Mental Health: Stress Vulnerability, Rights, and Nursing Strategies

This assignment provides a comprehensive question-and-answer exploration of various aspects of mental health, covering topics such as the stress-vulnerability-coping model, patient rights in mental health services, limitations of mental illness classification systems, indications for electroconvulsive therapy (ECT), symptoms and nursing interventions for hypomania, standardized psychometric screening tools, strategies for managing paranoid delusions, side effects and treatments for SSRIs, comparison of personal and clinical recovery, factors influencing health outcomes for individuals with mental illness, relapse prevention elements, suicide risk assessment, recovery-oriented mental state assessment, and the principles of trauma-informed care. The assignment delves into practical nursing strategies and theoretical frameworks essential for mental health care, emphasizing patient-centered and recovery-focused approaches. Desklib offers a wealth of similar solved assignments and resources to support students in their studies.

Running head: QUESTION-ANSWER 1
Question-Answer
Student’s Name
Institution Affiliation

QUESTION-ANSWER 2
Question-Answer
1. Describe the key ideas behind the stress-vulnerability-coping model in relation to
the development of mental illness. (2 marks)
The stress-vulnerability-coping model emphasizes on the determinative role of the interaction
between the environment and biological/genetic vulnerabilities in development of mental
health problems. It thus provides an assumption in understanding of the interactive impacts
of biological/genetic and psychosocial stress factors. The model suggest that genetic or
biological characteristics create varying levels of vulnerability in dissimilar individuals and
they are not sufficient in their won for development of severe mental conditions (Garcia &
Petrovich, 2011). With regard to psychosocial factors, they interact with basic vulnerability
characteristics to affect development of mental disorders (Wong, 2014)
2. State four rights a person has when they are a consumer of mental health services (2
marks)
(a) With regard to rights related to medications, consumers have a right to access effective
professional treatment, the right to access information regarding the drugs prescribed
including contraindications, desired effects, side effects, and complications, and the
freedom to accept or reject treatment. They also have a voice and choice in drug selection
(Elder, Evans, & Nizette, 2012). Consumers also have a right to receive prescriptions
from a mental health practitioner that is authorized by law (Usher, Foster, Bullock,
2008).
(b) Consumers have a right to confidentiality regarding their personal information (Muir-
Cochrane, Barkway, & Nizette, 2011).

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(c) Consumers have the right to engage in establishment of mental health policy,
representation of interests of mental health consumers, and provision of mental health
care
(d) Consumers have a right to considerate, dignified, and respectful care (Health Sydney
Local Health District, 2011).
3. What are the limitations of a classification system for mental illness across the
lifespan and across cultures? (2 marks)
The richness of the diagnostic assessment may be compromised due to loss of multiaxial system
associated with harmonization in the DSM 5 system. Multiaxial system provided a holistic
approach as it offered a way of recognizing prominent psychiatric disorders, medical conditions,
maladaptive personality functioning, environmental issues, significant stressors, and general
functioning.
The classification systems (DSM III) omits unconscious phenomena as criteria of diagnosis, and
it deletes some diagnostic or clinical terms considered important,
DSM-III system and its successors lack rich philosophical content in pragmatic utilization of old
terms and selection of new terms. Further, basic researchers and neuroscientists criticizes the
manual for lack of recognition on contributions relating to basic science in some diagnoses
specifically in neuropsychiatry. Also, the ethnocentrism of DSM has been deemed as a limitation
as it neglects particular concepts (Alarcon, 2009).
4. Describe two circumstances in which ECT may be indicated. Be specific. (1 mark)
ECT is indicated in depression with psychotic symptoms and therapy-resistant, major depression
(Wehling, 2013). ECT is indicated particularly when response to drug treatment is poor. In

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severe depression it is utilized when clients are in extreme depression status or the imminent risk
of suicide is severe.
ECT is also indicated in Mania when the condition is acute or when it is not responsive to
treatments to drugs
5. List the common symptoms of hypomania (1 mark)
Reduced need for sleep, flight of ideas, talkativeness, and elation (Richardson & Garavan, 2009).
Suggest nursing interventions for ONE of these symptoms (1 mark)
Sleep can be enhanced through good sleep hygiene where schedules for sleep can be normalized,
intake of caffeine and stimulants should be reduced, and individuals should engage in regular
exercise.
6. Name two standardised psychometric screening tools (1 mark)
Brief Symptom Inventory (BSI)
Hospital Anxiety and Depression Scale (HADS)
How will the named tools assist you in a comprehensive mental health assessment?
(1 mark)
The tools will be used in identification of individuals with certain forms of psychosocial health
care needs. More precisely, BSI will be used to measure anxiety, depression, and general level of
psychological distress while HADS will be used to screen for psychological distress in patients
with certain types of illnesses (Adler, Page, & Institute of Medicine, 2008).

