Week 1

Question 1

Mental health definition

Answer 1

mental health is not just the absence of a mental disorder. It is defined as a state of well being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community

Question 2

What is the DSM 4 TR definition

Answer 2

The successful performance of mental functions, in terms of thought, mood and behavior that results in productive activity

Question 3

What are the objectives of the MHA (1986)

Answer 3

To provide for the care, treatment and protection of mentally ill people who do not or cannot consent to that care, treatment or protection; To facilitate the provision of necessary psychiatric treatment and care to people with a mental disorder; to protect the rights of people with a mental disorder; to establish a ‘mental health review board’; to establish a psychosurgery review board; to provide a mechanism of review and appeal against MH detention and treatment by appointing community visitors; to establish a victorian institute of forensic mental health; to ensurethat people with a mental disorder are informed of and make use of the provisions of this act

Question 4

Principles of the Victorian MHA

Answer 4

patients with a mental illness in the state of Victoria are given the best possible care and treatment, appropriate to their needs, in the lest possible restrictive environment; provided the least possible intrusive manner, consistant with the effective provision of that care and treatment; rights are considered in providing for the care and treatment of people with a mental illness/disorder; the protection of members of the public any restriction upon the liberty of patients and other people with a mental disorder; and any interference with their rights, privacy, dignity and self respect are kept to the minimum necessary in the circumstances.

Question 5

Criteria for Involuntary treatment

Answer 5

The person appears to be mentally ill; the person’s mental illness requires immediate treatment and that treatment can be obtained by the person being subject to an involuntary treatment order; because of the person’s mental illness, involuntary treatment of the person is necessary for his or hers health and safety or for the protection of members of the public; the person has refused or us unable to consent to the necessary treatment for the mental illness; the person cannot receive adequate treatment for the mental illness in a manner less restrictive of his freedom of decision and action.

Question 6

acronym for involuntary treatment

Answer 6

RAILS. R= refuses necessary care and treatment that can only be obtained subject to an involuntary treatment order A= appears mentally ill I= immediate care and treatment L= least restrictive environment S= safety of self and others

Question 7

transporting a patient to hospital

Answer 7

registered medical practitioner isn’t available within a reasonable period to consider making a recommendation. A mental health practitioner considers that 1. the criteria in section 8(1) applies to this person 2. the person should be taken to an approved menta health service for examination by a registered medical practitioner for the purpose of making a recommendation; the mental health practitioner completes an authority to transport in the prescribed form containing the prescribed particulars; a person who has made a request under section 9(1)(a) in respect of that person, must not complete an authority to transport that person under subsection (1)(c)

Question 8

Section 10 of the MHA

Answer 8

A member of the police force may apprehend a person who appears to be mentally ill; the police member is not required to exercise clinical judgement and is only required to have reasonable grounds to form the belief that a person is mentally ill and has or is likely to harm themselves of others. There are no MHA forms for police to sign in regards to section 10

Question 9

Section 11 of MHA

Answer 9

Where a member of the police force or any other person has reasonable grounds for believing that a person who appears to be mentally ill is because of that mental illness incapable of caring for herself or himself may give the information on oath to a magistrate.

Question 10

Section 12 of MHA conditions

Answer 10

The patient can’t refuse psychiatric treatment including medication; the patient cannot discharge themselves from involuntary treatment; the patient must have any leave from hospital approved by the authorised; should the patient abscond the police are notified and returned when located; the authorised psychiatrist can give consent to certain procedures on the patients behalf; only the authorised psychiatrist of the M.H.R.B can discharge a patient from involuntary status.

Question 11

Section 12 of the MHA examination by authorised psychiatrist

Answer 11

the authorised psychiatrist is empowered to establish if the criteria of section 8(1) applies to the patient on review; review must occur within 24 hours of the order being made; the psychiatrist must be employed by an approved MHS; the authorized psychiatrist can

1. Uphold the patients recommendation and continue detention in hospital as a S12
2. uphold the patients recommendation and continue involuntary treatment in the community as a S14 or community treatment order
3. Discharge the patient. The patient has the option of being discharged from hospital or remain voluntarily.

