PSYCHIATRY EMERGENCIES

MENTAL HEALTH AND
PSYCHIATRIC NURSING
PSYCHIATRIC EMERGENCIES
1PREPARED BY JONES H.M- MBA11/6/2019

GENERAL OBJECTIVE
• Show an understanding of Psychiatric
emergencies and management
SPECIFIC OBJECTIVES
At the end of the unit the learner should be able to
7.1 Enumerate suicidal attempt
7.2 Identify aggressive patients
7.3 Identify depressed patients
PREPARED BY JONES H.M- MBA 211/6/2019

• SPECIFIC OBJECTIVES
7.4 Explain alcohol intoxication
7.5 Discuss drug poisoning
7.6 Describe drug and substance abuse

SUICIDAL ATTEMPTS
DEFINITION:
A failed suicide attempt (Latin: tentamen
suicidii), or nonfatal suicide attempt, is a suicide
attempt from which the actor survived.
AGGRESSIVE PATIENTS
INTRODUCTION
• Aggression arises from an innate drives or occurs
as a defense mechanism and is manifested either
by

• constructive or destructive acts directly towards
self or others.
• Aggressive people ignore the rights of other
people.
• They must fight for their own interests and they
expect same from others.
• An aggressive approach to life may lead to
physical or verbal violence.
• The aggressive behavior often covers a basic lack
of self confidence.

• Aggressive people enhance to their self
esteem by overpowering others and there by
proving their superiority.
• They try to cover up their insecurities and
vulnerabilities by acting aggressive.
• Aggression: Aggression refers to behavior that
is intended to cause harm or pain. Aggression
can be either physical or verbal.

Characteristics of aggressive behavior
• Aggressive behavior is communicated verbally or
non verbally
• Aggressive people may invade the personal space
of others
• They may speak loudly and with greater emphasis
• They usually maintain eye contact over a
prolonged period of time so that the other
person experiences it as an intrusive

• Gestures may be emphatic and often seem
threatening. (For example they may point
their figure, shake their fists, stamp their feet
or make slashing motion with their hands)
• Posture is erect and often aggressive people
lean forward slightly towards the other
person.
• The overall impression is one of power and
dominance

Types of aggression
• Instrumental aggression - aggression aimed at
obtaining an object, privilege or space with no
deliberate intent to harm another person
• Hostile aggression - Aggression intended to harm
another person, such as hitting, kicking, or
threatening to beat up someone.
• Relational aggression - A form of hostile
aggression that does damage to another's peer
relationships, as in social exclusion or rumor
spreading.

Moyer Classification
• Moyer (1968) presented an early and influential
classification of seven different forms of aggression,
from a biological and evolutionary point of view.
• Predatory aggression: Attack on prey by a predator.
• Inter-male aggression: Competition between males of
the same species over access to resources such as
females, dominance, status, etc.
• Fear-induced aggression: Aggression associated with
attempts to flee from a threat.

• Irritable aggression: Aggression induced by
frustration and directed against an available
target.
• Territorial aggression: Defense of a fixed area
against intruders, typically conflicts.
• Maternal aggression: A female's aggression to
protect her offspring from a threat. Paternal
aggression also exists.
• Instrumental aggression: Aggression directed
towards obtaining some goal, considered to be a
learned response to a situation.

DEPRESSED PATIENT
DEFINITION:
• Depression is a state of low mood and
aversion to activity that can affect a person's
thoughts, behavior, feelings and sense of well-
being.
• Depressed people may feel sad, anxious,
empty, hopeless, worried, helpless, worthless,
guilty, irritable, hurt, or restless.

Causes
• Life events and changes that may precipitate
depressed mood include childbirth,
menopause, financial difficulties, job
problems, loss of a loved one/family member
or friend, natural disasters such as
earthquakes, hurricanes, tornadoes, etc.
relationship troubles, separation,
bereavement and catastrophic injury.

• Medical treatments
• Certain medications are known to cause
depressed mood in a significant number of
patients.
• These include hepatitis C drug therapy and
some drugs used to treat high blood pressure,
such as beta-blockers or reserpine.

• Non-psychiatric illnesses
• Depressed mood can be the result of a number of
infectious diseases, neurological conditions and
physiological problems including
hypoandrogenism (in men), Addison's disease,
Lyme disease, multiple sclerosis, chronic pain,
stroke, diabetes, cancer,sleep apnea, and
disturbed circadian rhythm.
• It is often one of the early symptoms of
hypothyroidism (reduced activity of the thyroid
gland).

