Mental Health Nursing 2: 2010 Open Book Exams
1.1 Approved mental health
Approved mental health service is a premise where treatment of patient is to be given has been bestowed on the Governor in council. This can be a physical building, place, or service to be rendered. For any premise to receive such acclamation, it must have satisfied the laid procedures according to the act (Hatfield, & Lefley, 1993).
1.2 Community treatment
Community treatment order is an invocation requiring the patient to acquire treatment for the condition but is not detained. It happens when an authorized mental medical practitioner makes such an order to a person under treatment contrary to their will. This happens when the doctor ascertains that the individual has been diagnosed as a mentally unfit person .The treatment for the person is therefore done under the order.
1.3 Community visitor
A community visitor is to be appointed by recommendation of the minister (Thompson, 1993). The governor council will make the appointment for the areas .necessitating each appointee to hold office for a period of three years and can be eligible for the same post at the expiry of the same and is entitled to allowances as the job therefore demands.
1.4 Involuntary patient
The term involuntary patient means an individual who has been subjected to treatment without his consent with the inclusion of those on community treatment. It also refers to those in restricted non-consensual treatment with the inclusion of community treatment under restriction. The involuntary patient can also be an individual who is under a hospital transfer order, a person under examination order or diagnosis for examination and treatment. In some cases, there are persons who are detained and treated .This applies to patients who have not been identified by an approved mental health service to be under treatment.
1.5 Mental Illness
Mental health is a terminology used to refer to some level of recognition or the emotional sanity. It involves a person’s ability to have a relatively balanced life and being aware of their abilities .The ability to balance life challenges and the joys it brings. It is a holistic approach to what shapes a human being; religion, political psychological educational, clinical, social, personal though in most cases it can be explained in social terms.
1.6 Mental health review board
Mental health review board is a body appointed by the Governor in council with its president holding office for a period of 5 years. The body is to be constituted of a president and other members as may be necessary. The president can be reappointed but the other members cannot. In his appointment, he must have respect for the obligations and duties for which the body was made for .The board appointment should have respect for equality in gender. Should any member be incapacitated to perform his duties, an acting qualified member will be appointed through the same criteria. The acting member has all the powers to act on behalf of the incapacitated person. If the period expires in the middle of a session, his term is liable to continuity until such a time when the season ends. This applies to both an acting member and the incapacitated member. The removal of any member is done by the appointing office after consulting with the relevant office (Victoria Mental Health Review Board, 2000).
2.0 Using your reading of the Victorian MH Act explain the involuntary admission process for a person who is suspected to have a mental illness. Ensure you mention the correct forms that will be required
A person is said to be mentally ill if he turns down, accepts or due to attempt fails to express his opinions on political or religious matters. This individual may lack any religion affiliation .it can also be an opinion on philosophy, sexual matters. The sexual matters refer to sexual orientation or preference. Such an individual can take part or refuse to be apart of a political or a religion activity. An unstable person can also be deduced to be mentally ill if they engage in sexual promiscuity or immoral activities like crime. This can only be said to be true if the person is not under any drug that may present the individual with the said symptoms (Hatfield, & Lefley, 1993).
Mostly involuntary patients are taken to hospital by people who question their behaviors owing to a crime or a family member who has observed strange characteristics. The patient is recommended to a psychiatrist who does the examination and releases his finding within twelve hours. If he finds him to be mentally unsound, he is recommends to another doctor to verify the results .The individual is then taken to a magistrate at the next opportunity at this point the person is detained pending further analysis. The medical practitioner must therefore explain to the person reasons as to why he is being be detained, if he can substantiate that he is unable to understand he should arrange for a language or a sign that he best understands. What follows is the magistrate proceedings this to determine if the person needs detention. The magistrate must also ensure that the patient was issued with the written document stating their rights and the family of friends has been notified of the outcome.
