NURS21323 Mental Health Nursing

Module 1: Introduction

to Mental Health Nursing

(2023)
 Welcome and Introduction

Professor:
Email:
Office:

Communications:
 SLATE: Important announcements, weekly lessons, notes
and grades are available on SLATE—check before each
class.
Class Format:
 Expectations

Due Dates:
 Late penalties as per Sheridan Policy.
Group Case Study (15%)

 Responses should be comprehensive and documented with in-text

citations and references.
 Utilize a minimum of 3 scholarly sources.
 Completed in groups of 5.
 Submit your group names by class 3.
 Due: See schedule
Individual Case Study (20%)

 Responses should be comprehensive and documented with in-text

citations and references.
 Utilize a minimum of 3 scholarly sources.
 Due: See schedule
 Exams

Midterm Exam
 50 Multiple choice and multi-select questions
 Modules 1,2,3,4A,4B,4C
 Date: See schedule

Final Exam
 Multiple choice and multi-select questions
 Modules 1 to 10 inclusive
 Date: See schedule
Textbook
 Module 1 Overview

• Comprehensive Care Model

• Epidemiology, Incidence, Prevalence

• Goals of Mental Health Nursing

• Levels of Prevention

• Principles of Mental Health Nursing

• Neurobiology in Mental Health Nursing

 Comprehensive Care Model

What is Mental Health?

What is Mental Illness?

 Mental Health
• No one “official” definition of mental
health.
• WHO (2010) defines mental health as:
“A state of well-being in which
each individual is able to
realize his or her own
potential, cope with the
normal stresses of life, work
productively and fruitfully, and
make a contribution to the
community.”
http://www.who.int/topics/mental_health/en
Mental Illness
• Alteration in cognition (E.g.,
impaired with Alzheimer’s Disease)
• Alteration in mood (E.g., Major
Depression)
• Alteration in behaviour (E.g.,
Schizophrenia)
• Coupled with significant distress and
impaired functioning (Health
Canada, 2000).
• Refers to all mental disorders with
definable diagnoses.
 Mental Health as a Continuum
Optimal Mental Health
Characteristics
 Free from excessive emotional and
mental pain and disability
Thinks clearly
 Negotiates each developmental
stage
 Resilient
 Positive self-concept
 Involved in meaningful work
 Engages in play
Mental Illness
Characteristics
 Disturbance in brain/CNS
 S&S meet diagnostic criteria
 Incongruent thoughts, feelings,
behaviour
 Uncontrollable impulses
 Maladaptive coping
 Unable to maintain relationships
 Unable to separate fantasy from
reality
 Resilience

Ability and capacity to secure resources needed to support well-

being

Characterized by :
• Optimism
• Sense of mastery
• Competence

Essential to recovery-assists people to recover from painful

experiences and difficult events.
 Epidemiology of Mental Health Disorders

 Epidemiology-quantitative study of the patterns and distribution of

mental disorders

 Example:
Study risks and resiliency factors
­ Identify high-risk groups
­ Identify high-risk factors
 Epidemiology of Mental Health Disorders
Cont.

Incidence-refers to the number of new cases of mental disorders in a

health population within a given period of time.
Example: the # of Brampton adolescents who were diagnosed with major
depressive disorder between 2017 and 2022.

Prevalence-describes the total number of cases, new and existing, in a

given population during a specific period of time, regardless of when the
subjects became ill.
Example: the # of adolescents that screen positive for major depressive
disorder in Hamilton schools between 2017 and 2022.

# of adolescents that screen positive for major depressive

 Global Burden of Disease (WHO)
 10 Leading Causes of Burden of Diseases 2004 & 2030


http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part4.pdf?ua=1
Mental Illness in Canada (Public
Health Agency 2015)

 1 in 7 Canadians use health services for a mental illness annually.

 Women are more likely than men to use health services for mental
illness.
 The largest increase of the use of mental health services occurred
among adolescents 10-14 year olds.
 Boys under 15 years are more likely to use mental health services
than girls. Likely related to conduct disorders and attention deficit
disorder which occurs more frequently in boys.

(Pollard and Jakubec, 2023)

 CAMH Mental Illness and Addiction:
Facts and Statistics

 Mental illness is a leading cause of disability in Canada.

 By the time Canadians reach 40 years of age, 1 in 2 have—or have had—a mental
illness.

 34% of Ontario high-school students indicate a moderate-to-serious level of

psychological distress (symptoms of anxiety and depression). 14% indicate a serious
level of psychological distress.

 Canadians in the lowest income group are 3 to 4 times more likely than those in the
highest income group to report poor to fair mental health.