• Psychiatric syndromes
• A number of psychiatric syndromes feature
depressed mood as a main symptom.
• These include major depressive disorder
(MDD; commonly called major depression or
clinical depression) , bipolar disorder,
borderline personality disorder

Alcohol intoxication
Definition- intoxication (also known as drunkenness
or inebriation) is a physiological state induced by the
consumption of alcohol.
Causes and effect
• Intoxication is the consequence of alcohol entering the
bloodstream faster than it can be metabolized by the
liver.
• Some effects of alcohol intoxication are central to
alcohol's desirability as a beverage and its history as
the world's most widespread recreational drug.

• Common effects are -euphoria and lowered social inhibitions.
• Other effects are unpleasant or dangerous because alcohol
affects many different areas of the body at once and may
cause progressive, long-term harm when consumed in excess.
Symptoms
• Common symptoms of alcohol intoxication include slurred
speech, euphoria, impaired balance, loss of muscle
coordination (ataxia), flushed face, dehydration, vomiting,
reddened eyes, reduced inhibitions, and erratic behavior.
• Sufficiently high levels of blood-borne alcohol will cause coma
and death from the depressive effects of alcohol upon the
central nervous system.

Stages of alcohol intoxication
1. Euphoria
• Difficultyconcentrating
• Talkative
• Loweredinhibitions
• Brighter color in the face
• Fine motor skills are lacking

2. Excitement
• Senses are dulled
• Poor coordination
• Drowsy
• Beginnings of erratic behavior
• Slow reaction time
Impaired judgment
3. Confusion
• Exaggerated emotions
• Difficulty walking

• Blurred vision
• Slurred speech
• Pain is dulled
4- Stupor
• Cannot stand or walk
• Vomiting
• Unconsciousness is possible
• Decreased response to stimuli
• Apathetic

5- Coma
• Unconscious
• Low body temperature
• Possible death
• Shallow breathing
• Slow pulse
6- Death
Death as a result of respiratory arrest

Pathophysiology
• Alcohol is metabolized by a normal liver at the
rate of about one ounce (one two-ounce shot of
spirits, a normal beer, a regular sized glass of
wine) every 90 minutes.
• An "abnormal" liver with conditions such as
hepatitis, cirrhosis, gall bladder disease, and
cancer will have a slower rate of metabolism.
Ethanol is metabolised to acetaldehyde by
alcohol dehydrogenase (ADH), which is found in
many tissues, including the gastric mucosa.

• Acetaldehyde is metabolised to acetate by
acetaldehyde dehydrogenase (ALDH), which is
predominantly found in liver mitochondria.
• Acetate is used by the muscle cells to produce
acetyl-CoA using the enzyme acetyl-CoA
synthetase, and the acetyl-CoA is then used in the
citric acid cycle.
• It takes roughly 90 minutes for a healthy liver to
metabolize a single ounce, approximately one
hour per standard unit

Diagnoses
• relies on a blood test for alcohol, usually
performed as part of a toxicology screen.
• Blood alcohol content (BAC), also called blood
alcohol concentration, blood ethanol
concentration, or blood alcohol level is most
commonly used as a metric of alcohol
intoxication for legal or medical purposes.

Management
• Acute alcohol poisoning is a medical emergency due to
the risk of death from respiratory depression and/or
inhalation of vomit if emesis occurs while the patient is
unconscious and unresponsive.
• Emergency treatment for acute alcohol poisoning strives
to stabilize the patient and maintain a patent airway and
respiration, while waiting for the alcohol to metabolize:
Also:
• vital signs by monitoring ABCs, or Airway, Breathing, and
Circulation; that is, if the person is thought to be at risk

Management
• for severe respiratory depression, consider an
endotracheal tube to protect the airway and
assist with breathing.
• Protect the airway from aspirating stomach
contents that could cause aspiration pneumonia.
• Treat hypoglycaemia (low blood sugar) with 50ml
of 50% dextrose solution and saline flush, as
ethanol induced hypoglycaemia is unresponsive
to glucagon.

