Mental Health Care in the Community Chapter 5

Continuum of Care Ongoing clinical treatment and care matched with intensity of professional health services Care provided over time Facilitates stability, continuity and comprehensive services Achieve the highest level of functioning possible within the context of the illness and in the least restrictive environment

Coordination of Care Integration of appropriate services Services tailored to client’s strengths and limitations No duplication of services Collaboration among services Case management, often by a nurse

Generalist Case Management Services Brokerage service Does not necessarily provide the needed services Links the individual with the services Patients are usually outpatients with high-level service use. Staff-to-patient ratio is about 1:30.

Case Management Services Therapeutic tool in providing clinical services or as a brokerage system for coordinating care Goal: To act as a patient advocate by increasing access through coordinated efforts

Nurse as a Case Manager Community knowledge necessary Special training in psychopharmacology, therapies and psychosocial rehabilitation Skills needed include: – collaboration – teaching – management – leadership – group – research

Components of Care: Inpatient Care Crisis Interventions Acute Inpatient Care Partial Hospitalization Residential Services Respite Residential Care In-home Mental Health Care Outpatient Care

Other Services Outpatient Detoxification In-home Detoxification Assertive Community Treatment Psychiatric Rehabilitation Clubhouse Model Relapse Prevention Alternative Housing Arrangements Board-and-care homes

Assertive Community Treatment Interdisciplinary team approach that provides a comprehensive range of treatment, rehabilitation and supportive services Goal: To reduce recurrences of hospitalization Core elements include: – interdisciplinary team responsible for a small group of patients (1:10) – assertive outreach treatment to patients ADLs, grocery shopping, etc. – treatment plan of care – ongoing treatment and support

Alternative Housing Arrangements Personal Care Homes Board-and-care Homes Therapeutic Foster Care Supervised Apartments Clubhouse Models Relapse Prevention After-care Programs

Managed Care Efforts to coordinate patient care efficiently and cost-effectively Goals: To increase access to care and provide the most appropriate level of services in the least restrictive environment Typical services provided: – utilization management – care management – employee assistance program

Managed Care Public and private collaboration Role of nurse: – Maximize time with patient. – Focus on teaching social skills and prevention of relapse. – Teach self-reliance, and create empowering environments. – Provide crisis intervention and case management.

Psychiatric Rehabilitation Reintegration of persons with mental illnesses into the community Focus on increased functioning of persons with mental illness Structured program emphasizes acquiring skills such as communication or vocation skills.

Psychiatric Rehabilitation: Role of Nurse Adapt to the changing needs of persons with mental illness. Match the symptoms with an accurate diagnosis, and engage the patient in an appropriate trial of medication. Monitor target symptoms. Assess and educate on compliance issues, lab work, environment and lifestyle.

Discharge Planning Begins when an individual enters the setting All activities recorded Discharge Checklist – Text Box 5.2