Foundations of Mental Health Care in Canada

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Front Cover ES1 Morrison-Valfre's Foundations of Mental Health Care in Canada Morrison-Valfre's Foundations of Mental Health Care in Canada Copyright Dedication To the Instructor FEATURES OF THE FIRST CANADIAN EDITION LEARNING AIDS ANCILLARIES For Instructors For Students To the Student CHAPTER FEATURES EVOLVE RESOURCES Acknowledgements Contents I - Mental Health Care:Past and Present 1 - The History of Mental Health Care EARLY YEARS Ancient Societies Greece and Rome Middle Ages Dark Ages Superstitions, Witches, and Hunters The Renaissance The Reformation Seventeenth Century Eighteenth Century NINETEENTH CENTURY TWENTIETH CENTURY Psychoanalysis Influences of War Introduction of Psychotherapeutic Medications Adult Community Mental Health Programs TWENTY-FIRST CENTURY REFERENCES 2 - Current Mental Health Care Systems MENTAL HEALTH CARE IN CANADA Norway The United Kingdom Australia The United States CARE SETTINGS Inpatient Care Outpatient Care Community Support Systems Model Community Care Settings Case Management Psychosocial Rehabilitation Consultation Resource Linkage Advocacy Therapy Crisis Intervention Care Team Patient and Family PATIENT POPULATIONS IMPACT OF MENTAL ILLNESS Incidence of Mental Illness in Canada Economic Issues Social Issues REFERENCES 3 - Ethical and Legal Issues VALUES AND MORALS Acquiring Values Values Clarification RIGHTS Patient Rights Care Provider Rights ETHICS Ethical Principles Codes of Ethics Ethical Conflict LAWS AND THE LEGAL SYSTEM General Concepts Legal Concepts in Health Care LAWS AND MENTAL HEALTH CARE Patient–Caregiver Relationship Adult Psychiatric Admissions Areas of Potential Liability Patient Restraint CARE PROVIDERS’ RESPONSIBILITIES The Reasonable and Prudent Care Provider Principle REFERENCES 4 - Sociocultural Issues INFLUENCES OF CULTURE Health and Illness Beliefs Illness Behaviours On Mental Illness Stress and Coping CULTURAL ASSESSMENT Communication Environmental Control Space, Territory, and Time Social Organization Biological Factors CULTURE AND MENTAL HEALTH CARE REFERENCES 5 - Theories and Therapies HISTORICAL THEORIES Darwin’s Theory Psychoanalytical Theories Psychoanalytical Therapies Transference and Countertransference Analytical Psychotherapy Other Theories Individual Psychotherapy Interpersonal Psychology DEVELOPMENTAL THEORIES AND THERAPIES Cognitive Development Psychosocial Development BEHAVIOURAL THEORIES AND THERAPIES B.F. Skinner Other Behavioural Therapies HUMANISTIC THEORIES AND THERAPIES Perls and Gestalt Therapy Maslow’s Influence Maslow and the Blackfoot Nation Teepee Model Rogers’s Patient-Centred Therapy Current Humanistic Therapies SYSTEMS THEORIES COGNITIVE THEORIES AND THERAPIES Cognitive Restructuring Therapies Coping Skills Therapies Problem-Solving Therapies Reality Therapy SOCIOCULTURAL THEORIES Mental Illness as Myth BIOBEHAVIOURAL THEORIES Homeostasis Stress Adaptation Theory PSYCHOBIOLOGY Psychoneuroimmunology NURSING THEORIES PSYCHOTHERAPIES Individual Therapies Group Therapies Online Therapy SOMATIC THERAPIES Brain Stimulation Therapies Pharmacotherapy FUTURE DEVELOPMENTS REFERENCES 6 - Complementary and Alternative Therapies DEFINITION OF TERMS Allopathic Medicine Complementary Medicine Alternative Medicine Integrative Medicine Holistic Care BODY-BASED CAM THERAPIES Whole Medical Systems Ayurveda Homeopathy Naturopathy Traditional Chinese Medicine Biologically Based Practices Aromatherapy Dietary Supplements Herbal Products Regulation of Health Products Body-Based Practices Chiropractic Treatment Chelation Eye Movement Desensitization Massage Phototherapy ENERGY-BASED CAM THERAPIES Mind-Body Medicine Expressive Therapy Hypnotherapy Meditation Prayer and Spiritual Healing Mindfulness Energy Medicine Biofield Therapies Acupuncture. For more than 2 000 