Drug poisoning
Definition
• Poisoning can result from an overdose of either
prescribed drugs or drugs that are bought over
the counter.
• It can also be caused by drug abuse or drug
interaction.
• Accidental and intentional poisonings or drug
overdoses constitute a significant source of
aggregate morbidity, mortality, and health care
expenditure.

Drug poisoning
• The effects vary depending on the type of
drug and how it is taken (see table below).
When you call the emergency services, give as
much information as possible.
• While waiting for help to arrive, look for
containers that might help you to identify the
drug.
TABLE

Nursing Management
Goals -
• To maintain breathing and circulatio
• To arrange removal to hospital. If the casualty is
conscious:
• Help them into a comfortable position
• Ask them what they have taken
• Reassure them while you talk to them
• Monitor and record vital signs - level of response,
pulse and breathing - until medical help arrives

Nursing Management
• Look for evidence that might help to identify the drug,
such as empty containers. Give these samples and
containers to the paramedic or ambulance crew.
• If the casualty becomes unconscious:
• open the airway and check breathing be prepared to
give chest compressions and rescue breaths if
necessary place them into the recovery position if the
casualty is unconscious but breathing normally.
• DO NOT induce vomiting.

Prevention and Control
• Reduce Access to Drugs
• Reduce Inappropriate Prescription Use
• Develop education materials specifically for chronic
pain patients addressing use, misuse and proper
storage and disposal
Substance Abuse Primary Prevention
• Provide targeted education to youth professionals
based on evidence-based practice
• Early Intervention, Treatment & Recovery
• Overdose Intervention/Harm Reduction

Drug and Substance Abuse
Definition- What is a drug?
• A chemical substance which when taken
changes the functioning of the body and the
mind.
What is drug use?
• Using a drug for its intended purpose, eg use
of anti-malarialtablets to treat malaria,
panadol to relieve pain etc.

Drug and Substance Abuse
What is drug abuse?
• is an intense desire to use increasing amounts
of a particular substance or substances to the
exclusion of other activities. Improper use of
drugs, e.g. taking piriton to sleep instead of
using it to treat allergy, sniffing glue instead of
using it as an adhesive.

Categories of drugs abused
- Illicit (illegal) for example Heroine, Cocaine,
Chang'aa,Bhang, Kuber, Mandrax.
- Licit (legal) drugs for example Alcohol (Beer,
Wines & Spirits) Tobacco, Miraa.
Commonly abused drugs
• Alcohol, Chang'aa, Cigarettes, Bhang, Miraa,
Mandrax, Glue,Cocaine, Heroine, misuse of
prescription drugs.

Causes of abuse
• Peer influence
• Low self-esteem
• Media influence (TV, magazines, internet)
• Rebellion against parents, teachers, religion etc
• Curiosity
• Lack of knowledge of drugs
• Poor role models .
• Frustrations from home, school, body changes etc
• Inability to achieve goals set thus feeling like a failure
• False ideas and perceptions. e.g. bhang enhances
academic performance .

Effect of abuse
• Poor memory
• Reduced reasoning capacity
• Truancy and poor performance in school,
sports and other activities.
• Poor concentration
• Dropping out of school.
• Suspension and expulsion from schools .

Effect of abuse
• Risky sexual behavior leading to early pregnancy
& HIV/AIDS
• Crimes like theft,
violence,rape,incest,bestiality(sex with animals)
leading to legal implications .
• Poor health
• Personal neglect
• Withdrawal and isolation from society

Effect of abuse
• Being shunned by the society .
• Personal guilt
• Poor relations with parents, teachers, siblings
and peers .
• Physical and psychological addiction .
• Overdose of drugs can lead to DEATH.

• MarijuanWarning Signs of Commonly Abused Drugsa:
Glassy, red eyes; loud talking, inappropriate laughter
followed by sleepiness; loss of interest, motivation;
weight gain or loss.
Stimulants (including amphetamines, cocaine, crystal
meth): Dilated pupils; hyperactivity; euphoria;
irritability; anxiety; excessive talking followed by
depression or excessive sleeping at odd times; may go
long periods of time without eating or sleeping; weight
loss; dry mouth and nose

• Depressants (including Xanax, Valium, GHB):
Contracted pupils; drunk-like; difficulty
concentrating; clumsiness; poor judgment;
slurred speech; sleepiness.
• Heroin: Contracted pupils; no response of
pupils to light; needle marks; sleeping at
unusual times; sweating; vomiting; coughing,
sniffling; twitching; loss of appetite.

