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Mental
Health
Nursing
Applying Theory to Practice
Gylo (Julie) Hercelinskyj

& Louise Alexander
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
vii

CONTENTS
Guide to the text x CHAPTER 4

Guide to the online resources xiii Treatment modalities utilised in contemporary
Prefacexiv mental health service delivery 48
About the authors xv Introduction 49
Acknowledgementsxvii Pharmacological interventions 49
Psychosocial interventions 52
Motivational interviewing 52
SECTION 1
Mindfulness-based interventions 57
UNDERPINNINGS OF MENTAL HEALTH NURSING 1 Cognitive behavioural therapy 58
CHAPTER 1 Rational emotive behaviour therapy 60
Mental health nursing – then and now 2 Dialectical behaviour therapy 61
Introduction 3 Structured problem solving 62
Belief in supernatural origins of illness and disease 3 Psychoeducation 63
Asylums of the world 5 Chapter resources 65
History of Australia’s asylums and mental health nursing 6 CHAPTER 5
Treatments throughout history 8
Mental health nursing as a therapeutic process 68
The role and identity of the mental health nurse in
Introduction 69
contemporary service delivery 10
Interpersonal communication within the
Chapter resources 12
nurse–consumer relationship 69
CHAPTER 2 Core elements of the communication process 70
Theoretical frameworks underpinning practice 16 Effective communication skills 70
Introduction 17 The therapeutic relationship 74
Health, mental health and human behaviour 17 Therapeutic use of self 75
Biomedical theories of personality 17 Developing, maintaining and terminating
Psychodynamic theories of personality 18 therapeutic relationships 77
The behavioural/social cognitive orientation 23 The application of therapeutic communication
The humanistic orientation 26 qualities and skills in the clinical context 80
The use of psychological and sociological theories of Chapter resources 86
personality in mental health nursing practice 27 CHAPTER 6
Relevance of psychological and/or nursing theories to
Using evidence to guide mental health
nursing practice 29
nursing practice 91
Introduction 92
CHAPTER 3 What is evidence-based practice? 92
Ethics, law and mental health nursing practice 33 Implementing evidence-based nursing practice 93
Introduction 34 Critical appraisal of research evidence 99
Context of mental health legislation in Australia 34 Translating evidence into clinical practice 100
Legislation facilitating care and treatment of people Mental health outcome measures 101
with a mental health condition 36 Chapter resources 102
Mental health conditions, offending and the law 40
Legal and ethical dimensions of practice for nurses 41 SECTION 2
Compulsory care and treatment from a consumer
THE CLINICAL CONTEXT OF PRACTICE 106
perspective 43
Chapter resources 44 CHAPTER 7
Assessment and diagnosis 107
Introduction 108
The context of practice 108
Assessment in mental health 108
viii Contents
Comprehensive mental health assessment 111 Antisocial personality disorder (APD) 220
Modern diagnostic classification systems in mental Borderline personality disorder 224
health assessment 122 Chapter resources 232
CHAPTER 13
CHAPTER 8 Eating disorders 235
Schizophrenia spectrum and other Introduction 236
psychotic disorders 127 Anorexia nervosa 236
Introduction 128 Bulimia nervosa 246
Aetiology 128 Binge-eating disorder 252
Diagnostic criteria schizophrenia 133 Males and eating disorders 253
Clinical presentation and the mental state examination 136 Chapter resources 254
Treatment 141
CHAPTER 14
Recovery and relapse prevention 146
Other psychotic disorders 147
Substance-related and addictive disorders 258
Introduction 259
The historical context of substance use and misuse 259
CHAPTER 9 Understanding substance misuse, and defining
Bipolar and related disorders 152 illicit and psychoactive substances 259
Introduction 153 Addiction and dependence 260
Aetiology 153 Substance use, misuse problems and substance
Diagnostic criteria bipolar I and II disorder 155 use disorders 264
Clinical presentation and the mental state examination 158 Diagnostic criteria 274
Treatment 163 Biopsychosocial assessment framework 282
Recovery and relapse prevention 166 Clinical presentation and the mental state examination 285
Chapter resources 169 Chapter resources 294
CHAPTER 10 CHAPTER 15
Depressive disorders 171 Neurodevelopmental disorders 299
Introduction 172 Introduction 300
Aetiology and epidemiology 172 Neurodevelopmental disorders 300
Clinical presentation of depressive disorder in the Attention deficit/hyperactivity disorder 300
context of the mental state examination 176 Intellectual disability (intellectual disability disorder) 303
Treatment 177 Autism spectrum disorder 307
Persistent depressive disorder (dysthymia) 184 Risk assessment for people diagnosed
Depression in the perinatal period 185 with a neurodevelopmental disorder 312
Depression and older people 186 The impact of caring for a person with a diagnosis of a
Recovery and relapse prevention 189 neurodevelopmental disorder: who cares for the carers? 312
The family’s experience of depression 189 Chapter resources 313
CHAPTER 16
CHAPTER 11 Neurocognitive disorders 317
Anxiety disorders 195 Introduction 318
Introduction 196 Ageing in Australia today: contemporary
What is anxiety? 196 trends and issues 318
Aetiology 197 Healthy ageing 319
Diagnostic criteria 198 Elder abuse 319
Treatment of anxiety disorders 203 Mental health issues and older people 320
How do mental health nurses assist a person Delirium 321
experiencing anxiety? 207 Major neurocognitive disorders: dementia 323
Chapter resources 208 The impact of neurocognitive disorders on families 333
CHAPTER 12
Personality disorders 211 CHAPTER 17
Introduction 212 Obsessive compulsive and related disorders 339
Defining personality and understanding general Introduction 340
personality disorder 212 Obsessive-compulsive disorder 340
Introducing cluster A, B and C personality disorders 213 Hoarding disorder 344
Contents ix
Trichotillomania 347 CHAPTER 22

Excoriation 348 The family’s role in contemporary mental
Chapter resources 349 health service delivery 435
CHAPTER 18
Introduction 436
What is a family? 436
Trauma and stress-related disorders 351
Theories regarding family structure and functioning 436
Introduction 352
The family’s experience of caring for a loved
Understanding trauma and stress-related disorders 352
one with a mental health challenge 438
Trauma and stress-related disorders 353
Families and resilience 440
Assessment and treatment of trauma and
Mental health nurses work with families 441
stress-related disorders 357
Assessing family structure, function and dynamics 441
Developing an individualised plan of care for a person
Strategies for promoting family resilience 443
experiencing a disorder as a result of trauma/stress 359
Consumers’ views of the family in supporting them
Supporting family and other caregivers 362
through their journey 444
Supporting clients on the recovery journey 363
CHAPTER 23
CHAPTER 19
Other disorders of clinical interest 367 The multidisciplinary team 450
Introduction 451
Introduction 368
The multidisciplinary team 451
Conduct disorder 368
Characteristics of effective teamwork 453
Oppositional defiant disorder 373
Becoming a member of the multidisciplinary
Dissociative identity disorder 375
team: integrating into the team as a student nurse 457
Gender dysphoria 378
Research on consumers’ views on the role of the
Conversion disorder 382
mental health nurse as a member of the
Factitious disorder 384
multidisciplinary team 459
CHAPTER 24
SECTION 3
Community mental health context 464
CONTEMPORARY ISSUES IN MENTAL
Introduction 465
HEALTH NURSING 391
Historical factors of community mental health care 465
CHAPTER 20 Social determinants of mental health 465
Suicide and non-suicidal self-injury 392 Primary mental health care 466
Introduction 393 The roles of the mental health nurse 468
Suicide 393 Specialised community services 471
Theories of suicide 397 Chapter resources 477
Cultural considerations and vulnerable groups 397 CHAPTER 25
The role of the media 399
Cultural context in practice in Australia 482
Assessing risk of suicide 400
Introduction 483
Self-harm/injury (non-suicidal self-injury) 404
Historical and cultural determinants 483
Assessment and collaborative care for consumers
Social determinants 486
who experience self-injuring behaviours 406
Indigenous Australians’ social and emotional well-being 488
Culturally safe practice: racial issues 491
CHAPTER 21 Chapter resources 493
Recovery and resilience in mental health 413 CHAPTER 26
Introduction 414
Mental health first aid 497
Recovery and recovery-oriented practice 414
Introduction 498
Trauma-informed practice 416
Introduction to the MHFA acronym 498
Working with people 420
How to apply MHFA to various mental health problems 500
Be an ‘agent of change’ for recovery-oriented and
Cultural considerations of MHFA within vulnerable groups 509
trauma-informed practices 427
Mental health first aid for carers 511
The peer workforce and recovery 427
Recovery ethics and reflection 429
Chapter resources 431 Appendix 514
Glossary 517
Index 525
x
Guide to the text

CHAPTER
As you read this text you will find a number of features in every chapter
to enhance your study of mental health nursing and help you
2
understand howTHEORETICAL
the theory is applied in the
FRAMEWORKS real world.
UNDERPINNING
PRACTICE
CHAPTER-OPENING FEATURES
Gylo (Julie) Hercelinskyj
Identify the key concepts M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 7

LEARNING OUTCOMES
that the chapter will cover Upon completion of this chapter, you should be able to:
2.1 Define the terms health, mental health, human behaviour and personality
with the Learning outcomes 2.2 Describe biomedical theories of personality, their application and relevance to mental health nursing
practice and some of the major critiques of these theories
at the start of each chapter.
the control of the medical profession in Australia and nurses by medical staff and a three-year training
2.3 Describe psychodynamic theories of personality, their application and relevance to mental health nursing
at the same time that the first legislation relating
practice and tomajor critiques
some of the program approved by the relevant health authority in
of these theories
CHAPTER 1
Challenge your mental perspective
health was enacted through the 1843
2.4 Describe Lunacy cognitiveVictoria
behavioural/social was introduced.
theories of personality, their applicationHowever,
and relevancethis qualification
to mental
health nursing practice and some of the major critiques of these theories
on mental health Actnursing in Prior to this, the
(Curry, 1989). first superintendent was not recognised outside of Victoria, and nurses and
2.5 Describe humanistic theories of personality, their application and relevance to mental health nursing
had been a layperson, whose approach toandthe
somecare attendants were not registered with the Nurses’ Board
the real world with the practice
2.6 Describe
of the major critiques
how nursing
of these theories
of individuals with a mental health condition wastheorists have of drawn from psychological
Victoria (Reischel,and sociological
1974).theorists to understand
Learning from Practice focused on using psychosocial care
human
as a
behaviour
means
and
for
how this influences the role
Modern
of the mental health nurse
mental
2.7 Reflect on which psychological and/or nursing theories would be relevant to your health nursing education
nursing practice
74 vignette
U N D E Rand
P I N N I reflective
N G Smanaging
O F M E N TAtheir
L H E Abehaviour.
LT H N U R S I N G commenced in the mid-twentieth century (Reischel,
The ideological conflict between proponents of 2001); for example, recognised education and
questions. Then, consider
such models of care and those who LEARNING
supported FROM medicalPRACTICE registration as psychiatric nurses commenced in
how the chapterapproaches has to treatment ‘based in neurophysiology Victoria with the passing of the Victorian Nurses Act
difficulty focusing their thoughts on a broad, open Shelley is a 21-year and skills.
old woman who As livesdescribed
at home with previously, At theinterpersonal
end of the second visit, a registered nurse
impacted your and neuropathology’ (Curry, 1989,
question. However, too many closed questions can
p. 10)
her mother. contributed
Shelley
communication first
has been admitted for the 1958time (Reischel,approached
is the tocornerstone
1974). Rose Parallel
of the as she waswith
therapeutic
these
leaving developments,
the unit. Indicating
SECTION 1
understanding, to the the