years, a treatment in Asian medicine has cured disease and alleviated suffering. Acupuncture is... Biofeedback. Biofeedback teaches patients to control their physical responses by providing visual or auditory information about ... Qi Gong. Qi is the Chinese name for vital energy. Qi Gong and Tai Chi are systems of movement, regulation of breathing, and medi... Reiki. The word Reiki comes from the Japanese words rei, meaning “God’s wisdom” or “Higher Power,” and the word ki, which is “li... Therapeutic touch. Therapeutic touch is based on the practice of laying on of the hands. The healing energies of the therapist e... Colour therapy. As stated earlier, high-intensity light has been used to successfully treat SAD. Colour therapy is still being s... Electromagnetic Field Therapies TECHNOLOGY-BASED CAM APPLICATIONS CAM Mental Health Therapies Animal-Assisted Therapy Culturally Based Healing Nutrition Pastoral Counselling Self-Help Groups Stress Reduction and Relaxation WORDS OF CAUTION Adverse Effects Implications for Care Providers REFERENCES 7 - Psychotherapeutic Medication Therapy Antianxiety Medications Antidepressant Medications Mood-Stabilizer Medications Antipsychotic (Neuroleptic) Medications SIGNS AND SYMPTOMS PATIENT CARE GUIDELINES Assessment Coordination Medication Administration Monitoring and Evaluating Patient Teaching SPECIAL CONSIDERATIONS Adverse Reactions Nonadherence Informed Consent REFERENCES II - The Caregiver’s Therapeutic Skills 8 - Principles and Skills of Mental Health Care PRINCIPLES OF MENTAL HEALTH CARE The Mentally Healthy Adult Mental Health Care Practice Do No Harm Accept Each Patient as a Whole Person Holistic Framework Develop Mutual Trust Explore Behaviours and Emotions Encourage Responsibility Encourage Effective Adaptation One Step at a Time Crisis Intervention Provide Consistency SKILLS FOR MENTAL HEALTH CARE Self-Awareness Caring Insight Risk Taking and Failure Acceptance Boundaries and Overinvolvement Commitment Positive Outlook Nurturing Yourself REFERENCES 9 - Mental Health Assessment Skills DSM-5 Diagnosis Nursing (Therapeutic) Process ABOUT ASSESSMENT Data Collection Assessment Process Holistic Assessment Risk Factor Assessment The Patient at Risk OBTAINING A HISTORY Effective Interviews Sociocultural Assessment Review of Systems PHYSICAL ASSESSMENT MENTAL STATUS ASSESSMENT General Description Emotional State Experiences Thinking Sensorium and Cognition REFERENCES 10 - Therapeutic Communication THEORIES OF COMMUNICATION Ruesch’s Theory Transactional Analysis Neurolinguistic Programming CHARACTERISTICS OF COMMUNICATION Types of Communication Process of Communication Factors That Influence Communication LEVELS OF COMMUNICATION Verbal Communication Nonverbal Communication INTERCULTURAL COMMUNICATION Intercultural Differences THERAPEUTIC COMMUNICATION SKILLS Listening Skills Interacting Skills NONTHERAPEUTIC COMMUNICATION Barriers to Communication Nontherapeutic Messages PROBLEMS WITH COMMUNICATION Communicating With Mentally Troubled Patients Assessing Communication REFERENCES 11 - The Therapeutic Relationship Trust Empathy Autonomy Caring Hope Acceptance Rapport Genuineness Therapeutic Use of Self Preparation Phase Orientation Phase Working Phase Termination Phase ROLES OF THE CARE PROVIDER Change Agent Teacher Technician Therapist Environmental Problems Problems With Care Providers Problems With Patients REFERENCES 12 - The Therapeutic Environment USE OF THE INPATIENT SETTING Crisis Stabilization Acute Care and Treatment The Chronically Mentally Ill Population GOALS OF A THERAPEUTIC ENVIRONMENT Help Patients Meet Needs Teach Psychosocial (Adaptive) Skills Physiological Needs Safety and Security Needs Love and Belonging Needs Self-Esteem Needs Self-Actualization Needs Admission and Discharge Adherence REFERENCES III - Mental Health Challenges Across the Lifespan 13 - Challenges of Childhood