Mental Health Review PDF

Week 1 – Introduction to Mental Health and Stigma What is mental health versus mental illness - Mental health - a state of well being in which each individual is able to realize his or her own potential, cope the normal stresses of life, work productivity, and fruitfully, and mak...

Week 1 – Introduction to Mental Health and Stigma What is mental health versus mental illness - Mental health - a state of well being in which each individual is able to realize his or her own potential, cope the normal stresses of life, work productivity, and fruitfully, and make a contribution to the community - Mental illness - all mental disorders with definable diagnoses. Cognition may be impaired, as in Alzheimer’s disease; mood may be affected, as in major depression; behaviour may change, as in schizophrenia; or a combination of the three types of symptoms may be apparent. What is the mental health continuum? - The Mental Disorder Continuum assigns one endpoint as maximal mental disorder and the opposite endpoint as the absence of mental disorder, allowing for a range of impairment and distress. - It is a relative state instead of an absolute state - No one is at the ultimate level of health in every area all the time - Individuals can have anywhere from minimal to maximal mentally healthy behaviour, whether they are diagnosed with a mental disorder or not Mental health and culture - Canadian psychiatric mental health nursing practice takes place within the rich Indigenous and multicultural contexts of the country - In these contexts, culturally safe practice is a goal and is anchored by approaches to relational inquiry; broad, systemwide cultural competency; and trauma-informed practice - Cultural norms prescribe what is “normal” and “abnormal” and influence the development of mental health and illness concepts o For example, in Western society, hearing voices and seeing visions is generally viewed as a sign of pathology and deviates from the cultural norms o In some Indigenous cultures, however, vision quests, the seeking of visions, is honoured and valued and would not be viewed as pathological - one approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable behaviour. Social determinants of health – although important I am evaluating in your presentation 1. Income and social status 2. Employment/working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviours 8. Access to health services 9. Biology and genetic endowment 10. Gender  11. Culture 12. Race/Racism. Diagnosis of Mental Disorders: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), classifies around 350 mental disorders. The symptoms and causes of mental disorders are influenced by cultural and ethnic factors. Mental illness is characterized by alterations in cognition, mood, or behavior, coupled with significant distress and impaired functioning. Cognition, mood or behavior may be affected. Ways to Reduce Stigma: Know the facts and educate yourself about mental illness, including substance use disorders. Be aware of your attitudes and behavior. Examine your own judgmental thinking, which may be reinforced by upbringing and society. Choose your words carefully, as the way we speak can affect the attitudes of others. Educate others. Pass on facts and positive attitudes, and challenge myths and stereotypes. Focus on the positive. Mental illness, including addictions, is only part of anyone's larger picture. Support people by treating everyone with dignity and respect, and offer support and encouragement. Include everyone. It is against the law to deny jobs or services to anyone with these health issues. Week 2 – Mental Health Law (3 questions) I. Ten Basic Principles of Mental Health Care Law Developed from a comparative analysis of national mental health laws in 45 countries by the World Health Organization. Principles derived from the UN General Assembly Resolution 46/119 of December 17, 1991. 1. Promotion of mental health and prevention of mental disorders. 2. Access to basic mental health care. 3. Mental health assessments in accordance with internationally accepted principles. 4. Provision of the least restrictive type of mental health care. 5. Self-determination. 6. Right to be assisted in the exercise of self-determination. 7. Availability of review procedure. 8. Automatic periodical review mechanism.  9. Qualified decision-maker. II. Legal Context within Canada The Ontario Mental Health Act: o Sets out the powers and obligations of psychiatric facilities in Ontario. o Governs the admission process, categories of patient admission, assessment, care, and treatment. o Outlines powers of police officers and Justices of the Peace to order psychiatric examinations. o Refers to patient rights, including rights of appeal to the Consent and Capacity Board. Criminal Code of Canada - Part XX.1 Mental Disorder: o Addresses criminal liability of accused persons affected by a “mental disorder”. o Describes court powers to order assessments and make determinations regarding fitness to stand trial and verdicts of "not criminally responsible" (NCR). o Prescribes the composition and powers of Review Boards. III. Forms under the Mental Health Act of Ontario General Information: o MHA forms can temporarily take away a person’s rights under the Canadian Charter of Rights and Freedoms. o The intent is to act in a person’s best interest when