HLT54115 Diploma of Nursing HLTENN009 Mental Health Care Assessment

This document presents a detailed response to a nursing assignment focused on mental health care. It begins with an overview of the history of mental health care in Australia, tracing its evolution from early practices to modern, diverse approaches. The assignment then delves into the biopsychosocial model of health and illness, outlining its key components and their relevance to understanding mental health conditions. It explores the biological, psychological, and social factors that contribute to mental health disorders. The document also examines the national recovery framework for recovery-oriented mental health services, listing the practice domains and explaining how nursing care can contribute to the recovery of individuals with mental health conditions. Additionally, it discusses the Mental Health Act 2014, including rights, advocacy, privacy, confidentiality, diversity, and holistic care. Overall, the assignment provides a comprehensive understanding of mental health care principles and practices.

HLT54115 Diploma of Nursing
HLTENN009 - Implement and monitor care for a person with mental
health conditions
Written Assessment Student Copy
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Instructions to Students
Welcome to the written assessment. To successfully complete the assessment
requirements, you need to follow the following instructions.
Step 1
Read the study guide and the related resources.
Step 2
Read this assessment to gain an understanding of what you need to do to complete the unit.
Talk to your trainer or supervisor and ask for help if you need to.
Step 3
Complete all questions in this assessment. Please write clearly in pen (not pencil). You
may attach printed answers if you prefer. Do not remove any pages from this assessment.
Step 4
Complete the cover sheet and attach to this assessment. We recommend you make and
keep a copy of your assessments.
Step 5
Submit for assessment.
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Question 1
The following website may assist with this question
https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/mental-health-act-
2014-handbook
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-
toc~mental-pubs-i-nongov-how
http://www.aihw.gov.au/burden-of-disease/
http://www.aihw.gov.au/mental-health/
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-f-plan09-
toc~mental-pubs-f-plan09-con~mental-pubs-f-plan09-con-mag
http://heti.cystm.com/an-overview-of-the-history-of-mental-health-in-australia/
Part A
From your research provide a brief overview of the history of mental health care in Australia.
Mental health care in Australia is very develop and it holds a long history from the advent of
its services to the evolution of modern day services which has a diverse spectrum of care.
Nowadays, the diverse spectrum of care in the field of mental health care includes psychiatry,
mental health nursing, metal health social workers, psychotherapists, counsellors and other
specialists as well (Edward et al. 2015). As history goes on, before the year of 1811 – the
mental health patients were locked along with the criminals because the whole perception
was that all of them were insane. But the society and the specialists in Australia learned to
differentiate between the two branches of science – one is criminology and the other being
psychiatry. The first psychiatric hospital started and the principles of mental health care
gradually came to establishment and practice. But again and again – the history along with
the influence from the sociocultural and socio-political factors emphasized on the emergence
of five major professions which were actively involved in care and management of mental
health patients in Australia. These professions were psychology, occupational therapy,
psychiatry, mental health nursing and social work (Wynaden et al. 2016). With the passage of
time in the history, more professions such as art therapists, dieticians, music therapists,
exercise physiologists, speech and community rehabilitation nurses entered the field of
mental health care thus contributing to care of the patients suffering from mental illnesses. In
the mental health history encompassing both the world in general and Australia in generally,
before the early nineteenth century – the mental health, on overall was not even a medical
speciality as it was not differentiated from the act of criminal convicts. The intellectually and
cognitively disable ones were chained and locked up in very barbaric situations along with the
other social criminals. By the year of 1811 – for the first time ever in Australian history – the
mental health asylum was raised in the Castle Hill in the region of New South Wales that
intended to differentiate the cases of mentally ill from the criminals. An important event in the
mental health care of Australian history was the establishment of Lunatic Act in the year of
1843 that worked towards conceptualizations of different mental health conditions
(segregating one type from another), creating a broader wider awareness in the public and
amongst the administrators that these mental health conditions requires medical attention.
