Introduction to Mental Health Nursing Judith Wikel RN BSN MEd

 Review Mental Health Care in Britain, Australia, and the United States  Britain 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 Canada  Government-administered health plan Based on five principles Universality Portability Accessibility Comprehensiveness Public 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…  Holistically  As 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 Interventions  Community Teams…  Meet with clients 2-4 times per week  Accompanies client to appointments and other community activities  Help with daily living/social skills needs  Monitors medications  Nurtures relationships with persons interested in client’s well-being  Encourages client to call team instead of using ER

 Examples of Community Services…  Serving Individuals Rape crisis centers Meals on Wheels

 Serving Families  Women, Infants, and Children (WIC) Helps single parent families with nutritious food.

 Serving the Community  Utility companies  Government agencies  Prisons

 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.

 Holistic  The 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 Interviews  Personal values must not cloud professional judgments.  Do not make assumptions  Take into account the client’s cultural and religious values and beliefs  Pay particular attention to nonverbal communications  Have clearly set goals  Monitor your own reactions – DO NOT be judgmental.

 General description  Emotional state  Experiences  Thinking  Sensorium and cognition Please refer to Table 9-4 on page 91.

 Thought process (how one thinks)  Blocking  Flight of ideas – Rapid changes from on thought to another related thought  Loose associations  Perservation

 Though content (what one thinks)  Delusions  Obsession  Phobias  Preoccupations

 Others  Amnesia  Confabulation

 Recent memory is recall of events occurring within the last two weeks.  Remote memory is asking the client to recall events form person’s background.

 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 collection  Objective 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.  Age  Ethnicity  Culture  Gender  Education  Income  Belief 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