NORMAL CHILDHOOD DEVELOPMENT Common Behavioural Challenges of Childhood Mental Health Challenges of Childhood Environmental Issues Homelessness Abuse and Neglect Parent–Child Conflicts Primary Caregiver Dysfunction EMOTIONAL CHALLENGES Anxiety Depression Somatoform Disorders Post-Traumatic Stress Disorder BEHAVIOURAL CHALLENGES Children and Violence Children and Electronic Media Attention-Deficit/Hyperactivity Disorder Disruptive Behavioural (Conduct) Disorder Oppositional Defiant Disorder Eating Disorders Elimination Disorders DEVELOPMENTAL CHALLENGES Intellectual Development Disorder Learning Disorders Communication Disorders PERVASIVE DEVELOPMENTAL DISORDERS Autism SCHIZOPHRENIA THERAPEUTIC ACTIONS Meet Basic Needs Provide Opportunities Encourage Self-Care and Independence REFERENCES 14 - Challenges of Adolescence ADOLESCENT GROWTH AND DEVELOPMENT Physical Development Psychosocial Development COMMON CHALLENGES OF ADOLESCENCE Internal (Developmental) Challenges External (Environmental) Challenges Teens and Electronic Media Behavioural Disorders Emotional Disorders Mood Disorders Eating Disorders Chemical Dependency Personality Disorders Sexual Disorders Psychosis Suicide THERAPEUTIC INTERVENTIONS Surveillance and Limit Setting Building Self-Esteem Skill Development REFERENCES 15 - Challenges of Adulthood ADULT GROWTH AND DEVELOPMENT COMMON CHALLENGES OF ADULTHOOD Internal (Developmental) Challenges Personal Identity Cultural Identity Interpersonal Relationships Guiding the Next Generation Economics External (Environmental) Challenges Education Lack of Social Support Acquired Immunodeficiency Syndrome MENTAL HEALTH CHALLENGES OF ADULTS Therapeutic Interventions Health Care Interventions Preventing Mental Illness REFERENCES 16 - Challenges of Late Adulthood Facts and Myths of Aging Physical Health Changes Mental Health Changes Research and Aging COMMON CHALLENGES OF OLDER PERSONS Physical Adaptations Health Care Services Psychosocial Adaptations Economics Housing Loss and Death Substance Abuse Elder Abuse Dementia, Depression, and Delirium THERAPEUTIC INTERVENTIONS Age-Related Interventions Mentally Ill Older Persons Mental Health Promotion and Prevention REFERENCES 17 - Cognitive Impairment, Alzheimer’s Disease, and Dementia CONFUSION HAS MANY FACES Normal Changes in Cognition The Three “D’s” of Confusion Medications and the Older Population PATIENTS WITH DELIRIUM Finding the Cause Treating Delirium PATIENTS WITH DEMENTIA Symptoms of Dementia Gentle Persuasive Approach Dementia Care Causes of Dementia ALZHEIMER’S DISEASE Symptoms and Course Losses of Alzheimer’s Disease Stages of Alzheimer’s Disease After the Diagnosis Principles of Management THERAPEUTIC INTERVENTIONS Assessment Interventions for Patients Living With Alzheimer’s Disease Early Stage Middle and Late Stages Caregiver Support Caregiver Education REFERENCES IV - Patients With Psychological Challenges 18 - Managing Anxiety CONTINUUM OF ANXIETY RESPONSES Types of Anxiety Types of Anxiety Responses Coping Methods Defence Mechanisms Crisis Ineffective Coping Self-Awareness and Anxiety THEORIES RELATING TO ANXIETY Biological Models Psychodynamic Model Interpersonal Model Behavioural Model Other Models ANXIETY THROUGHOUT THE LIFE CYCLE Anxiety in Childhood Anxiety in Adolescence Anxiety in Adulthood Anxiety in Older Persons ANXIETY DISORDERS Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorders Panic Attack Specifier Agoraphobia Generalized Anxiety Disorder (GAD) Obsessive-Compulsive Disorder (OCD) Body Dysmorphic Disorder Hoarding Disorder Hair-Pulling Disorder (Trichotillomania) Excoriation Disorder (Skin Picking) Substance-/Medication-Induced Obsessive-Compulsive and Related Disorder Obsessive-Compulsive and Related Disorder Due to Another Medical Condition Other Specified Obsessive-Compulsive and Related Disorder Unspecified Obsessive-Compulsive and