MENTAL HEALTH CHAPTERS 1,2,3,4,6,7
Mental health◦ Ability to “cope with and adjust to the recurrent
stresses of living in an acceptable way”◦ Mentally healthy people successfully carry out
activities of daily living, adapt to change, solve problems, set goals, and enjoy life.
◦ Mentally healthy people cope well.◦ Mental health is influenced by three factors:
Inherited characteristics Childhood nurturing Life circumstances
Mental Illness is a disturbance in ones ability to cope effectively
CHAPTER 1
Early civilizations believed that mental illness was caused by wrath or evil spirits and by possessions.
Treatments were geared to removal of the evil spirit.◦ Examples- trephining(drilling holes in skull to
release evil spirits), Incantations, charms, sacrifice.
Mentally ill people were allowed to remain in societies as long as their behaviors were not violent. ◦ Violent members were banished.
Chapter 1Primitive Societies
The Greeks took many of their medical beliefs from other societies. Felt that mental illness can be explained through observation.
Hippocrates◦ Believed that nature was a strong healing force◦ Viewed mental illness as an imbalance of humors (air, fire, water, and
earth), overabundance or lack of one or more humors caused illness. This was known as humoral therapy- which lasted for centuries.
Plato◦ Recognized life as a dynamic balance maintained by the soul
Rational soul (head) Irrational soul (heart and abdomen)
◦ Believed that mental illness resulted when the rational soul was not able to control the irrational soul
By about 300 AD, epidemics had killed thousands, and the sick turned to churches for sanctuary.
Hospitals then were built to accommodate sufferers.
Chapter 1Greece and Rome
The Dark Ages◦ Priests were the caregivers for the sick.◦ Early Christians believed that disease was punishment for sins,
possession by the devil, and witchcraft.◦ To cure mental illness, many priests performed exorcisms and religious
ceremonies to drive out evil from affected individuals. Dark Ages
◦ Church doctrine stated that if people were insane, an outside force was causing the disorder.
◦ Church scholars even suggested that witches might be the source of human distress.
◦ Large institutions were established, and mentally ill individuals were herded into “lunatic asylums
Strong Arabic influence was felt in Europe.◦ Arabs had an extensive knowledge of drugs and awareness of the relationship
between emotions and disease. ◦ Universities were established- study medicine, surgery and care of the sick.
Chapter 1Middle Ages
Women were thought to be carriers of the devil because they stirred men’s passions.
Witch hunting was officially launched in 1487 with publication of the book The Witches’ Hammer. Due to this book receiving support from the Pope, many people were women, as well as children, and the mentally ill were burned at the stake
Few safe havens were available for individuals with mental illness during these troubled times.
Superstitions, Witches, and Hunters
The first English institution for mentally ill people was founded in 1247 by the Sheriff of London.
By 1330, Bethlehem Royal Hospital (or Bedlam) was a lunatic asylum. - Became infamous for its abuse to patients
Violently ill patients were chained to walls in small cells and often provided “entertainment” for the public
The First Mental Institutions
The Renaissance began in Italy around 1400. Mental illness was at last being recognized without
bias. By the mid-1500s, behaviors were accurately
recorded for personalities associated with melancholia (depression), mania, and psychopathology.
Despite advances in knowledge, the treatment of mentally troubled people remained inhumane.
Mental problems now were thought to be caused by some sort of brain disorder.
Sexual fantasies were still considered to be God’s punishment.
The Renaissance
It was during the seventeenth century that conditions for mentally ill individuals were at their worst.
People were still uncomfortable so they again moved to witch hunting as a way of protecting themselves from the unexplainable
Physicians and theorists were making observations and speculations about insanity.
Patients were bled, starved, beaten, and purged into submission.
Seventeenth Century
Psychiatry developed as a separate branch of medicine- later part of the 18th century
Inhumane treatment and vicious practices were openly questioned.
1792, Philippe Pinel liberated patients from their chains and advocated acceptance of the mentally ill as human beings in need of medical and nursing care.
In America, the Philadelphia Almshouse was erected. It accepted sick, infirm, prisoners, orphans and insane patients
The care and treatment of people with mental illness remained harsh in the United States as it was in Europe. ◦ Care for the mentally ill did not begin to improve until the
arrival of Alice Fisher, a Florence Nightingale-trained nurse.
Eighteenth Century
Dr. Benjamin Rush became a crusader for the insane.◦ His book titled Diseases of the Mind was the first psychiatric
text written in the United States. He advocated clean conditions and kindness
Mildly mentally affected people commonly were sold at slave auctions, while the more violent remained in asylums.