This Act actually shifted attention to the government about the responsibilities of treating
mental health conditions with more concern and empathy. The electroconvulsive therapies
came to practice and the moralistic questions were raised regarding the ethics of the
electroconvulsive therapy being practiced on schizophrenic and other severely ill mental
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patients. In the year of 1951 though – the drastic transformation embarked in the professional
sphere of mental health care – by the discovery of Chlorpromazine which came to widely
known as an anti-psychotic drug. Gradually- the more ethical and safer forms of
pharmacological management came to psychiatric practice. Around 1992, owing to the
Richmond report where various forms of abuses in mental ill practices were elucidated, a
deinstitutionalisation started in the Australian mental health scenario and the more laws,
policies, rules and regulations were bought to practice regarding the care of mental health
patients (Wakefield 2015).
Part B
The following websites may assist with this question
https://www.sane.org/mental-health-and-illness/facts-and-guides/292-families-friends-carers
https://www.boundless.com/psychology/textbooks/boundless-psychology-textbook/stress-
and-health-psychology-17/introduction-to-health-psychology-85/the-biopsychosocial-model-
of-health-and-illness-326-12861/
There is no single cause for mental health disorders; instead, they can be caused by a
mixture of biological, psychological and environmental factors. People who have a family
history of mental health disorders may be more prone to developing one at some point.
Changes in brain chemistry from substance abuse or changes in diet can also cause mental
disorders. Psychological factors and environmental factors such as upbringing and social
exposure can form the foundations for harmful thought patterns associated with mental
disorders.
Research the biopsychosocial model of health and illness. What are the key points of the
biopsychosocial model of health and illness?
Mental health conditions can arise from a number of psychological, biochemical, sociocultural
and demographic, genetic factors (Quinn et al. 2018). There can be a certain predisposition
to a certain type of mental illness in an individual or a pure traumatic event in an individual’s
life can lead to development of severe mental illness at some stage of life. Psychosocial
factors such as alcohol and other substance abuse over a period of time can also lead to
causation of personality and identity problems, greatly attributed to the behavioural
impairment (Orthwein 2017). Family history of mental illness as already mentioned can also
lead to transmission of mental health ‘predispositions’ to the progenies and under the right
trauma or situation – can bring the mental health condition to the surface. Various types of
psychotherapies have been invented and discovered and bought to practice over the year to
help treat the mental health conditions, from its roots to the surface. The various
pharmacological and non –pharmacological treatments in the mental health profession are
devised around the bio-psychosocial models of health and illness. The key points of bio-
psychosocial models of health and illness are as follows –
1. The biological aspect of the model takes into care – the gender, medication effects,
disability, physical illnesses, neurochemistry, reactivity to stressors, immune
dysfunction and the component of (genetic vulnerability if present).
2. The psychological component of the bio-psycho-social model takes into consideration
– learning, memory, esteem, emotion, behaviour, personality, family predispositions,
coping skills into light for better management of neuropsychological and psychosocial
cases.
3. The social aspects of the model - focuses on the social relationships of an individual
with the peers, family, relatives, friends and the colleagues.
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4. The Bio-psychosocial model of health and illness takes into consideration – the
‘systems hierarchy’ and ‘Individual reality’ to foster the ‘intra-system changes’.
5. The BPS model of health has various overlapping areas of sociology, psychology and
biology and these areas are to be addressed through a collaborative care concept.
6. The multi-disciplinary team must have a collaboration towards a more patient centred
care.
7. The BPS model of health and illness focuses on understanding and delivery of a
holistic care and the whole model in all its very aspects focuses on delivering a trans-
disciplinary patient care.
8. Subjective perceptions, personality predisposition, societal interrelationships and
physical diseases and condition forms the major underpinnings of mild to moderate to
severe mental health conditions.
9. The BPS model of health and illness by Engel, emphasizes otherwise than the pure
biological phenomenon of a disease and re-educates the specialists from not taking a
reductionist approach (that is just focussing on the biological aspect of disease) but a
holistic one.
Part C
The following website may assist with this question
http://www.health.gov.au/internet/main/publishing.nsf/Content/
67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf
The national recovery framework for recovery-oriented mental health services provides a
policy direction to enhance and improve mental health service delivery in Australia. The
framework consists of 17 capabilities, grouped into five fields of practice known as “practice
domains”. List the domains and discuss how you will ensure that you provide nursing care
within your scope of practice to contribute to the recovery of a person with a mental health
condition.