• Inhalants (glues, aerosols, vapors): Watery
eyes; impaired vision, memory and thought;
secretions from the nose or rashes around the
nose and mouth; headaches and nausea;
appearance of intoxication; drowsiness; poor
muscle control; changes in appetite; anxiety;
irritability; lots of cans/aerosols in the trash.

• Hallucinogens (LSD, PCP): Dilated pupils; bizarre
and irrational behavior including paranoia,
aggression, hallucinations; mood swings;
detachment from people; absorption with self or
other objects, slurred speech; confusion.
Preventive strategies
• Involve yourself in pleasurable activities like
games, drama, clubs and societies etc
• Develop a good reading culture .

Preventive strategies
• Apply critical thinking e.g. asking yourself, why am I doing
this? What for? What are the consequences of my actions?
• Develop mechanisms for dealing with difficulties, issues .
• Choose friends wisely .
• Develop your personal potential such as creativity,
• Appreciate, love and accept yourself as you are .
• Identify and pursue your purpose in life .
• Self awareness: identify your capabilities, strength,
limitations, weaknesses and appreciate them .
• Be aware of your physical, mental and emotional changes
taking place during adolescence and learn to cope

THANK YOU
END

MENTAL HEALTH AND
PSYCHIATRIC NURSING
FORENSIC PSYCHIATRIC

INTRODUCTION
• Forensic psychiatry deals with some of the most
disturbed and difficult to manage patients in
psychiatric practice
• Forensic psychiatry is a multi-professional
discipline where it is the norm to function as part
of a clinical team which will include psychologists,
occupational therapists, clinicians and social work
colleagues as well as community forensic
psychiatric nurses.

• Most forensic services operate from well-
equipped, purpose built modern facilities.
• The patients are invariably fascinating, with
complex, often multiple psychopathology.
• The range of referrals is immense, covering
minor and very serious offenders, non-offenders
with worrying behaviours and requests for advice
from the courts, the probation service, the prison
service and psychiatric colleagues

DEFINITIONS OF KEY TERMS
Forensic
• Pertaining to or applied in legal proceedings.
Forensic psychiatry
• It is the branch of psychiatry that deals with
the assessment and treatment of mentally
disordered offenders and includes those areas
where psychiatry interacts with the law.

DEFINITIONS OF KEY TERMS
Forensic nursing
• It is defined as a subspecialty of nursing that
has as its objective assisting the mental health
and legal systems in serving individuals who
have come to the attention of both.

TYPES OF PATIENTS THAT NEED
• The patient in the forensic setting is guilty of
committing a crime believed to be caused by
their mental illness.
• Alternatively, the forensic psychiatric patient
might have committed a crime independently
of their mental illness, but is presently too ill
to participate in court proceedings.

• For example, a patient experiencing symptoms
of schizophrenia might injure a neighbor
because he or she heard voices stating that
the neighbor intended to harm her or him.
• This is quite different from a patient who
injures someone whilst their illness is stable.
• A patient judged to have committed a crime in
connection with a mental illness might be
found not guilty by reason of insanity.

• The following are types of patients that are
admitted to forensic facilities:
Anti social personality disorder – is more
strongly related to offending and violence.
• Aspects related to offending in a person with
personality disorder include impulsivity, lack of
empathy, paranoid thinking, poor relationships
with others, problems with anger and
assertiveness.
Substance dependence (alcohol and drugs such
as cocaine, heroine, chamba)

• Intoxication reduces inhibitions and is strongly
associated with crimes of violence, including
murder.
• Neuropsychiatric complications of alcoholism
may also be linked with crime.
Learning disability – People with learning
disability may commit offences because they
do not understand

• the implications of their behavior, or because
they are susceptible to exploitation by other
people. Eg. Property offences, sexual offences
such as indecent exposure by males & arson.
Mood disorder – Depressive disorder is
sometimes associated with shop lifting and may
also lead to homicide & suicide.
• Manic patients may spend excessively and fail to
pay.
• They are also prone to irritability and aggression
leading to crimes of violence.

• Schizophrenia and other psychotic disorders –
are associated with violence especially if paranoid
or coupled with substance abuse.
• in cases where battered women have killed a
battering partner.
• Morbid jealousy
• Organic mental disorders – Dementia and
delirium. Eg aggression
• Epilepsy – Violence is commoner in the post ictal
state than ictally.

