Chapter 1

Mental Health & Mental Illness

Mental Health:
- Able to recognize own potential
- Cope with normal stress
- Work productively
- Make contribution to community

Traits of Mental Health: Ability to…

-Think rationally -Have a healthy self-esteem
-Communicate appropriately
(let people know what your needs are) -Realistic goals & reasonable
-Learn function within individuals’ role
-Grow emotionally -Be resilient
Mental Illness:
- Disorders with definable diagnosis
- Significant dysfunction in mental functioning related to
o Developmental
o Biological
o Physiological disturbances
- Culturally defined

Resilience:
- Ability & capacity to secure resources needed to support well-being
- Characterized by
o Optimism
o Sense of mastery
o Competence
- Essential to recovery

Risk & Protective Factors

- Individual attributes & behaviors
- Social & economic circumstances
- Environmental factors

Perceptions of Mental Health & Mental Illness:

- Mental illness vs physical illness
- Nature vs nurture
o Diathesis-stress model
Diathesis-Stress Model:
- Diathesis: biological predisposition
- Stress: environmental stress or trauma
- Most accepted explanation for mental illness
 - Combination of genetic vulnerability & negative environmental stressors
- Assertion: most psychiatric disorders result from a combination of ^

Social Influences on Mental Health Care:

- Consumer movement/recovery
- National alliance on mental illness (NAMI)
- Surgeon general’s report on mental health
- Human genome project
- New freedom commission on mental health
- Institute of health
- Brain research through advancing innovative neurotechnology’s (BRAIN) initiative
- Research diagnostic criteria (RDoC) initiative

Legislation & Mental Health Funding

- Mental Health Parity Act (1996)
o Parity = equivalence
o Required insurance companies to provide equal treatment coverage for psychiatric disorders
- Patient Protection & Affordable Care Act
o Coverage for most uninsured Americans through expanded Medicaid eligibility (for very poor)
o Created health insurance exchanges to offer more choices
o “Insurance mandate” for coverage

Epidemiology of Mental Disorders:

- Study distribution of mental disorders
o Identify high-risk groups
o Identify high-risk factors
- Incidence = number of new cases in a given time
o Disease w/ short duration
§ Common cold
o Many new cases in a given year
o * chronic disease such as diabetes will have a low incidence because the person will be dropped from the list of new
cases after the first year (or whatever time increment is being used)
- Prevalence = number of cases regardless of when they began
o Not many people suffering from a cold at any given time
- Lifetime risk = risk that one will develop a disease in the course of a lifetime
- Prevalence (ex):
o Major depressive disorder: Leading cause of disability in U.S. at 6.7% prevalence over 12 months
o Schizophrenia: 1.1% prevalence over 12 months; affects men and women equally
o Panic disorder: 2.7% prevalence over 12 months; typically begins in adolescence; 1 in 3 develop
agoraphobia
o Generalized anxiety: 3.1% prevalence over 12 months; risk is highest between childhood and middle
age

Clinical Epidemiology:
- Groups treated for specific mental disorders studied for:
o Natural history of illness
 o Diagnostic screening tests
o Interventions
- Results used to describe frequency of
o Mental disorders
o Symptoms appearing together

DSM-V:
- The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
- Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders
- Based on specific criteria influenced by multiprofessional clinical field trials

ICD-10-CM:
- International Classification of Diseases, 10e
- Clinical descriptions of mental and behavior disorders
o 2 broad classifications
o Subclassifications

Psychiatric Mental Health Nurses:

- Promoting mental health through assessment, diagnosis, & treatment of behavioral and mental disorders
- Use nursing, psychosocial, neurobiological theories and research
- Work with people throughout the life span
- Employed in a variety of settings and among varied populations

NANDA-I, NOC, NIC:

- The North American Nursing Diagnosis Association International (NANDA-I)
o Provides standardized nursing diagnoses
- Nursing Outcomes Classification (NOC)
o Source of standardized outcomes, definitions of these outcomes, and measuring scales
- Nursing Interventions Classification (NIC)
o Identifies seven domains of nursing intervention

Levels of Psychiatric Nursing Practice:

- Basic Level
o Psychiatric mental health registered nurse (PMH-RN)
o 2 years full-time work, 2000 clinical hours, 30 hours continuing education, followed by certification exam to add “BC” to the
RN title (RN-BC)
- Advanced Practice
o Psychiatric mental health advanced practice registered nurse (PMH-APRN)
o Master of Science or Doctorate

Future Challenges and Roles:

-education -science, technology, electronic health care
-aging population -patient advocacy
-cultural diversity -legislative involvement