Question 12

Community treatment orders Section 14

Answer 12

At any time, an authorised psychiatrist may make a community treatment order for a person who is subject to an involuntary treatment order if the authorised psychiatrist is satisfied that:

1. The criteria in section 8(1) apply to the person; and
2. the treatment required for the person can be obtained through the making of a community treatment order

Question 13

What are the conditions of a community treatment order

Answer 13

Patients on a community treatment order may have a residential clause applied by the authorsied psychiatrist. As long as the patient remains on the community treatment order, subsequent admissions will be as an involuntary patient even if the patient requests admission as a voluntary patient. If a patient fails to or refuses to comply with treatment prescribed, the authorised psychiatrist can revoke the community treatment order which means the patient is to be admitted to hospital as an involuntary patient.

Question 14

What members does the Mental Health Review Board (MHRB) consist of

Answer 14

the members of the board are 1. An independant psychiatrist, 2. a solicitor and 3. a community visitor

Question 15

What are the functions of the Mental Health Review Board (MHRB)

Answer 15

1. To hear appeals by or on behalf of involuntary patients and security patients
2. To periodically review the orders made on behalf of involuntary patients and security patients, along with their treatment plans
3. to hear appeals against the refusal of the chief psychiatrist to grant special leave to security patients
4. to hear appeals against the transfer of involuntary patients and security patients
5. to review orders for the transfer of involuntary patients to interstate facilities
6. such other functions as are specified by this act.

Question 16

What are patient rights according to Section 18 of the MHA

Answer 16

Every person on admission must be given the appropriate prescribed statement

1. Advising the patient to their legal rights and other entitilements, including the right to a second psychiatric opinion and obtain legal representation.
2. Containing any other information relating to the treatment and care of the patient that the Department considers relevant to his or her legal rights and other entitlement under the Act
3. The statement may be printed in different languages so that wherever possible a patient can be given a copy of the statement printed in a language with which the patient is familiar.
4. In addition to the statement, the patient must be given an oral explanation of the information contained in the statement. The patient needs to have understood the information conveyed and there needs to be every attempt made to relay this information in a manner the patient can best understand
5. It is the duty of the authorized psychiatrist to ensure that this section is complied within the approved mental health service.

Question 17

The treatment plan

Answer 17

The authorized psychiatrist must prepare, review on a regular basis and revise as required, a treatment plan for each patient

Question 18

In preparing, reviewing and revising a treatment plan for a patient what must the psychiatrist take into account

Answer 18

1. the wishes of the patient
2. Unless the patient objects, the wishes of any guardian, family member or primary carer
3. Whether the treatment to be carried out is only to promote and maintain the patients health or well being
4. any beneficial alternative treatments available
5. The nature and degree of any significant risks associated with the treatment or any alternative treatment
6. any prescribed matters

Question 19

If a patient is an involuntary patient, what is required of the treatment plan

Answer 19

The treatment plan for a patient who is detained in an approved mental health service must contain an outline of the treatment the patient is to receive.

Question 20

What is the definiton of seclusion

Answer 20

Seclusion means the solitary confinement of a person at any hour of the day or night in a room of which the doors and windows are locked from the outside

Question 21

According to S82 of the MHA (seclusion) what is required for the patient

Answer 21

1. the patient is to be reviewed at intervals of not more than 15 minutes by a RN
2. Subject to sub (section 3A), to be examined at intervals of not more than 4 hours by a registered medical practitioner
3. Be supplied with bedding and clothing
4. Be provided with food and drink
5. Be provided with toilet arrangements
6. be examined by the authorised psychiatrist at intervals of not more than 24 hours

Question 22

What is the criteria for secluding a patient according to S82 of the MHA (seclusion)

Answer 22

If it is necessary to protect the person or any other person from an immediate of intiment risk to his/her health or safety or to prevent the person from absconding.

