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Module 01: Introduction to Mental Health Nursing

<h3>Introduction</h3>
Mental health is one of the largest concerns in medical science in the United Kingdom. The requirement of nurses for mental health is increasing day by day as community clinics are facing an increased number of mental health patients each year and coping with that, employing new nurses. Mental health nurses have played a central role in support of mental health services. Mental health can be seen as an unstable continuum, where an individual's mental health may have many different possible values. Mental wellness is generally viewed as a positive attribute, even if the person does not have any diagnosed mental health condition. Most of the definitions of mental health highlight emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Some discussions are formulated in terms of contentment or happiness. Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving mental wellness. Positive psychology is increasingly prominent in mental health. In this age, nurses need to know much more about their job and field than at any time before. In the UK, authorities are giving more priority to quality than numbers in mental health sector nowadays.

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<h3>Mental Health Nursing</h3>
Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Communities contain a wide range of resources that can be used to promote mental health, prevent mental health conditions and support care and recovery of people with mental health conditions. Good mental health is related to mental and psychological well-being. Psychiatrists and social organisations work to improve the mental health of individuals and society at large include the promotion of mental well-being, the prevention of mental disorders, the protection of human rights and the care of people affected by mental disorders. According to the WHO (World Health Organisation), mental health is a state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community.

Mental health nursing is the appointed position of a nurse that specialises in mental health and cares for people of all ages experiencing mental illnesses or distress. These include schizophrenia, schizoaffective disorder, mood disorders, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm. Mental health is a discipline of nursing with a distinct character which makes a specific contribution to the care of people with mental health problems. Nurses in this area receive specific training in psychological therapies, building a therapeutic alliance, dealing with challenging behaviour, and the administration of psychiatric medication. In most countries, a psychiatric nurse will have to attain a bachelor's degree in nursing to become a Registered Nurse (RN) and specialise in mental health. Degrees vary in different countries and are governed by country-specific regulations.

Poor mental health can affect day to day functioning, relationships, physical health, and the ability to enjoy life. All nurses have a responsibility to promote good mental health to prevent problems and to support patients who may have a mental illness. Mental health nurses work in a variety of settings and support and treat people who have been diagnosed with a mental illness. Just like in physical health, nurses can promote mental health by building good relationships with patients, encouraging healthy behaviours, and recognising and treating symptoms early.

Mental health nurses work as part of a team of professionals and medical staff that includes doctors, social workers, therapists and psychiatrists. They work in a range of settings, including hospitals and people's homes. They support people with issues ranging from anxiety and depression to personality and eating disorders or addiction to drugs or alcohol. Mental health nurses may specialise in working with a particular group, for example, young people or offenders.

Typical duties of the job include:
<ul>
 	<li style="font-weight: 400;">Assessing and planning nursing care requirements.</li>
 	<li style="font-weight: 400;">Organising workloads.</li>
 	<li style="font-weight: 400;">Visiting patients at home.</li>
 	<li style="font-weight: 400;">Building relationships with, reassuring, listening and talking to patients.</li>
 	<li style="font-weight: 400;">Combating stigma and helping patients and their families deal with it.</li>
 	<li style="font-weight: 400;">Administering medication.</li>
 	<li style="font-weight: 400;">Agreeing and reviewing care plans and monitoring progress</li>
 	<li style="font-weight: 400;">Giving advice and arranging support for patients, relatives and carers</li>
 	<li style="font-weight: 400;">Liaising with doctors, social workers and other professionals</li>
 	<li style="font-weight: 400;">Assessing treatment success at case conferences and meetings</li>
 	<li style="font-weight: 400;">Writing and updating patient records</li>
 	<li style="font-weight: 400;">Encouraging patients to take part in therapeutic activities such as art and role play</li>
</ul>
A mental health nurse working in a hospital could be based on a psychiatric intensive care unit, psychiatric ward, outpatients unit or specialist unit focused on a particular issue, such as eating disorders. Mental health problems might arise due to stress, loneliness, depression, anxiety, relationship problems, death of a loved one, suicidal thoughts, grief, addiction, self-harm, various mood disorders, or other mental illnesses of varying degrees, as well as learning disabilities. Therapists, psychiatrists, psychologists, social workers, nurse practitioners or physicians can help manage mental illness with treatments such as therapy, counselling, or medication.

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<h3>The Background to Modern Mental Health Nursing</h3>
For hundreds of years, until the late twentieth century, mental health care in the UK was provided in large inpatient institutions which were often isolated communities and remote from the rest of society. The early equivalent of modern mental health nurses was referred to as ‘keepers’, and their main role was to clean the institution, occupy the inmates and contain those who were acutely unwell or aggressive without any recognisable options for treatment.

After the 1845 Asylums Act, keepers were referred to as ‘attendants’. Poor working conditions, low wages, long hours, and often living as well as working in the institution meant that being an attendant was not a popular choice of job, having low status and no prospects. Due to the large staffing requirements within institutions and the difficult working conditions, attracting staff was a challenge. Throughout the institutional era and well into the 1970s, there were frequent scandals and reports of abuse of inmates by attendants and, later, nursing staff. These failings were commonly attributed to a lack of adequate training and preparation of mental health nursing staff and the employment of unsuitable individuals.

The institutionalised period of mental health nursing is often portrayed as unremittingly bleak. However, standards of care across the nation were variable, with good and bad practice, and it is even possible to trace comparisons with modern health care values and practice in some cases. Examples include employing people with mental health problems within the service – in many institutions, former inmates who had recovered were employed and adopted a humane approach to the care of the inmates. Married couples were often jointly employed and introduced an extended family approach to working with inmates. In the eighteenth century, William Battie recognised the need for staff to be carefully selected and trained and that a pleasant environment beneficially influenced mental health. At the same time, the work of Joseph Tuke at the York Retreat offered an approach which treated people with mental health problems with respect and dignity, and their mental health improved accordingly.

Yet, frustratingly for the attendants, the development of their role was severely limited as they were employed to assist in the delivery of a medically-led approach which dominated the running of the institution but which did not yield results. Instead, the actual day-to-day work of attendants was more consistent with social welfare provision as many inmates remained living indefinitely in the institutions, uncured and unwell, but removed from a society where they would be vulnerable.
<h3>The Development of Modern Mental Health Nurse Training</h3>
From 1845, when mental health staff first became known as ‘nurses’, with the term applied to female attendants until the introduction of the National Health Services (NHS) in 1947, adult or general nursing resisted the inclusion of mental health nurses on the professional nursing register. The eventual inclusion of mental health staff was largely due to organisational restructuring with mental health services transferred from the control of local authorities to being included within the newly created NHS. At present, a few projects such as project 2000 or Problem based learning (PBL) has got attention in the UK.

Recent Developments in Nurse Training

Mental health nursing emerged out of an essentially practice-based role. Traditionally, training occurred in the practice setting, and until the 1980s was based on the apprenticeship model, where students spent most of their training in the clinical setting. This model focused on gaining practical skills and technical competence as opposed to theoretical knowledge, and, although often fondly remembered for teaching nursing in an authentic work setting, a review of nurse education in the 1980s advocated the adoption of a radical new approach.

Project 2000

Project 2000 was introduced in the 1980s to increase recruitment and professionalism in nursing and adopted a North American model pioneered by Patricia Benner in 1984, which involved a much more academic approach and an emphasis on theoretical learning since 1986. While students still had placements in practice, in contrast with the apprenticeship model, they were not included as members of staff but were supernumerary, and a significant amount of time on the programme was devoted to theoretical study in the classroom.

With the enhanced academic focus of Project 2000, nurse training was transferred from local schools of nursing into universities and other higher education institutions (HEIs). Yet while Project 2000 produced skilled communicators with an awareness of research and the ability to adapt to change, feedback suggested there was a deficit of clinical skills and practical competence, and there were doubts over the competence and suitability of students for qualified practice on completion of the course. The transition of theoretical teaching into universities, with students spending more time involved in academic study, led to the accusation that there was insufficient exposure to the experience of people with mental health problems and the impact of mental illness on the individual.

Problem-based learning (PBL)

Reviews of Project 2000 called for an increased focus of nursing training on the acquisition of practice-based skills and knowledge. A new philosophy was adopted, known as problem-based learning (PBL) or inquiry-based learning (IBL) which has endured to the present day and seeks to bridge the gaps highlighted as a result of Project 2000. While still not returning students to the rostered workforce, the new model involves students learning proficiencies and technical competencies in ‘skills laboratories’ at university. Practice-based scenarios are included as part of theoretical study in order to integrate theory and practice on a 50:50 basis.

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Branches of Mental Health Nursing

