Community Health special populations NURS PSY 150

What is advocacy? Seeks to ensure that people, particularly those who are most vulnerable in society, are able to: Have their voice heard on issues that are important to them. Defend and safeguard their rights. Advocacy is a process of supporting and enabling people to: Express their views and concerns. Access information and services. Defend and promote their rights and responsibilities. Explore choices and options

Forgotten populations Homeless and Incarcerated What is your role? __________ The difference…. Mandated basic health services for prisoners however, unavailable for majority of homeless.

Not in my back yard “Most Americans want the homeless off the street, but no one wants them next door.” Transitional housing Worthy vs unworthy (pg 606) Conditions leading to homelessness - How does someone become “down and out”? Evaluation at every point of care or service

Homelessness on the rise Deinstitutionalization Loss of Jobs for unskilled workers Loss of low-cost housing Drugs

Homelessness 1/3 have “severe” mental disorder “No other affluent country has abandoned its mentally ill to this extent” Where homeless individuals go for all healthcare services? Issue with continuity of care and preventive interventions Dx: substance abuse, depression, chronic conditions such as ETOH liver disease, TB, AIDS, asthma, back pain, DM, HTN – all require development of therapeutic relationships with healthcare workers for return care

Community support services Club House Model Care services: focus on rehabilitation, vocational needs, education and socialization, management of symptoms and medications Housing alone does not make a difference. Psychosocial rehabilitation services Peer support Vocational training Daily living skill training

Hx of reform Emergence of moral tx and asylums/ institutions Mental hygiene movement State hospitals Deinstitutionalization and community health

Institutionalization Deinstitutionalization 19th Century Beliefs of mental health caused by dysfunctional parenting Tx: enemas, ECT, purging, lobotomies Loss of social skills and increased dependency Dorthea Dix WWII changed view of mental disorders... D/t inadequate funding, overcrowding, understaffed hospitals Community Mental Health Centers Act 1963:partial hospitalization, emergency care, consultation, tx Lack of community resources and federal funding =

Incarcerated US has highest rate of imprisonment in the world Mentally ill are 3 x as likely to be arrested 30-40% depression, anxiety and/or substance abuse 5-8% schizophrenia, bipolar

Mental Illness in the prison system Cycle of poverty and incarceration Dx: psychosis, depression, personality disorders, substance abuse NANDA: ineffective coping, hopelessness, risk for suicide, risk for violence, chronic or situational low self-esteem, social isolation =

Healthcare trends & nursing Shorter stays for clients means nurses have less interaction and relationship-building time meaning the nurse often only sees the acute phase of illness, not the recovery What needs do you think these population has regarding care, safety, rehabilitation?

Ethical principals Respect for person – autonomy and self-determination Beneficence – doing good Nonmaleficence – avoiding harm Justice – fairness, equality, truthfulness Veracity – telling the truth Fidelity – remaining faithful to ones commitment Negligence – failure to provide basic physical needs

Involuntary treatment act Harm to ... Self Others Property Gravely Disabled “Safety hold” - 72 hours hold for assessment (weekends and holidays)- 14 days with or without meds