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Mental Health vs. Mental Illness

• Mental Health:
  • The WHO defines it as a state of well-being where individuals realize their potential, cope with life's stresses, work productively, and contribute to their community.
  • The Public Health Agency of Canada defines it as the capacity to feel, think, and act in ways that enhance the ability to enjoy life and deal with challenges, respecting culture, equity, social justice, interconnections, and dignity.
  • Psychiatry defines it as continually evolving, shaped by prevailing culture, societal values, cultural norms, societal expectations, and political climates.
  • Historically, it was inadequately described as "strange or different."
• Mental Illness:
  • Includes alterations in cognition, mood, or behavior, coupled with significant distress and impaired functioning.
  • It refers to mental disorders with definable diagnoses.
  • Cognition may be impaired with conditions like Alzheimer's.
  • Mood may be affected with conditions such as major depression.
  • Behavior may be changed with conditions like schizophrenia.
  • Mental illness can be a combination of cognitive, mood, and behavioral changes.

Mental Health Continuum

• The mental health continuum has four possible outcomes - severe mental health disorder with optimal mental health, no mental health disorder with optimal mental health, no mental health disorder with poor mental health and severe mental health disorder with poor mental health.
• Someone with schizophrenia who is stable on medication, visits the doctor, has a social life, and practices self care is an example of severe mental health disorder with optimal mental health.
• Optimal mental health can be achieved with no mental health disorder.
• Poor mental health can occur where someone has no mental health disorder who has poor coping skills against stressors.
• Severe mental health disorder with poor mental health occurs when someone is diagnosed with a mental health illness/disorder and is not able to cope with it.

Influences on Individual's Mental Health

• Support systems (friends, family, community)
• Religious influence
• Developmental events
• Personality traits and states
• Demographic and geographic locations
• Negative influences (psychosocial stressors, poverty, impaired parenting)
• Beliefs and values
• Hormonal and biological factors
• Inherited factors
• Environmental influences

Resilience

• Michael Ungar describes resilience as a process and outcome of complex, cultural systems, rather than an individual capacity.
• Accessing and developing resilience help people recover from painful and difficult events.
• Resilience is characterized by optimism, mastery, and competence

Mental Health and Culture

• Culture consists of shared beliefs, values, and practices guiding a group's members' thinking, actions, religion, geography, socioeconomic status, occupation, ability/disability, and sexual orientation.
• Culture acts as a blueprint for actions affecting care, health, and well-being.
• Culture influences how group members make sense of the world and make decisions about relating/behaving, what is deemed normal/abnormal and influences development of the concept of mental health and illness.
• In Western cultures, hearing voices or seeing visions may be seen as a deviation from reality, while Indigenous cultures may view it as an honor and value.

Social Determinants of Health

• According to the WHO these are some of the definitions
• Income and social protection
• Education
• Employment and job security
• Working life conditions
• Food insecurity
• Housing, basic amenities, and the environment
• Early childhood development
• Social inclusion and non-discrimination
• Structural conflicts
• Access to affordable health services of decent quality

How are mental disorders diagnosed? DSM5

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by the American Psychiatric Association in 1952.
• DSM5 provides clinicians, educators, and researchers with a common framework to understand and communicate about mental disorders allowing researchers and clinicians can work together to improve care for patients
• The 5th edition of the DSM is currently in use
• It has over 350 diagnoses influenced by psychiatrists, psychologists, licensed clinical social workers, licensed counselors, marriage and family therapists, and advanced-practice psychiatric mental health nurses
• The DSM-5 classifies disorders that people have, it does not classify people.
• It organizes diagnoses on a developmental hierarchy, listing disorders usually seen in infancy, childhood, and adolescence first, and neurocognitive disorders later.
• Diagnostic groups are closely situated if they are related to one another like - schizophrenia spectrum disorders which are next to bipolar-related disorders.
• Diagnosis is based on presenting symptoms and the impact of symptoms on the patient's life.
• Examples Neurodevelopmental, Schizophrenia spectrum and related, Bipolar and related, Depressive, Anxiety, Obsessive-compulsive, Trauma and stressor, Dissociative, Somatic symptom, Feeding and eating, Elimination, Sleep-wake, Sexual dysfunctions, Gender dysphoria, Disruptive, impulse control, and conduct, Substance and addictive, Neurocognitive, Personality disorders