“Once insane always insane” was no longer the rule as people were being helped.
Dorothea Dix surveyed asylums, jails, and almshouses. Because of her voice, care of the mentally ill greatly improved.
By the late 1800s, a two-class system of psychiatric care had emerged: “private care” for the wealthy and “publicly provided care” for the remainder of society.
Nineteenth Century United States
Clifford Beers wrote A Mind That Found Itself. ◦ A student from Yale who attempted suicide. He
spent three years as a patient in a mental institution and spoke of the beatings, isolation, and confinement of the mentally ill person.
◦ The social consciousness of a nation had finally been awakened.
Committee for Mental Hygiene was formed in 1909.◦ Focused on removing the stigma of mental illness◦ Under Beers guidance, the movement grew nation
wide.
Twentieth Century
Sigmund Freud ◦ Introduced the term psychoanalysis to the world ◦ Felt that forces within and outside the personality were
responsible for mental illness ◦ His theories dealt with the theme of repressed
sexual energies. ◦ He succeeded explaining human behavior in
psychological terms ◦ Presented the first comprehensive theory of
mental illness based on observation
Psychoanalysis
During World War I, men were drafted into service as rapidly as they could be processed.◦ Many were considered too “mentally deficient” to fight.
Plans were created to devise methods for early identification of problems, removal of mentally troubled personnel from combat duty, and early treatment close to the fighting front. War sparked a renewed interest in mental hygiene.◦ Drugs such as amphetamines were introduced. ◦ Insulin therapy was used for schizophrenia.◦ Electroconvulsive therapy (ECT) helped to improve severe
depression. ◦ Lobotomy helped eliminate violent behaviors.
In 1937, Congress passed the Hill-Burton Act.◦ Funded the construction of psychiatric units throughout the
United States
Influences of War
In 1946, Congress passed the National Mental Health Act. Provided funding for programs in research, training of mental health professionals, and expansion of facilities.
In 1949, the National Institute of Mental Health was organized.
As a result of the Korean War of the 1950s and the Vietnam War of the 1960s and 1970s, posttraumatic stress disorders became recognized among soldiers fighting wars.
Influences of War
Psychotherapeutic drugs are chemicals that affect the mind.
John Cade discovered that lithium carbonate could be used to control mood swings in bipolar (manic-depressive) illness.
Chlorpromazine (Thorazine) was introduced in 1956 and proved useful in controlling many behaviors observed in schizophrenia and other psychoses.
Psychotherapeutic Drugs
The federal government began the movement called deinstitutionalization. ◦ From 560,000 in 1955, the number of
institutionalized patients dropped to fewer than 120,000 people by 1994.
It was believed that people with mental disorders could live within their communities and work with their therapists on an outpatient
Functioning Outside of the Institution
The Community Mental Health Centers Act (1963)◦ Congress passed amendments to the Community Mental
Health Centers Act in 1975. The Medicare/Medicaid Bill of 1965- led to the release of
institutionalized patients into the community The President’s Commission on Mental Health (1978)-
Assess the mental health needs of the community Mental Health Systems Act (1980) Omnibus Budget Reconciliation Act of 1981 Omnibus Budget Reconciliation Act of 1987 National Alliance for Mental Illness (NAMI) (2006)
◦ Conducted the “first comprehensive survey and grading of state adult mental healthcare systems conducted in more than 15
Congressional Actions
Chapter 2Current Mental Health Care Systems
Inpatient care◦ Inpatient psychiatric admissions are based on
need. ◦ Clients must be able to pay for services and
cooperate with care providers; their level and severity of illness are also factors.
◦ Inpatient care provides clients with safe, stable, and therapeutic surroundings 24 hours a day.
◦ Clients may be committed to psychiatric care by way of the criminal justice system.
Care Settings
Outpatient care◦ Provides services to people with mental
problems in their home environment◦ Clients are able to remain within their
communities and associate with the real world. People who are unable to function in the
community setting experience recidivism.◦ Behavior pattern with relapse of a symptom,
disease, or behavior
Care Settings
The community support systems (CSS) model views clients holistically.
The goal is to create a support system that fosters individual growth and movement toward independence. ◦ Coordinated social, medical, and psychiatric
services assist this model in being successful.
Community Support Systems Model
The case management system
◦ A holistic system of interventions, designed to support the transition of mentally ill clients into the community Psychosocial rehabilitation Consultation Resource linkage (referral) Advocacy Therapy Crisis intervention
◦ Clients are involved with assessment, planning, and evaluation of their care.
