Psychiatric and

mental health
nursing

Psychiatric nursing or mental health

nursing is the appointed position of a
nurse that specialises in mental health,
and cares for people of all ages
experiencing mental illnesses or distress.
These include: schizophrenia,
schizoaffective disorder, mood disorders,
anxiety disorders, personality disorders,
eating disorders, suicidal thoughts,
psychosis, paranoia, and self-harm.

Nurses in this area receive specific training

in psychological therapies, building a
therapeutic alliance, dealing with
challenging behaviour, and the
administration of psychiatric medication.

In most countries, a psychiatric nurse will

have to attain a bachelor's degree in
nursing to become a Registered Nurse
(RN), and specialise in mental health.
Degrees vary in different countries, and are
governed by country-specific regulations.
In the United States one can become a RN,
and a psychiatric nurse, by completing
either a diploma program, an associates
(ASN) degree, or a bachelors (BSN)
degree.

Mental health nurses can work in a variety

of services, including: Child and
Adolescent Mental Health Services
(CAMHS), Acute Medical Units (AMUs),
Psychiatric Intensive Care Units (PICUs),
and Community Mental Health Services
(CMHS).

History

Civilian Public Service -93, Harrisburg, Pennsylvania,

psychiatric nursing class (8389167373)

The history of psychiatry and psychiatric

nursing, although disjointed, can be traced
back to ancient philosophical thinkers.
Marcus Tullius Cicero, in particular, was
the first known person to create a
questionnaire for the mentally ill using
biographical information to determine the
best course of psychological treatment
and care.[1] Some of the first known
psychiatric care centers were constructed
in the Middle East during the 8th century.
The medieval Muslim physicians and their
attendants relied on clinical observations
for diagnosis and treatment.[2]

In 13th century medieval Europe,

psychiatric hospitals were built to house
the mentally ill, but there were not any
nurses to care for them and treatment was
rarely provided. These facilities functioned
more as a housing unit for the insane.[2]
Throughout the high point of Christianity in
Europe, hospitals for the mentally ill
believed in using religious intervention. The
insane were partnered with “soul friends”
to help them reconnect with society. Their
primary concern was befriending the
melancholy and disturbed, forming
intimate spiritual relationships. Today,
these soul friends are seen as the first
modern psychiatric nurses.[3]
In the colonial era of the United States,
some settlers adapted community health
nursing practices. Individuals with mental
defects that were deemed as dangerous
were incarcerated or kept in cages,
maintained and paid fully by community
attendants. Wealthier colonists kept their
insane relatives either in their attics or
cellars and hired attendants, or nurses, to
care for them. In other communities, the
mentally ill were sold at auctions as slave
labor. Others were forced to leave town.[4]
As the population in the colonies
expanded, informal care for the
community failed and small institutions
were established. In 1752 the first
“lunatics ward” was opened at the
Pennsylvania Hospital which attempted to
treat the mentally ill. Attendants used the
most modern treatments of the time:
purging, bleeding, blistering, and shock
techniques. Overall, the attendants caring
for the patients believed in treating the
institutionalized with respect. They
believed if the patients were treated as
reasonable people, then they would act as
such; if they gave them confidence, then
patients would rarely abuse it.[4]
The 1790s saw the beginnings of moral
treatment being introduced for people with
mental distress.[5] The concept of a safe
asylum, proposed by Philippe Pinel and
William Tuke, offered protection and care
at institutions for patients who had been
previously abused or enslaved.[5] In the
United States, Dorothea Dix was
instrumental in opening 32 state asylums
to provide quality care for the ill. Dix also
was in charge of the Union Army Nurses
during the American Civil War, caring for
both Union and Confederate soldiers.
Although it was a promising movement,
attendants and nurses were often accused
of abusing or neglecting the residents and
isolating them from their families.[5]

The formal recognition of psychiatry as a

modern and legitimate profession
occurred in 1808.[2] In Europe, one of the
major advocates for mental health nursing
to help psychiatrists was Dr. William Ellis.
He proposed giving the “keepers of the
insane” better pay and training so more
respectable, intelligent people would be
attracted to the profession. In his 1836
publication of Treatise on Insanity, he
openly stated that an established nursing
practice calmed depressed patients and
gave hope to the hopeless.[3] However,
psychiatric nursing was not formalized in
the United States until 1882 when Linda
Richards opened Boston City College. This
was the first school specifically designed
to train nurses in psychiatric care.[6]

