Chapter 20 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 20: 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 of 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

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 is 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 with 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 may
include the following:
– Oral and written reminders
– Self-monitoring tools
– Cues
– Positive reinforcements by both the nurse and the family

High-Risk Populations
• The unemployed, the poor, and the homeless all report
higher levels of depression, anxiety, schizophrenia, and
substance abuse than 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 leave care in large,
complex health care 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 psychopharmacological needs.

Mood and Anxiety Disorders
• Epidemiology
– Social factors
– Biological theories of depression and anxiety
• Populations at risk for suicide
• Nursing interventions for mood and anxiety disorders
– In clients with somatic and mood symptoms, nurses
must always directly inquire if the client has had any
thought of harming himself or herself.

Attention Deficit/Hyperactivity Disorders
and Emotional Disorders in Children
• The main characteristics that help health care
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
Is the following statement true or false?
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
communities about mental health can be effective in
lowering the incidence of high-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 post-traumatic stress
disorder.
• By the early 1960s, a scathing report by the Joint
Commission on Mental Health and Illness about
conditions in state-supported psychiatric hospitals
prompted the adoption of the Community Mental Health
Center .
• Aided by advances in the development of pharmacologic
treatment of the mentally ill, the numbers of patients
treated in state mental hospitals precipitously declined.

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.

Question
The continuum of care for the chronic mentally ill
includes community services, such as supportive housing
and employment.

Answer
True
Rationale: The continuum of care for the chronic 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

Chapter 20 ppt

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