Question 23

What is S81 of the MHA

Answer 23

Section 81 of the MHA is in regards to restraints. In this section mechanical restraint, in relation to a person means the application of devices (including belts, harnesses, manacles, sheets and straps) on the person’s body to restrict his/her movement, but does not include the use of furniture (including beds with cot sides and chairs with tables fitted to their arms) that restricts the persons capacity to get off the furniture.

Question 24

When can mechanical restraints for the purpose of treatment for a mental disorder in an approved mental health facility be applied?

Answer 24

A. If that restraint is necessary
1. for the purpose of medical treatment
2. to prevent the person from causing injury to themselves or another person
3. to prevent the person from persistently destroying property
B. If the form and use of restraint has been:
1. approved by an authorized psychiatrist
2. in the case of an emergency, authorized by the senior RN on duty and notified to a registered medical practitioner without delay
C. for the period of time specified in the aproval or authorization under paragraph B.

Question 25

What are community visitors

Answer 25

the functions of a community visitor is to visit any mental health service in the region for which the community visitor is appointed and inquires into mental health facility.

Question 26

What do community visitors inquire into?

Answer 26

1. the adequacy of services for the assessment and treatment of people with a mental disorder 2. the appropriateness and standard of facilities for the accomodation, physical well being and welfare of persons receiving treatment or care for a mental disorder 3. the adequacy of opportunities and facilities for the recreation, occupation, education, training and rehabilitation of persons receiving treatment of care for a mental disorder 4. the extend to which people receiving treatment or care for a mental disorder are being given the best possible treatment appropriate to their needs in the least possible restrictive environment and least invasive manner consistent with the effective giving of that treatment 5. any failure to comply with the provisions of this act 6. any other matter that an official visitor considers appropriate having regard to the objectives specified in section 5 7. any complaint made to a community visitor by a person receiving treatment or care for a mental disorder.

Question 27

What is GABA (1986)

Answer 27

The purpose of this Act is to enable persons with a disability to have a guardian or administrator appointed when they need a guardian or administrator

Question 28

According to GABA what is a guardianship

Answer 28

Guardianship - A guardianship order appointing a plenary guardian confers on the plenary guardian in respect of the represented person all the powers and duties which the plenary guardian would have if he/she were a parent and the represented person his/her child.

Question 29

What is the definiton of Mental health

Answer 29

It is a state of emotional and social well being in which the individual realizes his/her own abilities, can cope with the normal stresses of life, can work productively or fruitfully, and is able to make a contribution to his or her community.

Question 30

What is a mental health problem

Answer 30

Problems with mental health, such as worry or sadness, which do not meet the criteria for a mental disorder

Question 31

What is a mental disorder?

Answer 31

a diagnosable illness that significantly interferes with an individuals cognitive, emotional or social abilities.

Question 32

What is mental health literacy?

Answer 32

knowledge and beliefs about mental disorders which aid and recognition, management or prevention. Mental health literacy includes ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self treatments, and of professional help available; and attitudes that promote recognition and appropriate help seeking.

Question 33

What is mental health promotion

Answer 33

mental health promotion is any action taken to maximize mental health and well being among populations and individuals. In Edward, Munro, Robins & Welch (2011) their definition "is an emerging area of health that includes research, policy development, community action and program activity".

Question 34

Social and emotional well being

Answer 34

A holistic Aboriginal definition of health that includes: mental health, suicide and self harm, emotional psychological and spiritual well being.

Question 35

What is the impact of mental illness

Answer 35

In 2003, mental illness ranked as the third biggest source of disease burden in Australia. Mental illness often starts in adolescence or early adulthood. Fifty percent of people have their first episode of mental illness by age 18. Seventy five percent of people have had their first episode by age 25. Mental illness rank as the biggest cause of disease burden for 15-24 year olds. It is important to detect mental health problems early and ensure the person gets properly treated and supported.

Question 36

What is the physical health of people suffering mental illness?

