-related disorders

  • Personality/Identity disorders

  • Mood disorders

  • Schizophrenia spectrum disorders

  • Neurocognitive disorders

  • Neurodevelopmental disorders

  • Disruptive, impulse-control, and conduct disorders

  • Substance-related and addictive disorders

  • Eating disorders

  • Other mental disorders (including paraphilic disorders, etc.)

Visualizing Mental Health (Metaphors and Models)

• Car-on-a-road metaphor: without mental illness, minimal effort to destination; with illness, reaching destination is harder; stressors include road conditions or car problems; severe stressors may prevent reaching destination.

• Mental health continuum: range from adaptive wellness to maladaptive illness; influenced by behaviors, emotions, cognition, and physical adaptation.

• No fixed point on the continuum; like a thermometer with a range of temperatures moving toward wellness or illness.

• Wellness end: absence of mental illness, managed stress, potential for growth.

• Neutral area: no manifestations of illness or wellness; functioning is possible but awareness/learning may be diminished.

• Disability end: manifestations of mental illness with significant functional impairment.

Continuum of Care (Wellness–Illness Model)

• Developed in the 1970s.

• Views mental health across three areas: well-being, neutrality, and disability.

• Well-being: absence of mental illness; stressors managed; potential for growth.

• Neutral: functioning normally despite absence of illness or wellness manifestations.

• Disability: clear manifestations of mental illness with functional impairment.

Diathesis–Stress Model

• Two-part theory explaining onset and exacerbation of mental illness.

• Diathesis: genetic or biological predisposition to illness.

• Stress: environmental changes (psychological or physiological) that precipitate symptoms.

• Examples:

  • Physiological: an infection leading to hallucinations.

  • Psychological: upcoming job change leading to excessive worry and tachycardia.

• Most disorders have onset via diathesis with stress, though some can be onset and exacerbated primarily by stress alone.

Contributing Factors to Mental Illness

• No single cause; several factors increase risk:

  • Life experiences (trauma, abuse)

  • Medical illnesses (e.g., chronic thyroid problems, cancer, diabetes)

  • Social factors

  • Biological/genetic factors

  • Substance use (alcohol or drugs)

• Future modules will discuss diagnosis-specific contributing factors.

Social Determinants of Mental Health (SDOMH) Framework

• SDOMH looks at how conditions in which people live, work, play, and age affect mental health and well-being.

• Similar to SDOH, SDOMH considers factors: biological, social, psychological, environmental, genetic, and behavioral.

• WHO framework (2014) outlines five main groups: life course, households, community, local services, and country-level factors.

• SDOMH informs interventions to improve housing stability, food security, community trust and safety, well-being, life satisfaction, and self-esteem.

Life Course

• Exposure to physical, environmental, and socioeconomic events at critical life stages impacts mental health; effects can propagate across generations and create disparities.

• Critical/sensitive periods: rapid neurological development stages where adverse events have lasting impact.

• Adverse Childhood Experiences (ACEs): traumatic or negative events such as physical/emotional abuse, neglect, sexual abuse, and dysfunctional home life.

• ACEs increase risk for depression, anxiety, behavioral and substance use disorders, and suicide; impede school/work/social success.

• Protective factors across life course include social support, health screenings, and accessible mental health resources (reduce impact of ACEs).

• Example: a child who experiences trauma has elevated lifetime risk for mental health disorders.

Households

• Factors: income, access to resources (food, water), parental mental and physical health, social support, maternal care.

• Unemployment increases risk of depression/anxiety and suicide attempts.

• Access to care is affected by insurance coverage and provider availability.

• NAMI data (2020): 11% of adults with mental illness reported no insurance coverage; 55% of U.S. counties lack a practicing psychiatrist; approx. one in five adults affected, yet less than half received treatment in 2020.

Community

• Built and natural environment, neighborhood safety, and civic engagement affect mental health.

• Crime and violence contribute to psychological distress (depression, PTSD) for those affected or who witness it.

• Interventions to reduce crime may reduce mental illness incidence in communities.

Local Services

• Local schools, social services, health services, family services, youth/elder services, and environmental quality (air/water).

• Youth programs, family counseling, and school engagement promote mental health.

• Early education access improves mental health outcomes; disparities in access exist when communities lack early education resources.

• Early interactions in preschool influence social-emotional development.

