Mental Health Nursing
Core concepts
Mental health nursing combines therapeutic communication, safety assessment, and psychopharmacology. Master the therapeutic relationship: active listening, empathy, open-ended questions, and boundaries. Know risk assessment for suicide and violence-direct, calm questioning about intent, plan, and means is appropriate and does not "plant" the idea. Understand major disorders (depression, bipolar disorder, schizophrenia, anxiety, PTSD, substance use) and their treatments. Psychopharmacology is high-yield: SSRIs (serotonin syndrome, initial suicidality monitoring), lithium (narrow therapeutic index; monitor levels, hydration, sodium), antipsychotics (extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome), and benzodiazepines (dependence, respiratory depression).
Traps in questions
A frequent trap is choosing a non-therapeutic response such as false reassurance ("It'll be fine"), giving advice, or changing the subject. Select responses that reflect feelings and encourage expression. Another trap: prioritizing medication teaching over immediate safety-if a patient expresses suicidal intent, the first action is safety (stay with the patient, remove means, initiate precautions), not education. Recognize that SSRIs can increase suicide risk early in treatment, especially in adolescents. For lithium, know signs of toxicity (tremor, confusion, vomiting) and that dehydration or low sodium raises levels.
Rule of thumb
Safety before therapy before teaching. When a question involves imminent harm, choose the action that keeps the patient safe; use therapeutic communication only after safety is addressed.
Worked example
A patient says, "Everyone would be better off without me." The best response is direct and caring: "Are you thinking about killing yourself?"-then assess plan and means and stay with the patient.