At this point, they will ascertain any cultural indulgence or medication that may have caused the behavior .The magistrate is at liberty to detain the person to up to three months under medical care or release them. If he does not he should issue a community treatment order. He can also adjourn the court for a person not exceeding 14 days. The mentally challenged person is then informed of the hearing. After he is admitted, the hospital should notify him of his hearing. A close friend or relative must be informed as well. The patient will be presented with a lawyer from the mental health advocacy service who is normally free but the patient can have his own if he so wishes. If the patient is of the view he no longer needs to be in a hospital they should explain where they plan to stay and to assess the hospital (Berger, 1981).
The magistrates will have a copy of the Patient file in the hearing. He will be in the court accompanied by his lawyer and a close friend or relative .At this point the magistrate is expected to make his ruling .If he feels he needs to stay he will be issued with the community order paper. If a patient is to be released, the magistrate will do so but if he feels, otherwise he can delay the release for fourteen days. If he feels he needs to stay, he will be placed on a temporal patient order, which has maximum of three months. If at the end of the three months, they still need to stay by the end of order he will attend hearing again with the mental health review tribunal to determine the extended stay (Callaway, 2002).
3.1. Carer of a family member who has a mental illness
This is the person who takes the responsibility of taking carte of the mentally disturbed person. He is also primary support the patient either in whole or substantially for cash benefits
3.2 Community Mental Health Nurse
A person authorized by the mental health board under the Act to handle the patient under the condition.
3.3 General Practitioners
It means a person who is a medical practitioner under the health Act 2005. but who is not specific to his role.
A person appointed by the board to handle the files of mentally disturbed. He compiles all the necessary documents for the hearing.
Refers to a person appointed to represent the patient before the magistrates. That is if he is a legal consultant. But if the individual is a medical consultant is any individual described in the act to possess the necessary requirement to act in that capacity.
4.0 Once a person has been received under the MH Act under what circumstances can an emergency registrar administer sedation?
The person has to give consent to the treatment; the consent is given after the psychiatrist has given clear details of the condition to enable him made concrete decision on the issue. The information conveyed to him must be free from any exaggeration or concealment. The patient should also be informed of alternative form of treatment and all his questions answered to the satisfaction. The patient is entitled to disclosure ensuring he has been briefed of the financial matters by the practitioner who proposes to do the treatment.
5.0 A patient must be seen by a Psychiatrist to confirm admission as an involuntary patient. Once a patient is received what time frame must be observed for the Psychiatric review?
The mentally ill individual should be issued with the prescribed printed statement which contains his rights .The patient is at liberty to withdraw their consent or seek a second opinion from another doctor. He may also discontinue the treatment if he so wishes. The statement contains relevant information as appertains to the treatment. He is also entitled to verbal explanation of the information in the statement. Should the doctor sense that he does not understand or is incapable to understand he should try to use the mode that he best understands (Quigley, 2007).
6.0 If a person is discharged from the inpatient unit on a Community Treatment Order, what restrictions can be placed on the patient?
The statement should therefore be in a language he understands once a patient has been received, the psychiatrist is supposed to issue duration. This in most case is not more than 12 months. He is also supposed to give specific information regarding where he should live if it is necessary. If the expiry of the duration authorized by the psychiatrist expires and the post examination still indicates mental unsoundness, the treatment for the condition can still be obtained by extension of the order. The extension takes effect from the time that the psychiatrist authorizes the treatment. Notably is that there is no limit to the number of times the order may be administered if the doctor is sure that it is necessary.
7.0 How often must a Community Treatment Order be reviewed and what is the maximum length of time a Community Treatment Order can be imposed?
If the doctor considers it fit to extend the order, he should inform the patient of the extension of the order and give him a copy of the same. He should explain to the patient the circumstances that led to the extension of the order. The question of how often a community be reviewed depends entirely on how the progress of the patient is. The maximum time it can be administered is only one year (Berger, 1981).
8.0 What is a Special Warrant and what powers does this provide?
A special warrant of arrest is a warrant given when a member of a police force has reasons enough to believe that a mentally ill person is incapable of caring for themselves he does so through taking an oath before a magistrate. After receiving such information, he may direct a member of the police force accompanied by psychiatrist to visit and ascertain the claims by examining him (Hatfield, & Lefley, 1993).
