Overview of mental health nursing in Canada

Question 1

More holistic approaches are reflected in the rise of:

Answer 1

• Recovery models of care
• Trauma Informed Approaches
• Harm Reduction
• Recognition of risk and protective factors
• Socioeconomic influences on mental health
• relational pactice
• importance of the therapeutic relationship to effective interventions

Question 2

Biologic View

Answer 2

mental illness had a biologic cause and could be treated with physical interventions. Biologic approaches and physical treatments such as bed rest; wet packs. grounded in the idea that overstrained nerves should obtain rest.

Question 3

Moral Treatment

Answer 3

• humane treatment
• Philippe Pinel influenced by Enlightenment ideas, believed that the insane were patients who needed humane treatment (removal of chains, stopped the abuses of drugging and bloodletting, and introduced more appropriate medical care)
• humane and supportive rehabilitative attitude of the Quakers was seen as an extremely important influence in changing techniques of caring for those with mental disorders.

Question 4

Institutionalization

Answer 4

the state of being placed or kept in a residential institution.

Question 5

Deinstitutionalization

Answer 5

downsizing of large provincial psychiatric hospitals, and a new orientation on community based services to support people with mental illness within their own communities.
- new rehabilitative services to support biologic approaches (psychopharmacology and safer application of ECT), use of group therapy and other psychotherapies, as well as the provision of day treatment.

Question 6

Psychiatric Nursing

Question 7

Psychoanalytic treatment

Answer 7

Sigmund Freud. personality theory based on unconscious motivations for behaviour, or drives.
- he delved into the patient’s feelings and emotions regarding past experiences, particularly early childhood and adolescent memories to explain the bases of behaviour.
- three stages (oral, anal, and genital) any interference in this normal development, such as psychological trauma, would give rise to neurosis or psychosis.
- repairing the trauma of the original psychological injury, was the treatment of choice.

Question 8

Psychosocial rehabilitation

Answer 8

promotes personal recovery, successful community integration and satisfactory quality of life for persons who have a mental illness or a mental health and/or substance use concern. Psychosocial rehabilitation services and supports are collaborative, person directed, and individualized, and an essential element of the human services spectrum. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning and social environments of their choice and include a wide continuum of services and supports.
- strengths based approach
- approaches are collaborative, person directed and individualized
- support people to have a meaningful life focus on determinants of good mental health
- place people in their chosen goal setting and support them there
- supported by scientific evidence

Question 9

Recovery model

Question 10

Harm Reduction

Question 11

Trauma Informed Practice

Question 12

Psychiatric Nursing

Answer 12

• at the turn of the 19th century, mental hospitals started implementing Schools of Nursing to build psychiatric nursing capacity and quality within their hospitals
• the need for PMH nursing was recognized near the end of the 19th century, intially there was resistance to training. the irst Training School for PMHN was established in 1888.
• two models for PMHN education

Question 13

Cornerstones of Canada’s approach to mental health prevention and mental health promotion

Answer 13

• Mental Health
• well-being
• mental illness
• recovery

Question 14

Mental Health

Answer 14

• A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and contribute to their society. It is integral to general health and can be possessed and enhanced, including in the presence of mental illness (WHO)
• Mental health means striking a balance in all aspects of your life: social, physical, spiritual, economic and mental (Canadian MH Association)

Question 15

Well-being

Answer 15

• a state of being healthy, happy, or prosperous; physical, psychological, or moral welfare
• well-being is not purposeful but it lies on the journey through life events and is experienced when the individual is self-forgetful about how he or she is supposed to live and instead engages in living well.
• Canadian Index of Wellbeing (used as a measure of the QOL in Canada, the CIW is calculated using 64 indicators across eight interconnected QOL domains.
• well-being is an individual’s sense of being content and happy with life and life situation; a sense of flourishing.

Question 16

Mental Illness

Answer 16

• mental disorder is the medical term for mental illness and refers to a diagnosable health condition based on an accepted classification system with criteria related to alterations in mood and affect, behaviour and thinking and cognition. These alterations are beyond the parameter of psychological states such as sadness and grief encountered in life.
• health conditions characterized by alteration in a variety of factors that include mood an affect, behaviour, and thinking and cognition. The disorders are associated with various degrees of distress

Question 17

Classification Systems for Mental Illness (LO-3)

Answer 17

ICD - International Classification of Diseases developed by the WHO
DSM-5 - Diagnostic and Statistical Manual of Mental Disorders (section 1: an introduction and explanation of its use, including a caution regarding its forensic use. Section 2: the diagnostic criteria and codes. section 3: emerging measures and models, an alternative model for personality disorders and conditions for further study. Organized along development and life span lines. Mental disorders are delineated in a way such that cultural, social and familial norms and values can be recognized as influencing the expression and experience of symptoms

