Numerous reports addressing the care of older people have highlighted deficiencies in th provision of nutrition, hydration, and personal hygiene. Healthcare organisations may inadvertently compromise dignity by prioritising measurable targets and not placing due emphasis on the core work of looking after frail older people who are at risk of having their dignity violated.

The concept of dignity draws on ideas of dignity of merit, moral stature, and Menschenwürde (human dignity) – the dignity that each individual has as an essential component of being a human being. It is argued here that older people, as a group, are particularly worthy of the dignity of merit of wisdom, by virtue of their experience and associated understanding.

A suitable environment is important to promoting dignity; the emphasis is not only on basics like nutrition, hydration, and hygiene but on the delivery of person-centred care that encourages understanding of an older person’s life story.

Dying will come to us all (with even greater certainty than old age), and all older people have a right to respect and dignity when dying. Understanding how someone lived their life, and what was important to that person allows us to co-write the final chapter with preservation of autonomy and maintenance of dignity of personal identity.

This chapter focuses on the management of acutely disturbed patients in psychiatric intensive care units (PICUs). It provides an overview of the nature of acutely disturbed patients, their symptoms and behaviours and the general challenges faced in managing their disturbance. The chapter discusses a philosophy for dealing with disturbed patients, appropriate assessment and care planning and a range of interventions that can be utilised, including verbal de-escalation, medication, physical intervention, seclusion and segregation. It also explores the development of activity and engagement programs for acute disturbance and the training and experience mix required for effective management. The roles of multidisciplinary team (MDT) members in the management of acute disturbance are outlined as well. The chapter highlights the prevalence of violence and aggression in healthcare settings and the importance of creating an informed and supported environment for staff to minimise risks. It concludes with recommendations for ensuring a safe environment and a philosophy of person-centred care in the management of acutely disturbed patients.

This chapter explores the nature and role of spirituality as it is worked out within the NHS in the UK. It examines the differences between spirituality and religion and explores the way in which spirituality has developed within the NHS, and is framed and used by the latter. It also discusses the idea of universal spirituality and the positive and negative implications of this concept. The chapter then considers the importance of spirituality for person-centred mental health care, focusing on issues around value, personhood, presence, trust, love and meaning. It concludes with some reflections on the importance of professional boundaries for spiritually oriented mental health care, and the key role that mental health chaplaincy plays in facilitating spiritual care within the NHS. Although the chapter focuses primarily on spiritual care within the UK healthcare system, the implications discussed and conclusions drawn apply to a broad range of contexts and practice.

This chapter discusses the required knowledge, skills, and confidence to provide a safe and compassionate environment by adopting trauma-informed care (TIC). Many people will have experienced traumatic experiences outside of the safety of their family unit, e.g., bullying, or sexual harassment. Therefore, we need to be cautious about blaming parents or care givers, without first establishing the situation and context of the traumatic history of the person.Many people who present to mental health, addiction and disability services, however, will report complex histories of physical, psychological, emotional, and sexual abuse (see chapter 15). Evolving research recommends therapeutically addressing complex, as distinct from single incident, trauma (Kezelman & Stavropoulos, 2019), requiring a particular skill set of the practitioner to provide effective therapy. This chapter focuses on the fundamental skills of responding to people who disclose their trauma, particularly sexual abuse, and how practitioners can respond in ways that foster human connectedness.

This chapter explores a range of challenges for students as they learn to apply interpersonal skills within the mental health practicum placement and other non-mental health settings. Exploration of the student’s attitudes, expectations and positive engagement within practice begins the chapter. This is followed by discussion of power relations characterising the therapeutic relationship, including the development of emotional competence. The chapter outlines reflective practice as a critical thinking process and clinical supervision for the beginning mental health nursing student. It explores the importance of developing skills to work within a trauma-informed care and practice framework. How to go about developing objectives for practice, the process of self-assessment and personal problem solving are discussed. Reflection, self in-action and post-placement are explored as they relate to learning in mental health. Throughout this chapter, critical examination of the ethical and political influences on care will be highlighted. This chapter also considers non-traditional opportunities to learn, and the experience of transition programs into mental health nursing.