Answer 36

- Higher rates of physical morbidity and mortality than non mentally ill clients - High rates of arthritis, asthma, cardiovascular disease, diabetes and cancers - High rates of obesity, smoking and low levels of exercise - A study published in 2010 showed that mortality rates amongst the mentally ill worsened over times compared to gains in all other causes of death - Recognition and managment impeded by the patient, illness, clinician attitudes and healthcare structures.

Question 37

What are predisposing factors for mental illness?

Answer 37

Characteristics present before the development of a disorder, and that place the person at higher risk for developing the disorder

Question 38

What are Precipitating factors for mental illness?

Answer 38

Stressors implicated eg. bereavement, sexual abuse, unemployment, poverty.

Question 39

What is nature Vs Nurture in regards to mental health?

Answer 39

Organic - biological, genetic | Functional - Environmental, due to early life experiences.

Question 40

What are biological factors in relation to MH

Answer 40

``` Genetic eg. Mood disorders Degenerative eg. Alzheimer s Trauma eg. Dementia, psychosis Poisons eg. Mental retardation Infections eg. Creutzfeldt-Jakob Vitamin Deficiencies eg. Wernicke-Korsakoff syndrome (thiamine). ```

Question 41

What are psychological factors in relation to MH

Answer 41

Personality type eg. depression Psychological defenses eg. delusional Locus of control eg. anxiety Self concept eg. eating disorder.

Question 42

What are socio cultural factors in relation to MH

Answer 42

Cultural background eg. eating disorder, substance abuse Social position eg. depression Bereavement eg. depression Disasters eg. PTSD Developmental transitions eg. marriage, childbirth, retirement, adjustment Gender eg. substance abuse disorder.

Question 43

What are individual protective factors?

Answer 43

temperment, attachment to family, good coping styles, intelligence, optimism

Question 44

What are family protective factors?

Answer 44

supportive, caring parents, secure safe family, stable family, supportive relationship with another adult

Question 45

What are school protective factors

Answer 45

sense of belonging, positive school climate, school against violence

Question 46

What are life events and situations protective factors?

Answer 46

Economic security, good physical health, opportunities of critical life transitions

Question 47

What are community and cultural protective factors?

Answer 47

Sense of connectedness, attachment and networks within community, strong cultural identity, access to support services.

Question 48

What is the nursing classification: NANDA

Answer 48

North American Nursing Diagnosis Association (NANDA) General nursing orientated There are 10 nursing diagnoses relating to elimination yet the most complex human activity - thought, has one nursing diagnoses eg. thought processes altered

Question 49

What is Psychiatric Diagnosis?

Answer 49

Loomis et al, 1987 Only one edition published PND-1 Not widely used in the field Most mental health nurses translate behaviors into a nursing diagnoses by relating the behavior to the cause eg. refusing food (behavior) related to fear that food is poisoned (cause).

Question 50

What is the medical classification for MHN

Answer 50

2 major systems ICD-10: International Classification of Diseases. World Health Organization Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Text Revision (DSM 4 TR). American Psychiatric Association (5th Edition in process).

Question 51

The DSM in MHN

Answer 51

First edition (1952) had 106 disorders Latest edition DSM-4-TR (2000) has 297 disorders Widely used in Australia for making a diagnosis (but ICD-10 coding used in records and in use in Europe).

Question 52

What is the DSM-4-TR?

Answer 52

Descriptive. Based on symptoms rather than cause Diagnostic criteria specified for each disorder Systemic description: associated features, specific age, cultural and gender related features, prevalence, incidence, risk, predisposing factors, familial pattern, course, complications, differential diagnosis.

Question 53

What are the effects of labelling in MHN

Answer 53

Labels can stigmatise Individual sees him or herself in a negative light, have less hope of recovery and perhaps make less effort at recovery Affect the ways others deal with the person Even clinician fall prey to stereotypes.

Question 54

Diagnosing Mental illness is divided into various Axis, what is classified as Axis 1

Answer 54

- Clinical disorders and other disorders that may be a focus of clinical attention - Includes all psychiatric disorders except personality disorders and mental retardation - 17 Categories: mood disorders, anxiety disorders etc.

Question 55

What does Axis 2 diagnose

Answer 55

Personality disorders and intellectual disability (mental retardation)

Question 56

What does Axis 3 diagnose

Answer 56

Physical disorder or general medical condition that is present in addition to the mental disorder May be causative, consequential or unrelated to the mental disorder

Question 57

What does Axis 4 diagnose

Answer 57

Psychosocial and environmental problems that contribute to the development or exacerbation of the disorder, may be positive or negative stressors.

Question 58

what does Axis 5 diagnose

Answer 58

Global Assessment of Functioning (GAF) scale ``` Severity of Disorder mild moderate Severe In partial remission In full remission ``` The lower score, more impairment

Question 59

Mental health or Psychiatric

Answer 59

Victoria: Psychiatric Nurse Renaming of public psychiatric services to Mental Health Services 2001 Traditionally Psychiatric= treatment of mentally ill Mental Health = health promotion and prevention

Question 60

What is the definition of Mental Health Nursing (MHN)

Answer 60

Mental health is a branch of nursing concerned with the prevention and treatment of mental disorders and their symptoms.

Question 61

What are the periods of history of MH

Answer 61

