How Mental Health Nurses Assess and Care for Psychiatric Patients

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Mental health nursing is a very in-demand specialization within nursing. It is an area that a practicing RN who wants to change and advance their career should consider. There is a strong effort being made to help close the gap in mental healthcare throughout the US. Still, to close the gap, there must be enough well-trained nurses and other medical professionals to meet the demand.

Mental health nursing is a challenging yet rewarding career offering various private and public employment opportunities. Assessing patients and de-escalating distressing and stressful situations is a large part of the job of a mental health nurse. Additional duties include working with a team of medical and mental health providers and counselors to create and execute a treatment plan that offers short and long-term solutions for the patient and their family.

This article covers the main methods mental health nurses use to assess and care for psychiatric patients.

Making an initial routine patient assessment

One of the major roles a mental health nurse plays is making initial patient assessments. This is important because it sets the foundation for the patient’s future care. Notes and observations are used to start working on a realistic plan to help a patient completely overcome a mental illness. Plans are also formulated to help patients learn to cope with a mental illness that can never be entirely cured, such as schizophrenia for example.

Here are the basic steps required to evaluate a patient.

Medical and mental health history

A mental health nurse must have access to previous medical and mental health records. The nurse may ask a patient to go into more detail about specific events. These are the formal records that are on file for a person.

It is also important to ask the patient if they need anything to be added. There are many instances where something relevant may have happened that they did not seek formal treatment for. This is very common due to the cost and accessibility of mental and physical healthcare services in the past.

Sometimes, mental and physical health issues can have genetic or environmental factors. For example, if a patient has a history of substance abuse in their family, it is far more likely that they will have the same problem at some point in life.

Growing up in a stressful environment with a mentally ill parent can increase the likelihood of problems for the children. Going over known issues can also help nurses determine if a chemical imbalance or another physical problem may contribute to someone’s mental health problems.

Social life and work

Noting a patient’s marital status, both now and in the past, is important. Nurses should uncover issues with any of these relationships; the cause of divorces and associated feelings are also important.

A person’s work can be a major part of their life, or it may just be something that pays the bills. Nurses need to evaluate whether a person can hold down regular employment or not. In some cases, someone experiencing poor mental health may be incapable of holding down a job, even part-time. The type of work a patient does can majorly affect their mental health too. An occupation that is stressful or exposes a patient to disturbing situations can lead to mental health problems.

Developmental behaviors and daily actions

A person’s overall behaviors and habits must be evaluated thoroughly. Behaviors that are harmful but are all too common are self-harm, drug and alcohol abuse, and physical violence. Emotional outbursts can also have a major effect on how a patient is able to live and interact with others. Learning how to establish self-control is a major aspect of correcting and coping with mental health issues, no matter what the underlying problems might be. Unhealthy coping mechanisms must be addressed.

Violent or suicidal thoughts and actions

Mental health issues can lead patients to take harmful actions towards themselves or others. The potential for violence or suicide is important to evaluate. Some mental health issues and substance abuse can have side effects that lead to temporary psychosis. Withdrawal from substances can be very hard. Some actions can be taken to lessen these effects and prevent a patient from harming themselves or others.

Suicide prevention can mean making sure a patient is never alone and does not have access to items they could use to harm themselves. These measures may need to be enacted for a short to moderate period, depending on the severity of the mental issues the patient is experiencing.

Assessing a patient’s mental mind frame

After a routine examination, a mental health nurse will delve into the minute details of a patient’s mental frame of mind. Some of these assessments are based on observations rather than verbal answers from a patient. Neglecting appearance and hygiene can occur when someone is experiencing mental health issues, for example. Depression, anxiety, substance abuse, and more can all lead to a gradual decline in hygiene or putting no effort at all into appearance. A person who appears well put together can sometimes be signaling a healthy mind frame.

In addition to these assessments, mental health nurses have a checklist of questions to ask. The questions are as follows.

Is the patient having any disturbing thoughts or compulsions?

Obsessions and compulsive behaviors can be life changing. A mental health nurse must delve into the patient’s current thought patterns and determine if they manifest harmful obsessive behaviors. This could range from fixating on a certain person, thing, or issue to obsessing about their appearance. Compulsive behaviors can lead to substance abuse. Other harmful compulsions could be gambling, cleaning too much, or anything else that is taken a step too far to be healthy.

