chapter 20 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 20: Community Mental Health


Chapter Highlights• Epidemiology of mental illness from a public health perspective

• Early intervention in the treatment of schizophrenia

• Strategies to enhance treatment adherence

• Public health implications of children with behavioral disorders

• Evolution of community mental health

• Policy development and legislation for mental health services

• Role and responsibilities of the community mental health practitioner


Question

Is the following statement True or False?

Genetic, biological, and environmental risk factors all influence the incidence of mental illness.


Answer

True

Rationale: Genetic, biological, and environmental risk factors all influence the incidence of mental illness. Early intervention can minimize the morbidity associated with mental illness.


Cultural Context of Mental Illness

• Genetic, biological, and environmental risk factors all influence the incidence of mental illness.

• Mental health and, conversely, mental illness are concepts bound by culture.

• Understanding of what connotes mental health is shaped by social norms that evolve from generation to generation.


Definitions of Mental Health

• No universally accepted definition of mental health; for practical purposes, widely accepted parameters for what behaviors connote psychopathology must be used to measure

– Incidence

– Morbidity

– Mortality


Scope of Mental Illness

• There is no difference is lifetime prevalence rates of major mental illness between developed and developing countries.

• The projected lifetime risk of developing a major mental illness is highest in countries where the population is subject to sustained violence.

• Psychiatric disorders are the leading cause of disability worldwide.


Question


Rationale: Adherence to psychopharmacology and psychotherapy does not enhance recovery from mental illness.


Answer

False

Rationale: Adherence to psychopharmacology and psychotherapy enhances recovery from mental illness.


Schizophrenia

• Epidemiology

• Early intervention programs for first-episode psychosis

• Primary prevention programs

• Enhancing treatment adherence in schizophrenia

• Role of community mental health teams in treatment of schizophrenia


Epidemiology of Schizophrenia

• About 1% of the world’s population suffers from schizophrenia.

• Symptoms of schizophrenia typically first appear in late adolescence or young adulthood and persist throughout a person’s life, causing significant impairment in all aspects of a person’s psychosocial functioning.


Early Intervention Programs for First-Episode Psychosis

• Early intervention programs—specialized teams of professionals whose primary goal is to maintain the individual’s current level of educational and vocational functioning through early treatment


Enhancing Treatment Adherence in Schizophrenia• Nonadherence with medication is the most common

factor associated with relapse and recurrence of psychotic symptoms.

• Nursing interventions to enhance medication adherence applicable to those with chronic mental illness may include the following:

– Oral and written reminders

– Self-monitoring tools

– Cues

– Positive reinforcements by both the nurse and the family


High-Risk Populations

• The unemployed, the poor, and the homeless all report higher levels of depression, anxiety, schizophrenia, and substance abuse than the general population.

• The number of mentally ill clients who are homeless has steadily increased in the United States as state governments embarked on a systematic plan to “deinstitutionalize” the mentally ill.


Deinstitutionalization

• The phenomenon of allowing patients leave care in large, complex health care systems in order to receive care in neighborhoods and communities on an outpatient basis


Role of Community Mental Health Teams in Treatment of Schizophrenia

• Respite services, day treatment facilities, and sheltered workshops are a few of the outpatient services that help alleviate the daily burden of care for families.

• To address these shortcomings in the delivery of care, community mental health teams coordinate both the psychosocial and psychopharmacological needs.


Mood and Anxiety Disorders

• Epidemiology

– Social factors

– Biological theories of depression and anxiety

• Populations at risk for suicide

• Nursing interventions for mood and anxiety disorders

– In clients with somatic and mood symptoms, nurses must always directly inquire if the client has had any thought of harming himself or herself.


Attention Deficit/Hyperactivity Disorders and Emotional Disorders in Children

• The main characteristics that help health care practitioners, including school nurses, differentiate ADHD from bipolar disorder are the pervasiveness of the symptoms and the predominant symptoms.


The Precipitous Rise in Autism—A Public Health Crisis

• Long-term outcomes of children with autism are improved with early identification and treatment.

• Screening tools for autism have been developed, but most are for use in toddlers and not in infants.

• Screening for prodromal symptoms in infancy; some of the more debilitating features of the disorder might be mitigated with early intervention and treatment.


Question

Is the following statement true or false?

Public health initiatives to educate communities about mental health can be effective in lowering the incidence of high-risk behaviors such as alcoholism.


Answer

False

Rationale: Public health initiatives to educate communities about mental health can be effective in lowering the incidence of high-risk behaviors such as suicide.


Evolution of Community Mental Health• Community-based treatment of the mentally ill gained

momentum as World War II veterans returned home exhibiting the symptoms of post-traumatic stress disorder.

• By the early 1960s, a scathing report by the Joint Commission on Mental Health and Illness about conditions in state-supported psychiatric hospitals prompted the adoption of the Community Mental Health Center .

• Aided by advances in the development of pharmacologic treatment of the mentally ill, the numbers of patients treated in state mental hospitals precipitously declined.


Evolution of Community Mental Health (cont.)

• Since deinstitutionalization began, there has been an outcry of frustration from nurses in the community about the lack of supportive services to meet the needs of people with chronic mental illness.


Question


The continuum of care for the chronic mentally ill includes community services, such as supportive housing and employment.


Answer

True

Rationale: The continuum of care for the chronic mentally ill includes community services, such as supportive housing and employment.


Legislation for Parity in Mental Health Insurance Benefits

• All health insurance coverage, including deductibles, copays, coinsurance, and out-of-pocket expenses, as well as all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits, will be the same regardless of health need or diagnosis.


Role and Responsibilities of the Community Mental Health Practitioner

• Teacher

• Clinician

• Advocate

chapter 20 ppt

Documents

incidence of mental

mental health services

symptoms of schizophrenia

environmental risk factors

true rationale

false rationale

following statement

projected lifetime risk