Learning Objectives

After studying this topic, you should be able

to:
Distinguish between mental health and mental
illness.
Identify factors that influence the development of
mental health
Analyze the role of a significant other or support
person in maintaining mental health.
Define psychiatric–mental health nursing.
 Cont…Learning Objectives

State the rationale for using the Diagnostic and

Statistical Manual, 4th Edition, Text Revision
(DSM-IV-TR) and ICD 10 in the psychiatric–mental
health setting.
 Concept of Mental Health

Mental health is a positive state in which

one is responsible, displays self-
awareness, is self-directive, is
reasonably worry free, and can cope with
usual daily tensions .
 Concept of Mental Health Cont….

Mental health refers to the ability to solve

problems; fulfill one's capacity for love and work;
cope with crises without assistance beyond the
support of family or friends; and maintain a state
of well-being by enjoying life, setting goals and
realistic limits, and becoming independent,
interdependent, or dependent as the need arises
without permanently losing one's independence.
 Definition of mental health

The successful performance of mental function,

resulting in productive activities, fulfilling
relationships, and the ability to adapt to change
and cope with adversity.

Mental health provides the capacity for rational

thinking, communication skill, learning,
emotional growth, resilience and self esteem
(USDHHS, 1999).
 Mental Health Continuum

Mental Mental
Illness Health

Degrees of
Functioning
 Mental Health Continuum

The mentally ill and mentally healthy can

possess characteristics of mental health.
Sickness is based on the degree to which
characteristics or behaviours affects a person’s
functioning.
Mentally ill show deficit in functioning and bring
them to seek help.
 Characteristics of Mental Health
Have positive self-concepts and relate well to
people and their environment.
Form close relationships with others.
Make decisions pertaining to reality rather than
fantasy.
Be optimistic and appreciate and enjoy life.
Be independent or autonomous in thought and
action, relying on personal standards of behavior
and values.
Be creative, using a variety of approaches as
they perform tasks or solve problems
Element of Mental health (Mohr,2006)

Self governance
Reality orientation
Progress toward
growth or
Mastery of
self-realization
environment
Tolerance of
uncertainty
Stress management
Self-esteem
 Influences on mental health ( Mohr, 2006)

Biological Psychological Sociocultural

influences influences influences

1. Prenatal, perinatal 1. Interactions 1. Family stability

neonatal events. 2. Intelligence 2. Ethnicity
2. Physical health questions 3. Housing
status. 3. Self concept 4. Child - rearing
3. Nutrition 4. Skill pattern.
4. History of injuries 5. Creativity 5. Economic level
5. Neuroanatomy 6. Emotional and 6. Religion
6. Physiology developmental 7. Values and belief
level.
Mental disorders and mental illness

Mental disorders are defines as health

conditions marked by alterations in thinking,
mood, or behaviour that cause distress, impair
ability to function, or both.

Mental illness is considered a clinically

significant behaviour or psychological syndrome
experienced by a person and mark by distress,
disability, or the risk of suffering ,disability or the
loss of freedom ( APA, 2000)
 Characteristics of Mental Illness

Feels inadequate
Has poor self-concept
Is unable to cope
Exhibits maladaptive behavior
Is unable to establish a meaningful relationship
Displays poor judgment
Is irresponsible or unable to accept responsibility
for actions
Is pessimistic
Cont…Characteristics of Mental Illness

Does not recognize limitations (abilities and

deficiencies)
Exhibits dependency needs because of feelings
of inadequacy
Is unable to perceive reality
Does not recognize potential and talents
because of poor self-concept
Avoids problems rather than coping with them or
attempting to solve them
Cont…Characteristics of Mental Illness

Desires or demands immediate gratification

Mental illness reflects a person's inability to cope
with stress, resulting in disruption,
disorganization, inappropriate reactions,
unacceptable behavior, and the inability to
respond according to the person's expectations
and the demands of society.
 Sign of Mental illness
Marked personality change
Confused thinking
Prolonged mood disturbance
Excessive anxiety, fear suspiciousness
Withdrawal from society
Abnormal self-centeredness
Depressed and Suicidal thinking
Extreme anger or hostility
Delusion, hallucination
Abuse of drugs and alcohol
Denial of problems, resistance to help
Inability to cope with daily activities
Misconceptions About Mental Illness

