Introduction to Mental Health Exam Review
Final Exam Blueprint - Introduction to Mental Health
- Topics & Weighting:
- Working with Families, Groups, & Spirituality: 5
- Survivors of Abuse or Neglect: 3
- Anger and Aggression: 3
- Depression Disorders: 6
- Suicide Prevention: 4
- Alternative therapies: 1
- Bipolar: 6
- Schizophrenia: 8
- Neurocognitive: 3
- Older Adult: 1
- Military: 3
- Child & Adolescent: 2
- Anxiety: 6
- Anxiolytic medication: 2
- Grief: 1
- Personality disorders: 6
- Substance abuse: 5
- Eating disorders: 3
- Sexual disorders: 3
Introduction to Mental Health
- Foundational Concepts:
- Legal & Ethical Issues in Therapeutic Care
- Revision Date: Riverside College of Health Sciences, 12/2025
Foundations of Mental Health Nursing
- What is Mental Health?
- Ability to adapt and positively function in the face of stressors.
- Mental Illness:
- Cognitive and emotional disturbances, abnormal behaviors, and impaired functioning.
- Social Determinants of Health:
- Understanding how life factors impact mental health.
Diagnostics and Statistical Manual of Mental Disorders (DSM)
- 5th Edition
- Known as the "Bible of Psychiatry"
- Outlines symptoms required for diagnosis
- Reviews categories for adults and children
- Guidelines provided for recording additional diagnostic information via Axis.
Mental Health Treatment History
- Pre-Enlightenment Era:
- Prior to late 1700s, mentally ill were seen as wild animals, criminals.
- Confinement methods used; blamed on demons.
- Enlightenment Era (1790s):
- Establishment of asylums for protection and humane treatment.
- The first mental hospital in the US was Eastern State Hospital.
- 1850s-1870s:
- Focus on treatment and study of mental illness.
- Linda Richards, the first psychiatric nurse, emphasized treatment and human dignity.
- Limited drug use, mainly sedatives (alcohol and opium for violent patients).
- Period of Psychotropic Drugs (1950s):
- Introduction of the first antipsychotic (chlorpromazine) and other psychotropic medications.
- Shortened hospital stays influenced the requirements for psychiatric nursing accreditation.
- Period of Community Mental Health (1960s):
- Deinstitutionalization and establishment of the Community Mental Health Centers Act.
- Introduction of the Continuum of Care model for mental health treatment.
- Decade of the Brain (1990s):
- Increase in brain research and biological explanations for mental health disorders.
Mental Health Continuum
- Definition:
- Range of mental health functioning from wellness (ability to cope) to illness (inability to cope).
- Influenced by behaviors, emotions, cognition, and physical adaptation.
- Levels:
- Crisis, Struggling, Surviving, Thriving, Excelling.
- Resilience:
- Ability to recover from stressors and difficulties, a goal achieved through therapy and support.
Diathesis-Stress Model
- Diathesis:
- Genetic or biological predisposition to mental illness.
- Stress:
- Psychological or physiological changes in the environment.
- Adverse Childhood Experiences (ACEs):
- Events that impact mental health development.
- Protective Factors:
- Conditions and behaviors that promote well-being, e.g., supportive relationships and access to healthcare.
Continuum of Care
- Levels:
- Tailored to patient needs, from least to most restrictive environments.
- Patient Activation Measure Survey:
- Changes during treatment; relapse may lead to rehospitalization.
- Collaborative team essential for rapport and care delivery.
Continuum of Care: Discharge Planning
- Factors to Consider:
- Least restrictive discharge options, medication compliance, and existing support systems.
- Safety planning critical, even if psych symptoms persist.
Legal, Ethical, and Political Issues
- M'Naghten Rule (1843):
- Definition of insanity related to mental illness during a crime.
- Omnibus Mental Illness Recovery Act (2000):
- Focus on enhancing community care and services.
- Tarasoff Rule (1976):
- The duty to warn identified potential victims.
- Mental Health Parity and Addiction Equity Act (2008):
- Requires insurance coverage for mental health services equivalent to medical treatment.
- HIPAA (1996):
- Protects patient records from unauthorized access.
- Mental Healthcare Act (2017):
- Protects patients' rights regarding mental illness treatment.
Legal Issues - Admission
- Criteria for Admission:
1. Imminent risk of self-harm.
2. Imminent risk of harm to others.
3. Inability to care for oneself due to mental instability.
- Types of Custody Orders:
- Emergency Custody Order (ECO): max 8 hours.
- Temporary Detention Order (TDO): max 72 hours until a hearing.
- Commitment Types:
- Involuntary: maximum of 30 days initially, extendable to 180 days if necessary.
