Mental Health • According to WHO, it is a state of (E)emotional, (S)social and (P)psychological wellness as evidenced by: ✓ Effective behavior and coping, ✓ Satisfying interpersonal relationships, ✓ Positive self-concept and ✓ Emotional stability. COMPONENTS OF MENTAL HEALTH According to Johnson (1997), mental health has many components and is influenced by a wide variety of factors. 1. Autonomy and Independence 2. Maximizing one’s potential 3. Tolerating life uncertainties 4. Self esteem 5. Mastering the environment 6. Reality orientation 7. Stress Management Mental illness • A condition that impacts a person's thinking, feeling or mood may affect and his or her ability to relate to others and function on a daily basis. • Each person will have different experiences, even people with the same diagnosis. FACTOR CONTRIBUTING TO MENTAL ILLNESS 1. Individual Factors a. Biologic make-up b. Anxiety c. Worries and fears d. A sense of disharmony in life e. A loss of meaning in one’s life Mental Disorder • According to the American Psychiatric Association (2000), it is a “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom”. 2. Interpersonal Factors a. Ineffective communication b. Excessive dependency c. Withdrawal from relationships d. Loss of emotional control 3. Cultural and social factors a. Lack of resources b. Violence c. Homelessness d. Poverty e. Discrimination such as racism, classism, ageism and sexism. Diagnostic and Statistical Manual of Mental Disorders (DSM) • • • • A handbook published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used by health care professionals such as psychiatrists, clinical psychologists, social workers, and licensed professional counselors in the United States and much of the world. It is the authoritative guide to the diagnosis and treat of mental disorders. DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders. DSM I (1952 – 1965) • • Contained 102 very broad diagnostic categories that were based on psychodynamic (Freudian) principles. The diagnostic categories were divided into two major groups of mental disorders that included: Conditions that were assumed to be caused by some type of brain dysfunction. DSM II (1968) • The American Psychiatric Association published a second edition of the Diagnostic and Statistical Manual of Mental Disorders DSM IV (1994 – 2000) • • • A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual. Approached psychiatric assessment and organization of biopsychosocial information using a multi-axial formulation, and there were five different axes. However, the phrase “clinically significant” is in some ways tautological here; its definition is precisely what is at stake when defining a mental disorder. DSM V • • • • Classifications of Intellectual Disability Severity. Intellectual disabilities as neurodevelopmental disorders that begin in childhood Characterized by intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living. Patient assessment measures for use at the initial patient interview and to monitor treatment progress, thus serving to advance the use of initial symptomatic status and patient reported outcome information. 3 most common diagnoses 1. Anxiety disorders 2. Depression 3. Post-traumatic stress disorder (PTSD) NOTE: These three conditions make up around 30 percent of all diagnoses of mental illness in America 20 chapters in the DSM 5 regarding mental disorders 1. Neurodevelopmental 2. Schizophrenia Spectrum and other Psychotic disorders 3. Bipolar and related disorders 4. Depressive disorders 5. Anxiety disorders 11. 12. Elimination Disorders Sleep-Wake Disorders 13. 14. 15. 6. Obsessive Compulsive and Related Disorders 7. Trauma and Stressor related disorders 8. Dissociative Disorders 9. Somatic Symptoms and related disorders 10. Feeding and eating disorders 16. Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse Control and Conduct Disorders Substance-related and Addictive Disorders 17. 18. 19. 20. Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Mental disorders Evolution of Mental Health Psychiatric Nursing Practice Time Period Ancient times Early Christian Times (1- 1000) Concepts of mental illness - Displeasure of the gods Punishment for sins and wrong doings. It was thought to be a natural phenomenon - a humanistic approach Imbalances of the four humors. Evil spirits possessed the body and must be driven out Renaissance (1300-1600) - Decline in the belief of possession Mental problems were irreversible Scientific inquiry and humanism Period of Enlightenment and Creation of Mental Institutions (18th Century) - A reform movement - chains removed. Need for medical care recognized. The first mentally ill patient was treated in hospital. Period of Scientific Study (19th Century) - Development of Psychopharmacology and Move towards Community Mental Health (20th Century) - Research began Legislation concerning mental health