The discrepancy between the founding of

psychiatry and the recognition of trained
nurses in the field is largely attributed to
the attitudes in the 19th century which
opposed training women to work in the
medical field.[1]

In 1913 Johns Hopkins University was the

first college of nursing in the United States
to offer psychiatric nursing as part of its
general curriculum. The first psychiatric
nursing textbook, Nursing Mental Diseases
by Harriet Bailey, was not published until
1920. It was not until 1950 when the
National League for Nursing required all
nursing schools to include a clinical
experience in psychiatry to receive national
accreditation.[5] The first psychiatric
nurses faced difficult working conditions.
Overcrowding, under-staffing and poor
resources required the continuance of
custodial care. They were pressured by an
increasing patient population that rose
dramatically by the end of the 19th
century. As a result, labor organizations
formed to fight for better pay and fewer
hours.[3] Additionally, large asylums were
founded to hold the large number of
mentally ill, including the famous Kings
Park Psychiatric Center in Long Island,
New York. At its peak in the 1950s, the
center housed more than 33,000 patients
and required its own power plant. Nurses
were often called “attendants” to imply a
more humanitarian approach to care.
During this time, attendants primarily kept
the facilities clean and maintained order
among the patients. They also carried out
orders from the physicians.[3]

In 1963, President John F. Kennedy

accelerated the trend towards
deinstitutionalization with the Community
Mental Health Act. Also, since psychiatric
drugs were becoming more available
allowing patients to live on their own and
the asylums were too expensive,
institutions began shutting down.[3]
Nursing care thus became more intimate
and holistic. Expanded roles were also
developed in the 1960s allowing nurses to
provide outpatient services such as
counseling, psychotherapy, consultations,
prescribing medications, along with the
diagnosis and treatment of mental
illnesses.[6]

The first developed standard of care was

created by the psychiatric division of the
American Nurses Association (ANA) in
1973. This standard outlined the
responsibilities and expected quality of
care of nurses.[5]

In 1975, the government published a

document called "Better Services for the
Mentally Ill" which reviewed the current
standards of psychiatric nursing
worldwide and laid out better plans for the
future of mental health nursing.[7]

Global health care underwent huge

expansions in the 1980s; this was due to
the government's reaction from the fast
increasing demand on health care
services. The expansion was continued
until the economic crisis of the 1970s.[7]

In 1982, the Area Health Authorities was

terminated.[7]

In 1983, better structure of hospitals was

implemented. General managers were
introduced to make decisions, thus
creating a better system of operation. The
year 1983 also saw a lot of staff cuts
which were heavily felt by all the mental
health nurses. However, a new training
syllabus was introduced in 1982, which
offered suitable knowledgeable nurses.[7]
The 2000s have seen major educational
upgrades for nurses to specialize in
mental health as well as various financial
opportunities.[7]

What the actual term of

Mental Health is
This section needs additional citations for
verification. Learn more

In the end, in order to know what the

Psychiatric nurses do we have to
understand what mental health really is
and who suffers from this. Mental health is
"Emotional, behavioral, and social maturity
or normality; the absence of a mental or
behavioral disorder; a state of
psychological well-being in which one has
achieved a satisfactory integration of
one's instinctual drives acceptable to both
oneself and one's social milieu; an
appropriate balance of love, work, and
leisure pursuits" by Medical News Today.[8]
People of all ages, teenagers, adults, and
the elderly can suffer from mental health
disorders. Statistically, "4.8 percent of all
American adults" (National Institute of
Mental Health),[9] suffer from mental
health problems. The most famous and
occasionally types of Mental Health
problems are Anxiety disorders, Mood
disorders, and Schizophrenia disorders.

Mental health is a state of wellness where

an individual can be productive, work, cope
and contribute to society. Mental health is
not a state where an individual is never
sad, angry, scared, or hurt. There are three
components to mental health: emotional
well-being, psychological well-being and
social well-being (S. Heinz et al., 2015).
Emotional well-being is the interest and
satisfaction with life. Psychological well-
being is for the most part, liking your own
personality, and managing friendships and
responsibilities. Social well-being is being
able to contribute to society and believe it
can be a better place. To add to this
definition, an individual should be able to
express and adjust their emotions in all
situations, be flexible, and have pleasant
relationships (CL, K, n.d).