with establishment of the Select theCommittee
inpatient unit at the on the
local acute inpatientstatements
mental health regardingthat she waschanges
concerned that to health
Rose appearscare delivery
uncomfortable
make an interaction seem like an interrogation. facility. Shelley’s first 132
relationship.
36 hours in the unit wereT H Eunsettled
C L I N I C A L Cwhile
O N TinEthe
X Tunit
O Fand
P Rthat
A CsheT I Cwas
E very happy to answer any
Lunatic Asylum, Tarban Creek in 1846. The findings of generally, and mental health care in particular, were
Reflection on Learning this committee
as
enabled medicalresisted
she was
practitioners
extremely
efforts by theto
The
suspicious
assume
therapeutic
of the nursing
also
relationship
staff and
being reported.
is
questions a specific
Rose
stiffen andHolland
may type
have, Rose’s
(1978,
ofwhole
p. 16)
body appeared
stated
to
that
The opening word and its effect nurses
helping
to engage with
relationship.
her. Shelley
It is a relationship
with a trembling
where
voice she
the
replied, ‘Why would
fromThe
Practice
opening at word the
the end of
responsibility
chosen for governance
in a conversation did
can and treatment. This
not believe she needed to be in hospital and became you care, my daughter
‘A greater emphasis was emerging on health services is lost to me and places like this don’t
extremely agitated when mental healthtonurse
staff attempted administeror clinician help. Iengages therapeutically
know what these places are like and the sooner she
chapter. development meant that the laythesuperintendentsaying wasthat everyoneoutside
conditions, institutions
schizophrenia such asishospitals’. Since this time,
influence the focus of the response. Consider prescribed medication, with the consumer was trying
or carerto tois assist
out of here to thought
the better
them for her!’
identify, to emerge in the researchers claim psychopharma
following words demoted
in Table to5.3.
the position of senior warden.
poison Curry
her ‘because (1989)
she knew nursing
latestrategies
too much’. Shelley’s teens education
mother into early inadulthood,
all disciplines withhas comeepisode-
a first under the (with atypical antipsychotics) is
plan and evaluate to meet their health-related
SECTION 2
argues that this arrangement established Rose has beenthe in twice to visit her. Nursingcontrol
medical staff have of nursing Following Rose’s abrupt
bodies such departure,
thethe registered Board
nurse
asked several timesneedsto make aor objectives.
time
age-onset
to meet with Rose
for males
Effective
to therapeutic
considered
ofthisthe earlyasWhat
20s,
relationships
interaction.
Nursing
and for femalesof
emotions, feelings and
others believe psychological the
and nursing systems for the asylums discussand was copiedobtain additional Victoria
in the and,
late 20s, in contemporary
and times, the Nursing and
TABLE 5.3 Shelley’s progress
start andwith attitudes information
and values that again
experiences could be
promote inbehind
the
trustpost-menopausal
Rose’s response? How could effective. Some argue a combina
FEATURES WITHIN CHAPTERS
The opening word of everywhere
questions throughout the colonies.
The first facility for individuals
regarding the circumstances leading to Shelley’s
On both occasions, and
with a mental
understanding
staff have
Midwifery
period admission.
observed that Rose avoids
(APA,
between
requirements
condition
Board2013).
varies
the
of Australia.
an understanding
to work
While
mental
for between
accreditation
of the
health
collaboratively
This
psychologicalorganisation
nurse
with Rose
theories assistof
development
and Shelley?
of educational programs
thesets
team the
the What we do know is that any in
WORD CHOSEN IMPLICATION eye contact with them, and saystheveryindividual.
little to Shelley We
and consider
seems the core individuals,
values that it is usually this crucial period will be more
health condition in Victoria wasill at established in 1848
ease in the environment. and
gradual defines the standards
or attenuated with for nursing (and
symptoms midwifery)
emerging as nothing at all (Orygen Youth He
What Implies that we are searching for facts. promote effective therapeutic engagement.
Recognise the core and was DSM V Diagnostic
proclaimed
P E
a ward of
R S O N A L I
Criteria
T y
the NSWfor
D I S O R D E R
asylum at
S 213
Consider practice.
mild, and approaches
The development
culminating to in respectful
of the treatments
significant carefor
distress as formental
the The active phase of schizoph
How UsuallyCreek.relates toItquestions
becamethat ask forknownfeeling as the Merri
specific mental Tarban health conditions withlocally
the Respect clients health
condition
from disorders
progresses.
diverse throughoutThe prodrome
backgrounds history isisdealt with in
considered
with the the prodrome and is characteris
responses.
Creek
16
Lunatic Asylum. Following separationThe from foundationmore the
of an detail
early, in the
emerging
effective following section. is and
stage ofrelationship
therapeutic schizophrenia, Psychosis is a generic term use
Diagnostic
Why criteriaNew boxes.
Usually
South suggests
Wales, we are searching for
it became knownreasonsasor the Yarra respect. Bend Cultural
Respectmay
considerations
can be alikeneddifficulttoconcept‘the warning’
boxes.
to define, or abutsub-threshold of acute symptoms; delusions, h
explanations.
Lunatic Asylum (Reischel, 2001). The first evidence
at the five common it is seenof in the presentation
way that we interact where symptoms with others: do‘Respect
not yet warrant thought disorder, which as you
which trait may When DIAGNOSTIC education CRITERIA
Usually refers
forto‘mental
a period ofnurses’
time. in Victoria wasisnoted
BK-CLA-HERCELINSKYJ_1E-180420-Chp02.indd 16
constructed and CULTURAL
a conclusive
demonstrated CONSIDERATIONS
diagnosis.
in the Duringinteraction’ the prodrome, the
19/03/19 4:11 PM
characteristic of schizophrenia.
CHA P TER 12
enging behaviours. Where in Focuses

the Annual Reportresponse
the consumer’s for 1887 of the Kew asylum
on location. (Candlin, in 2011,individual p. 63). Respect experiences
is demonstrated subtle behavioural
verbally changes and the individual loses touch with
General personality
Victoria disorder
(Reischel, 1974). Mental illness and European settlement includes of Australia
ose individuals prone Would/could Encourage an open focus to theThis was the beginning
interaction of a
and non-verbally diminishing
through such functioning.
behavioursThis as being occupational, exhibit strange or odd behaviou
TABLE 12.2 formal training system Prior vocational
to the settlement of Europeans in Australia, mental
he most challenges from and enable the consumer to for
makestaff in asylums. Reischel
a decision genuine, being social, non-judgemental, and
beingpsychological
competent infunctioning. may believe that someone is wa
Diagnostic criteria
(2001) general
regarding observespersonality
their thatdisorder
participation lectures were provided your
in the interaction. by medical Whenillnessexplored
was almost unheard of in Aboriginal
retrospectively and Torres
While most of these role, keeping the consumer’s health-related(i.e. needs after
in diagnosis), house through electronic device
A. An enduringstaff
patternwho also
ofSOURCE:
inner oversaw
experience andOFand
behaviorcontrolled
that deviatesthe educative Strait Islandermay cultures. With thepicture
colonisation
of anofindividual
Australia
s to them, there are AUSTRALIAN INSTITUTE PROFESSIONAL COUNSELLORS, N.D. focus and doingthe noprodrome
harm (Egan, 2014). create the microwave, etc.), and as such, d
potential negative traits markedly from the expectations
process. In 1902, of the individual’s culture.
a number of general This trained nurses who came had disease
manyand the introduction
emerging signs ofofschizophrenia,
many substances supply to their property. It is im
pattern is manifested in two (or more) of the following areas:and several trained previously
becauseunknown to Indigenous cultures (such as
) situation. For example,
A guide1.toCognition
were employed
openand questions
(i.e.,untrained
ways of perceiving
at the Kew
andnurses
asylum
interpreting self,employed in the
Empathy but they were mild, did not merit further the individual may be frightene
female were alcohol). Since European settlement,
investigation rates of mental
seen in the agreeableness
other are
people, and events).
Empathy can be described as(Fleischhacker
both a value that & Stolerman, 2014). The these experiences and therefore
When issues spelled out in terms
main male ward (Reischel, 1974). This was the of the person’s first health challenges in Aboriginal and Torres Strait Islander
ual who is easily taken 2. Affectivity (i.e., the range, intensity, lability, and underpins the prodrome
therapeuticmay last for a period
relationship and a of years, and because sensitivity and validation in rap
experiences, feelings
recorded and behaviours,
occasion the issues
of female staff being involved in the people have increased to an extent that significantly
n an individual presents appropriateness of emotional response). communication it skill
usually thatoccurs
is seen inin adolescence
the mentaland emerges during the nurse. The active phase is w
become clearer.care For of example,
individuals questions
with acould mental focus healthon: condition. passes the ratesand of mental health conditions among stages,
non-
d and maladaptive, 3. Interpersonal functioning. health nurse’s interactions formative social
with consumers, emotional developmental
family is most likely to require hospita
■■ experience: what happened? Indigenous Australians. Currently, rates of psychological
tion to their life, one 4. ImpulseWomen
control. were specifically referred to as nurses now, and carers.
members it can have catastrophic
As a value, empathy impacts on an
is related individual’s come into contact with the men
Identify important client health and safety issues, Highlight Thespecific key aspects of emergence
clinical of
■■ behaviour: what
defining did you do? distress among Indigenous Australians are more than
a personality disorder. B. The enduring pattern isthem inflexibledifferently
and pervasive fromacross their male colleagues
a broad to developing the life.capacity prodrome
to sense mayandincludeacknowledge the untreated, the active phase may
ese traits are not and the appropriate
■ ■ feeling: how did
who were
range of personal
itresponse
and
feel? known
social toattendants
as
situations. critical situations (Reischel, the 1974). feelings presentation twice those
of symptoms
another person.
of non-Indigenous
relevant
listed inisthe
It the to a
‘Clinical
ability
Australians
specific
to
(ABS, 2011).
mental
observations’ box.health months.
■■ here and now: how do you feel now?
to many individuals, with theC.Safety The enduringfirst
Education
pattern boxes.
leads continued to be provided
to clinically significant distress orto attendants understand condition
the consumer withfrom thetheir Clinicalviewpoint observations boxes. Following the active phase (a
when an individual impairment in social, occupational, or other important areas of (Egan, 2014). We consider empathy as a specific of treatment) is the residual pha
stics from these traits, SAFETY FIRST
functioning. communication skill later in the chapter.
CLINICAL OBSERVATIONS often been described as resembl
onality disorder. You D. The pattern isCASEstable and STUDY
of long duration, and its onset can be phase. During this phase, the in
istics of the personality DON’T traced
JUST back at leastON
FOCUS to adolescence
THE PROBLEM! or early adulthood. Unconditional Possible positiveearly regard symptoms of the prodrome withdraw, display a distorted aff
riteria for many of the In the context
E. The of PENNY’S
enduring the
pattern is not‘CALLING’
therapeutic better relationship,
explained as ita can be
manifestation
From a humanistic perspective, unconditional positive
Possible early symptoms are: and may demonstrate some odd
d below. easy to think thatI mental
or consequence completed
of another healthmy
mentalnurse training
disorder.
nurses only listenin theto1970s, back when regard nursesis central soto long that I have been
developing and fortunate
maintaining
■■ strange beliefs, perceptions or bodily sensations
enougha to see the amazing but are no longer classified as ps
problems. But this
F. The enduring
trained
is notisinthe
pattern
a hospital
notcase.
andtoalso
Practising
attributable
lived
within there
the physiologicala too. I guess I sort of therapeutic
positive progression of mental health
relationship. The capacity
■■ issues with maintaining concentration
care, to even to play a part in this... also experience issues with their
der recovery-oriented ‘fell’ into(e.g.,
framework
effects of a substance mental health.
ameans
drug I did aa medication)
of listening
abuse, rotation
for the in the or psychiatricvalueward and respect things weren’tperson
another always great
■■ suspicious thoughts
regardlessin mental of health
how when I first display more negative symptom
nherently conditions andcondition
another strengths,
consumer’s medical thewhat nurse manager
(e.g.,
worked pulled me
headpreviously,
trauma) aside and told me
what behave is started,
I would
they the but we were
essential feature
■■ superstitious beliefs
doingofthe best we could with what we
unconditional psychotic symptoms have subsi
n cognition, affectivity, their hopes are, and be anot good justaddition
what they to their
feelstaff,
wentand I haven’t reallypositive
wrong. looked regard.knew. It■■alsoI really believe I was able
is demonstrated to help many of my patients
through may still experience some issues
SOURCE: APA, 2013 changes to affect
al functioning. These It is by listening inback since. I certainly
framework that mental haven’t
healthregretted
nursesit. I’ve been nursing support
ongoing even and in the early days whereIn
encouragement.
■■ emergence of mild negative symptoms
medications
order to were do limited and For example, while the individu
uous or long-lasting) help to promote a sense of hope, self-determination and this, DeVito (2016) believes we must listen without
■■ social withdrawal. people are watching them throu
irment in the empowerment in consumers and their families/carers. judgement, yet critically. This is a complex idea: they may still be suspicious of p
Copyright 2020 Cengage Learning. All Rights Reserved. May How notcan be copied,
we listen scanned,
without or judgement,
duplicated, inbut whole or in part. WCN 02-200-202
critically,
n successfully in a social,
al manner. They also INTRODUCING CLUSTER A, B AND C and how can this be Youngdonepeople
in practice? who are This difficult to have an
considered
Prognosis
concept is explored in the following sections. It is understood that the earlier
TABLE 9.6 G U I D E TO T H E TE X T xi
Mood stabilisers: dose ranges and side effects
SECTION 2
MEDICATION NAME DOSE RANGE SIDE EFFECTS AND INDICATIONS
Acute: 500–2000 mg Po titrated over side effects are directly related to serum lithium levels. The following symptoms
lithium carbonate
(lithicarb™) approx. 3 days (regular blood testing should resolve once dosage stabilises, and include:
FEATURES WITHIN CHAPTERS required)

Acute mania serum levels
• Gi upset (mild nausea, diarrhoea)
• dizziness
0.6–1.2 mmol/l • muscle weakness.
96 U N D E R P I N N I N G S O F M Therapeutic
E N TA L H E A(maintenance)
LT H N U R S I N G
levels The following are more persistent side effects:
Analyse Case studies that present 0.6–0.8 mmol/lmental health nursing issues
• fine hand tremor in context, encouraging you to
integrate and apply the concepts discussed in the chapter. • fatigue
• thirst
• polyuria
CASE STUDY • anorexia or weight gain (1–2 kg)
SECTION 1
• constipation
A NEW CLIENT • headache
Tomas is a 19-year-old client recently diagnosed with • ECG changes with Tomas and support his mother. You decide to locate and
• skin conditions
review (e.g. acne).current and best evidence to develop your
the most
schizophrenia and living with his mother. He has been
sodium
unablevalproate
to return to his1000–2500 mg/day
study course or Po
findinwork since include: response.
Bd dose
(anticonvulsant)
dropping out of his VET with food the previous semester. He•isnausea;
course
Target serum levels 50–100 mg/l Questions
• diarrhoea
reluctant to accept the diagnosis and struggles to agree with 1 What background questions need to be answered in
• vomiting
a need to take his olanzapine. His mother has expressed • constipationorder to then develop the specific foreground question?
worries that she ‘cannot talk to him any more’ and get him • headache
2 Develop a searchable and answerable foreground
to take his medication. She says he is becoming worse and • sedation or question
fatigue using the PICO format to locate the highest
asks you what she should do. Tomas is a new client and it• muscle twitching. level of evidence to inform your approach to help Tomas
138 THE CLINICAL CONTE X T OF PRACTICE
is not clear howthat
Identify commonalities
lamotrigine to quickly
youdevelop
100–400 may medication
mg/daysee Po inwith adherence
Bd dose consumers experiencing
lamotrigine has efficacy
and a specific
in treating
his mother. mental
Bd where depressive health
episodes have occurred.
(anticonvulsant) Careful titration required as high • life-threatening rash
condition with the Commonalities commencingof the
doses MSE
have section
been related in each chapter
• double-vision (diplopia); of Unit 2.
Levels and types of research
to occurrence evidencerash; • dizziness;
of life-threatening current evidence, an understanding of how to classify
see the ‘safety first’ box. • headache;
the quality of research is needed. Research evidence
Clinicians
COMMONALITIES do not approach research
OFlevels
THE MSE: evidence for the
SCHIZOPHRENIA
serum are not a reliable • loss of is
coordination (ataxia);
SECTION 2
same purpose as thatmeasure of a researcher. frequently depicted in a hierarchy, often called an

of efficacy forResearchers
lamotrigine. pose • nausea & vomiting;
questions as research problems – frequently, for the • fatigue.‘evidence pyramid’, where the top of the pyramid
purpose ofappearance
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of research evidence
General
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An individual with schizophrenia
Target serum 4–12present
may mg/l slowly. side effects include: you should kill yourself’) or positive in
way to answer anomalies
the following the research inquestion. Instead, and
their appearance • dizzinessnature (‘You are important and special; this isor
clinicians levels of research-based evidence. The best – whymost you
need to have confidence that they are utilising the • headache trustworthy
have been – evidence
chosen’). Voicesis atcan
thebe top maleof the
or pyramid.
female (and
behaviour:
best currently available
■■ dishevelled evidence about the
(due to disorganisation, issuesspecific
with EF, lessAny
• loss of coordination search
(ataxia)for
frequently, evidence
childlike), for practice
although should
McCarthy-Jones et
clinical problem impacting on their client. Therefore, • sedation start
al. at thenote
(2014) top in of their
the pyramid.
study Clinicians
exploring should
hallucinations
motivation due to negative symptoms, etc.) • fatigue
the only movevoices downwere the levels
more when the evidence
While theis
■■ clinician
uncooperativeasks questions of the (due
with interview current research
to poor insight that male common.
• double-vision (diplopia) at a higher level. Figure 6.3 is divided
not available
evidence that bestandanswers the clinical problem.
into illness belief in the need to require • nausea individual may recognise the voice asA N someone who is
XIE T y dIsORdERs 207
Clinicians seekortosuspiciousness
find the best possible answer • vomiting into
known twotobroad them,layers:
unknown filtered
voicesinformation
are just asand common.
intervention) and paranoia
to clinical questions from databases containing very • fluid unfiltered
retention The information.
following subtypes Filtered
of information
auditory is sources
hallucinations
■■ poor eye contact (due to negative symptoms) or
largeintense of
areresearch evidence in which studies based on similar
Learn about thepools of
eyeresearch.
importance contactof To find the best possible
evidence
(paranoia) and clinical•research dry mouth. common
in nursing with the Evidence-based practice
in schizophrenia:
boxes, which HOW link DO MENTAL HEALTH