Question 18

Recovery

Answer 18

• related to mental illness means “gaining and retaining hope, understanding of one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life and a positive sense of self.” It is not synonymous with “cure”

Question 19

A bit of a history of mental illness care in Canada

Answer 19

• universal health insurance for hospital care and medical services developed in the 1950s and 1960s –> psychiatric departments established in general hospitals –> the Canadian Mental Health Association influenced policy development to integrate hospital care and community care, which led to deinstitutionalization

Question 20

Two Models of Care for PMHN Education

Answer 20

• Regional influences played a large role in the generation of the two models
• 1930s - ontario integrated care of the mentally ill into general hospital training
• Western Canada provinces in the 1950s were graduates of psychiatric hospital-based nurse training programs receiving the title of psychiatric nurse

Question 21

Construct, Binary & Paradox

Answer 21

Construct - to build or form by putting together parts; frame; devise (verb) OR something constructed; an image, idea or theory, especially a complex one from a number of simpler elements
Paradox - a statement or proposition that seems self-contradictory or absurd but in reality expresses a possible truth
Binary - consisting of two parts of components

Question 22

Positive Mental Health

Answer 22

• Society, community, family, individual

Question 23

Responding to Mental Illness

Answer 23

• Recovery
• Trauma Informed Practice
• Harm Reduction
• Therapeutic Relationship (TR)

Question 24

Nursing and Mental Health

Answer 24

Understand the things that may be influencing mental health in a given situation
Develop the necessary skills in order to genuinely connect to the person in front of you
Recognize your own responsibility in contributing to the mental health experience of others
Recognize your ethical obligation to care for yourself
Understand your boundaries and limitation in what or how much you can do to respond to the needs of others

Question 25

Construct

Answer 25

• diagnosis is constructed and are made up. Diagnosis has come into being and gone out of being. created by professionals in the field
• how do we make up a diagnosis:
  o Societal norms
  o Science behind a condition
  o DSM – they get specialists and put them in a room and say you must come up with a diagnosis for a behaviour that they’re seeing, then the experts argue based on experience, science, should it exist, what behaviours belong in certain categories.
  o Eventually they come up with an idea and give it a label and develop a criterion (behavioural) that they must see, then put it in the DSM and it becomes a diagnosis
  o The DSM, ICD, Mental Disorders are labels, we made them up. For a reason  because we are looking at patterns and science. We want a common language
  o Doesn’t mean there isn’t validity. There is a dark side to labeling

Question 26

Paradox

Answer 26

• Cant strive for mental wellbeing
• Mental wellbeing is learning how to be and in that being who am i? what do I have to contribute? What is my value?
• Have to figure these out for yourself. Can’t achieve it by striving

Question 27

Binary

Answer 27

• A this or that. Black or white. Yes or no.
• In psychiatry, we are stuck in a binary sometimes, moving towards grey but haven’t been in the grey
• Consequences of mental illness being something that can be investigated with science:
  o Chemical imbalance theory is just a theory
  o The idea that depression is related to a chemical imbalance is a theory. Don’t know that the imbalance came first or causes depression
  o We cant say that we have a scientific measure for mental illness
  o We’re saying that mental illness is a biological disorder somehow then treatment is going to be biological
  o If we root ourselves in that, what happens when the biological treatments don’t work  makes the person think there is something wrong with them because the biological treatment didn’t work
  o If we can change the way they live and the circumstances in which they live we can mitigate the mental illness (education, housing, income, safety, support)
  o If we can fix the external, we can begin to fix the internal (partly true)
  o Cant go down the road: mental illness is “this” or “that”

Question 28

Points to Remember in Patient Treatment

Answer 28

• We have to address the factors
  I the nurse could come to someone and say, we have interventions in all these areas that will be helpful for you to feel better. But if the person is not active in the interventions and they don’t have meaning for them it isn’t going to work
• Labels are constructed and we need them for certain reasons. Simply constructed by people in society. When we can move diagnosis in or out of DSM because society changes. They describe certain behaviours but not the person in front of you.
• Diagnosis are not the person and they are not static. That diagnosis is NOT the person in front of you
• Can feel hopeless, watch them make the same mistakes over and over again. They want a better life, but they cant get there by striving for it, they can only get there a little bit at a time.
• Accepting them exactly where they are at and being able to hold out hope for someone. What are their dreams and hopes and desires, and hold those out for them
• Hold out hope that peoples lives can be different. They are not a diagnosis, or a lable, they are a person
• Don’t want to get stuck in a certain way of thinking
• There is a lot of grey. Lots of different ways to approach illness and treat it

Question 29

Trauma informed Practice

Answer 29

• How do I interact with someone knowing they have experienced trauma but not necessarily knowing what that trauma is