1. Community Health special populations
NURS PSY 150

2. 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

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

4. 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

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

6. 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

7. 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

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

9. 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 =

10. 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

11. 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 =

13. 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?

14. 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

15. 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