FOUNDATIONS OF PSYCHIATRIC – MENTAL HEALTH NURSING

Mental Health and Mental Illness

- As long as people can carry out their social responsibilities and they behave appropriately are
viewed healthy
- Those who fail to fulfill roles and shows inappropriate behaviors are viewed as ILL

MENTAL HEALTH

- WHO defines HEALTH as a state of complete physical, mental, and social wellness, not merely
the absence of disease or infirmity
- MENTAL HEALTH has no UNIVERSAL definition
- It compromises of several factors and it is dynamic or ever-changing state

“Determination of mental health is difficult”

FACTORS that can influence mental health

CATEGORIES

- INDIVIDUAL/ PERSONAL- e.g. biologic make up, coping abilities

- INTERPERSONAL – e.g. ability to help others, effective communication, relationships, intimacy
with others
- SOCIAL/ CULTURAL – e.g. access to adequate resources, diversity if people, environmental, sense
of community

MENTAL ILLNESS

- Includes disorders that affects mood, behavior and thinking

- Often cause significant distress or impaired functioning or both. E.g. addiction, depressions

These individuals

- Feel dissatisfied with self and relationship with other

- Have ineffective coping and view their daily lives as unbearable
- May view their situations as hopeless

FACTORS contributing to mental illness

- INDIVIDUAL/ PERSONAL- e.g. intolerance of life’s uncertainties

- INTERPERSONAL – e.g. excessive dependency on or withdrawal, ineffective communication
(something that you want to speak but end up not speaking at all)
- From relationships SOCIAL/ CULTURAL – e.g. discrimination such as stigma, racism, classism,
ageism, and sexism, violence, discrimination

“Is this illness or bad behaviors?”

DSM-5

- Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM – 5)

- Taxonomy published by the American Psychiatric Association and revised as needed
- Described all mental disorders, outlining specific diagnostic criteria for each based on clinical
experience and research
- All mental health clinicians who diagnose psychiatric disorders use this diagnostic taxonomy
Although student’s nurses do not use this to diagnose your patients, this will aid you in
understanding the nature of the psychiatric condition

PURPOSE OF DSM5

- Provide a standardized nomenclature and language for all mental health professional
- Present defining characteristics or symptoms that differentiate specific diagnoses
- Assist on identifying the underlying causes of disorders

The classification system allows the practitioner to identify the factors that relate to a person’s
condition

TREATMENT of mental illness

- ANCIENT TIMES
ARISTOTLE 4 substances of Humor
Blood, water, yellow and black bile = Happiness, anger
Lunatics – people with mental illnesses has a cycles like full moon
- Period of enlightenment and creation of mental institutions (Insane Asylum)
- Sigmund Freud and treatment of mental disorders (view human subjectively)
Craplin begins classifying it with symptoms
Schizophrenia (buang = Schizophrenic)
Ber holing = butasan ang ulo to release the demon
- Development of psychopharmacology
Clorplomozin and lithium medicine the treats Schizophrenic
Haldol – number one drug of choice, well researched
Haloperidol- balances the dopamine
- Move toward community mental health
Asylums, nagging community based, from hospital to facility

21st Century

- On the US 44.7 M has mental illness (NIH, 2018)

- 19.2 received treatment within the past years

“The economic burden of mental illness in the US exceeds the economic burden caused by all kinds of
cancers”

- Mental disorders are the leading cause of disability in the US and Canada for persons 15 to 44
years of age
- Yet only 1 in 4 adults and 1 and 5 children and adolescents requiring mental health services get
the care they need
- Mas real sa ilaha ang nay real nga illness without knowing that mental illness is important

DEINSTITUTIONALIZATION- deliberate shift from institutional care in state hospital to community

facility setting

- Resulted to an 80% decrease in the bed capacity of public hospitals but the number of admission
also increase by 90%
- L ed to the term revolving door effect
 o Often boarded or kept in the ED while waiting to see if the crisis deescalates or until
an inpatient bed can be located or becomes available.
o Paabot lang kung kaya nimo tas kung okay na buy an naka
o This practice of boarding leads to frustration of health care personnel, dissatisfaction
with care for clients and their families, and some believe an increase in suicide

One result of DEINSTITUTIONALIZATION is the revolving door of repetitive hospital admission

without adequate community follow up

People with severe and persistent mental illness may show sign of improvement in a few days but
are not stabilized

Thus, they are discharged into the community without being able to cope with community living

- Psychotic med works after 2 weeks

Example. Gikan ka prison for almost 15 years pag gawas nimo wala naka kbalo sa himoon kay pila
man ka ka years sa sulod lahi na ang dagan sa outside world