Abnormal behavior is different or odd, and

easily recognized
Abnormal behavior can be predicted and
evaluated
Internal forces are responsible for abnormal
behavior
People who exhibit abnormal behavior are
dangerous
Maladaptive behavior is always inherited
Mental illness is incurable
Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition, Text
Revision (DSM-IV-TR)
To ensure consistency and commonality of
language, the American Psychiatric Association
(APA) has published a multiaxial system of
psychiatric disorder classification.
The Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition, Text Revision
(DSM-IV-TR) is the accepted standard for
identifying psychiatric disorders.
 DSM-IV-TR Multiaxial System

Axis I: Clinical Disorders and Other Conditions

That May Be a Focus of Clinical Attention

Examples: Delirium Due to a General Medical

Condition 293.0, Generalized Anxiety Disorder
300.02, Schizophrenia, Paranoid Type 295.30,
Noncompliance with Treatment V15.81,
Malingering V65.2. Identity Problem 313.82
Cont…DSM-IV-TR Multiaxial System

Axis II: Personality Disorders and Mental

Retardation

Examples: Borderline Personality

Disorder 301.83, Paranoid Personality
Disorder 301.0, Mild Mental Retardation
317, Profound Mental Retardation 318.2
Cont…DSM-IV-TR Multiaxial System

Axis III: General Medical Conditions (with

ICD-9-CM codes)

Examples: Concussion 850.9 (ICD-9-CM

code), Medication-Induced Postural
Tremor 333.1, Congestive Heart Failure
428.0 (ICD-9-CM code)
Cont…DSM-IV-TR Multiaxial System
Axis IV: Psychosocial and Environmental
Problems

This axis is for reporting psychosocial and

environmental problems that may affect the
diagnosis, treatment, and prognosis of mental
disorders.
The problems are grouped into the following
categories: primary support group, social
environment, educational, occupational, housing,
economic, access to health care services,
interaction with the legal system/crime, and other
psychosocial and environmental problems.
Cont…DSM-IV-TR Multiaxial System

Axis V: Global Assessment of Functioning

(GAF)

This axis is for reporting the clinician's judgment of the

individual's overall level of functioning. It is useful in
planning interventions and measuring outcomes.
The continuum coding scale of 0 to 100:
91–100: Superior functioning in a wide range of
activities,
41–50: Serious symptoms (eg, suicidal ideation, severe
obsessional rituals, frequent shoplifting) or any serious
impairment in social, occupational, or school functioning
(eg, no friends, unable to keep a job).
 Reflective thinking

What do you expect to see on psychiatric unit?

From where do you think your perception come?
Do you have a definition of mental health and
mental illness?
What influenced your definition?
Do you think that a person with hypertension
that is controlled with medication can still be
regarded as healthy? How does this compare
with a person who has schizophrenia that is
controlled with antipsychotic drugs?
 Questions you may have

Why and how do persons seek care?

Will I be able to communicate with the
client?
Will the client’s behaviour make me
uncomfortable?
Are psychiatric clients violent?
 How about In Indonesia ?
ICD -10 is accepted to be as a standard for
identifying psychiatric disorders and used DSM
IV as well.
ICD-10 created in 1992, In Indonesia it is
translated to Indonesian becoming : Pedoman
Penggolongan Diagnosis Gangguan Jiwa III (
PPDGJ III)
For Example :
F20.0 : Paranoid Schizophrenia
F20.1 : Hebephrenic schizophrenia
F20.3 : Undifferentiated schizophrenia
 Further readings
Mohr, WK (2006) Psychiatric –Mental
Health Nursing, Philadelphia, Lippincott
Williams & Wilkins, pp 3-16.
Shives, R (2005), Basic Concept of
Psychiatric Mental Health Nursing, pp 8-22
Stuart, GW & Laraia, MT (1998),
Principles and Practice of Psychiatric
Nursing, Philadelphia, Mosby pp 66-71
 Thank you very much and
have a nice day

SEE YOU THEN………….