Psychiatric Care and Mental Health in The Community Questions

Chapter 24 Populations Affected by Mental Illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Mental Health  Mental health refers to the absence of mental disorders and to the ability for social and occupational functioning.  Mental illness is diagnosable mental disorders that affect alternations in thinking, mood, or behavior associated with distress and impaired functioning. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Challenges in the Community      Complex patient comorbidity Lack of resources Competent mental health professional workforce and law enforcement Physical facility inadequacies Stigma of mental illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 A community’s mental health is a reflection of community as a whole. Mental illness is a significant public health problem affecting not only the person with mental illness, but also his or her families, friends, schoolmates, workmates, and others. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Psychiatric Care and Mental Health in The Community Questions

Community Mental Health Movement, 1960 to Present Day Blue Ribbon Panel report Action for Mental Health 1963 Community Mental Health Clinics Legislation 1960’s Deinstitutionalization Recommendations for intensive care of acutely ill mental patients and community mental health clinics Community mental health centers in some urban communities Discharged mentally ill from state hospitals patients returned to communities with inadequate resources (e.g. finances, housing, health care, supportive employment) 1981 Mental Health Block Grant, as States develop comprehensive mental health part of the Omnibus Reconciliation Act plans for persons with SMI 1986 State Mental Health Planning Act 1999 U.S. Surgeon General’s Report on Mental Health 2008 Mental Health Parity and Insurance coverage for mental health and Addiction Equity Act of 2008 substance use conditions 2010 Affordable Care Act Builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans Table 24-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Deinstitutionalization  Courts’ actions ➢ ➢  Insufficient community resources ➢ ➢ ➢ ➢  Limited involuntary institutionalization Set minimum standards for care in institutions Inadequate housing Insufficient supported employment Insufficient community mental health professional workforce Few community mental health care services Funding did not follow the change in policy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Present-Day Community Mental Health Reform     Mental Health Reform works toward monitoring federal legislation, administration activity, and public education initiatives. Makes community mental health a national priority by establishing early access, recovery, and high quality in mental health services as standards Medicalization of Mental Illness Brain Neuroimaging, Genetics, and Hope for New Treatments Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Medicalization of Mental Illness  Has helped put mental disorders on parity with other diseases ➢ Can impact treatment as forcefully as other medical conditions ➢ Hope to make insurance coverage equal to other medical treatments   Looks at holism and health and understanding on a functioning level Seen as treatment to achieve the absence of disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Factors Influencing Mental Health        Biological Factors Genetic Factors Brain Structural and Functioning Abnormalities Social Factors Gender, Racial, Sexual Orientation Disparities Natural and Man-Made Disasters Political Factors Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Mental Disorders Encountered in Community Settings        Schizophrenia Depression (adults, children, and adolescents) Bipolar disorder Anxiety disorders Eating disorders ADHD/ADD Suicide Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Schizophrenia  The most common psychotic disorder ➢ Positive symptoms include hallucinations, delusions, disorganized thinking and speech, and bizarre behaviors ➢ Negative symptoms include flat affect, poor attention, lack of motivation, apathy, lack of pleasure, and lack of energy ➢ Psychiatric Care and Mental Health in The Community Questions

Increased risk for alcohol use, depression, suicide, and diabetes ➢ Treatment is intensive—often with hospitalization (initially), antipsychotic meds, and psychotherapy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Depression  Most frequently diagnosed and one of the most disabling mental illnesses in the United States ➢ ➢ ➢ ➢ ➢ Includes major depressive disorder, dysthymic disorder, and bipolar Often co-occurs with serious physical disorders (heart attack, stroke, diabetes, and cancer) Health education includes risk factors identification, as well as how and when to obtain treatment Children and adolescents also suffer with depression. Treatment includes pharmacological therapy, psychotherapy, behavior therapy, electroconvulsive therapy, or a combination of these Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Bipolar Disorder  Mood disorder that presents with changes in mood from depression to mania. ➢ ➢ ➢ May co-occur with hallucinations and delusions. Management of bipolar disorder must be ongoing and involve close monitoring. Treatment generally involves use of mood stabilizing medication, often in combination with antipsychotic and antidepressant therapy. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Anxiety Disorders  Characterized by feelings of severe anxiety ➢ Generalized anxiety disorder ➢ Panic disorder ➢ Psychiatric Care and Mental Health in The Community Questions