Stigma

• Stigma refers to negative, unfavorable attitudes and the behavior they produce.
• It is a form of prejudice spreading fear and misinformation, labeling individuals, and perpetuating stereotypes.
• Stigma against people with mental illnesses is oppressive and alienating, preventing them from seeking help and denying access to support and treatment.
• Effects of stigma creates a greater negative impact on their health than the actual illness itself, social isolation, a restriction to the social support network, poverty, depression, loss of hope, suicide and is a main reasons that many people don't consider it a real health issue.
• Ways to Reduce Stigma:
  • Educate yourself on mental illness.
  • Be aware of your attitudes and behaviors.
  • Choose your words carefully.
  • Educate others on myths and stereotypes.
  • Focus on positives.
  • Support and encourage people.
  • Include everyone.

Basic Principles of Mental Health (WHO)

• Developed from a comparative analysis of national mental health laws in 45 countries worldwide
• Principles:
  • Promotion of mental health and prevention of mental disorders - everyone should benefit from the best possible measure to promote their mental well-being and to prevent mental disorders.
  • Access to basic mental health care - everyone needs access to basic mental health care
  • Mental health assessments in accordance with internationally accepted principles
  • Provision of the least restrictive type of mental health care - persons with mental health disorders should be provided with health care which is the least restrictive
  • Self-determination - requires consent
  • Right to be assisted in the exercise of self-determination - if unable to make decisions, consent from third parties of his or her choice
  • Availability of review procedure
  • Automatic periodical review mechanism - When a decision is affecting treatment or requires hospitalization, there should be a review mechanism
  • Qualified decision-maker- Can be judge or SDM. Needs to be competent, knowledgeable, and independent, and impartial if its a judge
  • Respect of the rule of law - should be in accordance with law of the land.

Ontario Mental Health Act (MHA)

• The Mental Health Act sets out the powers and obligations of psychiatric facilities in Ontario.
• It governs the admission process, categories of patient admission and sets directives around assessment, care and treatment.
• MHA can temporarily take away a person's rights under the Canadian Charter of Rights and Freedoms
  • Patients under the MHA must be informed of their rights, including access to a rights advisor and ability to appeal to the Consent and Capacity Board
  • Specifies various forms (ie: form 1, form 3) that professionals must complete for actions such as temporary detention
  • It outlines the powers of police officers and Justices of the Peace to make orders for an individual who meets certain criteria, to undergo psychiatric examination by a physician

Criminal Code of Canada

• Mental Disorder is a part of the Criminal Code which addresses the criminal liability of accused persons affected by a mental disorder
• It describes a court's powers to order assessments and determine fitness to stand trial, and rendering a verdict of “not criminally responsible"

Assessment and Hospitalization under MHA

• Categories of patient admission
  • Voluntary patient - A person who has voluntarily agreed to be admitted to a psychiatric facility for care
  • Involuntary patient - A person who has been assessed by a psychiatrist and meets the set criteria in section 20 of the MHA.
  • Informal patient - A person who has been admitted with the consent of their SDM because they are found incapable of consenting to their own admission, but do not meet criteria for involuntary admission
• Informal patients usually include minors (<12) or patients who can't make decisions due to cognitive impairment (ie: dementia, Alzheimer's)
• If someone undergoes psychosis (was previously in a competent state at baseline), SDM are not able to authorize admission to the hospital as informal patient
• Criteria for admission:
  • Imminent risk of harm to self
  • Imminent risk of harm to others
  • Unable to care for self due to a mental illness
• Patient may be admitted under court order (Form 6 and 8)

