Mental Health, Illness and Addiction Teaching activities and resources
This section supports educators with increased knowledge and skills to integrate mental health and screening, assessment and interventions related to mental illnesses in mental health and addiction curricula.
At the end of this section, the educator will ensure students achieve the following:
- Understand the continuum of mental health.
- Understand the concept of resiliency and mental health (i.e., concepts of stress, coping, adaptation, etc.).
- Understand mental health promotion, and prevention of mental illness.
Educators will use the Resource Section to:
- Understand the purpose of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in nursing, and identify DSM-5 diagnostic categories and criteria for the following conditions.
- Bipolar disorders
- Depressive disorders
- Anxiety disorders
- Substance-related and addictive disorders
- Trauma- and stressor-related disorders
- Personality disorders
- Delirium and Dementia
- Schizophrenia and other psychotic disorders
- Understand treatment and management of mental illness.
- Learn about co-morbidities, severity, and levels of disability related to mental disorders.
Mental Health Continuum
The definition of mental health is much more holistic than it once was. According to the Public Health Agency of Canada it is: “The capacities of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity” (Public Health Agency of Canada, 2014, para 2). However, mental health and mental illness are not the same thing. Mental illness is “a recognized, medically diagnosable illness that results in the significant impairment of an individual’s cognitive, affective or relational abilities. Mental disorders result from biological, developmental and/or psychosocial factors and can be managed using approaches comparable to those applied to physical disease (i.e., prevention, screening, diagnosis, treatment and rehabilitation)” (Epp, J., 2009, p. 82).
The “mental health continuum” best describes the relationship between health and illness where they are not at opposite ends of a single spectrum but on a continuum (Keyes, 2002). Every person can flourish or languish somewhere along the mental health continuum, and this state can vary on a daily basis. Inherent in the mental health continuum is the understanding that mental health is not simply the absence of mental illness. Rather the model adopts the notion that individuals can experience complete mental health even if they have been diagnosed with a mental illness (Keyes, 2002). On the other hand, individuals who are free of a diagnosed mental illness can still experience poor mental health if they have poor coping mechanisms. A useful tool for gaining further insight is the 2015 First Nations Mental Wellness Continuum Framework, which views mental well-being as “a balance of the mental, physical, spiritual, and emotional” that gives everyone—even the most vulnerable or mentally ill—an opportunity to live whole and healthy lives (Health Canada, 2015).
There is a relationship between being resilient and having good mental health. People who are “resilient” are able to recover from difficulties or change and move forward as they were before the disruption (Khanlou & Barankin, 2007). However, people who are resilient can develop a mental illness, which may lower resiliency (Khanlou & Barankin, 2007). Because nurses working in all practice settings along the continuum of health care will care for people with varying degrees of mental health and illnesses, they should be aware of and understand ways to improve resiliency in their interactions. Furthermore, faculty should impart not only the importance of using mental and illness knowledge to care for and impact populations, but to take leadership roles in advancing mental health promotion and driving improvements in mental health care delivery (CFMHN, 2016). Promoting mental health in fact encourages the development of resilience by implementing strategies that build on community-based strengths, provide opportunities, create safe places and encourage supportive resiliency (Khanlou & Barankin, 2007, p. 10).
Further research required:
There are many different types of mental illnesses. Knowledge of the American Psychiatric Association [APA] (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—a classification and diagnostic tool for mental illness—is key for nurse educators to teach students about mental illness pathology in order to understand treatment and interventions related to specific mental illness. It may not be imperative to teach about every mental illness, but rather the educator’s role is equally important to have students learn where to find credible, reliable resources.
Teaching and Learning Activities
The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to mental health and illness.
- Lived client and family experience—Appendix H
- Case studies—Section 9.3
- Simulation—Section 7.2
- Discussion of each illness conditions, causes, prevalence, and treatment/management
- Broad discussion on:
- Individual counseling
- Group therapy
- Family counseling
- Pharmacological therapy
- Complementary therapy
- Other Psychosocial interventions
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding mental health and illness. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.
- What causes mental illness (e.g., depression)? Give examples from neuroenzyme, hormonal, medication side effects, sociological, psychological, economic, relationship, social determinants, equity, co-morbidities.
- Can you have good mental health with a mental illness?
- What other conditions/illnesses are you at higher risk of because of a mental illness?
- What mental illness(es) are you at higher risk of because of other conditions/illnesses (e.g., diabetes, cardiac, cancer)?
- What is a concurrent disorder?
- How do the social determinants of health influence mental health and illness?
- What community and hospital-based mental health services/resources are available?
- What is the difference between mental health, mental illness and mental disability?
- What complementary therapies might be employed?
- What is the nurse’s role in the acute phase of illness? What is the nurse’s role in rehabilitation?
- What is the nurse’s role in the hospital and community mental health?
- What assessments are completed to determine changes in the mental status (e.g., Mental Status Examination)?
- What are the benefits and risks of diagnosis to the person?
Evaluation and Self-reflection
The following tools can be used to evaluate students in their understanding and application of mental health and illness.
- Test knowledge (e.g., conditions, signs and symptoms, treatment)
- Paper (e.g., students to write papers on certain mental illness/conditions, mental health, current controversies, etc)
- In-class presentations on different illnesses
- Reflection questions: What mental illnesses have touched your life?
- How does this influence your care?
- Mental Health Commission of Canada. (2013). Changing Directions, Changing Lives: The Mental Health Strategy for Canada
- Ontario Centre of Excellence for Child and Youth Mental Health
- Centre for Addiction and Mental Health—Portico Network
- Children’s Hospital of Eastern Ontario (CHEO)’s e-mental health portal
- Government of Ontario’s Connexx Ontario Health Services Information
- American Psychiatric Association (APA). (2006). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
RNAO BEST PRACTICE GUIDELINES
- RNAO 2016, Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON: Registered Nurses’ Association of Ontario.
- RNAO 2015, Engaging Clients Who Use Substances. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2015, Person- and Family-Centred Care. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2015, Supporting and Strengthening Families Through Expected and Unexpected Life Events. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2009, Supporting Clients on Methadone Maintenance Treatment. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2009, Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2005, Interventions for Postpartum Depression. Toronto, ON. Registered Nurses’ Association of Ontario.
- American Psychological Association (APA). (2013). Cultural Formulation and Cultural Formulation Interviews. In American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
- Keyes, C. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Research, 43(June): 207-222.
- Peplau, H.E. (1999). On semantics. Perspectives in Psychiatric Care. 35(3), 13.
- Frances, Allen. (2013). Saving Normal. New York, NY: Harper Collins.