Al-Hamd College of Nursing and Health Sciences, Bhakkar

Short Notes | Advanced concepts

Mental Health Nursing

(Post-RN BSN Semester-II, Fall 2023, Version-1)

Difficult words used in the notes and their simpler meanings:

1. Psychological: Related to the mind and emotions.

2. Stigma: Negative beliefs or attitudes towards something, often unfairly.

3. Therapeutic: Healing or having a positive effect on health.

4. Pharmacological: Related to the use of medication.

5. Cognitive: Related to thinking and understanding.

6. Psychotherapy: Treatment of mental health issues through talking and psychological

techniques.

7. SSRIs (Selective Serotonin Reuptake Inhibitors): A type of medication used to treat

depression and anxiety.

8. Compulsory: Required or mandatory.

9. De-stigmatization: The process of removing negative beliefs or stigma.

10. Holistic: Considering all parts of something, not just a single aspect.

11. Cognitive Function: The ability to think, learn, and remember.

12. Delirium: A sudden and severe change in mental function, causing confusion.

13. Dementia: A decline in mental ability, often seen in older adults.

14. Outreach: Providing services to people where they live or spend time.
 15. Empathy: The ability to understand and share the feelings of another.

16. Dysfunctional: Not working normally or properly.

17. Etiology: The study of the causes of diseases.

18. Geriatric: Relating to older adults and aging.

19. Rehabilitation: The process of helping someone to return to a healthy or normal life.

20. Vocational: Related to occupation or employment.

Unit 1: Introduction to Mental Health

What is Mental Health and How is it Different from Mental Illness?

1. Definition of Mental Health:

 Mental health refers to our emotional, psychological, and social well-being.

 It affects how we think, feel, and act.

 Example: A person with good mental health can handle daily stress and
maintain positive relationships.

2. Understanding Mental Illness:

 Mental illnesses are health conditions involving changes in emotion, thinking,

or behavior.

 They can be caused by a variety of factors including genetics, brain chemistry,

trauma, and life experiences.

 Example: Depression, a common mental illness, affects how a person feels,

leading to persistent sadness and loss of interest in activities.
 MENTAL VS MENTAL
HEALTH ILLNESS
What is Mental Health? What is Mental Illness?

Mental health is a state of well

Mental Illness is defined as a health
being in which the person realizes
condition that affects a person's
his or her own abilities, can cope
thinking, feeling, behavior or
with the normal stresses of life, can
mood. Such conditions may affect
work productively and fruitfully
someone's ability to relate to others
and is able to make a contribution
and function each day.
to his or her community.

Indicators of Good Mental Health Indicators of Mental Illness?

Resiliency Empathy Pulling Away from People
to Stress and Usual Activities

Feeling Numb or
Flexibility Spirituality Like Nothing Matters

Stable Feeling Helpless

Optimism
Relationships or Hopeless

Productive Respect for Self Experiencing Sever

Behavior and Others Mood Swings

Sense of Thinking of Harming

Self Confidence
Belonging Yourself of Others

Ability to take care Clear Inability to Perform

of self and others Thinking Daily Tasks

Sense of Well-being
and Contentment

Figure 1: Tthe difference between mental health and mental illness. Source: https://www.herefortexas.com/mental-
health-mental-illness-defined
What is the Magnitude and Burden of Mental Disorders?

1. Prevalence of Mental Disorders:

 Mental disorders affect millions of people around the world.

 In Pakistan, mental health issues are common but often not openly discussed.

In Pakistan, mental health issues are a significant concern, affecting an estimated 50 million
people. The challenge in addressing these issues is compounded by a severe shortage of
mental health professionals, with only around 500 psychologists and 400 psychiatrists for a
population exceeding 200 million. This scarcity is particularly pronounced in rural areas.
Stigma and limited awareness about mental health further hinder access to care, with many
attributing mental health problems to supernatural causes and seeking help from religious
healers instead of medical professionals. Women in Pakistan face additional challenges due
to societal stigmas and gender biases, making them more vulnerable to mental health issues.
Organizations and individuals are actively working to raise awareness and improve access to
mental health services, highlighting the urgent need for effective mental health care and
education in Pakistan.

2. Impact on Daily Life:

 Mental disorders can affect a person's ability to work, maintain relationships,

and enjoy life.

 They also place a burden on families and the healthcare system.