■■ movements or gestures may be overt and the
research to nursing NURSES
practice. if
■ command
■ the person hallucinations
is experiencing (‘Quickly!
high levelsETTurn
soURCE: AndREWs of2013;
Al., off
anxiety,the 2018
MiMs onlinE,
individual may present as distracted. butTV, it isthey can see you.

a short-term Hurry!’) In addition, it is
alternative.
C H A P T E R 11
ASSIST A PERSON EXPERIENCING ■ running-commentary
very
■ important to promote hallucinations
the use of deep onbreathing
behaviour
EVIDENCE-BASED PRACTICE
Mood
ANXIETY? and(‘It is interesting
relaxation that you
techniques that have chosen
a person can a red
use pento to
Individuals with schizophrenia who are paranoid may fill out your deposit slip
prevent/manage/reduce the today’)
impact of anxiety. This
Seasons
Nursing and bipolar
approaches disorders?
to assisting a person experiencing Systematic spring; however,voices the same information about hypomania is
be fearful, afraid or distressed. Individuals exhibiting ■■ multipleempowers
reviews knowledge who converse
a person to tobeeach about at
in control the a
anxiety focus
Title of study
significant on supportive
negative symptoms interventions,
may presenttherapeuticas not readily
individualavailable.or other
time when anxiety canthings (male
strip aFiltered
person voice:
of their ‘Hefeeling
will
communication
Seasonal variations
withdrawn and education.
in ratesDue
or depressed. Earlier
of hospitalization in
to suspiciousness, this chapter,
for mania theand Design never amount
of control. When the to anything, is he
personinformationlesswill never provide
anxious, measure
we introduced
hypomania
individual specific
in psychiatric
may refuse to strategies
hospitals
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NSW
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possible voice: from
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by a trustworthy person, so exploration (evidence syntheses
Authors December
increase 1999
is so pathetic;
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heanxiety
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forand guidelines)
Parker and Rebecca ICD ■ classification
person
■ non-verbal
has used labels.
auditory
previously hallucinations
that have been (such as music,
successful.
promoting a sense of emotional and
individuals who have a diagnosis of schizophrenia to physical safety.
sounds,
Working fromwhite noise, humming,
a strengths-based running is
perspective water,
a
Background
Sitting
disconnect withthea consumer,
power to their decreasing
home the dueamount
toCritically appraised Participation
of
paranoia, individual
animal noises).on for
articles powerful
Admission
(article synopses) reinforcer
information 27 255 the individual,
mental health as
patientsit shows
with mania
A number
stimulation of studies
they arehave suggested
encountering
and therefore storage of food items may become that
in individuals
the immediatewith
them
and they
hypomania
Visual do have
in all
hallucinations NSWskills
mental and
healthstrengths theyexplored.
facilities was can draw
bipolar
area, disorder
remaining experience
calm and higher
using
unhygienic and spoiled, rendering them unsafe forrates
clear of hospitalisation
concise language in
Randomised on. Reinforcing and supporting
are anotheracommon person in these
are all ways in Exploration
consumption. which the mental of libido health
is alsonurse cancontrolled trials
important,
Visual (RCTs)
hallucinations
SOURCE: UNIvERSITY OF CANBERRA LIBRARY, 2018
ways are part

perceptual of what is the
phenomenon core business ofVisual
of schizophrenia. mental
assist a person who is experiencing anxiety. The use of
Follow an individual
and may indicate person’s issuescase
with and the process
trustworthiness or of planning healthcare, nursing.
hallucinations
identifying
The following
commonly
problems,
nursing
Unfiltered
occur
performing
care
simultaneously plan draws
PRN (when necessary) medications
significant distractibility, rendering relationships may be indicated
Cohort studies
interventions and evaluating outcomes for that person withalongside the detailed
together aauditory
number Nursing
of these ideas.
hallucinations careinplans.
information over 80% of
difficult to maintain. Sleep may be impacted in
BK-CLA-HERCELINSKYJ_1E-180420-Chp09.indd 164 persons with schizophrenia (Waters et al., 2014). Visual 19/03/19 12:44 PM
times of stress or heightened paranoia, and therefore
Case-controlled studies/case series/reports
NURSINGof CARE
exploration PLANis essential.
sleep patterns
hallucinations are often described as three-dimensional,
solid, both colour and black and white, and can
Background information/expert opinion
Affect last for a few seconds or minutes. Typically, visual
MANAGING PANIC ATTACKS hallucinations may include images of people (including
In individuals who are experiencing increased negative
FIGURE
Consumer6.3 Diagnosis: Panic Attacks tightness in herfairies,
chest and difficulty breathing. She managedorto
symptoms of schizophrenia it is common to see affective God, Satan, ghosts, etc.), animals, shadows
Evidence
Nursingpyramid
Diagnosis: Extreme fear/panic whereby Maeve turn into a andside street, where she continued to experience these
blunting. This can range from restricted affect, where objects, those of a distressing nature may include
experiences feelings of intense dread and anxiety, tightness in symptoms insects, blood for several minutes before
or offensive writing they(Waters
subsided. et Eventually,
al., 2014).
there is some distortion of emotional expression, to a
the chest, palpitations, sweating and difficulty breathing. the symptoms
Perceptual settled down, which
disturbances lessenabled
commonly Maeve to contact
seen in
flat affect, whereby emotional expression is absent. It
Outcomes: Develop strategies to manage any future episodes her partner. She attended
schizophrenia include: the emergency department, where a
is important to consider how congruent the affect is to
of panic. range of tests was performed with all results being within normal
■■ olfactory hallucinations (e.g. smelling rotting food
the individual’s mood. Are they smiling while discussing
parameters.
or gas)Since this first visit, Maeve has experienced several
details of a perceived
Maeve is a 42-year-old woman
BK-CLA-HERCELINSKYJ_1E-180420-Chp06.indd plot
96 to kill them, for example?
who recently presented to the 17/03/19 5:25 PM
more of these episodes. As nothing physiological was identified,
■■ tactile hallucinations (e.g. feeling spiders crawling
emergency department. Maeve was driving to work along a Maeve has been asked to visit her local GP, who has referred her
Perception on skin)
busy arterial road when she suddenly felt faint and experienced for assessment to the practice nurse.
The most common perceptual disturbances in ■■ gustatory hallucinations (e.g. tasting ‘poison’ in food).
schizophrenia are auditory and visual hallucinations.
Thought
Auditory hallucinations
ASSESSMENT DATA EVIDENCE-BASED RATIONALE CONSUMER
Auditory
OBJECTIVEhallucinations
(O) (such RATIONALE
as hearing the voice Content RESPONSE
ofSUBJECTIVE
Copyright God)Cengage
2020 are commonly
(S) Learning.heard at a normal
All Rights Reserved.volume
May not be copied, scanned,are
Delusions or a diagnostic
duplicated, in component of schizophrenia
whole or in part. WCN 02-200-202
(although sometimes reported as whispering or yelling), (and psychosis) and are therefore very common in the
Maeve describes how she feels a Provide psychoeducation that Education provides Maeve with Maeve begins to understand the
insudden,
both severe
ears, for periods longerencompasses
and uncontrollable than a few minutesand
information conversations
information to help herof consumersconnections
understand who havebetween
a diagnosis of
events, her
REFLECTION ON LEARNING FROM PRACTICE
CHAPTER RESOURCES
SECTION 1
Lydia’s experience is not unlike that of others when admitted Mental health nurses need to be aware of their
xii G U I D E TO Tto
H Ea mental
TE X T health unit under the Mental Health Act. While professional, legal and ethical responsibilities in
SUMMARY
the Mental Health Act aims to support people with a providing and supporting care for people with a mental
mental health condition who require treatment, it can be illness. It is the responsibility of the nurse to ensure that
■■ This chapter has explored the legal and ethical contexts for ■■ Law and ethics apply in the context of nursing in Australia
a stigmatising and scary experience for consumers. The care and treatment provided is supportive of the person’s
nurses working in the field of mental health in the context of and all nurses working in health care need to be familiar
challenging aspect of this is for mental health nurses to human rights, and inclusive of their and their primary
mental health legislation in Australia. with local Mental Health Acts and other relevant
END-OF-CHAPTER
■■ Mental health legislation FEATURES
balance legislation whilst maximising choice, promoting
in various jurisdictions of Australia
safety and supporting consumers in their recovery.
carer/’s wishes.
legislation.
is varied. However, commonalities lie in the preservation of ■■ Of supreme importance are the issues of informed consent
dignity,
At the end upholding
of each duty of you
chapter care, will
and providing mentaltools
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youinvoluntary
to review,or compulsory
practisetreatment, and the
and extend mental
your
care that is in a least restrictive environment. health nurse should adopt a consumer perspective.
knowledge of the key learning outcomes.
■■ Contemporary ethical and legal frameworks facilitate
CHAPTER RESOURCES
Review recovery
your understanding of the key
and promote autonomous chapter
decision with with the Summary.
makingtopics
carer input.
SUMMARY
ONLINE STUDY
■■ This chapter TOOLSthe legal and ethical contexts for
has explored ■■ Law and ethics apply in the context of nursing in Australia
nurses working in the field of mental health in the context of and all nurses working in health care need to be familiar
mental health legislation in Australia. with local
■■ videos andMental Health
video links for Acts and other
the chapter relevant
video cases
Express
■■ Mental health legislation in various jurisdictions of Australia legislation. version of the summary of age trends table
■■ downloadable
Visit http://login.cengagebrain.com
is varied. However, commonalitiesand lie use thepreservation
in the access of Of supreme
■■ for importance are the issues of informed consent
this chapter
code that comes
dignity, upholding withduty
thisofbook forand
care, 12 months
providing access
mentaltohealth
the and involuntary
■■ revision quizzes or compulsory treatment, and the mental
resources
care thatandis instudy tools
a least for this chapter.
restrictive environment. health
■■ and nurse should adopt a consumer perspective.
more!
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■■ Contemporary
knowledge Express
ethical
and and website
legal
consolidate contains:
frameworks
yourfacilitate
learning through the Review questions.
recovery and promote autonomous decision making with
carer input.
REVIEW QUESTIONS
1 Choose the statement that best defines the difference 3 The following requirements are necessary for all patient
ONLINE
betweenSTUDY
law and TOOLS
ethics: consent:
a Ethics dictates behaviour, but law does not a The consent must be voluntary, specific to the
b Law is ‘prescriptive’ videos and video links for theinformed
intervention/treatment, chapter and
videothecases
person must
Express and ethics is ‘guiding’
■■
c Ethics is based on law ■■ downloadable