Interventions
Nursing interventions may be divided into
the following categories:[6]
Physical and biological
interventions
E…

Psychiatric medication E…

Psychiatric medication is a commonly

used intervention and many psychiatric
mental health nurses are involved in the
administration of medicines, both in oral
(e.g. tablet or liquid) form or by
intramuscular injection. Nurse practitioners
can prescribe medication. Nurses will
monitor for side effects and response to
these medical treatments by using
assessments. Nurses will also offer
information on medication so that, where
possible, the person in care can make an
informed choice, using the best medical-
based evidence available.

Electroconvulsive therapy E…

Psychiatric mental health nurses are also

involved in the administration of the
treatment of electroconvulsive therapy and
assist with the preparation and recovery
from the treatment, which involves
anesthesia. This treatment is only used in
a tiny proportion of cases and only after
all other possible treatments have been
exhausted.

A patients consent to receive the

treatment must be established and
defended by the nurse.[10]

Physical care E…

Along with other nurses, psychiatric mental

health nurses will intervene in areas of
physical need to ensure that people have
good levels of personal hygiene, nutrition,
sleep, etc., as well as tending to any
concomitant physical ailments. In mental
health patients, obesity is not rare because
some medications can have a side effect
of gaining weight which can cause the
patient to have low confidence and lead to
other health issues.[11] To fix this problem,
mental health nurses are urged to
encourage patients to get more exercise to
enhance their physical health, along with
their mental health by improving the
patients confidence and lowering stress
levels, improving their mental health which
has been a focus for mental health nurses
because many patients do not get enough
exercise.[11] Nurses may also need to help
the patients with alcohol or drug abuse
because mental health patients are at a
higher risk for this behavior.[11] Mental
health nurses need to be able to
communicate to patients about this. The
alcohol and drug abuse could cause the
patient to also have a higher risk of
sexually transmitted diseases because
alcohol and drugs can lead to more sexual
behavior.[11]

Psychosocial interventions E…
Psychosocial interventions are
increasingly delivered by nurses in mental
health settings. These include
psychotherapy interventions, such as
cognitive behavioural therapy, family
therapy, and less commonly other
interventions, such as milieu therapy or
psychodynamic approaches. These
interventions can be applied to a broad
range of problems including psychosis,
depression, and anxiety. Nurses will work
with people over a period of time and use
psychological methods to teach the
person psychological techniques that they
can then use to aid recovery and help
manage any future crisis in their mental
health. In practice, these interventions will
be used often, in conjunction with
psychiatric medications. Psychosocial
interventions are based on evidence-based
practice, and therefore the techniques tend
to follow set guidelines based upon what
has been demonstrated to be effective by
nursing research. There has been some
criticism[12] that evidence based practice
is focused primarily on quantitative
research and should reflect also a more
qualitative research approach that seeks
to understand the meaning of people's
experience.

Spiritual interventions E…

The basis of this approach is to look at

mental illness or distress from the
perspective of a spiritual crisis. Spiritual
interventions focus on developing a sense
of meaning, purpose, and hope for the
person in their current life experience.[13]
Spiritual interventions involve listening to
the person's story and facilitating the
person to connect to God, a greater power
or greater whole, perhaps by using
meditation or prayer. This may be a
religious or non-religious experience
depending on the individual's own
spirituality. Spiritual interventions, along
with psychosocial interventions,
emphasize the importance of engagement,
however, spiritual interventions focus more
on caring and 'being with' the person during
their time of crisis, rather than intervening
and trying to 'fix' the problem. Spiritual
interventions tend to be based on
qualitative research and share some
similarities with the humanistic approach
to psychotherapy.

