1. Psychiatric Mental Health Nursing Section I: Core Concepts for clinical practice

2. Mental Health is Everywhere Applications for a broad scope of areas of nursing practice, for example: – Maternal Child Nursing – Palliative Care and Hospice Nursing – Acute Care Nursing across the Lifespan – Community Nursing – Elder Care Nursing – What else?

3. Mental Health is Everywhere: The Learning Space Classroom space models the clinical space Ethical Congruence means that a respectful, non- judgmental attitude and carries over from the classroom to the clinical area and vice versa. Unfortunately, the converse also applies. Ethical congruence takes practice…we are all a work in progress. Social Media use: Clinical and classroom

4. Now let’s look at the historical and societal context for mental health and mental illness…

5. Bethlem Royal Hospital is the original ‘Bedlam’, one of the world’s oldest hospitals for the treatment of mental illness (1247-1948)

6. Inside Bedlam: How are historical Images of mental illness still very much with us today?

10. The ‘lunatic’ asylum.. (New York, 1900s)

16. Google-ing “crazy” 2011 2011 images of ‘crazy’

29. So…What words or ideas come to mind?

30. A modern example… “The doorway physical exam” Maden, S. (2002). Canadian Medical Association Journal 167(12), p. 1356

31. Mental health: Discrimination, Stigma and Cultural Safety What is discrimination? (please see diagram on next slide and handout) – Biased information leading to a stereotype (fixed image) – Prejudice (a way of thinking based on a stereotype) – Discrimination (action or inaction, based on prejudice) What is stigma? – Refers to negative attitudes (prejudice) and negative behaviour (discrimination) (Canadian Mental Health Association, 2011)

32. 1. Biased information leads to stereotyping Stereotyping: An often negative exaggerated belief, fixed image, or distorted idea held by persons, groups, political/economic decision makers 2. Prejudice A way of thinking based on stereotypes 3. Discrimination Action or inaction based on prejudice Source: Adapted from: McGibbon, E., Etowa, J. & McPherson (2008). Health care access as a social determinant of health. Canadian Nurse Journal, 104 (7), 22-27 The Cycle of Oppression 4. Oppression Discrimination backed up by systemic power (e.g. government, education, legal, and health system policies;

33. What is cultural safety? Was developed by Indigenous Maori nurses in New Zealand, originally meaning ‘no assault on a person’s identity’ Cultural safety moves beyond the traditional concept of cultural sensitivity (being accepting of difference) to analyzing power imbalances, institutional discrimination, and colonization. Current concepts of cultural safety are based on the Maori definition, and have been expanded to include a broad range of peoples and groups who experience discrimination and hence unsafe care…who are some of these groups?

34. Something to think about: How are stigma, discrimination and cultural safety all connected?

35. Discrimination, stigma, cultural safety and the CNA Code of Ethics 1.Providing safe, compassionate, competent and ethical care 2.Promoting health and well being 3.Promoting and respecting informed decision- making 4.Preserving dignity 5.Maintaining privacy and confidentiality 6.Promoting justice 7.Being accountable

36. Introduction to the Mental Status Exam Clinical Purpose Components (Text p. 138); Clinical documents for Addictions and Dementia

37. Components of the MSE Appearance, Attitude, Behaviour Speech Mood Affect Thought Form Thought Content Perceptions Cognitive Function Judgment and Insight