1. Slide 1Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts of Mental Health Chapter 34 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts of Mental Health The nurse can expect to use mental health nursing principles in a variety of health care settings. Basic mental health concepts are useful in understanding a patient’s behavioral responses to disease and dysfunction. Behavior is the manner in which a person performs any or all of the activities of daily living. Mental health is one’s ability to cope with and adjust to the recurrent stresses of everyday living.

4. Slide 4Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts of Mental Health Mental illness is evidenced by a pattern of behaviors that is conspicuous, threatening, and disruptive of relationships or deviates from acceptable behaviors. The nurse has the responsibility of assessing and intervening while maintaining a caring relationship of trust with the patient. Assist the patient and family to achieve satisfying and productive ways to deal with daily living. Building trust between the nurse and the patient is mandatory. Ways to do this include effective patient education. ( see bottom right page 1128 )

5. Slide 5Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care During early history, a physically or mentally ill person was thought to be possessed by evil spirits. For mental illness, the shamans or medicine men focused on removing evil spirits through magical treatments such as spells, potions, noises, or sacrifices and physical treatment such as vomiting, bleeding, massage, and trephining (cutting holes in the skull to release evil spirits). If these tribal rites were unsuccessful, the individual was abandoned to die by starvation or attack by wild animals.

6. Slide 6Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Mental illness during medieval times

7. Slide 7Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care In the Dark Ages, the church became powerful, and knowledge was kept in monasteries. Early Christians believed mental illness was punishment for sins committed, possession by the devil, or caused by witchcraft. Exorcisms, physical punishment and imprisonment, or banishment became the treatment for mental illness.

8. Slide 8Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Exorcist

9. Slide 9Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care During the 17th and 18th centuries, conditions for the mentally ill were worse than ever. Bleeding, starving, beating, purging, and confinement were the treatments of the day. During the latter half of the 18th century, psychiatry became a separate branch of medicine. In England, an asylum was built. The care was to encourage acceptable behavior by providing a nurturing atmosphere. In the United States, the Pennsylvania Hospital in Philadelphia was established for the treatment of the mentally ill.

10. Slide 10Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Pennsylvania Hospital in Philadelphia

11. Slide 11Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Popular mode of “curing” insanity

12. Slide 12Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care The 19th century saw the flourishing of institutions and asylums. Overcrowding and bureaucracy brought the decline of care provided by institutions. Dorothea Dix was appalled by the care of the mentally ill and set out to do something about it. Her efforts brought millions of dollars toward the development of mental hospitals throughout the United States.

13. Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The tranquilizer chair

14. Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The “Butter Barrel” and “Gyrator”

15. Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care The 20th century ushered in the reform of mental health care. The Committee for Mental Hygiene was formed in 1909; it focused on the prevention of mental illness and the removal of the stigma of mental illness. During the 1930s, electroconvulsive therapy (ECT) and insulin shock therapy were developed and used to treat schizophrenia. Frontal lobotomy was used to eliminate violent behavior.

16. Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. ECT

17. Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care In the 1940s, the passage of the National Health Act and the establishment of the National Institute of Mental Health were among the most important developments in the psychiatric medicine in the United States. The institute established research funding for the cause, prevention, and treatment of mental illnesses. The 1950s brought about the introduction of psychotherapeutic drugs causing deinstitutionalization. During the 1960s and 1970s, legislatures brought about changes in mental health treatment at the community level.

18. Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 1 st generation antipsychotics

19. Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Overview of Mental Health Care The Omnibus Budget Reconciliation Act of 1981  The act drastically reduced funding for the mental health system and put the monies into block grants for the community to use.  Deinstitutionalization was rapid, putting many mentally ill patients from state institutions into the streets. Now, in the 21st century, mental health concepts and principles are practiced in a variety to settings, including public health and home health care facilities, outpatient settings, and acute care hospitals.

20. Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Mental Health Continuum  On the illness end, the person is rarely in touch with reality, but on the healthy side, the person demonstrates a high level of wellness.  High-level wellness : a person who is able to handle multiple tasks, responsibilities and roles without interruption in their “mental” well-being.

21. Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Mental Health Continuum (continued)  Assessment of components of mental health A positive self-concept Awareness of responsibility for one’s behavior and its consequences Maintenance of satisfying interpersonal relationships Adaptability to changes Effective communication Awareness and acceptance of emotions and their expressions Recognition and use of supportive system

22. Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 34-4 Support system of family and friends as a component of mental health. (From Varcarolis, E.M.[2002]. Foundations of psychiatric mental health nursing. [4 th ed.]. Philadelphia: Saunders.)

23. Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Mental Health Continuum (continued)  The point at which a person is deemed to be mentally ill is determined by the behavior exhibited as well as the context in which the behavior is observed.  Mental illness results from an inability to cope with an overwhelming situation.

24. Slide 24Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Mental Health Contiuum

25. Slide 25Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 34-3 Mental health continuum.

26. Slide 26Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

27. Slide 27Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Personality and Self-Concept  Personality The relatively consistent sort of attitudes and behaviors particular to an individual  Patterns of mental, emotional, and behavioral traits woven together  Influenced by genetics and interactions with the environment  Individual’s internal and external patterns of adjustment to life

28. Slide 28Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Personality and Self-Concept (continued)  Erik Erikson Provided a framework for understanding personality development  If a given task is not mastered, then a set of behaviors can be predicted.

29. Slide 29Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. What do you see???

30. Slide 30Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Personality and Self-Concept (continued)  Sigmund Freud Personality development as having three parts  Id: Functions on a primitive level and is aimed primarily at experiencing pleasure and avoiding pain  Ego: Functions to integrate and mediate between the self and the rest of the environment  Superego: The moralistic censoring force; develops from the ego in response to reward or punishment from others  Responsible for the concept of “psychotherapy.”

