Chapter One
Foundations of Psychiatric Mental Health Nursing

Mental Health
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The WHO defines health as a state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity.
Mental health is influenced by individual factors, including biologic makeup, autonomy, and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities; by interpersonal factors, including effective communication, helping others, intimacy, and maintaining a balance of separateness and connectedness; and by social/cultural factors, including sense of community, access to resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive yet realistic view of the world (damn, that was a mouthful!).

Mental Illness
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The APA (2000) defines a mental disorder as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom”.
Deviant behavior does not necessarily indicate a mental disorder. Diagnostic and statistical manual of mental disorders

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The DSM-IV-TR is a taxonomy published by the APA.
The DSM-IV-TR describes all mental disorders, outlining specific criteria for each based on clinical experience and research.
The DSM-IV-TR has 3 purposes: o To provide standardized nomenclature and language for all mental health professionals. o To present defining characteristics or symptoms that differentiates specific diagnoses. o To assist in identifying the underlying causes of disorders. A multiaxial classification system that involves assessment on several axes, or domains of information, allows the practitioner to identify all the factors that relate to a persons condition. o Axis I is for identifying all major psychiatric disorders except MR and personality disorders.
Examples include depression and schizophrenia. o Axis II is for reporting mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms. o Axis III is for reporting current medical conditions that are potentially relevant to understanding or maintaining the person’s mental disorder as well as medical conditions that might contribute to understanding the person. o Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Included are problems with the primary support group, the social environment, education, occupation, housing, economics, access to health care, and the legal system. o Axis V presents a Global Assessment of
Functioning which rates the person’s overall psychological functioning on a scale of 0 to 100.
This represents the clinician’s assessment of the person’s current level of functioning.

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All clients admitted to a hospital or psychiatric treatment will have a multiaxis diagnosis from the DSMIV-TR.

Period of Enlightenment and Creation of Mental
Institutions
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In the 1790’s Phillippe Pinel in France and Willian Tukes of England formulated the concept of asylum as a safe refugee or haven offering protection at institutions where people had been beaten, whipped, and starved for their mental illness.
In the US, Dorothea Dix (1802-1887) began a crusade to reform the treatment of mental illness after a visit to the Tukes’ institution in England. She was instrumental in opening 32 state hospitals that offered asylum to the suffering. 100 years after establishment of the first asylum, state hospitals were in trouble. Attendants were accused of abusing the residents, the rural locations