FORENSIC PSYCHIATRIC CARE OF
PATIENTS DURING DETENTION
• In Zambia mentally disordered offenders are
cared for under the Penal Code 87 and Prisons
Act of the Zambian Constitution as follows:
Presumption of sanity:-Every person is presumed
to be of sound mind, and to have been of sound
mind at any time which comes in question, until
the contrary is proved.
• When a person getting psychiatric treatment
commits a serious offence while they are not
documented legally that they are suffering from
mental disorders,

• such a person is liable to prosecution until proven
mentally ill by a qualified and registered
psychiatrist.
• Insanity: A person is not criminally responsible
for an act or omission if at the time of doing the
act or making the omission he is, through any
disease affecting his mind, incapable of
understanding what he is doing, or of knowing
that he ought not to do the act or make the
omission.

• Defense of diminished responsibility: Where a
person kills or is a party to the killing of another,
he shall not be convicted of murder if he was
suffering from such abnormality of mind
• During detention correspondence between the
courts of law and the head of the psychiatric
department is entered into concerning the
detention and care of patients using the following
methods:

• Adjudication order forms
• Control order forms
• Detention Order form
• Court reports
• Give evidence in criminal proceedings on the
patient’s dangerousness, so that a suitable
sentence may be made.
• Transfer Order form

TREATMENT SETTINGS FOR MENTALLY
DISORDERED OFFENDERS
• In Zambia Chainama East is used to confine
people who have committed homicide or
grievous bodily harm to others, as a result of
being insane.
• Like a prison, Chainama East is a secure
environment with strict rules and regulations to
ensure safety and security to prevent patients
escaping.
• Individuals admitted to this place have been
charged with criminal offences and are deemed
too dangerous to live in the community.

• Chainama East is also used to care for persons
that develop mental disorder and therefore
require psychiatric treatment and care whilst
in prison.
• Those who have committed violence against
property as a result of insanity are kept in the
acute wards in Chainama and are guarded by
female or male prison warders.

LEAVE OF ABSENCE -Detained patients cannot go
on leave or be discharged from the hospital as
long as they are a danger to others and to
property.
ABSCONDING - Immediately it is noticed that a
patient has absconded, the police and relatives
should be notified, indicating the date, time,
circumstances under which the patient
absconded and clothes they were last seen
wearing, and direction which they took. A search
by police is instituted.

SEXUALITY - Sexual offences tend to be
repeated because patients with psychosexual
disorders may not cooperate with treatment
• Treatment of sex offenders can only be carried
out if the offender admits to having
committed the crime and if he or she is willing
to undergo therapy with a view to changing
his or her sex offending behavior.

FORENSIC PSYCHIATRIC NURSING
CARE
• is the therapeutic nursing inventions targeted at
patient’s behaviours (psychiatric symptoms) that
cause him/her to commit crimes.
• Nursing interventions therefore, are directed
towards reducing the frequency and severity of
these behaviors and include the following:
Crisis intervention- Treatment is aimed at
reducing emotional arousal that takes place
during a crisis together with any accompanying
behavioral disorganization by reassuring the
patient and enabling him/her to have an

CARE
• opportunity to express emotions, in a
supportive environment (empathy, non
judgmental).
Rehabilitation - If anger is behind the criminal
act specific programs targeting anger
management should be offered.
Suicide prevention – treatment for depression
and close observation by staff and relatives

CARE
• Behavior management – any abnormal behavior
such as being anti social or manipulative is
treated using behavior modification training.
• Substance abuse treatment – Detoxification is
done in the psychiatric unit and thereafter the
patient is referred and connected to long term
support groups.
• Discharge planning – begin to plan for the
discharge of the patient together with him/her
and relatives

Special challenges a nurse faces with
forensic patients
• Since forensic patients have two main
problems; namely the serious crime they have
committed and the mental disorder that
caused them to commit that crime, he or she
becomes very complicated and difficult to
manage.
• In fact, forensic patients are well known as
being very dangerous, both to each other, and
to staff caring for them.

Special challenges a nurse faces with
forensic patients
• Potential for Physical Violence
• Verbal abuse
• Difficulties in the nurse patient relationship

REFERRAL / DISCHARGE OF
FORENSIC PATIENTS
• Forensic offenders are reviewed every
fourteen days by two different psychiatrists
under the Detention Order. Their confinement
in a mental hospital tends to be for long
periods of time until it is determined that they
no longer pose a danger to the public and to
property; again by two psychiatrists who get
their views from the observations and
assessments by nurses, psychologists .

