Mental Health/Mental

Illness
Chapter 1
Objectives
 Define mental health/illness
 Continuum of mental health/mental illness
 Risk and protective factors
 Cultural influences
 Nature versus nurture
 Social influences of mental health care
 DSM-5
 Challenges/opportunities
Introduction
 In this course, students will learn:

 Psychiatric disorders

 Associated nursing intervention

 Treatment
What Does It Mean To Be
Mentally Well?
 A state of well being where individuals
are able to:

 Reach their potential

 Cope with normal stressors in life

 Work productively

 Contribute to the community

Mental Wellness
continued
 Mental provides the individual with:

 Capacity for rational thinking

 Communication skills

 Learning

 Emotional growth resilience

 Self esteem
Mental Illness
 Refers to psychiatric disorder that:
 Have a diagnosis
 Significant dysfunction that is related to:
 Development
 Biological and psychological dysfunction

 Example:
 Alzheimer’s disease (thinking is impaired)
 Depression (emotions are affected)
 Schizophrenia(alteration in behavior)
Mental Illness
 More common than we think
 21% of American adults experience a

mental illness
 24% of young adults (18-25) had the

highest level of mental illness

 25% of Americans have lived with a serious

mental illness (schizophrenia, bipolar

disorder)
 0.06% of adults have attempted suicide
 1.2% of young adults have attempted

suicide
Mental Health Continuum
 There is a “middle ground” between mental
health and mental illness.
 Mental health and mental illness fall along

points of a mental health continuum.

 Mental health is at point on the continuum.

These individuals have a sense of well

being/high to adequate ability to function.
 Mental illness is opposite end of the

continuum. Individuals have emotional

problems/concerns.
Mental Health Continuum
 Mental illness: Individuals can experience
mild to moderate distress/discomfort.
 Mild impairment: insomnia, poor

concentration. These problems are usually

temporary
Mental Health Continuum
 The most severely affected individuals fall
into the mental illness category.
 Individuals experience:
 Alterations in: thinking, mood, and behavior.
Mental Health/Illness
Continuum
 CONCLUSION
 We all fall somewhere on the continuum.
 Many people will never experience mental

illness.
 For those individuals who reach a

severe/acute level of impairment are able to

experience recovery.
 That range of recovery runs from a glimmer

of hope to a fulfilled satisfying life.

Risk and Protective
Factors
 There are several factors that contribute
to/or affect the progression and severity of
mental illness.
 Examples:
 Individual characteristics
 Socioeconomic circumstances
 The enviornment
Protective/Risk Factors
continued
 Individual Characteristic
 Individual attributes are characteristics that

are inborn and learned.

 Individuals all have a unique way of

managing thoughts, feelings, and

navigating life’s everyday pressures and
stressors.
 Biology/genetics influence mental illness.
 Resilience: the ability/capacity for

individuals to secure resources to support

mental wellness
Individual Characteristics
continues
 Resilience does not mean that individuals
are not affected by pressures.

 Individuals who ore resilient are capable of

and successful at managing their emotions,
thoughts, and behaviors.

 These individuals to not engage is self-

defeating behavior, do not focus of negative
thoughts.
 Page 4, Resilient Coping Scale
Socioeconomic
Circumstances
 Immediate social surroundings influence
personal attributes.
 The family has a tremendous effect on

developing and vulnerable individuals.

 The family dynamic can promote

confidence and appropriate coping skills.

 The family dynamic ALSO can instill anxiety,

feelings on inadequacy.
Socioeconomic Circumstances
continued
 The social environment also includes school and
peer groups.
 These also have the ability to affect mental
illness in a positive or negative way.
 Example: socioeconomic status can determine
resources available to support mental illness and
reduces concern for items such as clothing, food,
and shelter.
 Education can also influence the course of mental
illness.
 Education provides opportunities for a satisfying
career, security and economic benefits.
Environmental Factors
 Politics and culture influence mental illness.
 The availability to access certain services or

the lack of availability influences the course

of mental illness.
 Example: health care services, water,

safety, and the roadways, reimbursement

for mental health services.
Environmental Factors
continued
 Cultural beliefs, attitudes and practices
influences mental health.
 Mental health can be culturally defined.
 We as mental health care providers should do

is consider what a certain culture regards as

acceptable or unacceptable.
 When approaching mental illness in this way,

we can run the risk of interpreting mental

illness are those who violate social norms
and threaten (make anxious) those who
observe them.
Environmental Factors
continued
 Historically, people define sickness or wellness
according to their own current views.
 Cultures differ not only in their views regarding
mental illness, but also the types of behavior
categorized as mental illness.
 Examples:
 In certain areas of Southeast Asia (“running
amok”) is a person (male) engaging
indiscriminate violent behavior.
 In the USA, anorexia nervosa is looked at as
mental illness, whereby this is unheard of in third
word countries.
Perceptions of Mental
Illness
 Mental Illness vs. Physical Illness
 Often times there is a separation between

mental illness and physical illness.