Does the patient have any coping mechanisms they are aware of?

There is a major difference between healthy and unhealthy coping mechanisms. Patients need to have healthy coping mechanisms to deal with mental health issues, but all too often they may turn to unhealthy habits instead. This could be hanging out with the wrong crowd, eating too much, drugs, alcohol, excessive shopping, and many more. Emphasizing the importance of turning to healthy mechanisms like exercise, art, and other positive hobbies, is helpful and can lead to long-term results.

Therapeutic intervention

Therapeutic intervention must take place in the right location. For many people, this is best handled in a neutral location or, at the very least, a more comfortable location for the patient and their family. Regardless of where the intervention occurs, there should be an effort made to make everyone as calm and comfortable as possible.

De-escalation techniques

It is important to de-escalate situations that are becoming heated. Trying to solve problems and enact solutions can be difficult or impossible if a situation is tense and heated. Creating a calmer atmosphere where everyone can think more clearly is a step that must be made first.

Many tactics can be used to calm a situation down. Of course, each person and situation is different, so it is up to the nurse or others to decide which tactics are best to use at the time. Some of the most common methods are as follows.

Be a good listener and use good body language

When someone is upset, they want to know that their nurse is listening to what they say and valuing their words. Nurses should let their patients have a chance to express their feelings and needs entirely. They can respond when necessary but should not make major judgments or opinions until the time is right. Listening can be hard when dealing with someone who is particularly selfish or irrational, but it is important to stay calm and allow sufficient time.

If a nurse comes across as judgmental at any point, then it can make the patient shut down entirely and not take anything the nurse says seriously. If they think the nurse is judging them and not understanding their situation, it can make any effort to further help practically impossible. Nurses should never say it is wrong for someone to feel a certain way when trying to de-escalate a situation.

Body language can make a huge difference in a situation too. Defensive postures and gestures can greatly escalate a situation. Even if the nurse’s tone of voice is calm and what they are saying is true, if their body language is off, it can reduce the impact of their words. In some cases, it can even make their words seem dishonest if their body language portrays defensive or hostile intentions while their words are the opposite.

Choose questions carefully

Asking questions to better understand a person and their situation is an excellent idea, but nurses must ask the right questions. Open-ended questions that allow the patient to reveal important details about their life and motivations are good choices. In key areas, nurses may ask questions that allow for more detail if the patient seems amenable.

Start with temporary measures

Long-term changes start with small steps. Sometimes, temporary measures must be taken before more long-term goals can be approached. Trying to solve major issues in just an hour or two will not work. Mental health challenges take time.

Temporary measures may include ensuring someone has a safe place to stay and a supportive environment that encourages better behaviors and morale. This could be as simple as having someone stay with a caring relative or friend temporarily.

There is a major shortage of mental health nurses

The need for mental health nurses is great. Throughout the COVID-19 pandemic, the general population had an unfortunate uptick in mental issues. The rate of substance abuse has also skyrocketed. A major need for mental health services is not being met.

Any RN who wants to advance their career should consider an advanced degree that allows them to specialize as a Psychiatric Mental Health Nurse Practitioner (PMHNP). Wilkes University offers post masters PMHNP online programs that working nurses can complete on a schedule that works for them. In 18 months, they can gain a certificate and start a new career as a mental health nurse. They will learn the skills required to assess and evaluate patients and create treatment plans that are realistic and helpful for each situation. They will also learn about medications commonly used for specific needs so they can make informed choices on what to prescribe to a patient to help them overcome or cope with a mental illness or substance abuse.

Inpatient and outpatient services

Mental health nurses may provide their services at inpatient and outpatient facilities. Inpatient services tend to be for those who need to be under observation or experiencing drug withdrawal or major substance abuse issues, for example. If a person is deemed to be at risk of harming themselves or others, they may need to be admitted to a facility.

Most mental health services are performed on an outpatient basis. This means patients will regularly check in regarding their treatment. This is particularly important if a patient is on medications because they sometimes require dosage adjustments, or they may need to try a different medication for their issue.


Mental health nursing is an important field in medicine that is in very high demand. Over the coming decade, this demand is set to become even greater. Any RN looking for a change should know that now is a great time to take the next step in their career and help many people overcome mental illness and addiction.