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• Mental health is a state of well-being where individuals realize their potential, cope with normal stresses, work productively, and contribute to their community.
• Mental illness includes mental disorders with definable diagnoses that can impair cognition (Alzheimer's), affect mood (major depression), change behavior (schizophrenia), or a combination of these symptoms.
• The Mental Disorder Continuum uses endpoints as maximal mental disorder versus the absence of mental disorder, allowing for a range of impairment and distress.
• Mental health is a relative state, not absolute, and that no one is always at the ultimate level of health in every area.
• An individual's behavior may range from minimal to maximal mentally healthy, regardless of diagnosis.

Mental Health and Culture

• Psychiatric mental health nursing takes place within Indigenous and multicultural contexts.
• Culturally safe practice is a key goal that relies on relational inquiry, cultural competency, and awareness of trauma.
• Cultural norms dictate what is considered "normal" or "abnormal," which affects mental health and illness concepts.
• Western society generally views hearing voices or seeing visions as pathology, whereas some Indigenous cultures honour vision quests.
• One way of differentiating mental health from mental illness is considering what a particular culture deems acceptable behavior.

Social Determinants of Health

• Key factors include :
• Income and social status
• Employment/working conditions
• Education and literacy
• Childhood experiences
• Physical environments
• Social supports and coping skills
• Healthy behaviors
• Access to health services
• Biology and genetic endowment
• Gender
• Culture
• Race/Racism

Diagnosing Mental Disorders

• The DSM-5 classifies around 350 mental disorders.
• Cultural and ethnic factors influence the symptoms and causes of mental disorders.
• Mental illness involves alterations in cognition, mood, or behavior, leading to significant distress and impaired functioning.

Reducing Stigma

• Educate yourself about mental illness and substance use disorders.
• Examine judgmental thinking reinforced by upbringing and society.
• Word choice can affect the attitudes of others.
• Promote facts and positive attitudes to challenge myths and stereotypes.
• Recognize mental illness and addiction are only part of an individual's larger picture.
• Treat everyone with dignity and respect, offering encouragement and support.
• It is illegal to deny jobs or services based on health issues.

Mental Health Care Law: Ten Basic Principles

• The principles are based on analysis of national mental health laws in 45 countries by the World Health Organization and UN General Assembly Resolution 46/119.
• Key principles include:
• Promotion of mental health and prevention of mental disorders
• Access to basic mental health care
• Mental health assessments in accordance with internationally accepted principles
• Least restrictive type of mental health care
• Self-determination
• Right to assistance in exercising self-determination
• Availability of review procedure
• Automatic periodical review mechanism
• Qualified decision-maker

Legal Context within Canada:

• The Ontario Mental Health Act (OMHA) outlines the powers and obligations of psychiatric facilities in Ontario.
• The OMHA governs patient admission, assessment, care, and treatment; it also outlines powers for police and Justices of the Peace to order psychiatric examinations.
• The OMHA addresses patient rights, including appeal rights to the Consent and Capacity Board.
• The Criminal Code of Canada (Part XX.1) addresses the criminal liability of accused persons affected by a "mental disorder."
• It describes court powers for assessments and determinations related to fitness to stand trial and verdicts of "not criminally responsible" (NCR).
• It prescribes the composition and powers of Review Boards.

Forms under the Mental Health Act of Ontario

• MHA forms can temporarily take away a person's rights as per the Canadian Charter of Rights and Freedoms to act in the person's best interest when they are incapable.
• MHA forms allow for detaining people, but all treatment still requires consent.
• A physician can apply for a psychiatric assessment using Form 1, valid for 72 hours.
• The physician must examine the person within 7 days before signing and form an opinion about the disorder, its type, and degree of risk.
• A Justice of the Peace can order an examination using Form 2, valid for 7 days, allowing police to bring a person for psychiatric assessment.
• A psychiatrist completes Form 3, the Certificate of Involuntary Admission, if a patient is a risk to self or others or unable to care for self due to a mental illness, valid for 14 days.
• A psychiatrist completes Form 4, the Certificate of Renewal, if the risks remains at the end of the Form 3 period.
• 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
• When a patient no longer meets the criteria of the Mental Health Act, a psychiatrist completes Form 5, Change to Informal or Voluntary Status, which documents patient improvements.
• Form 9 is an Order for Return.
• Form 42 is a notice to the person of Application for Psychiatric Assessment after Form 1 is completed.
• Form 30 is a notice to the patient after a Form 3 or Form 4 is signed, as per subsection 38(1) of the Act.