Mental Health Nursing is very demanding work, physically and mentally. In most areas of nursing, mental health nurses are also expected to do shift work and take their turn in working weekends and on public holidays. Mental health problems can affect people of all ages and backgrounds. Patients' problems may be related to drug or alcohol use, childhood experiences or particularly stressful situations, for example, divorce or bereavement. Some have severe and enduring mental health conditions, such as schizophrenia or severe depression. Only in extreme cases are patients a danger to themselves and others. The mental health nurse plays a central role within a multidisciplinary team that normally includes medical and healthcare staff, social workers, psychologists and other therapists. They help patients control their mental health problems, cope better with life, and, where possible, recover. The main branches of mental health nursing can be listed as:
<ul>
 	<li style="font-weight: 400;">Child and Adolescent Mental Health: It deals with children and adolescents or young age people. People dealing with it needs to learn the basics of Child Psychology and mental ability or psychology of teenagers. Special care and ability to get close to these ages of people is must for the nurses. To discuss the theoretical framework of social constructivism and justify its appropriateness for and compatibility with an interpretive approach to child adolescent mental health (CAMH) nursing.</li>
 	<li style="font-weight: 400;">Adult Mental Health: Adult mental Health Nursing deals with adults who had developed a mental illness due to depression, frustration, excessive workload, social or family stress. For some people, mental health problems can be triggered by an event such as divorce, the death of someone close, birth, alcohol and drug abuse or changes in personal circumstances, including at work. Nurses working in this sector need to communicate with their patients as a friend and share their stigma to assess and treat them. Most of the adults in the UK are said to have at least some sort of mental health problem.</li>
 	<li style="font-weight: 400;">Mental Health of Disabled People: A physical disability is any physical condition that significantly impacts one or more major life activity. It is virtually limitless as to what a physical disability can be. An injury may constitute a disability to one person, but not another; it all depends on whether the injury impacts their daily life. For an injury to be considered a disability, it must impact mobility, work tolerance, self-care or communication. Some disabilities may affect all of these. These disabilities often create mental problems in the person. Nurses need to deal with these people and make them feel normal to treat them. Often the disability is not physical, but mental. Such as learning disability or autism.</li>
 	<li style="font-weight: 400;">Drug-Related Mental Problems: Chronic use of some drugs can lead to both short- and long-term changes in the brain, which can lead to mental health issues including paranoia, depression, anxiety, aggression, hallucinations, and other problems. Many people who are addicted to drugs are also diagnosed with other mental disorders and vice versa. Compared with the general population, people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true. When dealing with drug-related mental health problem nurses should have a wide range of knowledge about drugs and their effects. The main reason behind it is also important for the treatment.</li>
 	<li style="font-weight: 400;">Abuse Victims and High Profile Offenders: Those working with victims of sexual offenders and adults with mental health problems should be aware of the potential long-term psychological impact that sexual abuse has. Gender biases or myths about rape and assault should not cloud the judgement of those working with victims of sexual offenders. Those in positions where disclosure of sexual abuse to them is likely should ensure that victims should feel supported enough to disclose abuse and be believed when they do so in order to decrease the likely onset of negative long-term effects. In these types of cases, nurses should be extremely careful. Not only the offended but often the culprit also has mental health issues.</li>
</ul>
Community-based Mental Health Nursing: It deals with providing mental health support to any specific community or locality. Across the UK there is a range of specialist teams which support people in the community. Nurses can undertake further training and education to focus on a particular clinical area of mental health. Nurses need to work with children and adolescents, those with neurodevelopmental disorders, homeless people, mentally disordered offenders and older adults. Thus they need to learn to deal with every type of person in these cases. These kinds of facilities or teams often work in socially or economically backward communities. In the UK, immigrants from third world countries are the most common community that receive these kinds of services.

Introduction to Mental Health Nursing

General

Module 02: Mental Health over Life Span and Society

Mental Health over Life Span and Society

Module 03: Child Mental Health

<h3>Development of Child Mental Health</h3>
There are a few universally recognised stages of childhood, although these stages may have different names in different cultures. Children also go through stages of development in at least five different domains: neural, physical, social, emotional and cognitive. Studying cognitive development involves looking at cognition, the act or faculty of knowing, which includes logical reasoning, problem-solving and concept formation and that underlies the process of change in both cognitive and social development. There is evidence that children do benefit from both social interaction and direct instruction. There is also evidence that, in several areas, children internally modify existing schemes. Social and intellectual development cannot be studied independently of each other as social understanding holds the key to intellectual development. Nurses need to look after these factors to understand the mental health of a child.

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Physical health is a big part of mental health. That's because physical fitness helps your child stay healthy, have more energy, feel confident, manage stress and sleep well. Here are some ways to help your child stay physically fit and well: Offer healthy food and encourage healthy eating habits in your family.

 The emotional development of the child begins very early. It has been argued that babies are born with the ability to interact, and though the interaction may initially be regulated by an adult, infants gradually begin to instigate, as well as direct, social interchanges. Identical results across cultures suggest that there is a built-in withdrawal response to parental lack of communication. Some factors play an important role in developing the mental health of children. They may be listed as:

Social Interaction

 Social interaction in infancy is important and not only for attachment. Lack of positive interactions between infants and caregivers can lead to other negative long-term outcomes for the child.

Understanding Emotion

 By school age, children can refer to causes, consequences and behavioural signs of emotions and use social referencing to direct their behaviour. They know that unpleasant events cause anger/sadness. By the age of 6 or 7, children understand mixed feelings; they understand that people can experience two contradictory emotions at the same time. Which is feeling good and bad. The ability to see multiple, differing emotions is characteristic of the concrete operational stage. Emotional understanding develops through:
<ul>
 	<li>Interpreting emotions or social referencing.</li>
 	<li>Socialisation.</li>
 	<li>Social experiences, such as talking about feelings with parents and other adults.</li>
 	<li>Cognitive development.</li>
 	<li>The language which allows new ways of expressing and regulating feelings.</li>
</ul>
Culture and Emotional Expression

 Culture affects emotional expression and influences the way children express, manage and talk about emotions. Emotional socialisation is best illustrated in the cross-cultural study of display rules. Rules that specify when, where, and how it is culturally acceptable to display/express emotion by:
<ul>
 	<li>Setting limits to emotional expression.</li>
 	<li>Encouraging the expression of specific emotions.</li>
 	<li>Providing culture-specific norms for displaying emotions.</li>
</ul>
Emotional Regulation

 Emotional reactions and the ability to regulate these reactions depend on children’s interpretation of social contexts, understanding of display rules, and how well they understand the emotions and intentions of others. Socialisation and parental control have a huge impact on this and affect emotional regulation. Emotional regulation refers to the ability to modulate negative feelings. Not all children learn to regulate their emotions. Inadequate emotional regulation can lead to social and adjustment problems such as:
<ul>
 	<li>More frequent conflict with peers.</li>
 	<li>Less satisfying peer relationships.</li>
 	<li>Poor school adjustment.</li>
</ul>
 Pro-social behaviour such as sharing, helping, caregiving and compassion is learnt through explicit modelling by adults, as well as by adults explaining what acceptable behaviour is and why children should behave in a pro-social manner. This is called ‘emotional socialisation’. Socio-emotional competence is the ability to behave appropriately when strong emotions are aroused and require:
<ul>
 	<li>Awareness of own emotional state.</li>
 	<li>Awareness of the emotional state of others.</li>
 	<li>Capacity for empathy and sympathy.</li>
</ul>
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<h3>Family Development</h3>
 Family development is examined within a family therapy context. The difficulty in applying this model in practice is then discussed before briefly reviewing early theories on family development used by family therapists and how these ideas have evolved. As described earlier, child development is relatively well understood and has a sound evidence base and universal application. A pragmatic definition of what a family is would include everybody who is involved in meeting a child’s immediate emotional and developmental needs. It could include parents and their partners, siblings, grandparents and close friends. It is important to be guided by the family’s definition, so as not to impose your own values on clients. Family therapy grew out of the ideas developed by systems theorists in the 1940s and 1950s. The family was regarded as a system which had a range of self-regulating mechanisms governing its functioning, which in turn can be observed and influenced if necessary. The notion therefore that the family system would have a life cycle and hence its own developmental pathway was a natural extension of this theory, with attempts to define developmental milestones and common patterns through observation of families. Building upon existing ideas of individual life cycles, Haley described the family life cycle one might expect the ‘typical’ family to experience and the transitional challenges to its integrity it might have to face. This was expanded upon and developed as a therapeutic tool by Carter and McGoldrick (1989) and became a highly influential model in the field of family therapy. This model remains a useful aid when working with families to help them develop an understanding of their current dilemmas. The model proposed separate stages of family life through which a family passes during its development.

 A family’s development is shaped by wider contextual factors that are culture, ethnicity, class, gender, sexuality, as well as by their history, intergenerational patterns of behaviour and communication. An example of this is the difference between cultures regarding what is considered appropriate levels of intimacy, closeness and levels of dependency.
<h3>The Aetiology of Child Mental Health</h3>
 Risk factors for mental health problems among children can be broadly divided into biological, psychological or environmental, or any combination of these. However, although their mode of interaction remains unclear, risk factors rarely act in isolation. Single aetiological factors (whether they be biological, psychological or social) may play a major role or quite a minor one, dependent on the disorder and the context. Sometimes factors may not be relevant in the causation of problems or disorders but may be influential in maintaining a problem. Very often it is the interplay between the different factors that lead to the development of problems. Nurses need to outline each of these in turn, starting with individual risk factors before presenting a framework for thinking about specific environmental factors and finally considering the wider socio-political context. The interaction between genetics and the wider environment should also be considered. It is important to have an understanding of the aetiological factors that may play a part in the development of problems because some may be amenable to change, which will be relevant when it comes to treatment; some factors will be more easily managed or changed than others. Nursing training may often not cover aetiological factors relating to specific disorders, except as examples to illustrate specific points. But nurses must know that the factors that protect against mental health problems are often the opposite of those that cause such problems.

 Some of the risk factors inherent in the child are identified below:
<ul>
 	<li>Low IQ and learning disability.</li>
 	<li>Specific developmental delay.</li>
 	<li>Communication difficulty.</li>
 	<li>Difficult temperament.</li>
 	<li>Physical illness, especially chronic and/or neurological.</li>
 	<li>Academic failure.</li>
 	<li>Low self-esteem.</li>
</ul>
 The family is usually the place in which children spend their early years and is, therefore, a significant factor in the development of mental health problems. Risk factors in the family are:
<ul>
 	<li>Overt parental conflict.</li>
 	<li>Family breakdown.</li>
 	<li>Inconsistent or unclear discipline.</li>
 	<li>Hostile or rejecting relationships.</li>
 	<li>Failure to adapt to a child’s changing needs.</li>
 	<li>Physical, sexual and/or emotional abuse.</li>
 	<li>Parental psychiatric illness.</li>
 	<li>Parental criminality, alcoholism or personality disorder.</li>
 	<li>Death and loss, including loss of friendship.</li>
</ul>
 One also has to be aware of wider social and political contexts (such as war) that neither nurses nor families can influence. The factors below may also be less amenable to influence. Culture itself does not cause mental health problems. However, understanding cultural contexts may help nurses present issues in ways that are acceptable to families, thereby making them amenable to intervention. Risk factors in the community:
<ul>
 	<li>Socio-economic disadvantage.</li>
 	<li>Homelessness.</li>
 	<li>Disaster.</li>
 	<li>Discrimination.</li>
 	<li>Other significant life events.</li>
</ul>
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<h3>Child and Adolescent Mental Health (CAMH)</h3>
 CAMHS is used as a term for all services that work with children and young people who have difficulties with their emotional or behavioural wellbeing. Local areas have several different support services available. These might be from the statutory, voluntary or school-based sector, such as an NHS trust, local authority, school or charitable organisation. Children and young people may need help with a wide range of issues at different points in their lives. Parents and carers may also need help and advice to deal with behavioural or other problems their child is experiencing. Parents, carers and young people can receive direct support through CAMHS. Specialist CAMHS are NHS mental health services that focus on the needs of children and young people.

