1. Chapter 20: Mental health and mental illness

2. Learning objectives Identify seven characteristics of mental illness
Identify four causes of mental illness
Distinguish between fact and fallacy concerning mental illness
Explain the connection between mental and physical wellness
List guidelines for communicating with mentally ill residents
Describe common defense mechanisms
Describe the symptoms of anxiety, depression, and schizophrenia
Explain how mental illness is treated
Explain the nursing assistant’s role in caring for residents who are mentally ill
Identify important observations that should be made and reported
List the signs of substance abuse

3. Seven characteristics of mental health
What does mental health look like?
Mental health is the normal functioning of emotional and intellectual abilities.
What does mental health look like? These are the characteristics of a person who is mentally healthy:
Gets along with others
Adapts to change
Cares for self and others
Gives and accepts love
Deals with situations that cause anxiety, disappointment, and frustration
Takes responsibility for decisions, feelings, and actions
Controls and fulfills desires and impulses appropriately

4. Four causes of mental illness
Conditions that may cause or worsen mental illness
Mental illness is a disease that affects a person’s ability to function at a normal level in the family, home, or community.
The following conditions may cause or worsen mental illness:
Physical factors such as illness, disability, aging, substance abuse, or chemical imbalance
Environmental factors such as weak family relationships or traumatic childhood experiences
Heredity or family influence
Stress, including coping abilities

5. Fact vs. fallacy concerning mental illness
Truths regarding mental health
Fallacy is a false belief.
Truth: Mental illness is a disease like any other physical illness. People who are mentally ill cannot simply choose to be well.
Truth: Mental illness and intellectual disability are not the same. Intellectual disability is a developmental disability that causes below-average mental functioning. It is not a type of mental illness. One common point, however, is that residents with both conditions will need emotional support in addition to care and treatment.
Truth: Being mentally healthy can reduce stress and prevent some physical diseases. The reverse of this statement is also true. Mentally ill residents may experience high levels of stress that can affect their physical health.

6. Guidelines for communicating with mentally ill residents
NAs should remember these guidelines for communicating with residents who are mentally ill:
Do not talk to adults as if they were children.
Use simple, clear statements and normal tone of voice.
Communicate respect and concern.
Sit or stand at a normal distance. Use posture that says you are listening (body language).
Be honest and direct.
Avoid arguments.
Maintain eye contact.
Listen carefully.

7. Common defense mechanisms
A defense mechanisms are unconscious behaviors used to release tension or cope with stress.
NAs should be familiar with these defense mechanisms:
Denial
Projection
Displacement
Rationalization
Repression
Regression

8. Symptoms of anxiety, depression, and schizophrenia
Anxiety is uneasiness or fear, often about a situation or condition. Symptoms include:
Sweating
Dizziness
Chocking or smothering sensation
Cold, clammy hands
Dry mouth
Racing heart
Fatigue
Shakiness
Muscle aches
A phobia is an intense form of anxiety or fear. There are several types of phobia, but a common fear is claustrophobia – the fear of being in a confined space. Other types of anxiety-related disorders include:
Panic disorder – a disorder in which a person has repeated episodes of intense fear that something bad will occur.
Obsessive-compulsive disorder (OCD) - an anxiety disorder characterized by obsessive behavior or thoughts.
Post-traumatic stress disorder (PTSD) - an anxiety disorder caused by a traumatic experience.
Depression is one of the most common conditions associated with suicide in older adults. Symptoms of clinical depression include:
Apathy (lack of interest in activities)
Sleeplessness or excessive sleeping
Pain, including headaches or stomachaches
Repeated thoughts of death
Difficulty concentrating
Guilt
Irritability
Low energy or fatigue
Schizophrenia is a form of mental illness that affects a person’s ability to think, communicate, make decisions, and understand reality. Paranoid schizophrenia is a form of mental illness characterized by hallucinations and delusions. Symptoms of schizophrenia includes:
Inability to express logical thoughts
Lack of energy
Little emotion
Hallucination and delusions
Little interest in surroundings
Slow, repetitive, rhythmic movements

9. How mental illness is treated
Common treatments
Mental illness can be treated. The following are common treatments:
Medication
Psychotherapy
Psychotherapy is a method of treating mental illness that involves talking about one’s problems with mental health professionals.
Remember: Residents with mental illness have the right to participate in the planning of their care.

10. Important observations that should be made and reported
Things to observe and report
NAs role in caring for the mentally ill:
Observe residents carefully for changes. Document and report.
Support the resident and family.
Encourage residents to do as much for themselves as possible.
NAs should observe and report the following in residents with mental illness:
Changes in ability
Positive or negative mood changes (withdrawal)
Behavior changes
Comments about hurting self or others (including jokes)
Real or imagined physical symptoms
Events, situations, or people that provoke certain reactions

11. Signs of substance abuse
Substance abuse is the repeated use of legal or illegal drugs, cigarettes, or alcohol in a way that is harmful to oneself or others.
Signs of substance abuse:
Changes in physical appearance (red eyes, dilated pupils, weight loss)
Changes in personality (moodiness, strange behavior, disruption of routines, lying)
Irritability
Odor of cigarettes, liquor, or other substances on breath or clothes
Diminished sense of smell
Unexplained changes in vital signs
Loss of appetite
Inability to function normally
Need for money
Confusion or forgetfulness
Blackouts or memory loss
Frequent accidents
Problems with family or friends
Remember: Illegal drugs are not the only substances that are abused. Over-the-counter and prescription medications can be abused if taken incorrectly or excessively.
Remember: Residents who do not have doctors’ orders against drinking alcohol and who live in a facility where alcoholic beverages are allowed may drink alcohol if they wish to do so. NAs should not make judgments or gossip.

12. Review Identify seven characteristics of mental illness
Identify four causes of mental illness
Distinguish between fact and fallacy concerning mental illness
Explain the connection between mental and physical wellness
List guidelines for communicating with mentally ill residents
Describe common defense mechanisms
Describe the symptoms of anxiety, depression, and schizophrenia
Explain how mental illness is treated
Explain the nursing assistant’s role in caring for residents who are mentally ill
Identify important observations that should be made and reported
List the signs of substance abuse
We discussed seven characteristics of mental illness and four causes of mental illness. We talked about truths related to mental illness and discussed the connection between mental and physical wellness. Guidelines were outlined for communicating with mentally ill residents and described common defense mechanisms. We described the symptoms of anxiety, depression, and schizophrenia and explained how mental illness is treated. The nurse assistant’s role in caring for residents who are mentally ill were explained. Signs of substance abuse were listed, as well.