they are incapable of doing so. o MHA forms detain people, but all treatment requires consent. Form 1: Application by Physician for Psychiatric Assessment: o Any physician in Ontario can sign it. o The physician must examine the person within 7 days before signing and form an opinion about a mental disorder and the type and degree of risk. o Valid for 72 hours. Form 2: Order for Examination by a Justice of the Peace: o Allows police to bring a person for psychiatric assessment. o Valid for 7 days. Form 3: Certificate of Involuntary Admission: o Completed by a psychiatrist if a patient is a risk to self, others, or unable to care for self due to a mental illness. o Valid for 14 days. Form 4: Certificate of Renewal: o A psychiatrist completes this at the end of the Form 3 period if the patient remains at risk. o 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: o Completed by a psychiatrist when a patient on Form 3 or 4 no longer meets the criteria of the Mental Health Act. o Documents the patient's improvements.  Form 9: Order for Return: o For involuntary patients who are absent without leave from the hospital. o Signed by a hospital staff member delegated by the Officer-in-Charge. Form 42: Notice to person of Application for Psychiatric Assessment (Form 1): o Given to the person when a Form 1 is completed. Form 30: Notice to patient under subsection 38(1) of the Act: o Given to the patient promptly after a Form 3 or Form 4 is signed. IV. Autonomy All individuals have the right to decide whether to accept or reject treatment. The presence of psychotic thinking does not negate the patient's ability to provide or deny consent. A health care provider can face charges for providing life-sustaining treatment without the client’s agreement. Refusal of treatment may be challenged under specific circumstances: o When a client is mentally incompetent and treatment is necessary to preserve life or avoid serious harm. o When refusing treatment endangers the life or health of another. o During an emergency. o When the client is a child (consent is obtained from a parent or surrogate). V. Informed Consent Based on a person's right to self-determination and the ethical principle of autonomy. The patient must be informed of: o The nature of their problem or condition. o The nature and purpose of a proposed treatment. o The risks and benefits of that treatment. o Alternative treatment options. o The probability of success of the proposed treatment. o The risks of not consenting to treatment. The nurse's role includes ensuring that the following elements of informed consent have been addressed: o Knowledge: the client has received adequate information. o Competency: the individual’s cognition is not impaired, or if so, that the individual has legal representation. o Free will: the individual has given consent voluntarily without pressure or coercion. Implied consent occurs when a patient indicates a willingness to receive medication or a procedure. Patients must be considered legally competent until declared incompetent through a legal proceeding. If found incompetent, a legal guardian or representative may be appointed. Week 3 – Therapeutic, Relationships, Therapeutic Communication and Group Therapy Concepts of the therapeutic nurse-client relationship Basis of all psychiatric nursing treatment approaches To establish that the nurse is Safe Confidential Reliable Consistent Relationship with clear boundaries What is therapeutic use of self? 1. Use personality consciously and in full awareness 2. Attempt to establish relatedness 3. Structure nursing interventions Therapeutic Use of Self refers to a healthcare professional’s intentional use of their personality, insights, perceptions, and communication skills to establish a meaningful connection with a patient and promote healing. It involves building trust, showing empathy, and using oneself as a tool to enhance the therapeutic relationship. Key Components of Therapeutic Use of Self: 1. Empathy – Understanding and validating a patient's feelings. 2. Active Listening – Giving full attention and responding thoughtfully. 3. Genuineness – Being authentic and sincere in interactions. 4. Self-Awareness – Recognizing one's emotions, biases, and triggers. 5. Respect & Boundaries – Maintaining professionalism while showing care. 6. Encouragement & Motivation – Helping patients feel empowered. Why is it important? Builds Trust – Patients feel more comfortable and willing to share. Enhances Patient Outcomes – Leads to better adherence to treatments. Help patient examine self-defeating behaviours and test alternatives. Reduces Anxiety & Stress – Patients feel heard and understood. Facilitate communication of distressing thoughts and feelings. Strengthens the Therapeutic Alliance – Creates a stronger partnership between provider and patient which can assist with problem solving. Promotes Holistic Care – Recognizes emotional and psychological needs, not just physical symptoms. Promotes self-care and independence. Goals and concepts of relationships Social Relationships  - Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task - Mutual needs are met - Communication to give advice or to give or ask for help - Content of communication superficial Therapeutic Relationships - Needs of patient identified and explored - Clear boundaries established - Problem solving approaches taken - New