T Hhave T i C Aversion
E o R Ecapacity l f R A mofE w
the
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ACTiCE 31
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A person can be punished forand use the ethics
breaching access for
b this
Thechapter
consent does not need to be voluntary as long as
2codeWhere
that comes
there is with
an this book
actual or for 12 months
perceived access
conflict to the the
between ■■ revision quizzeshas the legal capacity
the person
resources
code ofand study for
conduct tools for this
nurses andchapter.
the law: ■■ and
c more!
The consent can be considered valid if obtained
The CourseMate Express website contains:
CRITICAL
a The codeTHINKINGtakes precedence through coercion as long as it is in the best interest of
THEoRE TiCAl fRAmE woRks undERPinning PRACTiCE 31
The law takes precedence on and discuss complex issues inthe patient to nursing with the
CHAPTER 2
Challenge b yourself to reflect relation
1 The conflict
c What factors iswould
settled
a with consideration
mental health nurse totake
the code dTheyThe consent
are sleepingmust be voluntary,
in separate rooms cover
and any
she intervention/
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thinking QUESTIONS
questions.
andaccount
into the law when considering which theoretical himtreatment during admission,
see her undressed. be informed
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her…
1 dChooseThe conflict
perspective is decided
might
the statement help by
thatthem theto
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understand
defines and
the Midwifery
a consumer’s
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locking me out’, Ivan
requirements arestates. ‘I have
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CRITICAL
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between of THINKING
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and ethics: Iconsent:
can speak to.’ Using a psychodynamic perspective,
2 a Jennifer has been
Ethics dictates receivingbut
behaviour, chemotherapy
law does notas part of her how
a The could the nurse
consent mustunderstand
be voluntary, Jennifer’s
specific current
to the
1 b What
breast
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cancer would aand
mental
treatment.
‘prescriptive’ The
ethicshealth
nurse nurse that
notes
is ‘guiding’ takewhen her They are sleeping in separate
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informed andthesheperson
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let
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husband
Ethics isattends
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on considering
appointment
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capacity ‘I just want
theory, identify whattofactors
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them. understand
Whenever a Ivan
consumer’s
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person’s
b The lockingdoes
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capacity perspective,
apply Bandura’s
Jennifer
2 code hasThe
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BK-CLA-HERCELINSKYJ_1E-180420-Chp03.indd been receiving
fornurse
44 asks
nurses andchemotherapy
Ivan privately ifaseverything
the law: part of her how
concept
c The couldof the
consent nurse understand
self-efficacy
can be to support
considered Jennifer’s
consumers current
valid if obtainedin 19/03/19 11:07 AM
a breast
isThe
okay cancer
between
code takes treatment.
him andThe
precedence nurse Ivan
Jennifer. notesbecomes
that when her behaviour?
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through coercion as long as it is in the best interest of
b husband
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diagnosis Whenever
and
consideration treatment.Ivancode
to the tries person’s development
d The consent must beover the course
voluntary, cover of their life.
any intervention/
to
Start your online speak with
and the reading
law Jennifer she turns her head and will
and research using the short list of Useful not 4 How can
treatmentthe mental
websites. health nurse apply Bandura’s
during admission, be informed and the person
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USEFUL visiblyWEBSITES
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talk about the cancer diagnosis and treatment.
■■ Approaches to Psychology – the humanistic approach: ■■ Hildegard Peplau’s interpersonal relations theory:
https://www.ryerson.ca/~glassman/humanist.html https://nurseslabs.com/hildegard-peplaus-interpersonal-
■■ Australian Psychological Society: relations-theory
USEFUL WEBSITES
USEFUL WEBSITES
https://www.psychology.org.au
CHAPTER 2
■ Approaches to Psychology
BK-CLA-HERCELINSKYJ_1E-180420-Chp03.indd 44 – the humanistic approach: ■ Hildegard Peplau’s interpersonal relations theory: 19/03/19 11:07 AM
Approaches
■■ to Psychology – the humanistic approach:
https://www.ryerson.ca/~glassman/humanist.html
■■ Hildegard Peplau’s interpersonal relations theory:
https://nurseslabs.com/hildegard-peplaus-interpersonal-
Expand your
SEARCH knowledge
ME! NURSING by reading
https://www.ryerson.ca/~glassman/humanist.html
■ Australian Psychological Society:
the Search me! nursing articles or conducting further research in the
https://nurseslabs.com/hildegard-peplaus-interpersonal-
relations-theory
Search
■■ me! nursing
Australian database
Psychological
https://www.psychology.org.au with the suggested key termsrelations-theory
Society: and activities.
Key terms
https://www.psychology.org.au 2 Read the article, ‘The effect of using Peplau’s therapeutic
■■ Hildegard Peplau relationship model on anxiety of coronary artery bypass
SEARCH
■■ Mental health ME! NURSING graft surgery candidates’ (Maghsoodi et al., 2014).
SEARCH ME!
■■ Mental illness NURSING
Expand your knowledge with Search me! nursing. Fast and
a While not specific to mental health, it is interesting
a Research Peplau’s four phases of the therapeutic
■■ Personality
convenient, this resource provides you with 24-hour access to reflect on the utility of the model in other clinical
relationship.
Key terms
■■ Phil 2 Read the article,
contexts ‘The effect
andlike
shows thatthe of
theusing Peplau’s
experience oftherapeutic
anxiety
toBarker
full-text articles from hundreds of scholarly and popular b You might also to review research into the
■■ Hildegard Peplau
■■ Therapeutic
journals and relationship
newspapers, including The Australian and The
relationship
application
model
is experienced
of Peplau’s
on anxiety
in allideas
health of coronary
contexts.
to other healthHow
artery bypass
would
contexts. you
■■ Mental health
KeywordNewactivities
York Times. Search me! allows you to explore topics 2 Readgraft surgery
explain
the article, candidates’
mental healthofto
‘The effect (Maghsoodi ettherapeutic
a nonprofessional?
using Peplau’s al., 2014).
■■ Mental illness
1 Read further
theand find current
article, references.
‘A literature review of the progress of aReadWhile
3 relationshipthe not specific
model
article, on‘Toward to mental
anxiety aofnew health,
coronary it isof
artery
definition interesting
bypass
mental health’
■■ Personality
For access,nurse-patient
the psychiatric go to http://login.cengagebrain.com.au
relationship as describedand by graft to reflect
surgery
(Galderisi on the
candidates’
et al., 2015). utility
Thisofarticle
(Maghsoodithe model al., in
etstarts otherthe
2014).
with clinical
definition
■■ Philfollow
Barkerthe instructions
Peplau’ (Stockmann, 2005). provided on the printed access card a contexts
While not and
specificshows
to that
mental the
health,experience
it is
developed by the WHO and argues for a new definition of of
interesting anxiety
from the front
■■ Therapeutic of this textbook.
relationship toisreflect on the utility
experienced in allof health
the model in otherHow
contexts. clinical
would you
a Research Peplau’s four phases of the therapeutic mental health.
Keyword The following key terms and activity questions can be used
activities contexts
explain and shows
mental that the
health to experience
a of anxiety
nonprofessional?
relationship.
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, a What is your
scanned, own personal
or duplicated, definition
in whole or in of mental
part. WCNhealth?
02-200-202
1 Read for additional
the research.
article, 3 Read is experienced
article,in‘Toward
thewould all healthacontexts.
newthe How
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of mental health’
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b Key might
terms also‘Alike
literature review
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b explain mental you
health incorporate
to a nonprofessional? ideas presented in this
theapplication
psychiatricof nurse-patient relationship as described
Peplau’s ideas to other health contexts. by (Galderisi et al., 2015).
paper into this definition? This article starts with the definition
■
xiii

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xiv
PREFACE
ABOUT THIS BOOK ■■ theory of communication

■■ legal and ethical considerations
Florence Nightingale once said, ‘nursing is an art ■■ extensive exploration of conditions (e.g.,
and a science’. This point perhaps best describes schizophrenia, depression, personality disorders etc.)
the dichotomy for students when entering mental ■■ complements the acclaimed DSM5 (2013)
health. For many students their previous learning has ■■ therapeutic use of medicines
focused on technical psychomotor skill acquisition. ■■ suicide and non-suicidal self-injury
For example, undertaking a physical assessment, ■■ non-pharmacological approaches to intervention
blood pressure, or administration of sub-cutaneous ■■ community mental health
medication. Mental health nursing requires a uniquely ■■ carer and family input
different, and human set of skills that can be very ■■ Indigenous perspectives
challenging for some. Mental health nursing centres ■■ mental health first aid.
on the individual, their needs, their challenges, their One of the most difficult aspects of mental health
hopes and their goals, and nurses require competent nursing for students is applying what they have leaned
therapeutic communication skills to help. into a clinical context. For example, how to undertake
Mental health nursing proficiency is a standard a mental state examination. This text has been
requirement of every nursing graduate. Individuals developed with these issues specifically in mind by:
with a lived experience of a mental health condition ■■ providing examples of common mental state
are understood to experience discrimination, examination presentations specifically according to
stigmatisation and disadvantage that results in the mental health condition
worsening of mental and physical health. While ■■ comprehensive exploration of mental state
mental health nursing is a highly specialised sector examination including provision of questions and
of healthcare, the increasing prevalence of mental definitions
health conditions means that all nurses must be ■■ the use of clinical observation and Safety First
suitably equipped to engage therapeutically with boxes to highlight specific areas of practice that
someone experiencing a mental health challenge. This students must be familiar with.
requires a combination of theoretical understanding This text provides a comprehensive introduction
of mental health and mental ill health, and how the to mental health nursing where the consumer is
person’s lived experience of a mental health condition central to the caring process, and how care is delivered
is central to working collaboratively with them. This by the multidisciplinary team. Core features of
understanding is then applied in practice through the this text will provide students with the foundation
multidisciplinary team by safely applying therapeutic knowledge and skills they can apply during their
skills in interactions with consumers experiencing clinical placement and future nursing career.
a mental health condition. This text provides a
comprehensive exploration of mental healthcare that Gylo (Julie) Hercelinskyj and
enables practical application of skills. Louise Alexander
Areas comprehensively covered in this text include:
■■ historical perspectives of mental healthcare
■■ recovery and trauma informed practice
xv

ABOUT THE AUTHORS
Gylo (Julie) Hercelinskyj is a senior lecturer Principal Lecturer Nursing, Three Counties School
in mental health nursing at Australian Catholic of Nursing and Midwifery, University of Worcester/
University (ACU), Melbourne. Julie’s clinical, teaching Associate Professor (adjunct) School of Nursing and
and research background is in older person’s mental Midwifery, La Trobe University
health, perinatal mental health, interpersonal skills ■■ Chapter 18: Trauma and stressor-related
and psychosocial nursing practice. Julie is a registered disorders, with Louise Ward.
nurse. She completed her original education in general
Glen Collett
nursing and then specialised in mental health nursing.
Ad. Dip Nursing Studies, Facilitating Learning in
Julie has a Masters in Nursing Studies and completed
Clinical Practice, P.Grad Certificate of Nursing, Papers
her PhD in 2011. She has presented at national and
in Alcohol and Drug Rehabilitation and Clinical
international conferences and has published in the
Speciality in Mental Health. Prior Nurse Unit Manager
area of emotional labour in mental health nursing.
for Addictions, Healthscope, Clinical Facilitator
Julie believes that all nurses need to incorporate
■■ Chapter 14: Substance-related and addictive
promoting mental health into their practice. This
disorders, with Desiree Smith
requires a clear understanding of mental health and
mental distress, the impact on the person and their Doseena Fergie
families and how nurses work collaboratively with PhD. FCATSINaM. 2016 Churchill Fellow. Project Lead,
people who have a lived experience mental distress, Indigenous Recruitment and Retention, (Postgraduate
and their families. & Academic), Australian Catholic University
■■ Chapter 25: Cultural context in practice in
Louise Alexander is a lecturer in mental health
Australia
nursing at Australian Catholic University (ACU),
Melbourne. Louise has a background in forensic Terry Froggatt
mental health nursing in acute, subacute and PhD. MSc. BHA (UNSW). RN.CMHN, Head - Faculty
rehabilitation areas. Louise is a registered nurse with of Health and Social Wellbeing, Honorary Fellow
post-graduate qualifications in psychiatric nursing, University of Wollongong, Nan Tien Institute
and professional education and training. She also has ■■ Chapter 3: Ethics, law and mental health nursing
a Masters in Education, and a PhD in Psychology. practice, with Alison Hansen

Louise has presented at conferences both locally and ■■ Chapter 7: Assessment and diagnosis, with Louise
internationally about teaching mental health nursing Alexander

and has a special interest in the use of simulation in ■■ Chapter 26: Mental health first aid, with Nygell
mental health teaching. Topp.

Louise is passionate about students’ developing
Karen Hall
a comprehensive understanding of the theoretical
RN, Dip VET, MMentHlth, PhD (cand.), Swinburne
underpinnings of mental health nursing. In particular,
University.
students’ understanding and ability to undertake a
■■ Chapter 24: Community mental health context
mental state examination, and activities that alleviate
pre-clinical placement anxiety. Louise currently Alison Hansen
oversees mental health nursing within the Bachelor RN, MAdvNursPrac (Mental Health), GCHE, PhD
of Nursing program and is the national course (Cand.), Lecturer, Monash University
coordinator for mental health nursing at ACU. ■■ Chapter 3: Ethics, law and mental health nursing
practice, with Terry Froggatt

Contributing authors
Peri O’Shea
Cengage would like to thank the numerous
PhD, M. Soc. Pol., Psyc. Hon., B. Soc. Sc. Lived
contributors who assisted in this publication.
Experience Researcher and Consultant – xperienhance
Melody Carter ■■ Chapter 21: Recovery and resilience in mental
PhD, MSc (ECON), PGCE(HE), BSc (HONS), RGN, health

DN, Senior Fellow of the Higher Education Academy,
xvi A b o u t t h e au t h o r s
Brian Phillips Louise Ward

DipSc, MSc, PhD, RN, Senior Lecturer in Nursing, PhD, MN (Mental health), PGDip Arts therapy,
Charles Darwin University PGCert ed. BN (Hons), RN, Associate Professor Clinical
■■ Chapter 6: Using evidence to guide mental health practice, School of Nursing and Midwifery, La Trobe
nursing practice University Australia.
■■ Chapter 18: Trauma and stressor- related
Desiree Smith
disorders, with Melody Carter
RN, BHSc (Nursing), GCPNP, MPH, Sessional Tertiary
Educator, Intake Clinician: The Melbourne Clinic Cengage would also like to extend thanks for partial
■■ Chapter 14: Substance-related and addictive chapter contributions to:
disorders, with Glen Collett
Russell Fremantle
Nygell Topp ■■Chapter 15: Neurodevelopmental disorders
RN, B.N, PGD Adult Ed, Accredited mental health first
Scott Truman
aid instructor
■■ Chapter 17: Obsessive compulsive and related
■■ Chapter 26: Mental health first aid, with Terry
disorders.
Froggatt
xvii

ACKNOWLEDGEMENTS
Gylo (Julie): This has been a journey shared with a You are both my biggest motivation, and my proudest
number of people. Thanks to Louise for agreeing to achievement. I love you both very much. Finally, I
go on this rollercoaster ride with me. To my amazing would like to dedicate this book to my nephew James.
husband Peter – your support, love and friendship Never forgotten.
have always been the mainstay in my life. You
Cengage and the authors would like to thank the
are my ‘rock’. Here’s to the future. To my children
following reviewers for their incisive and helpful
Ayisha and Shae and my amazing grandson Ralph,
feedback:
I am immensely proud of the people you are, and
■■ Trudy Atkinson – Central Queensland University
that I get to be your mum and grandma. Mum, your
■■ Rhonda Dawson – University of Southern
indomitable spirit inspires me to be best I can be
Queensland
personally and professionally. To my father, sister and
■■ Cheryl Green – University of Adelaide
brother, I miss you all. This book is dedicated to you.
■■ Phillip Maude – RMIT University
Louise: I would like to thank my family for their ■■ Eddie Robinson – Monash University
support during this journey. You have all had to ■■ Tracy Robinson – University of Canberra
put up with an awful lot of literary suffering, far in ■■ Susan Sumskis – University of Wollongong
excess of the usual undertakings of an academic: ■■ Sione Vaka – Massey University
manuscripts, PhD thesis and this book. In particular, ■■ Philip Warelow – Federation University.
I want to thank my husband Christian, and children

