PSYCHIATRIC NURSING
M E N TA L H E A LT H A N D M E N TA L
ILLNESS
Objectives
1- Define and explain mental disorder
2- Analyze why the term deviant behavior lacks a definition that
covers all situations
3- Compare and contrast the essential characteristics of mental
health with mental disorder
4- NAME THE FIVE MENTAL DISORDERS THAT RANK AMONG THE TOP TEN CAUSES
OF DISABILITY WORLDWIDE
5- Describe how societal attitudes, philosophical viewpoints, and
definitions of mental disorder have shifted throughout history
6- Explore the meaning of stigma for clients, families, friends,
communities, and mental health caregivers and agencies
CARING FOR PSYCHIATRIC
MENTAL HEALTH CLIENTS
Facing the unknown in a psychiatric–mental health setting
invites a variety of feelings, concerns, and questions.
Expectations related to caring for psychiatric–mental health
clients are influenced by a number of factors
FACTORS INFLUENCING EXPECTATIONS
Media
Other?
Upbringing
Expectations
Life experiences
Culture
PSYCHIATRIC MENTAL HEALTH CLIENTS
Psychiatric mental health clients are everyday, ordinary people.
Given the right circumstances, anyone can experience a mental
health problem ranging from mild and temporary to severe
and persistent.
Client because of its association with empowerment and self
responsibility and optimistic beliefs that people are capable
to change
Concepts of mental disorder and mental health are interactional
and derive their meaning not only from changes in brain
structure and biochemistry but also from how we define
certain behavior and social conditions
FACTORS IMPACTING MENTAL HEALTH
AND MENTAL ILLNESS
Biological
Mental
Illness
or
Mental
Health
Social
Cultural
MENTAL DISORDER CHARACTERISTICS
Mental disorder is a psychological
group of symptoms in which the
individual experiences:
1- distress (a painful symptom),
2- disability (impairment in one or
more important areas of
functioning),
3- or a significantly increased risk
of suffering, pain, loss of freedom,
or death.
• Signs and symptoms of mental
disorder are known as
Mental disorders are
a.
identified,
b.
standardized,
c.
and categorized in the Diagnostic and Statistical Manual of Mental Disorders–
IV-TR published by the American Psychiatric Association (APA).
FLOUTS SOCIAL NORMS IS AN EXAMPLE
OF SOCIAL DEVIANCE—NOT EVIDENCE
OF PSYCHOPATHOLOGY OR ABNORMAL
BEHAVIOR. PHOTO COURTESY OF
MICHAEL NEWMAN/PHOTOEDIT.
DEVIANCE
Is it bad?
Bizarre in one cultural context; acceptable in another?
Deviant political, religious, or sexual behavior
 Mental disorder—yes or no?
The concept of mental disorder lacks a definition
that covers all situations.
A sociologic definition of deviance is behavior
outside the social norm of a specific group; and
in its social context, deviant does not mean
“bad.”
Behavior that is considered bizarre or
unreasonable in one cultural context may be
considered desirable in another.
The appropriateness of behavior depends on
whether it is judged plausible or not according
to a set of social, ethical, and legal rules that
define the limits of appropriate behavior and
reality
Deviant political, religious, or sexual behavior or conflicts
primarily between an individual and society are not labeled
as mental disorders unless the deviance or conflict is a
symptom of dysfunction in the individual
WHAT DO THESE TERMS MEAN?
Crazy?
Berserk?
Insane?
Lunacy?
Nervous Breakdown?
Melancholy?
CHARACTERISTICS OF MENTALLY
HEALTHY INDIVIDUALS
Look at the following characteristics:
 Individuals Behavior
 Interpersonal Relationships
 Intrapersonal Relationships
There are many essential qualities of mentally healthy people.
Some are reality oriented to people, places, time, and events;
and have a basic knowledge of their strength and weakness,
and the ability to problem solve and maximize the potential to
grow.
-
Function independently and autonomously
-
Hold positive attitudes toward himself
-
Remain healthy with high level of stress
-
Adaptable
-
Master their environment
-
Perecive reality clearly
-
They are able to grow as they interact
collaboratively with others.
In these collaborative relationships, they not
only accept their own strengths and
weaknesses, but they also accept the
strength and weaknesses of others.
Their emotional and psychological states, and
values and behavior are consistent.
These qualities move the person along the
way to hardiness and resilience in his or her
life experiences
In general, mentally healthy people relate to others and have a self-concept that is
based in reality.
They are independent and autonomous and accept the challenges of life.
