Mental Health and Psychiatric Nursing
What you must understand
Know the core features of depression, anxiety, psychosis, bipolar disorder, and substance withdrawal, plus therapeutic communication and safety assessment. Suicide risk assessment is central: ask directly about intent, plan, and means, and act on any positive response.
Traps in questions
- Safety first. In psychiatric questions, the priority is always physical safety - remove harmful objects, maintain observation, and never leave a suicidal client alone.
- Therapeutic vs non-therapeutic communication. Offering advice, false reassurance, changing the subject, and asking "why" are non-therapeutic. Reflecting feelings and exploring are therapeutic.
- Withdrawal - alcohol and benzodiazepine withdrawal can be life-threatening (seizures, delirium); opioid withdrawal is distressing but rarely fatal.
- Medication adherence - non-adherence in psychosis is common; explore reasons rather than lecturing.
Worked rule of thumb
When a client expresses hopelessness, the correct response is a direct, calm question about suicidal thoughts, not reassurance. Asking does not increase risk. If risk is present, initiate safety measures and escalate.
Communication principle
Silence, active listening, and reflecting are tools. A question offering "everything will be fine" is almost always the wrong answer because it dismisses the client's experience.