Mental Health Act of Ontario Forms

• Form 2: Order for Examination by a Justice of the Peace
  • It authorizes detention any Justice of Peace to a schedule 1 psychiatric facility of an individual who is undergoing a mental health crisis for assessment
  • Any person (family, close friend) can request a Form 2 for someone they believe is in crisis and has reasonable evidence to support this (must swear under oath).
  • It authorizes the police to detain an individual and bring them to a Schedule 1 facility for assessment.
  • Police must stay with them and keep custody until they are admitted to the hospital.
  • The physician can assess them and place them on a Form 1 if necessary.
  • Form 2 is valid for a period of 7 days
  • Police can also detain and bring the patient to Schedule 1 facility if they have reasonable cause to believe that this patient is dangerous and waiting for the Justice of the Peace order can take too long
• Form 1: Application by Physician for Psychiatric Assessment
  • It is indicated when an individual is not willing or able to seek voluntary treatment, and immediate intervention is required (brought to Schedule 1 psychiatric facility).
  • Any doctors in Ontario can sign this form (NPs/PAs cannot).
  • If >7 days pass, a new assessment must be conducted.
    • If a patient is assessed and discharged or they have left, the doctor can sign the Form 1 from the time of assessment to up to 7 days.
  • The physician must have reasonable grounds to believe the individual meets one or more of the following criteria:
    • Risk of harm to self
    • Risk of harm to others
    • Unable to care for self due to a mental illness
  • Form 1is valid for up 72 hours. Time is legally started when the patient arrives at a Schedule 1 facility and has obtain a copy of the Form 42.
  • A psychiatrist must assess the patient in the 72 hours and decide
    • Discharged by the psychiatrist
    • Admitted as involuntary patient under Form 3
    • Admitted as voluntary or an informal patient
• Form 42: Notice to person of Application for Psychiatric Assessment (Form 1) - It is companion document to Form 1.
  • It is a safeguard to ensure patients are aware of their rights by informing the patient that they have been detained under the MHA for up to 72 hours.
  • The patient has the right to know the reason for detention, the right to consult a lawyer or consult a rights advisor
  • Form 42 must be given the patient immediately upon their detention to psychiatric facility as failure to do so can nullify the legal authority to detain even if the Form 1 has been signed.
• Form 3: Certificate of Involuntary Admission (2 weeks) - it occurs if after or during the 72-hour period that the patient still falls under the criteria for admission, the psychiatrist will complete a Form 3.
  • Only a psychiatrist can sign a Form 3 and if the psychiatrist was the MD who signed Form 1 then a different psychiatrist will need to assess and sign Form 3.
  • The form 3 is valid for up to 14 calendar days, including the day it was signed
• Form 4: Certificate of Renewal - Occurs at the end of 14 days of the Form 3, a psychiatrist will reassess a patient and determine if they still meet the criteria for admission
  • The 1st Form 4, the patient is involuntarily admitted for up to 1 month
  • The 2nd Form 4, the patient is involuntarily admitted for up to 2 months
  • The 3rd Form 4, the patient is involuntarily admitted for up to 3 months- Each Form 4 must be accompanied by a Form 30
  • With each Form 4, the patient is to be informed of their right to appeal the decision by the Consent and Capacity Board (CCB)
  • After the 3rd Form 4 as been issued, an automatic review is conducted by the CCB
  • Patient can contest or request an appeal at any time during their detainment/stay
• Form 30: Notice to Patient Under Certificate of Involuntary Admission/Cert of Renewal
  • Companion with Form 3 and each Form 4
  • Given promptly to the patient and inform them the reason for detainment and informs them of their rights After Form 30 as been issued
  • The clerk or nurse must contact the Patient Advocate Officer/Patient Rights Advisor. The officer-in-charge of the hospital also needs to be notified.
  • Within 24 hours, the advisor must meet with the patient to ensure that they understand their rights
  • The patient must be informed that they can agree to the detention or contest their involuntary status to the CCB
  • If the patient wishes to appeal, the advisor directs them to the CCB, and they will set up a tribunal. The courts will ask another psychiatrist to review the plan.
    • A lawyer, judge, mental health expert, a sonographer, and the patient must be present.
    • A Form 50 is used for appeals
• Form 5: Change to Informal or Voluntary Status
  • When a patient that is Certified on Form 3 or 4 and no longer meet the criteria of the MHA, the psychiatrist will sign a Form 5 to terminate the involuntary status of a patient and change the status to an informal or voluntary patient
  • Must include the reason for terminating involuntary status and must be completed by the psychiatrist documenting the patient's improvement.
  • Clerk or nursing staff must fax Form 5 to the CCB before patient is discharged or going out for a privilege
• Form 9: Order for Return → for Police
  • Issued by the Officer-in-Charge of the hospital when an involuntary patient leaves the facility without permission
  • Form 9 authorizes the police to apprehend and return the patient to the nearest Schedule 1 facility
  • Form 9 is valid for one month from the date of issue