QUESTION-ANSWER 5
7. You are caring for a person exhibiting paranoid delusional thinking in an acute inpatient
treatment facility. The person expresses the belief that the water is poisoned and
consequently refuses to drink.
a. List strategies that may assist the person to drink the volume required to maintain the
person’s physical health (1 mark).
I would use relational approach to build a sense of connection and trust with the patient. I can
then explain to the patient that I accept that they have the belief that the water is poisoned but I
do not share the same belief. I would then reinforce reality and explain that the water is not
poisoned and it is essential that they drink for their recovery. Since rational thinking may not be
effective in convincing the patient of the reality I will not debate the delusion
b. The person also believes that you and the other nurses involved in their care are
assassins. How will you respond to this expression of belief? (1 mark)
Firstly, I will let the person know that I know the feelings that can be triggered by their
delusions. For instance, I can tell the patient “it must feel so frightening to think that we want to
hurt you.” I will then try to reduce the patient’s anxiety. I can say “I think the presence of too
many people (nurses) is making you anxious. All of them will leave and only you and I will
remain in this room.” Also, I will ensure that the patient interacts with the same staff to avoid
further agitating the patient by presence of new faces.
8. State three common side effects of SSRI’s and briefly describe the treatment for
these side effects (1 mark)
Headache, insomnia, and sexual dysfunction

QUESTION-ANSWER 6
There are two approaches to treating sexual dysfunction. Firstly, an alternative antidepressant
may be used to replace the current one. Secondly, treatment of sexual dysfunction can involve
prescription of concomitant drug to counteract the side effects. Use of alternative antidepressant
is less efficient and thus the second strategy is recommended (Hales, Yudofsky, & Gabbard,
2008).
Treatment of insomnia should be short-term using a hypnotic at bed time.
Headache can be managed using pain relief preparations (Hales, Yudofsky, & Gabbard, 2008).
9. Compare and contrast personal recovery with clinical recovery. (1 mark)
Clinical recovery emphasizes on quantifiable amount of social functioning, symptomatology,
management of risk, and prevention of relapse in mental health. In other words, clinical recovery
is the medical view of reducing the symptoms or management of the condition through treatment
(Williams, 2015). In simpler terms, clinical recovery is used to refer to as depicting fewer or no
symptoms. On the contrary, personal recovery focuses on the centrality of hope, meaning,
identity, and personal responsibility. It is a continuous individual process as opposed to an
outcome to be achieved as it clinical recovery. Personal recovery is deemed as the ability to live
fruitfully well in face of the difficulties posed by the mental condition (Williams, 2015).
Identify two (2) factors considered critical to personal recovery. (1 mark)
Self-determination: strong self-determination forges engagement in health behaviors that are
positive such as increased service and medication adherence and other acts that enhance well-
being (Taylor, Moxham, Perlman, Patterson, Brighton, & Liersch, 2016).

QUESTION-ANSWER 7
Recognizing the need for the patient to help themselves and take responsibility for their distress
(Elder, Evans, & Nizette, 2012). One’s perception of wellness affects their personal recovery as
outlined by (Trenoweth 2016) who states that people are mentally healthy when they believe
they are healthy. The way one views their health status affects their recovery from mental
distress.
10. People with mental illness experience poorer physical health and a shorter life
expectancy than the wider population.
Identify a minimum of four factors that influence health outcomes for people living
with mental illness. (2 marks)
Racism
Cumulative stressors
Social isolation
Social support
Individual stress levels
Poverty and social segregation characteristics (Pacquiao & Douglas, 2018).
Employment status
Income
Educational attainment
Describe the four nursing strategies that can be implemented to improve health
outcomes (2 marks)

