1. Mental health and mental illness
Psychiatric Nursing
Mental health and mental illness

2. 1- Define and explain mental disorder
Objectives
1- Define and explain mental disorder
2- Analyze why the term deviant behavior lacks a definition that covers all situations
3- Compare and contrast the essential characteristics of mental health with mental disorder
4- Name the five mental disorders that rank among the top ten causes of disability worldwide
5- Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history
6- Explore the meaning of stigma for clients, families, friends, communities, and mental health caregivers and agencies

3. Caring for Psychiatric Mental Health Clients
Facing the unknown in a psychiatric–mental health setting invites a variety of feelings, concerns, and questions. Expectations related to caring for psychiatric–mental health clients are influenced by a number of factors

4. Factors Influencing Expectations
Media
Other?
Upbringing
Expectations
Life experiences
Culture

5. Psychiatric Mental Health Clients
Psychiatric mental health clients are everyday, ordinary people.
Given the right circumstances, anyone can experience a mental health problem ranging from mild and temporary to severe and persistent.
Client because of its association with empowerment and self responsibility and optimistic beliefs that people are capable to change

6. Concepts of mental disorder and mental health are interactional and derive their meaning not only from changes in brain structure and biochemistry but also from how we define certain behavior and social conditions

7. Factors Impacting Mental Health and Mental Illness
Biological
Mental Illness or
Mental
Health
Social
Cultural

8. Mental Disorder Characteristics
Mental disorder is a psychological group of symptoms in which the individual experiences:
1- distress (a painful symptom),
2- disability (impairment in one or more important areas of functioning),
3- or a significantly increased risk of suffering, pain, loss of freedom, or death.
Signs and symptoms of mental disorder are known as psychopathology.

9. Mental disorders are
identified,
standardized,
and categorized in the Diagnostic and Statistical Manual of Mental Disorders– IV-TR published by the American Psychiatric Association (APA).

10. Figure Nonconforming behavior or appearance that flouts social norms is an example of social deviance—not evidence of psychopathology or abnormal behavior. Photo courtesy of Michael Newman/PhotoEdit.

11. Deviance
Is it bad?
Bizarre in one cultural context; acceptable in another?
Deviant political, religious, or sexual behavior
Mental disorder—yes or no?

12. The concept of mental disorder lacks a definition that covers all situations. A sociologic definition of deviance is behavior outside the social norm of a specific group; and in its social context, deviant does not mean “bad.” Behavior that is considered bizarre or unreasonable in one cultural context may be considered desirable in another. The appropriateness of behavior depends on whether it is judged plausible or not according to a set of social, ethical, and legal rules that define the limits of appropriate behavior and reality

13. Deviant political, religious, or sexual behavior or conflicts primarily between an individual and society are not labeled as mental disorders unless the deviance or conflict is a symptom of dysfunction in the individual

14. What do these terms mean?
Crazy?
Berserk?
Insane?
Lunacy?
Nervous Breakdown?
Melancholy?

15. Characteristics of Mentally Healthy Individuals
Look at the following characteristics:
Individuals Behavior
Interpersonal Relationships
Intrapersonal Relationships

16. There are many essential qualities of mentally healthy people.
Some are reality oriented to people, places, time, and events;
and have a basic knowledge of their strength and weakness,
and the ability to problem solve and maximize the potential to grow.
Function independently and autonomously
Hold positive attitudes toward himself
Remain healthy with high level of stress
Adaptable
Master their environment
Perecive reality clearly

17. They are able to grow as they interact collaboratively with others
They are able to grow as they interact collaboratively with others. In these collaborative relationships, they not only accept their own strengths and weaknesses, but they also accept the strength and weaknesses of others. Their emotional and psychological states, and values and behavior are consistent. These qualities move the person along the way to hardiness and resilience in his or her life experiences

18. In general, mentally healthy people relate to others and have a self-concept that is based in reality. They are independent and autonomous and accept the challenges of life. To meet the challenges of life, they utilize problem solving consistent with the norms of their culture.

