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

Chapter_024.pptx

Chapter 24

Populations Affected by Mental Illness

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.

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

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.

Community Mental Health Movement, 1960 to Present Day

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

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

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

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

Mental Disorders Encountered in Community Settings

Schizophrenia

Depression (adults, children, and adolescents)

Bipolar disorder

Anxiety disorders

Eating disorders

ADHD/ADD

Suicide

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

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

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.

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.

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

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.

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.

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

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

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

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

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

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

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

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