CHAPTER 1
FOUNDATIONS OF PSYCHIATRIC- MENTAL HEALTH NURSING
GOOD TO KNOW!
Chapter Key Terms:
Asylum
Boarding
Case Management
Deinstitutionalization
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-
5-TR)
Managed Care
Mental Health
Mental illness
Phenomena of concern
Psychotropic drugs
Self-awareness
Social Determinants
Standards of Care
Utilization review firms
Learning Objectives:
1. Describe the characteristics of mental health and mental illness.
2. Discuss the purpose and use of the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition, Text Revision(DSM-5-TR).
3. Identify important historical landmarks in psychiatric care.
4. Discuss current trends in the treatment of people with mental illness.
5. Discuss the American Nurses Association (ANA) standards for psychiatric-mental health
nursing.
6. Describe the common student concerns about psychiatric nursing.
Nursing Concepts:
Ethics
Health Care Disparities
Health Care Systems
Health Policy
Health, Wellness, & illness
Legal Issues
Managing Care
Mood & Affect
Professional Behaviors
Mental Health vs. Mental Illness
Mental Health is Difficult to Define?
4 reasons:
1. No single, universal definition
2. Many components influenced by wide variety of factors
3. Dynamic, ever- changing state
4. Influencing factors:
a) Individual (personal)
b) Interpersonal (relationship)
c) Social/cultural (environment)
Mental Health- (WHO definition): State of complete physical, mental, and social wellness, not
merely the absence of disease or infirmity.
Mental Illness includes for 2 reasons:
Mental Health#1
A. Includes disorders that affect:
Mood
Behavior
Thinking
B. Mental disorders often cause significant distress and or impaired functioning.
Mental Health#2
A. Factors contributing includes:
Individual- biologic makeup, intolerable or unrealistic worries or fear.
Interpersonal- ineffective communication, inadequate social support.
Social/Cultural- unwarranted negative view of the world, discrimination
(stigma, racism, classism, etc.)
Diagnostic and Statistical Manual of Mental Disorders, 5 TH Edition, Text Revisions (DSM-5-TR)
Taxonomy
Published by the APA (American Psychiatric Association)
3 Main Purposes:
Standardize nomenclature and language.
Present defining characteristics or symptoms.
Assist in identifying the underlying causes of disorders.
Classifications:
Major Psychiatric Disorders
Medical Conditions
Psychosocial and Environmental problems.
Historical Perspective: Ancient Times
Sickness as Displeasure of God’s, punishment for sins, viewed as demonic or divine.
Aristotle and Imbalance of the four humors (Blood, Water, Yellow, and Black Bile),
balance restoration via bloodletting, starving, and purging.
Early Christians view as possession by Demons
Distinguished from Demons during renaissance
Hospital of St. Mary of Bethlehem- Officially declared a hospital for the insane.
4 Historical Perspectives:
Period of Enlightenment (1790’s)
Creation of asylums, moral treatment
Dorothea Dix
Sigmund Freud and Treatment of Mental Disorders
Scientific study, Treatment of mental illness.
Development of Psychopharmacology
Psychopharmacology (1950s): Development of Psychotropic Drugs
Move toward community mental health
Community Mental Health Movement
1. Deinstitutionalization
2. Legislation for disability income
3. Changes in commitment laws.
Mental Illness and the 21st Century: Current State
51.5 million adults in the US have a mental illness, though only 23 million
received treatment within the past year (National Institute of Mental Health,
2021)
Nearly 11 million children and adolescents are diagnosed with a mental
disorder.
Economic burden of mental illness exceeds the economic burden caused by all
types of cancer.
Leading cause of disability in US and Canada for those 15 to 44 years of age.
Yet only 1 in 4 adults and 1 in 5 children and adolescents are treated
Treatment still lagging in homeless and those with substance abuse problems.
Mental Illness and the 21st Century: Issues and Concerns
“Revolving Door’ effect due to Deinstitutionalization
Often ‘boarded’ in emergency department while awaiting inpatient beds.
Shorter hospital stays, decompensation, prehospitalization, and dual problem of both
mental illness and substance abuse
Homelessness (About one third have severe mental illness or a chronic substance use
disorder
Lack of adequate community resources
Community Based Care
Lack of Appropriate number of community mental health centers to provide services
Development of community support programs
Availability, quality of service highly variable
Inaccurate anticipation of extent of people’s needs
Despite flaws, positive aspects make hem preferable for treatment
Cost Containment and Managed Care
Managed Care Movement (early 1970’s)
Development of utilization review firms/ managed care organizations (1990” s), case
management.
Separation of mental health care from physical care for insurance coverage
Mental health Care management through privately owned behavioral health care firms.
Health Care Finance administration.
Mental Health parity, insurance coverage
Cultural Considerations
Culturally diverse population
Cultural difference influencing mental health and treatment of mental illness (see
chapter 7)
Changes in family structure
Psychiatric Nursing Practices: #1
Linda Richards: First American Psychiatric Nurse
Mclean Hospital, Belmont, MA: Site of first training for nurses to work with persons with
mental illness
Expansion of role with development of somatic therapies
Psychiatric Nursing Practice: #2
First Psychiatric Nursing Textbook (Nursing mental Diseases) was published in 1920
John Hopkins: First School of nursing to include psychiatric nursing Course (1913)
National League for Nursing (1950) requiring schools to include an experience in
psychiatric nursing.
Psychiatric Nursing Practice: #3
H. Peplau: Therapeutic Nurse Client relationship interpersonal dimensions (Foundation
for current practice)
J. Mellow: Focus on client’s psychosocial needs and strength
ANA and Standards of Care
Psychiatric Mental Health Nursing phenomena of concern (see box. 1.2)