To meet the challenges of life, they utilize problem solving consistent with the norms
of their culture.
Problem solving may mean seeking
assistance from someone and during
such time they seek appropriate
sources for help.
As they work through problems, they
develop more resilience.
Their behavior, emotions, and values
are adaptable to many growth
experiences.
Mentally healthy people are on a
lifelong growth process toward one’s
potential.
HISTORY
Understanding and approaches to “madness” throughout
history were influenced by:
 Social attitudes
 Philosophic viewpoints
Ideas that may be considered contemporary at one time often
have roots in earlier centuries. The modern medical concept
of “madness” as an illness is open to the same scrutiny ( ‫فحص‬
‫ )دقيق‬as interpretations of the past; examples include
witchcraft or mysticism.
HISTORICAL APPROACHES
Era of Magico-Religious Explanations
Attributing factors were





•
Superhuman forces
Violation of taboos (‫)المحرمات‬
Neglect of rituals (‫(الطقوس‬
Loss of soul
Witchcraft
Treatment centered on dealing with spirits and the forces inflicting pain and
suffering
HISTORICAL APPROACHES (CONT'D)
Era of Organic Explanations
 Hippocrates (4th century BCE) proposed imbalances in body humors. Treatment
centered on use of words (talking, interpreting dreams) and purging, bloodletting,
and ritual purification
Blood
The blood was believed to be produced exclusively by the liver.[
Yellow Bile
Excess of yellow bile were thought to produce aggression, and excess anger
reciprocally gave rise to liver derangement and imbalances in the humors.
Black Bile
from the belief that an excess of black bile caused depression.
Phlegm
Phlegm was thought to be associated with apathetic behavior,
DR. MASA'DEH
24
HISTORICAL APPROACHES (CONT'D)
Era of Alienation (‫)العزله‬
 Social exclusion
 Imprisonment (‫)الحبس‬
 “Ships of fools” witch
 “Lunacy” RELATED to the moon
The insane were driven out and excluded from society.
Theologic and magical explanations still prevailed.
“Treatment” included ritualized social exclusion, imprisonment,
and “ships of fools” to search for reason and spiritual
reintegration.
The exception was in the Arab world where the insane were believed to be divinely inspired
and consequently treated kindly.
The first asylum was built in Fez, Morocco early in the 8th century. During the Middle Ages
(400 CE) to the Renaissance (1300–1600 CE), troubled minds were thought to be
influenced by the moon (lunacy).
FIGURE 1-5 MOONSTRUCK WOMEN DANCING IN A
17TH-CENTURY SQUARE. THIS ACTIVITY IS THE
SOURCE FOR THE WORD LUNATIC. PHOTO COURTESY
OF PHILOSOPHICAL LIBRARY.
HISTORICAL APPROACHES (CONT'D)
Era of Alienation
 The exception: Arab belief was that the insane were divinely
inspired.
BEING CHAINED IN THE FOREGROUND,
AND IN THE BACKGROUND ARE TWO
SUNDAY VISITORS ON AN
ENTERTAINMENT OUTING. PHOTO
COURTESY OF PHILOSOPHICAL
LIBRARY.
HISTORICAL APPROACHES (CONT'D)
Era of Confinement
 The insane were fed, but were morally constrained and physically confined and
were frequently publicly beaten and tortured. Enormous asylums arose to confine
the insane to maintain social order. These included Hôpital Général in Paris and St.
Mary of Bethlehem (Bedlam) in London
FIGURE 1-7 A LANDMARK EVENT—PHILIPPE PINEL
UNCHAINING THE INSANE IN THE BICÊTRE HOSPITAL IN
PARIS. PHOTO COURTESY OF CHARLES CICCIONE/PHOTO
RESEARCHERS, INC.
HISTORICAL APPROACHES (CONT'D)
Era of Moral Treatment
 Emergence of reform ): Treatment continued to be inhumane based on
unsatisfactory explanations of mental illness, the belief that mental disorders were
incurable, and the idea that mad persons were dangerous.
 However, there was an emergence of reform and humanitarianism across Western
Europe and the United States, which resulted in more humane treatment
Reformers included William Cullen, Philippe Pinel, the Quakers under William Tuke,
Benjamin Franklin, and Benjamin Rush (“father of American psychiatry”).
Benjamin Rush explained mental illness as “excitement of the brain” and used
somatic treatments such as bleeding, purging, and developed the tranquilizing
chair to quiet the insane.