 Mental illness involves the brain, the most

complex organ in the body. The brain is

responsible for higher thought processes
that separate us from other creatures.
 Most importantly, the functioning of the

brain is a physical one.

Perceptions of Mental Illness
continued
 The problem is, the thought that psychiatric
disorders are all “in the head.”
 Additionally, it is the belief that psychiatric

disorders are under PERSONAL CONTROL.

 There is no distinction between a choice to

engage in “bad” behavior or “good

behavior.”
 This leads to what is known as “stigma.”
 STIGMA: the belief that the overall person

is flawed which leads to social shunning,

disgrace, and shame.
Perceptions of Mental Illness
continued
 The difference between mental and physical
illness can be found in the tradition of
explaining the unexplainable via
superstition.
 Example: The illness of epilepsy was once

explained by demonic depression or a

curse.
 Treatment included shunning,

imprisonment, and exorcisms.

 Epileptic seizures are the result of electrical

disturbances in the brain and “not under

personal control.”
Perception of Mental Illness
continued
 There are no specific biological tests to
diagnose most psychiatric disorders.
 There is not an MRI to diagnose OCD.
 Research tell us that most mental illnesses

are a result of intercellular abnormalities.

 There are signs of altered brain

function/structure in such illnesses as

schizophrenia, OCD, anxiety, and
depression.
Nature Versus Nurture
 It was once believed that extreme unusual
behavior resulted from the supernatural (evil
forces).
 In the 1800’s, the mental health pendulum

swung briefly to a biological focus.

 Germ theory: a specific agent in the

environment caused the disease.

 Germ theory was abandoned and researchers

could not identify causative factors for

mental illness. AKA, there is no such thing as
“mania” germ.
Nature versus Nurture
continued
 Eventually, biological causes continued to be
explored, psychological theories dominated
and focused on the science of the mind and
behavior.
 Psychological theories explained mental
illness as faulty psychological processes that
could be corrected by increasing personal
insight and understanding.
 Example: depression could be assisted by
exploring feelings from childhood when overly
protective parents discouraged independence.
Nature versus Nurture
continued
 The psychological approach was challenged
with the development of Thorazine.
 Originally developed as a medication for

anesthesia. However, it was found to have

calming effect on patient experience
psychomotor agitation and feelings of being
out of control.
 Many biological treatment modalities

included wet wraps, insulin shock therapy,

and lobotomy
Nature versus Nurture
continued
 The medical community began to believe
that if psychiatric problems responded to
medication that alter neuro chemsitry.
Social Influences on
Mental Health Care
 Consumer Movement and Mental Health Recovery.
(NAMI)
 Decade of the Brain
 Surgeon General’s Report on Mental Health
 Human Genome Project
 President’ New Freedom Commission on Mental
Health
 Institute of Medicine
 Brain Research Through Advancing Innovative
Neurotechnologies Initiative
 Research Domain Criteria Initiative
 Quality and Safety Education for Nurses
Research Domain Criteria
Initiave
 In other specialty areas, symptom based
classification has been replace by more
scientific understanding of the problem.
 Example: cardiologists do not diagnose a

cardiac problem based on the type of chest

pain.
 Hence the DSM.
 Mental health researches may be starting to

move away from this. : (

Quality and Safety Education
for Nurses
 Key areas for psychiatric nurses:
 Patient Centered Care
 Teamwork and Collaboration
 Evidence-Based Practice
 Quality Improvement
 Safety
 Informatics
Patient Centered Care
 Care should be given in an atmosphere of
respect and responsiveness, and the
patient’s values, preferences, and needs
should guide your care.
 The platinum rule?
Team Work and
Collaboration
 Nurses and the inter-professional team
members need to maintain open
communication, respect and shared
decision making.
Evidence-Based Practice
 Optimal healthcare is the result of
integrating the best current evidence while
considering the patient/family values and
practices.
Quality Improvement
 Nurses should be involved in monitoring the
outcomes of the care they give.
 Psychiatric nurses should be “care

designers” and test changes that will result

in quality improvement.
Safety
 The care provided should not add to injury.
 Example: nosocomial infections/decubiti

ulcers, lithium toxicity.