 They're multidisciplinary teams that often consist of:
<ul>
 	<li>Psychiatrists.</li>
 	<li>Psychologists.</li>
 	<li>Social workers.</li>
 	<li>Nurses.</li>
 	<li>Support workers.</li>
 	<li>Occupational therapists.</li>
 	<li>Psychological therapists, this may include child psychotherapists, family psychotherapists, play therapists and creative art therapists.</li>
 	<li>Primary mental health link workers.</li>
 	<li>Specialist substance misuse workers.</li>
</ul>
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<h3>Considerations and Nursing Assessments for Child Mental Health</h3>
There are a few factors that should be considered before working on child mental health. Some issues may give rise to problems for nursing. Issues that may give rise to problems are:
<ul>
 	<li>Pressures to conform to their family’s religion or other practices that do not sit comfortably with the young person.</li>
 	<li>Pressures to conform to expected gender roles (boys wanting to pursue careers generally considered to be in the female domain such as nursing and childcare, and vice versa).</li>
 	<li>Pressures to conform to social norms (e.g. the expectation that a young person will go on to further education despite this not being what they want).</li>
 	<li>Pressures to conform to family expectations that differ from what the young person wants (e.g. an expectation that the young person will work in the family business).</li>
 	<li>Sexual orientation.</li>
 	<li>Impending forced marriages.</li>
 	<li>Difficulty in reconciling the culture in the private and public domains.</li>
</ul>
The assessments must include a list of information. Key components of a comprehensive nursing child mental health assessment:
<ul>
 	<li>Presenting concerns and history of these.</li>
 	<li>Family history.</li>
 	<li>Social history.</li>
 	<li>Developmental history.</li>
 	<li>Integrating cultural issues.</li>
 	<li>Mental state examination of the child.</li>
 	<li>Risk assessment.</li>
 	<li>Formulation and agreeing with a care plan.</li>
</ul>
<h3>Therapeutics</h3>
Counselling remains an ambiguous and much-used term, with no single, consensually agreed definition to date. The term is also frequently used interchangeably with psychotherapy. Broadly, it involves an agreement between two parties to work together in trying to understand and resolve certain psychological difficulties held by one of them. However, a distinction needs to be made between the informed and informal use of such skills and the possession of accredited qualifications in psychotherapy and/or counselling. Therapeutic treatment is designed to treat an illness or to improve a person's health, rather than to prevent illness.

 An integral part of the therapeutic use of self is caring about what we are doing, i.e. being able to hold the clients in mind; creating the mental space with them to facilitate change and growth. Caring about what we are doing enables us to do it skillfully, i.e. to combine art and science. However, the therapeutic use of self is influenced by contextual factors, including external and organisational pressures, personal ‘life’ issues (e.g. illness in a family member), competence and confidence.

 A successful therapeutic relationship requires both the utilisation of skills and the therapeutic use of self. Skill employment and the therapeutic use of self require the mental space to be able to hold the client(s) in mind. From a psychodynamic perspective, attitudes which foster perceptiveness and therapeutic interaction include the practitioner’s attitude towards the client. An appropriate attitude includes:
<ul>
 	<li>Open-mindedness.</li>
 	<li>Curiosity.</li>
 	<li>Attending to verbal and non-verbal communication.</li>
 	<li>Listening and waiting.</li>
 	<li>Taking feelings seriously.</li>
 	<li>Understanding, holding and containing mental pain.</li>
</ul>

Child Mental Health

Module 04: Adolescent Mental Health

<h3>Considerations and Nursing Assessments in Adolescent Mental Health</h3>
There is no doubt that growing up can be an emotional rollercoaster for many young people, and it can be difficult for a parent or carer to identify when a child’s behaviour is related to a mental health condition, and when they may need specialist support. Youngsters can face a whole host of highs and lows during childhood and adolescence, as well as a wide range of unique pressures which can be related to school, friends, family, bullying, cyber-bullying, social media, peer pressure, sexuality and puberty. Young people may struggle emotionally and engage in unhealthy behaviours, and a proportion may go on to develop a persistent mental health problem such as anxiety, depression, stress and eating disorders.

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It is important to recognise that mental health difficulties don’t just affect adults; in fact, they are becoming increasingly common in children and young people. Recent studies suggest that nearly one in four young people will experience the symptoms of a mental health condition before they reach the age of 19.

It is crucial to address the needs of adolescents with defined mental health conditions. Avoiding institutionalisation and over-medicalisation, prioritising non-pharmacological approaches, and respecting the rights of children in line with the United Nations Convention on the Rights of the Child and other human rights instruments are key for adolescents.

Interventions for adolescents should consider:
<ul>
 	<li>The importance of early detection and provision of evidence-based interventions for mental and substance use disorders. WHO’s Mental Health Gap Action Programme (MHGAP) provides evidence-based guidelines for non-specialists to enable them to identify better and support priority mental health conditions in lower-resourced settings.</li>
 	<li>Transdiagnostic interventions. For example, those who target multiple mental health problems.</li>
 	<li>Delivery by supervised staff, who are trained in managing adolescents’ specific needs.</li>
 	<li>Engaging and empowering caregivers, where appropriate, and exploring adolescents’ preferences.</li>
 	<li>Face-to-face and guided self-help methods, including electronic mental health interventions. Due to stigma or the feasibility of accessing services, unguided self-help may be suitable for adolescents.</li>
 	<li>Psychotropic medication should be used with great caution and should only be offered to adolescents with moderate-severe mental health conditions when psychosocial interventions prove ineffective and when clinically indicated and with informed consent. The treatments should be provided under the supervision of a specialist and with close clinical monitoring for potential adverse effects.</li>
</ul>
Assessment of adolescent is almost the same as for a child. Key components of a comprehensive nursing Adolescent assessment:
<ul>
 	<li>Presenting concerns and history of these.</li>
 	<li>Family history.</li>
 	<li>Social history.</li>
 	<li>Developmental history.</li>
 	<li>Integrating cultural issues.</li>
 	<li>Observation of young people with their carers.</li>
 	<li>Risk assessment.</li>
</ul>
The Assessment Framework

It is useful to have an assessment framework, although the details may vary from service to service. There is little evidence or research regarding assessment processes in adolescent nursing (or even in other professional groups), although they have good face validity. Nurses will deal with some of these in some detail, while briefly highlighting other areas which are well described elsewhere in the nursing literature.
<ul>
 	<li>Presenting concerns: It is important to begin by clarifying what the child and/or their carers are expecting and what they know of the service. It is also important to establish their expectations and hopes for the meeting. Consent and confidentiality issues are best addressed early on. It can be helpful for the child to know that there are clear boundaries and that their perspective is as important as those of any adults. It is important also to find out what the child or young person and their family think are the main worries.</li>
 	<li>Family history: Establishing the family history involves identifying who is in the family and what constitutes the family from the adolescent’s perspective. A genogram can be a useful way to demonstrate family relationships. Depending on the presenting concerns and history, there may be a need to explore in greater detail how parents themselves were parented.</li>
 	<li>Social history: This usually means asking young people about their peer relationships and their interests. As children get older they begin to have more contacts outside of the family. This is a good opportunity to find out what is of interest to the patient in childhood and can be a good place to begin interviews as it helps engage with the adolescent. The older the patient the more important it is to ask about peer activities. Young people may be reluctant to share all aspects of this part of history with their carers. Drug and alcohol history is an important part of the social history, though again sensitivity may be required in getting honest answers from young people about their use of substances and alcohol.</li>
</ul>
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<h3>Factors of Adolescent Mental Health</h3>
Some vital factors play important roles in developing Adolescent mental health. They may be listed as:

Temperament

Individual temperament may make some young agers more vulnerable than others. Even children who have the same level of vulnerability may not experience the same environments or risks; so some, who are predisposed, go on to develop problems while others do not. It is impossible to change an adolescent’s basic temperament but therapeutic interventions can help them in both managing those aspects of their temperament that may cause problems and in reinforcing their strengths.

There are three broad categories of temperament: difficult/feisty; anxious/slow to warm up; easy. teenagers with positive temperamental features are more likely to interact positively with others. The warm responses evoked enhance self-esteem and self-efficacy. Interactions between adults and children who both have difficult temperaments often result in disruptive behaviour, especially where there is family conflict. Regardless of levels of family conflict, children with difficult temperaments are more likely to show disruptive behaviour.

Style of Attachment Relationship

Attachment refers to a specific type of biologically based relationship, which provides a secure base from which children can explore the world. Attachment relationships can be classified as either secure or insecure, with three types which are ambivalent, avoidant or disorganised; of insecure relationship identified. Attachment behaviour is operational from birth, designed to ensure survival by stimulating caregiving behaviour from a parent/carer. It is subsequently triggered by separation, or threatened separation, from the attachment figure. Repeated experience of interactions and quality of care received a result in the construction of an internal working model (IWM) of relationships from which generalised expectations are made.

Gender

There are several theories of gender development. Nurses experience tends to find that girls are more likely to present with emotional disorders (and self-harm, after adolescence) and boys with behavioural problems. It is unclear whether social expectations or genetics make girls more likely to internalise their problems and boys to express distress through externalising behaviours. Boys have a higher prevalence rate for most neurodevelopmental disorders such as autistic spectrum disorder or ASD. Eating disorders are generally much more common in girls.

The Family

The family is usually the context in which children spend their early years, and is, therefore, a significant factor in the development of mental health problems. The family may be a risk factor in those children from large families are at greater risk, as are children from poorer families. Nevertheless, healthy development is possible within several different family structures. Research on non-traditional families shows healthy development in a variety of family types.

Parenting Styles

Parenting can be classified on a number of dimensions, including warmth, sensitivity, directiveness and punitiveness. However, there are two dimensions of parenting which are demanding and responsive. Combinations of these led to the identification of three styles of parenting which are authoritative, authoritarian and permissive.

Authoritative parents are high in control and responsiveness, valuing compliance and setting behavioural standards while respecting the child’s developing autonomy and independence. They expect developmental and age-appropriate behaviour. Children of authoritative parents are the most competent, being more self-reliant, content, socially responsible, self-controlled and cooperative.