 Example: Someone with severe anxiety might find it hard to leave their house,
affecting their job and social life.

What are Health Promotion Programs in Mental Health?

1. Goals of Health Promotion Programs:

 To improve mental health awareness.

 To reduce stigma associated with mental illness.

2. Types of Programs:

 Educational sessions in schools and communities.

 Campaigns to promote mental well-being and healthy lifestyles.

 Example: Workshops teaching stress management techniques to nurses.

Why are Human Rights Important in Mental Health?

1. Rights of People with Mental Illness:

 People with mental illnesses have the same rights as others.

 This includes the right to respectful care and the right to privacy.

2. Challenges in Protecting These Rights:

 Stigma and discrimination can lead to rights violations.

 Mental health laws in Pakistan aim to protect these rights.

 Example: A patient with schizophrenia has the right to be treated with dignity
and not be isolated from society.

Table: Human Rights Relevant to Mental Health Issues

Right Description

Right to Dignified Patients should be treated respectfully, without

Treatment discrimination.

Right to Privacy Confidentiality of patient information must be maintained.

Right to Informed Patients should be informed about their treatment and

Consent consent must be obtained.

Right to Adequate Access to necessary mental health services and support.

Healthcare

Right to Live in the Patients have the right to live in their community and not be
Community isolated.
Note: These rights are based on international human rights standards and may be interpreted differently in local contexts.

Unit 2: History of Psychiatry and Psychiatric Nursing

What is the History of Psychiatry and Psychiatric Nursing in

Pakistan?

1. Evolution of Mental Health Care:

 Early mental health care in Pakistan was limited and often based on traditional
beliefs.
  Over time, psychiatric nursing evolved to incorporate modern practices and
medications.

2. Development of Psychiatric Nursing:

 Emphasis on patient-centered care and the importance of a therapeutic

environment.

 Integration of psychological theories into nursing practices.

Table: Milestones in the Development of Psychiatric Nursing in Pakistan

Year Event Significance

1950s Establishment of first mental hospitals Beginnings of organized mental

healthcare

1980s Introduction of modern psychiatric Shift towards pharmacological

medications treatments

2001 Enactment of Mental Health Ordinance Legal framework for mental health care

How Does the Mental Health Ordinance 2001 Affect Psychiatric

Nursing?
1. Key Provisions of the Ordinance:

 Focuses on the rights and welfare of mental health patients.

 Sets standards for mental health services and care facilities.

2. Impact on Nursing Practice:

 Enhanced focus on ethical and legal aspects of patient care.

 Recognition of the importance of informed consent and confidentiality.

Table: Key Provisions of the Mental Health Ordinance 2001

Provision Description

Rights Protection Safeguarding the rights of mental health patients

Standard of Care Establishing minimum standards for mental health services

Legal Framework for Treatment Guidelines for admission, treatment, and discharge
What are the Laws Governing Admissions and Discharge in Mental
Health Settings?

1. Admission Procedures:

 Criteria for voluntary and involuntary admissions.

 Legal requirements for documentation and consent.

2. Discharge Processes:

 Criteria for safe and ethical discharge planning.

 Importance of continuity of care post-discharge.

What are the Rights of Patients in Mental Health Settings?

1. Patient Rights:

 Right to receive care without discrimination.

 Right to be informed about their condition and treatment options.

2. Ethical Issues in Mental Health Care:

 Balancing patient autonomy with the need for treatment.

 Dealing with stigma and social misconceptions about mental illness.

Unit 3: Tools of Psychiatric Nursing

A. What is the Importance of Therapeutic Communication in Mental
Health Settings?

1. Definition and Purpose:

 Therapeutic communication involves the use of specific strategies to

encourage patients to express their feelings and thoughts.

 It helps in building trust and understanding between the nurse and the
patient.

2. Effective Communication Techniques:

 Active listening, empathy, and non-verbal cues.

 Avoiding judgment and offering support.

B. How is Mental Health Assessment Conducted?

1. Components of Mental Health Assessment:

 Gathering information about the patient’s history, symptoms, and behavior.

 Assessing mental status through observation and specific questions.

2. Tools Used in Assessment:

 Standardized questionnaires and scales.

 Clinical interviews and psychological tests.

C. Why is Self-Awareness Important for Psychiatric Nurses?

1. Understanding Self-Awareness:

 Self-awareness in psychiatric nursing refers to the nurse's understanding of

their own beliefs, feelings, and attitudes.

