Foundations of Mental Health Nursing

1. FoundationsofMental Health Nursing PVN 123 Instructor: Linda Dunckel MSN-Ed, RN

2. Objectives Define mental health and mental illness Identify key terms Describe history of mental health care Define mental health continuum Identify elements of effective/therapeutic communication Identify elements of a therapeutic nurse/ mental health client relationship Identify therapeutic strategies and nursing interventions utilized in the care of mental health patients Describe basic concepts related to assessment of mental health patients Identify legal and ethical issues in mental health Identify types and levels of anxiety Identify adaptive defense mechanisms used to cope with stress and anxiety

4. Primitive Times…………. Shaman/Medicine Men • Evil Spirit Possession • Spells • Potions • Noises • Sacrifice • Vomiting • Bleeding • Massage • Trephining • Abandonment

5. Greco-Roman Era Humoral Theory (Hippocrates) • Explained mental illness by observing behavior • Imbalance of humors • Hippocrates • Made patients comfortable • Warm baths • Massage • Music

6. Dark Ages (500 to 1400 AD) Punishment for sins Demonic possession Result of witchcraft Exorcism Physical punishment Imprisonment Mentally Ill were considered sub-human creatures and institutionalized

7. Renaissance and Reformation (15th & 16th Centuries) Johann Weyer First physician to specialize in Mental Health • Little change in terms of treatment • Reformation led to Catholic Institutions closing • Insane patients sent away to live on the streets

8. 17th and 18th Centuries • Progress in Sciences • BUT… • Treatment worse than ever ! • Bleeding • Purging • Confinement • Starving • Beating

9. Late 18th and 19th Century • Progress!! • Dr. Phillip Pinel • Advocated humane care • Classified illnesses by behaviors • Encourage acceptable behaviors by nurturing • First psychiatry training for nurses! • Linda Richards - First psychiatric nurse

10. 20th Century An Era of Mental Health Progress • 1909 – Committee for Mental Hygiene • Prevention of mental illness and removal of stigma around mental illness • 1930’s – New treatments/ Increased Education • Electroconvulsive Therapy • Insulin Shock Therapy • Frontal Lobotomy • ½ of nursing schools offering psychiatric courses • 1940’s - Research Funding • National Health Act • National Institute of Mental Health (NIMH)

11. Improvements in Treatment of Mental Illness • 1950’s - Psychotherapeutic Drugs • Got MH patients out of institutions and into the community (primary mental health goal) • Move toward deinstitutionalization of Mentally Ill patients (live and receive treatment in community)

12. Continued Improvement through Legislation • 1960’s & 1970’s – Mental Health Legislation • Changes MH treatment in the community • 1978 “President’s Commission on Mental Health” • Martha Mitchell – nurse educator is appointed to this commission (first nursing representation!) • Recommendations led to passing of Mental Health Care Systems Act – 1980 • Most comprehensive mental health care bill in U.S. History!

13. OMNIBUS BUDGET RECONCILIATION ACT 1981 • Drastic reduction in funding for mental health • Most distributed to grants at “community level” • Led to another rapid deinstitutionalization • State institutionalized patients discharged to the streets • Most could not find work • Families would or could not care for them • Mentally Ill became large percentage of “Homeless” population • Many receiving no diagnosis or treatment

14. Today……. • Mental Health concepts and practices found in: • Home Health • Public Health • Acute Care Hospitals • Long Term Care Facilities • Patients in every health care setting need emotional support • Holistic Health Movement and Community-Based Mental Health Movement • improving awareness • All individuals (sick or well) have emotional needs that need to be met

15. Nursing Care for the Mentally Ill • Provisions of care are based on standards of care established by: • American Nurses Association • American Psychiatric Nurses Association • International Society of Psychiatric-Mental Health Nurses • Nursing Process is fundamental to assessing and determining the care needed

16. Defining Mental Health and Illness

17. What is Mental Health?? http://www.youtube.com/watch?v=aNQBdIMM3mQ

18. Mentally Healthy People Can: Cope and adjust to every day stressors Enjoy activities Adapt to change successfully Set realistic goals Solve problems Have and maintain satisfying relationships

19. Things That Can Influence Mental Health Positive Influences Negative influences Inherent coping ability Mom/child bonding at birth Success in school Good health Financial security Positive relationships Cognitive impairment Sibling rivalry (extreme) Rejection by parent/s Deprived of maternal love Poor health Poverty Broken relationships Abuse

20. What is Mental Illness?

21. Evidence of Mental Illness: • Patterns of Behaviors • Conspicuous (attracts attention) • Threatening • Disruptive • Deviate from accepted social and cultural norms • Manifestation of dysfunction • Behavioral • Psychological • Biologic

22. Mental Health is Affected By: Inherited characteristics and traits Nurturing during childhood Circumstances in “Life”

23. Characteristics of Mental Illness Poor self concept Feelings of inadequacy Dependent behavior Pessimism (constant) Poor judgment Irresponsibility Maladaptive behavior Avoids problems Demands/Seeks immediate gratification

24. Characteristics of Mental Illness (Continued) • Unable to: • Accept responsibility • Recognized talents • Recognize limitations • Perceive reality • Establish meaningful relationships • Behaviors are usually a response to stress / anxiety

25. Prevalence Statistics!

26. Mental Illness - Young People Up to ½ of U.S. children and adolescents meet diagnostic criteria for at least one mental disorders by age 18

27. Mental Illness - Adults • The Centers for Disease Control and Prevention (CDC, 2013) says: • At any given moment about 1/4 of American adults are mentally ill • Over the course of their lifetimes about 1/2 of all Americans will develop at least one mental illness.

28. Serious Mental Illness - Adults

29. Mental Illness - Elderly Percent of nursing home residents with mental disorders: 66.7%(CDC, 2004)

30. Anxiety andDefense Mechanisms

31. Personality Sigmund Freud

32. Types of Anxiety Increasing levels of anxiety lead to decreasing ability to function!

33. Mild Anxiety

34. Moderate Anxiety

35. Nursing Interventions Mild to Moderate Anxiety Levels

36. Severe Anxiety

37. Panic

38. Nursing InterventionsSevere to Panic Anxiety Levels

39. Coping with Stress and AnxietyDefense Mechanisms (pp. 29-30- KNOW THESE!!!)

40. Mental Health Assessment andData Gathering

41. Mental Health Diagnoses Scores: 80 – 100 = normal function 60 – 80 = moderate problems 40 < = serious disability

42. The Mental Health Continuum

43. Types of Data

44. Collecting Data

45. Collecting Data (continued)

46. Collecting Data (continued)

47. Data Collecting Strategies

48. Screening Tools Mini-Mental State Examination http://www.youtube.com/watch?v=J_PxO4f017E

49. Screening Tools (continued) Glascow Coma Scale http://www.youtube.com/watch?v=hvki-dmQ23M

50. Special Considerations Children and Adolescents Older Clients • Evaluate: • Temperament • Social and environmental factors • Cultural and religious concerns • Developmental level • Observe status of: • Mood • Anxiety • Development • Behavior • Eating • Risk for suicide • Norms: • Trust others • See the world as safe • Accurate interpretation of environment • Mastery of developmental tasks • Use of appropriate coping skills • Evaluate: • Physical function • Economic/Social status • Environmental factors • Things that affect well-being and lifestyle • Standardized assessment tools include: • Geriatric Depression Scale • Michigan Alcoholism Screening Test • MMSE • Pain Assessment