NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues

In correctional mental health care, the competing needs of mental health care workers, custody staff, governmental bodies, and the seriously mentally ill (SMI) inmate patients and their families, conflict in America today. Significant research exists to support the inverse relationship between deinstitutionalization of mental health care in America and other democratic countries, and the rate of incarceration (Hudson, 2016). For example, the rate of population growth in American prisons between 1980 and 2010 was 11 times greater than the growth rate of the general population during the same

period of time (Rich, 2014). Nearly half of all incarcerated individuals in America experience some form of mental illness, a stark contrast to just 11% of the general population (Hoke, 2015). The deinstitutionalization of mental health care in America has shifted the burden of caring for seriously mentally ill individuals to their families, and in many cases, to the jails and prisons. In addition, and as implied in NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues, when America declared a “war on drugs” in the 1980s, this led to a significant increase of incarcerations for drug-related crimes, disproportionately affecting individuals with psychotic disorders and substance abuse problems (Baillargeon, Binswanger, Penn, Williams & Murray, 2009, as cited in Hoke, 2015).

NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues: America is home to the largest prison system in the world (Hoke, 2015). This provides evidence that America is a punitive society, and this cultural view has created policies and practices that have led to mass incarceration (Rich, 2014). In the context of this national sentiment, it becomes increasingly difficult to deliver an appropriate level of care to inmates, much less a level of care that is equivalent to care received in the community (Rich, 2014). In NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues, Jails and prisons frequently do not provide levels of mental health care in line with national standards (Hoke, 2015). Many barriers exist in providing an adequate level of mental health care to the SMI inmate population in America. Among the barriers to providing adequate mental health care to the SMI inmate population are lack of financial resources, lack of qualified provider resources, safety concerns, the nature of incarceration, and lack of policies to shift care of SMI inmates to more appropriate facilities designed to provide an acceptable level of mental health care. One example which is representative of this larger phenomenon is the management of those on suicide watch.

According to NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues, when an inmate expresses suicidal ideation or engages in self-harm behavior, they are moved to a holding area of the jail designed to prevent self-injury. This is referred to as suicide watch. These suicide watch holding areas are even less comfortable than regular jail housing. For example, inmates are provided only one stiff, tear proof blanket for warmth, and a single garment which affixes at the shoulders and side with large Velcro fasteners. Jails and prisons are almost always very cold environments due to the lack of soft surfaces. The suicide watch garment is only knee length and is sleeveless. The inmates are not allowed to have any undergarments due to the concern for ligature risk. They are not allowed plastic utensils to eat with due to the concern for possible self-harm. Suicide watch cells are placed in high traffic areas of intake or SMI housing units under constant supervision by custody staff removing what little privacy inmates ever experience. These areas tend to be too noisy for adequate sleep. Thus, in the name of safety, individuals who are struggling with emotional pain are stripped of basic comforts, their dignity, and privacy. This should not be acceptable, especially because in America, there is no other option for these individuals to be safely held in a more therapeutic environment.

State and federal policies to create long-term care facilities for the seriously mentally ill are needed. Funding for these facilities should be prioritized. Much of this funding can be diverted from the jails and prisons. Ironically, according to NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues, this would move America back toward institutionalization for the seriously mentally ill, reversing policies and practices instituted as far back as 1960. However, I believe this has become inevitable. Rates of death by suicide in jails and prisons are high, and account for over 30% of all incarceration deaths (Bureau of Justice Statistics, 2020).

In my experience as both a board certified psychiatric mental health nurse, and as the nursing supervisor in one of the largest county jails in America, the deinstitutionalization of long-term mental health treatment facilities in our country has proven to be both ineffective and costly. Recidivism rates remain high, in large part because community supports for treatment which would address the underlying issues that lead to incarceration are absent. Without changes in policy to devote appropriate resources for treating the seriously mentally ill, this troubling cycle will continue. Due to these many factors, I experience burnout, frustration, and a feeling of powerlessness to improve the care of the SMI inmates in my jail. As Kelly and Porr state in an article for the American Nurses Association, nurses feel this way today because of practicing in health care environments with limited resources which place limits on our ability to provide appropriate patient care (2018).

NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues References

Bailargeon, J., Binswanger, I. A., Penn, J. V., Williams, B. A., & Murray, O. J. (2009). Psychiatric disorder and repeat incarcerations: The revolving prison door. American Journal of Psychiatry, 166(1), 103-109.