 It’s important for maintaining professional boundaries and providing

unbiased care.

2. Developing Self-Awareness:

 Regular reflection on personal experiences and feelings.

 Seeking feedback and engaging in professional development activities.

Tables for Unit 3:

Table 1: Techniques of Therapeutic Communication

Technique Description Example

Active Listening Fully concentrating on what is being Nodding and providing

said feedback

Empathy Showing understanding and sharing “I can see why that would
feelings upset you.”

Open-ended Encouraging patients to share more “How did that make you
Questions information feel?”

Table 2: Common Tools for Mental Health Assessment

Tool Purpose Example

Beck Depression To assess the severity of Used in outpatient
Inventory depression psychiatric settings

Mini-Mental State To assess cognitive function Common in elderly patients

Examination

Hamilton Anxiety Scale To quantify the severity of Used in clinical trials and
anxiety symptoms research

Unit 4: Mental and Behavioral Problems and Related Vicious Circle

of Mental Health Burden
A. How are Anxiety and Substance Use Disorders Related?

1. Interconnection Between Anxiety and Substance Use:

 Anxiety disorders often co-occur with substance use disorders.

 People may use substances as a way to cope with anxiety, leading to a cycle
of dependency and worsening mental health.

2. Impact on Treatment and Recovery:

 Addressing both anxiety and substance use is crucial for effective treatment.

 Strategies include therapy, medication, and lifestyle changes.

B. What is the Relationship Between Smoking, Sexual Activities, and

Mental Health?

1. Smoking and Mental Health:

 Smoking is more common among people with mental health issues.

 It can be a coping mechanism but also exacerbates mental health problems.

2. Sexual Activities and Mental Health:

 Issues like compulsive sexual behavior or dysfunction can be linked to mental

health conditions.

 These behaviors may stem from or contribute to psychological stress.

C. How Do Mental Health, Poverty, and the Vicious Circle Interact?

1. Mental Health and Poverty:

  Poverty can lead to increased stress, affecting mental health.

 Mental health issues can also make it harder to maintain a job, leading to
financial difficulties.

2. Breaking the Cycle:

 Interventions need to address both mental health and socioeconomic factors.

 Community and governmental support play a crucial role.

Tables for Unit 4:

Table 1: Connection Between Anxiety Disorders and Substance Use

Anxiety Substance Reason for Use Complications

Disorder Used

General Anxiety Alcohol To relieve stress Increased dependency

risk

Panic Disorder Cannabis To reduce panic Worsening of anxiety

symptoms

Social Anxiety Sedatives To ease social interactions Potential for addiction

Table 2: Impact of Mental Health on Lifestyle Choices

Lifestyle Choice Mental Health Impact Potential Risks Coping Strategies

Smoking Stress relief Increased health Smoking cessation

problems programs

Sexual Behavior Coping mechanism Risk of compulsive Therapy and

behavior counseling

Financial Result of Debt and poverty Financial planning

Management depression/anxiety assistance
Unit 5: Mental Health Problems and Therapeutic Interventions

A. What are the Characteristics and Treatment of Dysfunctional

Anxiety Responses?

1. Understanding Dysfunctional Anxiety:

 It includes disorders like generalized anxiety disorder, phobias, and post-

traumatic stress disorder.

 Characterized by excessive worry, fear, or avoidance beyond normal anxiety.

2. Nursing Interventions and Treatment:

 Psychotherapy, particularly Cognitive Behavioral Therapy (CBT).

 Medications like SSRIs (Selective Serotonin Reuptake Inhibitors).

 Stress management techniques and lifestyle modifications.

B. How are Altered Mood States Managed in Mental Health

Nursing?

1. Altered Mood States:

 Includes conditions like depression and bipolar disorder.

 Symptoms range from persistent sadness to extreme mood swings.

2. Therapeutic Interventions:

 Individual and group therapy.

 Pharmacological treatment with mood stabilizers or antidepressants.

 Psychosocial support and lifestyle counseling.

C. How Do Nurses Address Deliberate Self-Harm and Suicidal

Behavior?

1. Understanding Self-Harm and Suicide:

 Self-harm is often a coping mechanism for severe distress.

 Suicidal behavior indicates a high level of psychological pain and despair.

2. Nursing Care and Prevention:

  Crisis intervention and safety planning.