19. Problem solving may mean seeking assistance from someone and during such time they seek appropriate sources for help. As they work through problems, they develop more resilience. Their behavior, emotions, and values are adaptable to many growth experiences. Mentally healthy people are on a lifelong growth process toward one’s potential.

20. History
Understanding and approaches to “madness” throughout history were influenced by:
Social attitudes
Philosophic viewpoints

21. Ideas that may be considered contemporary at one time often have roots in earlier centuries. The modern medical concept of “madness” as an illness is open to the same scrutiny (فحص دقيق) as interpretations of the past; examples include witchcraft or mysticism.

22. Historical Approaches
Era of Magico-Religious Explanations
Attributing factors were
Superhuman forces
Violation of taboos (المحرمات)
Neglect of rituals ((الطقوس
Loss of soul
Witchcraft
Treatment centered on dealing with spirits and the forces inflicting pain and suffering

23. Historical Approaches (cont'd)
Era of Organic Explanations
Hippocrates (4th century bce) proposed imbalances in body humors. Treatment centered on use of words (talking, interpreting dreams) and purging, bloodletting, and ritual purification
Blood
The blood was believed to be produced exclusively by the liver.[
Yellow Bile
Excess of yellow bile were thought to produce aggression, and excess anger reciprocally gave rise to liver derangement and imbalances in the humors.

24. Black Bile from the belief that an excess of black bile caused depression. Phlegm Phlegm was thought to be associated with apathetic behavior,
DR. MASA'DEH

25. Historical Approaches (cont'd)
Era of Alienation (العزله)
Social exclusion
Imprisonment (الحبس)
“Ships of fools” witch
“Lunacy” RELATED to the moon

26. The insane were driven out and excluded from society
The insane were driven out and excluded from society. Theologic and magical explanations still prevailed. “Treatment” included ritualized social exclusion, imprisonment, and “ships of fools” to search for reason and spiritual reintegration.

27. The exception was in the Arab world where the insane were believed to be divinely inspired and consequently treated kindly. The first asylum was built in Fez, Morocco early in the 8th century. During the Middle Ages (400 ce) to the Renaissance (1300–1600 ce), troubled minds were thought to be influenced by the moon (lunacy).

28. Figure 1-5 Moonstruck women dancing in a 17th-century square
Figure Moonstruck women dancing in a 17th-century square. This activity is the source for the word lunatic. Photo courtesy of Philosophical Library.

29. Historical Approaches (cont'd)
Era of Alienation
The exception: Arab belief was that the insane were divinely inspired.

30. Figure 1-6 A ward in Bethlehem Hospital about 1745
Figure A ward in Bethlehem Hospital about A patient is being chained in the foreground, and in the background are two Sunday visitors on an entertainment outing. Photo courtesy of Philosophical Library.

31. Historical Approaches (cont'd)
Era of Confinement
The insane were fed, but were morally constrained and physically confined and were frequently publicly beaten and tortured. Enormous asylums arose to confine the insane to maintain social order. These included Hôpital Général in Paris and St. Mary of Bethlehem (Bedlam) in London

32. Figure A landmark event—Philippe Pinel unchaining the insane in the Bicêtre Hospital in Paris. Photo courtesy of Charles Ciccione/Photo Researchers, Inc.

33. Historical Approaches (cont'd)
Era of Moral Treatment
Emergence of reform ): Treatment continued to be inhumane based on unsatisfactory explanations of mental illness, the belief that mental disorders were incurable, and the idea that mad persons were dangerous.
However, there was an emergence of reform and humanitarianism across Western Europe and the United States, which resulted in more humane treatment

34. Reformers included William Cullen, Philippe Pinel, the Quakers under William Tuke, Benjamin Franklin, and Benjamin Rush (“father of American psychiatry”). Benjamin Rush explained mental illness as “excitement of the brain” and used somatic treatments such as bleeding, purging, and developed the tranquilizing chair to quiet the insane.
DR. MASA'DEH

35. Historical Approaches (cont'd)
Benjamin Rush
"Father of American Psychiatry”

36. Figure Benjamin Rush, the “father of American psychiatry” and an idealist and humanitarian, nevertheless favored physical theories such as “excitement of the brain” to explain mental illness. He was preoccupied with somatic treatments such as bleeding and purging and developed the tranquilizing chair to quiet the insane. Photo courtesy of Philosophical Library.

