Clinical Helper for Mental Health Nursing

The vital guide for students and new graduates

Brenda Happell, Timothy Wand

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000256505
• Edition: 1
• Topic: Medizin
• Subtopic: Krankenpflege

Are you anxious about your mental health placement? Do you need help remembering the terms, therapies and guidelines?Mental health is a fascinating specialised field where you can make a real difference. The Clinical Helper for Mental Health Nursing is a quick and reliable reference for students and new graduates to reduce stress and boost confidence in the clinical setting.Covering the key information you must have at your fingertips, this pocket guide is essential for all nurses entering mental health practice.

CHAPTER 1 The mental health environment

Structure and settings

Mental health services have changed significantly since the days of large institutions located apart from other health services and the general community. They are now usually located within general hospitals (known as mainstreaming).

Most mental health services are publicly funded. The structure varies between states and territories, but usually includes some or all of the following:

• Acute inpatient units: provide short-term care and treatment for people diagnosed with a mental illness, experiencing severe symptoms and considered unable to be treated in a ‘less restrictive environment’.
• Community care units: provide longer term accommodation; these generally are located in residential areas and provide a more homely environment to assist people to make the transition to community living.
• Acute Care Team (ACT) or Crisis Assessment and Treatment Team (CATT): provide emergency community-based assessment and short-term treatment interventions to people in crisis; have a key role in deciding the most appropriate treatment option and deciding whether inpatient admission is necessary.
• Community care teams, also known as continuing care or case-management teams: provide ongoing support and treatment for people living in the community who still require professional assistance.
• Mobile support and treatment services (MSTS): provide intensive long-term support to people with prolonged and severe mental illness and associated disability. They provide assertive outreach and often operate for extended hours.

All district or area mental health services operate services for the adult population (aged between seventeen and 64); some also provide services for children and adolescents (aged from birth to sixteen years)—though they can be for older people in some services—and aged care services for those over 65.

Other specialist services are operated—usually on a state- or territory-wide basis—and can include:

• forensic mental health
• services for people with personality disorders
• transcultural mental health
• mother and baby services
• school-based youth health
• eating disorder services
• dual diagnosis (substance misuse and mental illness)
• dual disability (substance misuse and disability)
• Indigenous mental health
• brain disorder services
• early psychosis and early intervention
• headspace—specialised day services for youth.

Mental health services are also provided in some public hospitals and primary health-care settings— for example, the Mental Health Nurse Incentive Program, where mental health nurses work with general practitioners and private psychiatrists.

Many non-government organisations also provide important adjunct services, particularly in peer support, housing, skills, employment and pastoral care.

Unique approach to care and treatment

You may find the mental health setting quite different; service users are more often referred to as consumers or clients than patients, and you may also notice some or all of the following:

• Most people receiving services are cared for in the community, with hospital admission usually seen as a last resort.
• The environment is less formal, and consumers are more likely to be addressed by their first name.
• Consumers usually wear street clothes, not pyjamas.

• Nurses usually wear street clothes, not uniforms.
• Diagnosis is less likely to determine nursing care.
• There is less reliance on technology, and more reliance on the skills of nurses as people.
• There is more reliance on the therapeutic relationship: nurses spend less time with mechanical tasks and more time talking to, and more importantly listening to, consumers.
• Consumers are often involuntary and may not believe they need treatment.
• There is a stronger reliance on the multidisciplinary team to meet the needs of individual consumers.
• There is a blurring of roles between disciplines— particularly for case managers.

Common fears and concerns for nurses

If you are feeling nervous or apprehensive about going into the mental health-care setting—or even questioning whether you need to be here at all—you are not alone. Many nursing students and new graduates have concerns, including:

• the possibility of being physically and/or emotionally harmed by interacting with people with mental illness
• that you might make a consumer’s situation worse by saying or doing the wrong thing
• the sense that this is not ‘real nursing’, and there is not much to learn.

Talk to your peers—you’ll probably find similar concerns. Also remember the following:

• As a student or new graduate you are not expected to know everything.
• You have a right to be supervised.
• Violence and aggression are likely less common than you imagine.
• People who utilise mental health services are people with goals, needs and interests. See consumers as more than signs and symptoms, and communicate as you would with anyone else.
• Unless you are deliberately insensitive, you are unlikely to make a situation worse by what you say or do.
• Wherever you practise as a nurse, you will provide care for people diagnosed with a mental illness and experiencing mental distress. The skills and knowledge you develop in this setting will be invaluable.

Making the most of the experience

Make your experience more valuable by doing the following:

1. Be prepared
   • Read up on your course notes, refer to your textbook, be sure about your learning objectives, don’t be afraid to ask if you are unsure.
   • Learn what you can about the setting, including policies and procedures, and safety issues.
2. Be honest and open
   • Be aware of your limitations, and ask for help if you are uncertain.
   • Be aware of your own feelings. If you feel uncomfortable, think about why. Is it lack of knowledge of experience? Fear? Accept your feelings as valid, and allow yourself to work through them with support.
3. Take opportunities
   • Spend time with consumers, treat them with respect and learn from them.
   • Spend more time talking and less time reading case notes.
   • Attend handovers, intake meetings, team meetings and clinical reviews.
   • Be guided by clinical learning objectives, but do not be restricted by them.
   • Don’t rely solely on your clinical facilitator or preceptor—work with others to see different styles and approaches.
   • Where possible, work with members of other disciplines—their different perspectives will be enriching.
4. Value support and guidance
   • Seek regular feedback—don’t be afraid to express concerns and ask questions.
   • Participate in debriefing with clinical facilitators and speak up if you find yourself in disturbing or disconcerting situations. You will learn by raising these issues for peer discussion.

Table of contents

• Cover
• Title Page
• Copyright Page
• About the authors
• Contents
• Tables
• Common acronyms and abbreviations
• 1 The mental health environment
• 2 Promoting recovery-focused care
• 3 Communication
• 4 Assessment
• 5 Diagnoses
• 6 Symptom-based care
• 7 Physical treatments
• 8 Psychotherapies
• 9 Legal and ethical issues