31. Slide 31Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Personality and Self-Concept (continued)  Self-concept This is the framework of reference the individual uses for all he or she knows and experiences. It includes all perceptions and values held by the individual and the individual’s behaviors and interactions. During growth and development, the individual accumulates and processes information that helps form a basic perception of who he is, how he looks, and how others react to him.

32. Slide 32Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Stress  Stress is the nonspecific response to the body to any demand made on it.  An individual’s response to stressful situations or events is often a result of learned or conditioned behavior.  Stressor examples Physical, social or spiritual, economic, chemical  Mental health nursing concerns itself with behavior, particularly a person’s response to stressors.

33. Slide 33Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Anxiety  This is a vague feeling of apprehension that results from a perceived threat to self.  Anxiety is a major component of all mental health disturbances. Mild forms ready the body to meet stressful demands.  Problem solving and constructive action Severe forms interfere with daily activities.  Immobilized coping skills and result of emotional chaos

34. Slide 34Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Levels of Anxiety Stage / level one of anxiety (mild) : can be productive, readies us for action ex: study for a test. Stage / level two (moderate) : physical symptoms present…headache, upset stomach, diarrhea etc… Stage / level three (severe) : obvious change in vital signs…B/P goes up, pulse accelerates etc… Stage / level four ( panic ) : perception is gone. This is a potentially dangerous situation. The nurses’ PRIMARY responsibility at this level is to stay with the patient. Do not leave the patient alone !!!! At some point in this level the nurse may attempt to instruct the patient on deep breathing/relaxation techniques.

35. Slide 35Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. What level of anxiety would this scenario produce??

36. Slide 36Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Anxiety (continued)  Degree of anxiety influenced by How the person views the stressor The number of stressors being handled at one time Previous experience with similar situations Magnitude of change the event represents for the individual

37. Slide 37Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Motivation  The gathering of personal resources or inner drive to complete a task or reach a goal May be generated by  Perceived reward  Perceived threat of punishment The motivation to participate in care helps the patient through the stages of recovery quickly.

38. Slide 38Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Frustration  This involves anything that interferes with goal- directed activity.  Some people are more flexible and adaptable than others.  When adaptive behavior fails, anxiety increases and as a result emotional upheaval may occur !!

39. Slide 39Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Conflict  This is a mental struggle, either conscious or unconscious, resulting from the simultaneous presence of opposing or incompatible thoughts, ideas, goals, or emotional forces, such as impulses, denials, or drives.  Some conflicts are easily resolved; others are more complicated.

40. Slide 40Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Adaptation and Coping  Adaptation An individual’s ability to adjust to changing life situations using various strategies  Coping responses: Used to reduce anxiety brought on by stress Examples: Overeating, drinking, smoking, withdrawal, seeking someone to talk to, yelling, exercising, fighting, pacing, or listening to music Healthy coping responses: talking to a friend, music, problem solving/delegating etc…  May be used consciously or unconsciously

41. Slide 41Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts Related to Mental Health Adaptation and Coping (continued)  Defense mechanisms Unconscious intrapsychic reactions that offer protection to the self from a stressful situation Behavioral patterns that protect the individual against a real or perceived threat Blocking conscious awareness of threatening feelings Learn defense mechanisms !!!

42. Slide 42Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Illness Behaviors Illness  This is a state of homeostatic imbalance.  When a person does not feel well, the body is saying, “Pay attention to my needs.” Crisis  This is a time of change or turning point in life when patterns of living must be modified to prevent disorganization of the person or family.  Some individuals have difficulty coping with an illness or crisis.  Behavior is learned, and individuals bring their learned behavior patterns into the health care setting.

43. Slide 43Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. How Illness Affects Mental Health Illness Behaviors  Illness is the state of homeostatic imbalance.  Crisis is a time of change or turning point in life when patterns of living must be modified to prevent disorganization of the person or family.  Some individuals have difficulty coping with an illness or crisis.

44. Slide 44Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. How Illness Affects Mental Health Illness Behaviors (continued)  Common behaviors seen with illness Denial Anxiety Shock Anger Withdrawal

45. Slide 45Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Crisis Intervention A serious illness, the breakup of a relationship, a car accident, or the death of a loved one can trigger a crisis response in an individual or a family. Phases of Crisis Similar to Stages of Grief  Confusion, disbelief, and high anxiety  Denial  Reality; anger and remorse  Sadness and crying  Reconciliation and adaptation

46. Slide 46Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Crisis Intervention Nursing Interventions  Provide accurate information that aids in realistic perception of the situation. See patient teaching box on page 1131  Encourage venting of feelings.  Identify family supports and adequate coping mechanisms.  Active listening and restating the facts.

47. Slide 47Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment of emotional status Box 34-7 page 1132 Use of the nursing process to meet the needs of the patient Assessing the patients “emotional” status is a PRIORITY !!! The nurse must evaluate the patients emotional status in order to make adjustments in the plan of care… Affect: outward expression of inward emotions example: flat affect: no facial expression…patient may receive horrific news yet their facial expression will remain unaffected. Seen frequently in schizophrenics

48. Slide 48Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 34 Review Know definitions of key terms such as behavior, mental health, anxiety, crisis, rationalization, high level wellness, self concept, roles, regression, frustration, mental illness, affect, denial, deinstitutionalization, id, ego, super ego, panic, conflict, coping responses and therapeutic communication. Be familiar with nursing interventions for building trust, emotional assessments, and dealing with the depressed patient. Be able to differentiate the levels of anxiety. Understand the mental health continuum

49. Slide 49Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Review chapter 34 continued : Recognize healthy versus unhealthy coping mechanisms Understand “emotional “ assessment Know factors that influence the degree of anxiety that someone may experience when stressed