REFERRAL / DISCHARGE OF
FORENSIC PATIENTS
• According to His Excellency’s Pleasure (This is
Prerogative of Mercy of the President where
he pardons prisoners that have been
recommended by both prison and mental
health personnel); the psychiatrists will
complete a medical certificate in which a
patient’s mental fitness is confirmed.

COMMUNITY PSYCHIATRY
INTRODUCTION
• Community Psychiatry involves delivering mental
health care to clients while they continue to live in
their homes.
• In this way, community mental health services would
lessen social exclusion and stigma, as well as reduce
neglect of human rights often encountered in mental
hospitals.
• For mental health to be delivered effectively in the
community, interventions are carried out on the
following levels: promotional activities, and primary,
secondary and tertiary prevention.

• DEFINITION OF KEY TERMS
• Community Psychiatry
• Psychiatry focusing on detection, prevention and
early treatment and rehabilitation of emotional
and behavioral problems as they occur in the
community.
• Community mental health services support or
treat people with mental health problems whilst
they continue to live in their own homes.

• Institutionalism is a pattern of passive dependent
behavior observed among psychiatric inpatients, which
is characterized by hospital attachment and resistance
to discharge.
• Deinstitutionalization
• At the patient level, it refers to the transfer of a patient
hospitalized for extended periods of time to a
community setting.
• At the mental health care system level, it refers to a
shift in the focus of care from long term institutions to
the community, accompanied by discharging long-term
patients, and avoiding unnecessary admissions.

• Severe mental disorders are mental illnesses
characterized by functional disability (inability
to function in the following areas:
occupational, social, ADLs).
• Mental health promotion is a means of
reaching the goal of good mental health
through actions that are taken for the purpose
of fostering, protecting and improving mental
health.

LEVELS OF INTERVENTION IN
MENTAL HEALTH
Primary prevention is preventing psychiatric illness rather
than treating it.
• This is done by first identifying at risk groups, and then
promoting their mental health through educating them.
Secondary prevention is reducing the number of existing
mental illnesses through screening early diagnosis, prompt
treatment and education of signs and symptoms.
Tertiary prevention
• Attempts to reduce the severity of a mental disorder and its
associated disability through rehabilitation activities or
• The prevention of long term disability from chronic and
persistent severe mental illness. Such disability includes
poor social integration, aggression, indecent behaviors, etc.

Community mental health services in
Zambia today
• The Mental Health Policy of Zambia, which
guides the development of Mental Health
Services in the country, outlines the fact that
• Disabilities that result from neurological,
mental, and psychosocial disorders shall be
reduced through community rehabilitation.
• To ensure that mental health services are
delivered to the community,

Community mental health services in
Zambia today
• The strategic Plan for 2007-2011 has outlined how
service providers are to deliver services at community
level as follows:
• a) Conducting public educational programmes to
create awareness of mental health issues.
• b) Providing care and support skills to neighborhood
health committees through short courses and
supervisory guidance
• c) Networking with NGOs with similar interests to
promote mental health and prevent mental health
problems in communities. Such NGOs include user and
careers groups.

Examples of community mental
health services in Zambia
• Home visits
• Mental health corners in PHC clinics,
• Outreach clinics in Matero ref & Chilenje
clinics
• Assessment of new cases at UTH clinic 6 and
review of old cases as well at Chainama OPD
• Counseling for emotional, substance abuse
problems, mental disorders

ROLES OF A NURSE IN COMMUNITY
MENTAL HEALTH SERVICES
• Consultative role – Giving advice to other
professionals in the community about the type
and level of nursing care required for given client
groups.
• 2. Clinical role – Providing direct nursing care to
the patients in the community through home
visits.
• 3. Therapeutic role – Employing
psychotherapeutic and behavioral methods for
management of patients.

• Assessor / Researcher – The nurse may assess the
care given to clients and may also assess the
outcome of ongoing care programmes.
• 5. Educator – Creating awareness in the
community about mental health and mental
illness with special focus on vulnerable groups
• 6. Trainer / facilitator – Training of other
professional community leaders, school teachers
and other care giving professionals in the
community.

