Mental Health Concepts: Key Principles and Facts

Mental Health vs. Mental Illness

• Mental health involves realizing one's potential, coping with stress, working productively, and contributing to the community.
• Mental illness encompasses mental disorders with defined diagnoses, affecting cognition, mood, or behavior.

The Mental Health Continuum

• This continuum ranges from maximal mental disorder to the absence of mental disorder.
• Health exists as a relative, not absolute, state.
• Individuals can fall anywhere on the continuum, regardless of diagnosis.

Mental Health and Culture

• Canadian psychiatric mental health nursing considers Indigenous and multicultural contexts.
• Culturally safe practice is a goal, supported by relational inquiry, cultural competency, and trauma-informed practice.
• Cultural norms define what is "normal" and "abnormal", influencing mental health and illness concepts.
• Western societies view hearing voices as a sign of pathology.
• Some Indigenous cultures honor vision quests, not viewing them as pathological.
• Differing mental health from mental illness involves considering culturally acceptable behavior.

Social Determinants of Health

• Key factors include income, social status, employment, education, childhood experiences, physical environment, social supports, healthy behaviors, health service access, biology, genetics, and gender.

Diagnosis of Mental Disorders

• The DSM-5 classifies about 350 mental disorders.
• Cultural and ethnic factors influence symptoms and causes.
• Mental illness involves altered cognition, mood, or behavior, causing distress and impaired functioning.

Reducing Stigma

• Education about mental illness, including substance use disorders, is vital.
• Awareness of one's attitudes and judgmental thinking is important.
• Choose words carefully, as language impacts attitudes.
• Educate others, sharing facts and challenging stereotypes.
• Focus on the positive aspects, seeing mental illness as only part of the person.
• Support people with dignity and respect.
• Inclusion is essential, as discrimination is illegal.

Ten Basic Principles of Mental Health Care Law

• Developed from an analysis of mental health laws in 45 countries and UN Resolution 46/119.
• Key principles include promotion, access, assessments, least restrictive care, self-determination, assistance in exercising self-determination, review procedures, periodical review, and qualified decision-makers.

Legal Context within Canada

• The Ontario Mental Health Act defines powers and obligations of psychiatric facilities, governs admission, and outlines patient rights.
• The Criminal Code of Canada addresses criminal liability of those with mental disorders, court powers for assessments, and review board powers.

Forms under the Mental Health Act of Ontario

• The Mental Health Act forms can temporarily take away a person's rights.
• The intent is to act in the person's best interest when they are incapable of doing so.
• These forms allow people to be detained but all treatment requires consent.

Form 1

• Application by Physician for Psychiatric Assessment:
• Any Ontario physician can sign it.
• The physician needs to examine the person within 7 days before signing, and form an opinion about a mental disorder.
• It is valid for 72 hours.

Form 2

• Order for Examination by a Justice of the Peace:
• This allows police to bring a person for psychiatric assessment.
• It is valid for 7 days.

Form 3

• Certificate of Involuntary Admission:
• A psychiatrist completes it if a patient is a risk to self or others, or is unable to care for themselves.
• It is valid for 14 days.

Form 4

• Certificate of Renewal:
• A psychiatrist completes this at the end of the Form 3 period if the patient remains at risk.
• The first Form 4 is valid for up to one month, the second for up to two months, and the third for up to three months.

Form 5

• Change to Informal or Voluntary Status:
• Completed by a psychiatrist when a patient on Form 3 or 4 no longer meets the criteria of the Mental Health Act.
• this documents the patient's improvements.

Form 9

• Order for Return:
• For involuntary patients who are absent without leave from the hospital.
• Signed by a hospital staff member delegated by the Officer-in-Charge.

Form 42

• Notice to person of Application for Psychiatric Assessment (Form 1):
• Given to the person when a Form 1 is completed.

Form 30

• Notice to patient under subsection 38(1) of the Act:
• Given to the patient promptly after a Form 3 or Form 4 is signed.

Autonomy

• All individuals can decide whether to accept or reject treatment.
• Psychotic thinking doesn't negate the ability to provide or deny consent.
• Health care providers can face charges for providing life-sustaining treatment without consent.
• Challenging refusal of treatment may happen if the client is mentally incompetent, endangers others, during an emergency, or is a child.

Informed Consent

• This is based on self-determination and autonomy.
• The patient must be informed of the nature of their problem, proposed treatment, risks, benefits, alternatives, probability of success, and risks of not consenting.
• Nurses ensure the client has adequate knowledge, is competent, and gives consent voluntarily.
• Implied consent occurs with willingness to receive medication or a procedure.
• Patients are considered competent until legally declared otherwise.
• If found incompetent, a legal guardian may be appointed.

Therapeutic Nurse-Client Relationship

• This is the basis of all psychiatric nursing treatment approaches.
• The goal is to establish the nurse as safe, confidential, reliable, and consistent, with clear boundaries.
• Therapeutic use of self involves conscious use of personality, relatedness, and structured interventions.
• "Therapeutic Use of Self" is the intentional use of personality, insights, perceptions, and communication skills to connect with a patient/promote healing.
• It builds trust, shows empathy, and uses oneself as a therapeutic tool.

