12 Mental Health Nursing

Recognizing mental health presentations

Mental health conditions can affect mood, thought, perception, behavior, sleep, relationships, and daily functioning. Symptoms may overlap, and medical conditions, medications, substance use, or withdrawal can also cause or worsen behavioral changes. Report sudden or marked changes and help assess physical needs rather than assuming behavior is caused by mental illness.

Common presentations include:

• Depression: Persistent low mood or loss of interest may occur with low energy, changes in sleep or appetite, difficulty concentrating, hopelessness, or thoughts of death. Ask about self-harm and suicide when indicated; do not dismiss warning signs.

• Anxiety and panic: Anxiety disorders involve excessive fear or worry that persists or interferes with daily life. During intense anxiety, use a calm voice, short directions, and a low-stimulation setting, and assess for urgent physical symptoms.

• Bipolar disorder: Manic episodes can include unusually elevated or irritable mood, increased activity, reduced need for sleep, rapid speech, and impaired judgment. Depressive episodes may also occur. Note changes in sleep, energy, speech, and safety, and report them to the care team.

• Psychosis: Hallucinations, delusions, or disorganized thought can make a person feel frightened or unsafe. Respond to the person’s emotion without agreeing with a belief that is not shared. For example, say, “I can see this feels frightening; I do not hear the voice, but I will stay with you and help you feel safe.”

• Post-traumatic stress disorder (PTSD): Re-experiencing, avoidance, heightened arousal, and changes in mood or thinking may follow trauma. Explain care before touching or approaching, offer choices when possible, and avoid pressing for details of traumatic events.

These are general patterns, not diagnostic criteria. Qualified clinicians perform diagnosis and treatment planning. Treatment may include psychotherapy, medication, or both, individualized to the person’s needs.

Building trust through communication

Therapeutic communication helps build trust, understand the patient’s experience, and support safe care. Use active listening, a respectful tone, open-ended questions, and appropriate silence. Reflect or clarify what the patient says, such as asking, “What feels most difficult right now?” or “When you say you feel unsafe, what are you worried might happen?” Use plain language and allow time for a response. Ask how the person wishes to be addressed and consider language, culture, disability, and communication preferences.

Be honest about what you can do and explain next steps. Validate feelings without endorsing inaccurate perceptions, arguing, offering false reassurance, or making promises you cannot keep. Avoid judgment, threats, minimizing statements, and abrupt topic changes. When relevant, document the patient’s words accurately, along with observed behavior and actions taken.

Trauma-informed care emphasizes physical and emotional safety, transparency, collaboration, and the person’s voice and choice. These principles help reduce power imbalances and the risk of retraumatization.

Responding to crisis and immediate risk

A crisis may involve suicidal thoughts, self-harm, severe distress, psychosis, intoxication or withdrawal, or risk of harm to another person. Prioritize immediate safety and summon appropriate clinical help. Stay with a person at imminent risk when safe to do so, use calm and direct language, reduce noise and crowding, maintain a clear exit, and follow facility procedures. Do not leave a person alone when an immediate danger has been identified unless remaining would be unsafe; get help from the team.

When concerns arise, ask directly and plainly about suicidal thoughts, intent, plans, and access to means. Report findings promptly and follow the organization’s observation and escalation protocols. Warning signs can include talking about wanting to die, making a plan, withdrawing, giving away possessions, or sudden severe agitation. In the United States, call or text 988 for crisis support; use 911 or emergency services for an immediate life-threatening emergency.

For escalating agitation, use the least restrictive safe response: introduce yourself, maintain a nonthreatening posture and personal space, listen, acknowledge distress, offer simple choices, and set clear, respectful limits. Request trained assistance early.

Restraint or seclusion is not a punishment or a convenience measure. In hospitals, federal standards restrict its use to situations needed to protect immediate physical safety, require appropriate safeguards, and require discontinuation as soon as possible. Follow current law, orders, monitoring requirements, and facility policy.

Protecting dignity, privacy, and rights

Treat every patient with respect, protect privacy during care, use person-first and nonstigmatizing language, and involve the patient in decisions to the extent possible. Explain proposed care, invite questions, and support informed participation. Mental illness alone does not establish incapacity; decision-making capacity is specific to the decision and situation and must be handled according to applicable clinical and legal standards.

Protect confidential information and share it only as permitted for care or other legally authorized purposes. HIPAA generally protects mental health information like other protected health information, with special rules for separately maintained psychotherapy notes. Disclosure to family or others may be permitted in specified circumstances; do not assume a relative is entitled to information.

Patients have protections related to privacy, safety, and freedom from inappropriate restraint or seclusion. Rights concerning consent, refusal, admission, and discharge can depend on the circumstances and state law. Explain rights in accessible language, notify the appropriate clinician or patient-rights representative when a concern arises, and follow facility policy and applicable law.

• Crisis response