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Chapter 36

Mental Health Issues

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Objectives

1. Describe the history of community mental health and make predictions about the future.

2. Discuss the prevalence of mental illness in the United States and the world.

3. Describe essential mental health services and corresponding national objectives for improving mental health.

4. Discuss the health status of the population that has mental illness in the United States.

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Objectives, Cont’d

5. Evaluate standards, models, concepts, and research findings for use in community mental health nursing practice.

6. Describe the role of the community mental health nurse with individuals and with groups at risk for psychiatric mental health problems.

7. Apply the nursing process in community work with patients diagnosed with psychiatric disorders, families at risk for mental health problems, and vulnerable populations.

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Objectives, Cont’d

8. Examine strategies to improve the mental health of people who are at risk in a complex society.

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Scope of Mental Illness in the United States

Consumer AdvocacyNeurobiology of Mental Illness

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Mental Disorders Severe mental disorders Mental disorders are indiscriminate Leading cause of disability in North America 57.7 million adults in the United States suffer

from a mental disorder 6% suffer from a serious mental illness, such as

schizophrenia 13% of children and adolescents between 8

and 15 years of age have a diagnosable mental disorder.

Impact on overall health and productivity

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Consumer Advocacy National Alliance for the Mentally Ill (NAMI) Community Support Program (CSP)

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Neurobiology of Mental Illness 1990s: the “decade of the brain”

Great strides occurred through research in neurology, microbiology, and genetics that led to understanding the structural and chemical complexity of the brain.

Brain is not a static organ Both somatic and psychosocial interventions

need to be used to treat mental illnesses. Neuroradiological techniques

Angiography, CAT scans, NMR, PET, SPECT Discoveries in psychopharmacology

SSRIs

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Systems of Community Mental Health Care

Managed care Community mental health model Community mental health centers

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Evolution of Community Mental Health Care

Historical PerspectivesHospital Expansion,

Institutionalization, and the Mental Hygiene Movement

Federal Legislation for Mental Health Services

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Historical Perspectives In ancient times, mental illness was viewed

as a result of supernatural forces and those afflicted were shunned.

In the Greco-Roman era, mental and physical illnesses were seen as interrelated and resulting from physical conditions.

Humanitarian reform occurred near the end of the nineteenth century.

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Hospital Expansion, Institutionalization, and the Mental Hygiene Movement

Psychiatric hospitals became overcrowded with people who had severe mental disorders, with older adults, and with immigrants who were poor or unable to speak English.

Many patients were institutionalized for the rest of their lives.

Clifford Beers urged reform and influenced the founding of the National Committee for Mental Hygiene.

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Federal Legislation for Mental Health Services

Social Security Act National Mental Health Act of 1946 Joint Commission on Mental Illness and

Health established by NIMH in 1955 Community Mental Health Centers Act

passed in 1964

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Deinstitutionalization Civil Rights Legislation for Persons with

Mental Disorders Americans with Disabilities Act of 1990

Advocacy efforts

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Conceptual Frameworks for Community Mental Health

Systems theory Levels of prevention

Assertive community treatment (ACT) programs Intensive case management models

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Role of the Nurse Clinician Educator Coordinator

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Current and Future Perspectives Nationally and internationally, there are too

few mental health care services. Patient Protection and Affordable Health Care

Act passed in 2010

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National Objectives Children and adolescents Adults Adults with Serious Mental Illness

Wellness recovery action plans Older Adults Cultural Diversity

African Americans Hispanic Americans Asian and Pacific Islander Americans Native Americans