Every effort has been made to trace and acknowledge
Madeleine and Charlotte. Christian, thank you for
copyright. However, if any infringement has occurred,
your support during this process, and for believing
the publishers tender their apologies and invite the
in me. I love you. To my daughters, I know it always
copyright holders to contact them.
seems like mum is always busy ‘doing something’ but
I do hope you understand that I do it for you both.
SECTION
1
UNDERPINNINGS OF MENTAL
HEALTH NURSING
CHAPTER 1 MENTAL HEALTH NURSING –THEN AND NOW 2
CHAPTER 2 THEORETICAL FRAMEWORKS UNDERPINNING PRACTICE 16
CHAPTER 3 ETHICS, LAW AND MENTAL HEALTH NURSING PRACTICE 33
CHAPTER 4 TREATMENT MODALITIES UTILISED IN CONTEMPORARY
MENTAL HEALTH SERVICE DELIVERY 48
CHAPTER 5 MENTAL HEALTH NURSING AS A THERAPEUTIC PROCESS 68
CHAPTER 6 USING EVIDENCE TO GUIDE MENTAL HEALTH NURSING PRACTICE 91
From the days of the asylum and work of attendants through to contemporary mental health
service delivery, mental health nursing has evolved into a discipline that is guided by humanistic
principles and evidence for practice. Practice is founded on a range of theoretical perspectives,
legislative requirements, a variety of treatment and management options and therapeutic
processes. Section 1 explores these foundational ideas in order to set the scene for the
remainder of the book.
To understand the role of the mental health nurse as a member of the multidisciplinary
team in delivering recovery-oriented and trauma-informed care, Chapter 1 provides a
sense of the historical development of the discipline. Chapter 2 introduces some of the key
theoretical frameworks that underpin mental health nursing practice. You will read about
ideas from psychology and medicine as well as key contributions from mental health nursing
theorists. These ideas will be applied to practice and critiqued. Chapter 3 presents essential
knowledge regarding how mental health legislation underpins mental health service delivery,
how recovery has influenced recent legislation and the consumer perspective of compulsory
treatment and nursing practice, as well as key ethical considerations and issues related
to practice and ethical frameworks to identity these issues. Chapter 4 explores the range
of pharmacological and psychosocial treatment options currently used in contemporary
practice. Core to effective practice in mental health is the capacity to listen to, respond and
work collaboratively with consumers and their families. Chapter 5 explores the concept
of mental health nursing as a therapeutic process. The fundamental components of the
communication process, and the application of knowledge and skills to the therapeutic
process are identified and explored. Section 1 concludes with Chapter 6, which looks at how
mental health nurses understand, apply and critique evidence for practice. This includes
consideration of clinical reasoning and decision-making.
1
CHAPTER
1
MENTAL HEALTH NURSING – THEN AND NOW
Louise Alexander and Gylo (Julie) Hercelinskyj
LEARNING OUTCOMES
Upon completion of this chapter, you should be able to:
1.1 Describe early human beliefs in illness and disease that affected how mental illness has been perceived
1.2 Describe factors behind the rise and growth of asylums throughout the world as well as the conditions that
historically prevailed at asylums
1.3 Describe the history of asylums in Australia and the emergence of mental health nursing as a distinct
profession within Australia
1.4 Describe treatments of mental health conditions throughout history, including the improvement of care,
conditions and more humane perspectives on mental health and mental health nursing
1.5 Explore the role and identity of the mental health nurse in contemporary mental health service delivery
LEARNING FROM PRACTICE

To be honest, when I started nursing, I didn’t even realise But when I told my parents of my decision my father’s
there was an area of practice dedicated to working in response was: ‘Why can’t you be a normal nurse and work
mental health. But even in the beginning of my education, with babies?’
I was always drawn to those ideas and concepts that Even now many years later, when I say I am a mental
explored the person’s response to both health and illness. All health nurse I wait for what seems to be the inevitable
the science was important, but it was learning about people reaction from people. I watch their eyes widen, their jaw
that interested me the most. Having a clinical placement drop ever so slightly and then they say: ‘But what do psych
at a community mental health facility provided my first nurses actually do?’, ‘You’re a mental health nurse? That
experience of a positive learning opportunity. I loved the must be so hard’, ‘You deserve a medal’ or ‘Why did you
learning, the teamwork, and seeing the way consumers choose that?’ So, I tell them my story and hope they take
experienced their recovery journey. I wasn’t made to feel even a small level of understanding away.
small or insignificant and no-one made me cry. But even JD, mental health nurse
then, I still did not see myself as a mental health nurse. I
was going to be a midwife and thought completing mental JD has described her journey into mental health nursing,
health nursing after graduation would be useful in that work. one she herself admits she was surprised to have enjoyed.
I never became a midwife. The closest I came to holding You may find yourself in a similar position – contemplating
an infant was the time spent working in paediatrics. My your future as a nurse, and finding certain areas challenge
postgraduate year had clearly shown me that I wanted to your preconceived ideas. What is your understanding of
be a mental health nurse. It was there that I felt I could mental health nursing? Reflect on how you feel about your
contribute and make a difference as a registered nurse. upcoming mental health studies.
2
M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 3
INTRODUCTION The following terms were all socially appropriate and,

in fact, diagnostic labels of early mental health conditions:
CHAPTER 1
To understand where we are going in the profession of ■■ lunatic
mental health nursing, it is important to consider where ■■ idiot
we have come from. Often the history of mental health, ■■ raving mad
or psychiatry as it has been referred to historically, ■■ feebleminded
is understood in terms of its historical development, ■■ insane
treatment of people with a lived experienced of mental ■■ incoherent
illness and the plethora of iconic or infamous events ■■ intemperate
and images that surround it. Mental health nursing ■■ hysterical.
has been largely ignored, and seen only in relation to The institution that housed the mentally ill of
psychiatry and promulgated through literature, art, yesteryear was commonly called an ‘insane asylum’ or
film and television in ways that perpetuate many of a ‘lunatic asylum’.
the myths that surround mental health. Mental health
nursing has been overlooked by historians in terms of
the contribution it has made to the care of people with a BELIEF IN SUPERNATURAL ORIGINS OF
mental health condition in Australia, with only fleeting
ILLNESS AND DISEASE
references to mental health nursing in their work
(Maude, 2002). Nolan (1993) also believes much of the In today’s modern and civilised society, it seems
literature that does exist relates primarily to the history abhorrent to consider that disease and ill health have
of psychiatric services, with nursing only considered in a basis in any realm outside modern medicine. This was
a marginal capacity. For example, the image of nursing not the case in the fourteenth century, however. We
is inevitably viewed through the lens of Florence consider a time where preoccupation with witchcraft,
Nightingale’s exploits in the Crimea, her establishment sorcery and demonology was a common justification
of the first formalised nurse training school and the for regular occurrences of that era: plagues, famine and
publication of her text ‘Notes on nursing’ in 1859. general social unrest. By trusting in such supernatural
It is most likely that mental health nursing evolved concepts, believers of those times had something
from what was historically a correctional or custodial tangible on which to project their anger, fear and blame.
position within an asylum. Asylums were notoriously
inhumane places to reside and a significant portion of Witches
the history of mental illness encompasses this suffering. Witches and witchcraft were blamed for many events of
Workers within asylums monitored the whereabouts and the early and Middle Ages, ranging from simple misfortune
cared for the inhabitants confined there. From around (such as the death of a child, crop blighting or adverse
the mid-nineteenth century, the acceptable term for weather events) to the bizarre that had no basis in fact
attendants was ‘nurse’ and this included both male and (such as riding on a broomstick or changing form from
female attendants. This chapter explores some main human to animal). It is perhaps human nature to seek an
historical perspectives of the causes of mental illness, understanding of why ‘bad’ things occur, and for many
historical mental health rituals, the establishment of people ascribing blame to an evil, mythological being made
asylums throughout the world and then in Australia, sense. While there were varied and numerous reasons why
and the development of mental health treatments women were ultimately tried as witches, many of which
throughout human civilisation. In this chapter, we argue were purely matters of politics or the result of religious
that to understand and value the role of mental health differences, it is understood that some of those who were
care and nursing practice today, it is essential to see how persecuted were mentally unwell individuals who were
it evolved over the course of history. We approach this probably suffering psychosis. In the majority of cases, there
task by first looking at the history of mental health and was no treatment offered to the suspected guilty party, and
then introducing the role of the mental health nurse in ‘confessions’ were obtained under torture or other duress;
contemporary mental health service delivery, including usually to make a deliberate example of the victim. Witches
introducing recent debates on the professional identity of were burned at the stake (see Figure 1.1) or suffered what
the contemporary mental health nurse. is known as the ‘dunking test’. In this ultimate no-win
situation (see Figure 1.2), the witch was tied to a chair and
Historical terms lowered into a body of water such as a river or lake. She
While today it is unacceptable to refer to individuals was dunked in the water repeatedly, and if she died it
experiencing a mental health challenge as ‘mad’ or was determined that she was not a witch. If she managed
‘insane’, historically such terms were widely acceptable to survive the dunking, this meant that she was a witch,
and originated from actual medical diagnoses. Unlike and she would be outed as a devil and killed regardless.
their usage today, they were not intended to be Alternative recollections of this historical perspective also
derogatory. suggest that if she sank, she was deemed innocent (yet was
4 U N D E R P I N N I N G S O F M E N TA L H E A LT H N U R S I N G
now dead) and if she floated, she was guilty and was killed with us in the shape of a deer or any other shape that
anyway. It is unknown how many women and clergymen he would be in. We would never refuse him’ (Zacks,
SECTION 1
died under the pretence of supernatural and/or spiritual 1994). Isabel described in great detail the intimate
causes of civil unrest, but it has been suggested that knowledge of her sexual encounters with the devil:
hundreds of thousands of people were killed due to
And within a few days, he came to me, in the
such beliefs throughout the centuries (Elmer, 2016).
New Ward’s of Inshoch, and there had carnal
copulation with me. He was a very huge, black,
rough man, very cold; and I found his nature
SOURCE: IMAGE FROM ALT- UND NEU-WIEN. GESCHICHTE DER KAISERSTADT UND IHRER UMGEBUNGEN, ETC BY MORIZ BERMANN (1880), BRITISH LIBRARY
[semen] within me all cold as spring well water.

He will lie all heavy upon us, when he has carnal
dealing with us, like a sack of barley malt. His
member is exceedingly great and long; no man’s
member is so long and big as his. He would be
among us like a stud horse among mares.
The youngest and lustiest women will have
very great pleasure in their carnal copulation
with him, yea much more than with their own
husbands; and they will have an exceedingly great
desire for it with him, as much as he can give
them and more, and never think shame of it. He is
abler for us that way than any man can be (Alas!
that I should compare him to any man!) only he
is heavy like a sack of barley malt; a huge nature
[outpouring of semen], very cold as ice.
Source: Zacks, 1994
Given the content of this extract, it is possible that

Isabel was experiencing psychosis in the context of
mania or schizophrenia. Her plight was met with the
response that was common for the ‘witches’ of the
Middle Ages: she was killed.
FIGURE 1.1 Exorcisms and spirit possession

Witch being burned at the stake Most religions have a history of exorcism and the
history of such practices goes back thousands of
years. Exorcism has a place in the management of
SOURCE: IMAGE FROM CHAP-BOOKS OF THE EIGHTEENTH CENTURY BY JOHN ASHTON (1834)
the mentally ill in some countries even to this day,

and demonic possession has been attributed to many
strange beliefs or behaviours that now are commonly
associated with psychosis or schizophrenia (Craig,
2014). In the Middle Ages countless people suffered
painful treatments at the hands of clergymen seeking
to exorcise spirits from their inhabitant and these
frequently resulted in death (McNamara, 2011). Figure 1.3
depicts St Francis Borgia providing the last rites to a
dying man who appears haunted by demonic spirits.
While exorcism is predominantly associated
with Catholic practices throughout history, there are
many other historical examples in other cultures.
FIGURE 1.2 Aboriginal Australians have an embryonic history of
The dunking test spiritual Dreamtime dating back 50 000 years, which
includes entering spiritual dreamlands that have
In Scotland in 1662, Isabel Gowdie was accused of included possession (McNamara, 2011). Spirit possession
being a witch and she readily confessed to this crime is also recounted in the histories of Native America,
without requiring any torture. During her trial, Isabel pre-Columbian South America, West African Yoruba, Islam
was quoted as saying, ‘He would have carnal dealing and Northern and Southern Asia (McNamara, 2011).
M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 5
became colloquially known as institutionalisation.