 Empathetic communication and support.

 Referral to mental health specialists and support groups.

Tables for Unit 5:

Table 1: Therapeutic Interventions for Dysfunctional Anxiety Responses

Disorder Intervention Description

Type

Generalized Anxiety CBT Helps in changing thought patterns

Disorder

Phobia Exposure Therapy Gradual exposure to feared

object/situation

Post-Traumatic Stress EMDR Processes trauma through guided eye

Disorder movement

Table 2: Management Strategies for Altered Mood States

Mood State Therapeutic Approach Key Components

Depression Psychotherapy Talk therapy, cognitive restructuring

Bipolar Pharmacological Mood stabilizers, antipsychotics

Disorder Treatment

Dysthymia Lifestyle Modification Regular exercise, healthy diet, adequate

sleep

Table 3: Strategies for Addressing Self-Harm and Suicidal Behavior

Behavior Nursing Intervention Description

Self-Harm Safety Planning Creating a plan to prevent harm during crises

Suicidal Ideation Crisis Intervention Immediate support and de-escalation

Suicide Attempt Referral to Specialist Connecting with mental health professionals

Unit 6: Mental Health Disorders in Children

A. What are Attention Deficit Disorders and How are They

Managed?

1. Overview of Attention Deficit Disorders (ADD/ADHD):

 Characterized by difficulties in maintaining attention, hyperactivity, and

impulsiveness.

 Often identified in childhood and can affect academic and social

development.

2. Nursing Interventions for ADD/ADHD:

 Behavioral therapy to teach children coping and organizational skills.

 Medications like stimulants may be used to improve concentration.

 Educating parents and teachers about effective strategies to support the child.

B. How Does Child Abuse Impact Mental Health and Development?

1. Effects of Child Abuse:

 Can lead to a range of emotional and behavioral issues, including anxiety,

depression, and trust issues.

 Long-term effects might include difficulty in forming relationships and

increased risk of mental health disorders.

2. Nursing Role in Addressing Child Abuse:

 Recognizing signs of abuse and reporting as required.

 Providing emotional support and referral to specialized services.

 Educating families and communities about the impact of abuse and

prevention strategies.
Tables for Unit 6:

Table 1: Management of Attention Deficit Disorders in Children

Strategy Description Example

Behavioral Techniques to increase attention and Organizational skills training

Therapy decrease impulsivity

Medication Stimulants to improve focus Methylphenidate (Ritalin)

Parental Teaching parents strategies to support Consistent routines and

Education their child boundaries

Table 2: Effects of Child Abuse on Mental Health

Type of Abuse Potential Mental Health Impact Long-term Effects

Physical Abuse Anxiety, fearfulness Difficulty trusting others

Emotional Low self-esteem, depression Challenges in relationships

Abuse

Sexual Abuse Post-traumatic stress disorder (PTSD), Increased risk for mental health
guilt issues

Unit 7: Geriatric Related Mental Health Problems

A. What are the Common Psychiatric Assessments for Elderly Clients

with Compromised Cognition?

1. Key Assessments in Geriatric Psychiatry:

 Cognitive assessments like the Mini-Mental State Examination (MMSE) to

evaluate memory, attention, and language skills.

 Assessments for depression, anxiety, and other mood disorders prevalent in

the elderly.

2. Importance of Comprehensive Assessment:

 Accurate diagnosis is crucial for effective treatment planning.

  Understanding the impact of physical health on mental well-being in the
elderly.

B. How are Dementia and Delirium Managed in Geriatric Mental

Health?

1. Understanding Dementia and Delirium:

 Dementia is a progressive decline in cognitive function, affecting memory,

thinking, and behavior.

 Delirium is an acute, fluctuating change in mental status, often with confusion

and disorientation.

2. Nursing Interventions:

 Creating a safe and supportive environment.

 Medication management and monitoring for side effects.

 Providing support and education to caregivers.

C. What are the Nursing Care Needs for Elderly Clients with Mental
Health Problems?

1. Holistic Care Approach:

 Addressing both physical and psychological needs.

 Focusing on enhancing quality of life and promoting independence.

2. Role of the Nurse:

 Coordination of care with other healthcare professionals.

 Advocacy for the rights and needs of elderly patients.