The directive is therefore a special warrant form. The special warrant allows him to gain access to enter any premises and use force as necessary to enable the psychiatrist carry out his examination. A patient can be detained in a private mental institution as an involuntary patient but this is done with the consent of the person or a close family member after satisfactorily satisfying that there is need to do so.
Question 9: True or False
10.0 List 10 of the reasons why a person is not to be considered to have a mental illness and write a brief paragraph explaining why this is for each of these 10 reasons
10.1 If he is under medication
There are some drugs that have serious side effects that make individuals behave in a manner likely to suggest they are not mentally sound .However, this are temporal effects that disappear almost immediately after the withdrawal of the drug.
10.2 If he is under the influence of alcohol
Alcohol contains substances that alter the like-minded people to respond to situation or behave as if they are not conscious of the behavior. Such a person cannot be said to be mentally ill. Advancement of consumption of alcohol can permanently disorient the brain making it likely to cause mental illness.
10.3 If he fails to have an opinion on political issue
There are people by way of their nature refuse to make known their beliefs or opinions on politics. Such people cannot be considered to have a mental illness and may be oblivious of being questioned for their lack of opinions and information to support their line of argument or are simply ignorant of the topic.
10.4 If a person fails to express his sexual orientation
Because of culture or fear of being sidelined, some people are shy to express their sexual orientation or sexual preference. Others are simply into other topics they consider important other than sexual stuff .For these reasons they are not to be considered as having a mental illness.
10.5 If a person is antisocial
If a person is anti social and he refuses to be part of a group, he may also refuse to share his opinions and belonging making him appear withdrawn from conversation. This individual cannot be considered to be mentally disabled.
10.6 If an individual is intellectually disabled
There are people by the decision they may attract scrutiny and questions from the like-minded people. Such people cannot be said to be mad because they are conscious of their environment. They are only offside on the matters of making decisions that are wise.
10.7 If a person is immoral
People who trade their body for money or move from one sexual partner to another cannot be said to be mad because they are conscious of their actions. They are only pushed to the activity by the circumstance of life or by reasons well known to them
10.8 That a person has a particular economic or social status
A poor person or a dirty person cannot be said to be mentally unstable just because he cannot satisfy the social standards set by the society. If a person fails to meet his obligations in terms of finances or hygiene, he cannot be termed as having a mental illness.
10.9 If he fails to own up to any religion
There are people who fail to subscribe to any religion because of reasons occurring in their lives. They have no spiritual affiliation and refuse to acknowledge to the existence of any. Others may be in strange religion that perform funny rituals but are ware of their actions. Some religions may cause one to live a life so separate from what is widely acceptable
10.10 Individuals who refuse to be a part of political movement or activities
Due to the nature of politics, some people refuse to engage in political activities owing to broken promises and trustworthiness .This is because of the nature of their beliefs or their line of work. They cannot be termed as having a mental ill ness because of this.
11.0 An involuntary patient is found dead in a seclusion room by you? What is a reportable death and what are the responsibilities of the registered nurse?
A registered nurse means an individual who is authorized to be a nurse. Under the medical act, her role is to be a mediator and advocate of the patient. Her roles are to inform the authorized psychiatrist of any improvement of the patient. He should inform the proper of the death. A reportable death is a death that happens when no one is in the vicinity of the patient.
12.0 List the Axis contained within the DSM-IV (TR) and provide details of the focus of each including an example of a diagnosis that might be found on each of the Axis.
Axis 1 deals with the clinical disorders, which includes mental and learning disorders. The characteristics are anxiety, depression, phobia, bipolar disorder, ADHD, autism spectrum disorders, phobias, and schizophrenia.
Personality disorder is included in Common disorder axis 11 characterized by paranoism avoidant, dependant obssessive compulsive narcissistic, antisocial all of which are personality disorders.
