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Mental Health Notes:

Week 1: Seminar one outcomes Define mental health and illness Mental health:  State of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of everyday life, can work productively and fruitfully and is able to make a contribution to his or her own abilities. Mental illness:  A condition of impairment resulting in significant changes in emotional, psychological or social functioning. Discuss the impacts of stigma and stereotyping on people experiencing mental health difficulties  Illness can seem insurmountable  Lead to feelings of shame, hopelessness and isolation  Reluctance to ask for help or to receive treatment  Lack of understanding  Reduced opportunities for employment/ social interaction  Bullying, physical violence & harassment  Self-doubt  Increased hypochondriasis (persistent fear of serious mental illness) Describe the key elements of mental health nursing practice  Promote an optimal quality of life  Deliver services with the aim of facilitating sustained recovery  Involve all people in decisions regarding their treatment, care and support and opportunity to choose their treatment and setting  Recognise supports of rights of children and young people affected by mental illness Discuss the concepts of person-centred care and therapeutic communication as they apply mental health nursing. Person- centred care:  Treatment and care provided by health services that places the person at the centre of their own care. Involves:  Collaborative and respectful partnership  Patient can decide their own health, values, goals, past experience and knowledge of their own needs Principles:  Getting to know the patient by creating a holistic approach  Sharing of power and responsibility  Accessibility and flexibility  Environment that is conducive to person-centred care Therapeutic communication:  Is the interaction between a nurse and a patient that helps advance the physical and emotional health of a patient. o Nurses need to use various strategies to help the patient express their ideas and feelings in a manner that establishes respect and acceptance

Helps to: o o o o o

Enhances patient comfort levels Encourages a feeling of safety Increases trust Exchanges valuable information Individualized health care intervention strategies to benefit the patient

Define biopsychosocial model of care as it relates to mental health nursing:  Biopsychosocial model Is an interdisciplinary model that takes into consideration the biological, psychological and social factors and their complex interactions in understanding health, illness and health care delivery. o Bio: (Aspects of bio that influence health).  Brain changes, genetics, functioning of major body organs (liver, kidney)  Social: (Social factors that influence health of the individual) o Interactions with others, culture, economic status  Physio: (Psychological components) o Emotions, thoughts, behaviours o Self-esteem, fear of judgement Develop understanding of the concept of recovery including its definition, enablers and barriers to recovery Recovery:  Being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues. Enablers:  Promoting a culture and language of hope, As communicating positive expectations, promoting hope and optimism so the person feels valued, important, welcome and safe  Holistic and person centred:  Supporting personal recovery: Promoting autonomy and self-determination focusing on strengths and personal responsibility while engaging in collaborative relationships and reflective practice  Organisational commitment and workforce development:  Action on social inclusion and social determinants of health, mental health and wellbeing:  Self-determination: Leads to good life according to their own values and beliefs Barriers:  Use of alcohol and substances  Stigma of mental health issues (lead to lowered self esteem, concealed symptoms+ emotions)  Financial (cost of care can be expensive) Develop beginning understanding or trauma and its impact on mental wellbeing: reflect on the role of the nurse in delivering trauma informed practice Role of the nurse:  Develop trust/rapport to get the patient to explain the trauma to you  Collaboration and mutuality

 Empowerment, voce and choice: delivery system fosters recovery and healing Trauma: A severe physical injury of a specific experience that triggers mental and emotional distress and results in suffering and disruption to the person’s physical and/ or emotional wellbeing. Impact on mental wellbeing:  Increased PTS by re-experiencing the event in nightmares, avoiding places associated with the event  Increased emotions (fear, guilt, anger, isolation, emotional numbness, sadness) Trauma informed care: (Core features of trauma-informed care are safety, trustworthiness, choice, collaboration and empowerment).  Primitive brain (Brain stem) responsible for automatic functions such as breathing, HR and survival  Emotional brain: (Limbic system) is responsible for emotions, and memory (survival and safety)  Thinking brain: (Neo-cortex) is responsible for higher order tasks such as thinking, learning, decision making, reasoning, organising, planning. Nurses role:  Early assessment of trauma history  Reiterating the necessary for the person to feel safe and help to lower their distressing emotions o Relaxation techniques  Building trust in order to establish therapeutic relationship Develop beginning understanding of psychopathology and psychopharmacology Psychopathology:  A term that refers to either the study of mental illness or mental distress or the manifestation of behaviours and experiences that may be indicative of mental illness or psychological impairment Psychopharmacology:  The use of medications to treat psychiatric disorders.  Includes medication indications, interactions, side effects, precautions, consumer experience and education and the issues of adherence and as needed or prn administration. Psychotropic medication:  Any medication capable of affecting the mind, emotions and behaviour Central Nervous System:  Responsible for integrating sensory information  Takes signals from the peripheral nervous system, processes them and creates new signals to coordinate different actions. Temporal lobe: Processing sensory input and assigning emotional meaning Occipital lobe: Visual processing Parietal lobe: Integrates sensory information (touch, spatial awareness and navigation) Frontal lobe: Involved in attention, reward, short term memory, motivation and planning Neurotransmitters: 

