NCM117 MPB [PRELIM]

Concepts of Mental Health and Mental Illness 6. Reality orientation (person can distinguish real
A. Illness world from a dream, fact from fantasy and act
- State of Mental Health and Mental Illness in the accordingly
country and the World 7. Stress management (can tolerate life stresses ,
1. Mental Health Care Delivery System in the handles anxiety or grief and experience failure)
Philippines and its importance and impact in the
community Mental Illness / disorder
 Mental Health Act - is an illness or syndrome with psychologic or
behavioral manifestations and/ or impairment
in functioning due to social, psychologic,
genetic, physical /chemical, or biologic
disturbance

Mental health Act

- ‘a right to freedom from discrimination, right to
protection from torture, cruel, inhumane, and
degrading treatment; right to aftercare and
rehabilitation; right to be adequately informed
about psychosocial and clinical assessments;
right to participate in the treatment plan to be
implemented; right to evidence-based or
informed consent; right to confidentiality; and
Mental Health Illness Continuum right to counsel, among others’.
Mental Health
- Is a state of emotional, psychological, and social Mental Health in the Philippines
wellness evidenced by satisfying interpersonal  14% Filipinos with identified mental disorders
relationships, effective behavior and coping,  Increased unreported cases of disabled
positive self-concept, and emotional stability population with mental health issues
 Cost of treatment
Components of Mental Health
1. Autonomy and independence (work Mental Health Care Delivery System
interdependently or cooperatively with others)  Health Care Facilities
2. Maximization of one’s potential ( oriented  Sociocultural Factors
towards growth and self-actualization)  Promotion, Prevention, Advocacy and
3. Tolerance of life’s uncertainties (can face the Awareness
challenges of day-to-day living and have a
positive outlook)
4. Self-esteem (realistic awareness of his/her
abilities and limitations )
5. Mastery of the environment (can deal with
environment in capable, competent and
creative manner)

1 M.A.B, RN |
 NCM117 MPB [PRELIM]

Mental Health Gap Action Programme (mhGAP) Objectives

- Was developed in order to address specific  To promote participatory governance and
challenges in humanitarian emergency settings. leadership in mental health
- mhGAP-HIG provides guidance on the  To strengthen coverage of mental health
presentation, assessment and management of a services through multi-sectoral partnership to
range of mental, neurological and substance provide high quality service aiming at best
use conditions, as well as general principles of patient experience in a responsive service
care. delivery network
 To harness capacities of LGUs and organized
Mental Health Program (Ph) groups to implement promotive and preventive
- Mental health and well-being is a concern of all. interventions on mental health
- Through a comprehensive mental health  To leverage quality data and research evidence
program that includes a wide range of for mental health
promotive, preventive, treatment and  To set standards for compliance in different
rehabilitative services; aspects of services
- that is for all individuals across the life course
especially those at risk of and suffering from Program Components
MNS disorders; 1. Wellness of Daily Living
- integrated in various treatment settings from - All health/social/poverty reduction/safety and
community to facility that is implemented from security programs and the like are protective
the national to the barangay level; factors in general for the entire population
- and backed with institutional support - Promotion of Healthy Lifestyle, Prevention and
mechanisms from different government Control of Diseases, Family wellness programs,
agencies we hope to attain the highest possible etc
level of health for the nation because there is - School and workplace health and wellness
no Universal Health Care without mental health programs
Vision 2. Extreme Life Experience
- A society that promotes the well-being of all - Provision of mental health and psychosocial
Filipinos, supported by transformative multi- support (MHPSS) during personal and
sectorial partnerships, comprehensive mental community wide disasters
health policies and programs, and a responsive 3. Mental Disorder
service delivery network 4. Neurologic Disorders
Mission 5. Substance Abuse and other Forms of Addiction
- To promote over-all wellness of all Filipinos, - Provision of services for mental, neurologic and
prevent mental, psychosocial, and neurologic substance use disorders at the primary level
disorders, substance abuse and other forms of from assessment, treatment and management
addiction, and reduce burden of disease by to referral; and provision of psychotropic drugs
improving access to quality care and recovery in which are provided for free.
order to attain the highest possible level of
health to participate fully in society. Calendar of Activities
September 10 - World Suicide Prevention Day
October 10 -World Mental Health Day
2nd Week of October – National Mental Week

