Table Of ContentNUM1207 Module 1.1 Mental
Health and Mental Illness
Learning outcomes
● Understand the nature of mental health and wellness and the factors that influence them.
● Become aware of the prevalence of mental disorders and the impact they have on the individual,
communities and society.
● Define; mental health and identify factors that promote a person's wellbeing. Have a beginning
understanding of the incidence and prevalence of mental health problems.
● Explain the impact of social determinants on mental health and social and emotional wellbeing. f
● Identify the ‘cost’ of mental health on services, funding and in terms of disability (DALY’s).
● Describe the negative influence of misconceptions and discrimination (stigma and stereotyping)
experienced by people with a mental health problem.
● Have an awareness of how nurses, midwives and others can positively influence mental health
outcomes for service users, carers and communities.
Mental health and wellness
● Mental health is a psychological state where a person functions at a suitable level of emotional and
behavioral stability and comprises the person's ability to enjoy life and balance life events and energies
to achieve psychological equilibrium.
● WHO defines mental health as a “state of subjective wellbeing in which every individual realizes his or
her own potential, can cope with the normal stresses of life, can work productively, fruitfully and is able
to make a contribution to their community”.
Factors that promote a person's wellbeing
● Being healthy
● Having strong personal relationships
● Feeling safe
● Having an adequate living standard
● Having a sense of achievement and purpose
● Perceived security
● Feeling connected to the community
● Feeling secure in the future
● Mental health issues are problems of living rather than a consequence of a mysterious disease.
● Can impact on an person's ability to function, but are unlikely to meet criteria for diagnosis
Healthy mental health looks like
● Sense/state of wellbeing,
● Form positive relationships
● Use one's abilities to reach their potential
● Enables people to fully enjoy & appreciate other people, day to day life & their environment
● Deal with life's’ challenges
● Can cope with the ‘normal’ stressors of life
● Work productively & fruitfully
● Make a contribution to their community
● Flexible & adaptive
Social determinants of mental health
● WHO the social determinants of health are the conditions in which people are born, grow, work, live
and age, and the wider set of forces and symptoms shaping the conditions of daily life.
● Health determinants include anything that contributes to the health of the population, including the
effects of behaviours or risk to health.
● Understanding the determinants of health leads to greater mental health promotion, prevention and
early intervention
The determinants of health
Number of these areas certain groups are socially or economically disadvantaged or may experience
health outcomes lower than population norms
● housing & food
● activity, employment (income), education
● peace, social connectedness,
● justice, and equity
● stable & sustainable environments & resources
People experiencing mental challenges
Terminology
Consumer
● more active role, having rights, responsibility & a more equitable relationship with the health
care provider.
Patient
● biomedical model, illness, passive role, recipient of care – not inclusive of care, disparity
between the person, psychological & physical (interconnectedness of each area).
● People who have ‘experience of mental health challenges’, the person ‘living with mental
illness’, is the best person able to describe their lived experience.
Incidence and prevalence of mental health
problems
Statistics
Australian National Survey of Mental Health (2007) last survey by ABS
● 1 in 5 had a mental health problem within the preceding 12 months.
● Anxiety disorders (14%) the most common experienced = most frequently reported being
● PTSD (6%).
● Mood disorders were reported by 6% = depression the most common (4%).
● Substance use disorders (5%), harmful use of alcohol (reported by 35%).
● The comorbidity of both mental health & physical disorders, 11.7% of respondents had both a mental
disorder and physical condition.
● People with comorbid conditions are more vulnerable to alcohol and other drug relapses and
subsequently relapse of MH problems.
● Women 22%
● Men 18%
● Younger people were more likely to have a mental disorder than older people, 26% of people aged
16-24 had a disorder compared to 6% of people aged 75-85.
● 54% of those who have been homeless had a health problem (3x the rate than for non-homeless
people).
● Unemployed (29%).
● Incarcerated (41%).
● Psychotic disorders (preceding 12 months) 4-5 people per 1000 population with schizophrenia (47%)
majority males (56.3%).
