Bluegrass Community and Technical College Practical Nursing Program NPN 125: Mental Health Maureen Topley, BSN,

RN, Faculty CHAPTER 1: FOUNDATIONS OF PSYCHIATRIC-MENTAL HEALTH NURSING Videbeck (2011). Psychiatric-Mental Health Nursing, 5th ed. MENTAL HEALTH AND MENTAL ILLNESS How would you define someone as mentally healthy? How would you define someone as mentally ill? Mental Health y Difficult to define y No single, universal definition y Dynamic, ever-changing state y Influencing factors:  Individual -or personal factors include a persons biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities.
 Interpersonal- Effective communication, ability to help others, intimacy, and a balance of separateness and connectedness.

 Social/cultural- or environmental, factors include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic view of ones world. Mental Illness y Mental Disorder: behavioral or psychological syndrome or pattern (clinically significant)  Association with present distress or disability or increased risk of death, pain, disability or important loss of freedom y General criteria for diagnosis:  Dissatisfaction with characteristics, abilities, accomplishments  Ineffective or unsatisfying relationships  Dissatisfaction with ones place in the world  Ineffective coping with life events  Lack of personal growth

Influencing factors:  Individual- biological makeup, intolerable or unrealistic worries or fears, inability to distinguish reality from fantasy, intolerance of lifes uncertainties, a sense of disharmony in life, and a loss of meaning in ones life.  Interpersonal- ineffective communication, excessive dependency on or withdrawal from relationships, no sense of belonging, inadequate social support, and a loss of emotional control.  Social/cultural- lack of resources, violence, homelessness, poverty, an unwarranted negative view of the world, and discrimination such as stigma, racism, classism, ageism, and sexism.

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS y DSM-IV-TR is a taxonomy published by the APA. What is a taxonomy? Systematic arrangement in groups or categories according to established criteria Purposes:  Standardize nomenclature, language  Identify defining characteristics or symptoms  Assist in identifying underlying causes

It uses a multiaxial classification system that involves assessment on several axes or domains of information, allowing the practitioner to identify all the factors that relate to a persons condition. y Axis I: major psychiatric disorders except mental retardation and personality disorders What are two examples? Depression, schizophrenia, anxiety, and substance-related disorders. Axis II: mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms Axis III: current medical conditions potentially relevant Axis IV: reporting psychosocial, environmental problems List three examples of problems that could be included here: 1. Problems with primary support group 2. The social enviroment 3. education, occupation, housing, economics, access to health care, and the legal system. Axis V: Global Assessment of Functioning which rates the persons overall psychological functioning on a scale of 0 to 100. Remember this is the clinicians assessment of the persons current level of functioning.

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HISTORICAL PERSPECTIVES OF THE TREATMENT OF MENTAL ILLNESS y Ancient times  Sickness as displeasure of gods: punishment for sins; view as demonic or divine  Aristotle and imbalances of the four humors (blood, water, yellow and black bile); balance restoration via bloodletting, starving, purging  Early Christians view as possession by demons Period of Enlightenment (1790s)  Creation of asylums; moral treatment  Dorothea Dix what was her contribution? She opened 32 state hospitals that offered asylum to the suffering after visiting William Turkes hospitals. She believed society was obligated to those who were mentally ill. Advocated adequate shelter, nutritious food, and warm clothing. Sigmund Freud: Scientific Study and treatment of mental illness Psychopharmacology (1950s):  Development of psychotropic drugs Community Mental Health Movement  Deinstitutionalization  Legislation for disability income  Changes in commitment laws

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MENTAL ILLNESS IN THE 21ST CENTURY y Current State  More than 26% of Americans 18 and older have diagnosable mental disorder (NIMH, 2008)  15 million adults, 4 million children and adolescents with impaired daily activities  Economic burden exceeds that by all types of cancer  Leading cause of disability in United States and Canada for those 15-44 years of age  1 in 4 adults and 1 in 5 children and adults getting care needed Issues and concerns:  Revolving-door effect due to deinstitutionalization  Shorter hospital stays, decompensation, rehospitalization, dual diagnoses  Homelessness (1/3 estimated to have serious mental illness; over with substance abuse problems)  Lack of adequate community resources ACCESS: to address needs of full or part-time homeless persons with mental illness

Objectives for the Future (Originally 2010 Healthy People Objectives) (Box 1.1) 1. 2. 3. 4. Community-Based Care y How would you define this?

What are community support programs? What do they focus on?

What are the disadvantages of such programs?

y Are they beneficial? Cost Containment and Managed Care y y y y What is Managed Care? When did it begin? What are Utilization review firms or managed care organizations? What is Case management? Health Care Finance Administration (HCFA) administers two insurance programs 1. Medicare 2. Medicaidy Mental Health Parity Act -

Cultural Considerations y y y Culturally diverse population Cultural differences influencing mental health, treatment of mental illness Changes in family structure

PSYCHIATRIC NURSING PRACTICE y y y y Who is considered the first American psychiatric nurse? Where did psychiatric training for nurses begin? What are Standards of Care? Read and review Boxes 1.2-1.4 on pages 9-11