Authoritarian parents are low on responsiveness and high on demand/control. They set standards of behaviour demanding unrealistic levels of maturity. Obedience is valued, and the adolescent’s autonomy and independence restricted. Punitive measures of control are preferred. Children tend to be surly, defiant, dependent and socially incompetent (especially boys). Permissive parents are high on responsiveness, but low on control, tolerating more immature behaviour than other styles. They do not set consistent standards for the child’s behaviour.

Permissive neglectful parents provide no real care or supervision. There is little response by parents to teenager’s needs (emotional or otherwise), and little is demanded of children, resulting in young people who may not have any behavioural boundaries.

Abuse

Abuse within the family context can lead to several problems. In younger adolescent’s it may be expressed as behavioural problems. Early experiences of physical, sexual abuse and/or parental neglect are risk factors for depression and suicidal behaviour in adolescents.

Parental Illness

Parental illness impacts directly on family dynamics and parental styles. A parent who is ill may be inconsistent in their parental style. Additionally, children may have to take on more family responsibilities. Children who are carers have different social, emotional and psychological needs than children of healthy parents and can often feel isolated and lonely. It may be difficult for these children to form stable peer relationships as they have less time to ‘hang around’ and are not able to go out as much as other children.

The School Environment

Children and adolescents spend a great deal of time in schools, and the school environment can significantly impact on their mental health. It has long been established that there are certain types of schools that are associated with fewer mental health problems. Over the last decade, there has been an increasing political emphasis on giving British schools responsibility for mental health promotion. There has also been a significant amount of investment in promoting mental health in schools. The impact of such interventions has yet to be seen.

Socioeconomic Disadvantage

Poverty and socio-economic disadvantage are strongly correlated with the development of mental health problems in both children and adults. Sometimes it is assumed that the risk is genetic, whereas the environment may be the key risk factor. Poverty may compromise parenting resources, bringing with it unstable and fragmented communities. In terms of the macrosystem, one of the most pernicious factors that impact on children and families in poverty.

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Working with Families

It is probably more effective to have a principle-based approach to ensure that cultural issues are taken on board for all families. There are several reasons for this:
<ul>
 	<li>Prevents facts relevant to one individual being assumed to be relevant to others who may appear to be from a similar background.</li>
 	<li>Should prevent stereotyping of any groups.</li>
 	<li>Enables the provider to provide quality care irrespective of which factor diversity may be related to.</li>
 	<li>Works with the central philosophy that young people and their families all bring perspectives which need to be taken into account.</li>
</ul>
When working with families in a way which respects their cultural perspectives but also allows you to work within your professional expectations, the following approaches may be helpful.
<ul>
 	<li>Reflect on your own biases and prejudices to ensure that these do not consciously or subconsciously justify less than quality or equal care for all patients.</li>
 	<li>As many factors influence a family’s understanding of mental health and mental health services, at the outset of any assessment check the family’s understanding of what they think is going to happen.</li>
 	<li>Be aware that the family may play out expected roles and it may take a lot of encouragement to ensure that all perspectives are heard.</li>
 	<li>Don’t be afraid of asking if you are not sure – ask respectfully without judgement.</li>
 	<li>Don’t be intimidated into avoiding difficult questions just because someone is from a visibly different background. It is worth remembering that all young people have an equal right in the UK to be heard and valued.</li>
 	<li>Don’t assume that because the last family from a similar background believed that mental illness is caused by spirits, for example, so will this family. There may be different factors at play.</li>
 	<li>If there are a number of treatment options, don’t assume what the family will choose. Discuss all the options and ensure the family are able to make an informed choice. Different families will need different levels of explanation and time.</li>
</ul>
Working with family includes a list of procedures. Nurses need to remember them when dealing with the family.

Engagement

The beginning and initial phase of any family work need careful thought and preparation. It sets the scene for future work and influences the family’s attendance at any subsequent sessions. It is usually complicated by having to take several people’s needs and perspectives into consideration.

Preparation

The preparation starts with the method of invitation to the family work. This is usually by letter but can be arranged in another venue or over the telephone. The invitation is usually addressed to the main carers of the family as they will have to facilitate any attendance. This initial contact should include a clear explanation of what to expect and a brief explanation of the rationale for working with the family. It is probably best not to go into too much detail at this point as any questions can be explored more thoroughly at the meeting and with everyone who attends.

Gaining the Family’s Confidence

At the outset, the nurse needs to project an air of confidence and familiarity with the process to contain any anxieties or ambivalence the family might be experiencing. It is important to remember that in this context the nurse is on familiar territory and is probably meeting with families regularly, whereas the family may be facing an entirely new experience. Equally, as the aim is to work collaboratively with the family, it is essential that they retain a sense of being expert on their own predicament.

Introductions and Explanations

Starting with introductions is an obvious point but this can be a good opportunity to enhance the engagement. One technique is to ask one of the younger members of the family or the referred young person to introduce their family. It is vital to pay close attention to the names and style of address – for instance, that paternal grandmother is called ‘Nana’, as this helps prevent a family feel they are ‘just another case’. A good opening question is to ask everybody at the meeting – including the nurse – to describe their understanding of why they have been asked to meet. If each individual is given a chance to speak this can be quite a long process, but it serves to clarify expectations and models a respectful style of talking in the session.

Summarising the Process

Finally, it can be helpful to end the initial session with a brief reflection on the process so far; has it met their expectations? Would they like a further session? What do they think it will be useful to address next time? Has anything been said that needs further clarification?

Adolescent Mental Health

Module 05: Adult Mental Health

Adult Mental Health

Module 06: Planning and Implementation

Planning and Implementation

Module 07: Mental Health Nursing Models

<h3>The Interpersonal Model</h3>
The interpersonal model is concerned with the growth of the service user. The model is based on the idea that people have needs which can be physical, for example, food and somewhere to live and psychological and emotional, such as feeling valued by others and engaging in rewarding social relationships. In order for a person to experience a rewarding and enjoyable life, it is necessary that they achieve satisfaction in all these areas.

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The model regards the purpose of nursing as, firstly, to ensure the survival of the service user and to act as an agent of change through using interpersonal skills to achieve a therapeutic goal. Secondly, the nurse should assist the service user to understand their mental health problems and work through their experiences in a creative and innovative way. In this sense, mental illness is an experience within life and something from which the person can learn just as we can learn from any other event. The interpersonal model consists of the following steps: 

Orientation

It is suggested that service takers seek help either because they experience a ‘felt need’ or have expectations that health services can help in a particular way. Information is collected, and the service user and nurse together identify the nature of the problem. It is important to remember that this stage of the model is much more than ‘history-taking’ and represents the beginning of the nurse working therapeutically with the service user. Orientation can be very brief or prolonged depending on the needs of the patients.

Identification

In identification, the relationship between the service user and nurse develops to form an agreement on the appropriate interventions to meet the service user’s needs. The nurse is identified as responsible for the care plan, and the goals perceived by the nurse and service user might vary, as often there is a difference between what we want and what we need. Hence it is necessary to achieve a compromise where the service user and nurse agree on the prioritised needs.

Exploitation

At this stage, there is an agreement over the care plan and the interpersonal relationship functions towards achieving the mutually agreed goals of care. However, the nurse’s function can be variable, ranging from the counsellor, resource or teacher to technical expert and leader.

Evaluation

The interpersonal relationship is ended once the agreed goals have been achieved. The nurse evaluates the process to ascertain what can be learned and the new knowledge which has been gained, while the service user is no longer in need of the service. The interpersonal model is characterised by a focus on the service user’s problems, and the stages can be flexible in duration. In applying the model, another interpretation has been used which has the acronym SOAP. SOAP may be described as:
<ul>
 	<li style="font-weight: 400;">S: is the service user’s subjective experience, often described in his or her own terms, or using direct quotes.</li>
 	<li style="font-weight: 400;">O: is the objective perceptions of the nurse on how the problem affects the service user.</li>
 	<li style="font-weight: 400;">A: is the assessment of the nurse combining the subjective (S) and objective (O) data in viewing the problem.</li>
 	<li style="font-weight: 400;">P: is the plan resulting from the identification of the problems and the combination of the subjective (S) view of the service user, the objective perception of the nurse (O) and the assessment (A).</li>
</ul>
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<h3>The Tidal Model</h3>
Probably the most prominent model in modern mental health nursing is Phil Barker’s tidal model which functions on the premise that people are defined by their experience. The tidal model was developed within a practice-based setting and has enjoyed enduring success and popularity. The model connects human experience with the metaphor of water and tides, both of which are changeable and fluid. While our experiences appear to have boundaries which impose finite limits on us, as we progress towards the ‘horizon’, our own perception of our limitations and boundaries shifts. The comparison with the horizon invokes, on the one hand, the unlimited nature of personal experience, yet simultaneously the notion of our self-imposed illusory boundaries. The tidal model proceeds from four core assumptions.