- Dual problem of both mental and substance abuse are common

- Substance abuse issues cannot be dealt within the 3 to 5 days typical for admission in the
current managed care environment
- In the us, homelessness is a major problem, 33% of the population have a severe mental issues
with chronic substances abuse disorder
- Hallucination is TRUE but treated with psychotic drug
- ILLNESS, HOMELESSNESS, SUBSTANCE USER TRIAD sila sa US

Those who are homeless are found everywhere. It may be in the streets, park, bus terminals or they
may occasionally rent a house or room when they can afford it

Inpatient psychiatric treatment still accounts for most of the spending form mental health in the us,
so community mental health has never been given the financial base it needs to be effective

Each patient different ways to take care

OBJECTIVES FOR THE FUTURE

- Increase number of people identifies, diagnosed, treated, helped to live healthier lives
- Decrease rates of suicide, homelessness
- Increase employment for those with serious mental illness
- Provide more service for incarcerated persons with mental health problems
- In Philippines only DAVAO CITY has a facility for schizophrenic
-
COMMUNITY BASED CARE

- Persons with severe and persistent mental illness were either ignored or underserved by
community mental centers
- Lack of appropriate number of community mental health centers to provide services
- Many people needing services were and still are in the general population with their needs
unmet
- Development of community support programs – programs focus on rehabilitation, vocational
needs, education, and socializations as well as on management of symptoms and medication
- Availability, quality of services

MENTAL HEALTH OF FILIPINOS

- Psychiatric Nursing Practice and mental health services in the Philippines

- Mental health remains poorly resourced: only 3-5% of the total health budget is spent on mental
health and 70% of this spent on hospital care (WHO & Department of Health, 2006)
- Despite the legal bases of the Mental Health Act ( Ra 11036) which seeks to establish access to
comprehensive and integrated mental health service, while protection the rights of people with
mental disorders and their family members (Lally et al, 2019)
- Maliit lang ang facility but because of this act, all of the district will open an extension of mental
health facility that consist of consultation

- Overcrowding, poorly functioning units, chronic staff shortages and funding constraints are
ongoing problems, particularly in peripheral facilities
- There are no dedicated forensics hospitals, although forensics beds are located at the National
Center of Mental Health
- Mental health staff shortage is also indicated in the country it is only 2 – 3 per 100, 000
population ration compared to the standard 1- is to 100,000 population set by WHO

- Stigma is one barrier to help seeking behavior Filipinos

- A strong sense of family in the Philippines and so, when problems are thought to be a socially
related, Filipinos will turn to family and peer networks before seeking medical help (Tuliao,
2014) further limiting the urgency of seeking proper mental health assistance

STAND YOUR GROUND, BE FIRM, DON’T BE GASLIGHTED!

There is a national department of health medication access program for mental health that carries a
central list of essential medication, which are shown in box 1. These medications are available at all
service levels, but funding issues limit patient access, particularly access to newer medication. The
most commonly used antipsychotics in clinical practice are chlorpromazine and haloperidol;
escitalopram and fluoxetine are the most commonly used antidepressants.

- Psychiatric remains a less popular specialty for medical graduate in the PH, and the numbers
being trained are inadequate to meet a growing need
- Increased investment is urgently needed to improve the training and recruitment of psychiatrist,
nurses, psychologist

Psychiatric- Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

- The PMHNAP is a duly recognized nursing specialty organization of nurses working in the area of
psychiatry and mental health. The organization was established in 2010 thru the able leadership
of Professor Nenita Y. Davadilla

MISSION
Our mission is defined by the following objectives:

Education. To promote advance studies in Psychiatric- Mental Health allied behavioral health
sciences. Training. To promote effective, equitable and evidenced-based nursing interventions for
individuals, families, population group, and communities. To enhance knowledge, skills and attitudes
by providing education and training
Research. To engage in research work and promote effective, equitable and evidence-based nursing
interventions

Advocacy

To unite Filipino Nurses by forming creating linkages and collaboration with government, private,
and non- government institutions aimed towards a mentally healthy nation

STUDENT CONCERNS

Common concerns of nursing students beginning a psychiatric clinical rotation

- Fear of saying the wring thing

- Not knowing what to do
- Being rejected by clients
- Being physically threatened
- Recognizing someone they know as a client, and sharing similar problems or backgrounds with
clients

SELF AWARENESS

Awareness of one’s feeling beliefs, attitudes, values and thoughts called self-awareness, Is essential
to the practice of psychiatric nursing

- Kung alam mo ang sarili mo na hindi ka ganyan hindi ka ma apektuhan

Goal of self- awareness is to know oneself so that one’s values attitudes and beliefs are not
projected