Community Mental Health Nursing/ Community-Based Psychiatric Nursing Care

A. Historical Development 1808 The County Asylums Act 1808 build asylums, paid for by local rates, to replace the psychiatric annexes of general hospitals. 1900- Adolf Mayers: mental health clinics in the community 1908- Clifford Beers (schizophrenic): “A Mind That Found Itself” Advocated better treatment for mentally ill 1923 The Tavistock Clinic was founded as a centre for psychotherapeutic training and treatment. 1949- Nat’l Institute of Mental Health: Made use of Community Health Approach 1954 The first outpatient nurses were appointed at Warlingham Park Hospital, Croydon. 1961- Mental Retardation Facilities and Comprehensive Mental Health Centers Construction Act. 1975- Community Mental Health Centers Act: Required centers to offer services for people with serious mental illness who had been discharged 1981 The DOH published a consultation document entitled Care in the community 1995 The Mental Health Bill proposed new powers regarding the aftercare of people discharged from hospital. 1996 The Mental Health (Patients in the Community) Act 1995 came into force

This is a process of releasing psychiatric pts from psychiatric hospitals to isolated community mental health services. This reduces the population size of mental institutions and removes institutional processes from mental hospitals that may create dependency and hopelessness and other maladaptive behaviors C. Community Mental Health Care Models 1. A systems model of care: Developing a comprehensive Holistic care to people’s needs 2. Case Management: Ensuring care is available to people with chronic mental problem; Problem solving is its focus; 3. Client-centered approach: Recognize clients’ right for mental health information; Client collaborates with care provider in planning 4. Capitation and managed care model Prospective payment system: For reimbursing hospitals for inpatient services in which a predetermined rate is set for treatment; or Capitation: annual fee paid to a physician or group of physicians by a pt (once only C. COMMUNITY-BASED OUTPATIENT PROGRAMS

PROGRAMS: Improve selfesteem and social skills, promote independence, prevent isolation, and decrease hospitalization 2. ASSERTIVE COMMUNITY TREATMENT (ACT): Organize outpatient services for pts leaving hospitals but at risk for re-hospitalization.

B. Deinstitutionalization:

Services are delivered in client’s environment 3. MULTISYSTEMIC THERAPY (MST): Address multiple related needs of youths with behavioral and emotional problems and their families 4. MOBILE OUTREACH UNITS: Access to mental health care to those who do not seek mental health services 5. HOME PSYCHIATRIC NURSING CARE: Provide direct psychiatric care through home care agencies MENTAL HEALTH PROMOTION AND MENTAL ILLNESS PREVENTION Lower incidence of mental disorders; help people avoid stressors or cope with them more adaptively and to change so they no longer cause stress. MODELS 1. PUBLIC HEALTH PREVENTION MODEL: Focuses on amount of mental health illness for the entire population; HC should know Community needs assessment (technique) 2. MEDICAL PREVENTION MODEL: Its focus is biological and brain research to discover specific causes of mental illness; It identifies the disease for a plan of intervention and its cause 3. NURSING PREVENTION MODEL: Its focus are the risk factors, protective factors, vulnerability and human responses in the belief that mental disorders are multi-causal

It reduces effects of mental illness by screening, Crisis intervention, Short-term counseling CRISIS: disturbance caused by stressful events Phase 1: Anxiety activates the person’s usual mode of coping Phase 2: Increasing anxiety due to failed coping Phase 3: New coping mechanisms are tried or the threat is redefined so that old ones can work, resolution occurs Phase 4: Psychological disorganization Types of Crises 1. Maturational CrisisDevelop by events requiring role changes; If one has positive role models and has Interpersonal resources = early adjustment to new role 2. Situational Crisis- Life event upsets an individual’s or group’s psychological equilibrium; its occurrence: accidental, uncommon, unexpected Crisis Intervention: Brief, focused and time-limited strategy with catharsis, clarification, suggestion, reinforcement of behavior and exploration of solution F. TERTIARY PREVENTION Reduce severity of mental disorder; address specific functional deficits; reduce handicap, vocational training, and aftercare support, learn problem solving and interpersonal skills, provide recreation and socialization G. HOME PSYCHIATRIC NURSING CARE This has grown due to continued trend of deinstitutionalization,



growth of managed care and advocacy; It reinforces care provided by SO; and maintains the recipient’s dignity and independence; alternative to hospitalization for the purpose of evaluating a specific issue Context 1. Cultural Competence: Ethnic and cultural background awareness and understanding of the nurse’s cultural background and prejudices 2. Boundary Issues: Sharing in the rituals: foster trust, if pt is religious, one should respect it 3. Trust: Established in the initial home visit; without it, rapport is not established 4. Safety: Assessment of pt and nurse safety in environment Goals: Reduce the need for hospitalization, promote adjustment to community, and provide education to clients and families

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