(CAMH,2022)
CAMH Mental Illness and Addiction:
Facts and Statistics

 Studies in various Canadian cities indicate that between 23% and

67% of homeless people report having a mental illness.

 Among Ontarians aged 25 to 34, 1 of every 8 deaths is related to

opioid use.

 The disease burden of mental illness and addiction in Ontario is 1.5

times higher than all cancers put together and more than 7 times
that of all infectious diseases. This includes years lived with less than
full function and years lost to early death.

(CAMH,2022)
DSM5 (2013)

 The Diagnostic and Statistical

Manual of Mental Disorders, 5th
edition
­ Official medical guidelines of the
American Psychiatric Association
for diagnosing psychiatric disorders
(over 350 diagnoses)
­ Does not classify people, classifies
disorders people have (E.g., “an
individual with schizophrenia”, or
“my patient has major depression”)
 Psychiatric Mental Health Nursing

• Focuses on patients (individuals, families, communities) both in theory and practice.

• Utilizes an art and science approach (art of interacting , planning and intervention,
evidence - informed practice).
• Uses a wide variety of critical thinking skills.
• Offers a dynamic balance of rewards and challenges.

Primary Goals of Care:

1. Promote mental health
2. Prevent mental disorders
3. Treat patients with mental disorders
4. Restore health

(Pollard and Jakubec, 2023)

Video
Levels of Prevention of Mental Disorders

Primary
• Reduces incidence of disorders

Secondary
• Reduces prevalence
• Early identification and treatment

Tertiary
• Reduces residual effects
• Provides rehabilitation and restoration of health

(Pollard and Jakubec, 2023)

 Levels of Prevention Continued

Primary Prevention
• Primary prevention of most mental disorders is still in the early stages of development.
• Consistent evidence that a history of severe trauma (such as physical or sexual abuse) is
correlated with various mental health problems.
 Examples:
 Assist new parents in learning parenting skills.
 Hold seminars with parents on the topic of drug use.
 Prepare for “empty nest syndrome.”
 Meet with seniors to discuss strategies for linking with community resources and
staying socially active.

(Pollard and Jakubec, 2023)

Levels of Prevention Continued

Secondary Prevention
• Treat patients after making diagnosis.
• Refer patients to other therapies for additional treatment.

Tertiary Prevention
• Conduct seminars and workshops to teach patients job skills.
• Continue to meet with family who have a member with a mental health disorder.

(Pollard and Jakubec, 2023)

Clinical Principles of Mental Health Nursing

• Observe rather than infer.

• Expect and accept variations or changes in patient wellness.
• Accept the patient’s feelings but not all behaviors.

Use language that is:

 Simple
 Concrete
 Direct

• Encourage patients to take responsibility for their lives within their

capacity. Facilitate learning skills to accomplish this.
Avoid:
­ Heroics and rescue fantasy
­ Being judgmental
­ False reassurance
­ Giving opinions and advice
­ Clichés
­ Promising to keep secrets
­ Global statement
­ Sharing personal experiences

­ Making assumptions
Principles of Nurse-Patient Relationship

• The nurse-patient relationship focuses on patient needs and

problems.

• Therapeutic rather than social.

• Purposeful and goal-directed.

• Time-limited versus open-ended.

• Objective versus subjective.

Risk Factors for Mental Illness

 Biologic
 Genes, gender, age
 Psychologic
 Personality style, level of intelligence, belief system
 Sociocultural
 Absent, neglectful, abusive
 Environmental (physical and psychosocial)
 Toxins, drugs, pollution
 Poverty
(Pollard and Jakubec, 2023)
Diathesis–Stress Model

 Diathesis: Biological predisposition

 Stress: Environmental stress or trauma

• Most accepted explanation for mental illness.

• Combination of genetic vulnerability and negative environmental
stressors.

(Pollard and Jakubec, 2023)

Protective Factors

• Characteristics that guard against the risk and decrease the potential
for developing mental illness.

 Internal
Good health, stress tolerance, resilience, average or better intelligence,
flexibility and positive attitude

• External
Supportive network, adequate income, recreation, hobbies

(Pollard and Jakubec, 2023)

 Stigma

• Superstition, old belief systems

• Lack of knowledge and empathy
• Tendency to fear and exclude people who are
perceived as different

Results of Stigma:
• Carry label and face judgment of others
• Forces people to remain quiet about their mental illness
often causing them to delay seeking health care
• Avoid sharing their concerns
• Avoid following through with recommended treatment
Video
 Reflection: Differential Stigma
Consider the following conditions. From your perspective, rank order the conditions from most to least stigmatized (1-14).