QUESTION-ANSWER 8
(a) Advocating for extension of mental health services: as advocates nurses can influence
decisions related to policies to incorporate mental health screening as a constituent of
every individuals, all families and population-based assessments (Ivanov & Blue, 2008).
(b) Promoting services that are culturally competent: provision of linguistically and
culturally competent care by nurses is a strategy that can be used to address ethic and
racial health disparities.
(c) Promoting healthy behaviours: public health nurses can intensify efforts to emphasize on
lifestyle health behaviours.
(d) Improve health care access: delays in health care seeking may be attributed to certain
factors, including lack of insurance coverage by minority groups. Improving access to
health care is an essential strategy for improving health outcomes.
11. Describe four elements of relapse prevention? (2 marks)
(a) Awareness: this is the initial element of effective prevention of relapse. It is comprised of
acceptance and recognition components, factors that are essential in determining whether
individuals face the risk of recurrent mental conditions. This element also determines if
the surrounding people and cervices have the ability to accept and recognize the modified
mental health needs of the patient and respond properly.
(b) Anticipation and planning: this involves expectation of future situations and adequately
responding by making plans. Individuals who have experienced mental illnesses may

QUESTION-ANSWER 9
require daily plans for ensuring that they engage in everyday activities for maintaining
their wellness and preventing relapse.
(c) Alternatives and opportunities: a wide variety of service alternatives personalized to
address specific risk and protective characteristics of a patient should be provided.
(d) Access and early intervention: effective prevention of relapse needs prompt intervention
via access to adequate services and support (Muir-Cochrane, Barkway, & Nizette, 2011).
12. Suggest four questions you would ask to assess a person’s risk of self-harm or
suicide (2 marks)
What aspects in your life do you find worth living for?
Have you ever tried to harm yourself or thought of taking your life?
Some circumstances may make one feel like life is not worth living. How do you feel about your
own life?
Do you think about dying or your own death?
Where do you see yourself in five years?
13. Discuss how you would ensure that you conduct a mental state assessment that is
recovery-oriented. (2 marks)
Recovery-oriented mental health practice recognizes the uniqueness of individuals,
empowers and supports client’s decision making, promotes and protects their rights, involves
being respectful, honest, and courteous in all interactions, embraces partnership and
communication in the process of recovery. As such, to conducting a mental state assessment
that is recovery oriented I will be friendly to the patient. For instance, before initiating the

QUESTION-ANSWER 10
process I will ensure that a brief introduction is done where I will great the client and explain
what we would be talking about. Further, I will respect the patient’s autonomy and self-
determination during the process of evaluation and ensure that I develop holistic and
personalized evaluation items for their specific case. Additionally, I will ensure clarity and
openness during assessment while respecting the clients.
14. What are the key principles of the trauma informed care and how can they be
implemented into an acute mental health ward? (2 marks)
The key principles of trauma informed care are safety, peer support, trustworthiness and
transparency, empowerment, voice, and choice, collaboration and mutuality, and cultural and
historical concerns and gender awareness (Seng & Taylor, 2015). Trauma informed care can
be implemented into an acute mental health ward by recognizing the prevalence as well as
impacts of trauma, realizing how trauma has affected specific individuals in the ward, and
appropriately responding by ensuring re-traumatizing does not occur. As such, I will consider
the pervasive nature of trauma and forge an environment that promotes healing and recovery.
Implementing trauma informed care focuses on respecting and responding to the impacts of
trauma with the aim of specific support services to individuals.
15. Outline the principles of Least Restrictive Practice (2 marks)
Least restrictive practices are based on principles of creating a supportive environment to the
recovery and well-being of an individual, while maintaining their rights, freedom, and dignity to
the greatest extent possible. More precisely, least restrictive practice focuses on minimizing
relational, physical, and procedural restrictions and implementing them only when it is required.

QUESTION-ANSWER 11
The goal for least restrictive practice is to maximize independence and enhance recovery
(Sustere & Tarpey, 2019).
16. Identify one individual risk factor and one situational risk factor for violence and
aggression (1 mark)
Individual risk factor: Involvement with alcohol, tobacco, or drugs
Situational risk factor: reduced economic opportunities
Identify four nursing strategies to reduce the risk and avoid coercive measures. (2
marks)
(a) Using communication that is non-judgemental and recognize the feelings of the patient
while remaining in control of one’s emotions
(b) Nurses can also use limit-setting where clients are informed of acceptable and
unacceptable behaviours and associated consequences of unacceptable behaviours
(c) When a client is experiencing and demonstrating aggression and violence nurses should
lower their voice and project kindness, calm, and understanding
(d) Identify the patient’s source of distress and engage the patient in questions to recognize
the problem area
17. Why is it difficult to differentiate depression clinically from dementia and delirium?
(1 mark)