2 M.A.B, RN |
 NCM117 MPB [PRELIM]

Statistics Frontal Lobe

- The World Health Organization (WHO)  Problem-solving skills
estimates that  Abstraction
1. 154 million people suffer from depression  Self-evaluation
2. A million from schizophrenia  Insight
3. 877,000 people die by suicide every year  Judgment
4. 50 million people suffer from epilepsy  Reasoning
5. 24 million from Alzheimer’s disease and other  Concept Formation
dementias Parietal Lobe
6. 5.3 million persons with drug use disorders  Taste
 Touch
Psychobiologic Bases of Behavior
 Temperature
 Neuroscience: Biology and Behavior
 Movement
 Neuro-anatomy and Neurophysiology
 Language Processing
Temporal Lobe
 Primary auditory and olfactory areas
 Sensory and visual information
 Wernicke area
o receptive speech
 Hippocampus
o contributes to memory
Occipital Lobe
 Visual Integration
 Color vision
 Object and facial recognition
 Ability to perceive objects in motion
Cerebrum
Limbic System
- The largest part of the brain
- Basic emotions, needs, drives, and instinct
- control the voluntary muscular movements of
the body begin and are modulated in the limbic system
- Divided into 2 hemispheres: - Hate, love, anger, aggression, and caring
emotions
o Left and Right
- Memory
Cerebral Cortex
Hippocampus
- outermost surface of the cerebrum
- Storing information, especially emotions
- made up of gray matter (comprises cell bodies
attached to a memory
and dendrites)
- mainly involved in the consciousness - central to the creation and filing-away of
memories
- 4 lobes:
o Frontal, Parietal, Temporal and - plays important roles in the consolidation of
Occipital lobes information from short-term memory to long-
term memory

3 M.A.B, RN |
 NCM117 MPB [PRELIM]

Thalamus Serotonin
- “relay-switching center of the brain” - plays a role in the initiation of sleep and in
- sensory processing appetite, mood, temperature control, and other
- movement functions.
- emotion Glutamate
- memory - is the most common excitatory
Hypothalamus neurotransmitter in the nervous system;
- Bodily regulation - it is involved in a wide variety of functions.
- body temperature GABA (gamma-aminobutyric acid)
- sleep and wakefulness - is the most widespread inhibitory
- release of stress hormones neurotransmitter;
- Pituitary gland connected to ventral aspects of - it is also involved in a vast array of functions.
hypothalamus
Amygdala Freud Concepts Patterns of Behavior
- Emotional responses Sigmund Freud
- Sense of smell - The founder of psychoanalysis compared the
- Involved in modulation aggression and sexuality human mind to an iceberg.
Cerebellum - Explains the importance of dreams and
- “little brain” proposed to unlock the hidden parts of the
- Movement mind
- Learning physical tasks - Of Freud’s three basic personality structures
- Balance and posture o id, ego, and superego
Brain Stem o only the id is totally embedded
3 main parts
 Midbrain
 Pons
 Medulla Oblongata
Neurons
- or nerve cell is the brain's fundamental building
block for the transmission of information
Neurotransmitters
Acetylcholine
- Is important for the control of muscles and the
secretion of hormones, as well as for cognitive
function.
Norepinephrine (noradrenaline)
- Is key to the function of the sympathetic
nervous system and to the “fight-or-flight”
response.
Dopamine
- Helps to regulate reward behavior and mood, as
well as in the control of body movements.

4 M.A.B, RN |
 NCM117 MPB [PRELIM]

3 Basic Personality Structure

 ID
 EGO
 SUPER EGO

The Mind as an Iceberg

5 M.A.B, RN |
 NCM117 MPB [PRELIM]

Three basic personality structures Ego

Id -The superficial portion of the id responsible for
- The division of the mind or psych that is the reality testing, or learning to distinguish
seat of the libido. between self and environment, mediating
- From it arise the animalistic, chaotic impulses between the demands of the id and the super-
that demand gratification. ego.
- The id is not in contact with the outside world, Super Ego
only with the body, and thus centers its - That part of the psyche or personality that
demands on the body. develops from the incorporation of the moral
- It is governed entirely by the pleasure principle, standards and prohibitions from the parents,
to accede to its wishes regardless of the particularly the father.
consequences. - The super- ego is roughly equivalent to
conscience

 The entire phenomenal world of cognition is

due to this 2 ½ pounds of 100 billion nerve cells
inside each human head.
 The brain weighs less than 3% of our total
weight but burns 25% of our total oxygen
intake.
 It is a busy, powerful, phenomenal, mysterious
place.