Tables for Unit 7:

Table 1: Common Mental Health Assessments for the Elderly

Assessment Tool Purpose Key Elements

Mini-Mental State Assess cognitive function Memory, attention, language

Examination skills
 Geriatric Depression Scale Screen for depression in older Mood, energy, and outlook
adults assessments

Table 2: Management Strategies for Dementia and Delirium

Condition Nursing Intervention Description

Dementia Environmental Adjusting surroundings to reduce confusion

Adaptation

Delirium Acute Care Management Monitoring and managing acute changes in mental
status

Unit 8: Community Mental Health Nursing

A. What are the Various Models of Community Mental Health

Nursing?

1. Types of Models:

 Outreach Model: Nurses provide services in community settings like homes or

schools.

 Clinic-Based Model: Care is provided in community health centers or clinics.

 Integrated Care Model: Mental health services are combined with other
healthcare services.

2. Advantages of Each Model:

 Outreach: Accessible care, especially for those unable to visit clinics.

 Clinic-Based: Centralized services with a range of resources.

 Integrated: Holistic care addressing both mental and physical health.

B. What are the Functions of Mental Health Nurses in the

Community Setting?

1. Role of the Nurse:

 Assessment and early identification of mental health issues.

  Providing therapy, counseling, and education.

 Coordinating care with other healthcare providers.

2. Community Engagement:

 Raising awareness about mental health.

 Advocating for policies and resources to support mental health care.

C. How are Faith Healing Practices Incorporated in Community

Mental Health in Pakistan?

1. Understanding Faith Healing:

 In many communities, mental health issues are addressed through religious or

spiritual practices.

 Faith healing can be a significant aspect of mental health care for some
individuals.

2. Integrating Faith Healing with Professional Care:

 Recognizing and respecting cultural practices.

 Collaborating with faith healers where appropriate.

 Educating about the benefits of combining faith healing with medical

treatment.

Tables for Unit 8:

Table 1: Comparison of Community Mental Health Nursing Models

Model Setting Key Features

Outreach Home/School Direct care in patient’s environment

Clinic-Based Health Centers Wide range of services in a central location

Integrated Care Various Combined mental and physical health services

Table 2: Role of Mental Health Nurses in Community Settings

Function Description

Assessment and Early Detection Identifying mental health issues in community members

Counseling and Therapy Providing psychological support and therapy

Care Coordination Working with other health professionals for holistic care

Unit 9: From Promotion and Prevention to Rehabilitation and

Recovery in Mental Health

A. What are the Health Promotional and Preventive Measures for

Mental Health at the Workplace?

1. Workplace Mental Health Promotion:

 Initiatives like stress management workshops and employee assistance

programs.

 Creating a supportive work environment that acknowledges and addresses

mental health.

2. Preventive Measures:

 Training for managers to recognize and support employees with mental

health issues.

 Policies to prevent workplace bullying and reduce job-related stress.

B. What is Rehabilitation in Mental Health, and How is it

Maintained?

1. Understanding Rehabilitation:

 Rehabilitation focuses on helping individuals regain their functional abilities

after experiencing mental illness.

 Involves skill-building, therapy, and support to reintegrate into society.

2. Maintaining Mental Health:

 Ongoing therapy and support groups.

  Lifestyle changes and coping strategies to prevent relapse.

C. What are the Rehabilitative Needs of People with Serious Mental

Health Problems?

1. Identifying Needs:

 Needs vary and can include housing, employment, social skills, and managing
daily activities.

 Personalized care plans are crucial for effective rehabilitation.

2. Role of the Nurse:

 Assessing individual needs and developing care plans.

 Coordinating with other professionals for comprehensive care.

D. How Do Families and Communities Respond to the Rehabilitative

Needs of Clients?

1. Family Involvement:

 Education and support for families are key to successful rehabilitation.

 Family members often play a crucial role in providing care and support.

2. Community Response:

 Community support services like day centers or vocational programs.

 Public awareness and de-stigmatization efforts to foster acceptance and

support.

Tables for Unit 9:

Table 1: Workplace Mental Health Promotion Strategies

Strategy Description

Stress Management Programs Workshops and resources to manage work stress

Employee Assistance Programs Counseling and support for personal issues

Table 2: Key Aspects of Rehabilitation in Mental Health

Aspect Description

Skill Development Building social and vocational skills for independence

Therapy Ongoing psychological support and counseling

Support Groups Peer support for shared experiences and recovery strategies