Experiencing mental ill-health has long been recognised as being associated with a range of physical conditions that shorten life or impose limitations on physical well-being. Although the causes of this association are uncertain, it is absolutely clear that the experience of enduring mental ill-health in both Australia and Aotearoa New Zealand will be associated with a shorter life span (Firth et al. 2019; Cunningham, Peterson et al., 2014). The chapter addresses the more commonly experienced co-occurrring physical conditions (also known as comorbidities), looking at the prevalence and specific characteristics of each among those experiencing recurring mental ill-health. The effects of medication on physical health and well-being are explored. Complementary approaches to augmenting well-being are addressed. This includes exercise, diet and stress-reduction strategies as well as over-the-counter (OTC) drugs and complementary and alternative medicines (CAM). The final part of the chapter looks at approaches that are useful in preventing, or limiting the effects of co-occurring physical ill-health.

This chapter provides an overview of the common medicines prescribed within mental health care and explores the ways in which personal narratives and social expectations can influence the experience of taking medicines. The chapter also looks at concepts and practices that influence the management of medicines and encourage safe and high-quality use of medicines. These concepts include consumer experience, concordance, and shared decision-making. Facilitating a positive experience of medicinal use requires quality communication and team work, whereby nurses, psychologists, occupational therapists, dietitians, medical practitioners and pharmacists work in partnership with the consumer and carer.

This chapter explores the legal and ethical factors that inform mental health nursing, from multiple perspectives. The chapter proposes a legal and ethical framework that promotes human connectedness between the practitioner and people with mental health conditions and their families and whānau. The chapter includes theoretical and practical aspects of working within a legal framework and provides several narratives to bring to life what it means to experience compulsory treatment. It concludes by discussing proposed alternatives to compulsory treatment and a potential future legal framework that embraces a person’s autonomy and human rights. New Zealand – and each Australian state and territory – has its own mental health legislation. Although there are differences between them, they share the essential features of providing for treatment without consent, criteria of danger or risk to self and others, and certain procedural protections. Throughout this chapter we use the term ‘mental health legislation’ to refer to common aspects of the legislation in different jurisdictions.

Assessment in the mental health field is a dynamic process of learning, using experience and applying multiple sources of knowledge and evidence. This chapter presents an overview of assessment practices and processes undertaken within formal mental health care and discusses these within the context of consumer–health practitioner partnerships. We start by considering how assessment practices are a prominent feature of understanding a person’s situation and life context, and how these need to be based on the principles of person-centred, trauma-informed care and cultural safety. We discuss the importance of engagement and therapeutic relationships skills in ensuring consumers, carers and family members are meaningfully connected within a process for identifying the mental health problems the person is experiencing. Part of this awareness is reflecting on what it is like for a person to be assessed, and the power dynamics involved in naming experience, symptoms and diagnosis. The chapter then looks at the paradigm of comprehensive assessment, with specific discussions about strengths-based assessment, mental state examination and the roles of different health professionals.

This chapter introduces students in the health professions to a new and developing area of mental health practice: e-mental health. It describes a range of digital interventions and explores how digital and mobile technologies are providing additional avenues for helping people with mental health problems in densely populated and hard-to-reach communities. It is important for practitioners to acquire and develop proficient digital literacy skills in the e-mental health service sector. Some types of digital and mobile interventions are considered, along with some of the benefits and limitations that relate to e-mental health in general. As emerging health care professionals, students increasingly will be expected to utilise e-health interventions and strategies in the delivery of health care. The chapter introduces the e-mental health environment in general, and helps students to develop the knowledge and skills needed to implement person-centred e-mental health care to individuals and populations.

This chapter introduces the concept of mental illness, how it is diagnosed, and the main diagnostic classification systems used in health practice. The experiences and symptoms of people living with mental illness – according to criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 – are reviewed. It is emphasised that diagnostic criteria can be considered within an overall framework for conversation and engagement between practitioners, consumers, and carers, with the overarching aim of exploring and understanding the best response to distress and treatment approach to promote recovery processes. Criticisms towards diagnostic classification systems are also summarised. Finally, potential effects of the COVID-19 pandemic and its implication for people’s mental health are presented.