QUESTION-ANSWER 12
It is difficult to distinguish between delirium and dementia because features of the two
conditions overlap. Similarly, it is not easy to differentiate between depression and dementia
since depression presents with cognitive impairments similar with dementia.
18. Identify two common mental health disorders experienced by children (1 mark)
Anxiety
Attention deficit/hyperactivity disorder
What are the benefits of early intervention with children and young people? (1
mark)
Early intervention is essential in impacting outcomes in children and young individuals. It
reduces the risk of relapse and decreases the need for hospitalization. It prevents progress of a
mental condition and improves the mental health of the individual. Early intervention leads to
enhanced diagnosis and treatment and more timely and targeted referrals to services that are
specialized.
19. When undertaking a mental state examination, what aspects of the person’s
situation must be assessed in greater detail if the person has an intellectual
disability? (2 marks)
In individuals with intellectual disability the full range of symptoms may be experienced.
Evaluation of psychopathology should thus cover the entire range of all possible
psychopathology not only the instinctively reported by support workers or carers. The mental
state examination should differentiate between long-standing and new-onset symptoms.

QUESTION-ANSWER 13
20. Identify the minimum of two broad strategies (pillars) of the overarching principle
of harm minimisation in drug and alcohol use (1 mark)
Demand reduction pillar strategy
Supply reduction pillar strategy
Harm reduction strategy
Identify four reasons it is important to undertake an assessment of alcohol and
drug use as part of the overall mental health state assessment process (1 mark)
(a) Assessment of alcohol and drug use in the process of mental state evaluation allows
holistic evaluation of an individual (Halter, 2017).
(b) It helps to identify the severity or presence of alcohol use disorder
(c) It also helps to assess the risk factors related to substance abuse
(d) It helps to identify the appropriate type of intervention or treatment program and ensure a
well-rounded treatment is chosen

QUESTION-ANSWER 14
References
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Meeting Psychosocial Health Needs. Washington, D.C: National Academies Press.
Alarcón R. D. (2009). Culture, cultural factors and psychiatric diagnosis: review and projections. World
psychiatry : official journal of the World Psychiatric Association (WPA), 8(3), 131–139.
Elder, R., Evans, K., & Nizette, D. (2012). Psychiatric and mental health nursing. Chatswood, N.S.W:
Elsevier Australia.
Garcia, B., & Petrovich, A. (2011). Strengthening the DSM: Incorporating resilience and cultural
competence. New York: Springer.
Hales, R. E., Yudofsky, S. C., & Gabbard, G. O. (2008). The American Psychiatric Press textbook of
psychiatry. Washington, DC: American Psychiatric Press.
Halter, M. J. (2017). Varcarolis' Foundations of Psychiatric-Mental Health Nursing - E-Book: A
Clinical Approach.
Health Sydney Local Health District. (2011). Your rights and responsibilities as a mental health
consumer. NSW Government. Retrieved from
https://www.slhd.nsw.gov.au/MentalHealth/pdf/SLHD_21_Area_Rights_Responsibilities.pdf
In Rudnick, A. (2012). Recovery of people with mental illness: Philosophical and related perspectives.
Oxford, United Kingdom : Oxford University Press
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Delmar Cengage Delmar.
Muir-Cochrane, E., Barkway, P., & Nizette, D. (2011). Mosby's Pocketbook of Mental Health.

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Muir-Cochrane, E., Barkway, P., & Nizette, D. (2011). Mosby's Pocketbook of Mental Health. Mosby
Australia
Pacquiao, & Douglas, (2018). Social pathways to health vulnerability: Implications for health. (2018).
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Seng, J., & Taylor, J. (2015). Trauma Informed Care in the Perinatal Period. Edinburgh: Dunedin
Academic Press.
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The Journal of Forensic Psychiatry & Psychology. 1-15.
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determination in the context of mental health recovery. Australian Nursing and Midwifery
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Trenoweth, S. (2016). Promoting Recovery in Mental Health Nursing. London: SAGE Publications.
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Mosby Australia
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Williams, S. (2015). Recovering from psychosis: Empirical evidence and lived experience. Routledge
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Vulnerability-Stress Model. Routledge

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