DR. MASA'DEH
34
HISTORICAL APPROACHES (CONT'D)
Benjamin Rush
 "Father of American Psychiatry”
FIGURE 1-8 BENJAMIN RUSH, THE “FATHER OF AMERICAN PSYCHIATRY” AND AN IDEALIST AND
HUMANITARIAN, NEVERTHELESS FAVORED PHYSICAL THEORIES SUCH AS “EXCITEMENT OF THE
BRAIN” TO EXPLAIN MENTAL ILLNESS. HE WAS PREOCCUPIED WITH SOMATIC TREATMENTS SUCH AS
BLEEDING AND PURGING AND DEVELOPED THE TRANQUILIZING CHAIR TO QUIET THE INSANE.
PHOTO COURTESY OF PHILOSOPHICAL LIBRARY
.
HISTORICAL APPROACHES (CONT'D)
Era of Psychoanalysis
 There was an increase in the number of mental hospitals. Insanity was linked to
faulty life habits and treated with physical and somatic therapies. Sigmund Freud
explained human behavior in psychological terms.
HISTORICAL APPROACHES (CONT'D)
Contemporary Developments
 Social dimensions
 Brain dysfunction
 Neurochemical
 Medication therapy
21ST CENTURY RESEARCH
Bases for mental disorders
Psychotropic medications
Role of nutrients, biology, and genetics
MENTAL DISORDER STATISTICS
High incidence with physical illness
Account for 47% of all disability in economically developed
countries
Account for 28% of all disability worldwide
TABLE 1-1 PREVALENCE RATES FOR
VARIOUS MENTAL DISORDERS
STIGMA
A negative consequence of being diagnosed with a mental
disorder
Based on societal perception that mental illness is a blemish of
individual character
STIGMA IS A
WORLD WIDE PROBLEM
Stigma is about disrespect and leads to:
 Prejudice
 Discrimination
 A diagnosis of mental illness not only means the client must work to regain his or
her mental health, it also means the client must learn to cope with the stigma of
mental illness. The pain of facing mental illness is compounded with the negative
social perception that mentally ill people are a danger to society or lacking in
intelligence, and the incoherence that sometime accompanies mental illness will
cause some people to become afraid of them, ignore them, be rude to them, or
treat them as children. Interactions of this type are painful and disrespectful. It
interrupts getting help or utilizing help
The display of covert or overt negative behavior by the public must be addressed with
education. In the professional settings, education and supervision are needed.
Effort is being made to decrease the stigma attached to mental illness by public
figures sharing with the public their diagnosis of mental illness. Many times, a
person may not be fully aware of the negative message he or she is giving to the
client. Stigma still hurts and impedes the recovery process.
DR. MASA'DEH
44
No one wants to see a friend or family member being treated poorly or given lessthan-adequate care because of prejudice and discrimination. When care is
negatively impacted, it is likely to increase the length of treatment. Stigma
undermines the confidence that quality care will be provided and it also
decreases the client’s self-esteem
DR. MASA'DEH
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BOX 1-2 STIGMATIZING BELIEFS
ABOUT MENTAL ILLNESS
BOX 1-2 (CONTINUED)
STIGMATIZING BELIEFS ABOUT MENTAL
ILLNESS
BOX 1-2 (CONTINUED)
STIGMATIZING BELIEFS ABOUT MENTAL
ILLNESS
STIGMA IS AN OBSTACLE
To Better Mental Health Care
 It decreases the quality of life for those that have a mental illness
and for those that work with mental health disorders.
 Remember, Words are Powerful!
FIGURE 1-9 THE EFFECT OF STIGMA ON RECOVERY FROM MENTAL ILLNESS. THE PERSON’S
SYMPTOM IS THE MARKER THAT LEADS TO STIGMATIZATION BY SOCIETY. EVENTUALLY, THE
EFFECTS OF STIGMATIZATION NEGATIVELY INFLUENCE THE PERSON’S ABILITY TO RECOVER
FROM MENTAL ILLNESS.
PSYCHIATRIC—MENTAL HEALTH
NURSES: WHO ARE THEY?
promotes mental health through assessment, diagnosis,
and treatment of human responses to mental health
problems and psychiatric disorders (ANA, APNA, ISPN,
2007).
It is a specialized area of nursing practice that employs
theories of, and research on, human behavior as its
science and the purposeful use of self as its art.
Essential components include: health and wellness
promotion through identification of mental health
issues, prevention of mental health problems, care of
mental health problems, and treatment of persons
with psychiatric disorders (ANA, APNA, IPSN, 2007).