Therapeutic relationship E…

As with other areas of nursing practice,

psychiatric mental health nursing works
within nursing models, utilising nursing
care plans, and seeks to care for the whole
person. However, the emphasis of mental
health nursing is on the development of a
therapeutic alliance.[14] In practice, this
means that the nurse should seek to
engage with the person in care in a positive
and collaborative way that will empower
the patient to draw on his or her inner
resources in addition to any other
treatment they may be receiving.[14]

Therapeutic relationship aspects of

psychiatric nursing
E…

In 1913, Johns Hopkins University was the first

college of nursing in the United States to offer
psychiatric nursing as part of its general curriculum.
The most important duty of a psychiatric
nurse is to maintain a positive therapeutic
relationship with patients in a clinical
setting. The fundamental elements of
mental health care revolve around the
interpersonal relations and interactions
established between professionals and
clients. Caring for people with mental
illnesses demands an intensified presence
and a strong desire to be supportive.[15]

Understanding and empathy E…

Understanding and empathy from
psychiatric nurses reinforces a positive
psychological balance for patients.
Conveying an understanding is important
because it provides patients with a sense
of importance.[16] The expression of
thoughts and feelings should be
encouraged without blaming, judging, or
belittling.[17] Feeling important is
significant to the lives of people who live in
a structured society, who often stigmatise
the mentally ill because of their
disorder.[18] Empowering patients with
feelings of importance will bring them
closer to the normality they had before the
onset of their disorder. When subjected to
fierce personal attacks, the psychiatric
nurse retained the desire and ability to
understand the patient. The ability to
quickly empathise with unfortunate
situations proves essential. Involvedness
is also required when patients expect
nursing staff to understand even when
they are unable to express their needs
verbally.[15] When a psychiatric nurse gains
understanding of the patient, the chances
of improving overall treatment greatly
increases.
Individuality E…

Individualised care becomes important

when nurses need to get to know the
patient. To lives this knowledge the
psychiatric nurse must see patients as
individual people with lives beyond their
mental illness. Seeing people as
individuals with lives beyond their mental
illness is imperative in making patients feel
valued and respected.[19] In order to
accept the patient as an individual, the
psychiatric nurse must not be controlled
by his or her own values, or by ideas, and
pre-understanding of mental health
patients.[20] Individual needs of patients
are met by bending the rules of standard
interventions and assessment. Psychiatric
nurses spoke of the potential to 'bend the
rules', which required an interpretation of
the unit rules, and the ability to evaluate
the risks associated with bending them.[21]

Providing support E…

Successful therapeutic relationships

between nurses and patients need to have
positive support. Different methods of
providing patients with support include
many active responses.[18] Minor activities,
such as shopping, reading the newspaper
together, or taking lunch or dinner breaks
with patients can improve the quality of
support provided.[22] Physical support may
also be used and is manifested through
the use of touch.[22] Patients described
feelings of connection when nurses
hugged them or put a hand on their
shoulder.[18] Psychiatric nurses in Berg and
Hallberg's study described an element of a
working relationship as comforting
through holding a patient's hand.[15]
Patients with depression described relief
when the nurse embraced them.[16]
Physical touch is intended to comfort and
console patients who are willing to
embrace these sensations and share
mutual feelings with nurses.

Being there and being available E…

In order to make patients feel more

comfortable, the patient care providers
make themselves more approachable,
therefore more readily open to multiple
levels of personal connections. Such
personal connections have the ability to
uplift patients’ spirits and secure
confidentiality. Utilisation of the quality of
time spent with the patient proves to be
beneficial. By being available for a proper
amount of time, patients open up and
disclose personal stories, which enable
nurses to understand the meaning behind
each story.[20] The outcome results in
nurses making every effort to attain a non-
biased point of view.[20] A combination of
being there and being available allows
empirical connections to quell any
negative feelings within patients.

Being genuine E…
The act of being genuine must come from
within and be expressed by nurses without
reluctance. Genuineness requires the nurse
to be natural or authentic in their
interactions with the patient.[23] In his
article about pivotal moments in
therapeutic relationships, Welch found that
nurses must be in accordance with their
values and beliefs.[24] Along with the
previous concept, O’Brien [25] concluded
that being consistent and reliable in both
punctuality and character makes for
genuinity. Schafer and Peternelj-Taylor [19]
believe that a nurses 'genuineness' is
determined through the level of
consistency displayed between their verbal
and non-verbal behaviour. Similarly,
Scanlon[26] found that genuineness was
expressed by fulfilling intended tasks. Self-
disclosure proves to be the key to being
open and honest.[27] It involves the nurse
sharing life experiences and is essential to
the development of the therapeutic
relationship, because as the relationship
grows patients are reluctant to give any
more information if they feel the
relationship is too one sided.[27] Multiple
authors found genuine emotion, such as
tearfulness, blunt feedback, and straight
talk facilitated the therapeutic relationship
in the pursuit of being open and honest.[18]
The friendship of a therapeutic relationship
is different from a sociable friendship
because the therapeutic relationship
friendship is asymmetrical in nature.[18]
The basic concept of genuineness is
centered on being true to one’s word.
Patients would not trust nurses who fail in
complying with what they say or promise.

