Chapter 34
Basic Concepts of Mental
Health
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Basic Concepts of Mental Health
• The nurse can expect to use mental health nursing
principles in a variety of health care settings.
• Basic mental health concepts are useful in
understanding a patient’s behavioral responses to
disease and dysfunction.
• Behavior is the manner in which a person performs
any or all of the activities of daily living.
• Mental health is one’s ability to cope with and adjust
to the recurrent stresses of everyday living.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Basic Concepts of Mental Health
• Mental illness is evidenced by a pattern of behaviors that
is conspicuous, threatening, and disruptive of
relationships or deviates from acceptable behaviors.
• The nurse has the responsibility of assessing and
intervening while maintaining a caring relationship of trust
with the patient.
• WE HAVE A PROFESSIONAL, THERAPUTIC
RELATIONSHIP, NOT SOCIAL. Introduce self and
your role in caring for the pt
• Assist the patient and family to achieve satisfying and
productive ways to deal with daily living. One out of 3
people have some type of mental problem at some point
in their life
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Historical Overview of Mental
Health Care
• During early history, a physically or mentally ill
person was thought to be possessed by evil spirits.
• For mental illness, the shamans or medicine men
focused on removing evil spirits through magical
treatments such as spells, potions, noises, or
sacrifices and physical treatment such as vomiting,
bleeding, massage, and trephining (cutting holes in
the skull to release evil spirits).
• If these tribal rites were unsuccessful, the individual
was abandoned to die by starvation or attack by wild
animals.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Historical Overview of Mental
Health Care
• In the Dark Ages, the church became powerful, and
knowledge was kept in monasteries.
• Early Christians believed mental illness was
punishment for sins committed, possession by the
devil, or caused by witchcraft.
• Exorcisms, physical punishment and imprisonment,
or banishment became the treatment for mental
illness.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Historical Overview of Mental
Health Care
• During the 17th and 18th centuries, conditions for
•
•
•
•
the mentally ill were worse than ever.
Bleeding, starving, beating, purging, and
confinement were the treatments of the day.
During the latter half of the 18th century, psychiatry
became a separate branch of medicine.
In England, an asylum was built. The care was to
encourage acceptable behavior by providing a
nurturing atmosphere.
In the United States, the Pennsylvania Hospital in
Philadelphia was established for the treatment of the
mentally ill.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Historical Overview of Mental
Health Care
• The 19th century saw the flourishing of institutions
and asylums.
• Overcrowding and bureaucracy brought the decline
of care provided by institutions.
• Dorothea Dix was appalled by the care of the
mentally ill and set out to do something about it. Her
efforts brought millions of dollars toward the
development of mental hospitals throughout the
United States.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Historical Overview of Mental
Health Care
• The 20th century ushered in the reform of mental
health care.
• The Committee for Mental Hygiene was formed in
1909; it focused on the prevention of mental illness
and the removal of the stigma of mental illness.
• During the 1930s, electroconvulsive therapy
(ECT) and insulin shock therapy were developed
and used to treat schizophrenia.
• Frontal lobotomy was used to eliminate violent
behavior.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Historical Overview of Mental
Health Care
• In the 1940s, the passage of the National Health Act and
the establishment of the National Institute of Mental
Health were among the most important developments in
the psychiatric medicine in the United States.
• The institute established research funding for the cause,
prevention, and treatment of mental illnesses.
• The 1950s brought about the introduction of
psychotherapeutic drugs. So pts moved out of
institutions & into community centers and hospitals
• During the 1960s and 1970s, legislatures brought about
changes in mental health treatment at the community
level.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Historical Overview of Mental
Health Care
• The Omnibus Budget Reconciliation Act of 1981


The act drastically reduced funding for the mental
health system and put the monies into block grants for
the community to use.
Deinstitutionalization was rapid, putting many mentally
ill patients from state institutions into the streets.
• Now, in the 21st century, mental health concepts
and principles are practiced in a variety to settings,
including public health and home health care
facilities, outpatient settings, and acute care
hospitals.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Basic Concepts Related to Mental
Health
• Mental Health Continuum/ how well we cope and
function with daily life

On the illness end, the person is rarely in touch with
reality, but on the healthy side, the person
demonstrates a high level of wellness.

Any change=stress
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Basic Concepts Related to Mental
Health
• Mental Health Continuum (continued)

Assessment of components of mental health
• A positive self-concept
• Awareness of responsibility for one’s behavior and its
consequences
• Maintenance of satisfying interpersonal
relationships able to trust others
• Adaptability to changes
• Effective communication
• Awareness and acceptance of emotions and their
expressions
• Recognition and use of supportive system
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Figure 34-4
(From Varcarolis, E.M.[2002]. Foundations of psychiatric mental health nursing. [4th ed.]. Philadelphia:
Saunders.)
Support system of family and friends as a component of mental health.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Basic Concepts Related to Mental
Health
• Mental Health Continuum (continued)


The point at which a person is deemed to be mentally
ill is determined by the behavior exhibited as well as
the context in which the behavior is observed.
Mental illness results from an inability to cope with an
overwhelming situation.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Figure 34-3
Mental health continuum.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Basic Concepts Related to Mental
Health
• Personality and Self-Concept

Personality
• The relatively consistent sort of attitudes and behaviors
particular to an individual





Patterns of mental, emotional, and behavioral traits
woven together
Influenced by genetics and interactions with the
environment
Individual’s internal and external patterns of adjustment
to life
Theories: Erik Erikson a psychosocial theory
Sigmund Freud personality development Id, Ego,
Superego box 34-2 p 1126
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Basic Concepts Related to Mental
Health
• Personality and Self-Concept (continued)

Erik Erikson
• Provided a framework for understanding personality
development

If a given task is not mastered, then a set of behaviors
can be predicted.