Autonomy

• All individuals have the right to decide whether to accept or reject treatment, regardless of psychotic thinking.
• Healthcare providers may face charges for providing life-sustaining treatment without the client's agreement.
• Refusal of treatment can be challenged if:
• The client is mentally incompetent, and treatment is needed to preserve life.
• Refusal endangers the life or health of another
• During an emergency, or when the client is a child with consent from a parent or surrogate

Informed Consent

• Informed consent is based on self-determination and autonomy.
• Patients should be informed of:
• The nature of their problem or condition
• The nature and purpose of proposed treatment
• The risks and benefits of treatment
• Alternative treatment options
• The probability of success, and the risks of not consenting
• The nurse ensures that the patient has knowledge, competency, and free will to make decisions.
• Implied consent may occur when a patient indicates a willingness to receive medication or a procedure.
• Patients are legally competent until declared incompetent through a legal proceeding.
• A legal guardian/representative may be appointed if a patient is found incompetent.

The Therapeutic Nurse-Client Relationship

• The therapeutic nurse-client relationship is the foundation of all psychiatric nursing approaches.
• The nurse must be safe, confidential, reliable, and consistent while maintaining clear boundaries.
• Therapeutic Use of Self involves using one's personality, insights, perceptions, and communication skills to connect with patients and promote healing through trust and empathy.

Key Components of Therapeutic Use of Self

• Empathy: understanding and validating feelings
• Active Listening: giving full attention and responding thoughtfully
• Genuineness: being authentic and sincere
• Self-Awareness: recognizing emotions, biases, and triggers
• Respect & Boundaries: maintaining professionalism while showing care
• Encouragement & Motivation: helping patients feel empowered

Importance of Therapeutic Use of Self

• Builds Trust: patients feel more comfortable and willing to share.
• Enhances Patient Outcomes: leads to treatment adherence and helps patients examine self-defeating behaviors.
• Reduces Anxiety & Stress: patients feel heard and understood, thus facilitating communication.
• Strengthens the Therapeutic Alliance: creates a stronger provider/patient partnership which can assist with problem solving.
• Promotes Holistic Care: recognizes needs that promotes self-care and independence.

Relationships

• Social Relationships: focus on friendship, socialization, enjoyment, accomplishing a task, meeting needs, exchanging advice, and superficial communication.
• Therapeutic Relationships: identify/explore patient needs, establish clear boundaries, use problem-solving approaches, develop skills for change.

Transference

• Occurs when patients transfer past feelings, conflicts, and attitudes into current relationships due to unresolved childhood experiences
• Nurses should intervene if the transference inhibits the patient's therapeutic progress
• Transference can be positive or negative, resulting in clients expressing dependency, anger, or bitterness
• The therapeutic relationship typically does not need to be terminated unless the transference inhibits therapy.
• All safety concerns must be reported immediately.
• Transference must be reported, documented, and monitored to maintain boundaries.

Countertransference

• Countertransference occurs when the nurse transfers personal feelings onto the client.
• Nurses may be unaware or only minimally aware of their countertransference.
• Interventions involve identification, observation, and feedback by other staff members.
• Therapeutic relationships can be improved by sharing relationship progression and providing support to staff experiencing countertransference.
• Facilitating staff awareness is essential to ensure quality therapy and to preserve the therapeutic relationship.
• It is important to work through transference and countertransference. Supervision, peer group support, and guidance regarding ethical issues is important.

Therapeutic Communication

• Therapeutic communication is central to developing a therapeutic relationship, requires skill, takes time, involves developing a personal style, and requires empathy.
• Therapeutic Communication Strategies include:
• Silence
• Active listening
• Listening with empathy
• Clarifying techniques
• Paraphrasing
• Restating
• Reflecting, and exploring
• Requires asking open-ended and close-ended questions.
• Non-therapeutic communication techniques involve:
• Excessive questioning
• Giving approval or disapproval
• Giving advice
• Asking "why" questions
• Nurses should know the purpose of their message, communicate what is meant, and comprehend both intentional and unintentional communication from the patient.
• Communication includes:
• Clarity to ensure understanding, and continuity to promote connections among themes/ideas

Types of Communication:

• Verbal communication makes up 10%
• Non-verbal communication makes up 90%
• Nonverbal cues include tone of voice, emphasis, physical appearance, facial expressions, body posture, eye contact, and hand gestures.