37. Historical Approaches (cont'd)
Era of Psychoanalysis
There was an increase in the number of mental hospitals. Insanity was linked to faulty life habits and treated with physical and somatic therapies. Sigmund Freud explained human behavior in psychological terms.

38. Historical Approaches (cont'd)
Contemporary Developments
Social dimensions
Brain dysfunction
Neurochemical
Medication therapy

39. 21st Century Research Bases for mental disorders
Psychotropic medications
Role of nutrients, biology, and genetics

40. Mental Disorder Statistics
High incidence with physical illness
Account for 47% of all disability in economically developed countries
Account for 28% of all disability worldwide

41. Table 1-1 Prevalence Rates for Various Mental Disorders

42. Stigma
A negative consequence of being diagnosed with a mental disorder
Based on societal perception that mental illness is a blemish of individual character

43. Stigma is a World Wide Problem
Stigma is about disrespect and leads to:
Prejudice
Discrimination
A diagnosis of mental illness not only means the client must work to regain his or her mental health, it also means the client must learn to cope with the stigma of mental illness. The pain of facing mental illness is compounded with the negative social perception that mentally ill people are a danger to society or lacking in intelligence, and the incoherence that sometime accompanies mental illness will cause some people to become afraid of them, ignore them, be rude to them, or treat them as children. Interactions of this type are painful and disrespectful. It interrupts getting help or utilizing help

44. The display of covert or overt negative behavior by the public must be addressed with education. In the professional settings, education and supervision are needed. Effort is being made to decrease the stigma attached to mental illness by public figures sharing with the public their diagnosis of mental illness. Many times, a person may not be fully aware of the negative message he or she is giving to the client. Stigma still hurts and impedes the recovery process.
DR. MASA'DEH

45. No one wants to see a friend or family member being treated poorly or given less- than-adequate care because of prejudice and discrimination. When care is negatively impacted, it is likely to increase the length of treatment. Stigma undermines the confidence that quality care will be provided and it also decreases the client’s self-esteem
DR. MASA'DEH

46. Box 1-2 Stigmatizing Beliefs About Mental Illness

47. Box 1-2 (continued) Stigmatizing Beliefs About Mental Illness

48. Box 1-2 (continued) Stigmatizing Beliefs About Mental Illness

49. Stigma Is An Obstacle To Better Mental Health Care
It decreases the quality of life for those that have a mental illness and for those that work with mental health disorders.
Remember, Words are Powerful!

50. Figure 1-9 The effect of stigma on recovery from mental illness
Figure The effect of stigma on recovery from mental illness. The person’s symptom is the marker that leads to stigmatization by society. Eventually, the effects of stigmatization negatively influence the person’s ability to recover from mental illness.

51. Psychiatric—Mental Health Nurses: Who Are They?
promotes mental health through assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders (ANA, APNA, ISPN, 2007).
It is a specialized area of nursing practice that employs theories of, and research on, human behavior as its science and the purposeful use of self as its art. Essential components include: health and wellness promotion through identification of mental health issues, prevention of mental health problems, care of mental health problems, and treatment of persons with psychiatric disorders (ANA, APNA, IPSN, 2007).