was enacted. Hospitals for the mentally ill were established with long term custodial care. The start of the mental health movement. Large state hospitals were built, psychoanalysis developed, and community health care centers established. A holistic concept of care and short-term care introduced. GOAL: To return patients into society, so human service programs were established. There was a focus on prevention. - 21st Century - A diagnosable mental disorder A serious emotional disturbance impairing daily activities; leading cause of disability An economic burden Institutionalization versus deinstitutionalization; revolving door effect Community Based Care Psychiatric Nursing • An interpersonal process whereby the professional nurse practitioner assists an individual, family, and community to prevent or cope with the experience of illness and suffering and if necessary, to find meaning in those experiences (Travelbee, 1970). Mental Health Psychiatric Nursing • • A specialized area of nursing that uses the theories of human behavior and the purposeful use of self, as its art. It is an interpersonal process whereby it promotes mental health, prevents mental illness, early identification and intervention of emotional problems, and follow-up care to minimize long term effects of mental disturbance. Goals of Psychiatric Nursing 1. To help the client accepts himself 2. To promote relationship with other people 3. To learn to function independently on a realistic basis Scope of Psychiatric Nursing 1. Caring for physically ill patients in general hospital a. Normal Anxieties b. Moderate mental disturbance - ex. Operation c. Severe mental disturbance - ex. Amputation d. Acute Psychotic Care 2. Community Mental Health • This is established to deinstitutionalized the care of mentally ill clients. Its philosophy is that client resides within the community and therefore must be treated within the community level. • Community psychiatry is a trend that focuses in follow-up care for clients who returned to the community after a period of hospitalization for mental illness. • In a therapeutic community, group effort is very important. Patients are involved in decision making regarding roles and regulations. PRIMARY Altering the causative or risk factors to hinder development of illness ✓ Client and family teaching ✓ Stress reduction ✓ Psychosocial support 3 LEVELS OF CARE SECONDARY Reducing the effects of mental illness ✓ ✓ ✓ ✓ ✓ Screening Crisis intervention Suicide prevention Short-term counseling Emergency counseling & short-term hospitalization TERTIARY Minimizing long term residual effect ✓ ✓ ✓ ✓ Rehabilitation program Vocational training After-care support Partial hospitalization options Beliefs, Feelings, and Principles conducive to the Effective Practice of Psychiatric Nursing Belief Human beings are complex. Systems of interrelated parts, the whole of which is greater than the sum of the parts. Each individuals have some strengths and a potential for growth. Each individual is unique and has inherent value. All human beings are sufficiently similar that there is a basis for understanding and communicating with one another. All behavior is purposeful and is designed to meet a need or to communicate a message Behavior is learned as an adaptation to an earlier stressor and is the best possible adaptation the individual is capable of making at the time. All individual learns behavioral adaptation primarily in interaction with significant people in his environment. Feeling The nurse feels she can be helpful to the client, since she has expertise in many areas of nursing. Principle The nurse views the client as a holistic being with a multiplicity of interrelated and interdependent needs. The nurse is hopeful about the client’s ability to grow. The nurse focuses on the client’s strengths and assets, not on his weaknesses and liabilities. The nurse accepts the client as a unique human being who has value and worth exactly as he is. The nurse has the potential for establishing a relationship with most if not all clients. The nurse appreciates the uniqueness and inherent value of the client. The nurse feels empathy with the client’s feelings. The nurse feels curious about the meaning of the clients’ behavior The nurse cares about clients even though they may not reciprocate her feeling. The nurse feels competent in her ability to interact therapeutically with persons who are mentally ill. The nurse explores the client’s behavior for the need it is designed to meet or the message it is communicating. The nurse views the clients‘ behavior nonjudgmental while assisting him to learn more effective adaptation. The quality of the interaction in which the nurse engages with the client is a major determinant of the degree to which the client will be able to alter his behavioral adaptations in the direction of a more satisfying interpersonal relations.