6 M.A.B, RN |
 NCM117 MPB [PRELIM]

Unconscious (evidenced by) Characteristics of the Unconscious

Dreams  Recorder of experience
- the royal road to the unconscious  Cannot distinguish reality from imagination
Intuition »Right – brain function
- The power or faculty of knowing things without  Obeys the conscious mind
conscious reasoning.
Psychoanalytic Theory
 One familiar example of the operation of the - Refers to the definition and dynamics of
unconscious is the phenomenon where one fails personality development which underlie and
to immediately solve a given problem and then guide psychoanalytic and psychodynamic
suddenly has a flash of insight that provides psychotherapy
solution maybe days later at some odd moment - Psychoanalytic theory proposes that every
during the day. individual personality is the result of childhood
 “Eureka Experience” (e.g.,Archimedes) conflict.

Man Standards of Psychiatric Mental Health Nursing

- Is both his expressed self and the hidden aspect Practice
of himself, his past lived and unlived...” Standards of Care
Standard 1
 In Jung’s effort to analyze the deepest recesses Assessment
of the human personality and his own self, he 1. Consider the age
once said, a. 1 in 10 children suffer from a mental illness
 “My life is a story of the self- realization of the b. Adolescents – concerned with
unconscious confidentiality
c. Older adults – need special attention
(physical limitation)
2. Language barriers
- complex spiritual and social factors
- need an interpreter
3. Using Rating scales
- Depression – Beck inventory, Patient health
questionnaire
Standard II
Diagnosis
Standard III
Outcome Identification
Standard IV
Planning
Standard V
Implementation
 Standard Va
Counseling

7 M.A.B, RN |
 NCM117 MPB [PRELIM]

 Standard Vb Health teaching

Milieu Therapy  teaching
 Standard Vc Care management
Self-Care Activities  Nursing care
 Standard Vd
Psychologic Interventions Advanced Level Functions
 Standard Ve Health promotion
health teaching - Health maintenance
 Standard Vf Psychotherapy
Case Management - Individual, family, group, community
 Standard Vg Prescription
Health Promotion - Medication
 Standard Vh Consultation
Psychotherapy - Clinic
 Standard Vi
Prescription Authority and treatment Standards of Professional Performance
 Standard Vj  Standard 1
Consultation Quality of Care
Standard VI  Standard II
Evaluation Performance Appraisal
 Standard III
The Nurse Education
Qualifications  Standard IV
How to become a Psychiatric Nurse Collegiality
 Step 1  Standard V
Complete a Nursing Program Ethics
 Step 2  Standard VI
Earn your RN License Collaboration
 Step 3  Standard VII
Earn your Certification in Psychiatric Nursing Research Resource
 Standard VIII
Basic Level Functions of the Nurse Utilization
Counseling
 Intervention Where do they work?
 Problem solving  Psychiatric hospitals
Milieu therapy  Doctors’ offices
 Therapeutic environment  Assisted living facilities
Self-care activities  Long term care centers
 Encourage  Rehabilitation centers
 independence  Behavioral care companies
Psychobiologic interventions  Private homes
 Medications  Correctional facilities
 observation  Community mental health centers
8 M.A.B, RN |
 NCM117 MPB [PRELIM]