• Manager/Administration – Manager of the
resources, planning and co-ordination.
• 8. Liaison role
• – Nurses working in the community help
clients and their families by bridging the gap
between the client and the hospital.

• Advocacy – Nurses speak out for the rights
and interests of clients in the community by
raising awareness of clients’ needs in places of
employment, school and markets.
• Preventive roles as earlier seen, under
primary, secondary and tertiary levels.

ADVOCACY
MHN
13/ 11/ 2014

ADVOCACY
GENERAL OBJECTIVE
• At the end of the discussion students should
be able to define Advocacy,Principles of
advocacy,Nurses rights and patients right in
advocacy, community participation and
partnership and vulnerable populations.

ADVOCACY
SPECIFIC OBJECTIVE
–Definition and Principles of advocacy
–Nurses and Patients rights
–Community participation and partnership
–Vulnerable populations

ADVOCACY
• ADVOCACY- is commonly understood to mean
speaking, pleading or interceding for someone
else.
• ‘In relation to people with mental health
problems or learning difficulties, it has the
rather different meaning of helping people to
be heard, and ensuring that what they say
influences the decisions of clinical staff’ (Royal
College of Psychiatrists 1999: p. 6).

ADVOCACY
• Who is an advocate- An advocate is someone
who can both listen to you and speak for you
in times of need.
• Why advocacy:
• Having a mental health problem, or
experiencing mental distress, often means
that your opinions and ideas are not taken
seriously, or that you are not offered the
opportunities and choices you would like.

ADVOCACY
• Being labeled with a diagnosis of mental
illness is often linked to poverty,
unemployment and exclusion from everyday
life.
• In its simplest form, advocacy can mean just
listening respectfully to someone.

1Principles of Advocacy
Advocacy is a process of supporting and enabling
people to:
• express their views and concerns
• access information and services
• defend and promote their rights and
responsibilities
• explore choices and options.
• Advocacy goals:
• Problem Solving

1Principles of Advocacy
•Empowering Complainants
• Promoting the Healing Process

THE END
THANK YOU

ADVOCACY
MHN
13/ 11/ 2014

Characteristic of Advocacy
• Empowering and representation
• Independent advocates-express their partner
view without prejudice to themselves.
• Inclusive-everyone should be able to access an
advocate.
• Impartial- must not judge their partner
• Confidential-must keep information shared
secret.
• Free advocacy services –must be free to the
recipient

Types of Advocacy
Self-advocacy
• Self-advocacy is about speaking up for
yourself and making your views and wishes
clear.
• Most local user and survivor groups promote
and include self-advocacy.
Group advocacy
• Group advocacy (also known as collective
advocacy) is where a group of people with

Types of Advocacy
Group advocacy
• similar experiences meet together to put forward
shared views.
• Local mental health service-user groups, support
groups and patient councils are all examples of
group advocacy.
Peer advocacy-
• is support from someone with experience of
using mental health services.

Types of Advocacy
• Peer advocates can draw on their own
experiences to understand and empathize with
the person they are working with.
• Working with a peer advocate makes it easier for
advocate and user to have an equal relationship.
• Some peer advocates and advocacy schemes
work on an entirely voluntary basis, but the
majority are now funded user- and survivor-run
schemes with paid workers.

Types of Advocacy
Formal, professional, or paid advocacy
• Many voluntary organizations have developed
advocacy services, which train and pay some or
all of the advocates to work with anyone who
wants to use their service.
• Although not always the case, this kind of
advocacy is usually focused on short-term or
‘crisis’ work, rather than providing long-term
support.
• Many of the advocates working for formal
advocacy services are also users and survivors.

Types of Advocacy
Citizen advocacy
• Citizen advocacy matches people with
partners who are members of their local
community.
• Citizen advocacy partnerships tend to be long-
term, supportive relationships.
• Most citizen advocacy schemes have paid
coordinators, who train and support unpaid
volunteer partners.

Types of Advocacy
Citizen advocacy
• As well as helping with specific situations,
citizen advocacy partnerships are intended to
support vulnerable people so that they can
take a greater part in the life of their
community
Legal advocacy
• People with specialist knowledge and training,
such as lawyers and advice workers, are

Types of Advocacy
Legal advocacy
• sometimes called ‘legal advocates’.
• Legal advocates differ from other mental
health advocates in that they represent
people in formal settings, such as courts,
tribunals or complaints processes.
• A legal advocate will often give advice and
express their opinion about the best course of
action.