 Harm to both providers and patients should

be minimized through system effectiveness

and individual performance.
Informatics
 Information and technology are used for
communication, management of
knowledge, mitigate error, and support
decision making.
Legislation and Mental Health
Funding
 Mental Parity
 Imagine insurance companies singling out a

group of disorders (digestive illnesses) for

reduced reimbursement.
 Imagine people with colon cancer being

assigned higher copays than patients with

other types of cancer.
 This is exactly what happened to psychiatric

disorders.
Legislation and Mental Health
Funding (continued)
 Often times insurance companies:
 Do not cover mental health at all.
 Identified yearly or lifetime limits on mental

health coverage.
 Limited hospital days or outpatient visits.
 Assigned higher copayments or deductibles.
 Hence: the Patient Protection and Affordable

Care Act of 2010.

Epidemiology
 Definition: the study of the distribution of
mental disorders in human populations.
 Understanding the distribution assists with
identification of high risk groups.
 Individuals can have more than one mental
disorder or another medical disorder.
 The presence of two or more disorders is
known as COMORBIDITY.
 Example: schizophrenia is frequently
comorbid with diabetes due to side effects of
antipsychotic medication.
Epidemiology of Mental Disorders
continued
 Incidence: conveys information about the
risk of contracting a disease.
 Incidence refers to the number of new cases

of mental disorders in a healthy population

within a given period of time.
 Prevalence: describes the total number of

cases, new and existing in a given

population during a specific period of time,
regardless of when the person became ill.
Classification of Mental
Disorders
 Psychiatric nursing care is based on responses to
illness.
 RNs do not diagnose, prescribe or treat
psychiatric disorders.
 They intervene (using their nursing skills) with
illnesses such as depression.
 *NURSES, PHYSICIANS AND OTHER PROVIDERS
are a part of the interdisciplinary treatment team.
 The team must be will coordinated (biological,
psychological, social, spiritual, and cultural)
needs of the patient.
Classification of Mental Disorders
continued
 There are two major classification systems
used in the USA.
 DSM-5 (Diagnostic and Statistical Manual,

Fifth Edition.
 International Classification of Disease (10th

edition.)
Classification of Mental Disorders
continued
 Neurodevelopmental  Eating Disorders
Disorders  Elimination Disorders
 Schizophrenia Spectrum  Sleep/Wake Disorders
Disorders  Sexual Dysfunction
 Bipolar/Related Disorders  Gender Dysphoria
 Depressive Disorders  Disruptive/Impulse
 OCD Control/Conduct
 Trauma Disorders
 Dissociative Disorders  Substance Related
 Somatic Disorders Disorders
 Paraphilic Disorders  Neurocognitive Disorders
 Others
 Personality Disorders
Classification of Mental Disorders
continued
 ******* Common misconception!!!!!
 Classification of mental disorders classifies

people.
 The DSM-5 classifies diseases.
 Avoid stigmatizing labels. (He is a

schizophrenic, she is an alcoholic)

 Our patients suffer from schizophrenia, our

patient suffer with the disease of addiction.

Psychiatric-Mental Health
Nursing
 Psychiatric nurses care for patient that are
experiencing a crisis.
 A crisis can be physical, psychological,

mental, or spiritual.
 Psychiatric rotation will increase your

insight into the experiences of others with

mental illness.
 You will learn information about psychiatric

disorders and have the opportunity to

develop and use your nursing skill.
What is Psychiatric-Mental
Health Nursing?
 It is a nursing specialty devoted to
promoting mental health through
assessment, diagnosis and intervention of
behavioral problems, mental disorders and
comorbid conditions across the life span.
 Assist people who are in crisis or who are

experiencing life time problems.

 Psychiatric Mental Health Nursing: Scope

and Standards of Practice: defines the

specific activities of the psychiatric nurse.
Psychiatric Mental Health
Nursing
 Psychiatric nurses use the same nursing
process you have already learned to assess,
diagnose, identify outcomes, planning and
implementation, and evaluation.
Levels of Education
 Basic Level: completed a nursing program,
passed the state licensure exam (NCLEX).
 Qualified to work in a general/psychiatric
hospital.
 American Nurses Credentialing Center:
baccalaureate prepared, have worked 2
years in the psychiatric setting, 2000 hours
of continuing education = certification in this
specialty.
 Advanced Practice: NP, Masters prepared,
CNS
Trends Affecting the Future of
Psychiatric Nursing
 Education: Length of stay

 Community settings

 The demand for Mental Health Professionals

 Aging Population: Alzheimer’s Disease

 Cultural Diversity: cultural competence

Advocacy
 Advocacy: incidents of abuse, patient
confidentiality, support the patients right to
make decisions.

 THE END