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Mental Health Overview

-lifelong process of successful adaptation to an ever-changing internal and external environment

-positive/adaptive coping mechanisms

-individual is in contact with reality and the environment



-ability to function with healthy responses even when experiencing significant stress and adversity


What is resilience influenced by?

-optimism, or belief that a positive outcome is possible in the situation they are currently facing

-self efficancy, or belief that they have the ability to complete the tasks needed to take control of situations which influence their life



-can be emotion focused or problem focused

-problem focused is use of more problem solving and finding meaning


Ability to function

-within occupational or school environment

-within a family system


Cognitive Coping

emotional: oh its not that bad

problem: what are my odds of surviving


Behavioral Coping

emotional: physical activity to avoid thinking about the stressful event

problem: adhereing to a health care plan


Affective Coping

emotional: hoping for a miracle

problem: keeping feelings from interfering


Erikson's Stage: Young Adulthood

18-25 years (intimacy vs. Isolation)

successful: developing healthy romantic relationships without losing personal identity

unsuccessful: isolation, avoidance of intimacy, fear of commitment


Erikson's Stage: Adulthood

25-65 years (generativity vs. stagnation)

successful: productivity and creativity. Desire to care for and guide offspring
(if no kids, guide next generation)

unsuccessful: self-preoccupation, primary attainment of pleasure through self indulgence, stagnation


Erikson's Stage: Maturity

65-death (integrity vs. despair)

successful: sense of peace concerning life experiences, life choices framed within meaningful context, development of wisdom

unsuccessful: life experiences framed by bitterness/regret, may progress to hopelessness/depression


Mental Illness

-loss of the ability to respond to the environment in ways that are in accord with one's own or society's expectations

-characterized by thoughts, feelings, or behavior patterns that impair functioning and cause the individual (or others!) distress


Adaptations to Stress with mental illness

-feels out of control with self and with the environment

-has a negative perception of the environment/life in general

-has ineffective coping mechanisms


Personality Characteristics of mental illness

-non-accepting of self and dislikes self

-unrealistic perception of strengths and weaknesses

-thoughts and perceptions may not be reality based

-unable to find meaning and purpose in life

-lacks direction and productivity in life

-has difficulty in meeting own needs

-adapative vs maladaptive responses/behaviors/coping skills


Interpersonal Relationships with mental illness

-unable to love and care for others (with appropriate and healthy boundaries)

-unable to feel loved by others or accept feelings from others


Historical timeline of mental illness treatment

1793: released from chains in Paris Hospital

Mid 19th century: continued belief in moral causes of mental illness

1847-1851: Hope Retreat

1937: Electric Shock Therapy

1946: National Institute of Mental Health

1950: Intro of Psychotropic drugs

1963: Community Mental Health Centers Act of 1963 (De-institutionalization of care)

2008: mental health parity

2010: Affordable care act


Psychiatric/Mental Health Nursing

-diagnosis and treatment of human responses to actual or potential mental health problems

-specialized area of nursing practice


Psych nursing draws from multiple theoretical models

-Hildegard Peplau's
-Therapeutic use of self


Influence of Hildegard Peplau

-introduced the concept of a therapeutic relationship

-different from social relationship

-requires therapeutic use of self

-important for nurse to have self awareness/understanding of own philospohies about life, death and human condition


conditions that promote development of a therapeutic relationship



Stages of Therapeutic relationship

1. preinteraction
2. orientation
3. working
4 termination


the focus of a therapeutic relationship

-promotion of mental health and prevention of mental illness in individuals, families, and groups in the communities


Collaborative Inpatient care

-physician, nurse, social services, occupational therapy and mental health counselors, peer specialists


The physician creates a diagnosis based on...

-data gathered by other disciplines
-DSM 5


Social services...

helps the patient find placement



is short for the diagnostic and statistical Manual of Mental Illness version 5

-lists psychiatric diagnoses

-lists criteria patients need to meet to be diagnosed with a disorder


Role of the nurse

-safe milieu
-therapeutic milieu
-safe practice
-ethical and legal guidelines



-focus on maintaining safety of patients and staff

-accomplished through prevention

-monitoring patients

-assessing patients: implementing safety precautions prn

-controlling contraband

-milieu management strategies

-culture of safety implemented at some hospitals includes evidence based interventions


Milieu Therapy

Basic Assumptions:

-all patients have strengths as well as limitations

-every interaction is an opportunity for therapeutic intervention

-patients participate in making decisions and solving problems on the units

-personal responsibility is encouraged

-peer pressure used to give feedback

-inappropriate behaviors processed

-no restrictions or punishments: use group discussion first


Safe Practice

-knowledge of medication purpose, dosage range, primary side effects

-self awareness: insight into how individual communication is affecting patient

-therapeutic communication to help patient identify thoughts and feelings

-collaboration with interdisciplinary team to maintain safety

-requires knowledge of mental health disorders, how to assess mental status and identify mental status changes