Foundations of Psychiatric

Mental Health Nursing & Clinical

Practice
How does Mental Health differ from
Mental Illness?
Health
Autonomy/independence
Works towards self-
actualization
Able to face challenges
Self-esteem-knows
abilities/limitations
Masters environments
Reality oriented
Manages stress uses
support system

Illness
Behavioral/ psychological
syndrome e/b
Dissatisfaction w/self
Ineffective/non-
satisfying relationships
Dissatisfied w/place in
world
Unable to cope or
ineffective coping
w/life stressors/events
MENTAL ILLNESS - TODAY
NIMH estimates:
26% Americans 18+ have diagnosable MI
(57.7 mil /yr) (2006)
ADHD 3-5% school age children diagnosed
Great economic burden > all types of cancer.
In U.S. & Canada - Leading cause of disability in
persons 15-44 years-old
Only 1:4 adults & 1:5 children & adolescents receive
needed services.
Homeless est. 750,000 living in streets
1/3 with mental illness & with substance abuse

Historical Events in Mental Health
Period of
Enlightenment
Late 1700s-
1800s


Development of
Psychopharmacolo
gy
1950 - present

Protection/safe haven
Beginning of moral tx.
Dorothy Dix- opens
Asylum for the MI
(provides food,
clothes,shelter)
agitation, psychosis
depression
Shorter hosp stays
noise/violence in
hospitals

Deinstitutionalization
1963 Community
Mental Health Centers
Construction Act
(J.F. Kennedy
administration)
SSI/SSDI -Federal
Legislation to provide
income for disabled
least restrictive
environment concept
C M H Cs built
3 components:
1) release from state
hosp.
2.) diversion from
hosp
3) developed alternate
services In community
independence of MI

Lanterman Petries
Short Act
( LPS Act)
1970s changes in
commitment laws
Commitment laws
72 hr hold-14 day
holds -30 day holds
Conservatorships &
Guardianships
Can only be held
involuntarily if:
DTS
DTO
GD
Parity Act
1996
Eliminated
annual/lifetime $
amounts for mental
health care for
companies with > 50
persons
Substance abuse
exempt
DSM IV -tr
(Diagnostitic Statistical Manual)

Axis I Psychiatric Diagnosis

Axis II- Personality Disorder or Development Disorder

Axis III Medical Diagnosis (that impacts on mental
diagnosis)

Axis IV- Stressors (mild, moderate, severe,
catastrophic acute or enduring

Axis V GAF (Global Assessment Functioning Scale)
score