Mental Health Nursing 1 Week 1

Revised 7/2011 by Sue Willis

Introduction to Mental Health & Mental Health Nursing

Objectives
Define mental health & mental illness Explore historical perspectives on mental health Clarification of myths/values/attitudes related to mental illness Discuss the major hypotheses in relation to biopsycho-socio-physiological theories as an explanation of emotions and behavior Discuss the classification systems most commonly used in mental health services in Australia. Discuss the role of the mental health nurse Develop a beginning understanding of the standards of practice for mental health nursing in Australia

What is mental health?

Mental health is not the mere absence of disease It is more than merely being free from symptoms of mental illness

Australian Health Ministers (2003) defined mental health as a state of emotional and social well-being in which the individual can cope with the normal stresses of life and achieve his or her potential

Criteria for Good Mental Health

Positive attitudes towards self Personal and social support with which to respond to life challenges, Meaningful relationships with others, Access to employment and recreation activities, Sufficient income and suitable living conditions (Barkway, 2008).

What is mental illness?

Mental illness is a general term for a group of illnesses that affect the mind or brain: and then inturn effect, mood, behaviour and thought.

PERCENTAGE OF AUSTRALIANS AGED 16-85 WITH A MENTAL DISORDER IN LAST 12 MONTHS*

Type of Common Mental Disorder

Male %

Female %

Persons %

Anxiety Disorder
Affective Disorder

10.8% 5.3%

17.9% 7.1%

14.4% 6.2%

Substance Use Disorder

Any Common Mental Disorder

7.0%
17.6%

3.3%
22.3%

5.1%
20.0%

Another 1% of the Australian population will have the low prevalence mental disorder of Psychosis in one year.

Source: National Survey Mental Health Wellbeing 2 (NSMHWB), 2007

Historical Background - beliefs

Mental illness was viewed as punishment from Gods/God
Superstition, magic, witchcraft

Possession
Mental ill people were: Punished harshly, condemned, burned, restrained locked up and treated as criminals in detention with criminals, people with leprosy

Historical Background Cont

The de-institutionalisation movement - Started in the 1950s Mid 20th Century - The introduction of neuroleptic drugs Specialised mental health nursing education was not introduced not until after 1910 in Australia. The first training for psychiatric nurses began in 1882 at the McLean Asylum in Boston .

Societal attitudes towards people with mental illness

People in society has a negative attitudes towards people with mental illness and this is due to their lack of knowledge about mental illness and the impact of the media in the way they portray the person with mental illness (SANE Australia, 2000)
Language used to describe individuals with mental illness can be harmful, stigmatising and discrimitory
Eg. Those people, Maddies, Cookhoos and Crazy people

Misconceptions about mental illness

All people with mental illness are violent and aggressive
People who with mental illness have an intellectual disability People with mental illness will never recover People with mental illness should be locked up and kept away from society

The Mental Health Act

Governs the care, treatment and control of mentally ill and mentally disordered persons in NSW 2007

2007

Legal Definition of Mental Illness

Mental illness for the purposes of the MH Act means a condition that seriously impairs either temporarily or permanently, the mental functioning of a person and is characterised by the presence of any one or more of the following symptoms: Delusions Hallucinations Serious disorder of thought form Severe disturbances of mood Sustained or repeated irrational behaviour indicating the symptoms mentioned above.
Mental Health Act Guide Book (2003, p3)

Theories on mental illness

Chemical imbalances (serotonin, dopamine, acetylcholine, others) Anatomical abnormalities of brain (eg. Enlarged ventricles in schizophrenia) Biological factors genetics/hereditary (when both parents are with schizophrenia, 50% chance of having a child with schizophrenia) Substance or drug abuse (e.g., drug induced psychosis) drugs alter chemicals in brain Sociocultural Stressors

Mental illness is caused by the interrelationship between some or all of the above factors

Sociocultural Stressors
DisadvantagementThe lack of socioeconomic resources that are basic to adaptation StereotypeA depersonalized conception of individuals within a group