Related Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder Post-Traumatic Stress Disorder (PTSD) Acute Stress Disorder Adjustment Disorder Other Specific Trauma- and Stressor-Related Disorder Unspecified Trauma- and Stressor-Related Disorder THERAPEUTIC INTERVENTIONS REFERENCES 19 - Illness and Hospitalization THE NATURE OF ILLNESS Stages of the Illness Experience Stage 1: Symptoms Stage 2: The Sick Role Stage 3: Medical Care Stage 4: Dependency Stage 5: Recovery and Rehabilitation Effects of Illness Illness Behaviours THE HOSPITALIZATION EXPERIENCE Situational Crisis Stages of Hospitalization Common Reactions to Hospitalization Psychiatric Hospitalization THERAPEUTIC INTERVENTIONS Psychosocial Care Supporting Significant Others Pain Management Discharge Planning REFERENCES 20 - Loss and Grief THE NATURE OF LOSS Characteristics of Loss Loss Behaviours Throughout the Life Cycle THE NATURE OF GRIEF AND MOURNING The Grieving Process Stages of the Grieving Process Unresolved Grief Caregivers’ Grief THE DYING PROCESS Age Differences and Dying Terminal Illness Cultural Factors, Dying, and Mourning Stages of Dying THERAPEUTIC INTERVENTIONS Hospice Care Meeting the Needs of Dying Patients Loss, Grief, and Mental Health REFERENCES 21 - Depression and Other Mood Disorders CONTINUUM OF EMOTIONAL RESPONSES Biological Evidence Other Theories EMOTIONS THROUGHOUT THE LIFE CYCLE Emotions in Childhood Emotions in Adolescence Emotions in Adulthood Emotions in Older Persons Characteristics of Mood Disorders DEPRESSIVE DISORDERS Disruptive Mood Dysregulation Disorder Major Depressive Disorder Major Depressive Disorder With Specifiers Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Substance-/Medication-Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder BIPOLAR AND RELATED DISORDERS Bipolar I Disorder Manic Episode Hypomanic Episode Major Depressive Episode Bipolar II Disorder Cyclothymic Disorder Substance-/Medical-Induced Bipolar and Related Disorder Bipolar and Related Disorder Due to Another Medical Condition Other Specified Bipolar and Related Disorder Unspecified Bipolar and Related Disorder THERAPEUTIC INTERVENTIONS Treatment and Therapy Psychotherapies Electroconvulsive Therapy Transcranial Direct Current Stimulation Repetitive Transcranial Magnetic Stimulation Medication Therapies Antidepressants Antidepressants and Suicide Precautions Antimanics Nursing (Therapeutic) Process REFERENCES 22 - Physical Challenges, Psychological Sources ROLE OF EMOTIONS IN HEALTH ANXIETY AND STRESS Childhood Sources COMMON PSYCHOPHYSICAL CHALLENGES Theories of Psychophysical Disorders Cultural Influences Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Treatment Psychological Factors Affecting Other Medical Conditions Other Specified Somatic Symptom and Related Disorder Unspecified Somatic Symptom and Related Disorder Factitious Disorder Malingering IMPLICATIONS FOR CARE PROVIDERS REFERENCES 23 - Eating and Sleeping Disorders FEEDING AND EATING DISORDERS Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Clinical Presentation Bulimia Nervosa Clinical Presentation Binge Eating Disorder Obesity Clinical Presentation Guidelines for Intervention Treatments and Therapies SLEEP–WAKE DISORDERS Insomnia Disorder Hypersomnolence Disorder Narcolepsy Breathing-Related Sleep Disorders Obstructive Sleep Apnea/Hypopnea Central Sleep Apnea Sleep-Related Hypoventilation Circadian Rhythm Sleep–Wake Disorder Parasomnias Non–Rapid Eye Movement Sleep Arousal Disorders Nightmare Disorder Rapid Eye Movement Sleep Behaviour Disorder Restless Legs Syndrome Substance/Medication-Induced Sleep Disorder Other Sleep Disorders Guidelines for Intervention REFERENCES 24 - Dissociative Disorders CONTINUUM OF SELF-CONCEPT RESPONSES The Healthy Personality Self-Concept in Childhood Self-Concept in Adolescence Self-Concept in Adulthood Self-Concept in Older Adulthood DISSOCIATIVE DISORDERS