Community and Global Factors

• Human rights, health care access, housing, education policies, governance, and inequality shape mental health outcomes.

• Reducing child poverty is linked to better mental health outcomes; government policies can drive improvements.

• Protective factors include cyberbullying protections and child-focused social policies.

• Disasters (natural or man-made) and air pollution can worsen mental health outcomes.

• Religiosity/faith may be protective against certain mental health disorders.

Effect of Bias and Stigma on Mental Health Care

• About half of those with a mental health disorder do not receive care; delays occur due to fear of stigma or discrimination.

• Treatment rates and delays (2020): approximately $37\%$ of males receive treatment annually; average delay from onset to treatment about $11\text{ years}$.

• Values (culture, upbringing) influence self-perception and stigma, shaping responses to illness and treatment; manifests as public or organizational stigma.

• Types of stigma (APA framework):

  • Public stigma: negative attitudes toward people with mental illness (e.g., schizophrenia perceived as dangerous).

  • Self-stigma: internalized shame or belief that one is flawed.

  • Institutional stigma: policies or practices that restrict opportunities (e.g., insurance coverage favoring hospitalizations over psychiatric care).

• Bias concepts:

  • Implicit bias: unconscious biases influencing behavior.

  • Explicit bias: conscious discrimination or prejudice.

• Bias affects access to care and treatment choices; nurses should uphold ethical codes and professional standards (ANA) and core nursing values.

• Nursing ethics and standards:

  • Practice guided by Code of Ethics and Standards of Practice; core values include empowerment, inclusivity, integrity, collegiality, innovation, transparency, and stewardship.

  • A trusted nurse demonstrates integrity, respect, humility; inclusive practice embraces diversity; innovation drives excellence; empowered nurses engage in optimistic, problem-solving decision-making.

• DSM-5-TR is a key diagnostic tool (see below) but does not prescribe treatment.

DSM-5-TR and Classification of Mental Health Disorders

• DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision) is the principal diagnostic tool in the U.S. and in many other countries for defining and diagnosing mental health conditions.

• It provides criteria and clinical manifestations for disorders and supports consistent morbidity/mortality statistics for public health.

• DSM-5-TR harmonized with WHO ICD (International Classification of Diseases) coding system used internationally for consistent language.

• DSM-5-TR classifications include:

  • Neurodevelopmental disorders

  • Schizophrenia spectrum and other psychotic disorders

  • Bipolar and related disorders

  • Depressive disorders

  • Anxiety disorders

  • Obsessive-compulsive and related disorders

  • Trauma- and stressor-related disorders

  • Dissociative disorders

  • Somatic symptom and related disorders

  • Feeding and eating disorders

  • Elimination disorders

  • Sleep-wake disorders

  • Sexual dysfunctions

  • Gender dysphoria

  • Disruptive, impulse-control, and conduct disorders

  • Substance-related and addictive disorders

  • Neurocognitive disorders

  • Personality disorders

  • Paraphilic disorders

  • Other mental disorders

  • Medication-induced movement disorders and other adverse effects of medication

Purpose of the DSM-5-TR

• To provide clinicians with a common diagnostic language to describe mental health disorders.

• The DSM-5-TR informs assessment and planning, the planning process, and evaluation of care by aligning diagnoses across care settings.

• It does not describe treatments.

Assessment in Mental Health Nursing

• Assessments commonly include psychosocial history, medical history, and family history.

• DSM-5-TR criteria are used as a reference to aid planning, implementing, and evaluating client care.

Legal, Ethical, and Political Issues Related to Mental Health Care

• Insurance accessibility remains a barrier: in 2020, $11\%$ of adults with mental illness reported no coverage; $55\%$ of U.S. counties lack a practicing psychiatrist; transportation barriers can impede access to care; overall, about one in five adults are affected, but less than half received treatment in 2020.

• Nurses must practice legally and ethically: clients have rights to humane treatment, consent, confidentiality, and the right to refuse treatment.

• Ethical principles guiding nursing include beneficence, autonomy, nonmaleficence, and justice.

• Autonomy involves self-governance in decisions about care; balancing autonomy with safety can create ethical dilemmas (beneficence and nonmaleficence may limit autonomy to prevent harm).

• Justice concerns fair, equitable treatment, including consideration of staffing shortages and resource allocation, particularly for those with high acuity or lacking insurance.

