Psychiatric Care and Mental Health in the Community
Psychiatric Care and Mental Health in the Community
Read chapter 24 of the class textbook and review the attached PowerPoint presentation. Once done answer the following questions;
- Explain and give some examples of the concepts of community mental health and discuss the importance of community mental health promotion in special populations.
- Describe the biological, social, and political factors associated with mental illness.
- Describe different types of evidence-based treatment for mental disorders, including the use of psychotropic medication management, community case management, and crisis intervention. Give at least one example.
- Describe the role of mental health nurses in the community.
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INSTRUCTIONS:
As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 14 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard(which is mandatory). A minimum of 3 evidence-based references besides the class textbook no older than 5 years must be used and quoted according to APA guidelines. You must post two replies to any of your peers sustained with the proper references no older than 5 years in two different days to verify attendance and as well make sure the references are properly quoted and mention to whom you are replying to. The reply is a comment to your peer, not an extension of what you posted in your assignment. What I mean is that you can’t post in your replies the same that you posted in your assignment. A minimum of 800 words is required. Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment. I will also pay close attention to spelling and/or grammar. Please review the rubric attached to the lecture. You must present the assignment according to how it is posted, answering the questions by number and essay-style assignments will not be accepted unless otherwise specified. Psychiatric Care and Mental Health in the Community
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Chapter_024.pptx
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.
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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.
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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.
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Community Mental Health Movement, 1960 to Present Day
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Blue Ribbon Panel report Action for Mental Health 1963 Community Mental Health Clinics Legislation Recommendations for intensive care of acutely ill mental patients and community mental health clinics Community mental health centers in some urban communities 1960’s Deinstitutionalization 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 part of the Omnibus Reconciliation Act 1986 State Mental Health Planning Act States develop comprehensive mental health plans for persons with SMI 1999 U.S. Surgeon General’s Report on Mental Health 2008 Mental Health Parity and Addiction Equity Act of 2008 Insurance coverage for mental health and 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
Deinstitutionalization
Courts’ actions
Limited involuntary institutionalization
Set minimum standards for care in institutions
Insufficient community resources
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.
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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.
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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.
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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.
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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.
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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
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.
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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.
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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.
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Anxiety Disorders
Characterized by feelings of severe anxiety
Generalized anxiety disorder
Panic disorder
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.
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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.
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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.
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Suicide
Risk factors—IS PATH WARM?
Previous suicide attempts, mental illness, substance abuse, barriers to accessing mental health treatment
Protective factors
Appropriate mental health care, easy access to treatment, community support, and continuing support from medical and mental health providers. Psychiatric Care and Mental Health in the Community
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.
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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.
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Suicide
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.
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EBP Management of Mental Disorders
Psychotropic or Psychotherapeutic medications
Medications treat symptoms; they do not cure mental illness
Nurse needs to be up-to-date on medications:
http://www.nlm.nih.gov/medlineplus/druginformation.html
http:www.rxlist.com
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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.
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Community-Based Mental Health Care Initiatives
Americans understand that mental health is essential to overall health.
Mental health care is consumer and family driven.
Disparities in mental health services are eliminated.
Early mental health screening, assessment, and referral to services are common practice.
Excellent mental health care is delivered, and research is accelerated.
Technology is used to access mental health care and information.
– New Freedom Commission on Mental Health (2003). Psychiatric Care and Mental Health in the Community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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.
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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.
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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.
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