Asylums tended to be large buildings with dorms or
CHAPTER 1
rooms (which were locked) under the proviso that
they were providing specialised care for people with
mental illness. In reality, they were places of disease,
distress and depravity (Arnold, 2009). The world’s
first hospital for the mentally insane was opened in
Baghdad in 792 CE, and Europe soon followed suit,
but prior to this, families were generally responsible
for the keeping of mentally ill people, much to their
immense shame and embarrassment.
The superstitions associated with mental illness
SOURCE: ST. FRANCIS BORGIA HELPING A DYING IMPENITENT BY GOYA (CIRCA 1788), PUBLIC DOMAIN
rendered many families with disturbed family

members deemed to be unlucky and cursed, thus
resulting in them being isolated and ridiculed.
Lunatic asylums began to emerge in the sixteenth
century. These were not places of healing, but were
locked penal colonies where the mentally ill could
be abandoned by their long-suffering families,
often never to be seen again. Conditions were
appalling – vermin and disease were rife, the food
insufficient, sanitation grossly inadequate and the
caretakers sadistic – and overcrowding resulted in
inmates being unable to lie down or move around
(as they were almost always chained up anyway)
(Arnold, 2009). Individuals with an intellectual
disability were also housed in asylums in the same
FIGURE 1.3 horrendous conditions, and this is hypothesised as
St Francis Borgia (1510–72) helping a dying impenitent Francisco José being one of the more common reasons why many
De Goya people wrongly think even today that those with a
mental health condition are of lower intellect. These
ASYLUMS OF THE WORLD horrendous conditions continued worldwide until
An asylum was an institution where people with a around the 1850s, although in some countries they
mental health condition were housed. This process continued well into the 1900s.
CASE STUDY
THE ROSENHAN EXPERIMENT
The Rosenhan experiment is a further example of subjectivity Questions
within psychiatry. David Rosenhan was a psychologist, and in 1 The participants of the Rosenhan experiment were
1972 he and seven colleagues presented to various hospitals trying to make a point about diagnostic subjectivity in
across America fabricating mental illnesses of varying degrees. psychiatry. What do you think this means?
All were admitted to hospital for periods ranging from seven to 2 Reflect on your understanding of general medical
52 days, given invasive treatments against their will, and despite conditions. Is psychiatry unique to such ambiguity in
trying to convince doctors they were undertaking an experiment, diagnosis?
they were only released when they appeared to comply with
their diagnosis and subsequent treatment (Fontaine, 2013).
Bedlam Locals were encouraged to come and view the

One of the most notorious and infamous asylums in ‘lunatics’ of Bedlam as entertainment, and on the
the world was Saint Mary of Bethlehem, located in first Tuesday of the month people could peer through
London in the mid-sixteenth century (see Figure 1.4). holes in the stones for free. On other days, this outing
This asylum was quickly named ‘Bedlam’ and is would cost a penny. Around 100 000 people visited the
in fact the origin of the moniker itself. Bedlam has site every year, and Bedlam remained a popular tourist
a dark, well documented and researched history. attraction into the nineteenth century (Arnold, 2009).
6 U N D E R P I N N I N G S O F M E N TA L H E A LT H N U R S I N G
to hold the powerful and authoritarian roles in historical

WELLCOMECOLLECTION.ORG/WORKS/K2S5CH9Q. RELEASED UNDER CC BY 4.0.
psychiatry; many women remained institutionalised for

SECTION 1
mere convenience (Toy, 2014).

LINK TO LICENSE: HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/
SOURCE: ENGRAVING BY B. COLE, WELLCOME COLLECTION, HTTPS://
Mental health nursing in Australia