Admission Process
- Assessment Procedures:
- Determine correct unit based on needs and behaviors.
- Skin assessments for self-injury indications conducted by two staff members.
- Levels 2/3 checks to prevent contraband within patient belongings.
- Appropriate precautions established.
Patient Belongings
- Allowed Items:
- Clothing without strings and metal, personal hygiene items (secured), and books without binding.
- Contraband Examples:
- Items such as glass objects, recreational drugs, lighters, cash, or electronics.
Evidence-Based Practice in Mental Health Nursing
- Focus on nursing processes, building therapeutic relationships, and coordination of care.
Scope and Standard of Practice
- Priority:
- Safety
- Implementation:
- Coordination, education, pharmacological, complementary therapies, and milieu therapy.
Roles of Psychiatric Nurse
- Helping patients adapt and cope with stressors, developing therapeutic rapport, administering medications, and setting behavioral limits.
Mental Status Exam (MSE)
- Components of MSE:
- Movement and Gait: Monitor for abnormal signs such as tics or tremors.
- Appearance: Assess posture, grooming, signs of self-harm.
- Behaviors: Note mannerisms, gestures, expressions, and attention to command.
- Consciousness Level: Ranging from alertness to lethargy.
Mental Status Exam: Speech
- Criteria of MSE Speech Exam:
- Quantity: Talkative, spontaneous.
- Rate: Speed of speech.
- Volume: Loudness or softness of voice.
- Fluency: Assess clarity and hesitancy.
Mental Status Exam: Emotion
- Components:
- Mood (Subjective): Individual's emotional state.
- Affect (Objective): Signs of emotional expression.
Mental Status Exam: Perception
- Types of Perceptual Disturbances:
- Illusions: Misperception of actual stimuli.
- Hallucinations: Sensory experiences without external stimuli.
Mental Status Exam: Thought Content and Process
- Examples of Disturbances:
- Delusions: Fixed, false beliefs or unusual ideas.
- Thought Process Types:
- Linear, Circumstantial, Tangential, etc.
Maslow's Hierarchy of Needs
- Structural Levels:
1. Physiological Needs: Basic survival needs (food, shelter).
2. Safety Needs: Security of body, resources, health.
3. Love and Belonging Needs: Friendship and intimacy.
4. Esteem Needs: Self-esteem and recognition.
5. Self-Actualization Needs: Achieving personal potential.
Evidence-Based Practices in Mental Health
- Milieu Therapy: Supportive environments improve mental health.
- Trauma-Informed Care: Awareness of trauma impact on individuals.
Therapeutic Relationships
- Steps to Build:
- Pre-interaction, Orientation, Working, and Termination phases.
Psychopharmacology
- Understanding Medications:
- 50% of individuals with severe mental illness do not adhere to medication regimens.
- Mechanisms:
- Different classes and effects (SSRIs, antipsychotics, etc.).
Medication Effects and Side Effects
- Common Outcomes:
- Understanding medication interactions and risks of dependency.
Mental Health Theories and Therapies
Psychoanalytic Theory - Sigmund Freud
- Components of Personality:
1. Id: Instant gratification.
2. Ego: Rational self, adhering to rules.
3. Superego: Moral compass.
Psychosocial Development - Erik Erikson
- Stages of Development:
- Importance of overcoming challenges in stages.
Cognitive Behavioral Therapy
- Focus: Interplay between thoughts and behaviors.
Biopsychosocial Model Theory
- Understanding Disorders:
- Interplay of biological, psychological, and social factors.
Nursing Theories and Therapeutics
Imogene King - Goal Attainment Theory
- Nurse and Patient Collaboration: Setting and achieving health goals.
Hildegard Peplau - Interpersonal Relations
- Therapeutic Relationships: Engagement through mutuality and respect.
Psychoanalytic Therapy
- Explanation of Techniques:
- Exploring unconscious conflicts and transference.
Behavioral Therapy
- Focus: Modify maladaptive behaviors.
Recovery Interventions
- Therapeutic Management and Support:
- Facilitate recovery and improvement in patients.
Milieu Therapy
- Creating a Supportive Environment:
- Key elements include containment, structure, and validation.
Trauma Care Concepts
- Understanding Trauma's Impact:
- Support systems and adaptive coping strategies.
Questions and Resources
- Resource References:
- Textbooks: Essential readings for understanding mental health nursing.
- Organizations: Agencies providing additional educational resources.
Conclusion
- In-depth understanding of mental health nursing, legal and ethical considerations, treatment methodologies, and the therapeutic relationship.
- Importance of a compassionate, informed approach to patient care in mental health settings.