Promoting equality E…
For a successful therapeutic relationship
to form, a beneficial co-dependency
between the nurse and patient must be
established. A derogatory view of the
patient’s role in the clinical setting
dilapidates a therapeutic alliance. While
patients need nurses to support their
recovery, psychiatric nurses need patients
to develop skills and experience.[28]
Psychiatric nurses convey themselves as
team members or facilitators of the
relationship, rather than the leaders.[18] By
empowering the patient with a sense of
control and involvement, nurses encourage
the patient's independence.[18] Sole control
of certain situations should not be
embedded in the nurse. Equal interactions
are established when nurses talk to
patients one-on-one. Participating in
activities that do not make one person
more dominant over the other, such as
talking about a mutual interest or getting
lunch together strengthen the levels of
equality shared between professionals and
patients. This can also create the "illusion
of choice"; giving the patient options, even
if limited or confined within structure.[29]
Demonstrating respect E…

To develop a quality therapeutic

relationship, nurses need to make patients
feel respected and important.[20]
Accepting patient faults and problems is
vital to convey respect—helping the patient
see themselves as worthy and
worthwhile.[17]

Demonstrating clear boundaries E…

Boundaries are essential for protecting

both the patient and the nurse, and
maintaining a functional therapeutic
relationship. Limit setting helps to shield
the patient from embarrassing
behaviour,[30] and instills the patient with
feelings of safety and containment.[22]
Limit setting also protects the nurse from
"burnout”,[22] preserving personal stability—
thus promoting a quality relationship.

Demonstrating self-awareness E…

Psychiatric nurses recognise personal

vulnerability in order to develop
professionally.[23] Humanistic insight, basic
human values, and self-knowledge
improves the depth of understanding the
self.[31] Different personalities affect the
way psychiatric nurses respond to their
patients. The more self-aware, the more
knowledge on how to approach
interactions with patients nurses have.[25]
Interpersonal skills needed to form
relationships with patients were acquired
through learning about oneself.[26] Clinical
supervision was found to provide the
opportunity for nurses to reflect on patient
relationships,[32] to improve clinical
skills,[31] and to help repair difficult
relationships.[33] The reflections [20]
articulated by nurses through clinical
supervision help foster self-awareness.

Condition

Canada E…

The registered psychiatric nurse is a

distinct nursing profession in all of the four
western provinces. Such nurses carry the
designation "RPN". In Eastern Canada, an
Americanized system of psychiatric
nursing is followed. Registered Psychiatric
Nurses can also work in all three of the
territories in Canada; although, the
registration process to work in the
territories varies as the psychiatric nurses
must be licensed by one of the four
provinces.

Ireland E…

In Ireland, mental health nurses undergo a

4-year honors degree training programme.
Nurses that trained under the diploma
course in Ireland can do a post graduation
course to bring their status from diploma
to degree.
New Zealand E…

Mental Health Nurses in New Zealand

require a diploma or degree in nursing. All
nurses are now trained in both general and
mental health, as part of their three-year
degree training programme. Mental health
nurses are often requested to complete a
graduate diploma or a post graduate
certificate in mental health, if they are
employed by a District Health Board. This
gives additional training that is specific to
working with people with mental health
issues.
Sweden E…

In Sweden, to become a registered

psychiatric nurse one must first become a
registered nurse which requires a BSc.
(Bachelor of Science) in Nursing (three
years of full-time study, 180 higher
education credits). Then, one must
complete one year of graduate studies in
psychiatric/mental health nursing (60
higher education credits), which also
includes writing a MSc. (Master of
Science) thesis.[34] The registered
psychiatric nurse is an evolving profession
in Sweden. However, unlike in countries
such as the US, there is no psychiatric-
mental health nurse practitioner, so in
Sweden, the profession cannot for
example prescribe pharmacological
treatment.[35] Studies indicatet that the
nurses themselves wish for such clinical
ladder programs to recognize and
motivate the continuing professional
development of their profession.[36]

UK E…
In the UK and Ireland the term psychiatric
nurse has now largely been replaced with
mental health nurse. Mental health nurses
undergo a 3-4 year training programme at
Bachelor's degree level, or a 2 year training
programme at Master's degree level, in
common with other nurses. However, most
of their training is specific to caring for
clients with mental health issues.