Formerly custodial attendants, mental health nursing
emerged as a distinct profession in Australia around
1890 with the increased medicalisation of mental
health (Sands, 2009). Generally, men were responsible
for the care of the mentally insane, until women were
employed in the early twentieth century (Happell,
2007). Identification of nursing as a profession
emerged in the mid- to late twentieth century
FIGURE 1.4 and this resulted in the notion of specialisation in
Saint Mary of Bethlehem, or ‘Bedlam’
the field of psychiatry. With the development of
psychotropic medication in the 1950s, psychiatry
HISTORY OF AUSTRALIA’S ASYLUMS experienced changes in credibility and further
interest in psychiatry as a nursing specialisation. The
AND MENTAL HEALTH NURSING deinstitutionalisation of people with a mental
The first lunatic asylum to operate in Australia was New health condition in the late 1980s saw a move from
South Wales’ Castle Hill Asylum, which opened in 1811. institutionalised care to community-based care, and
Like many asylums of its time, Castle Hill has a dark thus the role and expertise of the psychiatric nurse
history. Treatment of mental illness did not usually serve also adapted (Happell, 2007).
as part of the purpose of such asylums, and if it did,
many ‘treatments’ were both inhumane and barbaric Mental health nursing history and education
when they were instituted in similar asylums in Europe. The history of psychiatry, or mental health as it is
A vast majority of the treatments of mental illness were now referred to, has had a considerable impact on
experimental, and often formed the basis of a speculated the development of nursing practice. The history
theory. The purpose of these institutions was to contain of (psychiatric) mental health nursing differs
the uncontainable – to control the uncontrollable. significantly from that of other branches of nursing
This included restricting (or preventing) access to the (Happell, 2007), where the influence of iconic figures
community (and thus eliminating perceived threats), as such as Florence Nightingale and Lucy Osborne on
well as cohabitation of prisoners, those suffering dissolute the development of nursing services in the Colonies
or intemperate habits (such as alcoholism or sexual is clear and has been extensively documented
promiscuity) and intellectually disabled individuals. (Bessant, 1999). Prior to the establishment of the
The gold rush of the 1850s resulted in both an first asylums in Australia, individuals with a mental
influx of migrants and serious increases in mental health condition were confined to jails or cared for
illness exacerbated by the use of alcohol and drugs privately. There was no distinction between those
such as opium. By the 1880s, more than 3% of individuals experiencing mental illness and those
Australia’s population were identified as lunatics (this who were intellectually disabled (Happell, 2007). Jails
figure was more than three times higher than just 30 were always custodial rather than treatment oriented,
years prior) and services were ill-equipped to manage so incarceration of individuals with a mental health
them. As a result, between 1811 and 1912 close to 30 condition was obviously ineffective.
asylums were opened across Australia. Despite this, The introduction of the first Australian asylum
it seemed nothing could keep up with the influx of at Castle Hill in 1811 failed to provide a feasible
those afflicted with ‘diseases of the soul’, and most alternative to existing options in the lives of the
asylums filled beyond capacity quickly, adding to the mentally ill. Although the philosophy underpinning
despair inhabitants were already experiencing. care was based on humane treatment, the day-to-day
While the personal tolls of drugs and alcohol reality of caring for patients was primarily about
provide a justifiable rationale for the increases in people containment. While this could partly be a
committed to asylums across Australia, they are not the consequence of the overcrowded conditions at Castle
only cause. In fact, a more sinister reason exists. Being Hill (Curry, 1989), it also reflected the prevailing
committed to an asylum was a seemingly easy task if you attitude that mental illness was incurable (Sands,
were a woman, married to a man who wanted to be rid 2009). The people who managed and cared for
of you. Getting out of such a facility was much harder (or individuals with a mental health condition were
seemingly impossible), and given the penchant for men referred to as ‘attendants’ and their work came under
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cheerfully took his turn at the pump, and so saved the captain and
me any anxiety on that account.
It had been no pleasure cruise after we passed Brisbane, and
became worse every day. There was not a dry place on board,
unless it was our throats. Everybody was constantly drenched with
the sea, and no one had a good square meal during the last four
days; but there was no discontent, everything was taken in good
part, and many a tough yarn was told while they were lashed to the
rail to keep themselves from being washed overboard.
After two days sheer battling for our lives, the wind died down, and
a steady southerly wind sprang up. This soon brightened our
prospects, and added considerably to our comfort. How thankful we
were for the peace and quiet after the rough and tumble experience
we had just passed through! The sea became as smooth as a mill
pond with just a steady south wind blowing, that drove us about five
knots an hour through the water. All our effects were brought on deck
and dried, and our sails, which had been considerably damaged,
were repaired, and on the fourteenth day we arrived at Cookstown.
Our passengers were soon landed, and Captain Brown took the little
vessel well into the river and moored her there until he decided what
he was going to do himself. I landed the following day, and soon
found that the Palmer was as far off as ever. The rainy season had
set in, and the roads were impassable. Whole districts between
Cookstown and the Palmer were under water, the rivers were
swollen and in flood, and no stores of any sort could be bought on
the road.
To describe Cookstown as I first saw it would be impossible. It
resembled nothing so much as an old English country fair, leaving
out the monkeys and merry-go-rounds. Tents were stuck up at all
points. Miserable huts, zinc sheds, and any blessed thing that would
shelter from the sun’s fierce heat and rain, were used as habitations.
There were thousands of people living in the tents and sheds, and
the place literally swarmed with men of all nationalities. Large plots
had been pegged out in the main street, on these were erected
either corrugated iron sheds, or large tents, and here all sorts of
merchandise was sold, cheap enough to suit all purses, but the wet
season was on, and there was no way of getting to Palmer. Parties
of men left every day in the rain and slush to try and reach what
seemed such a land of promise, but many returned saying that it was
no use trying, as the rivers could not be crossed. Hundreds of these
men lived out in the scrub with just a couple of blankets thrown over
some twigs for shelter, no fire being needed except for cooking. All
the scum of Melbourne, Sydney and Brisbane were gathered
together here, thieves, pickpockets, cardsharpers and loafers of
every description. This class had not come to dig for gold with pick
and shovel from mother earth’s bosom, but to dig it out of honest
men’s pockets by robbery and murder, and the robbing of tents in
their owners’ absence was becoming a daily occurrence, for
gathered there were the good, bad, very bad and indifferent.
One day a party of three men returned after having got as far as
the Normanby River. They had been caught between two streams,
and could neither get backward or forward. The patch on which they
were imprisoned was only a few feet above water, and for some time
they were not sure if they would not be swept off and drowned, as
the island was only about one mile long and a quarter of a mile wide.
Whilst they were searching for means to get over to Normanby
they made a gruesome discovery, one by no means uncommon.
There at their feet lying together were five dead bodies. They had
been starved to death, and under the head of each man was a small
leather bag of gold, averaging in weight about six pounds each.
What a terrible irony of fate—shut in between the waters and starved
to death, with over five thousand pounds between them! The bodies
were all shrunken and black, so burying them where they lay, the
party took the gold and divided it. A couple of days afterwards they
were able to swim their horses over the stream and return to
Cookstown.
There were several instances told about this time of miners who
had reached the diggings before the wet season had set in, gathered
a stock of gold, then finding their stores giving out, were forced to
pack up and retrace their steps for a fresh supply. Many, on that
terrible return journey, were struck down by the sun’s intense heat,
and after using their last small stock of food, died a miserable lonely
death by starvation, their treasures of gold powerless to buy them an
ounce of food.
It was quite a common occurrence for miners travelling up from
Cooktown with plenty of stores and provisions, but no cash, to arrive
on the banks of a swollen river, over which there was no means of
crossing, and to see on the other side of the river a party of men on
their way down to the coast with bags of gold, but with hungry, empty
stomachs. There they were, looking across at each other, one
holding up a bag of flour, and the other shaking his gold purse, each
powerless to help the other. Such was the lot of many of the diggers
at that time, but all the horrors, the suffering and death that took
place in that mad rush for gold, will never be known. ’Tis better so, I
saw men return from the gold fields, with thousands of pounds worth
of gold in their possession, but with frames so emaciated and ruined
with what they had gone through on their return journey, that their
very existence was a burden to them, their horses, dogs, and even
their boots had been eaten to keep them alive. It is a fact that they
have boiled their blucher boots for a whole day, and then added any
weeds they could find to make a broth of, so tenacious of life were
they.
There were hundreds of men idle in Cooktown. They had no
means of buying an outfit, even if the road to Palmer had been
passable, and many of them had no desire to go any further. These
could easily be distinguished from those who really wanted work
during the waiting time, so many there were that anyone who wanted
a man might easily get him for a whole day’s work for a good square
meal. Men would walk about among the tents and whenever they
saw food there they would beg. Many were getting a living by their
wits and knavery, and it was not safe to be about alone after dark,
unless you were well armed and prepared for these light-fingered
gentry. And yet the leading articles in the newspapers at that time
were painting in glowing terms the bustle and activity going on in the
rising city of Cooktown, declaring that any man who could use a
hammer or tools of any description could earn a pound a day.
Feeling a bit disheartened at the grim realities that I had
witnessed, and after knocking about Cooktown for a week, I called
on Captain Brown, and asked him if he was going to take the
“Woolara” back to Newcastle.
“No,” he replied, “I have sold her, and made a jolly good thing out
of her, too, and I’m going to have a try to get to the Palmer. What are
you going to do?”
“Well, I am undecided at present, there are so many returning
disheartened, and broken down in health, and they give such bad
accounts of the road to be travelled over before you reach the
Palmer, that I don’t care about tackling it alone.”
“Well, look here,” said the captain, “I have done very well by this
venture so far, and I don’t care about returning without having a try
for the diggings, even if I have to return. What do you say to us
joining forces, and trying our luck together. I will buy three horses
from the next squad that returns, and use one for a pack horse.”
I agreed to his plan, and the following day about a dozen
horsemen rode into Cooktown. They had been a month on the road,
several times they had narrowly escaped drowning, while trying to
cross the Normanby river. They had lost nearly the whole of their
provisions, and one of their mates had been seized by an alligator
before their eyes, while they were powerless to help him. Then they
had been obliged to kill two of their horses for food. They willingly
sold us three horses at fifteen pounds each, but strongly advised us
not to try the road for at least two months, or to wait for the end of
the rainy season. But the thought of the gold beyond made us eager
to take our chance. Had we gone back to Newcastle without trying,
our friends would have chaffed us unmercifully.
The next day we began our preparations. We bought a tent, two
small picks, two small spades and one gun. Captain Brown had a
gun and revolver. I had a revolver, and the gun that was bought was
for me, and a good supply of ammunition. As we were going where
money was of no value and food invaluable, and everything
depended on our being able to carry sufficient provisions, we got a
good supply of the best. We had cocoa, extract of beef, preserved
meat, tea and sugar, two hundred pounds of flour—this was divided,
one hundred pounds to the pack horse, and fifty pounds to each of
our horses—two large billy cans, a couple of drinking pots, two
knives, two basins, a tinder box and burning glass. When we were all
packed and ready to start, we looked like a couple of mountebanks
off to a village fair.
It was a fine morning when we started, but before we had got ten
miles from Cooktown our horses were sinking in the mire. Road
there was none, it was just a track or belt of morass, into which one
sank at times knee deep, and as night came on it rained in torrents,
so we picked out a dry piece of ground, and pitched our tent for the
night. We then hobbled the horses with about ten fathoms of line to
keep them from straying.
We slept well that night, for we were dead tired, and had we been
lying on a feather bed in a good hotel instead of on a piece of ground
that might soon be under water, we should have slept no better. As it
had ceased raining when we awoke we started on our way again
after we had breakfasted, and got along very well until noon. Coming
to a place where there was good grass for the horses we decided not
to go any farther that day, but to let the horses have the benefit of a
good feed.
The following morning we started early, and at noon met a party of
diggers returning from the Palmer. They had been fortunate enough
to get a fair amount of gold they said, but what a terrible condition
they were in, thin and emaciated as skeletons, with barely a rag to
cover them. Three of their party had been lost crossing the Laura
river, and one had died of sunstroke on the road.
“What is it like further ahead, mates?” asked Brown.
“Well, it is only just passable to the Normanby river from here. I
don’t think you will be able to cross it with your packs. We had to
swim it, holding on to the horse’s tails, and then we lost some of our
little stock of food, it was a narrow squeak for us all, horses and men,
but we are here, thank God, safe so far.”
Brown gave them a small tin of beef essence, and a few ship’s
biscuits that he had brought with him. The gratitude of the poor
hungry fellows was pitiful to see, then they offered us some of their
hardly won gold for it, which we promptly refused.
“No, no, mates,” said Brown. “You chaps have earned and suffered
enough for that. Keep it, and take care of it, and may you live to
enjoy it.”
We camped all together that night, after sitting yarning for some
hours, and when we had all eaten a very hearty breakfast we
separated, each party going on its way, like ships that pass in the
night, never to meet again.
Our track that day was very bad, just slush and mire, the horses at
every step sinking up to their knees. We were ready and expected to
meet with hardship on the road, but to realize the suffering to man
and horse dragging themselves along that quagmire is better felt
than described. Every moment we were afraid of them breaking
down, and when about two p.m. we got on a stretch of solid ground,
we pitched our tent, and gave them a good rest. So far we had not
seen a living bird or animal since leaving Cooktown. Had we been
depending on our guns supplying our larder with food we should
have had to go short, fortunately for us we were not.
The next day it was terribly hot, and, to add to our discomfort, we
had several heavy showers, which soon wet us through and through.
When these stopped and the sun came out again our clothes
steamed on us, just as though we were near a fire; this and the
steam arising from the ground made us feel faint and feverish. We
were also pestered with a common little house fly that swarmed
around us and was a perfect nuisance. At sunset we felt we could go
no farther, so pitched our tent on a patch of stony ground close to a
creek, where there was good grass, so we hobbled the horses and
let them graze.
We turned in early, for we were dead tired, and the mosquitoes
were buzzing round in myriads, with their incessant cry of “cousin,
cousin,” when about midnight we were roused by a tremendous row
near us, a peculiar indescribable noise was coming down from the
creek, which we could not account for. We both sprang up and
seized our guns, but the night was pitch dark. What it might be we
did not know, we did not go out, but remained in our tent on the
defensive. Never had either of us heard anything like it; it was as one
often hears, “sufficient to raise the dead.” We began to wonder if we
were surrounded by a mob of the blacks, who were lurking around
us, or was it the spirits of those who had perished on this lone track,
and who were trying to make us return to civilization, but whatever it
was, it was awful and above all the noise could be heard quite
distinctly—a piercing yell of pain, such as no human being or animal
we knew could utter. Thinking to frighten the blacks, if it were indeed
they, we shouted out to each other in different tones and names, to
give them the impression that we were neither alone or unarmed.
When the welcome daylight came we Went in search of the
horses. We could only find two, but on the bank of the creek, not far
from the tent, was the forepart of our third horse. It was bitten off
right under the forelegs, all the rest was gone. There on the ground
and in the soft mud were the signs of a struggle, and the marks of
some big body having been dragged towards the water. Close to the
water were the tracks of a huge alligator, and where it had come out
of and entered the creek, a deep furrow had been turned up by its
tail. This explained the noise in the night, it was the struggle and
death agony of the poor beast, it must have been drinking at the
creek and been seized by the alligator. This was a very serious loss
to us, and made us feel quite disheartened.
We remained where we were until noon. Then crossed the creek
and went on our way—our horses more heavily weighted than before
owing to the loss of the packhorse—and at sundown we pitched our
tent. Our fire was barely lighted to boil the billy for tea, when three
men crawled up to the tent. We were so surprised, that for the
moment we stood still looking at them, for they looked like
scarecrows with their clothes hanging in rags upon them.
“For God’s sake mates, give us something to eat, we are starving,
we have lost everything crossing the Normanby.”
“Aye, aye, lads,” said Brown. “Come up to the fire, and you shall
share our meal. Have you come from the Palmer?”
“No, we could not get there. It is six weeks since we left Cooktown,
and we are trying to get back. Our provisions gave out, and we could
neither go forward or get back, owing to the district being flooded
and impassable. Three days ago the strength of the river eased
down a bit, and we managed to cross by strapping our bits of
clothes, and the little food we had on the horses’ backs, then we got
on their backs and forced them into the water, but the current was so
great that they were borne down the stream, so we slipped off, and
getting hold of the horses’ tails with one hand, we swam with the
other. We managed to cross, but it was a desperate undertaking, and
we were so done up that we were too weak to tie up the horses. We
just lay where we landed and went to sleep. We never saw the
horses again, and have not the slightest idea what has become of
them. And now mates, we are stranded here, without a bite of food,
and unless you can help us here we must die; we can go no farther.
What is it to be?”
“Well, strangers,” said Brown, “my mate here and I were bound for
the Palmer. We have had a tough job of it so far, and we have had
quite enough of it. Hal a good meal, and rest yourselves well, and
we’ll all go back together.”
The poor fellows could hardly find words to thank him. They ate a
hearty meal, and washed it down with a good pot of tea, and very
soon after were in a sound sleep.
Brown and I sat talking far into the night. To tell the truth I was not
sorry he had decided to return, for with one thing and another, I had
begun to ask myself whether the game was worth the candle, and
seemed all at once to have sickened of the roaming about, and felt
that the ups and downs of sea life were luxury in comparison to
hunting for goldfields.
The following day we divided the stores between the two horses,
and prepared to tramp back to Cooktown.
CHAPTER XXV
We Return to Cooktown
The first day of our return journey we travelled as far as the creek
where we had lost our horse the day before. The poor fellows we
had rescued were completely done up, so Captain Brown
determined to go along slowly, and so give them a chance to pick up
their strength. Their names, they told us, were James Whitefield,
Henry Bagly and Thomas Pain. Whitefield, it seems, had been on
almost every goldfield in the colonies, and had three times been in
possession of twenty thousand pounds worth of gold. According to
his own account, which I afterwards verified, the man had not a
friend in the world, or a relative living. He was utterly indifferent to
worldly possessions, and after returning from the Victorian goldfields
had spent, or squandered, twelve thousand pounds in Melbourne in
three weeks. A woman in Burk Street took his fancy, and he bought
and furnished a house for her that cost him five thousand pounds,
then, after living with her there for ten days, he grew restless and
cleared out to the Charter Tower goldfields. He could neither read
nor write distinctly, because, as he said, he had no use for either.
The other two men were runaway sailors, who had been working
ashore for twelve months at Brisbane before starting for the Palmer.
The following morning we swam the creek after firing our guns and
shouting to scare any alligators that might be about. The creek was
about two hundred feet across, and for about sixty feet from the
south shore the depth was only about four feet, then the bed
suddenly dropped and the current rushed very strongly until the north
shore was reached, and there the landing was very bad as the scrub
came right down to the water. The way we crossed was as follows: A
small line was made fast to the after part of the saddles and
stretched along each horse’s back and a half hitch round its tail. The
horses were then driven into the water, and at once began to swim
across. Captain Brown and Whitefield hung on to the rope of one
horse, and the other two men and I took the other. Before we started
Brown told me to keep next the horse and watch it closely, and to
keep my sheath-knife handy for fear the current might sweep it away.
Brown’s horse led, and we stood to watch it land. When about half
way across Whitefield let go the rope, and with a swift stroke brought
himself alongside the horse on the lower side, then he kept one hand
on the saddle and used the other to propel himself. This eased the
horse somewhat, and he got over fairly easily.
After they had safely landed, Brown called out to me to ease all
weight off the horse. We started, and I swam alongside the horse like
Whitefield had done. The other men held on to the rope with one
hand and swam with the other, and we got along first class until
about fifty feet from the other side, when I felt my feet touch
something, and my heart came into my mouth. The next minute the
horse seemed to be jerked backward, and terrified he began to
plunge, snorting and neighing. Then I heard Whitefield sing out:
“Cut the rope! Cut the rope!”
I drew my knife, and while holding on to the saddle with my left
hand, reached over and cut the rope near the saddle, in my haste
cutting a gash in the horse’s back. At the touch of the knife, and with
the strain from behind relieved, the horse plunged ahead, and in a
minute we landed. I looked round for the other men, but they had
gone under.
“Whatever was the matter, Brown?” I asked.
“Well I don’t know,” he replied. “We saw the fellows go under, and
saw the horse floundering, and Whitefield called out cut the rope,
and if it had not been cut at that moment, the horse would have gone
under, and you, too, I expect.”
“But what do you think took them under?” I persisted. “We were
going along all right at first. Do you think it was an alligator,
Whitefield?”
“Oh, no,” he replied, “if it had been he would have gone for the
horse first. I think there must be a dead tree, or a snag down there,
and they must have struck it and been drawn down in the eddy. They
are dead enough by this time, anyhow.”
“But good heavens, mates, it’s awful,” said Brown, “to think we all
had breakfast together, and now two of us are dead. Were they
friends of yours, Whitefield, you seem to take it pretty coolly if they
were?”
“No,” he replied, “I didn’t know them. We met on the road over the
Normanby river, and beyond their names, I know nothing about
them, except that they had been sailors. They were jolly good mates
—I know that much, anyhow. As to my taking it coolly, well, mates,
my fussing about it would not bring them back, it may be our turn
next, we are not in Cooktown yet. I expect they suffered less in that
last lap of their race in life, than in any other part, and by this time
they’ll have learnt the grand secret.”
“Well, look here,” said Brown, “spread the tent and make some
tea, and I’ll go along the bank and see if there is any sign of their
bodies washing up.”
Whitefield and I soon had the tent spread, and the tea made. The
horses were hobbled, their loads taken off, and they were turned out
to graze. There was not much grass in the place, but a small shrub
that grew in abundance they ate freely of and seemed to enjoy.
Strange to say, although all our stores had been in the water there
was not much damaged. The two small bags of flour I thought would
have been ruined, but they were not. The water had only formed the
flour into a cake on the outside, but the inside was all right.
When the billy was set on to boil I strolled along the bank to meet
Brown, whom I saw was coming back. When I was close to him I
suddenly espied, about twenty yards from the edge of the river, a
bundle tied up with a stick through it, as though it had been carried
over a man’s shoulder. I walked towards it, and Brown, seeing it too,
walked over towards it. He gave it a kick with his foot, and the next
minute was on his knees untying it.
“Some Johnny’s swag,” he said, as he opened the bundle.
The covering was a piece of tent duck, inside it were a pair of
socks, and a wool shirt, both filthy dirty, rolled up inside the shirt was
a piece of canvas, which had apparently been the sleeve of a canvas
jacket. Both ends were tied with a strong grass like flax, and inside
was about eleven pounds of fine gold, that looked just like birdseed.
“Halves, Brown,” I said.
“Oh, no, not halves, mate,” he replied.
I drew my revolver and covered him.
“Why not?” I asked, my temper rising to a white heat at the sight of
the gold.
Brown smiled:
“Put back that revolver,” he said, “you mad-brained young beggar.
What about the other chap shan’t we give him a bit, he needs it just
as much as we do.”
“Oh, yes,” I replied, feeling a bit ashamed, “I agree to that.”
So we shared it out, five pounds each for Brown and me and one
pound for Whitefield. He thanked us, and said he had no claim to any
share, as he was only a stranger, and we were old mates. Who he
was, or what had become of the owner of the swag will never be
known. It was evident he had come from the diggings and had safely
crossed the river. Perhaps he was another of those without food,
who became exhausted, went mad, under the broiling sun, and had
wandered off, or he may only have lain down to sleep and during the
night had been seized by one of the alligators, which were very
numerous in the Normanby at the early stages of the gold rush. The
truth will never be known.
After we had eaten a good feed of damper and tea, we caught the
horses, loaded them up and continued our journey. It was terribly
rough the first few miles. The track was just a spongy quagmire, into
which we and the horses sank knee deep and could hardly pull our
feet out again so great was the suction. And every now and then the
poor beasts would look pitifully at us, as they bravely tried to get
along. However, just at sunset, we found a pitch of dry ground and
rested there for the night.
The following day we got along a little better, but our stores were
getting very low, and the sky began to look very threatening, and the
next morning we were up and off at daylight, but we had only gone a
few miles when the storm burst over us, and the rain came down in
sheets. We spread the tent, but it leaked like a sieve, while the
thunder and lightning was awful. We were soon wet through to the
skin, and everything else we had was in the same condition. We
were afraid to let the horses stray for fear of losing them altogether.
All night the rain came down in torrents, and when daylight came the
whole face of the country was a sheet of water;
“Pack up, lads,” said Whitefield, “we must get away from here
before the floods come down, and then we shall get bogged and that
will be the end of us. I’ve been through that once, and had to shoot
as good a horse as a man need wish for, he was slowly sinking in the
bog. I could not get him out, and the pitiful look in his eyes as he
sank deeper and deeper was more than I could stand, so I just
ended his misery by putting a bullet in his brain, so let’s get on while
we can.”
We managed to make a pot of tea, for we had very little else by
now, and started off again, but what a journey! Every hole and hollow
was full of water, and first one animal and then the other would
stumble into them, both man and beast, I think, had the roughest
time of their life that day, for at the best of it we were nearly up to our
knees, and sometimes a good bit above them. At sundown Brown
wanted to camp, but Whitefield urged us to push ahead until we
reached more solid ground. After a few miles of this quagmire, which
seemed to get worse, and when it was near midnight, we came up to
some bushes or scrub; we found the ground was a little higher and,
though still wet and sloppy, we felt we could go no further, so here
we camped for a few hours’ rest.
At daylight we found, to our surprise, that we were near a camp of
men making for the Palmer. There were quite twenty of them, and
they seemed to be well supplied with stores and horses, in fact, they
looked the most likely and best equipped party that I ever saw on the
way to the goldfields. They had two light-built carts, made specially
for that purpose. These carts were four-wheeled, of light, tough
material, the seams were well puttied and painted and over all the
outside was a cover of strong painted canvas, with two cane wood
runners underneath. When crossing the rivers, the horses were
taken out of the shafts, and the harness was put into the cart with the
stores, the horses would then swim over to the other side, taking the
end of a long line with them. On landing, the other end of the line
was made fast to the cart, and the horses who were on the river
bank easily pulled it across, thus keeping the stores dry. It was a
capital idea and had been well thought out, and would answer its
purpose well. They also had with them a powerful dog of the
Newfoundland breed that had been trained to swim across the
creeks and rivers with a light rope. The party were prepared for any
emergency that might offer itself, and their outfit must have cost a
good sum of money. When Whitefield saw them he offered to go and
assist them for his food, until they arrived at the diggings. Such was
the fascination that the goldfields held for this man. The party readily
accepted the offer of his services, and he joined them at once.
After watching the party start off, we also continued our journey,
and arrived in Cooktown twenty-four hours later. Many were the
enquiries made of us as to the state of the roads and prospects of
reaching the Palmer. There were still hundreds of men waiting in
idleness at Cooktown for the rainy season to pass. The place
seemed worse than when we left it, for wherever you turned there
were the loafers hanging round in scores. Brown was able to dispose
of his horses and tent for forty pounds, clearing ten pounds by the
deal, for horses were scarce and dear, and he might have got more if
he had stood out for it. We sold our gold to the bank and received
from them cash and notes to the value of two hundred and ten
pounds each. Then we put up at a second class restaurant and that
day I posted a money order, value one hundred and fifty pounds, to a
friend in Sydney, to bank for me until I came back, and in the event
of my death it was to be sent to my mother in Liverpool, and Captain
Brown posted a draft to his wife at Newcastle, New South Wales. It
was not safe by any means to have it known about the town that you
had any money on you, especially after dark, as there were plenty of
men in Cooktown at that time who would have cut your throat for
half-a-crown, and think themselves well off to get that much.
CHAPTER XXVI
A Trip to the Cannibal Islands and Captain
Brown’s Story
We stayed together in Cooktown for a couple of weeks, and then

