0 Chapter 33 Challenges for the Future

Elsevier items and derived items © 2005 by Mosby, Inc. 1 Worldwide, 4 of the 10 leading causes of disability in established market economies are mental illnesses. Escalating costs in several countries are forcing officials to take a close look at where and how health care funds are spent. Social changes, including our aging population, an overwhelmed welfare system, and a cost conscious U.S. Congress, are all influencing the health care system. Challenges for Delivering Mental Health Care

Elsevier items and derived items © 2005 by Mosby, Inc. 2 Clients may not speak English. Technological advances are opening new areas of exploration, and discoveries in human biochemistry are challenging our traditional ways of thinking. The development of treatment modalities and preventive measures will be challenging. Challenges for Delivering Mental Health Care

Elsevier items and derived items © 2005 by Mosby, Inc. 3 Historically, homeless people were unmarried, intermittently employed, white men, average age 50 years. They seldom actually slept in the streets because of availability of cheap hotels, missions, and “sleeping-rooms only” establishments. Today’s homeless are on average younger and much poorer, and one third of all homeless are families. Homelessness

Elsevier items and derived items © 2005 by Mosby, Inc. 4 The ADA (1990) is a federal statute designed to remove the barriers that deprived qualified people with disabilities of employment opportunities available to persons without disabilities. Employers are required to make reasonable accommodations to enable disabled persons—including those with mental disorders—to perform the essential functions of the job. Americans with Disabilities Act

Elsevier items and derived items © 2005 by Mosby, Inc. 5 The ideal composition of an interdisciplinary mental health care team is a client, a physician, a psychologist, a nurse, a dietitian, a social worker, a representative of the client’s spiritual beliefs, an occupational therapist, and other specialists as needed. The main function of the team is to coordinate care as the client moves through the health care system from inpatient to community setting. The Mental Health Care Team

Elsevier items and derived items © 2005 by Mosby, Inc. 6 Role of client has changed from passive participant to active consumer of health care services. Criteria for being considered  Ability to make choices  Understanding of important information  Appreciation of one’s personal situation  Ability to apply reasoning Client is obligated to be truthful and responsible and to cooperate with care Change and Mental Health Clients

Elsevier items and derived items © 2005 by Mosby, Inc. 7 Nurses participate fully as members of the treatment team.  Provide education for clients and their significant others.  Coordinate therapeutic interventions and activities of support agencies. Nurses play vital role in centers for the homeless where treatment teams assess each client’s medical, psychiatric, and social service needs. Expanded Roles for Nurses

Elsevier items and derived items © 2005 by Mosby, Inc. 8 Preventive health care  Routine screening for weight, hypertension, and response to medications provides nurses an opportunity to interact with clients. Collaborating with physicians to plan and implement programs for people with serious mental illness Nurse case managers work with psychiatrists to develop treatment plans for each client. Expanded Roles for Nurses

Elsevier items and derived items © 2005 by Mosby, Inc. 9 Whether change is unexpected or expected, some people experience intense reactions. Reactions to change generally in mental health take form of anxiety, mistrust, or loss.  When the comfort of a daily routine is disrupted, people become anxious.  Mistrust develops when people are uncertain about what is happening.  Loss is experienced when old, comfortable attitudes or behavior must be given up. Managing Change