Mental Health Assessment and Interventions

This assignment delves into the field of mental health assessment, covering topics like evidence-based interventions for individuals with mental illnesses, multicultural considerations in assessment, forensic mental health evaluations, physical examination techniques relevant to mental health, and the use of art therapy. It examines research findings, case studies, and best practices in assessing and treating diverse populations within mental health settings.

Mental Health Assessment 1
Mental Health Assessment
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Introduction
Nursing was defined over fifty years ago as a “significant, therapeutic, interpersonal process” which
focused on what nurses do, when Peplau (cited in Barker) developed it over the years. Consider the
American Nurses Association definition which revolves around diagnostic and treatment oriented
procedures to real or potential mental health issues. Assessment forms the foundation of nursing care.
According to Tim Coombs (2014), in Australia the codification of comprehensive assessment is the
competency for nursing practice.
Standards of assessment and practice are less clear. Coombs has set about defining the process and
content of comprehensive nursing assessment for patients with mental disorders. Ryan et al (2006 cited
in Coombs 2014) have documented that nurses are required to carry out assessments in community
settings, not only inpatient units. Woolford and et. al., (2015) has found in a survey of 118 nurses that
93% saw assessment as moderate to critical in nursing roles. Competencies for registered nurses as per
the Australian Nursing and Midwifery Council (2006, p.5) also highlight the importance of
“comprehensive and systematic” nursing assessment.
Standard physical and social assessment and a mental status exam were earlier stresses upon. But as
per the Australian College of Mental Health Nurses Inc (2010), assessment appears in relation to
cultural factors. Effective care involves assessing all aspects of the patient's needs.
Aim
The aim of this essay is to understand the nurse's role in mental health assessment keeping the origins
of psychopathology, principles of evidence based strategies, the recovery model in mind and
understanding how mental health issues impact the individual, significant others and society as a

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whole.
Purpose
This essay seeks to clarify the importance of mental health assessment using quantitative and research
based tools such as the MMPI-2 (revised) and the HiPOC model rather than focusing on diagnostic
criteria like ICD-10 and DSM-IV or North American Nursing Diagnostic Assessment (NANDA) as a
means of assessing disorders. It also seeks to highlight the role of the nurse as a practitioner using
evidence based strategies and the recovery model to make patient outcomes positive.
Themes for Discussion
The essay seeks to explore the impact of psychopathology on individuals, others and the community
and examine how nursing influences the clinical outcomes through effective assessment, use of
evidence based care and principles of recovery model to help in gaining positive mental health,
reducing risk and restoring functionality.
Nurses need to be seen beyond medical custodians and work as partners in the recovery process. Most
mental health nursing assessment however, focuses on specific aspects like describing3 the need for
assessing key behaviours such as aggression (Mackay et al 2005 in Coombs 2014) or suicidal ideation
and action (Temkin and Crotty 2004 in Coombs 2014). Special observations in mental health ICUs or
specific populations like dementia were also studied (Coombs 2014). Others such as Sands (2007 in
Coombs 2014) defined assessment in terms of service delivery like triage or consultation liaison
(Brownlie and et. al., 2014). Moreover, assessment may mean different things to different nurses,
according to Barratt (1989 in Coombs 2014). In this study, for example, 4 different definitions of
assessment were mainly found to occur. An Australian study by Hamilton et al. (2004 in Coombs 2014)
found that immediacy was found to be the most important element in nursing mental health assessment

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Nurses have taken both independent and interdependent assessment (Cowman et al. 2010 in Coombs
2014). O'Brien et al. (1999 in Coombs 2014) found that assessment skills of nurses grew when patients
were already diagnosed by psychiatrists and nurses generally lacked training in assessment of clinical
psychopathology. Hepworth and McGowan (2013) carried out in depth interviews to find differences in
assessment by inpatient and community nurses and that aspects like understanding of theory and
interpersonal skills also played a role. Ultimately, what matters is how deeply the nurses grow their
knowledge base and apply the same, for the benefit of the MHP.
Discussion
Psychopathology and Its Impact on People
Brownlie and et. al., (2014) found in an Australian sample of 3998 adults over 18 years as against 2000
Japanese adults, discriminatory attitudes and discriminatory behaviour was far greater. Greater stigma
was attached to psychosis than depression or anxiety, more so in Australia than Japan. This points to the
potentially stigmatising impact of chronic mental health conditions for the individual.
While long term institutionalisation has been replaced by ambulatory care(Andrews, Hall, Teesson &
Henderson, 1999)mental disorders are not restricted by the ICD-10 or the DSM IV-r. According to the
World Health Organisation (2014), mental health is influenced by the extent to which individuals can
cope with stressors and make meaningful contributions to society. Australia's National Survey of
Mental Health covers the following surveys:

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Table 1.1: National Survey of Mental Health (Components)
Survey Most Recent Year Conducted
National Survey of Mental Health and Wellbeing 2007
National Survey of People with Psychotic Illness 2010
Australia Child and Adolescent Survey of Mental
Health and Well Being
2012-2013
Source: Adapted from: AIHW (2016)
Table 1.2: National Survey of Mental Health and Well Being (Comparison across 1997-2007)
Age Group Approx. Value (2007)% Approx. Value (1997)%
65+ 8 6
55-64 15 11
45-54 22 18
35-44 23 19
25-34 25 20
18/16-24 26 27
6-17 11 14
Source: Adapted from AIHW (2016)
Close to 7.3 million or 45% of Australian men and women experience a mental health condition such
as substance abuse, depression or anxiety at least once in their life (Australian Bureau of Statistics,

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2008). As can be seen in table 1.2, values of those suffering from mental health issues did not change
much across 1997 to 2007.
Analysis by the National Survey of People with Psychotic Illness (2010) has found 64,000 patients on
an average, utilise mental health services in Australia each year. Analysis from the Young Minds Matter
survey (2012-2013)56,000 children and teens aged 4-17 experienced mental health issues. . According
to ABS (2015), 2,300 Australians commit suicide each year. An AIHW publication (2016) states that in
many cases, mental health problems may not fulfil the diagnostic criteria.
Impact On Significant Others
Dawson et al (2017) found that partnerships between caregivers and significant others and service
providers helps to facilitate access and positive care experience. When carers lack information or face a
burden, there can be a negative impact on stress. Fortinash and Worret (2014) found that the negative
impact of caregiving on mental health of caregivers has plenty of research support. For example, in one
data collection by the Australian Bureau of Statistics, close to 30% of caregivers and loved ones
reported worry or depression and a direct impact on their health. He also stress that caring for a person
with mental illness involves uncertainty for the caregiver.
The researchers also cited a study by Dunn, Burbine, Bowers and Tantleff-Dunn (2001) which found
stress was moderated by factors like coping style and support in influencing negative outcomes for
caregivers. Deal, McWilian, Cooper and Trivette (1989) found quality rather than quantity of social
support is important. Sense of mastery and self efficacy also mediated caregiver/signficiant other stress.

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Bible and et. al., (2017) also found that high levels of depressive symptoms though less chances of
physical morbidity are associated with caregiver stress. Therefore, while negative mental health
outcomes may exist for individuals caring for the patients, their physical well being has lesser chances
of being impacted. But psychopathology involves more dimensions as well, including the community.
On Society
Trivedi and et. al., (2015) found public attitude towards those treated for mental disorders like
schizophrenia was negative, though less so than professional assessments. More discrimination and
negative outcomes were rated by health professionals, because of greater knowledge of mental
conditions (Trivedi and et. al., 2015). The Australian National Mental Health Policy has evolved
several frameworks for treatment of mental health and changing the stigmatisation faced at the hands of
the community and medical professionals. This takes on another dimension in the context of care for
indigenous community members.
Woolford and et. al., (2015) found that mental health outcomes for indigenous communities was
poorer due to lack of services and infrastructure to provide support for their socio-emotional well
being.
Evidence Based Care Strategies and Role of Nurses

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Burns and Grove (2010) have cited the early origins of evidence based treatment. Bernadette Mazurek
Melnnyk and Ellen Fineout-Overholt (2011) found that results need to be trustworthy, credible,
accurate and complete for evidence based care strategies to work. Rosenbaum and his colleagues found
that PA is a useful addition to care for mental disorders in EBT. The evidence based practice (Hepworth
and McGowan, 2013) has a hierarchical approach which tends to create a question mark for EBP for
mental health nursing.
Hepworth and McGowan (2013) hold that the current approach to EBP “ requires reconstruction to
support the consumer-focused nature of mental health nursing, and to facilitate the implementation of a
recovery model for mental health care.” Sackett et al. (1997, in Rycroft Malone et al. 2004) gave the
most lucid definition of EBP in nursing as the wise, explicit and conscience based attitude towards
“current best evidence” for caring for individual patients. Santos and et. al., (2014)hold that a more
broader definition of evidence is needed.
Evidence can include systematic reviews and meta analysis results. Practice of nursing is through
contract and relations between practitioners and public. Centrality of this therapeutic relationship
complements scientific evidence. Knowledge that can be tested and found credible is evidence (Higss
& Jones 2000, p.310-311). Evidence based strategies rely on clinical experience, research, patient and
clients as well as carers and the local environment. Evidence based, person centred care strategies also
involve knowledge accrued through nursing practice called professional craft knowledge by Santos and
et. al., 2014) For clinical reasoning to advance, explicating, analysing and critiquing or what Stetler et
al. (1998) call “affirmed experience” is important. Skilled facilitation is the key here (Harvey et al.
2002).