Multidisciplinary health care team◦ Professionals working within the mental health system have various
educational backgrounds.◦ The care team assists in providing quality client care and consists of
psychiatrists, social workers, psychologists, nurses, and others who share their professional expertise and develop therapeutic plans for clients.
Client and family◦ Clients contribute important information that may make the difference
between success or failure of therapeutic plans.
Community Mental Health Settings
Certain groups of people in every community are at high risk for developing mental health problems.◦ Homeless people ◦ Children, families, adolescents, and older adults◦ People who are HIV (human immunodeficiency
virus) positive◦ Clients who live in rural areas
High-Risk Client Populations
Economic issues◦ Funding has not kept pace with the need for
services.◦ Congress established the Health Care Financing
Administration in 1983. Social issues
◦ Mentally ill individuals are likely to be struggling with basic issues, such as poverty, homelessness, and substance abuse.
Factors That Affect Mental Health Care
Chapter 3 Ethical and Legal Issues
Attitudes are ideas that help shape our points of view.◦ Can also describe one’s outlook
Belief is a conviction that is intellectually accepted as true whether or not it is based in fact.
Value is something that is held dear or a feeling about the worth of an item, idea, or behavior.◦ Formed in childhood
Morals reflect one’s attitudes, beliefs, and values.◦ Not easily changed
Values and Morals
A right is described as a power, privilege, or existence to which one has a just claim.
Rights help to define social interactions because they contain the principle of justice; they equally and fairly apply to all citizens.
Rights also are associated with obligations.
Rights
The Patient’s Bill of Rights (1972)◦ All clients have the rights to respectful care,
privacy, confidentiality, continuity of care, and relevant information.
◦ Addresses clients’ rights to Examine their bills Refuse treatment Participate in research
The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities was adopted in 2003.◦ Statements of rights for the most vulnerable people
in society.
Patient’s Rights
Ethics is a set of rules or values that govern right behavior. Ethics reflect
◦ Values◦ Morals◦ Principles of right and wrong
The purpose of ethical behavior is to protect the rights of people. Ethical codes serve two purposes: ◦ Act as guidelines for standards of practice◦ Let the public know what behaviors can be expected from their health care
providers Ethical principles on which codes of ethics are based include the
following: Autonomy- Right of people to act for themselves and make choices Beneficence- To actively do good Nonmaleficence- Do No Harm Justice- all clients are treated equally Fidelity- Do what you say-keep your promises Veracity- duty to tell the truth
Ethics/Ethical Behaviors
Have been developed by◦ International Council of Nurses◦ American Nurses Association◦ National Federation of Licensed Practical Nurses◦ Canadian Nurses Association
Provide information to clients, be truthful, and support your clients, but consult your supervisor if any question of appropriateness arises.
Codes of Ethics
Ethical dilemmas exist when there is uncertainty or disagreement about the moral principles related to a course of action.
Ethical dilemmas arise when problems cannot easily be solved by decision making, logic, or use of scientific data.
Ethical Conflict
Laws are the controls by which a society governs itself.◦ Apply to every member of society◦ Created as a result of
Rules Regulations Morals Ethical principles
Laws and the Legal System
Public law◦ Focuses on the law between government and its
citizens◦ Protects the members of society◦ Also known as criminal law◦ Consists of misdemeanors and felonies
Private law◦ Focuses on the law between citizens and/or
institutions◦ Torts and contracts◦ Also known as civil law
Public vs. Private Law
Client-caregiver relationship◦ Caregiver and client enter into an implied contract
of acceptance of service. ◦ Care providers are legally responsible for their
professional obligations and behaviors.
Laws and Mental Healthcare
When a client initiates the request for mental health services, it is considered a voluntary admission.◦ Voluntarily admitted clients may legally discharge
themselves at any time. Involuntary admission is a process for
institutionalization initiated by someone other than the client. ◦ Involuntary psychiatric admissions provide a
protected, therapeutic environment.◦ Clients may stay for days to years.
Adult Psychiatric Admissions
Care providers in mental health are faced with balancing client rights and the need to protect society.
The most common crimes in health care settings include homicide, controlled substance violations, and theft.
Areas of Potential Liability
Both negligence and malpractice are rooted in the “reasonable and prudent person” theory.
Negligence ◦ Omission (or commission) of an act that a
reasonable and prudent person would (or would not) do
Malpractice ◦ Failure to exercise an accepted degree of
professional skill that results in injury, loss, or damage
Negligence and Malpractice
Mental health care providers help clients cope with their problems.
They provide dignified, humane treatment, which includes protection of rights as human beings, citizens, and clients.