``` Confinement - pre 1790's Caring - Pinel (1794), Tuke (1796) Classification - Kraepelin, Freud Chemicals - 1950's Community - 1960's Computerised scans - funciton - 1990's Chromosome - map genome 2001 Consumer movement - 2000's ```

Question 62

What are the geographical locations of MHN

Answer 62

Higher numbers of MHN in capital cities Very low number of MHN in smaller regional and remote areas Implication - rural remote nurses must be competent to deliver mental health care Under servicing of rural and remote locations.

Question 63

Describe the shortage of MHN

Answer 63

Department of Education, Employment and Workplace Relations (DEEWR) monitors the labour market in Australia Current shortage of MHN in all states and territories.

Question 64

What are the professional bodies and practice standards

Answer 64

- APHRA and NMBA - National Standards of MH services (2010) - ANMC - national competency standards and regulation processes - Australian College of Mental Health Nurses (ACMHN) (2010) standards of practice

Question 65

What does AHPRA do?

Answer 65

- From 1 July 2010 - 10 Health practitioner boards - National Registration and Accreditation Scheme across Australia - Set standards and policies that all registered health practitioners must meet.

Question 66

AHPRA and Nursing and Midwifery Board of Australia

Answer 66

- Registration standards - Approves codes and guidelines to provide guidance to professions - Codes - Ethics, professional conduct - Guidelines - Professional boundaries, practice guidelines.

Question 67

What does the Nursing and Midwifery Board of Australia do?

Answer 67

Approves: - Accreditation standards - Education providers and programs of study for the nursing/midwifery Handles notifications, complaints, investigations and disciplinary hearings Assesses overseas trained practitioners who wish to practice in Australia

Question 68

What are the ACMHN Standards and Credentialing

Answer 68

- 9 Standards of MHN practice (2010) - Credentialing: Qualifications; post graduate qualification and clinical experience = Mark of quality or achievement. Conferred by ACMHN postgraduate - 18 months Masters - 3 years.

Question 69

What is the ladder of nursing education

Answer 69

Bachelor of nursing (3 yrs full time) Post graduate qualification - Honours, Graduate certificate, Graduate diploma, master of nursing, Master of nursing course work, research or combination. Doctorate by Course work Doctorate by Research

Question 70

What are the general roles of MHN Assessment skills

Answer 70

Comprehensive psychiatric assessment including Mental Status Examination (MSE) and Risk Assessment Ongoing monitoring of the patient mental state, wellbeing and treatment needs.