This chapter discusses the required knowledge, skills, and confidence to provide a safe and compassionate environment by adopting trauma-informed care (TIC). Many people will have experienced traumatic experiences outside of the safety of their family unit, e.g., bullying, or sexual harassment. Therefore, we need to be cautious about blaming parents or care givers, without first establishing the situation and context of the traumatic history of the person.Many people who present to mental health, addiction and disability services, however, will report complex histories of physical, psychological, emotional, and sexual abuse (see chapter 15). Evolving research recommends therapeutically addressing complex, as distinct from single incident, trauma (Kezelman & Stavropoulos, 2019), requiring a particular skill set of the practitioner to provide effective therapy. This chapter focuses on the fundamental skills of responding to people who disclose their trauma, particularly sexual abuse, and how practitioners can respond in ways that foster human connectedness.

Readers of this book will have thought deeply about how to collaborate with and support people with a mental illness, their families and carers. The preceding chapters have given considerable emphasis to a narrative approach. This final chapter discusses leadership, particularly for new entrants into mental health settings.Effective clinical care is person and family centred. It seeks to understand and involve consumers, carers and families in rich discussions about their needs, preferences and values. This understanding and involvement is combined with evidence-based practice to support consumers in their treatment and recovery goals.At the heart of the decision to take this approach has been the fundamental belief in human connectedness. By working through this text, readers have been challenged to think about how and when to move in new ways when working with resilient and vulnerable people, which is helpful across a range of practice settings when seeking to make a difference in the lives of people experiencing a mental illness. While this is important in providing a theoretical and practical basis for care, it is at the point of care that effective leadership is required.

This chapter begins with an overview of the rural and regional clinical context, and explores the connections that rural mental health practitioners have within rural communities. Models of mental health promotion and service delivery are discussed. The nature of life in rural settings and the ways in which climate and geographical location affect the mental health of people are also considered in the context of mental health resilience and vulnerability. Attention is given to the effects of natural disasters, agribusiness, mining, the itinerant rural workforce and under-employment, and the associated mental health consequences. This chapter discusses some rural community benefits in regard to mental health promotion, such as a deeply felt sense of close social proximity despite significant geographical distances between rural people. After reading this chapter, students will be able to reflect on, and critically think about, the ways in which mental health promotion, well-being and recovery can be enhanced among rural populations.

This chapter reflects a coming together of key issues and themes embedded in everyday work with consumers and carers. In recent times, the definition of a carer has expanded to include immediate family and friends, and may also include extended family members such as grandparents and cousins. In transcultural and other contexts, it is important to use humanistic language in line with a recovery approach; for example, the terms ‘support person/people’ and ‘support networks’ may be preferable to the term ‘carer’ in mental health practice and mental health nursing. This approach provides a foundation for human connectedness, and sets the consumer narrative as central to mental health practice and mental health nursing, specifically.The chapter introduces students to a narrative-based understanding of mental health and trauma-informed mental health care, as well as key concepts in mental health and mental illness. It discusses mental health nursing as a collaborative, specialised field of nursing.

This chapter introduces the intersections between mental health care and drug and alcohol care. It addresses the implications for holistic health care needs related to dual drug and alcohol use, and concurrent mental health conditions. It tells the contemporary, real-life story of a person who developed an episode of psychosis following consumption of premixed alcohol and caffeine drinks. The chapter also describes change models applied to substance use and recovery, such as motivational interviewing and stages of change readiness. Both common and less common drugs and their misuse affect the physical, social, cognitive and mental health dimensions of people with mental health conditions. Reflective exercises guide readers to consider how they will be able to promote mental health and well-being and minimise drug-related harm to individuals and communities in a practice context.

This chapter begins with an overview of the rural and regional clinical context, and explores the connections that rural mental health practitioners have within rural communities. Models of mental health promotion and service delivery are discussed. The nature of life in rural settings and the ways in which climate and geographical location affect the mental health of people are also considered in the context of mental health resilience and vulnerability. Attention is given to the effects of natural disasters, agribusiness, mining, the itinerant rural workforce and under-employment, and the associated mental health consequences. This chapter discusses some rural community benefits in regard to mental health promotion, such as a deeply felt sense of close social proximity despite significant geographical distances between rural people. After reading this chapter, students will be able to reflect on, and critically think about, the ways in which mental health promotion, well-being and recovery can be enhanced among rural populations.