Characteristics Depersonalization/Derealization Disorder Dissociative Amnesia and Dissociative Amnesia With Fugue Dissociative Identity Disorder Trance Other Specified Dissociative Disorders THERAPEUTIC INTERVENTIONS Treatments and Therapies Pharmacological Therapy Nursing (Therapeutic) Process REFERENCES V - Patients With Psychosocial Challenges 25 - Anger and Aggression Gender Aggression Aggression Throughout the Life Cycle Scope of the Problem Today THEORIES OF ANGER AND AGGRESSION Biological Theories Psychosocial Theories Sociocultural Theories THE CYCLE OF ASSAULT Trigger Stage Escalation Stage Crisis Stage Recovery Stage Depression Stage Oppositional Defiant Disorder Intermittent Explosive Disorder Conduct Disorder Antisocial Personality Disorder Pyromania Kleptomania GUIDELINES FOR INTERVENTION Assessing Anger and Aggression Mental Status Assessment Psychosocial Assessment Therapeutic Interventions Trauma-Informed Care REFERENCES 26 - Outward-Focused Emotions: Violence SOCIAL FACTORS AND VIOLENCE Theories of Violence Domestic Violence Intimate Partner Abuse Abuse During Pregnancy Child Abuse Adolescent Abuse Elder Abuse Sexual Abuse Violence Against Health Care Workers Violence, Trauma, and Crime Group Abuse Post-Traumatic Stress Disorder Rape-Trauma Syndrome THERAPEUTIC INTERVENTIONS Special Assessments Treating Victims of Violence Preventing Violence in Your Life REFERENCES 27 - Inward-Focused Emotions: Suicide CONTINUUM OF BEHAVIOURAL RESPONSES Myths About Suicide IMPACT OF SUICIDE ON SOCIETY Cultural Factors Social Factors DYNAMICS OF SUICIDE Characteristics of Suicide Categories of Motivation THEORIES ABOUT SUICIDE New Biological Evidence Effects of Suicide on Others Survivor Guilt SUICIDE THROUGHOUT THE LIFE CYCLE Suicide and Children Suicide and Adolescents Suicide and Adults Suicide and Older Persons Medical Assistance in Dying THERAPEUTIC INTERVENTIONS Assessment of Suicidal Potential Therapeutic Interventions for Suicidal Patients REFERENCES 28 - Substance-Related Disorders and Addictive Disorders Substance Use and Age Scope of the Problem Today CATEGORIES OF ABUSED SUBSTANCES Severity of Impact and Legality Alcohol Signs of Alcohol Intoxication Signs of Alcohol Withdrawal Caffeine Cannabis Hallucinogens Dissociative Anaesthetics Inhalants Opioids (Narcotics) Sedatives (Hypnotics or Anxiolytics) Stimulants Tobacco (Nicotine) OTHER MEDICATIONS Stages of Addiction Substance-Related Disorders and Addictive Disorder Clinical Presentation Similarity Between Addiction and Other Disorders Three Main Malfunctions Leading to Addiction GUIDELINES FOR INTERVENTION Assessment Treatments and Therapies Abstinence and Harm Reduction Nonmedical Treatment Medical Treatment Relapse Nursing/Therapeutic Process REFERENCES 29 - Sexuality and Sexual Disorders THE CONTINUUM OF SEXUAL RESPONSES Self-Awareness and Sexuality SEXUALITY THROUGHOUT THE LIFE CYCLE Sexuality in Childhood Sexuality in Adolescence Sexuality in Adulthood Sexuality in Older Adulthood Sexuality and Disability SEXUAL ORIENTATION GENDER IDENTITY Gender Identity Terminology PARAPHILIC DISORDERS Other Specified Paraphilic Disorders Unspecified Paraphilic Disorder Therapeutic Approach Penile Plethysmograph or Phallometry SEXUAL DYSFUNCTIONS GENDER DYSPHORIA PORNOGRAPHY THERAPEUTIC INTERVENTIONS Psychosexual Assessment Nursing/Therapeutic Process REFERENCES 30 - Personality Disorders CONTINUUM OF SOCIAL RESPONSES PERSONALITY THROUGHOUT THE LIFE CYCLE Personality in Childhood Personality in Adolescence Personality in Adulthood Personality in Older Adulthood Biological Theories Psychoanalytical Theories Behavioural Theories Sociocultural Theories PERSONALITY DISORDERS Eccentric Cluster Erratic Cluster Psychopaths and Sociopaths Fearful Cluster THERAPEUTIC INTERVENTIONS Treatment and Therapy Nursing (Therapeutic) Process REFERENCES 31 - Brain Function, Schizophrenia, and