What About Mental Health

Care?
By: Hillary Colbry

a hopeful BSN

All of These Objectives to Learn
 Identify the problems in caring for mental
health patients
 Become aware of why is matters to healthcare
and nursing practice
 Identify relatable nursing theories for the
problem
 Identify current healthcare policies, resources,
and quality and safety issues
 Identify the potential solutions nurses can do to
help the resolve the issue

Introduction
 1 in 4 people experience mental ill at some
point
in their lifetime

 Comorbid disease processes between mental
and physical health
 ↑ Risk for obesity and metabolic syndrome

(Stanley,

2011)

 Average time to treatment
Females: 208 days

(Schimmele, 2009)

Males: 203 days

Why the health care system is NOT
working for people with mental
illness
 There are NO WELL PRACTICED STANDARDS for diagnosis or history
mental health
 Mental hospital beds not always available
 Difficulty accessing and remaining in
care

Why does it matter to nurses?

 Mental Illness can present itself in any area of nursing care
 Mental Illness continues to not be accepted in the general
population despite its popularity among the human race
 Existence in the workplace-Coworkers
 We CAN help

Health Care Environment: Policies
(Garfield, 2010)

 Patient Protection and Affordability Care Act (PPACA):
 More people will be eligible for Insurance Now mandated coveragepenalties for employers
Ratio for coverage with
behavior: medical has to be EQUAL
 Private Insurance Companies &
Medicare/Medicaid
Differs greatly

Health Care Environment Resources
 Resources
 Care managers
 Mental Health Services Block Grant
 Pine Rest

Health Care Environment:
Quality & Safety Issues

(Bailey, 2014)

 Quality Issues
 Discrimination from healthcare workers
 Those receiving treatment for common mental disorders:
24%
 Safety Issues
 Life expectancy with severe mental illness
 Average 20 years less for men
 Average 15 years less for women

Inferences and
Implications/Consequences
 What do we need?
 Education
 Standards
 People with a mental illness are two and a half times more likely to die
from ALL MAIN CAUSES OF DEATH when compared to the general
population (Stanley, 2011)

Root Cause Analysis

Educatio
n
Social
Awareness &
Understandi
ng

History &
Stigma

Social
Instability

Standard
s of Care
Poor
Mental
Health

Theory Base: Interdisciplinary Care
 Abraham Maslow’s
Basic Human Needs
(Maltese)

 Focus: Factors in assisting
mental health rather than
factors assisting to mental
illness.
 Purpose : To bring
individuals to selfactualization = welcoming
of uncertainty, inner
directed, caring etc.

Theory: Nursing Care
 Roper-Logan-Tierney Model for Nursing

(Nursing, 2013)

 Base: Holistic, Activities of daily living (ADL’s), what living means to the
patient
 Purpose: Identify how patient has changed due to illness, injury, or
admission
 Identify: 5 aspects that influence ADL’s
Biological, Psychological, Sociocultural, Environmental, and
Politicoeconomic
 Action: Nurse determines interventions to ↑ independence and any
support to ↑ meaning of living

Recommendations
 Critical time intervention (CTI) (Tomita, 2015)
 First 9 months is crucial
 Referral to standard community based services, outpatient psychiatric
treatment, Social services(CTI worker)—From hospital discharge
 3 Phases
1. Identify support networks
2. Direct assistance to support networks
3. Termination of intervention

Recommendations: Nurses

(Happell, 2014)

 Reducing use of antipsychotic meds
 Encouraging healthier lifestyle
 Screening for physical health problems
 Coordinating physical health services between primary and mental health
care
 Engaging consumers is physical healthcare mgmt.
 Linking together a range of services for the consumer
 Increasing public awareness of the physical ill-health of consumers

ANA Standards

(American, 2010)

 Standard 1: Assessment
 Standard 5D: Prescriptive Authority and Treatment
 Standard 13: Collaboration

References
 American Nurses Association. (2010). Nursing: Scope and standards of practice, 2nd Ed. Silver Spring, MD.
 Bailey, D. S., & Smith, G. (2014). Why 'parity of esteem' for mental health is every hospital doctor's concern. British Journal Of Hospital Medicine (17508460), 75(5), 277-280.
doi:10.12968/hmed.2014.75.5.277
 Garfield, R., Lave, J., & Donohue, J. (2010). Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services, 61(11), 10811086. doi:10.1176/appi.ps.61.11.1081
 Giandinoto, J., & Edward, K. (2014). Challenges in acute care of people with co-morbid mental illness. British Journal Of Nursing, 23(13), 728-732.
doi:10.12968/bjon.2014.23.13.728
 Happell, B., Platania-Phung, C., & Scott, D. (2014). Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental
health. Journal Of Clinical Nursing, 23(7/8), 1018-1029. doi:10.1111/jocn.12371
 Happell, B. (2010). Moving in circles: a brief history of reports and inquiries relating to mental health content in undergraduate nursing curricula. Nurse Education Today, 30(7), 643648.
doi:10.1016/j.nedt.2009.12.018
 Maltese, A. Theories for mental health practice. Los Angeles Valley College. Retrieved from
https://www.lavc.edu/instructor/maltese_a/docs/ns110/5%20theories%20for
%20mental%20health.ppt
 Nursing Theory. (2013) Roper-Logan-Tierney model of living. Nursing Theory. Retrieved from http://
www.nursing-theory.org/theories-and-models/roper-model-for-nursing-based-on-a- model-of-living.php
 Smith, T. E., Easter, A., Pollock, M., Pope, L. G., & Wisdom, J. P. (2013). Disengagement from care: perspectives of individuals with serious mental illness and of service providers.
Psychiatric Services, 64(8), 770-775. doi:10.1176/appi.ps.201200394
 Stanley, S. H., & Laugharne, J. E. (2011). Clinical Guidelines for the Physical Care of Mental Health Consumers: A Comprehensive Assessment and Monitoring Package for Mental
Health and Primary Care Clinicians. Australian & New Zealand Journal Of Psychiatry, 45(10), 824-829. doi:10.3109/00048674.2011.614591
 Schimmele, C., Wu, Z., & Penning, M. (2009). Gender and remission of mental illness. Canadian Journal Of Public Health, 100(5), 353-356
 Tomita, A., & Herman, D. B. (2015). The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness after hospital discharge.
Journal Of Nervous & Mental Disease. 203(1), 65-70. doi:10.1097/NMD.0000000000000224