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.

Carbon is the vehicle for the collaboration between life on Earth and the climate of the planet. The Sun supplies the energy for plants to create organic carbon by linking reduced carbon atoms together with O, H, N, and minor amounts of many other elements in a vast variety of organic matter forms (see online Chapter 8 of Emerson and Hedges (2008), www.cambridge.org/emerson-hamme). Reduced organic carbon is thermodynamically unstable, and many organisms derive energy by oxidizing it to CO2, the most stable form of inorganic carbon in an oxygen-containing world. In our atmosphere, CO2 causes a strong greenhouse effect warming the planet, and paleoclimate observations indicate past changes in the concentration of atmospheric CO2 have driven profound climate shifts.

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.