1. Populations Affected by Mental Illness
Chapter 24
Populations Affected by Mental Illness
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

2. Mental Health
Mental health refers to the absence of mental disorders and to the ability for social and occupational functioning.
Mental illness is diagnosable mental disorders that affect alternations in thinking, mood, or behavior associated with distress and impaired functioning.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

3. Challenges in the Community
Complex patient comorbidity
Lack of resources
Competent mental health professional workforce and law enforcement
Physical facility inadequacies
Stigma of mental illness
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4. A community’s mental health is a reflection of community as a whole
A community’s mental health is a reflection of community as a whole. Mental illness is a significant public health problem affecting not only the person with mental illness, but also his or her families, friends, schoolmates, workmates, and others.
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5. Community Mental Health Movement, 1960 to Present Day
Blue Ribbon Panel report Action for Mental Health
1963 Community Mental Health Clinics Legislation
Recommendations for intensive care of acutely ill mental patients and community mental health clinics
Community mental health centers in some urban communities
1960's Deinstitutionalization
Discharged mentally ill from state hospitals patients returned to communities with inadequate resources (e.g. finances, housing, health care, supportive employment)
1981 Mental Health Block Grant, as part of the Omnibus Reconciliation Act
1986 State Mental Health Planning Act
States develop comprehensive mental health plans for persons with SMI
1999
U.S. Surgeon General’s Report on Mental Health
2008 Mental Health Parity and Addiction Equity Act of 2008
Insurance coverage for mental health and substance use conditions
2010 Affordable Care Act
Builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans
Table 24-1
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6. Deinstitutionalization
Courts’ actions
Limited involuntary institutionalization
Set minimum standards for care in institutions
Insufficient community resources
Inadequate housing
Insufficient supported employment
Insufficient community mental health professional workforce
Few community mental health care services
Funding did not follow the change in policy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

7. Present-Day Community Mental Health Reform
Mental Health Reform works toward monitoring federal legislation, administration activity, and public education initiatives.
Makes community mental health a national priority by establishing early access, recovery, and high quality in mental health services as standards
Medicalization of Mental Illness
Brain Neuroimaging, Genetics, and Hope for New Treatments
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8. Medicalization of Mental Illness
Has helped put mental disorders on parity with other diseases
Can impact treatment as forcefully as other medical conditions
Hope to make insurance coverage equal to other medical treatments
Looks at holism and health and understanding on a functioning level
Seen as treatment to achieve the absence of disease
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

9. Factors Influencing Mental Health
Biological Factors
Genetic Factors
Brain Structural and Functioning Abnormalities
Social Factors
Gender, Racial, Sexual Orientation Disparities
Natural and Man-Made Disasters
Political Factors
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10. Mental Disorders Encountered in Community Settings
Schizophrenia
Depression (adults, children, and adolescents)
Bipolar disorder
Anxiety disorders
Eating disorders
ADHD/ADD
Suicide
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

11. Schizophrenia The most common psychotic disorder
Positive symptoms include hallucinations, delusions, disorganized thinking and speech, and bizarre behaviors
Negative symptoms include flat affect, poor attention, lack of motivation, apathy, lack of pleasure, and lack of energy
Increased risk for alcohol use, depression, suicide, and diabetes
Treatment is intensive—often with hospitalization (initially), antipsychotic meds, and psychotherapy
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12. Depression
Most frequently diagnosed and one of the most disabling mental illnesses in the United States
Includes major depressive disorder, dysthymic disorder, and bipolar
Often co-occurs with serious physical disorders (heart attack, stroke, diabetes, and cancer)
Health education includes risk factors identification, as well as how and when to obtain treatment
Children and adolescents also suffer with depression.
Treatment includes pharmacological therapy, psychotherapy, behavior therapy, electroconvulsive therapy, or a combination of these
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

13. Bipolar Disorder
Mood disorder that presents with changes in mood from depression to mania.
May co-occur with hallucinations and delusions.
Management of bipolar disorder must be ongoing and involve close monitoring.
Treatment generally involves use of mood stabilizing medication, often in combination with antipsychotic and antidepressant therapy.
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14. Anxiety Disorders Characterized by feelings of severe anxiety
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
May be attributed to genetic makeup and life experiences of the individual.
Treatment varies with disorder.
Support from family and friends beneficial.
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15. Eating Disorders
Often triggered by developmental milestones (e.g., puberty, first sexual contact) or another crisis (e.g., death of a loved one, ridicule over weight, starting college)
Primarily affect females
Bulimia nervosa (binge eating)
Anorexia nervosa (obsessed with fear of fat and with losing weight)
Treatment: long-term nutrition counseling, psychotherapy, and behavior modification
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16. ADHD and ADD ADHD: attention deficit hyperactivity disorder
ADD: attention deficit disorder
Usually appear before age 7 and often accompanied by related problems (e.g., learning disability, anxiety, and depression)
Three major characteristics are inattention, hyperactivity, and impulsivity.
Symptoms are typically managed with a combination of behavior therapy, emotional counseling, and practical support.
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17. Suicide Risk factors—IS PATH WARM? Protective factors
Previous suicide attempts, mental illness, substance abuse, barriers to accessing mental health treatment
Protective factors
Appropriate mental health care, easy access to treatment, community support, and continuing support from medical and mental health providers
Warning signs of suicide
Question those at risk in terms of thoughts, plans, lethality, means, and intent.
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18. Suicide How do you remember the warning signs of suicide?
Try using this easy-to-remember mnemonic:
IS PATH WARM?
I – Ideation S – Substance abuse P – Purposelessness A – Anxiety T – Trapped H – Hopelessness W – Withdrawal A – Anger R – Recklessness M – Mood changes
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19. Identification of Mental Disorders
Early identification, appropriate treatment, and rehabilitation can reduce duration and disability and decrease possibility of relapse.
Direct questioning
Observations
Use of standardized assessment tools or questionnaires
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20. EBP Management of Mental Disorders
Psychotropic or Psychotherapeutic medications
Medications treat symptoms; they do not cure mental illness
Nurse needs to be up-to-date on medications:
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21. EBP Management of Mental Disorders (Cont.)
Psychotherapy
A process of discovery that helps alleviate troubling emotional symptoms and returns individuals to a healthy life
Involves use of professional, therapeutic relationships and the application of psychotherapy theories and best practices
Changes a client’s attitudes, feelings, beliefs, defenses, personality, and behavior
Individual, family, couple, group therapy
Play, cognitive, behavioral therapy
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22. Community-Based Mental Health Care Initiatives
Americans understand that mental health is essential to overall health.
Mental health care is consumer and family driven.
Disparities in mental health services are eliminated.
Early mental health screening, assessment, and referral to services are common practice.
Excellent mental health care is delivered, and research is accelerated.
Technology is used to access mental health care and information.
– New Freedom Commission on Mental Health (2003)
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23. Multidimensional Roles of the Community Mental Health Nurse
Court representative
Educator
Researcher
Collaborator
Consultant
Case manager
Content expert
Administrator
Activist
Politician
Advocate
Initiator
Evaluator
Grant writer
Practitioner
Coordinator
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24. Multidisciplinary Roles
Educator and advocate
Improves public awareness of effective treatments and existing community resources
Dispels myths
Provides accurate information
Influences policy and legislation
Advocates for clients
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25. Multidisciplinary Roles (Cont.)
Practitioner and coordinator
Provides direct care, helps consumer “navigate” within web of agencies and providers
Takes action to solve an immediate problem
Plans and intervenes to ensure safety, continuity, and quality of care
Anticipates and evaluates actions of other providers
Communicates with consumers, families, rehabilitation services, and government or social agencies
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