Psychiatric Mental Health Nursing in Acute Care Settings

Inpatient Psychiatric Care Admissions reserved for Suicidal Homicidal or Extremely disabled in need of short-term acute care

Funding Psychiatric Mental Health Care Private pay insurance Managed care plans Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Managed behavioral health care organizations (MBHOs) Medicaid Medicare

Mental Health Funding Legislation Paul Wellstone and Peter Domenici Mental Health and Addiction Equity Act of 2008 Restricts insurance companies from requiring higher co- payments or higher deductibles for mental health or substance abuse

Uninsured Patients Medicare Medicaid Social Security Social Security Disability Income (SSDI) Supplemental Security Income (SSI) Veterans Administration

Inpatient Psychiatric Care Admission options Direct admission Hospital emergency department Criteria to justify admissions Danger to self or others or unable to care for basic needs Voluntary or involuntary

Patient Rights Hospitalized patients retain their rights as citizens Obligation to balance patient's needs for safety with patient's rights as a citizen Mental health facilities have written statements of patient's rights and applicable state laws

Multidisciplinary Treatment Team Meet within 72 hours of patient's admission Multidisciplinary treatment plan or clinical pathway is guideline for patient’s care during hospital stay

Nursing Care Admission assessment Ensuring safety Physical health assessment Milieu management

Nursing Care Continued Structured group activities Documentation Medication administration Medication adherence

Nursing Care Continued Pain management Crisis management Medical crises Behavioral crises Preparation for discharge to community

Psychiatric Mental Health Nursing in Community Settings

Community Mental Health Nursing Movement 1963 Community Mental Health Centers Act (Kennedy) Shift care from institution to the community Deinstitutionalization 1960s Federal entitlement programs Social Security Disability Supplemental Security Income Medicaid Medicare Housing assistance Food stamps

Community Mental Health Nursing Movement Continued Challenges Few choices for outpatient treatment Limited funding More clients than resources Resistance of seriously mentally ill patients to treatment 1980s Commission on Mental Health (Carter)

Roles and Functions of Community Mental Health Nurse Biopsychosocial assessment Negotiating flexible and resourceful treatment goals and interventions Member of a multidisciplinary team Biopsychosocial Care Manager Promoting continuation of treatment Providing care in a variety of settings

Continuum of Psychiatric Treatment Most acute treatment (short-term) Intensive outpatient treatment (usually short-term) Transitional outpatient treatment (usually long-term) Ongoing outpatient treatment (long-term)

Community Settings Partial hospitalization program (PHP) Intensive, short-term treatment with patient able to return home each day Patients receive 5 to 6 hours of treatment daily Typically 5 days a week Average length of stay 2 to 3 weeks Multidisciplinary team (psychiatrist, RN, and social worker)

Community Settings Continued Psychiatric Home Care Four requirements Homebound status of patient Presence of psychiatric diagnosis Need for skills of RN Plan of care under physician

Community Settings Continued Assertive Community Treatment (ACT) For clients with repeated hospitalizations, severe symptoms, or inability to participate in traditional treatment Multidisciplinary team Work with patients in homes, agencies, hospitals, or clinics ACT team provides support and resources; on call 24 hours a day

Community Settings Continued Community Mental Health Centers Emergency, adult, and children’s services for those who have no access to private care Provide Medication administration Individual therapy Psychoeducational and therapy groups Family therapy Dual-diagnosis treatment

Resolving Ethical Dilemmas Role of nurse Act in the best interests of the patient and society to the degree possible Resources for consultation Hospital ethics committee Agency ethics consultant Professional nursing organizations State board of nursing

Barriers to Mental Health Treatment Stigma associated with mental disorders Scarcity of care in rural areas Inability to afford health insurance Fragmented care for children and adults with serious mental illness High unemployment and disability among seriously mentally ill Undertreatment of older adults Lack of national priority for mental health