Mental Health and Mental Illness CHAPTER 1

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 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

3 Seven Signs of Mental Health Mental Health

Mental Health: Some Attributes 4

Factors That Can Affect Mental Health 5

6 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

7

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 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?

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Resilience Ability and capacity to secure resources needed to support well-being Characterized by Optimism Sense of mastery Competence Essential to recovery

10 Mental Health-Illness Continuum All Human Behavior lies along a continuumMental IllnessHealth

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 11

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 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?

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 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

Contrast and compare the focus and approach of the mental health recovery model to the evidence-based practice (EBP) model. Recovery Model Consumers as partners Mental health care: Consumer and family driven Increasing consumer's ability in: Coping, facilitating recovery, and building resilience Individualized care: Consumer centered and recovery oriented EBP Model 1990s “Decade of the Brain” Scientific evidence for psychologic and sociologic treatments Neurobiology of psychiatric disorders Psychopharmacology Medical model 14All Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.

Substance Abuse and Mental Health Services Administration (SAMHSA) 15 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16 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

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 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

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Audience Response Questions  How many Americans per annum (snapshot of one year) have a diagnosable mental health disorder in the United States? A. 10% B. 50% C. 25% D. 65%

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19 Audience Response Questions  Which of these mental health problems has the highest annual prevalence in the United States? A. Schizophrenia B. Bipolar disorder C. Major depressive disorder D. Generalized anxiety disorder

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20 Audience Response Questions  What percentage of of Americans will develop a mental health disorder in their lifetime? A. 45% B. 70% C. 90% D. 30%

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21 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)

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 22 ICD – 9-CM and ICD-10 International Classification of Diseases Clinical descriptions of mental and behavior disorders

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 23 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

24 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)

25 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

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 26 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

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 27 Levels of Psychiatric Nursing Practice Basic Level - RN Advanced Practice- APRN Each has clearly defined roles

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 28 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

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 29 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. 30 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.

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 31 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).

Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 32 QSEN How could the application of QSEN prevented her death? Patient centered care Teamwork and collaboration Evidence-based practice Quality Improvement Safety Informatics