Assumptions of the tidal model:
<ul>
 	<li style="font-weight: 400;">Mental health nursing relates to the person’s future development, as opposed to the origins of distress, and interpersonally involves the nurse and service user. Barker and Buchannan-Barker emphasise the purpose of nursing as focusing on working with the person’s immediate needs in the present, as opposed to seeking to identify the origins of the problem. However, this does not dismiss the importance of the person’s past, and in fact it is acknowledged that this has a significant influence; however, the model prioritises the person before us in their present condition.</li>
 	<li style="font-weight: 400;">Only the person undergoing mental distress accurately experiences the problem. Mental illness is often assessed through the person’s observable behaviour and the assumptions of health care professionals about what it means, yet this does not necessarily yield a true picture of the nature and extent of what the person is experiencing.</li>
 	<li style="font-weight: 400;">The correct function of nursing is for the practitioner to help the person rediscover their life through reconciling their past and present and realising future opportunities through working collaboratively in an interpersonal relationship.</li>
 	<li style="font-weight: 400;">Mental illness is experienced as a disturbance of living and the activity and focus of the mental health nurse, probably uniquely among other branches of nursing, are on the person’s relationship with what is defined as mental health and illness.</li>
</ul>
Implementation of the tidal model:
<ul>
 	<li style="font-weight: 400;">Curiosity: the mental health nurse aims to find out about what the person thinks, feels and knows about themselves.</li>
 	<li style="font-weight: 400;">Resourcefulness: the mental health nurse aims to identify a person’s positive coping mechanisms.</li>
 	<li style="font-weight: 400;">Empowering the person: by working on the need the person prioritises at that time and working with them in collaboration.</li>
 	<li style="font-weight: 400;">Viewing the crisis as an opportunity: to allow the person to radically redirect their life, goals and priorities.</li>
 	<li style="font-weight: 400;">Setting small-scale: achievable goals.</li>
 	<li style="font-weight: 400;">Identifying the simplest actions: to generate change for the person.</li>
</ul>
<h3>The Recovery Model</h3>
The role of the mental health nurse and other multidisciplinary health care professionals in secure and forensic services is extremely important in supporting the person to retain a sense of hope and identity in often challenging circumstances. The philosophy that provides a guide on how we can practice in accordance with this goal is the recovery model. The idea of recovery can be summarised as optimism about the future and it is well described in the following three statements:
<ul>
 	<li style="font-weight: 400;">A person with a mental illness can experience recovery in spite of their illness not being cured.</li>
 	<li style="font-weight: 400;">Recovery is a way of living and a person with a mental health problem can still have a satisfying and hopeful life, and contribute meaningfully to society, even with the limitations caused by illness.</li>
 	<li style="font-weight: 400;">Recovery involves the development of new meaning and purpose in a person’s life which extends beyond the catastrophic effects of mental illness.</li>
</ul>
These statements represent a set of principles with a focus on:
<ul>
 	<li style="font-weight: 400;">Holistic assessment of the needs of the person experiencing severe mental illness.</li>
 	<li style="font-weight: 400;">Awareness of the person’s strengths, social, spiritual and cultural environment.</li>
 	<li style="font-weight: 400;">A determination to work with the individual to achieve the best possible clinical and social outcomes which are set by the person experiencing the illness.</li>
</ul>
To move beyond words and implement this approach in practice as professionals, we need to:
<ul>
 	<li style="font-weight: 400;">Work collaboratively in partnership with people and/or carers to identify realistic life goals and enable them to be reached.</li>
 	<li style="font-weight: 400;">Genuinely promote social inclusion in whatever way we can and however small these interventions might seem.</li>
 	<li style="font-weight: 400;">Be optimistic about the possibility of positive individual change.</li>
</ul>
Six categories of nurse-patient interactions have been identified concerning verbal and social interaction in the nurse-patient relationship. These are:
<ul>
 	<li style="font-weight: 400;">Building and sustaining relationships.</li>
 	<li style="font-weight: 400;">Supportive/encouraging relationships.</li>
 	<li style="font-weight: 400;">Social skills training.</li>
 	<li style="font-weight: 400;">Reality orientation.</li>
 	<li style="font-weight: 400;">Reflective interactions.</li>
 	<li style="font-weight: 400;">Practical skills training.</li>
</ul>
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<h3>The Ten Essential Shared Capabilities</h3>
Nurses working or studying mental health should be well aware about The Ten Essential Shared Capabilities or 10 ESC and their impact on our understanding of the practice of mental health nursing now. While the specific implementation of the 10 ESC is discussed in short in this text depth, it must be considered how nurses found that learning about the 10 ESC has enhanced their emerging development as future mental health nurses. The 10 Essential Shared Capabilities are:
<ul>
 	<li style="font-weight: 400;">Working in partnership.</li>
 	<li style="font-weight: 400;">Respecting diversity.</li>
 	<li style="font-weight: 400;">Practising ethically.</li>
 	<li style="font-weight: 400;">Challenging inequality.</li>
 	<li style="font-weight: 400;">Promoting recovery.</li>
 	<li style="font-weight: 400;">Identifying people’s needs and strengths.</li>
 	<li style="font-weight: 400;">Providing service user-centred care.</li>
 	<li style="font-weight: 400;">Making a difference.</li>
 	<li style="font-weight: 400;">Promoting safety and positive risk.</li>
 	<li style="font-weight: 400;">Personal development and learning.</li>
</ul>
Central to carrying out the 10 ESC in practice is ensuring you have incorporated their real meaning into your personal and professional values. Yet there is evidence to suggest that these principles have been slow to filter through into practice. Repeatedly students have identified that there is limited awareness of the 10 ESC in practice areas among qualified staff and mentors. Among the reasons suggested for this was: ‘The lack of information that current mental health professionals have of the 10 ESC; the pressures of having other priorities such as practice documents and reports due’.

However, it is frequently stated that the 10 ESC is an expectation of good clinical practice, in that, because trainee nurses are finding them helpful, they can be expected to have a beneficial influence as new staff join the profession. In reflecting on learning about the 10 ESC in pre-registration training, one student mental health nurse remarked: ‘They are values that we apply every day, but the 10 ESC give a platform to refer to. I discovered that the 10 ESC are within the CPA policy and I have been able to use this to apply the values to practice.’ Another student remarked: ‘I believe as a student nurse, I contribute to making a difference by going the extra length to treat patients with dignity, especially attending to personal care. Taking a genuine interest helped me to build trust with the patients.’ The values of the 10 ESC are, therefore, not only evident in the student’s beliefs but implemented in actions and interventions with service users who are appropriate to their needs.

Central to the 10 ESC, making a genuine impact on improving practice are positive changes to that practice and the way in which students understand their role. Often these changes are only slight or subtle, yet they have a significant effect on the service users who receive the care. There are a number of examples of instances where student mental health nurses reported that an awareness of the 10 ESC made a positive impact on a practice situation.
<h3>Diathesis-Stress Model</h3>
The diathesis, or predisposition, interacts with the individual's subsequent stress response. Stress is a life event or series of events that disrupt a person's psychological equilibrium and may catalyse the development of a disorder. Thus the diathesis-stress model serves to explore how biological or genetic traits interact with environmental influences to produce disorders such as depression, anxiety, or schizophrenia.

The diathesis-stress model asserts that if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder. A popular explanation for the aetiology of depression is the diathesis-stress model. Initially developed to explain the origins of schizophrenia in the 1960s, and adapted for the study of depression in the 1980s, this model states that stress may activate a diathesis or vulnerability, transforming the potential of predisposition into the actuality of psychopathology. The model proposes that there is a synergism between the diathesis and stress that yields an effect beyond their combined separate effects into depressive symptomatology and thus, the effects of stress on the depression risk are dependent on the diathesis. Implicit in this theory is that there will be not only additive but multiplicative interactive effects on the liability scale.

Mental Health Nursing Models

Module 08: Mental Health in the Digital Age-Part 1

<h3>Overview of Mental Health in the Digital Age</h3>
As we know that, Mental Health is defined by the World Health Organisation (WHO) as, “a state of well-being in which an individual can realise his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community”. Indicators of mental health include perceived life satisfaction, generally positive emotions, optimism, purpose in life, healthy relationships with others, and self-acceptance. Mental health is the optimal psychological state, and attaining that state is a putative goal for people everywhere. It is part of overall health and is influenced by genetic, biological, and environmental factors. On the other hand, mental illness is a serious public health problem around the world, with about 450 million people having a mental health disorder.

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Anxiety and depression are the most common disorders. About 25% of adults in the US and the United Kingdom (UK) will experience a mental illness in a given year. In the UK, the Organisation for Economic Co-operation and Development (OECD) estimates that the cost of mental health problems is about £70 billion per year. In addition to the economic impact, there are other negative consequences. In the WHO European region, about 25–35% of the population has a mental disorder in a given year.

Although rates of mental illness vary depending on the disorders included and the source of data, there is no doubt that these disorders affect significant numbers of people, negatively impact their quality of life, and involve losses to society at large. We now live in a world that is saturated by digital technology. The changes that have come about as a result of this technology have been described and researched all over the world.

The World Wide Web was introduced in the 1990s and by the end of that decade had become part of life for a significant portion of the population. In the 2000s, computers became faster and smaller, mobile phones were commonplace, and many people in the developed world began to rely on this technology to navigate their daily lives. In the current decade, the 2010s, we have smartphones and tablets and cloud computing, all of which put the Internet at our fingertips.

There are those who would draw a connection between the risks inherent in the new technologies and increases in mental health problems, but to our knowledge, such a connection is not supported by data. As with earlier innovations (telephones, television), the novelty evokes fears, and the media sometimes inflames these fears with coverage of extreme cases of harmful consequences of technology use. In reality, there are both risks and benefits to digital technology, and we believe that the benefits far outweigh the risks. Nevertheless, it is important to understand the intersection of mental health and digital technology in order to make informed decisions about the many options available in cyberspace.

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<h3>Mental Health on the Internet: Opportunity</h3>
The explosion of Internet content relevant to mental health means there are many and varied avenues to obtaining information online about mental health topics. The Internet is always available and has copious amounts of information which can be located easily, anonymously, and generally without cost. Accessibility to the Internet has increased so much that most people in developed countries have either a personal device with Internet connectivity or free access via computers in public spaces, such as a local library. In addition to information, there are online groups that purport to provide help and support to those with particular mental disorders.

Self-diagnosis Online

People with mental health problems (like those with physical health problems) may seek to diagnose their problem using online resources. This is appealing because one does not have to wait for an appointment, talk about embarrassing symptoms to a physician in the room, or pay a fee to self-diagnose.

To determine the viability of online screening for depression, researchers adapted a well-known depression screening measure to an online format and made it available to visitors to a consumer health information site with a mental health area. Over the eight months of the test, 24,479 persons completed the measure, more than half of whom met the cut-off score for depression. Less than half of those who were positive for depression had received any treatment for the disorder prior to taking the measure; 58% indicated that they thought treatment would be helpful, and similar percentages expressed a preference for counselling and medication in the follow-up survey.