Nurses and clients rights
• The International Council of Nurses’ (ICN) Code of
Ethics also includes a central role for advocacy.
• As with the definition offered by Benner, the role
of collaboration with patients, other healthcare
providers, and society is evident in these
statements from the ICN Code of Ethics for
Nurses:
• In providing care, the nurse promotes an
environment in which the human rights, values,
customs and spiritual beliefs of the individual,
family and community are respected.

• The Code of Ethics describes the responsibility of
the nurse to work through appropriate channels
to address concerns about the healthcare
environment.
• In addition, the Code of Ethics identifies a range
of advocacy skills and activities that nurses are
expected to demonstrate.
• These activities promote the profession and form
the basis of the advocacy role for the professional
nurse.

• The skills include service to the profession
through teaching, mentoring, peer review,
involvement in professional associations,
community service, and knowledge
development/dissemination (ANA, 2001).
• These activities and skills form the basis of
advocacy role of the professional nurse.
• The nurse ensures that the individual receives
sufficient information on which to base

• consent for care and related treatment.
• The nurse shares with society the
responsibility for initiating and supporting
action to meet the health and social needs of
the public, in particular those of vulnerable
populations.

Clients rights
• Advocacy under the Mental Capacity Act 2005
The Mental Capacity Act 2005 applies to
people who lack mental capacity to make a
particular decision.
• The Act states that in certain situations, an
Independent Mental Capacity Advocate
(IMCA) must be appointed to help people who
lack capacity to make a decision and have no
one else to speak on their behalf.

Clients rights
• This could happen when an NHS body wants to
provide ‘serious medical treatment’ or there are
plans to provide the person with long-term
accommodation in hospital or a care home.
• This includes people who have been detained
under the MHA for longer than 72 hours, such as
those under sections 2 and 3, and people living in
the community under Mental Health Act
guardianship, conditional discharge and
supervised community treatment.

Clients rights
• Others who are not ‘qualifying patients’ but who
are receiving treatment in hospital for mental
health problems may also be entitled to IMHA
support if they are considering certain treatments
under the MHA, such as neurosurgery and electro
convulsive therapy.
• The experience of an in-patient admission,
whether voluntary or under a section of the
Mental Health Act (MHA), can be confusing and
disempowering.

Clients rights
• Exercising your right to be informed and
involved in your own care and treatment is
difficult when you are distressed or when your
views may be discounted as part of your
‘illness’.
• In hospital, an advocate will help you get
information about your legal rights, your
medication or discharge plans.

Community participation and
partnership
• In the community, an advocate might assist you
with a benefit claim, finding the right housing, or
getting the community care services you want.
• An advocate can provide support if you want to
complain about services you are not happy with.
• They might also help you find out about work,
education or leisure opportunities in your area.

Vulnerable Populations
• Vulnerable populations are groups that are
not well integrated into the health care system
because of ethnic, cultural, economic,
geographic, or health characteristics.
• This isolation puts members of these groups
at risk for not obtaining necessary medical
care, and thus constitutes a potential threat to
their health.

• Commonly cited examples of vulnerable
populations include racial and ethnic
minorities, the rural and urban poor,
undocumented immigrants, and people with
disabilities or multiple chronic conditions.
Health Domains of Vulnerable Populations
• The health domains of vulnerable populations
can be divided into 3 categories: physical,
psychological, and social.

Physical domain:
• Those with physical needs include high-risk
mothers and infants, the chronically ill and
disabled, and persons living with HIV/acquired
immunodeficiency syndrome.
• Chronic medical conditions include
respiratory diseases, diabetes, hypertension,
dyslipidemia, and heart disease.

Psychological domain:
• In the psychological domain, vulnerable
populations include those with chronic mental
conditions, such as schizophrenia, bipolar
disorder, major depression, and attention-
deficit/hyperactivity disorder, as well as those
with a history of alcohol and/or substance
abuse and those who are suicidal or prone to
homelessness.

Social domain
• In the social realm, vulnerable populations
include those living in abusive families, the
homeless, immigrants, and refugees

THANK YOU FOR LISTENING
AND PARTICIPATING
HELP BUILD A BETTER NATION BY
REDUCING MENTAL DISORDERS
THE END

PSYCHIATRY EMERGENCIES

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