In the mental health recovery oriented services, there are 5 specific domains on which the
health care is based:-
1. Domain 1: Promoting a culture and language of hope and optimism – as a mental
health care nurse – it is my first and foremost duty to deliver a culturally competent
service to the mental health subjects (Kendler 2016). Addressing the esteem needs
and the belonging needs of the patient should be an integral part of promotion of
language and culture of hope and optimism in the patient.
2. Domain 2: Person 1st and holistic – helping the subject with a holistic nursing care is
my nursing priority. Applying the biopsychosoical model of health – at first, I would
administer the right antidepressant and antipsychotic medications as prescribed by
the psychiatrists in order to address the physical or rather biological components of
the disease. Secondly, I would provide cognitive behavioural therapy and talk therapy
to the patient (with the help of a psychotherapist) to treat the psychological
components of the BPS model. Preventing cognitive distortions while re-educated
right and relaxed though patterns to the patient is an important strategy. Thirdly, as a
mental health nurse, I would strengthen the psychosocial factors and frameworks
relating to the patient and his condition.
3. Domain 3: Supporting personal recovery – as a mental health nurse, I would promote
autonomy, self-determination in the patient. I would regularly motivate him to achieve
the clinical goals and self-improvement skills. Focussing on his personal strengths so
as to strengthen these further and helping the patient – develop a personal sense of
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responsibility towards his or her own life is the cardinal nursing intervention. Hence, I
would adhere to the same.
4. Domain 4: Organisational commitment and workforce development – as nursing
professional, I would work towards more collaboration with the other disciplinary
expertise in order to deliver holistic, patient centred care to the patient. I would adhere
to organisational commitment by strictly following the mental health care policies and
regulations. I would comply by the evidence based practices and the latest best
practice guidelines in order to deliver the most appropriate patient care. To more
compliance and commitment as a Enrolled nurse – I would adhere to the Australian
national standards of mental health practices such as effectiveness, efficiency,
appropriateness, continuity, responsiveness, capability, safety, accessibility and
sustainability.
5. Domain 5: Action on social inclusion and the social determinants of health, mental
health and wellbeing – this is an important domain pertaining to mental health care
and profession. I would use by reasoning, problem solving and decision making skills
to full effect in order to help the patients in a holistic manner. I would, as a Enrolled
nurse – strengthen the socio economic connections of the patients and build a
positive social network around the patient that would help physically, mentally, socially
and economically. Regarding the social and self-esteem of the patient – as a Enrolled
nurse I would the important steps towards problem solving, decision making and care
planning of the patient that addresses his esteem and belonging needs ( the
dysfunction of which is the main problem with most mental health patient in Australia
and globally). I would involve him into social activities and recreational activities that
promote his esteem and belonging.
Question 2
Part A
Discuss the Mental Health Act 2014. Include in your answer
 Rights and Advocacy
 Privacy and confidentiality
 Diversity
 Holistic care
The Mental health act 2014 empowers the persons (in Australia) affected with the mental
health conditions at the very centre taking their own decisions related to their health and
mental well-being. The Mental health Act of 2014 assists and guides the mental health care
professionals such as psychiatrists, psychologists, social workers, the health therapists and
the nursing professionals to take up a collaborative approach in treatment of the mental
health patients. The Mental health act promotes rights and advocacies of the patient through
a rightful, informed care. The Mental health Act of 2014 promotes diversity in the services of
mental health by collaborating with multi-disciplinary professionals in order to deliver an
informed mental health care. An effective communication between the service providers, the
clients, the consumers, facilitators and the health care professionals in Australia, is supported
and guided by the Mental Health Act, 2014. The act promotes decision making in the mental
health subject by promoting a meaningful patient centred intervention experience. The Act
supports and directs a holistic care to the mental health patients in Australia through the BPS
model (Crosby, Quinn and Kalinyak 2015). According to Act, the individuals’ dignity,
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autonomy and rights should be protected, promoted during assessment, recovery and
treatment of the mental health patients.
Part B
To whom does the Mental Health Act apply?
The Mental Health Act applies to the all mental health professionals of Australia such as
psychologist, psychiatrists, nurses and the therapist working in the legal framework of
Australia. The Act is mostly direct towards care of children and young adults as a priority.