Legal & Ethical Considerations

• MHA forms suspend an individual's civil liberties.
• MHA forms detain people–but do not force them to adhere to treatment. Treatment can only be administered if:
  • The patient is capable and has given informed voluntary consent
  • The patient is found incapable and a legally valid SDM has given consent

Autonomy

• All individuals have the right to decide whether to accept or reject treatment
• Psychiatric mental health staff should know that the presence of psychotic thinking does not mean that the patient is mentally incompetent or incapable of understanding; instead the client should have the ability to provide or deny consent
• A health care provider can be charged with assault and battery for providing life sustaining treatment to a client when the client has not agreed to it
• The client should receive information such as what treatment alternatives are available, why the practitioner believes this treatment is the most appropriate as weel as outcomes, risks and adverse effects

Under Which a Client’s Treatment May Be Performed Without Obtaining Informed Consent

• When a client’s mental capacity is such that they are mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm
• When refusing treatment endangers the life or health of another During an emergency in which a client is in no condition to exercise judgment When the client is a child (consent is obtained from parent or surrogate)

What is Informed Consent?

• Based on a person's right to self-determination and autonomy it should be obtained for surgery, electroconvulsive treatment, or the use of experimental drugs or procedures.
• Patients have the right to refuse participation in experimental treatments or research
• Informed consent includes
  • The nature of their problem or condition
  • The nature and purpose of a proposed treatment
  • The risks and benefits of that treatment
  • The alternative treatment options
  • The probability of success of the proposed treatment
  • The risks of not consenting to treatment
• A nurse may sign as a witness on a consent form, however, legal liability for informed consent lies with the physician
• Three elements of Informed Consent
  • Knowledge: the client has received adequate information on which to base his or her decision
  • Competency: the individual's cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has legal representation
  • Free will: the individual has given consent voluntarily without pressure or coercion from others
• The capacity to understand the consequences of one's decisions establishes as patients must be considered legally competent until they have been declared incompetent through a legal proceeding
• The patient may be appointed a legal guardian or representative, who is legally responsible for giving or refusing consent for the patient while always considering the patient's wishes
• These are potential family member orders of election
  • Spouse
  • Adult children or grandchildren
  • Parents
  • Adult siblings
  • Adult nieces and nephews

Concepts of the Therapeutic Nurse-Client Relationship

• Understanding that the nurse is safe, discreet, reliable, and consistent and that the relationship will be conducted within appropriate and clear boundaries are key
• There are specific goals and functions
  • Facilitating verbal expression of distressing thoughts and feelings
  • Assisting the patient to develop self-awareness and insight into their thoughts, feelings, and behaviours, for them to better manage the activities of daily living
  • Helping patients examine self-defeating behaviours and test alternatives
  • Promoting self-care and independence

Therapeutic vs Social Relationships

• Social Relationships
  • Defined as a relationship that is initiated primarily for friendship, socialization, enjoyment, or accomplishment of a task.
  • Mutual needs are met during social interaction.
  • Communication skills may include giving advice and sometimes meeting basic dependency needs during a stressful time.
• Therapeutic Relationships
  • The psychiatric nurse maximizes his or her communication skills, understanding of human behaviours, and personal strengths to enhance the patient's growth.
  • The focus of the relationship is on the patient's ideas, experiences, feelings, and personal issues introduced during the clinical interview, with the development of personal insight as a desired outcome.
  • The nurse and the patient identify areas that need exploration periodically, evaluate the degree of change in the patient's understanding of the stressors, and pinpoint strategies to manage them differently.
  • Focused on the patient's problem and needs.
  • Working under clinical supervision (i.e., being evaluated, receiving feedback, and gradually gaining autonomy and responsibility) is an excellent way for a psychiatric nurse's focus and boundaries to remain clear.
  • In Summary
    • The needs of the patient are identified and explored.
    • Clear boundaries are established.
    • Alternative problem-solving approaches are taken.
    • New coping skills may be developed.
    • Insight is developed, and behavioural change is encouraged.