coping skills developed - Behavioural change encouraged Transference and countertransference Transference (focuses on the patient) Transference is the "transference" (to transfer) of past feelings, conflicts, and attitudes into present relationships, situations, and circumstances. According to psychoanalytic theory, transference evolves from unresolved or unsatisfactory childhood experiences in relationships with parents or other important figures (Wilson & Kneisl, 1996) Nursing intervention: - Nurses need to intervene in cases of transference when it becomes apparent that the patient's therapeutic progress is inhibited due to the effects of the phenomenon. - In some cases transference is positive, positive in the sense that the transferred feelings and attitudes toward the nurse result from past fulfilling experiences and relationships. - The negative may heavily outweigh the positive in some situations. For example, a patient may react in a therapeutically antagonistic manner, expressing excessive dependency or angry, bitter, or contemptuous feelings towards a particular nurse or group of staff. Thus, discomfort arises in both parties. The patient may be uncomfortable in expressing these feelings in such a negative manner, and the nurse will usually dislike being the object of such expression. - In cases of transference, the therapeutic relationship does not usually need to be terminated (e.g., assigning another primary nurse to care for the patient), except when the transference poses a serious barrier to therapy or safety. In this case – the therapeutic relationship MUST be immediately terminated, and nurse MUST immediately report safety concerns to appropriate source. - Important to note, transference must be reported, documented and monitored for clinical safety for both patient and nurse to ensure boundaries are maintained within the therapeutic nurse-client relationship. Being mindful the goal would be to guide the patient to independence by teaching them to assume responsibility for their own behaviors, feelings, and thoughts, and to assign the correct meanings to relationships based on present circumstances instead of the past. - Helping the patient work through the transference is beneficial in two important ways: the therapeutic value of the relationship may be restored and even improved, and the  patient may also learn to identify this behavior in other relationships, thus improving interpersonal skills. Countertransference (focuses on the nurse/therapist personal thoughts and feelings onto the client) Counter-transference involves the same principles, except the direction of the transference is reversed. Counter-transference, a normal occurrence as well, involves the nurse’s reactions, behaviors, thoughts, and feelings toward the patient (Wilson & Kniesl, 1996). Unresolved conflicts from the nurse’s past may evolve as countertransference. For example, a patient who displays childlike dependency toward a nurse may evoke a parental attitude from that nurse, depending on the meaning they assign to the relationship with the patient, and if past conflicts are significant to the present situation. Nurses may be completely unaware or only minimally aware of the countertransference as it is occurring. Nursing Interventions - Interventions for counter-transference involve identification, observation, and feedback by other nurses and staff members. - The nurse or staff member experiencing the counter-transference should be supportively assisted by other staff members to identify their feelings and behaviors and recognize the occurrence of the phenomenon. - The therapeutic relationship can often be improved by offering the nurse or other staff member feedback about the progression of the relationship. - It is important to recognize the effects of transference and counter-transference on the patient and the staff as this phenomena also can affect the entire therapeutic environment if not managed properly, as the rest of the therapeutic community of patients and staff may perceive the relationship in a positive or negative manner. - Facilitating staff awareness and education regarding these phenomena is essential to help ensure the quality of therapy and to preserve the integrity of the therapeutic, nurse-patient relationship. Identifying and working through various transference and counter-transference issues is central to working therapeutically with the patient if we are to achieve professional and clinical growth and allow for positive change in the patient. Transference and counter-transference, as well as numerous other issues, are best dealt with through the use of supervision by either the peer group or the therapeutic team. Besides helping with boundary issues, supervision supplies practical and emotional support, education, and guidance regarding ethical issues. Regularly scheduled supervision sessions provide the psychiatric nurse with the opportunity to increase self- awareness, clinical skills, and growth, as well as allow for continued growth of the patient. No matter how objective clinicians may try to be in examining their interactions, professional support and help from an experienced supervisor are essential to good practice. For therapeutic communication: these are more application questions*** Ensure you complete all reading in the text… Therapeutic communication Central to the formation of