Bureau of Justice Statistics. (2020). Mortality in local jails, 2000-2016 – Statistical tables (NCJ 251921). U.S. Department of Justice, Office of Justice Programs. https://www.bjs.gov/content/pub/pdf/mlj0016st.pdf

Hoke, S. (2015). Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers. Online Journal of Issues in Nursing, 20(1), 1. https://doi-org.ezp.waldenulibrary.org/10.3912/OJIN.Vol20No01Man03

Hudson, C. G. (2016). A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014. International Journal of Mental Health, 45(2), 135–153. https://doi-org.ezp.waldenulibrary.org/10.1080/00207411.2016.1167489

Kelly, P. & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing 23(1) Manuscript 6. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Rich, B. A. (2014). Observations on the nature and extent of injustice in the American prison system. The American Journal of Bioethics: AJOB, 14(7), 1–3. https://doi-org.ezp.waldenulibrary.org/10.1080/15265161.2014.918211

I also work mental health in Hospital in Texas.  I understand that mental health can be challenging especially for the patients that need to stay hospitalized due to chronic mental illness.  Placement is one of the most challenging problems we run across.  Our patients stay is usually 3-7 days in the hospital.  We currently have a patient that has been admitted for 90 days. This is the type of patient that needs long term inpatient care, and even for the rest of their lives.  We have resources that we can send them too but the Doctors feels that certain patients with chronic mental health would get hurt in the streets due to people not understanding their illness.  I agree that there is a gap and a loop hole in the policy of helping the chronically mental health patients get to a long term safe place facility.  We have a local facility that houses mental health patients for up to 1 year.  Most times families are burnt out and feel like they hit a wall. According to Esposito (2016), ” Thirty percent of people released from state psychiatric hospitals go to homeless shelters and “that’s just unacceptable.”

I’m sure you see so much more burnout with staff in the prisons due to feeling that the deinstitutionalization is not effective.  I agree because I remember my grandparents telling me stories about how facilities used to house chronic mental health patients for long term and these facilities were big and beautiful.  Today we don’t see that and it shows here in the hospital I currently work at since placement is always a problem. Since 1955, 93% of hospital beds have been lost in psychiatric hospitals (Mental Illness Police 2005).

Community Living Options for People With Serious Mental Illness. (n.d.). Retrieved December 16, 2020, from https://health.usnews.com/wellness/mind/articles/2016-10-26/community-living-options-for-people-with-serious-mental-illness

Patrick Moynihan: Deinstitutionalization Failed. (2019, January 23). Retrieved December 16, 2020, from https://mentalillnesspolicy.org/media/eft/deinstitutionalization-deadly-moynihan-torrey.html

NURS 6053 Week 3 Discussion: Organizational Policies and Practices to Support Healthcare Issues RESPONSE 2

I really enjoyed reading your post regarding mental health in prison systems. I too have provided care to this population in a psychiatric hospital setting. I agree that these individuals are often stripped of their dignity as a result of organizations’ measures to ensure safety. However, some things do not make sense to me. For example, you stated that patients in the prison system may not have plastic cutlery. In my healthcare facility patients can have plastic spoons and forks but not knives. This to me is mind-boggling. I have brought this up during a staff meeting challenging why it is ok to have the other plastic items and not knives when self-harm can still be done with spoons and knives. The Leadership/Management team was not successful in providing an alternative. How frustrating!

As the stressor of staffing is a dominant issue in our field of nursing healthcare staff are at higher risk for burnout. When our resources are low it also effects the quality of care being delivered to patients. Recently, The Joint Commission has stepped in after conducting a survey of 2,000 healthcare workers and found that “Only about 5% of respondents surveyed said their organization was highly effective at helping staff deal with feelings of burnout. Only about 39% said their organization was “slightly effective” at dealing with burnout, and 56% said their facility was either slightly or highly ineffective at it” (Palmer, 2020).

Tackling these challenges often depends on funding. In my experience as a nurse, my findings of a proactive environment were in non-profit facilities. I felt that my voice was heard, actions were taken, and patient/staff satisfaction was higher. Organizations that are non-profit have an abundant number of resources that can benefit both employees and the patients they serve. Brinkmann (2018) found that organizations who fund research can help inform the development of new policies by defining clinical priorities. “For-profit systems benefit from investors’ money and have more flexibility about which services they offer, often seeking more profitable ones” (Masterson, 2017).

Some healthcare organizations are implementing burnout interventions which include resilience training. These positive interventions may decrease employee turnover, improve problems in performance and delivery of care, and most importantly enhance patient satisfaction (Moore, 2020).

References

Brinkmann, J. T. (2018, January). Healthcare policy: Where it comes from and how to change it. The O&P EDGE Magazine – OPEDGE.COM. 

Masterson, L. (2017, May 25). Nonprofit, for-profit hospitals play different roles but see similar financial struggles. Healthcare Dive. 

Moore, C. (2020, January 9). Resilience training: How to master mental toughness and thrive. PositivePsychology.com. 

Palmer, J. (2020, January 6). Joint Commission Portal addresses nurse burnout. Patient Safety & Quality Healthcare.