Other Psychoses A FEW FACTS ABOUT OUR BRAINS BRAIN FUNCTION Normal Brain Function Perceptions Thoughts Abnormal Brain Function Positive Symptoms Negative Symptoms Cognitive Symptoms Psychosis THE SCHIZOPHRENIA SPECTRUM Delusional Disorder Brief Psychotic Disorder Schizophreniform Disorder Schizophrenia Insight Development and Course Prevalence Suicide Risk Aggression Interview Tips and Strategies for Patients With Schizophrenia Uncovering Dangerous Psychotic Process Speech Disturbances Other Characteristics of Schizophrenia: Clinical Picture Schizoaffective Disorder Substance/Medication-Induced Psychotic Disorder Psychotic Disorder Due to a Medical Condition Catatonia Associated With a Mental Disorder Catatonic Disorder Due to a Medical Condition Unspecified Catatonia Other Specified Schizophrenia Spectrum and Other Psychotic Disorder Unspecified Schizophrenia Spectrum and Other Psychotic Disorder THERAPEUTIC INTERVENTIONS Treatments and Therapies Pharmacological Therapy Nursing (Therapeutic) Process Special Considerations Neuroleptic Malignant Syndrome Tardive Dyskinesia Anticholinergic Effects Nursing Responsibilities REFERENCES 32 - Chronic Mental Health Disorders SCOPE OF MENTAL ILLNESS PUBLIC POLICY AND MENTAL HEALTH Effects of Deinstitutionalization EXPERIENCE OF CHRONIC MENTAL ILLNESS Meeting Basic Needs Access to Health Care Behavioural Characteristics Physical Characteristics Psychological Characteristics SPECIAL POPULATIONS Children and Adolescents Living With Chronic Mental Illness Older Persons Living With Chronic Mental Illness Persons With Multiple Disorders Inpatient Settings Outpatient Settings Psychiatric Rehabilitation THERAPEUTIC INTERVENTIONS Treatments and Therapies Pharmacological Therapy Nursing (Therapeutic) Process Documentation and Transfer of Accountability Electronic Health Record Organization of Nursing in Mental Health Care Assignment: The Primary Nursing Model. Since low levels of anxiety and good therapeutic relationships are so valuable for a pati... The Nurse in Charge of the Shift. A typical mental health unit can be acute 24/7. Most nursing interventions are collective, tha... Therapeutic Environment and Nursing Work Station. Mobile nursing stations (MNSs) on wheels equipped with a computer and locked c... The Myth of Intermediate Observation. Unfortunately, many medical care facilities still engage in old practices without any evid... The Myth of Chemical Restraint. All across Canada, the use of restraints to ensure personal and public safety is typically regul... Mental Health Care in the Community REFERENCES 33 - Challenges for the Future CHANGES IN MENTAL HEALTH CARE Change in Settings Challenges Created by the Canadian Health Care System Long-Acting Injectables Homelessness The Canadian Charter of Rights and Freedoms Cultural Influences THE MENTAL HEALTH CARE TEAM Team Members Interdisciplinary Interactions Mental Health Care Delivery Settings CHANGE AND MENTAL HEALTH PATIENTS Competency Empowerment of Patients Obligations of Patients Obligations of Care Providers Providers of Care Expanded Role for Nurses The Change Process OTHER CHALLENGES The Challenge to Care A Look to the Future REFERENCES A - Mental Status Assessment at a Glance B - A Simple Assessment of TardiveDyskinesia Symptoms C - Canadian Standards for Psychiatric-Mental Health Nursing Standard II: Performs/Refines Client Assessments Through the Diagnostic and Monitoring Function Standard III: Administers and Monitors Therapeutic Interventions Standard IV: Effectively Manages Rapidly Changing Situations Standard V: Intervenes Through the Teaching-Coaching Function Standard VI: Monitors and Ensures the Quality of Health Care Practices Standard VII: Practices Effectively Within Organizational and Work-Role Structure Glossary A B C D E F G H I J K L M N O P Q R S T U V W Index A B C D E F G H I J L M N N O P Q R S T U V W Y Z