Mental Health vs. Mental Illness: Definitions and Scenarios

• Mental health: Described as "the foundation for emotions, thinking, communication, learning, resilience, and self-esteem," plus a factor of wellness and societal contribution.
• The ability to complete daily living activities reflects one’s mental health.
• Mental illnesses: Health conditions involving changes in emotion, thinking, or behavior, and are associated with distress and/or problems functioning in social, work, or family activities.
• Mental illness does not stem from one case, but rather from a variety of risk factors, which include:
  • Traumatic life events
  • Biological and/or chemical imbalances
  • Substance use
  • Loneliness and isolation
• Examples of psychological stressors include starting a new job or losing a loved one.
• Over time, the inability to cope with stress may manifest as mental illness.
• Bias in mental health includes stereotyping, prejudice, or discrimination against a group of people in comparison to another group, which is unfair.
• Stereotyping within mental illness: The belief that all those who have depression want to harm themselves.
• Prejudice in mental illness: Healthcare individuals think that those who have a mental health disorder are simply attention-seeking and dismiss their concerns.
• Discrimination in mental illness: Insurance companies covering inpatient stays for mental illness at a decreased rate compared to a medical illness.
• Implicit bias: Bias that occurs outside of one's conscious awareness.
• Explicit bias: Intentionally displaying behaviors of discrimination toward someone.

Three Types of Stigma

• Public Stigma: Negative attitude toward those who have a mental illness; expressed in discriminatory attitudes or actions.
• Self-Stigma: An individual adopting a negative view or internalized shame regarding their condition
• Institutional Stigma: Governmental policies or organizations limit opportunities for those with mental illness; can be both intentional and unintentional.

DSM-5-TR

• Diagnostic guide used by mental health providers.
• Contains the description, manifestations, and the criteria needed to diagnose a mental health disorder
• Purpose: To assist providers in using common diagnostic language to describe clients with mental health disorders and to plan care.
• Divides disorder descriptions into the following classifications:
  • Neurodevelopmental disorders
  • Schizophrenia spectrum and other psychotic disorders
  • Bipolar and related disorders
  • Depressive disorders
  • Anxiety disorders
  • Obsessive-compulsive and related disorders
  • Trauma- and stressor-related disorders
  • Dissociative disorders
  • Somatic manifestations and related disorders
  • Feeding and eating disorders
  • Elimination disorders
  • Sleep-wake disorders
  • Sexual dysfunctions
  • Gender dysphoria
  • Disruptive, impulse-control, and conduct disorders
  • Substance-related and addictive disorders
  • Neurocognitive disorders
  • Personality disorders
  • Paraphilic disorders
  • Other mental disorders
  • Medication-induced movement disorders and other adverse effects of medication
• Nurse assessment elements include:
  • Psychosocial History
  • Medical History
  • Family History
• Nurses can use the DSM-5-TR diagnosis description as a reference to assist with planning, implementing, and evaluating client care.
• Ethical principles that guide nursing include:
  • Beneficence: Obligation for healthcare providers to act in a manner of doing good for a client and preventing harm.
  • Autonomy: The ability of the individual to make decisions regarding care and treatment.
  • Nonmaleficence: Doing no harm to the client, or avoiding causing pain or suffering to the client.
  • Justice: Fair and equal care and treatment for all clients, regardless of background or culture.

Mental Health Law and Legal Implications

• Tort: A civil wrongful act that is either intentional or unintentional that results in harm to another person.
  • A violation of a client's protected rights and represents a breach of the duty of the nurse.
  • Can be either unintentional or intentional.
• Intentional Tort: The person knowingly performed unsafe, unlawful actions or an act of omission, and can be considered a criminal action.
  • Examples include: Assault, Battery, and False imprisonment
• Unintentional Tort: Nurse didn't use forethought in the action or omission of action but harm still occurred.
  • Examples Include: Negligence, and Malpractice
• Informed consent: An individual's voluntary agreement to participate in treatment or medical procedures based on their understanding of the risks and benefits as well as any alternative treatments.
• Competence: A client's ability to understand information, use reasonable thought processes, communicate their wishes, and understand the consequences of their decisions (This is a legal term.)
• Capacity: A client's ability or inability to make decisions about proposed medical treatments or aspects of their health care.

Team Roles and Responsibilities in Interprofessional Teams

• Psychiatrists: Can diagnose medical and psychiatric illnesses, prescribe medications, give treatment orders, and do talk therapies.
• Psychologists: Trained in the assessment of brain function and talk therapies.
• Social Workers: Help in creating treatment goals and addressing the longer-term needs of clients, and are trained to do psychotherapy
• Occupational Therapists: Provide skill assessments and rehabilitation.
• Counselors/Therapists: Trained to use therapeutic techniques and work with clients in reducing clinical manifestations of mental health disorders.
• Psychiatric Pharmacists: Specialize in mental health care and are skilled in the management of medications related to mental health disorders.