Key Components

• Empathy: Understanding and validating feelings.
• Active Listening: Giving full attention.
• Genuineness: Being authentic.
• Self-Awareness: Recognizing emotions and biases.
• Respect & Boundaries: Maintaining professionalism.
• Encouragement & Motivation: Empowering patients.

Why This Matters

• Builds Trust: Patients are comfortable and willing to share.
• Enhances patient outcomes: Patients adhere to treatment.
• Reduces anxiety/stress: Patients facilitate communication.
• Strengthens therapeutic alliance: Creates partnership.
• Promotes holistic care: Recognizes all needs.

Transference

• This involves transferring past feelings and conflicts into present relationships.
• It stems from unresolved childhood experiences.
• Nursing intervention is needed when therapeutic progress slows.
• Can be positive or negative, affecting the nurse-patient dynamic.
• Termination isn't always needed unless therapy or safety is seriously at risk.
• Transference must be reported, documented, and monitored to ensure clinical safety for all parties.

Countertransference

• This involves the nurse's personal feelings and thoughts impacting the client.
• It's normal and involves the nurse's reactions toward the patient.
• Unresolved conflicts may evolve as countertransference and nurses may be completely unaware.

Nursing Interventions

• Interventions include identification, observation, and feedback from staff.
• The nurse should be supported in identifying feelings.
• Improving a therapeutic relationship involves nurse feedback.
• Transference can affect the therapeutic environment.
• Awareness, education, and supervision for both improve therapeutic quality.
• Supervision helps with boundary issues and support.
• Regular supervision ensures self-awareness, skills, and growth.
• Working through issues is central to growth, best achieved through supervision.

Therapeutic Communication

Central to forming therapeutic relationships.

• Skills, style, rhythm, and empathy take time to develop.
• Clarity ensures accurate understanding through joint effort.
• Continuity promotes connections among feelings or events.

Strategies include

Silence, active/empathetic listening, clarifying techniques, asking open/close-ended questions.

Non-therapeutic techniques

• Excessive questioning
• Giving approval/disapproval
• Giving advice
• Asking "why" questions
• Nurses need to know intent, meaning, and patient comprehension.
• Verbal communication is 10% of messaging. It includes beliefs, values, perceptions, and is used to convey understanding.
• Nonverbal communication is 90% of messaging, and it includes tone, appearance, expressions, posture, and eye contact.

Group Therapy

• This is psychotherapy in a small group, guided by a therapist, to discuss challenges and develop strategies.
• A trained therapist is required to facilitates discussions and ensures safety.
• Groups usually contains 5-15 participants with similar issues such as anxiety, depression, or addiction.
• Sessions can be open or closed, and follow a specific format.
• Shared Experiences - Members learn from each other through support and encouragement

Types

• Cognitive-behavioral, psychoeducational, support, interpersonal, and skill development.
• Benefits include reduced isolation, support, diverse perspectives, improved social skills, and cost-effectiveness.

Types of Assessments

• Comprehensive assessment involves a complete health history, physical exam, and evaluates affects on living.
• Focused assessment involves specific information on a need/problem, often using standardized tools.
• "Mental Status Assessment (MSA)/ Mental Status Examination (MSE)" is where mental health is assessed systemically.
• The findings of the MSA are subjective, and rely on clinician's knowledge/communication.
• The nursing process considers age, gathering data, and review of systems.
• The main goal includes a mental status examination (MSE) and psychosocial assessment with religious or cultural assessment. trauma and violence assessments are also incorporated.
• Assessments identifies factors for prevention and ideally occur on admission, then every 48 hours.
• As the 7th step in the nursing process, documentation includes changes in condition, consents, reactions, and concerns.

Risk assessment

• This identifies factors for prevention.
• Factors to consider: nutritional status, reduced mobility, repetitive stress, neurological concerns, incontinence, age, level of conciousness, etc.
• Ideally, a client should be assessed for risk on admission, again in 48 hours, and as often as the level of morbidity indicates
• Tools include the Braden and Norton scales.

Trauma and Violence Informed Care

• Trauma is an overwhelming experience which affects safety, trust, and worldview "What happened to you?" is often asked to approach the situation. Trauma can result from single events or prolonged exposure to distressing situations. It impacts a person's emotions, behaviors, and physical well-being

• Safety, choice, control, trust, and collaboration are important.

• Acute, chronic, complex, and secondary are types of trauma.

Trauma unfolds in phases:

• Acute, short-term, and long-term with TIC principles such as understanding, creating safety, recognizing signs, and promoting empowerment.

• "Trauma- and Violence-Informed Care (TVIC)" recognizes links between trauma and inequities.

• Understanding trauma & violence, creating safe environments, promoting choice & control, and strength-based approaches (focusing on resilence) are required to understand trauma

Explore core characteristics, stigma reduction strategies, and the WHO's Ten Basic Principles of Mental Health Care Law. Understand the focus and patient rights within Ontario's Mental Health Act. Grasp the key aspects of mental health disorders and classification.