Internet Support Groups: Helpful

Online support groups extend to cyberspace a format that has been effective in the face-to-face context. The therapeutic factors identified for therapy groups also apply to support groups (which may not have a professional leader), and studies have determined that these factors operate in online groups just as they do in traditional ones:
<ul>
 	<li style="font-weight: 400;">The support group helps members see that they are not alone in their troubles, that others have similar problems and often experience similar feelings.</li>
 	<li style="font-weight: 400;">Hearing from others who have made significant progress can still hope in those just beginning to face a problem.</li>
 	<li style="font-weight: 400;">The need to belong is a basic human drive, and support groups foster a sense of trust and belonging among members.</li>
 	<li style="font-weight: 400;">In a support group, members may offer support or advice that is helpful and appreciated by others, which in turn boosts the self-esteem of that member.</li>
</ul>
<ul>
 	<li style="font-weight: 400;">Emotions, even those long stifled, may find a safe place for expression in support groups, releasing the pressure and energy used to keep them under control.</li>
</ul>
<ul>
 	<li style="font-weight: 400;">Finally, members receive information and education about the problem in the group, and also have an opportunity to receive feedback from others in an honest manner.</li>
</ul>
In addition to having similar therapeutic factors, online groups appear to exhibit similar dynamics and processes as in face-to-face groups. The online environment in synchronous groups also demonstrates the unique effects of that platform, with earlier and greater self-disclosure, often leading to more rapid development of cohesion among members. Online groups can be particularly valuable for those who have mobility problems or who reside in isolated areas, where attending a face-to-face meeting may require time and resources (such as transportation) that are absent. Others may have low-incidence mental disorders so that finding a group of others with similar concerns in a local area is unlikely. In addition, some online groups are available 24/7 and include members from around the world, allowing members to find support in times of crisis.

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<h3>Mental Health on the Internet: Danger</h3>
It is important to remember that the Internet is not a refereed medium. There are no editors or external reviewers who evaluate the content to determine whether it should be published (or posted). Thus, anyone with the basic skills necessary to create and maintain a website can post information; the accuracy and quality of that information are not guaranteed.

Wrong Diagnose

People often try to do their self-diagnose on the internet as it is cheap and easy. But this can be a big mistake if the site or process is not perfect. This condition occurs when symptoms are interpreted to be evidence of a disorder when in fact, they are common symptoms that may not indicate a disorder at all. An analogy in physical medicine is the self-diagnosis of a brain tumour based on a headache. Although brain tumours are quite rare, 25% of sites that resulted from a search for “headache” gave a brain tumour as a potential cause. Such information is likely to provoke unnecessary alarm. In mental health, most people experience anxiety at times, but it is also a symptom of serious disorders. Without contextual information, for example, a complete history, it is unwise to form a diagnostic opinion based on limited information.

There is no shortage of online tests to diagnose a wide range of mental health problems, from mood disorders to personality disorders. Published tests used by trained mental health professionals are subjected to careful testing to determine reliability (consistency of scores) and validity (how accurately the test measures what it purports to measure), and most companies that sell these tests require evidence of the proper training of the clinician who intends to use them. On the other hand, self-tests might not be reliable or valid, but users may assume the results are accurate and may become more concerned than the reality warrants.

Quality of Mental Health Information Online

There is a large quantity of mental health information online. But one can not assure that all of it is of good quality. The design and accessibility of websites vary, with some being more text-based, and others integrating audio and video. Some are more easily navigated than others. This is to say, for a person seeking information, there is likely to be a site that will appear in their preferred format. This also means the person may have to check numerous sites before finding one that is suitable for their needs and preferences.

Some persons find reading personal accounts from those who experience a disorder to be valuable, as these may present a perspective that is lacking in more factual sites. Sometimes these personal accounts offer suggestions for managing the disorder based on the individual’s experience. Authors of such accounts believe they are using their experience in the service of others. These motives for posting personal accounts are understandable; readers must keep in mind that each person with a disorder is unique, and while someone else’s experience may be enlightening, it may also be dissimilar in ways that are important.

One way to evaluate potential bias on a mental health website is to see if products or services are being promoted or sold. If they are, the information may be selective; it may include only information that supports the positions/approaches being marketed. For information posted by individuals, often those who have or have had a disorder, keeping the potential bias of the author in mind is wise. An individual may post his/her own story, or a chronicle of his/her own experience with the disorder, with the ostensible goal of helping others by providing an example. Whether intentional or not, such postings are also ways to obtain attention or validation, and the material may include or exclude relevant details. The user of such information should approach it with an understanding that these accounts may be more helpful to the author than to the reader. There are few mental disorders for which there is only one road to recovery; those who have been helped may believe their own path is the map for others.

In the field of mental health, new studies are being published constantly, and new insights or information are being added. This means an online source of information should be current. It is prudent to use the most current information.

Internet Support Groups: Toxic

Online support groups are recently gaining popularity among people. But it’s dangers can not be ignored. Often support groups increase problems. In many cases, the lack of effective communication skills contributes to exacerbating the presenting problem. It increases depression or anger among patients. It can be noticed that in an online environment, people often disregard societal norms about appropriate disclosure. In an online group, this can have mixed effects. A participant who finds the anonymity to be freeing may choose to disclose more personal information than would be the case in a face-to-face group.

Sharing too much too soon in a group can generate feelings of vulnerability, which may then result in the person pulling back from group interactions. When a person reveals significant personal content, he or she may hope for something from the group that is not provided (e.g., sympathy, concern, empathy); the disappointment can discourage further participation. On the other hand, group members may be overly harsh or judgmental in their feedback to others as a result of the online disinhibition phenomenon. If the group is professionally led, these dynamics will be processed, and members will be helped to understand and learn from their own and others’ behaviour. In an online support group that is leaderless or peer-led, the skills to manage these situations may be absent, increasing the potential for significant psychological harm.

There are some groups that actively promote what most consider to be disordered behaviour, and they are termed as toxic groups. It is essential that readers are aware that individuals with these views might choose to join more traditional groups to “recruit” members for their own agendas. Leaderless groups could be more vulnerable to such strategies; we hope that professional leaders would be alert to this possibility and quickly intervene if such behaviour emerges.

Although any group has the potential to be damaging to particular individuals, this section focuses on groups that are considered problematic by most “reasonable person” standards. We refer here primarily to groups that promote self-harm including deliberate self-injury, eating disordered behaviours and suicide, difficulties expressing psychological pain, and a desire to alter one’s present (unpleasant) psychological state. Many persons who engage in these behaviours report a sense of release of tension and anxiety following a self-injurious behaviour.
<h3>Research and Ethics in the Digital Age</h3>
Online interactions with others were no more than a form of fantasy ultimately meant that we gave license to those who questioned or even dismissed the potential harm caused by a confrontational or abusive exchange, or downplayed another’s hostile intentions, because he or she was, to all intents and purposes, without physical form.

However, advances in technology, the ability to post and send images, to share videos and movies, and the emergence of social networking sites and applications have all brought the offline and online worlds closer together or, more likely, transcended any boundaries that once existed. Through social media, we present ourselves to the outside world in a way in which we feel comfortable. Our online personas may, at times, be idealised versions of ourselves, without the imperfections and confusions that arise in daily life, but they are personas in which we invest and in which we hope others will invest by “linking”, “following”, or “befriending” us.

Online interactions have meaning and researcher should not underestimate the emotional power of that meaning or assume that the online environment is understood only in terms of fantasy or fiction. The questions arise as: what does this mean for those of us who conduct research online? How might sampling be affected by our use of online forums to recruit participants? How do we support those who participate in our studies remotely? Do we consider the impact our questions might have upon an individual? Is informed consent enough to make a study ethical?

Ultimately, many of the ethical questions posed here were, and are, just as valid in conducting postal or telephone surveys. However, in one recent article, researchers argued that, for their qualitative study of one minority group, online recruitment offered a more heterogeneous sample than more traditional forms of recruitment, where there had been a reliance upon support from organisations that provided services for those most in need.

While recruitment and representativeness are perennial problems in all social research, perhaps the issue that most significantly affect the ethics of online research relates to the types of questions we ask. The increasing availability of standardised measures for use in online research presents challenges for the ethical researcher. Firstly, who has access to the data generated by the study, and the standardised measure particularly? Secondly, is it appropriate to ask questions remotely that were originally part of a clinical interview or that were administered by qualified professionals who met their participants? In answer to the first question, data generated from publicly funded research grants ultimately belong to the public, though it may be anonymised or redacted. Additionally, some standardised questionnaires or instruments are scored by the copyright holders (commercial companies) rather than the researchers, who receive a file with the relevant data. Copyright holders may also ask for the raw data to enhance their own assessments of the reliability and validity of their questionnaire or instrument (thus enhancing its marketability).

The issue of informed consent in online research needs to be examined. Just as in offline research, studies often attract those who identify with the content, and thus extreme experiences can be over-represented.

Mental Health in the Digital Age-Part 1

Module 09: Mental Health in the Digital Age-Part 2

Mental Health in the Digital Age-Part 2

Module 10: Common Mental Disorders-Part 1

Common Mental Disorders-Part 1

Module 11: Common Mental Disorders-Part 2

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<h3>Obsessive-compulsive Disorder</h3>
Obsessive-compulsive disorder or OCD has two main parts: obsessions and compulsions.

Obsessions are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind. They can make you feel very anxious, although some people describe it as 'mental discomfort' rather than anxiety.

Compulsions are repetitive activities that you do to reduce the anxiety caused by the obsession. It could be something like repeatedly checking a door is locked, repeating a specific phrase in your head or checking how your body feels. Symptoms of OCD are shown in the tables below:

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Some theories suggest that OCD is caused by personal experience. For example:
<ul>
 	<li style="font-weight: 400;">If you've had a painful childhood experience, or suffered trauma, abuse or bullying, you might learn to use obsessions and compulsions to cope with anxiety.</li>
 	<li style="font-weight: 400;">If your parents had similar anxieties and showed similar kinds of compulsive behaviour, you may have learned OCD behaviours as a coping technique.</li>
 	<li style="font-weight: 400;">On-going anxiety or stress, or being part of a stressful event like a car accident or starting a new job, could trigger OCD or make it worse.</li>
 	<li style="font-weight: 400;">Pregnancy or giving birth can sometimes trigger perinatal OCD.</li>
</ul>
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<h3>Personality Disorders</h3>
Personality disorders are a type of mental health problem where your attitudes, beliefs and behaviours cause you longstanding problems in your life. The word ‘personality’ refers to the pattern of thoughts, feelings and behaviour that makes each of us the individuals that we are. We don't always think, feel and behave in exactly the same way; it depends on the situation we are in, the people with us and many other things. However, if you have a personality disorder, you may often experience difficulties in how you think about yourself and others. And you may find it difficult to change these unwanted patterns.