Question 71

What is the role of the MHN in Counseling Skills

Answer 71

- Interview and Assessment - Communication - Developing a nurse - client relationship - Crisis intervention - Stress management - Therapy

Question 72

What is the role of the MHN in Milleu Therapy

Answer 72

- Maintaining a safe environment - Providing structure and support - Setting limits on challenging behaviour - role modelling - coordinating the therapeutic program

Question 73

What is the role of the MHN in Biological Interventions?

Answer 73

- Administering an Monitoring medication - Assessing, maintaining & optimising clients physical health - Preparing and caring for people - maintaining and promoting mental health - Explaining treatment regimes. - Psycho Education

Question 74

What is the role of the MHN in Health Teaching

Answer 74

- Clarifying misconceptions regarding mental illness - combating stigma - developing "mental health literacy" in general public - maintaining and promoting mental health explaining treatment regimes

Question 75

What is the role of the MHN in case management?

Answer 75

- Coordinating the treatment plan - Liaising with the client - Liaising with family and treatment team - Advocacy

Question 76

What are the sub specialties of MHN?

Answer 76

Lifespan - Peri-natal, child and adolescent, Adult, Psycho-geriatric Diagnosis - Drug and Alcohol, post natal, Depression, Eating disorder, etc Continuum - Early intervention, Crisis Assessment, continuing care, rehab Setting - Forensic , ED Liaison, Rural, Community, inpatient, Primary Care, GP practices (MHNIP), Research, etc,

Question 77

What are Psychiatric Mental Health care Nurse Practitioners?

Answer 77

- Nurse Practitioners are clinical and professional leaders - Work involves direct service delivery - Have advanced training, clinical expertise and skills to best use - Work within a model of nursing practice that meets a particular service need(s) - Practice is supported by evidence based policies/guidelines agreed by their employeer. - Each nurse practitioner model is different

Question 78

What is the definition for a mental health nursing practitioner?

Answer 78

The title Nurse Practitioner is protected, preventing the use of the title 'nurse practitioner' by anyone who is not endorsed by AHPRA as a Nurse Practitioner (NP).

Question 79

What Education is required to become a Nurse Practitioner?

Answer 79

- The minimum education requirement for endorsement as a Nurse Practitioner in Victoria is a completed clinically based master's degree or a completed specific Nurse Practitioner's Masters - A mandatory component of the educational requirement is a therapeutic medication module(s) (masters level).

Question 80

Who are ACMHN?

Answer 80

- They are a professional body who represent MHN - They were established in 1975 - They represent MHN - The set standards - They play a role in policy development - Collegial support - Annual Conference - Journal

Question 81

What Journals are used in MHN?

Answer 81

- international Journal of Mental Health Nursing - Journal of Psychiatric and Mental Health Nursing - Full Texts available in PDF via e-journal in Library

Question 82

In a population basis what is the severity of mental illness?

Answer 82

``` Severe = 21% Moderate = 33% Mild = 46% ```

Question 83

What does co-morbidity mean?

Answer 83

Having more than 1 illness at a time eg. anxiety and depression.

Question 84

Social isolation in Mental Health

Answer 84

Most people had contact with familhy and feiends, but people with a mental illness were less likely to have regular contact (90%) then were people without a mental illness (95%) People with mental illness were less likely to feel that they could rely or confide in family (85% compared to 92%).

Question 85

What are the likely living arrangements for people suffering from mental illness?

Answer 85

People with a mental illness are more likely to be living by themselves (15%) compared to (13%) or to be seperated, divorced or widowed (15% compared to 13%).

Question 86

What impact does work have for the mentally ill?

Answer 86

Employment affects income and social engagement Unemployment higher (4.0 to 2.7%)

Question 87

What is the likelihood of people experiencing mental health issues seeking professional help?

Answer 87

two thirds of people with a mental health disorder had not used a MHS in the previous year 16 to 34 Year olds are less likely to have used a service than 35 to 54 year olds 1 in 10 GP encounters for mental health reasons Rate of access declines with remoteness Woman access more than men.