IntoleranceUnwillingness to accept different opinions or beliefs from people of different backgrounds

StigmaAn attribute or trait deemed by the person's social environment as unfavorable PrejudiceA preconceived, unfavorable belief about individuals or groups that disregards knowledge, thought, or reason

DiscriminationDifferential treatment of individuals or groups that is not based on actual merit

RacismThe belief that inherent differences among the races determine individual achievement and that one race is superior

What is Mental Health Nursing

A specialised field of nursing that focuses on meeting the mental health needs of the person, in partnership with family, significant others, and the community in any setting. It is a specialised interpersonal process, embodying a concept of caring, which is designed to be therapeutic.

Mental Health Nursing

is provided in a variety of settings: In-patient/hospital (adult, child & adolescent units) Emergency mental health services Community mental health services
- triage & assessment - case management - crisis intervention - early intervention & first episode psychosis - rehabilitation - accommodation - peri & post natal depression clinics - anxiety & depression clinics - court Liaison - G.P/Mental Health Liaison

Corrections health mental health services

Classification systems in MH Care

ICD-10 AM Diagnostic categories for serious mental illness ( International classification of diseases ; WHO generated documented; basis of diagnosis with the clinical documentation tools , used globally ) DSM IVTR ( Diagnositic and Statistical Manual of Mental Disorders version 4, revised used primarily in the US and some mental health personnel use it in Australia

 Global Assessment of Functioning (GAF) Axis System of diagnosis NSW Mental Health Clinical Documentation; is a set of standardised documentation used throughout NSW public hospitals. MH Documents include a set of Outcome Measurement Tools for each age group to be used by staff, patients and carers eg. HoNOS, RUG ADL, LSP16, K10 etc

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). Washington: American Psychiatric Association Publishers. Available online via STATRef Australian Bureau of Statistics (ABS). (2006). Mental health in Australia: A snapshot, 2004-05. 4824.0.55.001. Australia 2006. Canberra: AGPS. Available online via ABS website Australian Nursing & Midwifery Council. (ANMC) (2006). Code of professional conduct for nurses in Australia. Dickson, ACT: ANMC. Or accessed via: http://www.anmc.org.au Australian Nursing & Midwifery Council. (ANMC) (2008). Code of ethics for nurses in Australia. Dickson, ACT: ANMC. Or accessed via: http://www.anmc.org.au

References cont.
Australian Nursing & Midwifery Council. (ANMC) (2006). National competency standards for the registered nurse (4th ed.). Dickson, ACT: ANMC. Or accessed via: http://www.anmc.org.au Boyd, M. A. (2008). Psychiatric nursing: Contemporary practice (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Council of Australian Governments (COAG). (2006). National action plan on mental health 2006-2011. Canberra: National Printing Office. Fontaine, K. (2009). Mental health nursing (6th ed.). New Jersey: Prentice Hall. Horsfall, J. (1994). Social constructions in women's mental health. Armidale, Australia: University of New England Press.

References cont.
Horsfall, J. Stuhlmiller, & Champ, S. (2000). Interpersonal nursing for mental health. Sydney: MacLennan & Petty. Kneisl, C. & Trigoboff, E. (2009). Contemporary psychiatric-mental health nursing (2nd ed.). New Jersey: Prentice Hall. NSW Health. (2008). Mental health clinical documentation. PD2005_358. Sydney: NSW Health. Patton, G. C., Coffey, C., Carlin, J. B., Degenhardt, L., Lynskey, M., & Hall, W. (2002). Cannabis use and mental health in young people: a cohort study. British Medical Journal, 325, 1195-1198. Stuart, G. W., & Laraia, M.T. (2005). Principles and practice of psychiatric nursing (8th ed.). St Louis: Mosby. Varcarolis E.M. (Ed.). (2002) .Foundations of psychiatric mental health nursing (4th ed). Philadelphia: WB Saunders.