Final Exam: NR607/ NR 607 (Latest 2024/ 2025 Update) Diagnosis & Management in Psychiatric Mental Health III Complete Review (Weeks 5-8) Questions and Verified Answers| 100% Correct

Final Exam: NR607/ NR 607 (Latest 2024/ 2025 Update) Diagnosis & Management in Psychiatric Mental Health III Complete Review (Weeks 5-8) Questions and Verified Answers| 100% Correct | Grade A – Chamberlain

Social determinants of health
-Health Care Access and Quality
-Neighborhood and Built Environment
-Social and Community Context
-Economic Stability
-Education

importance of gender-affirming psychotherapy during gender transition
-Trans Youth with Supportive Parents

77% reported life satisfaction
33% reported life dissatisfaction
70% described mental health as very good or excellent
15% described their mental health as poor
23% report suffering depression
75% report not suffering depression

-Trans Youth with Unsupportive Parents

64% reported low self-esteem
13% reported high self-esteem
0% faced no housing problems
55% faced housing problems.
4% did not attempt suicide
57% attempted suicide

Structural stigma in U.S. drug policies: Punitive Policies
-pregnant women anonymously tested for drug use:

prevalence of use similar between Black & White women
➣Black women 10x more likely to be reported to law enforcement

-Indigenous women suffer from higher SUD rates compared to other racial & ethnic groups

disproportionately affected by criminalization laws at the federal, state, & tribal levels.

-Consistent use of medication for OUD tx during pregnancy is significantly lower for women of color.

Trauma responses: how the nervous system responds to trauma
-Flee
-Fight
-Freeze
-Collapse

Trauma-informed care
-Safety
-Trust & Transparency
-Peer Support
-Empowerment & Choice
-Cultural, Historical, & Gender Awareness

Trauma-informed care: Safety
-most fundamental principle to avoiding retraumatization
-Creating a physical setting & client-provider interactions that generate physical & psychological safety are foundational to providing trauma-informed care.

Trauma-informed care: Trust and Transparency
-Establishing a trusting relationship or therapeutic alliance is critical to the trauma-informed approach.

kind, respectful interactions
empowering intake procedures
transparency in discussions of treatment goals & modalities appropriate to the client’s developmental level.

Trauma-informed care: Peer Support
-Providing opportunities for connecting with other trauma survivors may help to establish safety, foster hope, and promote healing through shared experience.
-Collaboration: Empowering the client to play an active role in decisions about their treatment

when developmentally appropriate, fosters a sense of responsibility & helps to balance the level of power between the provider & client.

Trauma-informed care: Empowerment & Choice
-Listening to & acknowledging the client

help them find their voice & give them a sense of control over their story.
-Prioritizing choice empowers clients to be partners in their care
can promote self-efficacy, agency, & dignity.

Trauma-informed care: Cultural, Historical, and Gender Awareness
-acknowledges that some trauma may be a result of a client’s culture, historical events such as war or conflict, or being a part of a marginalized or minority group.

Sensitivity to a client’s cultural, historical, or gender identity is important to ensuring their comfort & safety during tx

Social Determinants of Mental Health (SDOMH)
-Socioeconomic Status
-Education
-Social Support
-Childhood Experiences
-Discrimination & Mental Health Stigma
-Access to Reimbursement for Mental Healthcare
-Criminalization of Mental Health Behaviors
-Physical Environment
-Social & Cultural Factors
-Social Media

SDOMH: Socioeconomic Status
can negatively affect mental health:
-Low income
-poverty
-unemployment
-job insecurity
-lack of access to resources

SDOMH: Education
-Lower educational attainment plays a role in mental health outcomes

less education influences the knowledge, skills, & opportunities for personal & professional growth

SDOMH: Social Support
-lack of supportive relationships with family, friends, communities, or other social connections

increase stress & feelings of isolation • decrease resilience & self-esteem

SDOMH: Childhood Experiences
-Adverse childhood experiences (ACEs)

can have long-lasting effects on mental health
increase risk of developing mental disorders later in life

SDOMH: Discrimination & Mental Health Stigma
-Experiencing discrimination or stigma against serious mental illness, SUDs, or other forms of mental disorders

lead to chronic stress, low self-esteem, isolation, and prevent timely diagnosis, tx, & support

SDOMH: Access to Reimbursement for Mental Healthcare
-Limited access to & reimbursement for mental healthcare services can prevent timely dx, tx, & support.

exacerbating mental health issues

SDOMH: Criminalization of Mental Health Behaviors
-Failure of the justice system to recognize the behaviors of poorly treated serious mental illness & SUDs can worsen mental health outcomes

SDOMH: Physical Environment
-Living in unsafe, violent, or unhealthy physical environments

contribute to chronic stress & negatively impact mental health

SDOMH: Social & Cultural Factors
-Cultural norms, social norms, & societal expectations can negatively shape individual experiences & mental health outcomes

SDOMH: Social Media
-Hurtful social media communication may lead to high stress & suicides

especially among youth

Structural Racism and Racial Trauma
-refers to how institutions, policies, & practices systematically disadvantage some racial or ethnic groups while privileging others
-Structural Racism in Mental Health Services