● Australian Indigenous people have a higher rate of psychological distress and children and adults –
higher hospitalisation than that for other Australians in all age groups (except 0-4) & above 65 years
(AIHW, 2011).
The cost of mental health problems Australian
context
● The cost of mental ill-health in Australia each year was around $4,000 per person, or $60 billion in total
(2016).
● Australian Institute of Health & Welfare (2019) 4.2 million people received mental health-related
prescriptions in 2017-18.
● National recurrent expenditure on mental health-related services was estimated to be around $9.1
billion in 2016–17.
● $5.7 billion was spent on state/territory mental health services in 2016–17;
○ $2.6b on public hospital services; $2.1b on community services.
● $536 million was spent on specialized mental health services in private hospitals in 2016–17.
● Mental ill-health and suicide is, conservatively, in the order of $43 to $51 billion per year.
○ Additional to this is an approximately $130 billion cost associated with diminished health and
reduced life expectancy for those living with mental ill-health.
Disability and mental health
Disability in mental health refers to an individual's impairment in one or more important areas of functioning
● Disability adjusted life years (or DALY’s) are a measure of the burden of ill health obtained by
calculating potential life lost by virtue of being in a state of disability or poor health.
● 2020 - depression - one of the greatest health problems worldwide, second only to heart disease, with
major impact on health services, productivity and economic growth (WHO, 2012).
● The impact of chronic disability (of mental illness) on an individual's life can be measured in days out of
their normal / usual role.
● Mental health problems 3rd among Australian causes of DALYs (13%) of the total – after cancer (19%)
& cardiovascular disease (16%) AIHW (2011).
● Mental health problems are predicted to rank first in 2030 (WHO, 2008).
Productivity commission MH draft report
Mental health and wellbeing of Australia’s population, the prevention and early detection of mental illness, and
treatment for those who have a diagnosed condition.
Inquiry
● early help for people, improving experiences with MH care and beyond the health system,
participation of people, education/work, reforming funding & commissioning services/supports.
Misconceptions about mental health problems
Stigma is more than just a negative connotation, it invokes rejection, stereotyping and discrimination. It often
involves inaccurate and hurtful representations of people who have mental illness.
Perpetuation of stigma
● Community perceptions & attitudes
● Misinterpreted/misrepresented by the media
● Preconceived ideas by person diagnosed (fear of rejection, alienation)
● Dual vulnerability –Mental health stigma & racial stigma
Minimising stigma
● Awareness
● Education self & others
● Language that is positive
● Facilitating social inclusivity practice and behave in an unbiased manner and to minimise stigma
– not perpetuate
In summary
● Nurses and midwives have a responsibility to ensure that they are well informed regarding current
statistics, trends, models and philosophies relating to all areas of mental health.
● Examine your own beliefs, values and perceptions in regard to mental health so as to practice and
behave in an unbiased manner and to minimise stigma – not perpetuate it.
● Social determinants of health have a significant influence on the mental health and wellbeing of
individuals and communities.
● The degree of disability associated with mental disorders influences a person's ability to function in all
aspects of life.
● An appreciation of the prevalence of mental health problems and disorders assists nurses and
midwives to understand the impact of mental disorders on the health outcomes of individuals, families,
the health care system and the demand for and on community services.
● Mental health issues are not confined to patients in the hospital, there are many people in the
community and in the workforce who struggle to cope with their day-to-day lives and this impacts on
them.
NUM1207 1.2 Nursing in Mental
Health – Then & Now
Learning outcomes
● Describe factors behind the changes of asylums to modern day contemporary care.
● Identify historical practices of early treatment for mental illness.
● Describe the history of asylums in Australia and the emergence of mental health nursing as a distinct
profession within Australia.
● Identify the main changes to care from the late 18th century to a more humanistic perspective in modern
day holistic mental health nursing.
● List and describe the different ‘terminologies’ applied to describe a person who may be in the
nurse/midwife’s care.
