Introduction to Mental Health Nursing

Judith Wikel RN BSN MEd

Review Mental Health Care in Britain, Australia, and the United StatesBritain has a National Health Care System –

tax revenues provide most of the financing for health care

Australia has a Public Health Care Plan – this plan does not cover Mental Health

In the United States - Wow!

Mental health in CanadaGovernment-administered health plan

Based on five principlesUniversalityPortabilityAccessibilityComprehensivenessPublic administration

United States continued…Currently the emphasis is to shift from

institutional to community mental health care.

This shift is causing the demand for mental health care to grow.

In the United States mentally ill people make use of community services only sporadically.

Often patients wait until major problems occur before seeking treatment.

A “Band-Aid” approach is used and often the results in only the presenting problem to be addressed.

County jails are full of people needing in-patient psychiatric care.

The CSS model views the client… HolisticallyAs an individual

Goal of the CSS model is to create a support system that fosters individual growth and movement toward independence through the use of coordinated social, medical, and psychiatric services.

Community mental health services are based on the needs of specific populations.

Several services may be available in various settings throughout the community.For example – Local ER, Day treatment

centers,Psychiatric home care, Community mental health centers.

Assertive Community Treatment (ACT)Provides medical, psychosocial, and

rehabilitative services via a community based team that operates seven days a week, 24 hours a day.

Teams usually consist of a social worker, psychiatrist, addictions counselor and four clinicians (two social workers and two RNs).

Mental Health Care Team InterventionsCommunity Teams…Meet with clients 2-4 times per weekAccompanies client to appointments and

other community activitiesHelp with daily living/social skills needsMonitors medicationsNurtures relationships with persons

interested in client’s well-beingEncourages client to call team instead of

using ER

Examples of Community Services…Serving Individuals

Rape crisis centers Meals on Wheels

Serving FamiliesWomen, Infants, and Children (WIC)

Helps single parent families with nutritious food.

Serving the CommunityUtility companiesGovernment agenciesPrisons

Psychiatrist – MD with residency in psychiatry

Psychiatric nurse – all levels of nursing education

*Expressive therapist – specialized degree in art therapy and assisting the patient to express their feelings.

Dietitian – specialized training in dietetics.

Please refer to pg 16.

Homeless HIV or AIDs Those in Crisis Clients living in rural areas Older Adults

The process serves as an organizational framework for effective care.Assessment, diagnosis, planning,

intervention, and evaluation.Please refer to Chapter 9 and read

about how the nursing process works in Mental Health.

HolisticThe nurse must see the patient as a

“whole” assessment must include gathering information about the physical, intellectual, social, cultural, and spiritual aspects of each client.

The more complete the picture, the more effective the treatment approaches will be.

Effective InterviewsPersonal values must not cloud professional

judgments.Do not make assumptionsTake into account the client’s cultural and

religious values and beliefsPay particular attention to nonverbal

communicationsHave clearly set goalsMonitor your own reactions – DO NOT be

judgmental.

General description

Emotional state

Experiences

Thinking

Sensorium and cognitionPlease refer to Table 9-4 on page 91.

Thought process (how one thinks)BlockingFlight of ideas – Rapid changes from on

thought to another related thoughtLoose associationsPerservation

Though content (what one thinks)DelusionsObsessionPhobiasPreoccupations

OthersAmnesiaConfabulation

Recent memory is recall of events occurring within the last two weeks.

Remote memory is asking the client to recall events form person’sbackground.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) - is the book providing the Axis guidelines for clinical disorders as they relate to Mental Health.

Clients are assessed and classified according to five categories or axes. Using the multiaxial system helps care providers gain a more complete understanding of each person.

Please refer to Table 9-1 and Table 9-2 Page 86.

The next step in the nursing process is Assessment, and the mental health treatment plan is started. Assessment includes the “gathering,

verifying and communicating of information relative to the client”

Data collectionObjective data is measured and shared.Subjective data relates to clients’

perceptions.

Data collection continued Interview is a meeting of people with the

purpose of obtaining or exchanging information. The interview is an excellent method for obtaining assessments. It also serves as the starting point for building the therapeutic relationship.

Sociocultural Assessment includes the following assessments. AgeEthnicityCultureGenderEducation IncomeBelief system

Inpatient admission criterion:A person’s behavior becomes a threat to

the safety of self or others.People within the environment are not able

or willing to support the mentally troubled person.

The person perceives himself or herself as unable to cope or maintain behavioral control.

Be sure to read all material.

Rely on Objectives to assist in preparing for test.

Clarify with an instructor as needed.

Good Luck! Judith Wikel PN Instructor