Goals and Concepts of a Therapeutic Relationship

• Relationship boundaries
  • Physical boundaries: general rooms, space as well as treatment and conference rooms
  • The contract: set time, confidentiality, and agreement between nurse and patient as to roles and responsibilities of all involved
  • Personal space: physical space, emotional space, and space set by roles
• Blurring of boundaries
  • When the relationship is allowed to slip into a social context
  • When the psychiatric nurse's needs (for attention, affection, or emotional or spiritual support) are met at the expense of the patient's needs.
  • Boundaries are necessary primarily to protect the patient. The most egregious boundary violations are those of a sexual nature.
• Blurring of roles
  • The blurring of roles in the psychiatric nurse-patient relationship is often a result of unrecognized transference or counter-transference.
  • Transference and counter-transference are psychological concepts that often come up in therapeutic and healthcare settings because of the close relationships formed between patients and caregivers.
  • Can influence communication, trust, and the therapeutic relationship between nurses and patients. Awareness of these phenomena is essential for maintaining professionalism and ensuring patient-centered care.

5 Steps Approach to Setting Limits

1. Explain which behaviour is inappropriate
2. Explain why the behaviour is inappropriate
3. Give reasonable choices with consequences
4. Allow time
5. Be prepared to enforce your consequence

Peplau's Model of the Nurse-Patient Relationship

• Pre-Orientation phase
• Orientation phase
  • Establishing rapport
    1. Build trust and create a safe environment where the patient feels respected and understood
  • Parameters of the relationships
    1. Roles and responsibilities of both the nurse and the patient and their formal or informal contact
    2. A contract emphasizes the patient's participation and responsibility because it shows that the psychiatric nurse does something with the patient rather than for the patient.
    3. Mutual agreement about those goals is also part of the contract
  • Confidentiality
    1. The patient has a right to know if specific information may be shared with others on the treatment team and who else will be given the information.
    2. The patient also needs to know that the information will not be shared with relatives, friends, or others outside the treatment team, except in extreme situations like child or elder abuse and intention not to follow through with the treatment plan as well as threats of self-harm or harm to others and child abuse.
• Planning for terms of termination
  • Planning for termination begins in the orientation phase
  • Can also be mentioned during the working phase if appropriate
  • The date of the termination should be clear from the beginning
• Working phase
  • Maintain therapeutic relationship
  • Gather further data
  • Promote patient's
  1. Problem-solving
  2. Self-esteem
  3. Use of language
  • Facilitate behavioural change
  • Overcome resistance behaviours
  • Evaluate problems and goals, and redefine them as necessary
  • Promote practice and expression of alternative adaptive behaviours.
• Termination phase
  • The tasks of termination are as follows that involve the psychiatric nurse to engage consciously in the termination phase of the therapeutic relationship
    1. Summarizing the goals and objectives achieved in the relationship
    2. Discussing ways for the patient to incorporate into daily life any new coping strategies learned
    3. Reviewing situations that occurred during the nurse-patient relationship
    4. Exchanging memories, which can help validate the experience for both the nurse and the patient and facilitate the closure of the relationship
  • Occurs when the
    • Feelings are aroused in both the patient and the nurse about the experience they have had when these feelings are recognized and shared, patients learn that it is acceptable to feel sadness and loss when someone they care about leaves.
    • Termination can be a learning experience; patients can learn that they are important to at least one person, and psychiatric nurses learn continually from each clinical experience and patient encounter.
    • By sharing the termination experience with the patient, the psychiatric nurse demonstrates genuineness and caring for the patient for this encounter that may have just occurred
    • This encounter may be the first successful termination experience for the patient.

