Generally, a mainstream understanding of health is applied when mental health (illness) presentations are considered, assessed, and treated using a biomedical Western perspective and standpoint (Wilson & Waqanaviti 2021). This chapter explores mental health through an alternative First Nations lens, that of social and emotional well-being (SEWB). While there is a scarcity of national data that specifically measure the social and emotional well-being of First Nations people, data that are available paint a consistent picture: one of much higher rates of use of mental health services by First Nations people, compared to other Australians (Australian Institute of Health and Welfare [AIHW], 2009).This chapter sets the context for further discussion regarding First Nations people and explores issues relating to social and emotional well-being and mental health. Colonisation and its history are discussed, as well as the subsequent decimation/devastation that followed and continues today. The resilience and struggle that has taken place, along with cultural recognition and renewal, ultimately shapes the present.

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.

As mental health practitioners, we will encounter the broad and diverse range of sexual orientations and gender identities within the people we serve. In this chapter we focus on the cultural diversity of genders and sexualities, and the effects of marginalisation, interpersonal and intimate partner violence and abuse on people’s mental health (Bosse et al., 2018). We describe the ways in which mental health practitioners are able to practise empathically and effectively in gender, diversity, and disclosures of violence and abuse. Throughout the chapter, we will be reading Riley’s story to help us understand how mental health services can be more supportive and accepting of gender and sexual diversity.

This chapter will discuss the process of positive ageing, the life course, and the changing cultural norms of older people within contemporary society. The chapter will assist nurses to consider and understand how ageism and subsequent stigma and discrimination can impact on the well-being of the older person and their family/loved ones. The multiple losses and associated mental health problems will also be presented. The specific approaches to nursing care required to support human connectedness with older people will also be discussed. Common mental health problems, associated risk factors and considerations for treatment embedded within a recovery approach are explained. The chapter concludes with future issues for this area of specialty nursing practice.

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.

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.

While the health systems in Australia, New Zealand and other developed countries are regarded as some of the finest in the world, there is an ever-present need to ensure flexibility regarding cultural competence and responsiveness and cultural inclusivity across a range of practice settings. If current rates of immigration to Australia continue to grow, it is estimated that by 2050 approximately one-third of Australia’s population will be overseas-born (Cully and Pejozki, 2012).This chapter examines the mental health needs of people from refugee and immigrant backgrounds, with emphasis given to asylum seekers. Mental health issues that may affect these populations are explored, as is engagement between people of refugee and asylum seeker backgrounds and mainstream mental health services. This chapter seeks to deepen and broaden readers’ understanding of the effects of trauma among people of refugee background, and links this to strategies that might be used by mainstream mental health practitioners and services in response.

While photosynthesis and the production of organic matter dominate the surface ocean, respiration is the process that most influences the chemical perspective of oceanography in the deep ocean. For a chemist, respiration is simply photosynthesis (Eq. 3.10) run in reverse, with O2 consumed while CO2, nutrients, and energy are liberated. The flux of organic matter out of the surface ocean (the biological pump) is the driving force for the respiration reactions that occur in the deeper ocean. The delicate balance between the supply of organic matter via the biological pump and the renewal of water by mixing with ocean surface waters determines the distribution of metabolites below the euphotic zone. In this chapter, we explore how these processes interact to produce the complex and fascinating distributions of O2 and nutrients in the deep sea.

Patterns of chemical distributions within the ocean are primarily controlled by biological processes and ocean circulation. Sunlight penetrates only the top 100 meters or so of the ocean (the euphotic zone), just 4 percent of the average ocean depth, but supplies the energy for photosynthesis that is the basis for most marine chemical transformations. Much of the organic matter produced by photosynthesis is consumed by bacteria and animals in the euphotic zone, but some also escapes the sunlit upper waters into the dark sphere. Density stratification between the warmer surface mixed layer and colder deep waters helps to keep the metabolic products of photosynthesis and respiration separate.

The study of radioisotopes provides the added dimension of time to the chemical perspective of oceanography. Stable elements and isotopes (Chapter 6) are useful tracers of the sources and transformations of marine materials, but they carry no direct information about the rates and dates of their associated processes. However, such temporal distinctions are made possible by many different, naturally occurring radioactive isotopes with their wide range of elemental forms and decay rates. These highly dependable atomic clocks decay by nuclear processes that are insensitive to temperature and pressure and that allow them to be detected at very low concentrations. A fanciful analogy of how these tracers are used is an experiment in which you attach hundreds of clocks that operate only at pressures less than one atmosphere to helium-filled balloons and release them to float in the atmosphere. After the helium leaks out of the balloons, the clocks would fall to the Earth scattered across the landscape. Because each clock records only the time spent aloft, their position and time would convey information about the direction and speed of local winds.

Regardless of the setting of mental health care, an interprofessional or multidisciplinary approach is a sound response to the multifaceted problems faced by people with mental health problems. Through collaboration with consumers, the needs of the person experiencing mental health problems can be comprehensively met.An interprofessional workforce involves a range of professions and other staff with different educational backgrounds. These are broadening, increasingly, from the traditional professions employed in mental health services – medical, nursing, social work, psychology and occupational therapy – to embrace other workers with skills to contribute. Some of these groups are subject to regulation through their professional bodies and national regulatory authorities. Other groups working with the mental health workforce are not subject to such authority or regulation. This has supported the development of standards for the mental health workforce in Australia and Aotearoa New Zealand, in order to provide uniform and consistent guidelines to govern everyone working with people experiencing mental health problems.

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 will discuss the process of positive ageing, the life course, and the changing cultural norms of older people within contemporary society. The chapter will assist nurses to consider and understand how ageism and subsequent stigma and discrimination can impact on the well-being of the older person and their family/loved ones. The multiple losses and associated mental health problems will also be presented. The specific approaches to nursing care required to support human connectedness with older people will also be discussed. Common mental health problems, associated risk factors and considerations for treatment embedded within a recovery approach are explained. The chapter concludes with future issues for this area of specialty nursing practice.

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.

In this chapter a brief synopsis is provided of the terminology of learning disability (LD), intellectual (ID) and developmental disability (DD). Determinants of physical and mental well-being and associated comorbidities for people living with IDD are explained. Students are enabled to recognise, facilitate and optimise an individual’s rights, identity, autonomy, and self-determination in any community or mental health setting.Deinstitutionalisation was informed by philosophical approaches including normalisation (Wolfensberger, 1972; Nirje, 1969), social role valorisation (Wolfensberger, 1983) and the social model of disability (Oliver, 2013; Race et al., 2005). These approaches inform mental health assessment and responsiveness through reasonable adjustments or accommodations (Heslop et al., 2019). Within Aotearoa New Zealand and Australia, these philosophies are exemplified through the principles embedded within EGL (Enabling Good Lives) and the NDIS (National Disability Insurance Scheme) respectively and are linked to responsibilities under the Convention on the Rights of Persons with Disabilities (United Nations, 2006) when working with those in mental distress.