● Explore the role and identity of the nurse in contemporary mental health service delivery.
Historical overview of MH
● Custodians/attendants ‘of the asylum’
● Historical terms - ‘mad’, ‘insane’ and ‘lunatic’
● Supernatural origins of disease and illness
○ 14th century, witches, exorcisms & spirit possession
● Ancient mental health care
○ The asylum
■ institution where people with a MH condition were housed.
○ Institutionalisation
■ places of suffering, disease, distress and depravity.
■ Notoriously inhumane places to reside.
○ ‘Lunatic asylums’
■ 16th century, not places of healing, but locked penal colonies.
History of MH in Australia
● 1890- MH nursing emerged as a distinct profession with the increased medicalisation of mental health.
● Mid-late 20th century the identification of nursing as a profession emerged as a specialisation in the
field of psychiatry.
The first legislation
● 1843 - Lunacy Act.
● 1887 - First evidence of education for ‘mental nurses’ (Victorian annual report – Kew asylum (Victoria).
● 1958 - Modern MH nursing education commenced in the mid 20th century – Victorian Nurse Act of
1958.
People experiencing mental challenges
Terminology
● Consumer = implies a more active role, person having rights, responsibility and a more equitable
relationship with the health care provider.
● Patient = biomedical model, implication of illness, passive role – recipient of care, not inclusive of care.
People who have ‘experience of mental health challenges’, the person ‘living with mental illness’ is the person
best able to describe their lived experience.
Treatments throughout history
Historical treatments
● Trephination (8000BCE to 600 BCE) drilling of a small hole into the skull.
● Straight jacket (1700’s) confining garment where the patient's arms were strapped securely
across their body.
● Shock treatments (1920’s -1950’s) (insulin, fever, medicine) insulin in large doses was given
over a period of weeks resulting in a coma.
● Lobotomy (1935) surgical intervention that severs the pathways between frontal lobes and
lower regions of the brain.
Changes to care
● The late 18th century saw conditions begin to improve in many asylums, fresh air and
interaction - more humane treatments.
● Talk therapies were developed in an effort to explore an individual's past experiences and
consider the impact of these on their current MH problem.
● Mid 20th century (1950’s) psychotropic medication resulted in a revolution in both the treatment
and care of people with mental health conditions.
● Psychiatry experienced changes in credibility and further interest in psychiatry as a nursing
specialty.
● Late 1980’s deinstitutionalisation of people from facilities.
The role of the nurse & midwife
In contemporary service delivery
● Nurses and midwives will work with people living with mental illness - in diverse contexts and varying
roles.
● Comprehensively trained nurses and midwives will increasingly carry out their work from a;
○ biomedical and interpersonal framework;
○ applying the biopsychosocial approach (person holistically).
● Holistic interpersonal approach which views the relationship that develops between the nurse and
consumer as the central feature of MH nursing.
● The needs of the consumer and support given is based on the identified needs of the person through
collaboration and partnership.
In summary
● Asylums were established in response to an increasing need to contain and segregate people with
mental illness rather than treat them.
● Treatment & care was often barbaric, detrimental to recovery and lead to increased suffering.
● The history of mental health nursing in Australia is linked to psychiatry as a discipline.
● Early treatments were predominantly from a medicalised approach.
● Changes to mental health and education in this area has coincided with more understanding around
the complexities and nature of mental disorders which has led to improved assessments, care,
treatments and a recovery focused practice.
● As nurses and midwives of the future, practice should continue to be evidenced based, compassionate
and of a holistic and person-centered nature.
● Working from a humanistic and holistic values base is the foundation for work in nursing & particularly
mental health in modern day practice.
NUM1207 Module 1.3 Theoretical Frameworks
Underpinning Mental Health Practice
Learning outcomes
● Describe and critique the biomedical psychological and sociological theories of personality and
behaviour.
● Specific developmental issues at different stages of the life span - how they may intersect
● Describe the humanistic orientation to mental health and relevance to nursing/midwifery practice.