You might be given a diagnosis of personality disorder if all three of these apply:
<ul>
 	<li style="font-weight: 400;">The way you think, feel and behave causes you or other significant problems in daily life. For example, you may feel unable to trust others or you may often feel abandoned, causing you or others unhappiness.</li>
 	<li style="font-weight: 400;">The way you think, feel and behave causes significant problems across different aspects of your life. You may struggle to start or keep friendships, to control your feelings and behaviour or get on with people at work, for example.</li>
 	<li style="font-weight: 400;">These problems continue for a long time. These difficult patterns may have started when you were a child or teenager and can carry on into your life as an adult.</li>
</ul>
Psychiatrists tend to use a system of diagnosis which identifies 10 types of personality disorder:
<ul>
 	<li style="font-weight: 400;">Paranoid personality disorder.</li>
 	<li style="font-weight: 400;">Schizoid personality disorder.</li>
 	<li style="font-weight: 400;">Schizotypal personality disorder.</li>
 	<li style="font-weight: 400;">Antisocial personality disorder (ASPD).</li>
 	<li style="font-weight: 400;">Borderline personality disorder (BPD).</li>
 	<li style="font-weight: 400;">Histrionic personality disorder.</li>
 	<li style="font-weight: 400;">Narcissistic personality disorder.</li>
 	<li style="font-weight: 400;">Avoidant (or anxious) personality disorder.</li>
 	<li style="font-weight: 400;">Dependent personality disorder.</li>
 	<li style="font-weight: 400;">Obsessive compulsive personality disorder (OCDP).</li>
</ul>
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<h3>Post-traumatic Stress Disorder</h3>
Post-traumatic stress disorder or PTSD is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such as 'shell shock'. But it's not only diagnosed in soldiers as a wide range of traumatic experiences can cause PTSD.

Each person's experience of PTSD is unique to them. You might have experienced a similar type of trauma to someone else, yet be affected in different ways.

The common symptoms that a person may feel or show are listed in a table below:

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The situations we find traumatic can vary from person to person. There are many different harmful or life-threatening events that might cause someone to develop PTSD. For example:
<ul>
 	<li style="font-weight: 400;">Being involved in a car crash.</li>
 	<li style="font-weight: 400;">Being violently attacked.</li>
 	<li style="font-weight: 400;">Being raped or sexually assaulted.</li>
 	<li style="font-weight: 400;">Being abused, harassed or bullied.</li>
 	<li style="font-weight: 400;">Being kidnapped or held hostage.</li>
 	<li style="font-weight: 400;">Seeing other people hurt or killed, including in the course of your job.</li>
 	<li style="font-weight: 400;">Doing a job where you repeatedly see distressing images or hear details of traumatic events.</li>
 	<li style="font-weight: 400;">Traumatic childbirth, either as a mother or a partner witnessing a traumatic birth.</li>
 	<li style="font-weight: 400;">Extreme violence or war, including military combat.</li>
 	<li style="font-weight: 400;">Surviving a terrorist attack.</li>
 	<li style="font-weight: 400;">Surviving a natural disaster, such as flooding or an earthquake.</li>
 	<li style="font-weight: 400;">Being diagnosed with a life-threatening condition.</li>
 	<li style="font-weight: 400;">Losing someone close to you in particularly upsetting circumstances.</li>
 	<li style="font-weight: 400;">Learning that traumatic events have affected someone close to you (sometimes called secondary trauma).</li>
 	<li style="font-weight: 400;">Any event in which you fear for your life.</li>
</ul>
Some factors may make you more vulnerable to developing PTSD or may make the problems you experience more severe, including:
<ul>
 	<li style="font-weight: 400;">Experiencing repeated trauma.</li>
 	<li style="font-weight: 400;">Getting physically hurt or feeling pain.</li>
 	<li style="font-weight: 400;">Having little or no support from friends, family or professionals.</li>
 	<li style="font-weight: 400;">Dealing with extra stress at the same time, such as bereavement or money worries.</li>
 	<li style="font-weight: 400;">Previously experiencing anxiety or depression.</li>
</ul>
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<h3>Some Other Disorders</h3>
Schizophrenia

You could be diagnosed with schizophrenia if you experience some of the following symptoms:
<ul>
 	<li style="font-weight: 400;">A lack of interest in things.</li>
 	<li style="font-weight: 400;">Feeling disconnected from your feelings.</li>
 	<li style="font-weight: 400;">Difficulty concentrating.</li>
 	<li style="font-weight: 400;">Wanting to avoid people.</li>
 	<li style="font-weight: 400;">Hallucinations, such as hearing voices or seeing things others don't.</li>
 	<li style="font-weight: 400;">Delusions, which could include paranoid delusions and strong beliefs that others don't share.</li>
 	<li style="font-weight: 400;">Disorganised thinking and speech.</li>
 	<li style="font-weight: 400;">Not wanting to look after yourself.</li>
</ul>
Psychosis

Psychosis also called a psychotic experience or psychotic episode, is when you perceive or interpret reality in a very different way from people around you. You might be said to 'lose touch' with reality. The most common types of psychosis are:
<ul>
 	<li style="font-weight: 400;">Hallucinations.</li>
 	<li style="font-weight: 400;">Delusions.</li>
</ul>
You might also experience
<ul>
 	<li style="font-weight: 400;">Disorganised thinking and speech.</li>
</ul>
Psychosis affects people in different ways. You might experience it once, have short episodes throughout your life, or live with it most of the time.

Postnatal Depression and Perinatal Mental Health Problem

Having a baby is a big life event, and it's natural to experience a range of emotions and reactions during and after your pregnancy. But if they start to have a big impact on how you live your life, you might be experiencing a mental health problem.

Around one in five women will experience a mental health problem during pregnancy or in the year after giving birth. This might be a new mental health problem or another episode of a mental health problem you've experienced before. These are known as perinatal mental health problems.

Hearing Voices

Hearing voices is an auditory hallucination that may or may not be associated with a mental health problem. It is the most common type of hallucination in people with psychotic disorders such as schizophrenia. However, a large number of otherwise healthy individuals have also reported hearing voices. It is estimated that between 5% and 28% of any general population hears voices that other people do not.

The orthodox treatment is with major tranquillisers. These do not get rid of the voices. In the past, mental health professionals were taught not to let voice hearers talk about their voices as this was thought to be colluding with the person’s delusions and not helpful. Most often professionals sought to distract the voice hearer from their voices. Research has shown that many people hear voices, and some cope well with their voices, without psychiatric intervention. It has also been found that many people who hear voices regard them as a positive part of their lives.

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Phobias

A phobia is a type of anxiety disorder. It is an extreme form of fear or anxiety triggered by a particular situation (such as going outside) or object (such as spiders), even when there is no danger. For example, you may know that it is safe to be out on a balcony in a high-rise block, but feel terrified to go out on it or even enjoy the view from behind the windows inside the building. Likewise, you may know that a spider isn’t poisonous or that it won’t bite you, but this still doesn’t reduce your anxiety. It is called “Height phobia” and is among the most common types of phobia.

Someone with a phobia may even feel this extreme anxiety just by thinking or talking about the particular situation or object. Many of us have fears about particular objects or situations, and this is perfectly normal. 

A fear becomes a phobia if:
<ul>
 	<li style="font-weight: 400;">The fear is out of proportion to the danger.</li>
 	<li style="font-weight: 400;">It lasts for more than six months.</li>
 	<li style="font-weight: 400;">It has a significant impact on how you live your day-to-day life.</li>
</ul>
Seasonal Affective Disorder

Seasonal affective disorder or SAD is a type of depression that you experience during particular seasons or times of the year. Depression is a low mood that lasts for a long time and affects your everyday life. If you have SAD, you'll experience depression during some seasons in particular, or because of certain types of weather.

It's common to be affected by changing seasons and weather or to have times of the year when you feel more or less comfortable. For example, you might find that your mood or energy levels drop when it gets colder or warmer, or notice changes in your sleeping or eating patterns. But if your feelings are interfering with your day to day life, it could be a sign that you have depression – and if they keep coming back at the same time of year, doctors might call this seasonal affective disorder or 'seasonal depression'.

Common Mental Disorders-Part 2

Module 12: Legislations Related to Mental Health in the UK

<h3>Laws in the UK</h3>
The Mental Health Act is a law that tells people with a mental health disorder what their rights are and how they can be treated. The term "mental health disorder" is used to describe people who have:
<ul>
 	<li style="font-weight: 400;">A mental illness.</li>
 	<li style="font-weight: 400;">A learning disability.</li>
 	<li style="font-weight: 400;">A personality disorder.</li>
</ul>
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Being detained (also known as sectioned) under the Mental Health Act is when the patients are made to stay in the hospital for assessment or treatment. It's important that they know what happens to them when they are detained, what their rights are, and where they can seek help.

For hundreds of years, there has been provision within the law for the care of the mentally ill. Periodically there have been developments and revisions of this legislation, often in response to public pressure to redress abuses, yet also to reflect changing views and opinions within society about how the mentally ill should be treated.

It is worth remembering that not everyone receiving mental health services is subject to mental health legislation. Often on open inpatient units, there are people who are voluntary or informal admissions alongside people who are formally detained under the Mental Health Act 2007. The Mental Health Act is used where the person does not agree that they have a mental health problem and will not accept treatment for their mental illness. In these circumstances, the person might, after assessment by appropriately trained mental health professionals, be deemed to require compulsory mental health care.

Prior to the Lunacy Act, lunacy legislation in England was enshrined in the County Asylums Act of 1808, which established institutions for poor and for criminally-insane, mentally ill people. The institutions were called asylums, and they gave refuge where mental illness could receive proper treatment. The first asylum owing to the County Asylums Act opened at Northampton in 1811. By 1827 however only nine county asylums had opened, and many patients were still in gaol as prisoners and criminals. As a consequence of this slow progress, the Lunacy Act 1845 created the Lunacy Commission to focus on lunacy legislation.

The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. In most cases when people are treated in a hospital or another mental health facility, they have agreed or volunteered to be there. They may be referred to as a voluntary patient. But there are cases when a person can be detained, also known as sectioned, under the Mental Health Act (1983) and treated without their agreement.

The Mental Capacity Act, 2005 resulted from a concern that there should be legislative guidance in the care and treatment of people who lack the mental capacity to be able to provide informed consent to care or treatment. The Act came into force in 2007 as a statutory framework intended to empower and protect people who may not be able to make their own decisions. The Act also enables people to plan ahead for a time when they may lose their capacity. Examples include where a person is experiencing a dementia-type illness or recurrent bouts of severe depression. The person can make their wishes known when they may not be able to express them at the specific time their opinion is required.