Therapeutic Communication and Client Rights

• Clients can refuse service with a certain provider, as long as the current provider makes attempts to connect the client with a more amenable provider.
• The American Medical Association Code of Ethics requires physicians to not only provide respectful care, but to agree to second opinions about treatment, cooperate with other professionals, and not cease care of the client until another provider takes over care.
• Continuation of care is part of the nurse’s discharge plan.
• Client Bill of Rights template is provided by The American Hospital Association.
• The Affordable Care Act of 2010 created the client bill of rights.

Workplace Legal and Moral Protections

• Incivility: Rude or disrespectful behavior, whether intended to harm or not.
• Harassment: Broad display of unwelcome conduct, often characterized by insulting, or offending another person.
• Abuse: Pattern of behavior where a person deliberately and repeatedly acts to humiliate or denigrate another person.
• Ensuring competency in documentation: Using quotes from clients

Aspects of Mental Health Documentation

• Describe what happened objectively, plus a thorough assessment
• Describe care provided and client response.
• Document when providers were notified or other members of the team were contacted.
• Use client's own words to describe events or situations.
• If plan of care changes, provide clear documentation of changes and client response Provide clear reassessment of client conditions both during and after the event.
• Relapse: A recurrence or exacerbation of the symptoms of the original disorder.
• Relapse is common with serious mental illness.

Standards of Practice for Mental Health Nursing

• Assessment: Collecting and synthesizing comprehensive health data, pertinent to the patient’s/client’s health and/or situation.
• Diagnosis: Analyzing the assessment data to determine diagnoses, problems, and areas of focus for care and treatment, including level of risk.
• Outcomes Identification: Identifying expected outcomes based on the patient's/client's goals and their individual circumstances.
• Planning: Developing a patient/client-centered plan that prescribes strategies and alternatives to attain expected outcomes.
• Implementation: Implementing the patient/client-centered plan.
  • Coordination of Care: Coordinating care delivery.
  • Health Teaching, Health Literacy, and Health Promotion: Employing strategies to promote health and a safe environment.
  • Consultation: Provides consultation to maximize outcomes, collaborate with other clinicians, provide services and contribute to system change.
  • Pharmacological/Biological Therapies and Prescriptive Authority: Incorporates knowledge of pharmacological and biological interventions with applied clinical skills to restore the patient's/client's health and prevent further disability
  • Complementary/Integrative Therapies: Incorporates knowledge of complementary/integrative interventions with applied clinical skills to restore the patient’s/client’s health and prevent further disability.
  • Milieu Therapy: Provides a safe, therapeutic, recovery-oriented environment in collaboration with patients/clients/families, and other clinicians/ancillary staff/care partners.
  • Therapeutic Relationship: Uses the therapeutic relationship as the basis for interactions and the provision of care.
  • Counseling and Psychotherapy: Uses counseling interventions to assist patients/clients in their individual recovery journeys.
• Evaluation: Evaluating progress toward attainment of expected outcomes.
• Milieu therapy: Provides a safe, therapeutic and recovery oriented environment
  • Nursing Consideration: Therapeutic Milieu
• Trauma-informed care: Interacting with clients in a compassionate and empathetic way
• Adverse Childhood Experiences (ACEs): Past trauma that is present in a client's mental health

Freud's Psychoanalytic Theory

• Id: (instant gratification) One of Freud's three components that helps determine an individual's personality and how they behave or interact in the world. This is known for instant gratification; this can be physical needs or desires.
• Ego: One of Freud's three components that helps determine an individual's personality and how they behave or interact in the world. This is rationality to an individual’s conscious and unconscious personality.
• Super ego: One of Freud's three components that helps determine an individual's personality and how they behave or interact in the world. This is concerned with morals and following rules, often considered conscious and developed based on an individual’s culture and what they are taught as right and wrong.

Mental Health Continuum Stages

• Excelling: The peak of well-being on the mental health continuum.
• Thriving: Satisfactory level of mental well-being and is able to function normally.
• Surviving: Unsettled state of mind and indicates that problems may worsen.
• Struggling: Trouble in mental health leading to anxiety and/or depression, plus low energy, and struggles with work.
• Crisis: A state of emergency impacting an individual's mental healtt that often can include: suicidal ideation, anxiety, and depression to the point where social isolation and lack of self-care are present.
• Mental Health Self-Check Tool: Healthy functioning, Reacting, Injured and Ill functioning
• Assertive Community Treatment: Home based treatment models provide clients with mental health conditions.

Explore the nuances of mental health versus mental illness, psychological stressors, and various forms of bias and stigma. Understand the differences between implicit and explicit bias. Examples of public attitudes toward mental illness and the impact of psychological stress are provided.