Ch. 25 Community Mental Health Nursing (Test 2) Flashcards
When did treatment for the mentally ill begin?
Before 1840, there was no known treatment for the mentally ill, who were removed from the community to a place where they could do no harm to themselves or others.
Who is responsible for the establishment of mental hospitals?
In 1841, Dorthea Dix, a former schoolteacher, started a campaign that resulted in the establishment of a number of hospitals for the mentally ill.
Mentally ill population after mental hospital establishment?
The mentally ill population grew faster than the number of hospitals, creating overcrowding and poor conditions.
When were a number of federal acts passed, attempting to improve quality of care for mentally ill?
In the 1940s and 50s
When was the Community Mental Health Centers Act passed? What did it call for?
- It called for the construction of community health centers
What is deinstitutionalization? When did it occur?
It is the closing of state mental hospitals and discharging of mentally ill individuals. It begun in 1963 after the Community Mental Health Centers Act.
1980s funding changes?
In the 1980s federal funding was reduced, and the number of community health centers was diminished.
Cost containment- when was it initiated? what did it affect?
Cost containment by prospective payment was initiated in 1983, drastically affecting the amount of reimbursement for health-care services.
What happened after cost containment?
Clients are being discharged from the hospital with a greater need for aftercare than in the past, when hospital stays were longer.
Outpatient services
Outpatient services have become an essential part of the mental health-care system.
What is primary prevention? (Public Health Model)
Defined as services aimed at reducing the incidence of mental disorders within the population
What is nursing in primary prevention focused on? (Public Health Model)
Focused on targeting groups at risk and providing educational programs
What is secondary prevention aimed at? (Public Health Model)
Services aimed at reducing the prevalence of psychiatric illness by shortening the course (duration) of the illness
How is secondary prevention accomplished? (Public Health Model)
Through early identification of problems and prompt initiation of effective treatment
What is tertiary prevention aimed at? (Public Health Model)
Services aimed at reducing the residual defects that are associated with severe or chronic mental illness
How is tertiary prevention accomplished? (Public Health Model)
By preventing complications of the illness and promoting achievement of each individual’s maximum level of functioning
What is primary prevention? (The community as a client)
To identify stressful life events that precipitate crises and target the relevant populations at risk, and to intervene with these high risk populations to prevent or minimize harmful consequences
Who are populations at risk in maturational crises?
Individuals experiencing maturational crises: adolescence, marriage, parenthood, midlife, retirement
Population at risk- Adolescents: What stage are they in? What issue do they have? What do they need?
Identity v. role confusion (Erikson). They have issues of control. They need support from parents.
Populations at risk- Adolescents: what do their issues include?
Self esteem and body image, peer relationships, education and career, values and beliefs, sexuality, drug and alcohol abuse, physical appearance
Populations at risk- Marriage: Issues include?
Synchronization of two lives; differences in religion, ethnicity, social status, or race; need for communication and compromise
Populations at risk- Parenthood: Issues include?
Total responsibility for another human being, parent-infant bonding, changing husband-wife relationship, knowledge about stages of growth and development
Populations at risk- Midlife: Issues include?
Age related physiological changes, relationship with adult children, relationship with aging parents, death of parents, empty nest syndrome
Populations at risk- Retirement: Issues include?
Negative feelings related to lack of productivity, loss of self worth; depression, financial issues
Retirement age culture
Higher risk of depression and suicide compared to other cultures like Native Americans or oriental cultures- because of lack of respect, elder abuse, money, etc.
What are populations at risk in situational crises?
Poverty, high rate of life change events, environmental conditions, trauma
Individuals in situational crises- Poverty
Direct correlation between poverty and emotional illness. May have to do with inadequate and crowded living conditions, nutritional deficiencies, medical neglect, unemployment, homelessness
Individuals in situational crises- High rate of life change events
A large number of significant events occurring in close proximity decrease a person’s ability to deal with stress, including: death of a loved one or divorce, being fired from job, physical illness, change in living conditions, change in body image
Individuals in situational crises- Environmental conditions
Environmental conditions can create situational crises, including: tornadoes, floods, hurricanes, earthquakes
Individuals in situational crises- Trauma
Traumatic experiences outside the usual range of human experience, including: military combat, being a victim of violent personal assault, undergoing torture, being taken hostage or kidnapped, being the victim of natural or manmade disaster
What is secondary prevention? (The community as a client)
Early detection and prompt intervention with individuals experiencing mental illness symptoms
What are populations at risk regarding secondary prevention? (The community as client)
Individuals experiencing maturational and/or situational crises
Secondary prevention of maturational crises in adolescence
Assistance required when disruptive and age inappropriate behaviors become the norm and the family can no longer cope with the situation.