The latest act on mental health in the UK is The Mental Health Units (Use of Force) Act 2018 Commencement (No. 1) Regulations 2019. This law defines and maintains the use of force to handle any mental patient.

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<h3>Requirements of Nursing Practice in the UK</h3>
To work as a mental health nurse in the UK, you need to be registered with the Nursing &amp; Midwifery Council or NMC. To be eligible to register you must complete an accepted pre-registration nursing programme, run at an NMC approved educational institution or AEI. Nursing programmes can be taken in four disciplines, including:
<ul>
 	<li style="font-weight: 400;">Adult.</li>
 	<li style="font-weight: 400;">Children.</li>
 	<li style="font-weight: 400;">Learning disability.</li>
 	<li style="font-weight: 400;">Mental health.</li>
</ul>
A small number of institutions offer dual field degrees, allowing you to study in two of the above areas. Courses typically last three years (four for dual field), with the first year spent studying common foundation modules that cover all branches of nursing and the last two specialising in your chosen area. Half of the programme is based on clinical practice, giving you a direct experience of working with patients and families.

You may be able to get accreditation of prior experiential learning or APEL, if you have practice-based learning or a degree in another health-related subject, such as life and medical science, social work or psychology. Having APEL may shorten your course to two years, but as this is at the discretion of individual institutions it's always best to check.

Currently, the most common route to becoming a Registered Nurse in Mental Health is through university and the completion of a degree in mental health nursing. A registered psychiatric or mental health nurse (RPN or RNMH) is a nurse who specialises in caring for those with mental health needs. Psychiatric nurses assist the interdisciplinary team in the treatment of the patient's psychiatric illness and symptoms. Psychiatric nurses are able to work in a variety of locations including hospitals, outpatient facilities, health departments, mental health agencies and long-term care centres. There are plenty of courses to choose from, with over 60 universities in the UK offering degrees that specialise in mental health nursing.

Nursing degree apprenticeships have recently been developed and these offer a more flexible route to becoming a nurse. You'll work for an NHS employer as a nursing degree apprentice and will be released for part-time study at a university. Training takes place in a range of practice settings.

The NHS employs the majority of mental health nurses. While some work is carried out in mental health and secure hospitals, the majority is based in the community. Some mental health nurses also work in special units within prisons or for telephone helplines. Outside the NHS, leading employers include:
<ul>
 	<li style="font-weight: 400;">The large private healthcare companies, such as BUPA and the General Healthcare Group</li>
 	<li style="font-weight: 400;">Mental health charities</li>
 	<li style="font-weight: 400;">The armed forces.</li>
</ul>
Some projects are jointly run by the NHS in partnership with social services, local authority departments or other agencies. Many posts offer the chance to work in a more specialist role with a particular group of clients or involving those with a specific mental health condition.

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<h3>Comparison of Nursing Practice Requirements</h3>
Canada

The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "RPN". In Eastern Canada, an Americanised system of psychiatric nursing is followed. Registered Psychiatric Nurses can also work in all three of the territories in Canada; although, the registration process to work in the territories varies as the psychiatric nurses must be licensed by one of the four provinces.

Ireland

In Ireland, mental health nurses undergo a 4-year honour’s degree training programme. Nurses that trained under the diploma course in Ireland can do a post-graduation course to bring their status from diploma to degree.

New Zealand

Mental Health Nurses in New Zealand require a diploma or degree in nursing. All nurses are now trained in both general and mental health, as part of their three-year degree training programme. Mental health nurses are often requested to complete a graduate diploma or a post-graduate certificate in mental health if they are employed by a District Health Board. This gives additional training that is specific to working with people with mental health issues.

Sweden

In Sweden, to become a registered psychiatric nurse one must first become a registered nurse which requires a BSc. (Bachelor of Science) in Nursing (three years of full-time study, 180 higher education credits). Then, one must complete one year of graduate studies in psychiatric/mental health nursing (60 higher education credits), which also includes writing an MSc. (Master of Science) thesis. The registered psychiatric nurse is an evolving profession in Sweden. However, unlike in countries such as the US, there is no psychiatric-mental health nurse practitioner, so in Sweden, the profession cannot, for example, prescribe pharmacological treatment. Studies indicate that the nurses themselves wish for such clinical ladder programs to recognise and motivate the continuing professional development of their profession.

UK

In the UK and Ireland, the term psychiatric nurse has now largely been replaced with mental health nurse. Mental health nurses undergo a 3-4 year training programme at Bachelor's degree level, or a 2 year training programme at Master's degree level, in common with other nurses. However, most of their training is specific to caring for clients with mental health issues. RMNs can continue into further training as Advanced Nurse Practitioners (ANPs): this requires completion of a 9 month Master's programme. The role includes prescribing medications, being on call for hospital wards and delivering psychosocial interventions to clients.

US

In North America, there are three levels of psychiatric nursing. The licensed vocational nurse (licensed practical nurse in some states) and the licensed psychiatric technician may dispense medication and assist with data collection regarding psychiatric and mental health clients. The registered nurse or registered psychiatric nurse has the additional scope of performing assessments and may provide other therapies such as counselling and milieu therapy.

The advanced practice registered nurse (APRN) either practice as a clinical nurse specialist or a nurse practitioner after obtaining a master's degree in psychiatric-mental health nursing. Psychiatric-mental health nursing (PMHN) is a nursing speciality. The course work in a master's degree program includes speciality practice. APRN’s assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders, as well as performing the functions associated with the basic level.

They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRN’s have the authority to prescribe medications. Qualified to practice independently, psychiatric-mental health APRN’s offer direct care services in a variety of settings: mental health centres, community mental health programs, homes, offices, HMOs, etc.

Psychiatric nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found in practice settings, teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.

Australia

In Australia, to be a psychiatric nurse, a bachelor's degree of nursing need to be obtained in order to become a registered nurse (RN), and this degree takes 3 years full-time. Then a diploma in mental health or something similar will need to also be obtained, this is an additional year of study. An Australian psychiatric nurse has duties that may include assessing patients who are mentally ill, observation, helping patients take part in activities, giving medication, observing if the medication is working, assisting in behaviour change programs or visiting patients who are at home. Australian nurses can work in public or private hospitals, institutes, correctional institutes, mental care facilities and homes of the patients.

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Rights of Patients

There are strict regulations on patient’s rights in the UK. Their rights are protected by different laws. Use of excessive force is also prohibited. According to the Mental Health Units (Use of Force) Act 2018:
<ul>
 	<li style="font-weight: 400;">The responsible person for each mental health unit must publish a policy regarding the use of force by staff, who work in that unit.</li>
 	<li style="font-weight: 400;">Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection in relation to those units.</li>
 	<li style="font-weight: 400;">Before publishing a policy under subsection, the responsible person must consult any persons that the responsible person considers appropriate.</li>
 	<li style="font-weight: 400;">The responsible person must keep under review any policy published under this section.</li>
 	<li style="font-weight: 400;">The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.</li>
 	<li style="font-weight: 400;">If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.</li>
 	<li style="font-weight: 400;">A policy published under this section must set out what steps will be taken to reduce the use of force in the mental health unit by staff who work in that unit.</li>
</ul>
National Health Services or NHS has a fixed set of rights for patients which are:
<ul>
 	<li style="font-weight: 400;">You have the right to receive NHS services free of charge, apart from certain limited exceptions. You won’t be refused access to these services on unreasonable grounds</li>
 	<li style="font-weight: 400;">You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality</li>
 	<li style="font-weight: 400;">You have the right not to be unlawfully discriminated against when receiving NHS services</li>
 	<li style="font-weight: 400;">You have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this isn’t possible</li>
 	<li style="font-weight: 400;">You have the right to drugs and treatments that have been recommended by the National Institute for Health and Care Excellence (NICE) if your doctor says they are clinically appropriate for you. You have the right to expect local decisions on funding of other drugs and treatments to be made rationally, following proper consideration of the evidence. The Handbook to the NHS Constitution explains that NHS commissioners are allowed to have a policy not to fund a particular treatment but they must consider requests for funding in exceptional individual cases</li>
 	<li style="font-weight: 400;">You have the right to accept or refuse treatment that is offered to you. You mustn’t be given any physical examination or treatment unless you've given valid consent. If you aren’t capable of giving valid consent, consent must be obtained from someone who is legally able to act on your behalf, or the treatment must be in your best interests.</li>
</ul>
If one of your legal rights has been broken, as a first step, it is usually best to try to sort any problems directly with the NHS. However, in some situations, you might have to court to get the problem sorted out.

There are different types of court action, depending on the problem you face. For example, you might want to go to court to challenge how a decision was made (this is called judicial review). Or you may have a claim for clinical negligence or unlawful discrimination. You should get legal advice if you’re considering court action.

Legislations Related to Mental Health in the UK

<h3>Course Overview </h3>
Start from where you are and use what you have to help people with mental health disorders. Get started with this complete Level 5 Certificate in Mental Health Nursing course and be the hero to save those who are suffering in silence!

This inclusive course will appropriately train you to be an effective team member of doctors, social workers, therapists, and psychiatrists working with mental health. You will improve your people skills with expert tips and tricks, connecting with patients to make them feel at ease. The course process will help you support people suffering from anxiety, depression, eating disorders and many other psychological dysfunctionalities.

Enrol today and take the first step forward to be part of a profession that serves humanity.
<h3>Learning Outcomes:</h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1">Understand the importance of mental health awareness and nourishment</li>
 	<li style="font-weight: 400;" aria-level="1">Get introduced to assisting mental health support workers and arrange nursing requirements</li>
 	<li style="font-weight: 400;" aria-level="1">Know how to connect with patients and make them feel heard and comfortable</li>
 	<li style="font-weight: 400;" aria-level="1">Learn how to deal with a patient’s family and document medical condition</li>
 	<li style="font-weight: 400;" aria-level="1">Be able to motivate and encourage patients for therapies</li>
 	<li style="font-weight: 400;" aria-level="1">Supervise patients activities and progresses</li>
</ul>

Start from where you are and use what you have to help people with mental health disorders. Get started with this complete Level 5 Certificate in Mental Health Nursing course and be the hero to save those who are suffering in silence!

Level 5 Certificate in Mental Health Nursing

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