therapeutic relationship  Skills take time Development of own style and rhythm Empathy Therapeutic Communication Strategies: Silence Active listening Listening with empathy Clarifying techniques Paraphrasing Restating Reflecting Exploring Asking questions and eliciting patient responses Open-ended questions Close-ended questions Nontherapeutic Communication Techniques: Excessive questioning Giving approval or disproval Giving advice Asking “why questions” The nurse should (1) know what they are trying to convey (the purpose of the message), (2) communicate what is really meant to the patient, and (3) comprehend the meaning of what the patient is intentionally or unintentionally conveying. Communication should include (1) clarity, which ensures that the meaning of the message is accurately understood by both parties "as the result of joint and sustained effort of all parties concerned," and (2) continuity, which promotes connections among ideas "and the feelings, events, or themes conveyed in those ideas.” Types of Communication: Verbal (content of message)- All words a person speaks Communication is 10% verbal Communicates Beliefs and values Perceptions and meaning Can convey Interest and understanding  Insult and judgement Clear or conflicting messages Honest or distorted feelings Nonverbal (process of message) - actions Communication is 90% nonverbal Tone of voice Emphasis on certain words Physical appearance Facial expressions Body posture Amount of eye contact and Hand gestures Group therapy Group therapy is a form of psychotherapy where a small group of individuals, typically guided by a trained therapist, meet to discuss and work through common challenges. It provides a supportive environment for participants to share experiences, gain insights, and develop coping strategies. Key Features of Group Therapy 1. Led by a Trained Therapist – A mental health professional facilitates discussions and ensures a safe, productive environment. 2. Multiple Participants – Groups usually consist of 5–15 people with similar issues (e.g., anxiety, depression, addiction, trauma). 3. Structured Sessions – Meetings can be open (new members can join) or closed (fixed membership), following a specific format. 4. Shared Experiences – Members learn from each other, offering support, feedback, and encouragement. Types of Group Therapy Cognitive-Behavioral Group Therapy (CBGT) – Focuses on changing negative thoughts and behaviors. Psychoeducational Groups – Provides education about specific conditions, such as addiction or anxiety. Support Groups – Offers emotional support and coping skills (e.g., grief groups, addiction recovery). Interpersonal Process Groups – Explores relationship patterns and emotional struggles. Skills Development Groups – Teaches skills like stress management, social skills, or anger control. Benefits of Group Therapy Reduces Isolation – Helps individuals realize they are not alone.  Provides Support & Encouragement – Members uplift each other. Offers Different Perspectives – Learning from others' experiences can be insightful. Improves Social Skills – Encourages communication and connection. Cost-Effective – More affordable than individual therapy. Week 4 – Mental Status Assessment / Risk Assessment What are the two types of assessments? Comprehensive Assessment: Involves a complete health history and physical examination. Considers the psychological, emotional, social, spiritual, ethnic, and cultural dimensions of health. Attends to the meaning of the client’s health–illness experience. Evaluates how all of this affects the individual’s daily living. Focused Assessment: 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. Briefer, narrower in scope, and more present-oriented than comprehensive assessments. Nurses often employ standardized assessment tools. What type of assessment is the Mental Status Assessment? Mental Status Assessment (MSA)/ Mental Status Examination (MSE) A systematic approach to assessing an individual’s psychological, emotional, social, and neurologic functioning. The components of the MSE are standard across clinical settings, but the findings are highly subjective. Findings rely heavily on the clinician’s knowledge, communication skills, interpretation, and judgment. It is important for clinicians to be self-reflective and to collaborate with colleagues to develop an unbiased understanding of the client’s experience. Includes: o Appearance o Behavior  o Cognition Is part of Psychiatric Mental Health Nursing Assessment, which also includes: o Gathering data o Review of systems o Laboratory data o Psychosocial assessment o Trauma and violence informed approaches o Spiritual or religious assessment o Cultural and social assessment o Validating the assessment o Using rating scales When is assessment done with patients? Timing of Assessments Throughout nurse-client interactions Assessment is a part of all nurse–client interactions. It begins with the initial encounter and continues through the duration of caring for the patient. Psychiatric Mental Health Nursing Assessment includes gathering data, review of systems, lab work, MSE, psychosocial, trauma, spiritual, cultural and social aspects, and using rating scales. Risk Assessments should ideally occur: o On admission o Again in 48 hours o As often as the level of morbidity indicates Site-Specific Assessment Schedules: o Long-term care facilities: At admission, then every week for four weeks and quarterly thereafter o Intensive Care Units: Daily o General medical/surgical units: Every other day o Community: Every home visit Assessment and the nursing process? Assessment in the Nursing Process A part of all nurse–client interactions. Begins with the initial encounter and continues while caring for the patient. Requires a broad theoretical knowledge of human, social, and health sciences, as well as the ability to think critically, and use psychomotor and interpersonal skills. Assessment activities include observation, examination, interview, and consultation. Conducted interprofessionally. Includes standardized nursing assessments. Considers age. Involves gathering data and review of systems.  