Psychiatric and mental health nursing

One of the most prominent subfields of nursing to emerge since the end of World War II is that of psychiatric and mental health nursing, which involves assessing, diagnosing, managing, and treating a wide array of mental disorders, including schizophrenia, substance abuse, bipolar disorder, depression, and early-onset dementia. Following the development of psychoanalysis in the 1890s, the field of psychiatric health itself has expanded greatly as researchers and counselors began to study and treat mental disorders with increased rigor. In addition, cutting-edge studies gave nuance and depth to what had largely been stereotypes and simplifications of individuals suffering from various mental disorders. Since 1950, psychiatric research has largely redefined the nature of mental disorders and has classified dozens of mental conditions that previously had not been recognized as clinical conditions.

Psychiatric and mental health nurses help support individuals with mental illness as well as their families. In addition, these nurses can be part of group counseling programs, and they often can work within communities to promote mental health awareness. Unlike traditional nurses who assist in hospitals and clinics to treat physical trauma and illness that can show improvements relatively quickly, psychiatric and mental health nurses help to manage and treat mental illnesses, many of which require long-term care or even lifetime management. That puts particular stress on the profession, leading to high turnover rates. The need for certified psychiatric and mental health nurses far exceeds the number of qualified and available nurses.

Background

The emergence of the psychiatric and mental health nursing field reflects a revolution in treating mental health disorders. For centuries, mental disorders were not considered illnesses. Doctors (and families, for that matter) rarely saw effective treatment as an option—people with severe mental illness were typically housed apart from the community in specially designed hospitals or care programs. Within this medical paradigm, the job of a nurse was largely to administer medicine to sedate patients as a way to prevent them from hurting themselves or others. By the mid-nineteenth century, conditions in such hospitals had degraded to the point that radical reform of such facilities emerged as a major social activism campaign in both the United States and Europe.

When mental illness began to be more extensively researched in the mid-1950s, the medical field began to recognize how many more people were suffering from mental disorders than those with the most severe cases who had been placed into special institutionalized facilities. Indeed, in 2010, the World Health Organization (WHO) defined mental health as the number-one health problem worldwide. The WHO estimated that 40 percent of the world’s population struggles with some type of mental health issue. Common mental health problems include depression, alcohol and drug addiction, Alzheimer’s disease, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, eating disorders, personality disorders, and a variety of anxieties and stress-related illnesses that can be manifested in such symptoms as insomnia, mood swings, panic attacks, low self-esteem, poor diet, social isolation, and physical manifestations such as headaches and chronic pain. The WHO further estimated that one-fifth of the adult population in the United States over the age of eighteen, or just under 50 million people, were receiving treatment for mental health problems.

This number may, in fact, be lower than the total number of adults suffering from mental illness. Indeed, the WHO estimated in 2017 that even in high-income countries, nearly 50 percent of those with depression were not receiving treatment. Given the stigma associated with mental health, many people resist seeking help and instead try to handle the symptoms on their own. In addition, facilities equipped to help and doctors and nurses trained in the field are not readily accessible, particularly in rural areas, and long-term treatment can be difficult to secure. Insurance carriers do not always cover the high costs of long-term mental health treatment; the Mental Health Parity Act requires that insurers not provide less favorable terms for mental health services than for physical health services if they do provide mental health coverage, but the law does not mandate that they provide such coverage in the first place. All of these factors contribute to a situation in which many of those who most need mental health services are not receiving them.

Psychiatric and Mental Health Nursing Today

Psychiatric and mental health nursing is considered an advanced specialty, and in contrast to most registered nurses, practitioners often have master’s or doctoral degrees. Certification for mental health nurses is offered by the American Nurses Credentialing Center. Mental health nursing involves a broad range of treatment, termed biopsychosocial—as the word indicates, mental health nursing draws on biology, psychology, and sociology. Nurses who enter the mental health care field function in a number of interrelated capacities within clinical treatment. Psychiatric mental health advanced practice registered nurses provide primary care services in the form of counseling, patient assessments, and regular psychotherapy sessions. In directing this therapy regimen, psychiatric and mental health nurses develop a plan of care and evaluates it for its effectiveness in addressing the patient’s symptoms.

Advanced mental health nurses, those with master’s or doctoral degrees, can also prescribe psychiatric medications to enhance the chances of success. Nurses carefully observe the effect of such medications over the term of patient care and can adjust dosages or prescribe different medications according to the individual patient’s progress or side effects. Mental health nurses also work with the families of patients and encourage that network of support as crucial to long-term treatment success.

The psychiatric and mental health care nurse recognizes the levels of complexity that create mental health disorders and, thus, works with a patient’s body and mind as well as with the larger community within which that patient lives to help that patient live the most productive and rewarding life possible.

Bibliography

Curtis, Catherine, and Audra Baker. Psychiatric Mental Health Nursing Success. 2nd ed. Philadelphia: Davis, 2013. Print.

Hogan, Maryann, et al. Mental Health Nursing. 3rd ed. New York: Pearson, 2012. Print.

"Psychiatric-Mental Health Nurses." American Psychiatric Nurses Association. APNA, n.d. Web. 28 Sept. 2016.

Reynolds, W. and D. Cormack. "Psychiatric and Mental Health Nursing: Theory and Practice." Psychiatric and Mental Health Nursing. Ed. William Reynolds. New York: Springer, 1990. 3–22. Print.

Townsend, Mary C. Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. 6th ed. Philadelphia: Davis, 2013. Print.

Townsend, Mary C. Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. 8th ed. Philadelphia: Davis, 2014. Print.

Varcarolis, Elizabeth M. Essentials of Psychiatric Mental Health Nursing. 2nd ed. Philadelphia: Saunders, 2014. Print.

Womble, Donna. Introductory Mental Health Nursing. 3rd ed. Philadelphia: LWW, 2015. Print.