Ancient times: sickness represented:

• displeasure of the gods
• punishment for wrong doing
• treatment included:
  • starving
  • urging
  • bloodletting

period of enlightenment:

• 1790's
• creation of asylums or safe havens to offer protection

sigmund freud

• father of mental health
• studied mental disorders scientifically by 1900's

What happened in the 1950's?

• psychotropic drugs first available

Deinstitutionaliziation began with:

• the Community Mental Health Centers Act of 1963

DSM-IV-TR

• A taxonomy published by APA
• used by mental health pro's.
• describes all mental disorders according to specific diagnostic criteria

DSM-IV-TR based on what:

• a multitaxial classification system
• AXIS-1 through AXIS-5

Axis I

• Mayjor phsyciactiric disorders
• except mental retardation & personality disorders

Axis II

• Mental retardation
• personality disorders
• maladaptive personality features
• defense mechanisms

Axis III

• Current  medical conditions

Axis IV

• Psychosocial and enviromental problems

Axis V

• Global Assessment of Functioning Score (GAF)

first drug available for mental health

• lithium
• thorazine
• haldo?

dorthea dix

• activist on behalf of mentally ill
• established 1st generation of mental asylums
• served in civil war

APA

• American phsyciatric association

5 most common mental disorders in the world

1. mayjor depressive disorder
2. alcohol abuse
3. schizophrenia
4. self-inflicted injuries
5. bipolar disorder

revolving door concept

• hospital stays shorter but more frequent

linda richards

• first profesionally trained nurse
• in 1873 said that the mentally sick should be cared for just as well as the physically sick.

first formal training of nurses in mental health occured?

first phsyciactric textbook published in ?

psychiactric mental health nursing phenomena of concern?

Hill burton act

• in 1930s introduced 1st law to address mental illness

national mental health act of 1946

• provided $$ to train nurses and other in the field of mental health

The community mental health centers act of 1963

• Revised 1980- to provide a full set of services within the community

patient bill of rights

african americans

• family oriented- matriarchal
• clients make own decisions
• handshakes/eyecontact=respect
• view mental illness as
  • spiritual imbalance
  • punishment for sin

American indians/native americans

• speak slow W/ pauses
• light-touch handshake
• avoid eye contact
• believes mental illness comes from
  • ghosts
  • breaking taboos
  • loss of harmony w/enviroment
• dont touch/question them

arab americans

• greet w/smile & handshake
• eldest male=family spokesperson
• view mental illness caused by:
  • fear
  • manipulation
  • god
  • loss of country,family,friends
• mental illness has stigma>treatment sought only when all other remedies fail.

cambodians

• no phys contact when greeting
• politeness highly valued-women=no eye contact
• family oriented-3generations in 1 house
• silence common
• avoid
  • social chatter
  • touching persons head
• mental illness viewed as cause by
  • war
  • brutality

Chinese

• silence = respect
• avoid eye contact w/ authority figures
• extended families common-wife joins husbands family
• keep distance
• eldest male=family spokesperson
• mental illness caused by
  • disharmony of emotions
  • evil spirits

cubans

• outgoing
• animated in conversation
• Direct eye contact=respect & honesty
• extended family important-family oriented
• Mental illness views:
  • inherited or caused by stress
  • a stigma for the family

filipinos

• greet w/smiles & not handshakes
• direct eyecontact=impolite
• family oriented
• views of mental illness:
  • as having religious & mystical causes

haitians

• greet with handshake
• may smile/not even when not understanding
• less eye contact W/ authority figures
• close,tightly knit family-matriarchal
• mental illnes not well accepted >viewed as having supernatrural causes

japanese americans

• little eyecontact with authority figures
• family oriented
• may nod to be polite- not necessarily agree
• self-disclosure minimal>ask openended questions
• Mental illness considered shameful so they're reluctant to seek treatment

Mexican americans

• eye contact w/authority figures avoided
• matriarchal
• touched by strangers not appreciated except for handshake
• silence denotes disagreement
• illness comes from imbalance of person/enviro.