Includes a mental status examination (MSE) and psychosocial assessment. Incorporates trauma and violence informed approaches. Includes spiritual or religious assessment along with cultural and social assessment. Involves validating the assessment and using rating scales. Aids in identifying risk factors to incorporate into a client-specific prevention plan of care. Should ideally occur on admission, again in 48 hours, and as often as the level of morbidity indicates. Contributes to nursing diagnoses, which identify problems. Leads to outcomes that reflect desired changes. Is systematic and ongoing. Includes documentation of symptoms. Aids in recording relevant information, so the patient receives the best and most personalized care. What is considered the 7th step in the nursing process? Documentation is considered the 7th step in the nursing process. o It is primarily for recording relevant information, so the patient receives the best and most personalized care. o Includes documentation of:  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 What is risk assessment? Risk Assessment Aims to identify risk factors that are then incorporated into a client-specific prevention plan of care. Ideally, the client should be assessed for risk on admission, again in 48 hours and as often as the level of morbidity indicates. Risk assessment tools include: o The Braden Scale o The Norton Scale The 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.  o These factors should be considered when performing a risk assessment, and include:  Nutritional status (malnutrition and dehydration)  Reduced mobility or immobility  Repetitive stress syndrome (involuntary movements)  Posture/contractures  Neurological/sensory impairment  Incontinence (urinary and fecal)  Extremes of age  Level of consciousness  Acute illness  History of previous pressure damage  Vascular disease  Severe chronic or terminal illness Site of care assessment schedule: o Long-term care facilities – At admission, then every week for four weeks and quarterly thereafter o Intensive Care Units – Daily o General medical/surgical units – Every other day o Community – Every home visit When should risk assessments be completed? Ideally, a client should be assessed for risk: o On admission o Again in 48 hours o As often as the level of morbidity indicates Site-Specific Assessment Schedules: o Long-term care facilities: At admission, then every week for four weeks and quarterly thereafter o Intensive Care Units: Daily o General medical/surgical units: Every other day o Community: Every home visit Week 5 – Trauma and Violence Informed Care What is Trauma? Trauma is described as an experience that overwhelms an individual’s ability to cope. It can result from events such as abuse, assault, accidents, war, or natural disasters. Trauma changes an individual’s worldview, affecting their sense of safety, trust, and control What are the 3 Things We Must Provide Our Patients Who Have Experienced Trauma? 1. Safety – Ensuring physical, emotional, and psychological security. 2. Choice & Control – Empowering patients by involving them in decisions regarding their care. 3. Trust & Collaboration – Building a relationship based on respect, understanding, and shared decision-making Definitions of Trauma 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. It impacts a person’s emotions, behaviors, and physical well-being Types of Trauma 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). Secondary Trauma – Indirect exposure to trauma through others, such as healthcare workers and first responders Process of Trauma Trauma unfolds in phases: 1. Acute Phase – Immediately after trauma, reactions include shock, confusion, and emotional distress. 2. Short-Term Responses – Symptoms like hypervigilance, avoidance, anxiety, and mood swings. 3. Long-Term Impact – Can result in PTSD, depression, substance use, and difficulty with relationships Trauma-Informed Care (TIC) Principles/Approaches TIC emphasizes: Understanding trauma’s widespread impact. Creating a safe and supportive environment. Recognizing signs of trauma. Promoting empowerment and collaboration Trauma- and Violence-Informed Care (TVIC) Principles TVIC goes beyond TIC by recognizing the link between trauma and social inequities. Key principles include: 1. Understanding Trauma & Violence – Recognizing how social factors contribute to trauma. 2. Creating Safe Environments – Ensuring emotional and physical safety. 3. Promoting Choice & Control – Giving patients autonomy in their care. 4. Using Strength-Based Approaches – Focusing on resilience rather than pathology