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CHAPTER 1
Mental Health and
Mental Illness
Mental Health
(WHO 2007)
• A state of well-being
• Able to recognize own potential
• Cope with normal stress
• Work productively and fruitfully
• Make contribution to community
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Seven Signs of Mental Health
Effective
Coping
Satisfying
Relationships
Happiness
Mental
Health
Healthy
Self
Concept
Control of
Behavior
Appraisal
of Reality
Effective
in Work
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Mental Health: Some Attributes
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Factors That Can Affect Mental Health
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Mental Illness
• Disorders with definable diagnosis
• Considered clinically significant when marked by
• Patient’s distress
• Disability or Risk of disability
• Loss of freedom
• Culturally defined
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Case Study
• Mrs. M is your neighbor. She works full time and is
dealing with a troubled teenage son and her
elderly parents. She confides in you that she
“can’t deal with her life right now.”
• How could you assess her mental health?
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Resilience
• Ability and capacity to secure resources needed to
support well-being
• Characterized by
• Optimism
• Sense of mastery
• Competence
• Essential to recovery
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Mental Health-Illness Continuum
• All Human Behavior lies along a continuum
Mental
Illness
Mental
Health
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Diathesis-Stress Model
• Diathesis – Biological predisposition
• Stress – Environmental stress or trauma
• Most accepted explanation for mental illness
• Combination of genetic vulnerability and negative
environmental stressors
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Case Study (Cont.)
• Returning to the problem of your neighbor, Mrs. M, who is
having difficulty coping with a full-time job, teenage son, and
elderly parents, what about your neighbor’s behavior might
indicate a mental illness?
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Social Influences on
Mental Health Care
• Consumer/recovery movement
• National Alliance on Mental Illness (NAMI)
• Decade of the brain
• New Freedom Commission on Mental Health
• Mental Health Parity Act
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Contrast and compare the focus and approach of the mental
health recovery model to the evidence-based practice (EBP)
model.
• Recovery Model
• EBP Model
• Consumers as partners
• 1990s “Decade of the Brain”
• Mental health care:
• Scientific evidence for psychologic
and sociologic treatments
• Consumer and family driven
• Increasing consumer's ability in:
• Coping, facilitating recovery,
and building resilience
• Individualized care:
• Neurobiology of psychiatric
disorders
• Psychopharmacology
• Medical model
• Consumer centered and
recovery oriented
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Substance Abuse and Mental Health Services
Administration (SAMHSA)
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Epidemiology of Mental Disorders
• Study distribution of mental disorders
• Identify high-risk groups
• Identify high-risk factors
• Lead to etiology of mental disorder
• Use information to
• Improve clinical practice
• Plan public health policies
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Clinical Epidemiology
• Groups treated for specific mental disorders
studied for
• Natural history of illness
• Diagnostic screening tests
• Interventions
• Results used to describe frequency of
• Mental disorders
• Symptoms appearing together
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Audience Response Questions
How many Americans per annum (snapshot of one year) have a
diagnosable mental health disorder in the United States?
A.
B.
C.
D.
10%
50%
25%
65%
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Audience Response Questions
Which of these mental health problems has the highest annual
prevalence in the United States?
A.
B.
C.
D.
Schizophrenia
Bipolar disorder
Major depressive disorder
Generalized anxiety disorder
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Audience Response Questions
What percentage of of Americans will develop a mental health
disorder in their lifetime?
A.
B.
C.
D.
45%
70%
90%
30%
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DSM-5
• The Diagnostic and Statistical Manual of Mental Disorders, 5th
edition
• Official medical guidelines of the American Psychiatric
Association for diagnosing psychiatric disorders
• Sample – Generalized Anxiety Disorder (Box 1-3)
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ICD – 9-CM and ICD-10
• International Classification of Diseases
• Clinical descriptions of mental and behavior
disorders
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NANDA-I
• The North American Nursing Diagnosis
Association International
• (NANDA-I) describes a nursing diagnosis as a
clinical judgment about individual, family, or
community responses to actual or potential health
problems and life processes.
• NIC/NOC
• Evidence-based practice
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The DSM-IV-TR
Multiaxial System
• Axis I: Mental disorder that is the focus of
treatment
• Axis II: Personality disorders and mental
retardation
• Axis III: General medical disorder relevant to the
mental disorder in axis I
• Axis IV: Psychosocial and environmental
problems
• Axis V: Global Assessment of Functioning (GAF)
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Global Assessment of Functioning (GAF)
Scale
• Theoretical number used in planning care, measuring
treatment impact, predicting outcome (0 – 100)
• Hypothetical continuum of psychological, social and
occupational functioning
• 100 – superior functioning
• 70 – mild symptoms
• 50 – serious symptoms (may see hospitalization at this
level)
• 20 or below – definite hospitalization indicated
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Psychiatric Mental Health Nurses
• Employ purposeful use of self
• Use nursing, psychosocial, neurobiological theories and
research
• Work with people throughout the life span
• Employed in a variety of settings
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Levels of Psychiatric
Nursing Practice
•Basic Level - RN
•Advanced Practice- APRN
•Each has clearly defined roles
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Audience Response Questions
A person has a high level of resilience. Which other characteristic
would the nurse expect this person to have?
A. Optimism
B. Stubbornness
C. Agreeableness
D. Stoicism
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QSEN
• Patient-centered care: Care should be given in an
atmosphere of respect and responsiveness, and the
patient’s values (rather than our own), preferences, and
needs should guide care.
• Teamwork and collaboration: Nurses and
interprofessional teams need to maintain open
communication, respect, and shared decision making.
• Evidence-based practice: Optimal health care is the
result of integrating the best current evidence while
considering the patient/family values and preferences.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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QSEN
• Quality improvement: Nurses should be involved in
monitoring the outcomes of the care that they give. They
should also be care designers and test changes that will
result in quality improvement.
• Safety: The care provided should not add further injury.
Harm to patients and providers is minimized through both
system effectiveness and individual performance.
• Informatics: Information and technology is used to
communicate, manage knowledge, mitigate error, and
support decision making.
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QSEN
• Betsy Lehman was a health reporter for the Boston
Globe and was married to a cancer researcher. She
herself was diagnosed with cancer and was mistakenly
prescribed an extremely high and wrong dose of an
anti-cancer drug. Ms. Lehman sensed something was
wrong and appealed to the health care providers, who
did not respond. The day before she died, she begged
others to help because the professionals were not
listening (Robert Woods Johnson, 2011).
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QSEN
How could the application of QSEN prevented her death?
Patient centered care
Teamwork and collaboration
Evidence-based practice
Quality Improvement
Safety
Informatics
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