__ Marijuana user __Anorexia/Bulimia

__ Depression __Gambling addiction
__ Heroin User __Dementia
__ Bipolar __Autism
Disorder __Schizophrenia
__ Alcoholic __Post-traumatic stress disorder
__ Learning __Dependency on pain medication
Disorder
__ Ex-convict
Destigmatize

Public Education and Awareness:

 Decrease fear
 Decrease ignorance
 Increase respect
 Decrease stereotyping

The Canadian Alliance for Mental Illness and Mental Health (CAMIMH) has identified
combating the stigma of mental illnesses and preventing discrimination against people
with mental illnesses as one of the most pressing priorities for improving the mental
health of Canadians.

http://www.camimh.ca/
Neurobiology in Mental Illness

• Human thoughts, feelings, and actions begin in the central nervous

system.

• The brain acts as primary mediator organ, controlling and determining

how people interact with the world (cognition, mood, E.g., anxiety)

• Brain structure and neurotransmitters play a pivotal role in mental

illness.
Figure 6-1 Functional areas of the cerebral cortex. (From Thibodeau GA, Patton KT: Anatomy
& physiology, ed 6, St Louis, 2007, Mosby.)
 Neuroanatomy

 Cerebrum: largest part of the brain

 Frontal lobe: voluntary motor ability, thought processes (make decisions,
insight, motivation)
 Prefrontal cortex: cognition, memory, and analytical functions
 Temporal lobe: auditory, language comprehension (stores sounds in
memory), connects with limbic system allow expression of emotion
(sexual, aggressive, fear)
 Occipital lobe: visual, color recognition, visual memories, visual association
 Parietal lobe: sensory and motor, touch, receive and identify sensory
information, proprioception and body awareness
Figure 6-4 Electrical and chemical synapses. B, Chemical synapses involve transmitter chemicals
(neurotransmitters) that signal postsynaptic cells, possibly inducing an action potential. (From
Thibodeau GA, Patton KT: Anatomy & physiology, ed 6, St Louis, 2007, Mosby.)
Neurotransmitter Dysfunction Mental Disorder

Dopamine-abstract thinking, Increase-disorganized Schizophrenia, Mania

decision making thoughts
Decrease- no joy or
pleasure Depression, Parkinson’s
Disease

Serotonin-calmness Decrease- irritable, hostile, Depression

sleep regulation, hunger decreased impulse control

Norepinephrine-alertness, Decrease-low energy Depression

fight or flight

GABA(amino butyric acid)- Decrease-irritability Anxiety disorders

calmness

Acetylcholine-emotional Decrease-short term Alzheimer’s disease

regulation, learning, memory memory, antisocial behaviors
Neuroimaging

 Will serve a greater role in identifying brain differences in mental

illnesses
­ Structural: gross anatomical details E.g., CT, MRI
­ Functional: show some activity of the brain E.g., PET Positron
emission tomography

 Neurogenomics-study of genes and the nervous system.

Point to Ponder…

Select the comment that most clearly reflects a speaker who views
mental illness with stigma.

A. “Mental illness is a brain disorder that changes how messages are

sent and received.”
B. “Most people with mental illness are just trying to get attention for
themselves.”
C. “Some mental illnesses are inherited and show up in different
generations of a family.”
D. “Environmental events can cause some types of mental illnesses.”
 Point to Ponder…

While shopping at a grocery store, a nurse recognizes a former

psychiatric patient who is also shopping. Select the nurse’s best action.
A. The nurse should not acknowledge the individual.
B. Offer a greeting and inquire about the person’s current health.
C. Greet the former patient only if he or she initiates contact.
D. Leave the grocery store immediately.
 Point to Ponder…

Choose the item that does not fit in the following category: Lobes of the
cerebrum

A. Frontal
B. Parietal
C. Hypothalamus
D. Occipital
E. Temporal
 References

CAMH.(2022). Mental illness and addiction: facts and statistics.

https://www.camh.ca/en/Driving-Change/The-Crisis-is-Real/Mental-Health-
Statistics
Halter, M.J. (2019). Varcarolis’s Canadian psychiatric mental health nursing (2nd Edition).
Elsevier Saunders.
Mental Health Commission of Canada. (2012). Mental health strategy. Retrieved from
http://strategy.mentalhealthcommission.ca/the-facts/#sthash.2WcCw7s4.dpuf
Pollard,C., Jakubec, S.(2023). Varcarolis’s Canadian psychiatric mental health nursing (3 rd
Edition). Elsevier.
World Health Organization. (2004). Global burden of disease 2004. Retrieved from
http://www.who.int/healthinfo/global_burden_disease/GB
D_report_2004update_part4.pdf?ua=1
Next Class

• Module 2: Legal and Ethical Aspects in Clinical

Practice