intro Flashcards
health
complete physical, mental, and social well being
not just absence of disease or illness
enjoyment of self and env
mental health
continuum
individuals reach own potential, cope with stress, work productively, contribute to community
mental illness
health conditions involving changes in emotion, thinking, behavior (or combo)
associated with distress and/or problems functioning in social, work, family activities
attributes of mental health
rational thinking, resiliency, self esteem, self awareness, emotional growth, self care, learning and productivity, communication skills, meaningful relationships, spiritual satisfaction
elements that contribute to mental health
biologic
psychologic
sociocultural
biologic elements of mental health
prenatal, perinatal, neonatal events
physical health
nutrition, hx of injuries, neuroanatomy (all brains are different), physiology
psychologic elements of mental heatlh
interaction, IQ, self concept, skills, creativity, emotional dev level (changes throughout life)
sociocultural
fam stability, ethnicity, housing, child rearing patterns, strict or loving upbringing, economic level, religion, values and beliefs
resilience
ability and capacity to secure resources needed to support wellbeing
characteristized by optimism, sense of mastery, competence
essential to recovery -> adapting
can determine incidence, severity, and prognosis of mental illness
incidence and prevalence
1/5 adults
F > M
18 - 25 yo highest
early 19th century theories
inheritance
moral degeneracy: mentally ill by virtue of bad character
germ theory -> segregation
septic foci theory -> remove infection by sx = cure (bleeding, leaches, etc)
diathesis stress module
diathesis = biological predisposition
stress -> env or trauma
most accepted explanation for mental illness
combo of genetic vulnerability and negative env stressors
early tm
1800 - 1900
s/s behavior (under control of person): can be adjusted by restraining (phys or chm), sx (lobotomy), insulin, hydrotherapy, sedative cold wet packs, electroshock
lunacy act
asylums and institutions
1845
mental health treatment act
mental hospitals
1930
mental health units
acute care
in reg hospitals
1970s
1990
community mental health
less hospital time, transition to community
2000
integrate primary and mental health care
deistitutionalization
mass movement of severely mentally ill from state hospitals to out pt care
many hospitals closed, more meds (psychotropic), greater nursing role
deinstitutionalization and lack of community spaces
lacked self care skills
many went to prison - dont get treatment and become worse, cant get resources or jobs with criminal records
cyclic pattern: homeless, ED, re-arrested
revolving door treatment -> many go to ED
also influenced by managed care (health insurance): decreased LOS, increased stringent admission criteria
still limited community support
victimization
much higher rate
verbal abuse, bully, threat, theft, physical assault, rape
former partners and fam -> exploit and abuse
hcp
institutions can be dangers -> staff and other pts
many prefer danger in community over danger in institution
social influences on mental health care
consumer movement/recovery
national alliance on mental illness (NAMI)
surgeon generals report on mental health
new freedom commission on mental health
consumer movement/recovery
people with MI advocate for their rights, fought against discrimination and forced treatment
national alliance on MI
1 group that fought for rights
dedicated to building better services, treatment, research, support, awareness, decrease stigma
communicate that MI are brain disorders
eliminate stigma and descrimination
advocate for people with MI
improve access to tm services
integrate MI into community life
NAMI services
support groups, educational programs, public awareness events, fam-fam, in our own voice, participation station (hangout with MI), warm line (crisis line-ish), NAMI walk
report of the surgeon general
1999
2 main points: MH is fundamental and necessary to healthy life, there is effective tm avail
disorders are real health conditions with enormous consequences
range of tm avail for most
seek tm bc it can help
new freedom commission on MH
2003
called for streamline system with less fragmentation in care
advocate for early dx and tm
principles of recovery
increased assistance with housing and employment
link btw mental and overall health, family and consumer driven, eliminate disparities, screenings and referrals at primary, more tech and housing
fayette county mental health court
systems navigator = peer support specialist -> match participants to housing and support services
multidisciplinary team of judges, prosecutors, providers, case workers, peer support specialists provide a tm oriented, person centered approach to address individual needs
based on tm jurisprudence and restorative justice principles to reduce reoffending
get out of jail and MH services needed
get referral, staff screen for eligibility, get out of jail if follow tm plan
tim’s law
dont perform well in com (stopped meds), guardians can advocate for out pt tm
anosognosia = dont believe they have illness