Helps and Hinders

• The factors that support the nurse-patient relationship, allowing it to progress in a mutually satisfying manner are:
  • Consistency
    1. Ensures that a nurse is always assigned to the same patient and that the patient has a routine for activities.
    2. Interactions are facilitated when they are frequent and regular in duration, format, and location.
    3. The importance of consistency extends to the nurse's being honest and consistent (congruent) in what is said to the patient.
  • Pacing
    1. Letting the patient set the pace and letting the pace be adjusted to fit the patient's moods.
    2. A slow approach helps reduce pressure and at times, it is necessary to step back and realize that developing a strong relationship may take a long time.
  • Listening
    1. Letting the patient talk when needed The nurse becomes a sounding board for the patient's concerns and issues.
  • Initial impressions
    1. Positive initial attitudes and preconceptions are significant considerations in how the relationship will progress.
    2. Preconceived negative impressions and feelings such as the patient has or interesting or challenging can lead to poor outcomes.

Additional Considerations

• Promoting patient comfort and balancing control usually reflect caring behaviors as well control refers to keeping a balance in the relationship: not too strict and not too lenient
  • Transference
    • Transference occurs when a patient unconsciously redirects feelings, emotions, or attitudes from a past relationship (often with a parent, caregiver, or authority figure) onto a current healthcare provider, therapist, or nurse.
    • Example - A patient views a nurse as a parental figure and behaves overly dependent or rebellious
• Counter-Transference
  • Occurs when the caregiver, nurse, or therapist unconsciously redirects their feelings or past experiences onto the patient. This can arise from personal triggers, unresolved conflicts, or emotions tied to the caregiver's life.
  • Example - A nurse becomes overly attached to a patient who reminds them of a family member or feels irritated or avoids a patient because it reminds them of someone who caused them distress in the past

Factors that Encourage and Promote Growth

• Genuineness
• Empathy versus sympathy- we understand the feelings of others versus we feel the feelings of others
• Positive regard
  • Attitudes
  • Action --Attending --Suspending values judgement --Helping patients develop resources

Factors That Affect Communcation

• Personal factors
  • Emotional factors
  • Social factors
  • Cognitive factors
• Environmental factors
  • Physical factors
  • Societal determinants
• Relationship factors
  • Status of individuals in terms of social standing, power, roles, responsibilities, and age

Verbal and Non-Verbal Communication

• Verbal communication
  • Communicate beliefs and values or perceptions and meanings and what may be considered insults or judgment.
  • Convey messages clearly to avoid conflicting or implied messages or clear and honest feelings.
  • Words are culturally perceived and therefore clarifying the intent of certain words is very important.
• Nonverbal communication
  • Communication is 90% nonverbal
  • Are messages expressed through directly observable behaviors like tone of voice, certain words, physical appearance, facial expression, body posture, amount of eye contact or hand gestures
  • Sometimes these behaviors operate outside the awareness of the person exhibiting the behaviors or unconsciously as well as be observed and interpreted in light of a person's culture, class, gender, age, sexual orientation, and spiritual beliefs.

Communication for Nurses

• Communicate interpretation of feelings and attitudes of the nurses.
  • Therapeutic communication strategies --Silence as well active silence
• Observing the patient's nonverbal behaviors
• Understanding and reflecting on the patient's verbal message
• Detecting inconsistencies or things that the patient said that require clarification
• Clarifying techniques like paraphrasing which is to clarify using different words or fewer words or restating which is means saying the same keywords that the patient just said
• Reflecting is means to assist the person to better understand their thoughts as well as exploring enabling the nurse to examine important ideas, experiences, or relationships more fully by asking open and close ended questions.
• Nontherapeutic communication techniques
  • Excessive questioning - which can lead to respect or be sensitive or providing advice instead of personal decisions that prevent the patient from making their own decisions or asking "why" questions that imply judgment.

Cultural Considerations Influencing Communication

• Communication styles
• Eye contact
• Cultural filters
• Touch

The Clinic Interview

• Should include consideration such as the pace during setup
• Setting anywhere as the purpose is to make the patient feel safe and secure Same height Avoid a face-to-face stance Avoiding a desk barrier Don't make the patient feel trapped in a room

During Initiation of Interview

• Introduce yourself to the patient
• Describe the purpose of the meeting
• Issues of confidentiality should be addressed Ask them how they would like to be addressed as (name) using questions like "Where should we start or "Tell me a little about your difficulties".