Btw… when drug abuse starts personality development
stops. For example, age 12-19 identity v role confusion
The pt never progresses to the next stage of intimacy v
isolation so never figure out who they are and cannot
have healthy intimate relationships

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Basic Concepts Related to Mental
Health
• Personality and Self-Concept (continued)

Sigmund Freud
• Personality development as having three parts



Id: Functions on a primitive level and is aimed primarily at
experiencing pleasure and avoiding pain CHILD
Ego: Functions to integrate and mediate between the self
and the rest of the environment ADULT
Superego: The moralistic censoring force; develops from
the ego in response to reward or punishment from others
PARENT
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Basic Concepts Related to Mental
Health
• Personality and Self-Concept (continued)

Self-concept
• This is the framework of reference the individual uses
for all he or she knows and experiences.
• It includes all perceptions and values held by the
individual and the individual’s behaviors and
interactions.
• During growth and development, the individual
accumulates and processes information that helps form
a basic perception of who he is, how he looks, and how
others react to him.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Basic Concepts Related to Mental
Health
• Stress=INTERNAL BODY’S RESPONSE




Stress is the nonspecific response to the body to any
demand made on it.
An individual’s response to stressful situations or
events is often a result of learned or conditioned
behavior.
STRESSOR=SOMETHING THAT CAUSES STRESS
Stressor examples
• Physical, social or spiritual, economic, chemical, school

Mental health nursing concerns itself with behavior,
particularly a person’s response to stressors.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20
Basic Concepts Related to Mental
Health
• Anxiety


This is a vague feeling of apprehension that results
from a perceived threat to self.
Anxiety is a major component of all mental health
disturbances.
• 1.Mild forms ready the body to meet stressful demands.


Problem solving and constructive action, test, dark alley
2. Moderate : NVD, inc HR, B/P, high-pitched talk
• 3. Severe forms interfere with daily activities.


Immobilized coping skills and result of emotional chaos
4. PANIC attack feeling of impending doom, extreme
terror, feels like having a heart attack
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Basic Concepts Related to Mental
Health
• Anxiety (continued)

Degree of anxiety influenced by
•
•
•
•
How the person views the stressor
The number of stressors being handled at one time
Previous experience with similar situations
Magnitude of change the event represents for the
individual
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 22
Basic Concepts Related to Mental
Health
• Motivation

The gathering of personal resources or inner drive to
complete a task or reach a goal
• May be generated by


Perceived reward
Perceived threat of punishment
• The motivation to participate in care helps the patient
through the stages of recovery quickly.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 23
Basic Concepts Related to Mental
Health
• Frustration

This involves anything that interferes with goaldirected activity.

Some people are more flexible and adaptable than
others.

When adaptive behavior fails, anxiety increases.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 24
Basic Concepts Related to Mental
Health
• Conflict AKA ambivalence



This is a mental struggle, either conscious or
unconscious, resulting from the simultaneous
presence of opposing or incompatible thoughts, ideas,
goals, or emotional forces, such as impulses, denials,
or drives.
Some conflicts are easily resolved; others are more
complicated.
An example of this is when a woman first finds out she
is pregnant
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 25
Basic Concepts Related to Mental
Health
• Adaptation and Coping

Adaptation
• An individual’s ability to adjust to changing life situations
using various strategies

Coping responses: Used to reduce anxiety brought on
by stress
• Examples: Overeating, drinking, smoking, withdrawal,
seeking someone to talk to, yelling, exercising, fighting,
pacing, or listening to music

May be used consciously or unconsciously
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 26
Basic Concepts Related to Mental
Health
• Adaptation and Coping (continued)

Defense mechanisms p 1129 Things we do to cope
with anxiety and stressful events
• Unconscious intrapsychic reactions that offer protection
to the self from a stressful situation
• Behavioral patterns that protect the individual against a
real or perceived threat
• Blocking conscious awareness of threatening feelings
• Denial “I can’t believe I have cancer”
• Projection “I failed the class because the teacher didn’t
like me”
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 27
Illness Behaviors
• Illness


This is a state of homeostatic imbalance.
When a person does not feel well, the body is saying,
“Pay attention to my needs.”
• Crisis



This is a time of change or turning point in life when
patterns of living must be modified to prevent
disorganization of the person or family.
Some individuals have difficulty coping with an illness
or crisis.
Behavior is learned, and individuals bring their
learned behavior patterns into the health care setting.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 28
How Illness Affects Mental Health
• Illness Behaviors



Illness is the state of homeostatic imbalance.
Crisis is a time of change or turning point in life when
patterns of living must be modified to prevent
disorganization of the person or family.
Some individuals have difficulty coping with an illness
or crisis.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 29
How Illness Affects Mental Health
• Illness Behaviors (continued)

Common behaviors seen with illness
•
•
•
•
•
Denial
Anxiety
Shock
Anger
Withdrawal
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 30
Crisis Intervention
• A serious illness, the breakup of a relationship, a car
accident, or the death of a loved one can trigger a
crisis response in an individual or a family.
• Phases of Crisis Similar to Stages of Grief

Confusion, disbelief, and high anxiety

Denial

Reality; anger and remorse

Sadness and crying

Reconciliation and adaptation
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 31
Crisis Intervention
• Nursing Interventions

Provide accurate information that aids in realistic
perception of the situation.

Encourage venting of feelings. “Tell me what this
diagnosis means to you” “Have you experienced
anything like this before?” “How did you handle it?”

Identify family supports and adequate coping
mechanisms.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 32