1. Chapter 4 Settings for Psychiatric Care Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2.  1950s: Thorazine  1960s: Community Mental Health Centers Act— deinstitutionalization  1980s: Carter’s Commission on Mental Health— recommended more community-based care Social Influences on Psychiatric Care Settings 2 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3.  George W. Bush’s New Freedom Commission on Mental Health  2010—Affordable Care Act Social Influences (Cont.) 3 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4.  Primary prevention  Secondary prevention  Tertiary prevention Prevention Strategies 4 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5.  Primary care providers  Specialty psychiatric care providers  Patient-centered health/medical homes  Community clinics  Psychiatric home care  Assertive community treatment (ACT) Outpatient Psychiatric Mental Health Care 5 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6.  Partial hospitalization programs (PHPs)  Other outpatient venues for psychiatric care  Telephone crisis counseling  Telephone outreach  Internet  Telepsychiatry Outpatient Psychiatric Mental Health Care (Cont.) 6 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7.  Strong problem-solving and clinical skills  Cultural competence  Flexibility  Knowledge of community resources  Autonomy Psychiatric Nursing in Outpatient and Community Settings 7 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8.  Biopsychosocial assessment  Case management  Promoting continuation of treatment  Teamwork and collaboration Psychiatric Nursing in Outpatient and Community Settings (Cont.) 8 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9.  You are working with a patient who will be discharged into the community soon. What are some problems that may affect the success of treatment? Case Study 9 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10.  Comprehensive emergency service model  Hospital-based consultant model  Mobile crisis team model  Crisis stabilization/observation units Emergency Care and Crisis Stabilization 10 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11.  Admission reserved for individuals who are  Suicidal  Homicidal  Extremely disabled and in need of short-term acute care Inpatient Psychiatric Care 11 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12.  Admission options  Direct admission  Hospital emergency department  Criteria to justify admissions  Danger to self or others or  Unable to fulfill basic needs  Voluntary or involuntary Inpatient Psychiatric Care (Cont.) 12 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13.  Hospitalized patients retain their rights as citizens  Patient’s need for safety must be balanced against patient’s rights as a citizen  Mental health facilities have written statements of patient’s rights and applicable state laws Patients’ Rights 13 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14.  Members of each discipline are responsible for gathering data and participating in the planning of care  Treatment plan or clinical pathway provides a guideline for patient’s care during hospital stay Multidisciplinary Treatment Team 14 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15.  Surroundings and physical environment  Managing behavioral crises  Safety  Suicide risk Therapeutic Milieu 15 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16.  Admission assessment  Physical health assessment  Therapeutic groups  Documentation Nursing Care 16 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17.  Medication management  Medical emergencies  Preparation for discharge to community Nursing Care (Cont.) 17 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. 1.An occupational health nurse screens factory workers for depression. Which level of prevention is applicable to this activity? A. Primary B. Secondary C. Tertiary D. Not sure Audience Response Questions 18 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19. 2.A hospitalized client diagnosed with major depression tells the nurse, “I need my belt to keep my pants up. They keep falling down.” Which response should the nurse provide? A. “Your belt is locked in the business office for safekeeping, along with all your other valuables.” B. “For safety reasons, hospitalized clients are not allowed to keep certain personal possessions.” C. “I cannot provide your belt, but I will help you get some pants with an elastic waistband.” D. “I will ask the psychiatric technician to get your belt for you.” Audience Response Questions 19 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.