Tactics to Avoid During Interviews

• Do not give false reassurance, argue or minimize, interpret situations for the patient, probe about sensitive topics which they do not wish to discuss, participate in criticism of another staff member, try to focus on data and facts, listen attentively and pay attention to nonverbal cues.
• Follow helpful guidelines by speaking briefly, saying nothing when you do not have a lot to say, focusing on feelings when in doubt.
• Avoid relying on question and advice and be sure to pay attention to nonverbal cues

Consideration

• Look at considering that attends that impact a patient - eye contact, body language, vocal tracking, verbal quality
• Make sure to conduct clinical supervision as part of the process
• Provide recordings during treatment

Group Therapy

• Group therapy is a form of psychotherapy in which one or two therapists work with a number of clients simultaneously
• Aims include relieving distress through discussing and expressing feelings; helping to change attitudes, behaviour and helping to encourage more adaptive ways of coping as teaching coping skills
• Anyone can attend
• Group therapy can be especially helpful for people with limited access to mental healthcare
• Can Also Benefit From
  • Grief
  • Eating Disorders
  • Chronic Pain
  • Anger Management
  • Intimate Partner Violence
  • Cultural/Intergenerational Trauma
  • Chronic Illness

How Does Therapy Work?

• Typically meet for one to two hours and the group will usually be seated a certain way so each group that comes in may be living with either a mental health concern such as an eating disorder
• Be aware that as part of the process may remain considered with Group members were expected can be discussed with others as part of psychotherapy as can be used to focus on interpersonal experience.
• Some therapist may use sharing focused data or data sets that include interpersonal experience as well as potential growth.
• Types of therapies may include process or structured approaches
• The group dynamic allows members to feel supported and accepted, and it can reduce stigma and isolation which allows members to better under how each other interact with one another
• There are two types of assessments- comprehensive and focus.

Overview

• Comprehensive Includes a complete health history and physical examination Considers the psychological, emotional, social, spiritual, ethnic, and cultural dimensions of health and attends to the meaning of the client's health-illness experience and evaluates how all of this affects the individual's daily living
• Focused A focused assessment is the collection of specific information about a particular need, problem, or situation. May involve evaluation of such things as medication effects, risk for self-harm, knowledge deficits, or the adequacy of supports and resources As the name suggests, focused assessments are briefer, narrower in scope, and more present oriented than are comprehensive assessments. Uses Nurses standardized assesment tools like Glasgow Coma Scale [GCS]

Mental Status Assessment

• Assesment of the patients functions - description the patients appearance, speech, motor skilled mood and all cognitive abilities as related to their orientation what is appropriate to do based on level or hygiene etc based on culture as well can be excessive of reduce by behaviour

Other Considerations

• Can be considered of harming self or others
• The Mental status assessment is typically performed when a healthcare provider suspects a change in a patient's mental state, like altered behavior, behavior or in monitoring the progression of a known neurological condition; it can also be included as part of a routine clinical evaluation.
• Assessment begins with the initial encounter, continues through the duration of caring for patient using reviewing system data or assessment or any considerations given any violence approach etc.

7 Steps in Nursing Process

• Changes in patient condition
• Informed consents
• Reaction to medication
• Documenting symtoms and any concerns including safety concerns-thoughts concerns What is risk and when to access and report: any sign of harm, any increase is substance

Weeks 5 Trauma

• Trauma results from exposure to an incident or series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual's functioning and well-being.
  • Safety
  • Trust
  • Choice Trauma can be acute or in responses to a terrible event like an accident or longer can be long term Types of Trauma: Acute: overwhelming that's from a single event Complex: has to do with long term effects Others: Historical, Intergenerational , Physical ,social

Key Aspects of Trauma

• Signals act as signs of possible danger and triggered the freeze and altered to various issues
• The process may causes various long term affects .and in Healthcare Workers or fatigue

TIC

• Safety
• Trustworthiness
• Peer support
• Collaboration
• There are a variety of signs to look which decrease in production with a priority with any emotional numbness with their emotions

TVIC

• To attention on the impact of violence on people's lives which related to a need to to not be as violence
• Connect to draw on the community including organizational violence
• Implement trauma violence approche