assisted out pt tm
MH parity act
parity -> equivalence
insurance companies provide equal tm coverage for psych disorders and substance abuse disorders
pt protection and affordable care act
coverage for most uninsured americans expanded medicaid eligibility (for very poor)
create health insurance exchanges to offer more choices
insurance mandate for coverage
barriers to delivery of adequate and accessible mental hc
need is increasing
limited access: transportation, wait time, income/cost/insurance
provider limitations: #, knowledge
stigma
stigma
widespread fear and misunderstanding of MI
heightened by focus on extraordinary S in film and literature
major clinical and public health issue, burden on those with MI
fight: talk openly, educate self and others, be conscious of language, show empathy and compassion, stop criminalization, advocate for reform, encourage equality in how MH is perceived
recovery
is possible, even if cure isnt
process of change through which individuals improve their health and wellness, live a self directed life and strive to reach their full potential
dual dx
co occuring MI and substance use disorder
co morbidity
can be 2 MI or medical
2 co occurring chronic illnesses
adherence
used to be compliance
managing care based on plan of care developed as part of hct, stick to this developed poc
DSM-5
official medical guidelines of APA for dx psych disorders
based on specific criteria influenced by multiprofessional clinical field trials
psych nurses
private practice, hospitals, community health, universities and colleges
basic psych nursing
RN-BC, 2yrs (2000 hrs), 30 hr continuing education
advanced practice psych nursing
master or dr
screen, eval, promo, edu
assess/examine
formulate differential dx
order, conduct, interpret labs, dx, procedures
psychotherapy
direct and provide home health
prescribe, monitor, manage, eval meds
integrated MH services in general health settings
skills of all nc with roots in psych
safety (thoughts and env), tc, nurse -pt relationship, milieu management, relaxation, motivational interviewing, self efficacy, suicide, manage aggressive behavior, psychopharm, crisis intervention, disaster MH, instill hope
interdisciplinary team
plan of care
pt -> self efficacy (design own poc)
fam/SO, RN, MD, CNS/APRN, psychologist, SW/LCSW, pharmacist, recreational (activity) therapist, drug and OH counselor, teacher, mental health associates
acute care setting
get pt stable enough and send elsewhere
highly structured, optimize safety, address crisis, intervention, 3-7 days avg (peds longer)
long term care setting
rec if pt needs > 7 days for stabilization, not locked unit
partial hospitalization
alternative for pt that need some supervision but not appropriate for in pt
transitional step
decrease readmission, med monitoring, coping skill
specialty treatment settings
peds, geriatric, vets, forensic, OH and drugs, self help, eating disorder, all male, all F, co-ed
day treatment
step below PHP (partial program) -> allow fam to work, during day
adult, ongoing, chronic
need structure of scheduled activity for 2-3 days/wk, group focused
improve coping skills, enhance strength, address shortcomings, improve functioning and independence, build social skills that foster + interpersonal relationships
4 wks or less
day treatment staff
psychiatrists, psychologists, RN, social workers
in pt
admission: voluntary or involuntary
danger to self or others
cant care for basic needs, and/or gross impairment of judgement, imminent risk, cant protect self
voluntary admission
pt or guardian and hcp agree with need
consent form signed
involuntary admission
72 hr hold, can sign voluntary, court can be petitioned for further care
72 hrs only when court is open
patient rights
same rights
recieve or refuse tm, dignity, involvement in poc, AMA, protection from harm, legal counsel, communicate, confidentiality, least restrictive means
implied consent: cant communicate but willing to take med
capacity and competency
restraint and seclusion
first: verbally intervene, decrease stim, diversion, prn meds, listen
orders and doc, nurse can do in emergency then get order, never prn or standing
chm -> agitation, less restrictive than phys or mech
least restrictive means of tm: assess -> decrease stim (go to rm) -> prn meds (oral) -> seclusion area (escort) -> IM prn meds -> restraints if danger
confidentiality exceptions
warn and protect 3rd parties
child and elder abuse
confidential even after death
therapeutic milieu
surroundings and phys env of unit, provides sense of security/safety/management
interact with peer and staff help pt engage and increase social competence and self worth
real life training ground to practice communication and coping skills
activities, unit rules, reality orientation practices and groups
therapeutic milieu components:
containment: locked unit, basic needs of food, shelter, safety, security
support: encouragement, praise, + feedback, autonomy and coping
validation: privacy, cultural needs, feelings lead to clients holistic health
structure: control and limit maladaptive behaviors and setting limits
involvement: promote self efficacy