Group Therapy

• Group therapy occurs in a small group of individuals that are guided by a therapist to discuss and work through challenges.
• It provides a supportive environment to share experiences, gain insight and develop coping strategies.

Key Features of Group Therapy

• Led by a trained therapist who facilitates discussions.
• Includes multiple participants with similar issues.
• Uses Structured session (open or closed).
• Has Shared Experiences supporting the use of feedback and support.

Types of Group Therapy:

• Cognitive-Behavioral Group Therapy (CBGT): Chanding negative thought an behaviors
• Psychoeducational Groups: Provides education about conditions like addiction or anxiety
• Support Groups: Offers emotional coping skills
• Interpersonal Process Groups: Explores relationship patterns and issues
• Skills Development Groups- Teaches stress management, social skills or controlling anger.

Group Therapy Benifits

• Reduces Isolation
• Provides Support & Encouragement
• Offers Different Perspectives
• Improves Social Skills
• Cost-Effective

Aspects of Assessments

• Complehensive Assesments: Involves a complete health history physical and examination, considers all factors and evaluates how everything affects daily living.
• Focused Assesment: Is the specific gathering of information about one aspect of a situation. Is what they are feeling and nurses often use standerized assessment tools.
• mental Status Assessment: Asses a persons psychological, emotional, social and neurological thinking. The findings are subjective and is based on clinicians' understanding/knowledge.

MSA Includes:

• Apperance
• Behavior
• Cognition
• Is part of all nursing
• Gathering data
• Review of symptoms
• Laboratory data
• Psychosocial assessment
• Trauma and violence informed approaches
• Spiritual or religious assessment
• Cultural and social assessment
• Validating the assessment
• Using rating scales
• Risk Assessments should ideally occur on admission, again in 48 hrs or when the patient is indicating.
• Site-Specific Assessment Schedules: At admission, then every week for four weeks and quarterly thereafter

Assessment in the Nursing Process

• Should consider all people and understand what they are trying to convey, and communicate it to the patient for the correct meaning. Includes all standardized nursing and aging.

Documentation includes:

• Changes in patient condition
• Informed consents
• (for medications and treatments)
• Reaction to medication
• Symptoms (verbatim when appropriate)
• Concerns of the patient
• Safety concerns (thoughts of harm to self or others)
• Incidents of mandatory reporting
• (children's protective services, police)
• Any untoward incidents in the health care setting
• Risk assessment Aims to identify risk factors that are then incorporated into a client-specific prevention plan of care.
• Potential to develop pressure ulcers may be influenced by intrinsic risk factors that relate to aspects of the client's physical, psychosocial, or medical condition.

Trauma and Violence Informed Care

• Trauma is described as an experience that overwhelms, impacts, and changes how the patient is feeling.

Providing care with the 3 S

• Safety: must be physical
• Choice & Control: empowering those who are involved
• Trust & Collaboration Trauma can be defined in various ways, but a trauma-informed perspective asks, "What happened to you?" instead of "What's wrong with you?" Trauma can result from single events or prolonged exposure to distressing situations.
• Acute Trauma: Results from a single distressing event (e.g., car accident, assault).
• Chronic Trauma: Prolonged exposure to distressing events (e.g., ongoing abuse, domestic violence).
• Complex Trauma: Exposure to multiple traumatic events, often beginning in childhood (e.g., neglect, family violence). .

Phases

• Acute Phase: Reacting with shock, confusion, and emotional distress Short-Term Responses – Symptoms like hypervigilance, avoidance, anxiety, and mood swings.
• Long-Term Impact – Can result in PTSD, depression, substance use, and difficulty with relationships Understanding trauma's widespread impact.
• Providing a support system
• Recognizing signs of trauma
• Promote good collaboration

TVIC includes:

• Understanding Trauma & Violence – Recognizing how social factors contribute to trauma.
• Creating Safe Environments – Ensuring emotional and physical safety.
• Promoting Choice & Control – Giving patients autonomy in their care.
• Using Strength-Based Approaches - Focusing on resilience rather than pathology