Captain Brown was offered the command of a small vessel trading
between Cooktown, Townsville, and the Solomon Islands, sometimes
calling at Port Moresby, New Guinea. He at once offered me the
berth of mate in her, and I gladly accepted, as it was quite a new part
of the world to me, and just what I wanted. The “Pelew” was a smart
little schooner of a hundred and fifty tons, could sail like a water
witch, and was a right staunch little craft. We shipped three deck
hands, one a young Danish seaman, who had cleared out from an
English ship at Brisbane, and two Kanakas. The Dane was a smart,
active young fellow, his only drawback being that he could not speak
a word of English, but it was evident he would soon learn. The
Kanakas were two splendid types of the Solomon Islanders, they
were sharp, intelligent men and could speak “pigeon” English. In
their younger days they had been slaves on a Queensland sugar
plantation, but for the last two years they had been on one of the
missionary schooners cruising among the Pacific Islands. They took
life very merrily, and were always laughing, no matter what had to be
done—they got some fun out of it. Work was no trouble to them, and
when there was no work going on they would wrestle with each
other, tumbling each other about until the perspiration rolled off them,
but they never lost their tempers over it, but would finish up with a
hearty laugh. Sometimes they would get the young Danish sailor to
wrestle with them, but they could do just what they liked with him, he
was muscular and strong, but they were slippery as eels, and twisted
and twirled as though there was not a bone in their bodies, and
always slipped out of his fingers before he could get a grip on them.
It was great fun to Captain Brown and me to see the Kanakas,
Tombaa and Panape, trying to teach Neilson, the Dane, to speak
English, and Neilson trying to teach them Danish. That seemed the
only thing they could not get any fun out of. At last Panape gave it
up, and would not have it at any price.
“That no tam good,” said he, shaking his head. “Good fellow white
man—speak Englis’—no that allee samee you. You no takee allee
same good fellow captain—good fellow, mate?”
“No,” said Neilson in English.
“You no tam good, then,” said the Kanaka. “All good fellow speak
Englis’. Me good fellow—me speak Englis’. Tombaa, he good fellow
man, too—he speak allee samee missiony man, he teach us to say
prayer to ‘Big Fellow Master’ (God), prayer belong sleep, prayer
belong get up. Tombaa you speak white fellow commandments.”
I drew nearer to them, anxious to hear a Kanaka’s version of the
ten commandments. Tombaa stood up, and throwing his chest out
like a proud turkey cock, he delivered the following version:—
The Ten Commandments in Kanaka.
I. Man take one fellow God, no more.
II. Man like him God first time, everything else behind.
III. Man no swear.
IV. Man keep Sunday good fellow day, belong big fellow
Master.
V. Man be good fellow longa father, mother belonga him.
VI. Man no kill.
VII. Man no take him mary belonga ’nother fellow man.
VIII. Man no steal.
IX. Man no tell him lie ’bout ’nother fellow man.
X. ’Supose man see good fellow something belonga
’nother fellow man, he no want him all the time.
I was much amused at their interpretation, what it lacked in length
was made up by the clear definition of the meaning of the ten
commandments, and these two lived up to it.
We left Cooktown with a general assortment of cargo for
Townsville, and a few deck passengers. The wind being fair and the
weather fine, we made the passage in fifty-four hours, anchoring
inside Magnetic Island. Our cargo and passengers were soon
landed, and the schooner loaded for Port Moresby, New Guinea. The
cargo consisted of cloth, prints, calicoes, ribbons of all sorts and
colours, tobacco (horrid stuff), spirits, axes and various joinery tools,
etc., and some agricultural implements. We also had four
passengers—German officials—going to the German settlement,
north-east New Guinea.
We left the port at sunrise. The weather was fine, one of those
lovely tropical days when the sky blends its prismatic hues and the
easterly breeze, as it whistles through the shrouds, brings new life
and energy into one’s veins. The sea all around was covered with
silver-crested waves and as the little “Pelew” cut her way through the
sparkling waters she sent them like showers of jewels along her
painted sides. What a joy it was to me to be once more on the
ocean, to feel once more the motion of the vessel beneath my feet,
and to quaff the salt breeze that was like the wine of life. We had a
delightful passage, but owing to the numerous reefs and shoals we
were kept constantly on the lookout. These seas require the most
careful navigation, and I was surprised to find that Captain Brown
seemed quite at his ease among the reefs, although, when I
mentioned this and asked him about his life in these regions, I could
never get any very definite answers from him. However by putting
two and two together, from his chance remarks, I came to the
conclusion that he had been what is known as a “blackbird catcher,”
an “island scourger,” a “dealer in living ebony,” or a “sandlewood
thief.”
We made the passage to Port Moresby in five days. As soon as
we anchored in the bay three native crafts came off for our cargo, the
agent who was in the first boat seemed half a savage himself, and
had a most repulsive face. Captain Brown gave orders that no one
was to leave the ship on any pretext whatever, except the German
passengers, and they did not seem to like the job either, but that was
what they had come out for. No natives were allowed to come on
board. Their appearance was not very inviting, they were quite
naked, with the exception of a strip of pounded bark or cocoanut
fibre round their waist, their woolly heads were decked with shells
and tufts of grass, while round their necks each had a necklace of
shark’s teeth. Though fine, well-built, powerful looking fellows, their
features were not what we should call handsome, as their foreheads
are low and retreating, the face broad, the cheek-bones prominent,
the nose flat and the lips thick. We heard that there was an English
missionary living amongst them and doing a good work.
After delivering what goods we had for the store-keeper, we
received orders to proceed to Gaurdalcana in the Solomon Islands,
and deliver the balance to the store-keeper there.
Captain Brown then told me that the natives of the Solomon
Islands were cannibals, “so you had better be careful while we are
amongst these islands, and,” he continued, with a sly twinkle in his
eyes “you have to be very cautious in dealing with them, for they are
very partial to roast sailor. I had a terrible experience on one of the
islands some years ago. I was in a smart little brig, cruising among
the Islands. We were out on a blackbird (native) catching expedition.
We sailed into the bay at the south-east point of San-Christobal. The
brig ‘Carl’ of blackbird notoriety, had been there a few times, and
after getting a number of the natives on board to trade as they
thought, they had been invited into the saloon, and their eyes were
dazzled by the beads and toys and other things spread on the table.
Unsuspecting of any treachery they stayed until the gentle rolling of
the vessel caused them to ask with some surprise what it meant, by
this time the ship was well under way, and fast leaving San-
Christobal behind them. They tried to rush on deck, but found
themselves covered with the rifles of some of the ship’s crew, they
were soon overpowered and made prisoners and put into the hold
with others who had been lured to the vessel by the same device—
all to be sold as slaves to the North Queensland planters—but we
were not aware of this at the time.
“Well, as we drew up towards the head of the bay we suddenly
grounded on a reef, and while we were rushing about backing and
filling the sails, the natives swam off in hundreds and boarded the
vessel on all sides. We let go the ropes and seized whatever we
could lay our hands on to defend ourselves, but in a minute three of
our men were beaten to death with clubs. The captain was aft by the
wheel, and as soon as I saw the natives climbing over the rail I drew
my knife and sprang aft near him, and together we fought like
demons. But the copper-coloured fiends thronged round us, and one
big fellow at last got a blow in with a club that laid the captain
senseless on the deck. But his triumph was short, and mine too, for I
ripped him open with my knife, and the next minute was knocked
senseless on the deck myself. When I came to, I was on the floor of
a hut on shore, trussed like a fowl, with my arms and legs bent
behind me and lashed together. I struggled and twisted to get my
hands free, but it was no use, I could not do it. I raved and shouted
for some one to come and put me out of my misery. At last, as if in
answer to my cry, one of the women came and looked in, and seeing
me struggling, she picked up a club, and smashed me on the head
with it, and again I became senseless. The next thing I remembered
was being rolled over and over and my flesh being pinched by two or
three natives. After jabbering among themselves for a few minutes
they left me, and directly afterwards I heard the captain’s voice
shouting not far off, and a lot of jabber among the natives. I could not
see what was going on, but I knew that they were taking the poor
fellow to kill and roast him. I tore at my bonds, until the lashings cut
into the flesh. Suddenly a horrible yell burst on my ears, and I knew it
was the captain’s death cry. I shook like a leaf, and the perspiration
rolled off me like raindrops. I was on the rack with torture, knowing
full well what was before me, and that at any minute my turn might
come. I swooned away with horror at the thought, to be brought to
later by a burning stick being thrust into my face. I saw four of the
devils were in the hut, and a whole crowd outside. They put a small
spar through my arms, and two of them lifted me up between them,
like a Chinaman carrying a load. As they carried me along towards a
large fire in the middle of a clearing, near a large hut, like a meeting
house, my stomach and face were scraping the ground, and, oh!
God, what a terrible sight met my eyes. There just in front of me was
the roasting body of the poor skipper. He had been a bad devil in his
time and many an islander had suffered at his hands, but they had
got their revenge on him for it.
“The head man or chief now spoke to a big powerful savage, and
the latter approaching me with a large knife, was about to plunge it
into me to rip me open, when the head man, who was jumping about
before me, suddenly fell forward on his face and lay still. The others
looked on and shouted. Then some of the elder ones, seeing there
was something wrong, walked up to the prostrate chief, and touched
him. Finding he did not move, they turned him over, but he was
dead. I thought they would fall on me at once when they realized
this, but they only set up a great wail and beat their breasts with their
hands. Then two of the old men spoke up, and all was quiet. After
they had done speaking several of the men came to me, and I
thought my last moment had come, but, to my surprise, they gently
untied my hands and feet. For a few minutes I was unable to stand,
but as soon as I could, one of the old men picked up the spear and
club of the dead chief, placed them in my hands, and pointed to the
hills. I was not long in taking advantage of my freedom, and made
tracks at once. I could hardly believe that I was free, and expected
every minute to hear them coming after me.
“Why I had been spared was a mystery to me then, but I
afterwards learned that they released me through some superstitious
fear, and a belief that the spirit of their dead chief had entered into
me, had I been so minded they would have made me chief of the
tribe; this they tried to make me understand when the old man
placed in my hands the spear and club belonging to the dead chief. It
would have made no difference to me had I known, all I wanted was
to put as many miles as possible between the cursed place and
myself.
“I remained in hiding for a couple of days up among the hills, and,
strange to say, I never saw a single native come near to the place
where I was. Another thing I noticed in my wanderings was the
absence of children. I don’t remember seeing a single youngster. As
a rule there are plenty of them knocking about on most of these
islands, so I came to the conclusion that this was an island where it
is the custom for nearly all the children of both sexes to be killed by
their parents, perhaps eaten, too. I lived on bananas, cocoanuts, and

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Gylo (Julie) Hercelinskyj

Guide to the text x CHAPTER 4

Trichotillomania 347 CHAPTER 22

Guide to the text

Identify the key concepts M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 7

understanding, to the the

enging behaviours. Where in Focuses

FEATURES WITHIN CHAPTERS required)

same purpose as thatmeasure of a researcher. frequently depicted in a hierarchy, often called an

boxes, which HOW link DO MENTAL HEALTH

individual may present as distracted. butTV, it isthey can see you.

ways are part

c Ethics is based on law ■■ downloadable

WORD-BASED TEST BANK AND STUDENT REVISION QUIZ

ARTWORK FROM THE TEXT

FOR THE STUDENT

SEARCH ME! NURSING

ABOUT THIS BOOK ■■ theory of communication

■■ recovery and trauma informed practice

a Masters in Education, and a PhD in Psychology. practice, with Alison Hansen

internationally about teaching mental health nursing Alexander

mental health teaching. Topp.

practice, with Terry Froggatt

PhD, MSc (ECON), PGCE(HE), BSc (HONS), RGN, health

Brian Phillips Louise Ward

excess of the usual undertakings of an academic: ■■ Sione Vaka – Massey University

I want to thank my husband Christian, and children

Louise Alexander and Gylo (Julie) Hercelinskyj

LEARNING FROM PRACTICE

INTRODUCTION The following terms were all socially appropriate and,

[semen] within me all cold as spring well water.

Given the content of this extract, it is possible that

FIGURE 1.1 Exorcisms and spirit possession

the mentally ill in some countries even to this day,

became colloquially known as institutionalisation.

rendered many families with disturbed family

Bedlam Locals were encouraged to come and view the

to hold the powerful and authoritarian roles in historical

psychiatry; many women remained institutionalised for

mere convenience (Toy, 2014).

Mental health nursing in Australia

A Trip to the Cannibal Islands and Captain

We stayed together in Cooktown for a couple of weeks, and then

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Guide to the text x CHAPTER 4