Part C
Define mental illness.
Mental illness is diverse spectrum of psychological conditions that adversely affect the
functioning and ability of an individual. These psychological conditions can be derived from
social, cultural, physical, incidental, accidental, family and genetic factors that have a marked
effect on the cognitive functioning of the individual. The major and widely known mental
health conditions are depression, schizophrenia. According to the main classifications of
mental illnesses in the field of psychiatry – there are neurodevelopmental, schizophrenia
spectrum and other psychotic disorders, depressive disorders, bipolar and related disorders,
obsessive compulsive and related disorders, trauma and stressor related disorders,
dissociative disorders, anxiety disorders, somatic symptom disorders, feeding and eating
disorders, elimination disorder, sleep wake disorders, gender dysphoria, sexual dysfunctions,
disruptive, impulse control and conduct disorder, substance abuse and addictive disorders,
neuro-cognitive disorders, paraphilic, personality and other disorders.
Part D
The following website may assist with this question
http://www.mhrt.nsw.gov.au/the-tribunal/
Outline the involuntary review processes for your State.
The involuntary review process in New South Wales begins by taking into consideration
whether the subject has a serious mental illness and exhibits violent and aggressive
behaviours in social situations. As per the involuntary review process – the person’s
continuing condition, physical deterioration is also considered. In the process, at first an
involuntary patient order is given by the magistrate in a mental health facility (for up to a 3
months period). The service can be extended by magistrate from s35 to s37. The review, as
per the Australian law, has to be done every 3 months one first 12 months and following that,
once every six months in the next year.
Part E
Outline the restraint policies and procedures in the nursing home.
The restraint policies and procedures in mental health care determine the following:-
 Considers the patient’s cultural background
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 If Aboriginal or a Torres Strait Islander patient or his descent is admitted, take the
traditional practices and beliefs of the person is taken account
 The policies are collaborated between traditional healers and health care
practitioners who come from indigenous communities;
 The mechanical body restraints along with the seclusion are used a last option and
that too as a safety option and not as punishment (Doernberg and Hollander 2016).
 Providing an informed care to the patient and family
 The most important part is that the policies focus on pharmacological interventions
as a safety measure than a punishment or a convenience.
 Regular assessment and regular medical examinations should be conducted.
 Information about the care must be provided to the patient’s family as well.
Part F
The following websites may assist with this question
https://mhsa.aihw.gov.au/services/admitted-patient/restrictive-practices/
http://www0.health.nsw.gov.au/policies/pd/2012/pdf/PD2012_035.pdf
Access a policy and procedure for restraint and seclusion in a health care setting in your
state. Discuss the legal implications and your role as an EN.
Referring to the ‘Aggression, seclusion and restraint: Preventing, minimising and managing
disturbed behaviour in mental health facilities in NSW’ – the debriefing policy and procedure
is very important tool –
This ‘de-briefing technique’ involves thorough understanding and analysis of the restraint and
seclusion procedures after each of the performed reviews. This debriefing strategy is an
important tool and a vital strategy in mitigating the adverse effects of traumatizing events
involved with restraint and seclusion.
 In the initial ‘post event debriefing’ – as an EN, I will ensure that everyone is safe and
procedure are in continuous monitoring, working towards risk mitigation and returning
to pre event status. In this stage – I will also identify the social and situational needs in
order to address the legal implications.
 In the therapeutic intervention or “talk session” with the consumer – this is very
important stage in the whole procedure, where as an EN I will talk to the consumer
about what happened in the event and how he feels about the same. In this stage, I
would talk about the legal and procedural parameters of the alternatives in order to
prevent the similar events happening in the very future. I would apply an outcome
informed process to develop consumers care and develop safety and management
plan (Smith 2017).
 In a formal debriefing session – on the following days, I would coordinate with the staff
involved, treatment team, attending doctor in order to contribute to the overall restraint
and seclusion event review process.
Question 3
People with a mental illness can be among the most disadvantaged in society, and they often
confront many barriers as a direct result of their illness. Stigma and discrimination is one
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major barrier and can often be worse than the illness itself. Changing perceptions about
mental illness can go a long way towards breaking down some of the barriers that stigma and
discrimination creates.