Axis 3 is explained as having acute medical condition and physical disorders .It involves having a brain injury and other medical/physical disorders that may make existing diseases worse
An axis 5 disorder is caused by psychosocial and environmental factors .e.g. social, economic or criminal barriers. If a patient cannot be able to meet his basics needs e.g. a home he is put in foster care.
Axis 6 is the global evaluation of functioning or for children under the age of 18 years .It is the score given on a sore card of between zero to 100 and is used to generate a mental report of the health of a person. The score shows a healthy patient if it is higher.
13.0 Search the World Wide Web for Hildegard Peplau and do a search for her publication. Write at least 4 pages about her life, her theoretical frameworks, her publications and her major contributions to Mental Health Nursing.
Hildegard Peplau was born in Pennsylvania and upon graduation she worked in the operating room as a supervisor after attaining her B.A and later M.A in psychiatric nursing, she died in her home at the age of 89 after a short illness. She is a woman dedicated at her work and gave her very best. In one of the paper she presented in 1958, she notes that the internet had linked so much between people who came together to share knowledge. She advanced many theories and literature in her field. One of the journals she published was on therapeutic effect. She defined it as the effect of any type of treatment one receives whether the results were expected or not. She noted that the difference in the effects is made up of the nature of the ailment however there is no much difference between therapeutic effect and side effect.
She contributed to the many theories among them the interpersonal relations model. She defined an interpersonal relationship as being an association between two individuals. It can be based on anything like love or business. They could be neighbors, workmates or members of the same church governed by law, doctrines just to mention a few. Some interpersonal relationships are not healthy .People are of the opinion that a relationship is either romantic or that of a child to a parent however a relationship between a pastor and his congregation or mayor and his town of governance is also a relationship in itself. . This is so because of some level of interdependence (Huey, 1975).
Further, she explained the interpersonal skills defining those recognized by law and those of blood. She highlighted kinship ties and the level of interdependence they pose on each other. She noted communication to be the key aspect of this relationship and has two be a two-way traffic with both the parties respecting the union have to be a part of. The disparity, in the communication chain varies with whomever we are communicating with. The transmission mechanism has five elements where the message is sourced, encoded in a channel, where the signal is carried to the receiver, decoded upon destination and untimely where the message ends up.
She looked at the graduation of relationship. From a mere friendship to major liking that leads to soul mates. She exploited the sexual relationships that are present, giving them identity according to what the parties are deriving from them. She also pointed out the roles of a nurse, which according to her were primary roles. She explained this roles noting that when the nurse first met her patient he was stranger to him, he must therefore transfer information to her that makes her the resource manager. The nurse sometimes stands in for him thus adopting the role of a surrogate. She is remembered as the founder of psychiatric nursing because of her contributions and the role she played to ensure that advancement of education and the standards of the practice was above the scale. Through her theory of interpersonal skill, and its significance in offering therapeutic balance she coined the remedy for the psychiatric treatment.
She discussed four experiences that are felt in response to treatment. These are needs, frustration, conflict, and anxieties. She identified the stages of the relationship as orientation, identification, exploitation and resolution (Tomey, & Alligod, 2006). Her support for the mentally incapacitated, her works to improve the relationship between patients and the nurses so that they are more comfortable with each other .She wore many hats as a writer, innovator and a nurse. She was a legend and faced life with courage even with her own problems she led the association of the American nurses as their president and steered the world of nurses with so much conviction. She was a nurse for almost fifty years and the changes she influenced many in her field long after she is gone .She is quoted saying that the test of a good idea is tested by the staying power. She participated in formulating many policies for the government. Even in retirement, she continued to work as a visiting professor in the university and advisor to the world health organization (Holland, 1977).
She received nine honorary doctorates and later was recognized by the American Nurses Association upon when they launched the Hildegard Peplau Award to ward her contribution to the profession. Among other honors she received were nursing highest honors and the christiane Reimann prize. She was also recognized among other 50 great Americans, the only nurse to ever enter the list. Hildegard E. Peplau was truly a legend (Forchuk, C, & Peplau, E, H, 1993).
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