• Involuntary admission and treatment may be required in certain clinical scenarios; this involves court orders and state-specific laws; nurses serve as advocates for patient rights and safety.

• Privacy and confidentiality: HIPAA (1996) protects sensitive health information; psychotherapy notes have extra protection; information is disclosed only to those directly involved in care unless consent is given.

• Duty to warn and protect: clinicians must warn potential victims if a patient poses a clear and imminent danger to another person.

• Mandatory reporting laws: nurses and other professionals must report mistreatment or abuse of vulnerable individuals (children, elderly, disabled) to authorities; laws vary by state and failure to report can lead to legal liability.

Culturally Sensitive Nursing Care

• Culturally sensitive care is essential to patient-centered care.

• Goals: autonomy, equity, and care tailored to client needs and preferences.

• Cultural competence and humility: clinicians should develop skills to understand diverse cultures and reflect on personal biases.

• Cultural humility involves recognizing power imbalances and seeking support to address biases.

• Client values and cultural health care beliefs influence understanding of health, illness, and treatment.

• Holistic practices may include acupuncture, massage, herbal remedies, diet/exercise patterns, and other traditional practices.

• Holistic nursing addresses physical, emotional, social, spiritual, and intellectual health.

• A combined approach of patient-centered care, cultural competence, and cultural humility, with integration of cultural resources and preferences, promotes client autonomy and empowerment.

Culturally Sensitive Nursing Care: Practical Applications

• Assess client values and practices, including holistic and traditional healing modalities.

• Engage in self-reflection to identify biases; seek supervisory support when biases are identified.

• Build therapeutic relationships that honor client diversity and promote shared decision-making.

• Respectful communication and inclusion of family and community resources when appropriate.

• Document culturally informed care plans and continuously evaluate outcomes for culturally appropriate care.

Connections to Foundational Principles and Real-World Relevance

• Historical shifts (from asylums to community care) reflect evolving public health philosophy: prioritize prevention, early intervention, and social determinants.

• SDOMH aligns mental health care with broader health equity goals and social justice.

• Ethical principles (autonomy, beneficence, nonmaleficence, justice) guide clinical decision-making, especially around involuntary treatment and rights protection.

• DSM-5-TR provides standardized language for communication across disciplines and settings, enabling consistent care and robust epidemiological data.

• HIPAA and privacy protections reinforce patient trust and encourage treatment-seeking behavior.

• Culturally sensitive care improves engagement, adherence, and outcomes in diverse populations, reflecting the ethical commitment to equity and respect.

Key Formulas and Numbers to Remember

• National Mental Health Act: $1946$

• Chlorpromazine advancement: $1950s$

• Kennedy Act: $1963$

• Healthy People 2030 priorities and goals (overview)

• Prevalence statistics:

  • Adults with a reportable mental illness: >44\,\text{million} in the U.S.

  • Uninsured adults with mental illness (2020): $11\%$

  • Counties with practicing psychiatrists (2020): $55\%$ without one

  • Affects approximately $1/5$ of adults

• Treatment delay (2020): $\approx 11\text{ years}$

Summary of Key Terms

• Mental health: foundation for emotions, thinking, learning, resilience, self-esteem; essential for relationships and societal participation.

• Mental illness: health conditions involving changes in emotion, thinking, or behavior causing distress or impairment.

• SDOMH: framework linking social determinants to mental health outcomes across five domains (life course, households, community, local services, country-level factors).

• ACEs: adverse childhood experiences that increase lifetime risk for mental health issues.

• Stigma types: public, self, institutional; bias: implicit vs explicit.

• DSM-5-TR: diagnostic standard harmonized with ICD; classifies disorders, sets diagnostic criteria, but does not prescribe treatment.

• HIPAA: privacy protections for health information; psychotherapy notes receive extra protection.

• Duty to warn: obligation to warn potential victims when a patient poses a danger.

• Mandatory reporting: legal obligation to report abuse or neglect of vulnerable populations.

• Culturally sensitive care: patient-centered, culturally competent, and culturally humble approaches.

• Core nursing values: empowerment, inclusivity, integrity, collegiality, innovation (or invocation as written), transparency, stewardship.

• Autonomous decision-making vs safety: balancing patient autonomy with safety considerations in clinical care.