 Private clinics  Most health insurance companies do not cover

 Schools mental health related conditions.
 Military care and hospitals  We need a mental health law.
 So like any other diseases, it could be
Whom do they work with? prevented, managed and even cured.
 Children
 Adolescents Philippine Mental Health Act 11036
 Adults - The state affirms the basic right of all Filipinos
 Older persons to mental health as well as fundamental right of
 People with substance abuse disorders people who require mental health services
 People with eating disorders Objectives
1. Effective leadership and governance for mental
 Forensics
health
 Consultant
2. National mental health care system
3. Protect rights of patients
Related Laws in Mental Health
4. Strengthen information systems, evidence
The Philippines still do not have a mental health law –
based research for mental health
- A law that will protect the rights of Filipinos
5. Integrate mental health care in the basic health
who have a mental disorder.
services
6. Strategies promoting mental health in
 Mental health is everyone’s concern.
educational institutions, workplace and in
 Mental health is not just having a mental
communities
disorder.
Rights of Service Users
 The World Health Organization (WHO) defines
 Freedom from discrimination
mental health as the way a person thinks feels
or acts in a given situation. It is how you see  Respect political, civil, economic, social,
yourself (one’s self-esteem). religious, educational and cultural rights
 It is how to relate to another person and how  Access to evidence based treatment
you meet the demands of the everyday life  Affordable
 Humane treatment
Mental disorder  Accessible
- is a medical condition that affects one’s thought  Confidentiality
processes and perception of reality  Informed consent
- It affects our behavior that one could act Patients’ Rights and Responsibilities
differently, and there is a sudden change in a  appropriate medical care & humane treatment
person.  Informed consent
- We may just want to cry and suddenly laugh.  Privacy & confidentiality
We may hallucinate and be delusional.  Information
- There is a problem in our brain, in our minds.  Choose health care provider & facility
 Self determination
 WHO reported that one of five people suffer  Religious belief
from mental health problems worldwide.  Medical records
 In the Philippines, there are only five  To leave
psychiatrists per 10,000,000 Filipinos.  To refuse participation in Medical Research
9 M.A.B, RN |
 NCM117 MPB [PRELIM]

 To receive visitors Republic Act 7305 Magna Carta of Public Health

 To express grievance Workers
 To be informed of his rights and obligations as a a. Promote and improve social and economic
patient wellbeing of the health workers
b. Develop their skills and capabilities
Magna Carta for Women RA 9710 c. Join and remain in government service
- A comprehensive women’s human rights law
that seeks to eliminate discrimination through  Married public health workers
the recognition, protection, fulfillment, and  Security of tenure
promotion of the rights of Filipino women  Discrimination prohibited
Salient features  No understaffing/overloading of health staff
 Third level positions in government  Normal hours of work
 Leave benefit of two (2) months with full pay  Night shift differential
 Employment in the field of military, police and  Salary & additional compensation
other similar services
 Equal access - Education, scholarship, training Ethico-Legal Considerations
 Women in media and film Legal and Ethical Concepts
 Equal status given to men & women Ethics
- Study of philosophical beliefs about what is
Republic Act 7277 considered right or wrong in society
- Disabled persons are part of Philippine society Bioethics
- Same rights as other persons in society - Ethical questions arising in health care
- More meaningful, productive and satisfying life Principles of bioethics
- Promote welfare of the disabled persons a. Beneficence: duty to act to benefit others
- Respect for disabled persons b. Autonomy: respecting rights of others to make
- Remove all prejudice decisions
c. Justice: duty to distribute resources equally
Magna Carta for Disabled Persons d. Fidelity: maintaining loyalty and commitment to
Rights patient
e. Veracity: duty to communicate truthfully
 Employment
 Education
Mental Health Laws:
 Health
Civil Rights and Due Process
 Social services
Civil rights:
 Telecommunication
- people with mental illness are guaranteed same
 Accessibility
rights under federal/state laws as any other
 Political & civil rights
citizen
 Housing program 1. Due process in civil commitment: courts have
recognized involuntary commitment to mental
hospital is “massive curtailment of liberty”
requiring due process protection, including:
a. Writ of habeas corpus: procedural mechanism
used to challenge unlawful detention