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Russell and et. al., (2016) also emphasise the need for 360 degree feedback and patient narratives as
well as audit data for effective evidence based practice. Forbes and Watt (2015) found that evidence
based practice originating in the work of the epidemiologist from Britain, Archie Cochrane is the
mantra for the 21st century. Estabrooks stresses the need for experiential rather than research based
evidence though. Four levels of nursing practice are there, with EBP being the highest. It should be
remembered that evidence is replicable, verifiable and meets scientific standards.
Table 1.3: Evidence based hierarchy
Level Action
1 Systematic review of RCTs and randomised trials
2 Single RCT and randomised trial
3 Systematic review of correlational/observational
studies
4 Single correlation/observation study
5 Systematic review of qualitative/descriptive.
Physiological studies
6 Single descriptive/qualitative/physiological study
7 Opinions of experts, committees
Source: Adapted from Polit and Beck (2008)
Recovery
The five stages of recovery are moratorium, awareness, preparation, rebuilding and growth. In

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Australia (Fortinash and Worret (2014) have stressed that integrating evidence based practices and the
recovery model is critical. The practice of deinstutionalization and the growth of the recovery model
stresses the future of the mental health movement (Heilbrun and et. al., 2014). Researchers also
distinguish between mental health recovery, in terms of physical recovery, trauma recovery and
addiction recovery. Redefining the self and becoming empowered form cornerstones of the recovery
model.
Paniagua and Yamada (2013) have emphasised the recovery model even for chronic cases like
schizophrenia. Apart from Australia, Ireland and US are some of the other countries introducing the
recovery policy into mental health (Department of Health 2001). The centrality of symptom reduction
in this context is still a matter of debate. Hepworth and McGowan (2013) have even proposed the
recovery alliance theory of mental health nursing, based on integration of the recovery model with
humanistic principles. For those recovering from psychopathology, the recovery model is increasingly
important.
Psychopathology of Mental Illnesses and The Role of the Nurse
The Royal College of Australia and New Zealand Psychiatrists, provide evidence based
recommendations for management of schizophrenia by treatment type and illness phase. Choi-Kain ,
Albert, Gunderson and John (2016) emphasise implementation, integration and stepped care for
personality disorders like BPD. According to research, evidence based treatments including dialectical
behaviour therapy, mentalization based treatment, general psychiatric management, and transference
linked psychotherapy are the key.

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Nurses can also apply evidence based treatment for bipolar disorders using mood stabilising
medications along with cognitive therapy and psycho-education. CBT, TCA and SSRIs are the line of
treatment offered by the nurse in the event of panic and anxiety disorders. For depression, CBT is
equally effective. Risk management and functional efficacy can thus be restored through the evidence
based approach and therapeutic modalities like CBT in combination with medication.
Mental health assessment is a large part of the treatment process as well. HiTOP or Hierarchical
Taxonomy of Psychopathology addresses key deficits of traditional taxonomies. Proposed by Kotov et
al. , this is an empirically driven classification system. While DSM and ICD-10 refined psychiatric
classification, these conventional systems consider diseases to be categorised, rather than viewing it on
a continuum, (Morey et al. 2012 in Kotov et al.). Traditional diagnosis is also associated with limited
reliability and do not encompass heterogenous and multiple psychopathologic processes. Co-morbidity
further complicates clinical decision making for the nurse. Despite significant impairment, many
patients do not meet the criteria of conventional assessment systems. Beyond the current testing are
several dimensional assessment tools such as Minnesotta Multiphasic Personality Inventory (MMPI;
Hathaway & McKinley, 1942).
Research has shown the MMPI-2 (revised) to be an accurate predictor of behavioural correlates of
functional impairment and high risk behaviours such as sensation seeking, alcohol and drug abuse in
the mentally ill (Johnson, Selibom &Phillips. 2014; Tarescavage, Luna-Jones & Ben-Porath, 2014).
Individual MMPI-2 RF scale scores map on to psychopathology hierarchical models in ways predicated
by theory for disorders like PTSD (Selibom, Lee, Ben-Porath, Arbisi & Gervais, 2012). Anderson et al
(2015) also found MMPI-2 correlated with the personality disorder classification of DSM-V.
Traditional classification, diagnosis and assessment systems must be supplemented with new

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quantitative assessment for robust mental health assessment.
Conclusion
The nurse plays a critical role at all stages of the treatment and therapy cycle. Tools like MMPI-2 help
in holistic and accurate assessment of psychopathology while CBT complements medication. Nurses
have to evolve into the role of practitioners and go beyond traditional medical models, for ensuring
positive mental health outcomes. A multi-faceted nursing role is needed in mental healthcare settings.

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