52. Two sets of standards guide professional psychiatric–mental health nursing practice: 1- Standards of Practice 2- Standards of Professional Performance
DR. MASA'DEH

53. Standards (cont'd)
Psychiatric-Mental Health Nursing Standards of Practice
Assessment
Diagnosis
Outcomes Identification
Planning
CFL 2-1-3

54. Standards (cont'd)
Psychiatric-Mental Health Nursing Standards of Practice
Implementation
Coordination of Care
Health Teaching and Health Promotion
Milieu Therapy
Pharmacological, Biological, and Integrative Therapies
CFL 2-1-3

55. Standards (cont'd)
Psychiatric-Mental Health Nursing Standards of Practice
Implementation
Prescriptive Authority and Treatment (APRN only)
Psychotherapy (APRN only)
Consultation (APRN only)
Evaluation
CFL 2-1-3

56. Box 2-1 Psychiatric–Mental Health Nursing Standards of Practice

57. Box 2-1 (continued) Psychiatric–Mental Health Nursing Standards of Practice

58. Standards (cont'd) Standards of Professional Performance
Quality of Practice
Education
Professional Practice Evaluation
Collegiality
Collaboration
CFL 2-1-3

59. Standards (cont'd) Standards of Professional Performance Ethics
Research
Resource Utilization
Leadership
CFL 2-1-3

60. Box 2-2 Psychiatric–Mental Health Nursing Standards of Professional Performance

61. Personal and Professional Identity
Influenced by one’s self view
Attitudes, values, expectations and beliefs
CFL 3-1-1

62. Personal and Professional Identity (cont'd)
Self-awareness and self-reflection are critical to effective, compassionate psychiatric care
Must examine, feelings, thoughts, and behaviors
CFL 3-1-2

63. Personal Integration and the Psychiatric-Mental Health Nurse
How do you know your self? How do you separate your identity from others?
Developing comfort with behavior and values outside the social norm
CFL 3-2-1, CFL 3-2-2

64. Personal Integration and the Psychiatric-Mental Health Nurse (cont'd)
Developing detached concern
Creating a common ground
CFL 3-2-3, CFL 3-2-4

65. Figure 3-1 Self-awareness of feelings
Figure Self-awareness of feelings. Superficial feelings are visible; deeper feelings are submerged.

66. Personal Integration: Managing the Affective Self
Self-awareness of all levels of feelings
Exploration and understanding of dominant emotional themes
Recognition and acceptance of one’s own feelings without judgment
Recognizing and challenging one’s dogmatically held beliefs
CFL 3-2-5, CFL 3-2-6

67. Qualities of Effective Psychiatric-Mental Health Nursing
Psychiatric–mental health nursing is a highly specialized area of nursing practice that requires nurses to practice the use of self artfully in therapeutic relationships. Being : Self-awareness Personal integration Moral integrity الوعي الذاتي التكامل الشخصي النزاهة الأخلاقية
CFL 3-3-1

68. Qualities of Effective Psychiatric-Mental Health Nursing (cont'd)
Respect Availability Spontaneity Hope Acceptance Sensitivity Vision
Accountability Advocacy Spirituality Empathy Critical thinking Self-Disclosure
CFL 3-3-2

69. Sociocultural Influences and Psychiatric-Mental Health Nursing
Cultural and social class differences
Sociocultural heritage
Beliefs, values, attitudes, and behavior
Potential for misdiagnosis:
Importance of obtaining a cultural profile
CFL 3-5-1, CFL 3-5-2, CFL 3-5-3

70. Maintaining Empathic Abilities
Definition of empathy (ability to understand and share the feeling of the others)
Relationship to personal integration
Challenges to developing and maintaining empathy
CFL 3-6-1

71. Respect and the Psychiatric-Mental Health Nurse
Accountability for one’s behaviors and actions in stressful situations
Conveying messages of respect
Preserving the dignity and self-worth of another
CFL 3-7-1

72. Taking Care of the Self Developing and practicing assertiveness
Seeking solitude
Maintaining physical health
Attending to internal signals of stress
CFL 3-8-1, CFL 3-8-2

73. The Problem of Burnout
It’s a condition in which health care professionals lose their concern and feeling for their clients and come to treat them in detached
Working with intensely troubled people
Caring and burnout
Cues to burnout; language used to describe client, avoidance of interaction, rigidly applying rules, using jokes to put down clients ands their experience
Reducing burnout
CFL 3-8-3