Responsibility of the Care Provider
Chapter 4Sociocultural Issues
Culture is a total way of life. ◦ Shared system of values that provides a framework for
who we are Race describes a group of people who share
distinct physical characteristics.◦ Skin color, facial features
Ethnicity is associated with the customs, cultural habits, and socialization patterns of a particular group. ◦ Values, traditions, expectations, and customs are passed
from one generation to another.
The Nature of Culture
Spirituality and religion play important roles in the concept of culture.
Spirituality refers to belief in a power greater than any human being.
Religion relates to a defined, organized, and practiced system of worship.◦ Often mental health clients have religious components
to their illnesses. Culture is an abstract concept, composed of the
values, beliefs, roles, and norms of a group. ◦ Cultural values strongly influence thinking and actions.
A culture’s belief system develops over generations. ◦ Formed by feelings and convictions that are believed to
be true
The Nature of Culture
Beliefs about mental health have a strong impact on outcomes of treatment.
Values and beliefs help to define norms, which are a culture’s behavioral standards.◦ Norms are the established rules of conduct that define
which behaviors are encouraged, accepted, tolerated, and forbidden within a culture.
◦ A role is an expected pattern of behaviors associated with a certain position, status, or gender.
Stereotype is an oversimplified mental picture of a cultural group.◦ Stereotyping may take negative, positive, or traditional
forms. ◦ Prejudice (extreme negative stereotyping)
Health care providers need to know and understand their own racial, ethnic, religious, and social stereotypes.
Characteristics of Culture
Health care providers should practice cultural competence.◦ Transcultural nursing
All care providers must guard against the tendency to transfer their own cultural expectations onto clients or to make generalizations based on their own cultural attitudes
Cultural assessments allow us to learn how clients perceive and cope within their world. ◦ Communication
Verbal and nonverbal components
◦ Environmental control How the individual perceives he/she controls the environment
◦ Space, territory, and time Space comforts, control over space, concept of time
Cultural Assessment
Treating refugees◦ A refugee is a person who, because of war or
persecution, flees from his or her home or country and seeks refuge elsewhere.
◦ Stress-related problems are a factor. ◦ Obtain immigration history and a history of
arrival to the new country, time, and who or what was lost.
◦ Refugees tend to have a greater incidence of depression, anxiety, and stress disorder.
Culture and Mental Health Care
Chapter 6Complementary and Alternative Therapies
Allopathic medicine◦ Uses medical and surgical methods to treat
disease Complementary medicine
◦ Treatments that agree or “work with” allopathic therapies Massage
Alternative medicine◦ Treatments that are used instead of
conventional medicine Herbal therapy
Alternative and Complementary Therapies
Integrative medicine attempts to blend the most effective practices and treatments from both conventional and alternative treatment systems. ◦ Emphasis is on interrelationships among body,
mind, and spirit. ◦ Holistic care
We are no longer content to treat the illness. We are learning to treat the whole person.
Integrative Medicine
National Center for Complementary and Alternative Medicine◦ Dedicated to exploring complementary and
alternative healing practices in the context of rigorous science
◦ CAM therapies can be divided into two basic groups. Body-based CAM Energy-based CAM
NCCAM
Whole medical systems◦ Ayurveda
Focus is on the innate harmony of the body, mind, and spirit.
◦ Homeopathy Uses natural substances in micro-doses to relieve
symptoms◦ Naturopathy
Views disease as an alteration in the process by which the body heals itself
◦ Traditional Chinese medicine (TCM) Based on the view that the body is a delicate balance of
opposing forces: yin and yang
Body-Based CAM
Biologically-based practices attempt to improve the human condition through the use of substances extracted from nature.
Examples◦ Aromatherapy
Use of certain scented essential oils to promote health and well-being
◦ Dietary supplements “Dietary ingredient” supplement to the diet
◦ Herbal products Use of certain plants (herbs) to treat disease and alleviate
suffering
Biologically-Based Practices
Practices that focus on moving the body into an improved state of function through treatment
Examples◦ Chiropractic treatment
Relationship between body structure (the spine) and function is the subject of study for chiropractic care.
◦ Chelation Uses the chemical ethylenediaminetetraacetic acid (EDTA) and its ability
to bind with heavy metals
Examples◦ Eye movement desensitization
Uses controlled eye movements to help reprocess traumatic memories
◦ Massage Manipulation of muscles and connective tissue to relax the body and
enhance well-being
◦ Phototherapy Use of bright lights for the treatment of depression
Body-Based Practices
Practitioners believe in a vital, life-force energy that flows through the human body.
Energy medicine is divided into two parts.◦ Biofield therapies
Examples include acupuncture, biofeedback, Qi Gong, Reiki, therapeutic touch, and color therapy.