Two sets of standards guide professional psychiatric–mental health nursing practice:
1- Standards of Practice
2- Standards of Professional Performance
DR. MASA'DEH
52
STANDARDS (CONT'D)
Psychiatric-Mental Health Nursing Standards of Practice
 Assessment
 Diagnosis
 Outcomes Identification
 Planning
STANDARDS (CONT'D)
Psychiatric-Mental Health Nursing Standards of Practice
 Implementation
 Coordination of Care
 Health Teaching and Health Promotion
 Milieu Therapy
 Pharmacological, Biological, and Integrative Therapies
STANDARDS (CONT'D)
Psychiatric-Mental Health Nursing Standards of Practice
 Implementation
 Prescriptive Authority and Treatment (APRN only)
 Psychotherapy (APRN only)
 Consultation (APRN only)
 Evaluation
BOX 2-1 PSYCHIATRIC–MENTAL
HEALTH NURSING STANDARDS OF
PRACTICE
BOX 2-1 (CONTINUED)
PSYCHIATRIC–MENTAL HEALTH
NURSING STANDARDS OF PRACTICE
STANDARDS (CONT'D)
Standards of Professional Performance
 Quality of Practice
 Education
 Professional Practice Evaluation
 Collegiality
 Collaboration
STANDARDS (CONT'D)
Standards of Professional Performance
 Ethics
 Research
 Resource Utilization
 Leadership
BOX 2-2 PSYCHIATRIC–MENTAL
HEALTH NURSING STANDARDS OF
PROFESSIONAL PERFORMANCE
PERSONAL AND PROFESSIONAL
IDENTITY
Influenced by one’s self view
 Attitudes, values, expectations and beliefs
PERSONAL AND PROFESSIONAL
IDENTITY (CONT'D)
Self-awareness and self-reflection are critical to effective,
compassionate psychiatric care
 Must examine, feelings, thoughts, and behaviors
PERSONAL INTEGRATION AND THE
PSYCHIATRIC-MENTAL HEALTH NURSE
How do you know your self? How do you separate your identity
from others?
Developing comfort with behavior and values outside the social
norm
PERSONAL INTEGRATION AND THE
PSYCHIATRIC-MENTAL HEALTH
NURSE (CONT'D)
Developing detached concern
Creating a common ground
FIGURE 3-1 SELF-AWARENESS OF FEELINGS.
SUPERFICIAL FEELINGS ARE VISIBLE; DEEPER
FEELINGS ARE SUBMERGED.
PERSONAL INTEGRATION: MANAGING
THE AFFECTIVE SELF
Self-awareness of all levels of feelings
Exploration and understanding of dominant emotional themes
Recognition and acceptance of one’s own feelings without
judgment
Recognizing and challenging one’s dogmatically held beliefs
QUALITIES OF EFFECTIVE
PSYCHIATRIC-MENTAL HEALTH
NURSING
Psychiatric–mental health nursing is a highly specialized area of nursing practice that
requires nurses to practice the use of self artfully in therapeutic relationships.
Being :
Self-awareness
Personal integration
Moral integrity
‫الوعي الذاتي‬
‫التكامل الشخصي‬
‫النزاهة األخالقية‬
QUALITIES OF EFFECTIVE
PSYCHIATRIC-MENTAL HEALTH
NURSING (CONT'D)
Respect
Accountability
Availability
Advocacy
Spontaneity
Spirituality
Hope
Empathy
Acceptance
Critical
thinking
Sensitivity
Self-Disclosure
Vision
SOCIOCULTURAL INFLUENCES
AND PSYCHIATRIC-MENTAL
HEALTH NURSING
Cultural and social class differences
Sociocultural heritage
 Beliefs, values, attitudes, and behavior
Potential for misdiagnosis:
 Importance of obtaining a cultural profile
MAINTAINING EMPATHIC ABILITIES
Definition of empathy (ability to understand and share the
feeling of the others)
Relationship to personal integration
Challenges to developing and maintaining empathy
RESPECT AND THE
PSYCHIATRIC-MENTAL HEALTH
NURSE
Accountability for one’s behaviors and actions in stressful
situations
Conveying messages of respect
Preserving the dignity and self-worth of another
TAKING CARE OF THE SELF
Developing and practicing assertiveness
Seeking solitude
Maintaining physical health
Attending to internal signals of stress
THE PROBLEM OF BURNOUT
It’s a condition in which health care professionals lose their
concern and feeling for their clients and come to treat them
in detached
Working with intensely troubled people
Caring and burnout
Cues to burnout; language used to describe client, avoidance of
interaction, rigidly applying rules, using jokes to put down
clients ands their experience
Reducing burnout