1. Chapter 31 Serious Mental Illness Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2.  Affects 5% to 7% of U.S. population  Presents difficulties in multiple areas  Chronic or recurrent  Patients at risk for multiple physical, emotional, and social problems  Difficulties in a wide range of functions Serious Mental Illness (SMI) 2 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3.  Before deinstitutionalization, psychiatric hospitals were long-term residences  Patients became dependent on services and structure and were unable to function independently Older Adults with SMI 3 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4.  Limited experience with formal treatment  Contribute to a cycle of treatment, brief recovery, and relapse  Additional problems, such as increased frequency of relapse, legal difficulties, homelessness, substance abuse, and unemployment Young Adults with SMI 4 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5.  Rehabilitation—focuses on  Managing patients’ deficits  Helping them learn to live with their illness  Recovery—focuses on  Achieving goals of patients’ choosing  Leading increasingly productive and meaningful lives Rehabilitation versus Recovery 5 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6.  Establishing a meaningful life  Comorbid conditions  Physical disorders  Depression and suicide  Substance abuse Issues Confronting Those with SMI 6 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7.  Social problems  Stigma  Isolation and loneliness  Victimization  Economic challenges  Unemployment and poverty  Housing instability  Caregiver burden Issues Confronting Those with SMI (Cont.) 7 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8.  Treatment issues  Nonadherence  Anosognosia  Medication side effects  Treatment inadequacy  Residual symptoms  Relapse, chronicity, and loss 8 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. Issues Confronting Those with SMI (Cont.)

9.  Comprehensive community treatment  Community services and programs  Psychiatric or medical-somatic services  Case management Medication monitoring Assertive community treatment (ACT)  Day programs  Crisis intervention services Resources for Persons with SMI 9 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10.  Community services and programs  Emergency psychiatric services  Group and individual psychotherapy  Housing services Resources for Persons with SMI (Cont.) 10 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11.  Partial hospitalization programs (PHPs)  Guardianship  Community outreach programs  Substance abuse treatment 11 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. Resources for Persons with SMI (Cont.)

12.  Assertive community treatment (ACT)  Cognitive-behavioral therapy (CBT)  Cognitive-enhancement therapy (CET)  Family support and partnership Evidence-Based Treatment Approaches 12 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13.  Social skills training  Supportive psychotherapy  Vocational rehabilitation and related services Evidence-Based Treatment Approaches (Cont.) 13 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14.  Advance directives  Consumer-run programs  Wellness and recovery action plans (WRAP)  Technology  Exercise Other Potentially Beneficial Services or Treatment Approaches 14 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15.  Assessment strategies  Nursing diagnoses (Table 31-1)  Intervention strategies (Box 31-2) Nursing Care of Patients with SMI 15 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16.  Mandatory outpatient treatment  Criminal offenses and incarceration  Transinstitutionalization Current Issues 16 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. 1.James Holmes was the shooter at the Batman premiere in Aurora, Colorado, in 2012. Do you think this incident contributes to the stigma of mental illness in our society? A.Yes B.No C.Not sure Audience Response Questions 17 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. 2.The focus of the clubhouse model of treatment is A.stabilizing and preventing crises. B.conducting research studies in the community. C.providing socialization and building independence. D.intensive treatment of severe and persistent mental illness. 18 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. Audience Response Questions

19. 3.Can we, as a society, conclude that the deinstitutionalization movement related to care of persons with serious mental illness was successful? A.Yes B.Partially C.No D.Not sure Audience Response Questions 19 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.