Chemical messenger necessary for communication between neurons

Serotonin:

 Monoamine  Produced by digestive systems and brain  Present in platelets  Mood disorders (depression)  Anxiety disorders  Mood stabilises (improves mood)  Regulates appetite, sleep, autonomic functions Dopamine:  Neurotransmitter in brain  Major role in the reward motivation (component of behaviour)  Associated with schizophrenia, psychosis, depressant and mood, ADHD, binge eating  Drug + alcohol abuse Acetylcholine:  Serves as transmitter substance of nerve impulses  Motor neurons release to activate muscles  Important role in mental processes (memory and cognition)  Severe depletion is associated with Alzheimer’s disease GABA:  Gamma aminobutyric acid  Major inhibitory neurotransmitter in CNS  Role of Gaba: is to inhibit/ reduce activity of neurons or nerve cells  Important role in behaviour, cognition and body response to stress Adrenaline:  Neurotransmitter released from SNS in response to stress  Increases HR, BP, RR, pupils dilate, intestinal muscles relax  Associated with depression, anxiety, panic disorder, ADHD  Increases force of skeletal muscle contraction and contraction of heart Glutamate:  Excitory neurotransmitter relative of GABA  Depression, schizophrenia  Excess leads to anxiety, ADHD  Regulates dopamine in nucleus and affects reward system Seminar two outcomes: Ethical principles:    

Autonomy: Promotes the right of an individual to be able to make their own decisions and will be able to take responsibility for decisions made. Beneficence: (doing good). Work towards actions that support and benefit clients and their family members. (Actions taken for the benefit of others). Non-maleficence: The duty to do no harm, implies both a duty of care to avoid actual harm and considering the risks of any potential harm. Justice: The equal or fair of all individuals

Develop understanding of legislation in mental health care: Rationale for mental health legislation:  

Protect individuals from the consequences of behaviours Provides clinicians with a legal framework within which to provide involuntary treatment to individuals who meet the criteria of that legislation.

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Includes various support and appeal processes that allow the consumer to question decisions and to have legal representation in the decision-making process. Civil commitment: legal procedure is a civil rather than a criminal process and provides states with two powers to restrain the autonomy of individuals. o Consequences:  Individual is physically removed from society by being hospitalized  Conditions: Accepting mental healthcare, including medication & living at certain location

Process of civil commitment:  

Application: Completed by family members, general practioner or health professionals Assessed: By medical practioner (psychiatrist) who will determine if a person needs to be committed. o Occurs in-patient setting: Involuntary treatment (up to two weeks) and if the patients mental health state improves the period of compulsory treatment can be stopped

Orders:  

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Assessed order: (Registered medical practitioner, mental health practioner and allows the patient to be detained so a mental health assessment can be conducted) Temporary treatment order: authorised psychiatrists for duration of 28 days o Criteria:  Person has a mental illness  Serious deterioration in person’s mental/ physical health  Serious harm to the person or another person  No less restrictive means Treatment order: made by mental health tribunal after psychiatrist orders it o Community treatment order (12 months) o Inpatient treatment order (6 months) Time frames are able to be extended, provoked or shortened

Develop beginning understanding of the Mental Health Act (2014):  

Promotes voluntary treatment in preference to compulsory treatment and establishes robust safeguards and oversights to protect the rights, dignity and autonomy of people living with a mental illness Encourages strong communication between health practitioners, consumers their families and carers. It supports people with a mental illness to make and participate in treatment decisions and to have their views and preferences considered and respected.

Principles:   

Assessment and treatment are provided in the least intrusive and restrictive way People are supported to make and participate in decisions about their assessment, treatment and recovery Individual’s rights, dignity and autonomy are protected and promoted at all times

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Priority is given to holistic care and support options that are responsive to individual needs Wellbeing and safety of children and young people are protected and prioritised Carers are recognised and supported in decisions about treatment and care

Core concepts of rights of the mental health consumer: 

The principles include the provision of mental health services in the least restrictive way possible, promoting recovery and the best possible therapeutic outcomes and participation and support in decision-making.

Privacy and confidentiality:    

The wellbeing and safety of children and young people are protected and prioritised Carers are recognised and supported in decisions about treatment and care Individuals rights, dignity and autonomy are protected and promoted at all times Only able to reveal information with consent of the patient

Consent:  

Person receiving mental health services should be involved in all decisions about their assessment, treatment and recovery and be supported to make or participate in those decisions and their views and preferences should be respected. Assess competence to consent to treatment

Advanced statements: (Document that is written by the consumer which details their treatment preferences if they require compulsory treatment)   

Patients are able to write down the type of care that they would prefer Nominate a person as patient with treatment they may be incompinate to make their own decisions o Nominated person- chooses treatment in the best interest of the patient Priority is given to holistic care and support options that are responsive to individual needs

Supported decision making: 

People are supported to make and participate in decisions about their assessment, treatment and recovery

Using a case study, navigate key sections of the Mental Health Act (2014): Objectives:    

Individuals rights, dignity and autonomy are protected and promoted at all times Priority is given to holistic care and support options that are responsive to individual needs The wellbeing and safety of children and young people are protected and prioritised Carers are recognised and supported in decisions about treatment and care

Developing understanding of the role of the nurse in caring for patients under Compulsory Treatment Orders in the mental health setting and the community      

Ensuring safety by providing a secure environment Ongoing clinical assessments Medication aimed at reducing acute symptoms Personal care for consumers unable to care for themselves (Hygiene, Hydration and nutrition) Supportive psychological care (being with the person, psychotherapeutic support, safe socialisation, visits or contact with friends or family members) Explaining the intended benefits of medications and providing the consumer with choices about how the medication is administered.