RMNs can continue into further training as

Advanced Nurse Practitioners (ANPs): this
requires completion of a 9 month Master's
programme. The role includes prescribing
medications, being on call for hospital
wards and delivering psychosocial
interventions to clients.

US E…

In North America, there are three levels of

psychiatric nursing.

The licensed vocational nurse (licensed

practical nurse in some states) and the
licensed psychiatric technician may
dispense medication and assist with
data collection regarding psychiatric
and mental health clients.
The registered nurse or registered
psychiatric nurse has the additional
scope of performing assessments and
may provide other therapies such as
counseling and milieu therapy.
The advanced practice registered nurse
(APRN) either practices as a clinical
nurse specialist or a nurse practitioner
after obtaining a master's degree in
psychiatric-mental health nursing.
Psychiatric-mental health nursing
(PMHN) is a nursing specialty. The
course work in a master's degree
program includes specialty practice.
APRN’s assess, diagnose, and treat
individuals or families with psychiatric
problems/disorders or the potential for
such disorders, as well as performing
the functions associated with the basic
level.[37] They provide a full range of
primary mental health care services to
individuals, families, groups and
communities, function as
psychotherapists, educators,
consultants, advanced case managers,
and administrators. In many states,
APRN’s have the authority to prescribe
medications. Qualified to practice
 independently, psychiatric-mental health
APRN’s offer direct care services in a
variety of settings: mental health
centers, community mental health
programs, homes, offices, HMOs, etc.

Psychiatric nurses who earn doctoral

degrees (PhD, DNSc, EdD) often are found
in practice settings, teaching, doing
research, or as administrators in hospitals,
agencies or schools of nursing.

Australia E…
In Australia, to be a psychiatric nurse a
bachelor's degree of nursing need to be
obtained in order to become a registered
nurse (RN) and this degree takes 3 years
full-time.[38] Then a diploma in mental
health or something similar will need to
also be obtained, this is an additional year
of study. An Australian psychiatric nurse
has duties that may include assessing
patients who are mentally ill, observation,
helping patients take part in activities,
giving medication, observing if the
medication is working, assisting in
behaviour change programs or visiting
patients who are at home. Australian
nurses can work in public or private
hospitals, institutes, correctional institutes,
mental care facilities and homes of the
patients.[39]

See also
List of counseling topics
Mental health professional
Psychiatric and mental health Nurse
Practitioner
Hildegard Peplau - psychiatric nurse
theorist
 Tidal Model - model developed for
mental health nursing

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External links
"Mental Health Nurse Job Profile" .
"Nursing Interview Questions and Best
Answers" .
"Nurse Job Interview Tips" .
"The Nursing and Midwifery Council's
Code of Conduct" .
"Compassion in Practice: The 6Cs of
Nursing" .
"Training to Be a Mental Health Nurse" .
"Creating a Nursing Portfolio" .
"A Day in the Life of a Psychiatric
Nurse" .
"Nursing Careers: A Career in Mental
Health Nursing" .
"The Guardian's Healthcare
Professionals Network" .
"The Guardian's Mental Health
Network" .
Keyes, Corey L. M. (July 2006). "Mental
health in adolescence: Is America's
youth flourishing?". American Journal of
Orthopsychiatry. 76 (3): 395–402.
doi:10.1037/0002-9432.76.3.395 .
PMID 16981819 .
Galderisi, Silvana; Heinz, Andreas;
Kastrup, Marianne; Beezhold, Julian;
Sartorius, Norman (2015). "Toward a
new definition of mental health" . World
Psychiatry. 14 (2): 231–233.
 doi:10.1002/wps.20231 .
PMC 4471980 .

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