Secondary prevention of maturational crises in adolescence- inpatient care required for?
Conduct disorders, adjustment disorders, eating disorders, substance related disorders, depression and anxiety disorders
Secondary prevention of maturational crises in marriage- common problems?
Common problems in marriage include: substance abuse, disagreements (sex, money, children, gender roles, infidelity)
Examples of reasons for intervention at the secondary level of prevention with parents include?
Physical, emotional, or sexual abuse of a child, physical or emotional neglect of a child, birth of a child with special needs, diagnosis of a terminal illness in a child, death of a child
Secondary prevention of maturational crises in midlife
Individual may be unable to integrate all the changes that are occurring during this period, resulting in depression, anxiety, and substance abuse
Secondary prevention of maturational crises in retirement
When individuals are unable to successfully grieve for this part of their lives, it can result in depression and suicidal ideation
When do individuals need secondary prevention with situational crises?
When intervention at the primary level has failed and the individual is unable to function socially or occupationally
Where may secondary prevention with situational crises occur?
In an inpatient or outpatient setting
Who is tertiary prevention for? (Community as a client)
Individuals with severe and persistent mental illness
Historical and epidemiological aspects of individuals with severe and persistent mental illness
Approximately 100,000 persons with mental illness reside in public mental hospitals. Deinstitutionalization of persons with chronic mental illness began in the 1960s. Large segments of people with chronic mental illness are left untreated.
Barriers to care of individuals with severe and persistent mental illness? (Under tertiary prevention and the community as a client slides)
Fragmentation and gaps in care for children, fragmentation and gaps in care for adults with serious mental illness, high unemployment and disability for people with serious mental illness, older adults with mental illnesses not receiving care, mental health and suicide prevention are not yet national priorities
Goals for mental health reform? (Under tertiary prevention and community as client)
- Americans will understand that mental health is essential to overall health, 2. mental health care will be consumer and family driven, 3. disparities in mental health services will be eliminated, 4. early mental health screening, assessment, and referral to services will be common practice, 5. excellent mental health care will be delivered and research will be accelerated, 6. technology will be used to access mental health care and information
Tertiary prevention treatment alternatives (Community as client)
Community mental health centers, Program of Assertive Community Treatment (PACT), day-evening treatment/partial hospitalization programs, community residential facilities, psychiatric home health care
Tertiary prevention- Care for the caregiver? (Community as a client)
Primary caregivers require support and assistance in providing round the clock care to their loved one with a severe and persistent mental disorder
Number of US homeless?
Estimated at between 250,000 and 4 million
How many homeless are under 18?
39%
How many homeless between ages 25 and 34?
25%
How many homeless are ages 55-64?
6%
What gender are most homeless?
Men
How much do families compromise of the homeless?
33%, more in rural areas
Percentage of A.A., Hispanic, Caucasian, Asian, and Native American homeless?
42% A.A., 39% Caucasian, 13% Hispanic, 4% N.A., 2% Asian
How many homeless suffer from some sort of mental illness?
26%
What is the most common mental illness among the homeless?
Schizophrenia
Types of mental illness of homeless?
Schizophrenia, bipolar affective disorder, substance abuse disorder, depression, personality disorders, organic mental disorders
Contributing factors to homelessness among the mentally ill
Deinstitutionalization, poverty, a scarcity of affordable housing, lack of affordable health care, domestic violence, addiction disorders
Community resources for homeless?
Interfering factor- residential instability. Health issues- alcoholism is common, thermoregulation, tuberculosis is on the rise, dietary deficiencies, STDs, special health needs of homeless children
Types of resources available for homeless
Homeless shelters, health care centers and store front clinics, mobile outreach units