Demonstrate the role of the nurse in planning and delivering least restrictive care for people with mental illness Least restrictive model of care:  

Enhances patient’s autonomy, respects their rights, individual worth, dignity and privacy. Encourage participation: Ensure they have opportunities to express their wishes and to be involved in developing their care plan.

Community Treatment Order:  

Community based alternative to involuntary hospitalization for people deemed able to be effectively treated out of hospital and requires a person to accept medication, therapy, rehabilitation or other services up to 12 months. Purpose: o Prevent deterioration o Treated in community o Re-admitted

Electroconvulsive therapy:  

Used for major depression Involves passing a carefully controlled electric currents through the brain which affects the brain’s activity and aims to relieve severe depression and psychotic symptoms.

Seclusion:       

Involuntary supervised isolation of a person in a locked, non-stimulating room Spartan (contains only mattress, blanket and bed pan) Limiting furnishing helps to prevent consumers from harming themselves or others. 15m obs Basic needs monitored Doc reviewed every 4hrs Debrief (patient centred care)

Restrictive interventions:      

At risk of harm Non-compliant to meds Risk to others Aggressive (obstruct property) Signs of deterioration Less stimulating environment for meds to work

Week two: Seminar three: Explain the rationale for assessment, diagnosis and classification of mental disorders Rationale:    

Understanding of consumers, formulate a plan of care and contribute to the decision making of multidisciplinary teams Helps to review goals, redefine problems and strengths and develop new strategies to assist in the consumer’s recovery Diagnose mental health conditions Differentiate between mental and physical health problems

Nurses need to:  

Establish therapeutic relationship to collect a range of information to formulate a collaborative plan of care Collect and interpret information and their perspectives of current situation

Classification and diagnostic system: 

Way to standardized care

Diagnosis: 

Accurately group together people whose clinical symptoms are sufficiently similar with the aim of optimising treatment and clinical outcomes.

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Catalogues mental illnesses American physicist association Western society

DSM5:

ICD10:   

Comprehensive manual of all known diseases WHO Europe

Identify skills required for performing mental health assessment 

Requires all interpersonal skills (rapport is essential) o Attending o Empathy o Listening o Reflection o Paraphrasing o Responding o Trust o Compassion o Open ended questions

Explain the process of psychiatric interviewing:   

Establish initial rapport with the patient and ask about presenting complaint or problems Elicit specific information (history of presenting problems, medical information) See any concerns/ questions

Outline the information required to conduct a comprehensive bio/psycho/social mental health assessment. 1. Identifying information  Name  Age  Gender  Employment  Ethnicity  Main support persons  Living situation  Address + contact details 2. Presenting problem  Issue that caused the person to present for mental healthcare 3. History of presenting problem

 Events leading up to assessment  Onset, duration, course & severity 4. Mental health history  Treatment?  Medications? 5. Substance use history 6. Family history  Any mental health history 7. Development and social history  Stages of consumer’s life  Influence on personality, coping style & current problem 8. Trauma 9. Cultural issues 10. Spirituality 11. Forensic history 12. General health history  Childhood illnesses  Any current/ chronic illnesses  History of head injury  Loss of consciousness  Any known allergies? 13. Physical health assessment  Health history  Head to toe assessment  Systems approach (head to toe)  CNS: Pt A+O, PPP  CVS: vital signs within clinical acceptable parameters (chest pain, discomfort, shortness of breath?  RES: Cough, sputum  GIT: BO/ BNO (change in dietary habits)  Elimination: Able to go to bathroom?  Mobility: Ambulate?  Skin: D+I and well perfused 14. Laboratory investigations  Understanding role of physical illness  Establish adherence to prescribed medication  Assess organ function Develop understanding of key domains of Mental State Examination (MSE): MSE: 

Semi- structured interview that enables assessment of a person’s neurological and psychological status across several domains

-Enables nurses to formulate nursing diagnoses and care planning -Provides a baseline for identifying the presence and impact of symptoms of mental illness -Used to inform a formal diagnosis of mental illness

Domains:

General appearance and behaviour:

Description:

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General appearance: clothing, grooming (dishevelled), hygiene, evidence of self-care Behaviour: posture, eye contact, restlessness, tearfulness, nervous mannerisms (note motor activity tremors & shaking), demeanour in interview

Affect:

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Affect (expressed emotion) Overall emotional tone

Mood:

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Mood (sustained emotional state). Describe mood Does mood abruptly change from one state to anothe...