◦ Electromagnetic field therapies The use of energy to treat illness Examples include magnetic therapy, repetitive
transcranial magnetic stimulation (TMS), pulsating electromagnetic therapy, and millimeter wave therapy.
Energy Medicine
Alternative approaches to mental illness emphasize the interactions of body, mind, and spirit.◦ Animal-assisted therapy◦ Culturally based healing◦ Diet and nutrition◦ Expressive therapies◦ Pastoral counseling◦ Self-help groups◦ Stress reduction and relaxation
CAM Mental Health Therapies
Chapter 7Psychotherapeutic Drug Therapy
Psychiatric medications act on the body’s nervous system primarily by altering the delicate chemical balances within that system.
Most interrupt the chemical messenger (neurotransmitter) pathways within the brain.
A primary responsibility of health care providers, especially nurses, is to differentiate therapeutic from unwanted effects.
How Psychotherapeutic Drug Therapy Works
Four classes of psychotherapeutic drugs:◦ Antianxiety agents◦ Antidepressants ◦ Antimanics◦ Antipsychotics
People who are receiving medications must be monitored routinely for effectiveness, side effects, and life-threatening adverse reactions.
Classifications of Psychotherapeutic Drugs
Antianxiety agents are drugs that reduce the psychic tension of stress. ◦ Anxiolytics or “minor tranquilizers”
Medications in the antianxiety group are divided by their chemical formulas into categories.
Benzodiazepines◦ Mainly used to decrease anxiety◦ Act by increasing gamma-aminobutyric acid
(GABA) activity, which results in decreased anxiety◦ Because long-term use of antianxiety drugs can
result in dependence, therapy for clients usually is limited to a few months.
Antianxiety Medications
Buspirone (BuSpar)◦ Belongs to the azaspirone drug class◦ Does not cause the sleepiness or muscle relaxation
associated with benzodiazepines◦ Therapeutic effects not seen for 3 to 6 weeks after
treatment initiation Pregabalin (Lyrica)
◦ Side effects are fewer than those of other antianxiety drugs so patients are more likely to comply with treatment.
Interactions◦ Central nervous system (CNS) depression when combined
with CNS depressants◦ Increased concentrations of the cardiac drug digoxin◦ Interfere with absorption into the bloodstream when taken
with antacids
Antianxiety Medications
Antidepressant medications act on the body by increasing certain neurotransmitter activities.
The physician’s first choice for the treatment of depression is often an antidepressant.
Antidepressants are divided into categories:◦ Tricyclic antidepressants◦ Monoamine oxidase inhibitors (MAOIs)◦ Selective serotonin reuptake inhibitors (SSRIs)◦ Atypical antidepressants◦ Selective serotonin/norepinephrine reuptake inhibitors (SSNRIs)
Antidepressant medications may be taken 1 to 4 weeks before symptom relief is noted.
Side effects include dry mouth, nose, and eyes, urinary retention, and hypertensive crisis.◦ These discomforts can be so bothersome that some people
refuse to take their medications regularly. MAOIs have many drug and food interactions
Antidepressant Medications
Lithium◦ Naturally occurring salt used to treat the manic
phase of bipolar depression◦ Well absorbed into the bloodstream and
excreted faster than sodium by the kidneys Important for clients to balance their salt intake, fluid
intake, and activity◦ Interacts with a variety of other drugs◦ Levels higher than 1.5 mEq/L are considered
toxic.◦ Clinical improvement commonly takes as long
as 3 weeks.
Antimanic Medications
Antipsychotics also are called major tranquilizers or neuroleptics.◦ Used to treat the symptoms of major mental disorders
(schizophrenia, acute mania, and organic mental illnesses) and resistant bipolar (manic-depressive), paranoid, and movement disorders
Interactions◦ Antacids
Hinder the absorption of antipsychotics into the bloodstream◦ Alcohol◦ Antianxiety medications◦ Antihistamines◦ Antidepressants◦ Barbiturates◦ Meperidine (Demerol) and morphine
Produce severe CNS depression when mixed with antipsychotics
Antipsychotic Medications
Noncompliance is an informed decision made by a client not to follow a prescribed treatment program.◦ The physician should be notified. ◦ Work with your clients to find and eliminate the
factors that lead to noncompliance
Noncompliance
Presenting clients with information about the benefits, risks, and side effects of specific treatments ◦ Enabling them to make voluntary and
knowledgeable decisions about their care Patient Self-Determination Act
◦ States that clients have the right to accept or refuse care and cannot be pushed, coerced, or talked into following a certain course
Informed Consent
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