harkness2e chap21 ppt

Copyright © 2016 Wolters Kluwer • All Rights Reserved

Chapter 21: Community

Mental Health

Chapter Highlights

• Epidemiology of mental illness from a public health

perspective

• Early intervention in the treatment of schizophrenia

• Strategies to enhance treatment adherence

• Public health implications for children with behavioral

disorders

• Evolution of community mental health

• Policy development and legislation for mental health

services

• Role and responsibilities of the community mental health

practitioner

Copyright © 2016 Wolters Kluwer • All Rights Reserved 2

Question

Is the following statement true or false?

Genetic, biological, and environmental risk

factors all influence the incidence of mental

illness.


Answer

True

Rationale: Genetic, biological, and

environmental risk factors all influence the

incidence of mental illness. Early

intervention can minimize the morbidity

associated with mental illness.


Cultural Context of Mental Illness

• Genetic, biological, and environmental risk

factors all influence the incidence of

mental illness.

• Mental health and, conversely, mental

illness are concepts bound by culture.

• Understanding of what connotes mental

health is shaped by social norms that

evolve from generation to generation.


Definitions of Mental Health

• No universally accepted definition of

mental health; for practical purposes,

widely accepted parameters for what

behaviors connote psychopathology must

be used to measure

• Incidence

• Morbidity

• Mortality


Scope of Mental Illness

• There is no difference in lifetime prevalence

rates of major mental illness between developed

and developing countries.

• The projected lifetime risk of developing a major

mental illness is highest in countries where the

population is subject to sustained violence.

• Psychiatric disorders are the leading cause of

disability worldwide.


Question


Rationale: Adherence to psychopharmacology

and psychotherapy does not enhance

recovery from mental illness.


Answer

False

Rationale: Adherence to psychopharmacology

and psychotherapy enhances recovery from

mental illness.


Schizophrenia

• Epidemiology

• Early intervention programs for first-

episode psychosis

• Primary prevention programs

• Enhancing treatment adherence in

schizophrenia

• Role of community mental health teams in

treatment of schizophrenia


Epidemiology of Schizophrenia

• About 1% of the world’s population suffers

from schizophrenia.

• Symptoms of schizophrenia typically first

appear in late adolescence or young

adulthood and persist throughout a

person’s life, causing significant

impairment in all aspects of a person’s

psychosocial functioning.


Early Intervention Programs for First-Episode Psychosis

• Early intervention programs—specialized

teams of professionals whose primary goal

is to maintain the individual’s current level

of educational and vocational functioning

through early treatment


Enhancing Treatment Adherence in Schizophrenia

• Nonadherence to medication is the most

common factor associated with relapse and

recurrence of psychotic symptoms.

• Nursing interventions to enhance

medication adherence applicable to those

with chronic mental illness


High-Risk Populations• The unemployed, the poor, and the

homeless all report higher levels of

depression, anxiety, schizophrenia, and

substance abuse than do the general

population.

• The number of mentally ill clients who are

homeless has steadily increased in the

United States as state governments

embarked on a systematic plan to

“deinstitutionalize” the mentally ill.


Deinstitutionalization

• The phenomenon of allowing patients to

leave care in large, complex healthcare

systems in order to receive care in

neighborhoods and communities on an

outpatient basis


Role of Community Mental Health Teams in Treatment of Schizophrenia

• Respite services, day treatment facilities, and

sheltered workshops are a few of the outpatient

services that help alleviate the daily burden of

care for families.

• To address these shortcomings in the delivery of

care, community mental health teams coordinate

both the psychosocial and the

psychopharmacological needs.


Mood and Anxiety Disorders

• Epidemiology

• Social factors

• Biological theories of depression and anxiety

• Nursing interventions


Attention-Deficit/Hyperactivity Disorders and Emotional Disorders in Children

The main characteristics that help healthcare

practitioners, including school nurses, differentiate

ADHD from bipolar disorder are the pervasiveness of

the symptoms and the predominant symptoms.


The Precipitous Rise in Autism—A Public Health Crisis

• Long-term outcomes of children with autism are

improved with early identification and

treatment.

• Screening tools for autism have been developed,

but most are for use in toddlers and not in

infants.

• Screening for prodromal symptoms in infancy;

some of the more debilitating features of the

disorder might be mitigated with early

intervention and treatment.


Question


Public health initiatives to educate

communities about mental health can be

effective in lowering the incidence of high-

risk behaviors such as alcoholism.


Answer

False

Rationale: Public health initiatives to educate



risk behaviors such as suicide.


Evolution of Community Mental Health

• Community-based treatment of the mentally ill gained

momentum as World War II veterans returned home

exhibiting the symptoms of posttraumatic stress disorder.

• Aided by advances in the development of pharmacologic

treatment of the mentally ill, the numbers of patients

treated in state mental hospitals precipitously declined.

• The continuum of care for the chronically mentally ill

includes community services, such as supportive housing

and employment.


Evolution of Community Mental Health (cont.)

• Since deinstitutionalization began, there

has been an outcry of frustration from

nurses in the community about the lack of

supportive services to meet the needs of

people with chronic mental illness.

• Public health initiatives to educate



risk behaviors such as suicide.


Question


The continuum of care for the chronically

mentally ill includes community services,

such as supportive housing and employment.


Answer

True

Rationale: The continuum of care for the

chronically mentally ill includes community

services, such as supportive housing and

employment.


Legislation for Parity in Mental Health Insurance Benefits

• All health insurance coverage, including

deductibles, copays, coinsurance, and out-

of-pocket expenses, as well as all

treatment limitations, including frequency

of treatment, number of visits, days of

coverage, or other similar limits, will be

the same regardless of health need or

diagnosis.


Role and Responsibilities of the Community Mental Health Practitioner• Teacher

• Clinician

• Advocate


Psychological First Aid

• Populations traumatized by disasters

• Populations at risk for psychological

trauma

• Psychological first aid is recommended to

help support survivors and first responders

to natural and intentional disasters.


harkness2e chap21 ppt

Education