● Outline nursing conceptual models (including Peplau’s model) that can be utilised for nursing care
within the mental health setting.
● Develop an understanding of mental health and illness from a theoretical perspective.
● Describe the relationship of psychological and sociological theories and concepts to mental health
problems across the life span approach.
● Describe the application of (bio, psych, social, humanistic) theories to practice in nursing and midwifery
care.
Introduction
● Foundation for understanding mental health problems and psychopathology within the context of
normal human development.
● Specific developmental issues at different stages of the life span - how they may intersect with mental
health and in the development of disorders or in response to adverse/negative situations, events,
trauma.
● Nature v nurture may lead to a ‘hiccup’ in processes and functioning from an early age.
Major viewpoints of personality development or an explanation
of human behavior ?
1. Biomedical
2. Psychodynamic
3. The behavioral/social cognitive orientation
Theories of personality
1.Biomedical model:
a. Result of maintaining an internal psychological equilibrium or balance.
b. ‘Normal’ behaviour represents balance and abnormal behaviour represents dysfunction.
2.Psychodynamic: (Freud)
a. Abnormal behaviour reflects unconscious conflicts within the person.
b. Mental processes and mechanisms may be unhealthy to the person and/or ineffective and
become maladaptive or result in mental or emotional dysfunction.
3.The behavioral/social cognitive orientation
a. Personality is determined by prior learning. Stresses the importance of how the environment or
persons social structure can shape behaviours. (Pavlov, Watson, Skinner, Bandura)
The humanistic orientation
● Approach emphasises the importance of free will and self determination.
● Positive role of emotions such as joy, love and hope in coping with life's problems.
● People possess an innate capacity to develop and grow.
● Person orientated view where the personal consumer cannot be reduced into components of their
parts.
● Sees the person in a holistic sense and the individual as unique in their humanness.
Theorists: Carl Rogers & Abraham Maslow
Relevance to nursing & midwifery practice
● importance of the therapeutic relationship – education and practice.
● concepts such as unconditional positive regard and empathy are central to a person centred focus of
practice.
NUM1207 Module 1.4 Mental Health Promotion,
Prevention & Primary Health Care
Learning outcomes
● Outline the difference between mental illness, mental disorder and mental health problems.
● Describe the impact of mental illness on the individual, family, society.
● Define mental health promotion; and describe the relationship between prevention, promotion, early
intervention and primary health care.
● Examine the key priorities for the action, prevention and promotion of mental health in the community.
● Describe the determinants of mental health and wellbeing and the biopsychosocial approach/model of
mental health care.
● Differentiate between protective factors, risk factors and the stress-vulnerability model that may impact
on a person's mental health and wellbeing.
● Describe the role of mental health promotion and illness prevention in the MH context.
● Acknowledge the importance of early intervention in preventing and minimising the onset of mental
illness and /or reducing its impact (highlight ways to promote mental health).
● Describe the role of the nurse and midwife in the delivery of mental health care in primary health care
services.
● Identify services accessible to people living with mental health challenges in the primary health care
area.
Introduction
● Previous focus on mental health promotion was at a population, community and individual level.
● Focus led to the development on key mental health services with a focus on:
○ mental health promotion
○ illness prevention
○ recovery
○ primary mental health care
● Many factors can impact on mental health and wellbeing, these are out of reach of MH services
specifically (employment, housing, education, social inclusion).
● Multidisciplinary and multi-level approach needed.
Mental Illness, disorder or problem?
Mental Illness
● A person has a mental illness if the person has a condition that:
○ is characterised by a disturbance of thought, mood, volition, perception, orientation or
memory and;
○ significantly impairs (temporarily or permanently) the person’s judgment or behaviour.
Mental disorder comprises a broad range of problems, with different symptoms.
● However, they are generally characterized by some combination of abnormal thoughts,
emotions, behaviour and relationships with others.
1. Exaggeration of feelings, thoughts and behaviours
2. Lose touch with what’s going on around them
3. Thoughts and feelings become disturbed
