MENTAL HEALTH Lecture #1 Audio Notes

Mental health concepts vary across the world and even within regions; the idea of what constitutes schizophrenia or depression can look different depending on cultural context.
Schizophrenia may be interpreted differently across cultures (e.g., believed to involve speaking with spirits in some areas), whereas in other contexts trauma and abuse are prominent factors in mental distress.
Even among family members in the same household, people can differ drastically in how they manage stress; genetics may be the same (example: twins), but environments differ. This raises the nature vs nurture question in patient outcomes.

Genetically identical individuals (twins) can have different stress adaptations due to differing environments; this highlights the complexity of predicting mental health outcomes.
Consideration of “the what-ifs” (fears, anxiety, panic, OCD) and how some compulsive behaviors (e.g., touching a door three times) may provide temporary relief but may become maladaptive.

Regardless of a patient’s socioeconomic status, every person should be treated with respect; negative judgments are inappropriate in care.
If a patient requests judgment, they can seek other avenues (the speaker mentions corporal consequences historically, implying a boundary against punitive judgments by clinicians).
Clinicians should reflect on personal biases and avoid bringing bias into patient care; vulnerable patients deserve safe, stigma-free treatment.
Staff have the right to speak up about abuse or disrespect they experience, reinforcing that patient safety and staff safety are priorities.

Patients are vulnerable when sick; clinicians must protect safety and dignity, avoiding demeaning or discriminatory behavior.
An example is given of racism toward staff; the stance is that staff deserve respectful treatment just as patients deserve respect.
The goal is to hear the patient openly and create a sense of safety; the patient’s need for safety underpins all care decisions.

Historically, straight jackets were used, though they are not used today; description emphasizes how heavy and restrictive they are.
An anecdote compares a straight jacket to being wrapped in canvas with laces at the back, illustrating the severity of restraint methods used in the past.

The pandemic created public health stressors and access challenges to care.
Behavioral shifts included substantial increases in substance use: 40\% of people who weren’t drinking began drinking, and there was a 60\% increase among those who were drinking more consistently.
Access to help during the crisis was problematic, affecting how people sought and received treatment.

Trauma can be physical, mental, emotional, sexual, or financial, and contributes to mental illness.
Real-world examples include intimate partner dynamics where a spouse controls finances, limiting access to money and resources, which compounds trauma.

Some patients experience adverse effects (e.g., sexual dysfunction, restless legs) that may lead to poor adherence, even if symptoms improve.
Side effects can make continuing medication or treatment undesirable, contributing to relapse or a revolving door back to crises or emergency rooms.

Even when resources exist, there is a necessity to improve outreach so that the population understands and can access them; resources exist for adolescents but may not be well-publicized.

There are two hospitals in the state that treat adolescents; one is associated with Emily Bradley and has a history worth exploring.
The facility (Hasbro) treats two disorders not well addressed elsewhere: factitious disorder (bodily symptoms without an underlying organic cause) and eating disorders; it provides in-house treatment for these conditions rather than transferring patients elsewhere.
The term “factitious disorder” is used to describe patients who present with symptoms they or others cause or simulate; the facility’s approach is highlighted as innovative.

Culturally diverse populations influence how mental health issues are experienced and treated; standards of care must account for cultural differences.
The association standards of care for mental health guide practice and ensure a consistent, ethical approach across diverse populations.

Suicide guidelines and the duty to warn protect patient and public well-being, balancing safety with rights.
Seclusion and false imprisonment are ethical and legal concerns; clinicians must be mindful of rights and due process when applying restrictive interventions.

The synergy model emphasizes matching the right patient with the right nurse for the right situation, rather than applying a one-size-fits-all approach.
For example, a psychiatric nurse is not suited to handle urinary issues, and an orthopedic nurse is not ideal for caring for a newborn; appropriate placement improves outcomes.
In ER cases involving trauma, matching clinicians to patient needs is crucial; trauma-informed and sensitive approaches are emphasized.

Some patients may struggle with multiple doctors and medication regimens; organized care helps reduce confusion and improve adherence.
Insurance coverage and care models influence whether mental health care is accessible and continuous; parity with physical health services is implied as a goal.
Frequency of care varies with stability: some patients may be seen up to twice a week, others monthly or every three months depending on stability.

The need to consider hospital-based care models and how patients qualify for insurance coverage.
Cultural differences influence mental health treatment, requiring standards of care that are inclusive of diverse communities.

Physical safety is the top priority; clinicians should be aware of patient movements and risks.
Always inform team members when entering a patient’s room and ensure coverage when taking breaks to avoid lapses in supervision; this is illustrated with a cautionary example from Butler Hospital.
In some cases, dementia patients or others may become physically challenging; planning and communication are essential to maintain safety.

Core functions include counseling and the therapeutic milieu; emphasis is placed on practice that supports healing environments.
The therapeutic relationship should avoid telling patients how they feel; instead, clinicians should facilitate exploration and support from appropriate experts.

Self-awareness: The speaker states the need to monitor one's attitude to avoid being nasty.
Respect for diverse values: Importance of respecting others' beliefs and ideas, even when they differ from one's own.
Ethical practice implications: Nonjudgmental stance supports therapeutic rapport and safety.

The act of admitting the patient into care/holding facility.
The ethical and legal duty to report: contacting law enforcement when required by law or safety concerns.
Balance between patient care and public safety.