10 M.A.B, RN |
 NCM117 MPB [PRELIM]

b. Least restrictive alternative doctrine: mandates Rights Regarding Restraint and Seclusion
least drastic means be taken to achieve specific 1. Doctrine of least restrictive means of restraint
purpose for shortest time always the rule
Admission to the Hospital 2. Legislation provides strict guidelines for use
1. Voluntary: sought by patient or guardian a. When behavior is physically harmful to
a. Patients have right to demand and obtain patient/others
release b. When least restrictive measures are
b. Many states require patient submit written insufficient
release notice to staff c. When decrease in sensory overstimulation
2. Involuntary admission (commitment): made (seclusion only is needed)
without patient’s consent d. When patient anticipates that controlled
a. Necessary when person is danger to self or environment would be helpful and requests
others, and/or unable to meet basic needs seclusion
as result of psychiatric condition 3. Recent legislative changes have further
restricted use of these means and some
3. Emergency involuntary hospitalization facilities have instituted “restraint free” policies
a. Commitment for specified period (1-10
days) to prevent dangerous behavior to Patient Confidentiality
self/others 1. Ethical considerations
4. Observational or temporary involuntary a. Confidentiality is right of all patients
hospitalization b. ANA Code of Ethics for Nurses (2001)
a. Longer duration than emergency asserts duty of nurse to protect
commitment confidentiality of patients
b. Purpose: observation, diagnosis, and 2. Legal considerations
treatment for mental illness for patients a. Health Insurance Portability and
posing danger to self/others Accountability Act (HIPAA), 2003
 Health information may not be released
Issue of Legal Competence without patient’s consent, except to
1. All patients must be considered legally those people for whom it is necessary in
competent until they have been declared order to implement the treatment plan
incompetent through legal proceeding 3. Exceptions
a. Determination made by courts a. Duty to Warn and Protect Third Parties
b. If found incompetent, court-appointed legal  Tarasoff v. Regents of University of
guardian, who is then responsible for giving California (1974) ruled that
or refusing consent psychotherapist has duty to warn
2. Implied consent patient’s potential victim of potential
a. Many procedures nurse performs has harm
element of implied consent (e.g., giving b. Most states have similar laws regarding duty to
medications) warn third parties of potential life threats
b. Some institutions require informed consent c. Staff nurse reports threats by patient to the
for every medication given treatment team

11 M.A.B, RN |
 NCM117 MPB [PRELIM]

Child and Elder Abuse Reporting Statutes Negligence/Malpractice

1. All states have enacted child abuse reporting 1. Negligence or malpractice is an act or an
statutes omission to act that breaches the duty of due
a. Many states specifically require nurses to care and results in or is responsible for a
report suspected abuse person’s injuries
2. Numerous states have also enacted elder abuse 2. Elements necessary to prove negligence
reporting statutes a. Duty
a. Agencies receiving federal funding (i.e., b. Breach of duty
Medicare/Medicaid) must follow strict c. Cause in fact
guidelines for reporting abuse of older d. Proximate cause
adults 3. Damages Cause in fact
a. Evaluated by asking “except for what the
Tort Law Applied to Psychiatric Settings nurse did, would this injury have occurred?”
1. Protection of patients: 4. Proximate cause or legal cause
- legal issues common in psychiatric nursing are a. Evaluated by determining whether there
related to failure to protect safety of patients were any intervening actions or individuals
2. Protection of self that were in fact the causes of harm to
a. Nurses must protect themselves in both patient
institutional and community settings 5. Damages
b. Important for nurses to participate in a. Include actual damages as well as pain and
setting policies that create safe suffering
environment 6. Foreseeability of harm
a. Evaluates likelihood of outcome under
Torts circumstances
- Torts are wrongful acts that cause a patient to
suffer harm. Nursing Intervention: Suspected Negligence
Intentional Torts 1. Most states require legal duty to report risks of
 Assault harm to patient
 Battery 2. Nurse has obligation to report peer suspected
 False Imprisonment of being chemically impaired
 Invasion Of Privacy a. Report to supervisor is requirement
 Defamation Of Character 3. If nurse knows physician’s orders need to be
Unintentional Torts clarified or changed, it is nurse’s duty to
 Negligence intervene and protect patient
 Malpractice 4. Abandonment
a. Legal concept may arise when nurse does
not leave patient safely back in hands of
another health care professional before
discontinuing treatment

12 M.A.B, RN |
 NCM117 MPB [PRELIM]

Avoiding Liability
 Respond to the client
 Educate the client
 Comply with the standard of care
 Supervise care
 Adhere to the nursing process
 Document carefully
 Follow up and evaluate
 Maintain a good interpersonal relationship with
client and family

13 M.A.B, RN |