Communication in nursing is an essential component of all therapeutic interventions. The
knowledge and interpersonal skills that a nurse uses to communicate are essential aspects of
helping the person who is experiencing a mental health illness, as well as facilitating the
development of a positive nurse-client relationship. This requires the nurse to use a range of
appropriate and effective communication and engagement skills with individuals, their carers
and other significant people involved in their care.
Communication is an integral part of nursing profession and a very useful tool used to foster
collaboration with the patients and their families (Ryan and Hurley 2018). While the
interpersonal skills like attention to details, active listening, maintaining the right posture,
proximity and vocal tones (non-verbal communication techniques) are to be facilitated by the
nursing professionals – it is also very pivotal, that I as an Enrolled nurse – should use a
culturally competent communication and empathic communication with exhibition of kindness,
compassion and beneficence in order to lift the above mentioned community and
sociocultural barriers related to discriminating with mental health patients. Even through
public speeches in a community awareness program – I , along with the senior nurses can
inform the public about the veracities of mental health profession and the importance of
developing and maintain the esteem of person suffering from mental health disorders (Wade
and Halligan 2017). I would promote empathy amongst the professionals, peers and the
general public so they understand the importance of eliminating the inequities in social
treatment of mentally ill patient. I would foster a holistic, all collaborative, informative and
normalizing mental health care and psychosocial care towards betterment of the mentally ill
subjects (Pincus, Chua and Gibson 2016).
Question 4
Discuss the values and philosophies that underpin mental health care.
There are many values and nursing philosophies that underpin the quality and delivery of
mental health care services which are as follows –
1. Autonomy – as a EN, I must be and should be able to main the patient autonomy
through preservation and sustenance of patient identity, rights and confidentiality. This
is a very important nursing principle and value.
2. Integrity – as an enrolled nurse, I must practice this crucial nursing principle and value
to deliver a professional patient centred care to the subject. It is highly important I
should focus towards maintaining the dignity and self-respect of the patient which is
major issue amongst the mental health care patients.
3. Beneficence – As an EN, I must deliver mental health service that is only of benefits
to the patients.
4. Non- Maleficence – As an EN, I must focus on eliminating the chances of any harm to
the mental health patient.
5. Totality – as an EN, I must be obedient and completely dedicated to the mental health
patient and his stages of recovery.
Some important principles that are extremely important in caring for mental health
patients are –
1. Watson’s philosophy and the Science of caring – this nursing philosophy is
targeted to deliver a holistic transcendal experience to the patient as the mental
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health nurses delivers a spiritual ‘holistic mind, body and spirit experience to the
patient’. The nursing is patient centred and individualistic and focuses creating a
higher degree of harmony with the mental health patient so that he can work
actively with the nurses towards his own recovery (Alligood 2017).
2. Human becoming nursing – is quite a new philosophy in nursing that emphasizes
on the humanistic nursing perspective. It is extremely cardinal for the mental
health nurses to experience the pain and internal emotions of the patient,
empathically and become human with the patient treatment process, thus
bettering the quality of mental health care on each day.
Question 5
The following website may assist with this question
http://www.health.nsw.gov.au/mhdao/Pages/legislation.aspx
Discuss the rights of the person with a mental health condition
The rights of the person with a mental health condition are very important and are as follows:-
1. Right to privacy - the patient must be given the right to have privacy which is
important for his esteem needs.
2. Right to information – the mental health patient must be informed with the kind of care
that is provided (Bech 2016).
3. Right to voluntary participation and decision making – after being informed – the
patient should be given the opportunity to decide whether or not to go for the
treatment decided for him.
4. Right to autonomy and confidentiality – is also very vital.
5. Right to dignity and respect is critical to the patient’s perception of the service and
self-motivation towards health development and betterment.
Question 6
Case study
Summary
Mrs Julie Davis, a 43 year old teacher, has come to hospital by ambulance complaining of
severe pains in the chest. She is very worried and agitated and is visibly shaking, crying and
reporting an extreme fear of dying. She stated that this fear just ‘pops out’. She stated that
this is the third time this has happened in the last three months.
- Mrs Davis is a 43 year old woman of average height and average build.
