Psychiatric Mental Health Nursing, 5th Edition Mental Health and Illness Continuum.

Psychiatric Mental Health Nursing, 5th EditionPsychiatric Mental Health Nursing, 5th Edition

Mental Health and Illness Continuum


Mental Health Defined as “The successful adaptation to

stressors from the internal or external environment, evidenced by

thoughts, feelings, and

behaviors that are age-

appropriate and congruent

with local and cultural

norms.”


Holism: Five Dimensions of the Person

The person at a development stage 1. Physical - basic needs, healing capacity 2. Intellectual – memory, learning 3. Emotional – feelings, self image 4. Spiritual – relatedness, beliefs 5. Sociocultural – culture, relationships Another way to define Health is the ability to

integrate all dimensions.


Mental Health Freud – “To work and to love” - Occupational functioning role as mother, wife work outside home roles meet requirements and expectations - relationships intimate satisfying and have reciprocity


Continued: Can meet basic needs Able to cope with daily stress Can resolve conflict successfully Positive self concept/positive way of dealing with

self: talk, cry, sports. Capacity for empathy and social sensitivity


Mental Illness Defined as “Maladaptive responses to stressors

from the internal or external environment,

evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.”


Illness Symptoms get in the way of effective

occupational, role and relationship functioning - paranoia – “People I work with are out to make

me look like a fool or for me to fail.” - hallucinations – The voices tell the person to

jump out of the window - low self-esteem – “I am unlovable”.


Continued: Suicidal thinking Extreme anger or hostility Delusions, hallucinations Abuse of alcohol and drugs Denial of problems Inability to cope with daily activities


Continued: Marked personality change Confused thinking Prolonged mood disturbance Excessive anxiety, fear, suspiciousness Withdrawal from society Abnormal self-centeredness


Mental Health and Illness Continuum

*_____________________________________* Mental Degrees Mental Health of Illness Functioning

Exacerbations/acute episodes


Myths about Mental Illness To be mentally ill is to be different and odd To be healthy, a person must be logical and

rational - All of us dream “irrational” dreams every night - “irrational” emotions are not only a universal

experience but necessary for a fulfilling life There are people who show extremely abnormal

behavior and are mentally ill who are far more like the rest of us than different from us


Remember Mental health and illness - Exist on a continuum All people move back and forth Not all mental illnesses are equal It can happen to anyone


Reasons for impaired function

1. Stressors such as -Developmental phases/Life events - Job security - Poverty/Economic pressures - Crime

2. Inability to cope with stressors, life changes – Adaptation

3. Genetics


Psychological Adaptation to Stress

Anxiety Behavioral adaptation

responses to anxiety

At the mild level, individuals

employ various coping

mechanisms to deal with stress. A few of these include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.


Psychological Adaptation to Stress Anxiety – caused by stress. We all have it. A diffuse apprehension that is vague in nature

and is associated with feelings of uncertainty and helplessness.

Extremely common in our society. Mild anxiety is adaptive and can provide motivation for survival.



Anxiety Peplau’s four levels of anxiety

– Mild – seldom a problem

– Moderate – perceptual field diminishes

– Severe – perceptual field is so diminished that concentration centers on one detail only or on many extraneous details

– Panic – the most intense state



Anxiety Anxiety at the moderate to severe level that remains unresolved over an extended period of time can contribute to a number of physiological disorders – for example, migraine headaches, IBS, and cardiac arrhythmias.

Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving – for example, anxiety disorders and somatoform disorders.



Anxiety Extended periods of functioning at the panic

level of anxiety may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.



Anxiety At the mild to moderate level, the

ego calls on defense mechanisms for protection, such as

– Denial– Displacement– Identification– Intellectualization– Projection

– Regression

– Repression

– Sublimation

– Suppression

– Undoing


Summary MH – Successful adaptation (and coping) to

stressors from the internal and external environment

MI – Maladaptive responses to stressors from the internal and external environment, evidenced by thoughts, feelings and behaviors that are incongruent with local cultural norms

Interfere with functioning


Case Lois is a 23 year-old college student who wrote

about herself, “Most of the time I’m happy and feel pretty good about myself. I’ve learned that what I get out of something is often proportional to the effort I put into it. My grades are OK.”

Where is Lois on the Health/Illness Continuum?


Role of the Psychiatric Nurse Advocacy Teaching Therapeutic relationship –the tool for nursing care Using the nursing process Performing mental status assessment Maintaining a therapeutic milieu (environment) Cultural assessment –does the patient believe in

a folk healer?


Continued: Maintaining the least restrictive environment legal requirement related to seclusion related to restraints types of restraints: environmental (room),

chemical, mechanical


Health Promotion and Maintenance - Education programs

- Stress management

- Crisis intervention Do in out-patient/community mental health

centers/schools


Health Restoration In-patient care The patient is a danger to self or others Suicidal, homicidal or cognitively impaired and

cannot meet basic need – impaired safety Voluntary Involuntary admission – court ordered, time

limited, 72 hours and then a court hearing to determine need for further care


Addition nursing roles Administer meds and monitor compliance Assist with problem solving Teach new coping skills


Community Resources Day hospital (Partial Hospitalization) Community Mental Health Centers Preserves the family, keep the patient function

at the highest level possible, minimizes stigma or in-patient hospitalization, lowers costs

Medication centers Alternative Living Group homes, foster care, cooperative

apartments, shelters


Conclusion Mental Illness is everywhere You will care for patients with mental illnesses in

any setting you will practice Non-acute vs acute Healthy people can become mentally ill due to

stressors; in addition to the causes and stressors previously covered, it can be due a serious diagnosis, lose of a body part.

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Psychiatric Mental Health Nursing, 5th Edition Mental Health and Illness Continuum.

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