puerto ricans

• Elders prefer less eye contact> younger prefer eye contact
• family very important-all activities/decisions revolve around family
• religious/spiritual practices very important
• express gratitude through cooking>refusal to accept=insult
• mental illness is hereditary or a punishment

Russians

• use direct eye contact
• great respect for elders-strong family bonds
• close space for family & friends_not strangers
• send sick to bed-no medications
• mental illness views
  • caused by stress
  • moving into new enviroment

South asians

• avoid direct eye contact_considered rude
• touching not common
• mental illness viewed:
  • caused by spells cast by enemies/evil spirits

vietnamese

• no eye contact with authorities
• Highly family oriented
• head is sacred, feet profane
• mental illness viewed:
  • caused by disharmony or punishment by ancestral spirits

Manslows heirarchy of needs

bottom 2 top

1. physiological needs
2. safety/comfort needs
3. love & belonging needs
4. Self Esteem needs
5. self actualization needs

abraham maslow

• an american psychologist
• studied needs or motivatoin of individuals focusing on the whole person
• created the hierarchy of needs

MOT

• mandated outpatient treatment
• requirement for clients to continue participation in treatment involuntarily after being released from hospital

conservator

• Appointed by a judge to take care of someone mentally ill that can not care for themselves.

Seclusion

• involuntary confinement of someone
• goal is to give client a chance to ragain physical and emotional self control

you need what for seclusion and restraints

• face 2 face evalutation by a licensed practitioner w/in 1 hour of restraint/seclusion
• physicians order q 2h
• assessment by nurse q2 hrs
• close supervision

duty to warn

• mental health clinicians have the duty to warn third partys about threats even if stated in therapy sessions based on situations.

what are boundries of confidentiality in mental health?

• the same as everyone else except the duty to warn,

tort

• wrongful act that results in injury, loss, or damage

unintentional tort

• negligence and malpractice

malpractice must include

1. DUTY
2. BREACH OF DUTY
3. INJURY OR DAMAGE
4. CAUSATION

INTENTIONAL tort

• assualt
• battery
• false imprisonment

assault

• threats

battery

• harmful/unwanted contact with client
• unecessarily restraing a client

utilitarianism

which action would produce the greatest benefit for the most people

autonomy

• persons right to self-determination and independence

beneficience

• ones duty to benefit or to promote good

non maleficence

• requirement to do no harm to others

justice

• fairness

veracity

• duty to be honest or truthful

fidelity

• obligation to honor commitments or contracts

does the patient have the right to refuse medication?

when giving medication always:

• give lowest dose of drug to see how ptnt will react to it initially

congruency and incongruency

• congruency is when verbal and nonverbal agree
• incongruency is when verbal and non verbal dont agree

verbal communication vs. non verbal communication

• verbal: uses contents with context to say things.
• nonverbal:behavior accompanied by verbal communication(body language, eye contact, facial expressions,tone of voice etc.)

significance of nonverbal communication

• can indicate speakers thoughts, feeling, needs, and values acted out mostly unconciously

theraputic communication most comfortable at

concrete vs. abstract messages

• concrete: specific&clear
• abstract: messages are unclear, vague, require interpretation

accepting

• indicating reception of message
• E.G.: Saying "yes" or nodding

broad openeing

• allowing client to take initiative to intro. topic
• E.G: " Is there something you would like to talk about?

Consensual validation

• Searching for mutual understanding
• EG: "Tell me if im understanding correctly?"

encouraging comparison

• asking that similarities and difference be noted
• "have you had similar experiences"

encourage description of perceptions

• asking the client to verbalize what they percieve
• "tell me when you feel anxious" "what is happening"

encouraging expression

• asking client to appraise the quality of their experiences
• "what are your feelings about that?"

exploring

• Delving further into a subject or idea
• " tell me more about that"

focusing

• concentratin of a single point

general leads

• giving encouragment to continue
• " go on"

theraputic relationship & its difference from regular relationships

• therapeutic relationship focuses on needs, experiences,feelings, and ides of the client only
• regular relationships are based on friendship, socialization, companionship