- Mrs Davis has come to the hospital’s emergency department fearful that she may be
having a heart attack. She came by ambulance because she thought she was dying.
Her heart has been checked and it is fine so she has been referred to you to for a brief
psychiatric evaluation. You are the intake / triage nurse.
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• You are expected to gather information using patient- centred interviewing skills.
During the presentation you begin to believe that Mrs Davis is suffering from Panic
Disorder with Agoraphobia.
• You do not need to make a diagnosis or recommend investigations. You need to
make a decision about further referrals for Mrs Davis.
Context
Mrs Davis reports that she is often nervy and that she has always been like this. She
describes herself as a worrier. Over the last two years she has become more and more
anxious. Now she might stay awake at night sweating and feeling fearful. This stops her from
getting back to sleep. She does not know what is wrong with her but thinks that something
terrible is going to happen to her.
Over the past three months this fear has kept her confined more and more to the house. She
now only goes out for very important things. Two months ago she took leave from work as a
teacher because she could not go to work. She has also lost weight and does not do her
normal hobbies or see her friends. She now spends much of her day ruminating negatively,
reading or watching TV. This makes her feel down in mood. She expresses much relief in
being able to tell her story. She then begs for help, explaining that she is “going mad”.
Background and Medical History
Mrs Davis presented to paramedics and then the emergency department in a very emotional
state, claiming that she thought she was dying of a heart attack. After arrival at hospital her
heart was monitored and no irregularities were found. In fact, she begged to have her heart
tested. When these showed there was nothing wrong with her heart, she pleaded to have
more tests. Because of this, it is suspected that she may be suffering from a psychiatric
issue. When questioned further she said that she is a “worrywart” and is always thinking that
things will go bad.
Over the past five years she has had fears that she had cancer, was going to lose her job
and that she was vulnerable to being attacked. This constant rumination has disabled her
and has affected her work and personal relationships.
She is very emotional with her husband and often fights with him because he pushes her to
return to work. When she feels very sad, weak and tired she may go to bed for a week or
more. When she is like this she says she is very “flat”.
When Mrs Davis was seven years of age she was in a car accident and spent much time in
hospital recovering. She often ruminates on this and strongly believes the world is unsafe.
She often sees her doctor about feeling tired, sleepy and nervous. She is taking no
medications, but asks if she should be taking “something”.
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Social History
Mrs Davis has worked as a primary school teacher for twenty years. She describes the job
as being stressful with a large workload. She loves the job and loves the kids, though she
described them as sometimes being hard to handle. Over the last few years she described it
as a relief to be able to get home to get away from the pressure.
To help her relax she sometimes goes to bed, or if feeling very bad she might also have a
drink or two. This can cause problems in the household because she has two children, Ben
aged 10 and Melissa aged 13, who need attention and support.
Mrs Davis describes herself as friendly, but anxious when she socialises, which is rare these
days. She worries that she might be hurt if she is away from the house. Her husband
understands this and supports her when they are out. About two years ago when she was
with her husband he slammed on the car brakes so as not to hit a dog. It made her very
anxious and she can’t forget the incident. She is now drinking more and currently will only
leave the house if she must.
She reported that the house finances are strained because she cannot work. She does not
smoke or use any other type of drug. She has lost weight and is now of average build.
She has been married to her husband Dave for 15 years. Dave is a self-employed
electrician.
Behaviour, affect and mannerisms
• Very cooperative during the interview. Very willing to please, repeats answers a
number of times.
• Very agitated, visibly shaking, crying, face gaunt and fearful. Speaks nervously and
rapidly and clutches her hands in anxiety. When she first presents she is terrified.
This reduces as she talks and is told repeatedly that she is not dying and that her
heart is normal. Often begs for help.
• Is dressed smart casual and is well groomed though somewhat dishevelled due to
her extreme agitation. Face was pale and withdrawn. Hair is dishevelled.
Ideas
• She believes that she is going crazy
• Strongly believes that she is having a heart attack and is going to die.
Concerns
• Fears that she is dying and that she has major heart problems.
• Fears that she is sick and will never be happy again; that she is crazy and will never
get better.
• Thinks others are laughing at her and critical of her.
Expectations/Hopes
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