Black men 4x more likely dx’d with schizophrenia than White males.
Black, Indigenous, & People of Color (BIPOC) youth with behavioral & mental health conditions are more likely to be directed to the juvenile justice system than to specialty care institutions compared to non-Latinx white youth.
Providers are less likely to be located in low-income neighborhoods with Black and Latinx residents compared to high-income neighborhoods with less than 1% of Black or Latinx residents.
Black people make up 12% of the country’s population but 33% of the total prison population.
BIPOC are less likely than Whites to own their homes regardless of their level of education, income, location, marital status, & age.
Black people are less likely than Whites to hold jobs that offer retirement savings prioritized by the U.S. tax code.
➣creates a persistent wealth gap between White & Black communities where the median savings of blacks are 21.4% of the median savings of whites.

effects of structural racism on mental health
-Racial & ethnic minority groups consistently experience higher rates of psychological distress, mental illness, & poor mental health outcomes than their White counterparts

attributed to the chronic stressors & adverse experiences of living in a racist society
-cumulative impact of racism can lead to racial trauma or race-based traumatic stress (RBTS)

Racial symptomology may appear similar to individuals diagnosed with:
posttraumatic stress disorder (PTSD), sexual assault, domestic abuse, or war zone survivors

symptoms of racial trauma:
-Depression, social anxiety, stress, substance abuse, agoraphobia, suicidal ideology, psychosis
-Intrusion symptoms

nightmares, flashbacks, physical reactions in the presence of reminders
-Avoidance behaviors
staying away from places that are reminders of racist experiences
-Negative changes to thoughts or mood
feelings of isolation, a belief that the world is unsafe
-Decreased interest in previously enjoyable activities
-Changes in arousal and reactivity
-Cultural paranoia, avoidance of White people (dominant group members), somatic complaints, and excessive worries about loved ones

Agnieszka has experienced persistent racial discrimination since immigrating to the United States, which has led to chronic stress, anxiety, depression, and post-traumatic stress disorder (PTSD), exacerbating her chronic depression

What racism’s effect is the patient experiencing?
Limited access to resources
Intersections with other social determinants
Cultural mistrust and mental healthcare disparities
Discrimination and racial trauma
Discrimination and racial trauma

Princiana has encountered ongoing barriers to accessing housing and quality education. Her job insecurity and a lack of housing opportunities have escalated her feelings of hopelessness, powerlessness, and low self-esteem, detouring her from timely treatment for her mental health.

Mateo has experienced ongoing racism as a person of color (POC), which has caused him to mistrust the mental healthcare system, resulting in inadequate care and treatment for his chronic schizophrenia

Diona is homeless due to substance use disorder and has chronic pain. In the emergency department, she self-reports a pain rating of 10 out of 10 and does not receive the same assessment and treatment as her White counterparts

types of stigma related to structural racism and mental health inequities:
-Internalized
-Anticipated
-Experienced
-Perceived

Type of stigma that is Perceptions of social beliefs (e.g., stereotypes, prejudice, discrimination) that occur on the part of the client or provider
Perceived

Type of stigma that is Perceptions of being a victim of stereotypes, prejudice, or discrimination that occur on the part of the client
Experienced

Type of stigma that is Taking inward stereotypes, prejudice, or social discrimination that occur on the part of the client
Internalized

Type of stigma that is Expectations of discrimination that occur on the part of the client
Anticipated

Risk of Mental Health Disorders after COVID-19
154,000 COVID-19 patients in the VA system with no hx of mental illness 2 years prior to infection:
-depression: 39% increase
-anxiety: 35% increase
-sleep problems: 41% increase

Racial Trauma Assessment
-Often PTSD assessment tools are used

provide few racial-trauma-specific prompts and it is unknown if they were validated using people of color
tend to measure the impact of a specific traumatic event, not the accumulation of lifetime events

-Race-Based Traumatic Stress Symptom Scale (RBTSSS)

assesses symptoms associated with experiences of racism trauma
has a complex scoring system
measures only a single event
does not adhere to the DSM-5 framework for diagnosing trauma

-UConn Racial/Ethnic Stress and Trauma Survey (UnRESTS)

easy-to-use
culturally informed tool for assessing racial trauma within a DSM-5 framework
lengthy & requires provider administration.

-Racial Trauma Scale (RTS)

newly developed self-report measure to quantify and assess trauma symptoms specific to racial discrimination

Racial Trauma Scale (RTS)
9-Item Short-Form Research Version
-scored by adding all items
-Total scores range from 9 to 36
-three subscales:
(a) Lack of Safety: 3, 5, 9
(b) Negative Cognitions: 2, 6, 7
(c) Difficulty Coping: 1, 4, 8

Racial Trauma-Informed Interventions
-principles of trauma-informed care:

Empowerment
Trustworthiness
Collaboration
Choice
Safety

-healing ethno-racial trauma (HEART) framework (4 phases)

I. Establish sanctuary space for clients experiencing ERT
II. Acknowledge, reprocess, & cope with symptoms of ERT
III. Strengthen & connect individuals, families, & communities to survival strategies & cultural traditions that heal
IV. Liberation & resistance

Racial Trauma Community Collaboration & Advocacy
-Concurrently addressing all determinants of health through changes in practice and policies is foundational to advancing anti-racism and health outcomes and equity
-Equitable access to health care is one example of an upstream intervention to reverse historical discrimination

PMHNP Roles: Advocacy, stakeholder engagement, coalition building, & cross-sector partnerships

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