Phobias ➢ Obsessive-compulsive disorder (OCD) ➢ Posttraumatic stress disorder (PTSD)    May be attributed to genetic makeup and life experiences of the individual. Treatment varies with disorder. Support from family and friends beneficial. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Eating Disorders   Often triggered by developmental milestones (e.g., puberty, first sexual contact) or another crisis (e.g., death of a loved one, ridicule over weight, starting college) Primarily affect females ➢ ➢  Bulimia nervosa (binge eating) Anorexia nervosa (obsessed with fear of fat and with losing weight) Treatment: long-term nutrition counseling, psychotherapy, and behavior modification Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 ADHD and ADD      ADHD: attention deficit hyperactivity disorder ADD: attention deficit disorder Usually appear before age 7 and often accompanied by related problems (e.g., learning disability, anxiety, and depression) Three major characteristics are inattention, hyperactivity, and impulsivity. Symptoms are typically managed with a combination of behavior therapy, emotional counseling, and practical support. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Suicide  Risk factors—IS PATH WARM? ➢  Protective factors ➢  Previous suicide attempts, mental illness, substance abuse, barriers to accessing mental health treatment Appropriate mental health care, easy access to treatment, community support, and continuing support from medical and mental health providers Warning signs of suicide ➢ Question those at risk in terms of thoughts, plans, lethality, means, and intent. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Suicide How do you remember the warning signs of suicide? Try using this easy-to-remember mnemonic: IS PATH WARM? I – Ideation S – Substance abuse P – Purposelessness A – Anxiety T – Trapped H – Hopelessness W – Withdrawal A – Anger R – Recklessness M – Mood changes Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Identification of Mental Disorders  Early identification, appropriate treatment, and rehabilitation can reduce duration and disability and decrease possibility of relapse. ➢ ➢ ➢ Direct questioning Observations Use of standardized assessment tools or questionnaires Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 EBP Management of Mental Disorders  Psychotropic or Psychotherapeutic medications ➢ Medications treat symptoms; they do not cure mental illness ➢ Psychiatric Care and Mental Health in The Community Questions

Nurse needs to be up-to-date on medications: ➢ http://www.nlm.nih.gov/medlineplus/druginformatio n.html ➢ http:www.rxlist.com Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 EBP Management of Mental Disorders (Cont.)  Psychotherapy ➢ A process of discovery that helps alleviate troubling emotional symptoms and returns individuals to a healthy life ➢ Involves use of professional, therapeutic relationships and the application of psychotherapy theories and best practices • Changes a client’s attitudes, feelings, beliefs, defenses, personality, and behavior • Individual, family, couple, group therapy • Play, cognitive, behavioral therapy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Community-Based Mental Health Care Initiatives 1. Americans understand that mental health is essential to overall health. 2. Mental health care is consumer and family driven. 3. Disparities in mental health services are eliminated. 4. Early mental health screening, assessment, and referral to services are common practice. 5. Excellent mental health care is delivered, and research is accelerated. 6. Technology is used to access mental health care and information. – New Freedom Commission on Mental Health (2003) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Multidimensional Roles of the Community Mental Health Nurse ✓ Court representative ✓ Educator ✓ Researcher ✓ Collaborator ✓ Consultant ✓ Case manager ✓ Content expert ✓ Administrator ✓ Activist  Politician  Advocate  Initiator  Evaluator  Grant writer  Practitioner  Coordinator Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Multidisciplinary Roles  Educator and advocate ➢ Improves public awareness of effective treatments and existing community resources ➢ Dispels myths ➢ Provides accurate information ➢ Influences policy and legislation ➢ Advocates for clients Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Multidisciplinary Roles (Cont.)  Practitioner and coordinator Provides direct care, helps consumer “navigate” within web of agencies and providers ➢ Takes action to solve an immediate problem ➢ Plans and intervenes to ensure safety, continuity, and quality of care ➢ Anticipates and evaluates actions of other providers ➢ Communicates with consumers, families, rehabilitation services, and government or social agencies ➢ Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 …