Challenges in Mental Health Nursing

1. Challenges in
Mental Health (Psychiatric) Care
Dr. Riaz.K.M. MSc (N), PhD.
Assistant Professor, Govt. College of
Nursing, Thrissur, Kerala
riazmarakkar@gmail.com

2. Objectives
• Describe misconception as a challenge in mental health
• Explain scope and challenges in mental health
• Lists the priorities of the Helsinki Declaration
• Lists the challenges on Roles and Responsibilities
• Explain Challenges in Providing Care within Psychiatric
Wards for Improving Psychiatric Care
• Explain the challenges related to Role of mental health
nurses and Lack of clinical guidelines
• Explain the challenges in Creating international network of
mental health nurses, Recovery-Focused care and Values-
based education

3. Why this topic
• Challenge
+
• Control for future Change in MH
+
• Commitment

4. Challenge
Noun
• A call to someone to
participate in a
competitive situation or
fight to decide who is
superior in terms of ability
or strength.
• A call to prove or justify
something
Verb
• Dispute the truth or
validity of.
• Invite (someone) to
engage in a contest

5. Control
• The power to influence
or direct people's
behaviour or the course
of events
• Determine the
behaviour or supervise
the running of
Commitment
• The state or quality of
being dedicated to a
cause, activity, etc
• A willingness to give your​ ​ ​
time and energy to​
something that you ​
believe in, or a promise or​ ​
firm decision to do​
something

6. “Future nursing” – challenge?
• “Transformational nursing”,
• “Translational nursing”,
• “Interdisciplinary nursing”,
• “Multidisciplinary nursing”,
• “Multileveled nursing,”
• “Integrative nursing”,

7. Priorities of the Helsinki Declaration
(1964 & 2013)
1. Foster awareness of the importance of mental well-
being
2. Collectively tackle stigma, discrimination and
inequality
3. support people with mental health problems and
their families to be actively engaged in treatment
process
4. Design and implement comprehensive, integrated and
efficient mental health systems (promotion,
prevention, treatment and rehabilitation)
5. Address the need for a competent workforce,
effective in all settings and areas

8. A former student’s view
• Mr X, 29, studied mental health nursing. He now works in an
adult acute admission ward
• “Throughout my studies and career so far it has been clear
there are still many misconceptions of mental health nursing
and patients - the expectation of violence as a daily feature of
my job is still, without a doubt, a strong one.
• In my spare time I practice kung fu and during one training
session received a black eye; I was surprised by how many
people assumed I’d received the injury at work.

9. • “I think the most powerful tool we have in
changing these misconceptions is challenging
stigma as it arises. Advertising campaigns are all
very well, but it’s in conversation with the
general public that, as professionals, we can
address these misconceptions and negative
stereotypes.”

10. Scope/Challenge
• Misconceptions (both the public and fellow nursing
professionals) - fuel for stigma and discrimination
• The mental health nursing profession- subject of many
misconceptions
• The mental health nursing profession - “brand”
• The responsibility for challenging misconceptions lies with
each member of the mental health nursing community

11. Scope/Challenge
• Shift of practice from mental illness to mental health,
leaving a vacuum in the care of serious mental illness.
• Deinstitutionalization of mental illness care, with
emptying out or closure of many public mental
hospitals.
• Limited access to urgent psychiatric care
• Marked decline in hospital stays for patients with
psychiatric disorders.

12. Scope/Challenge
• Inadequate reimbursement for time-consuming “talk
therapy” without compensatory procedural
reimbursement.
• Lack of parity of coverage for physical and mental
illness.
• Rapid decline of psychotherapy and shift toward
drug therapy and “med checks” practice.

13. Scope/Challenge
• Expansion of criteria for psychiatric disorders in
subsequent Diagnostic and Statistical Manual of
Mental Disorders editions.
• Growth of various mental health professions in
practices not supervised by psychiatrists.
• Criminalization of the seriously mentally ill, with
misuse of jails as mental hospitals.

14. Scope/Challenge
• Income inequality and class differences have reached
historic highs in recent years- lack of health
insurance
• we can no longer afford the waste, duplication, and
profits of private payers.
• Public payers are more efficient, provide more value,
and control costs better than private payers
• a larger role of government and public financing of
health care
• Progress of single-payer initiatives

15. Scope/Challenge
• Broadening scope and the shift to community
based mental health services introduce greater
levels of complexity, affecting the role
• Planning and management will take a more
central place, and accountability is likely to
become more transparent.

16. Challenges in
• Community characteristics
– MH configuration
– Prevalence of disorders
– Demand of services
– Demographics
• Institutional characteristics
– Ownership
– Facility type
– Organization of services
– Size and occupancy
– Staff patient ratio
– Source of payment
• Provider characteristics
– Demographics
– Specialty training
– Method of payment
• Patient characteristics
– Demographics
– Insurance coverage
– Risk factors
– Protective factors

17. Challenges in
• Entry status
• Clinical
• Legal
• Diagnostic evaluation
• Diagnosis
• Severity
• co morbidity
• Treatment approach
• style of treatment
• intensity
• frequency
• appropriateness
• Treatment response
• Compliance
• Change in symptoms
• Medication effect
• complication
• Disposition
• Clinical
• Legal
• Follow up / Placement

18. Challenges in
• Specific outcomes
– Clinical
– Functioning
– Mortality
– Quality of life
– Societal costs

22. Challenges on
Roles and Responsibilities
1. Therapeutic role
2. Membership of multi-
disciplinary team
3. Functioning in diverse
roles and settings
4. Broadening societal
scope of psychiatric
nursing
5. Partnership working
6. Leadership
7. Information systems
8. Research
9. Competence
10. Career development
11. Status and funding
12. Legislation
13. Stigma

23. Challenges in Providing Care within
Psychiatric Wards
• Politics and Rules of Organization,
• Safety and Security Issues,
• Uncertainty about the Role,
• Lack of Trained Staff,
• Socio cultural Issues,
• Limited resources,
• Complexities in role,
• Pre- licensure, post-licensure challenges,
• Professional obstacles,
• Public perception

24. Challenges in
Improving Psychiatric Care
• Empowerment across
– Psychiatric Nurses,
– Mentally Ill Patients and their Families,
– The Psychiatric Mental Health System, and
– the Cultural Context.

25. Challenges in
Role of mental health nurses

26. Challenges in
Role of mental health nurses
• Assessment
• Care planning
• Drug administering (Even Prescribing)
• Advocacy
• Case management
• Community care
• Psycho education
• Psychotherapy

27. Challenges towards de
institutionalization
• Reallocation of staff from hospital to
community based services
• Development of new set of competencies is
needed

28. Challenges related to
Lack of clinical guidelines
• Absence of national guidelines for mental
health nurses
• Lack of evidence based practice
• Lack of research
• Activity of professional bodies

29. Challenges in
Creating international network
• A lack of core indicators leads to invisibility and
marginalization of people affected by mental disorders
• Mental illness is not perceived as amenable to quick solutions
• Human resource planning
• Integration of mental health into the social development
sector
• Avoiding a narrow focus on psychosocial issues
• Access to mental health interventions

30. Challenges in Recovery-Focused care
• Recovery-focused care gives professionals an insight
into service users’ needs
• Involving family members in care and discussing how
mental illness affects all areas of a person’s life can
help to build trust
• A lack of time is often cited as a reason for nurses
not focusing on recovery
• Nurses can provide person-centred care by involving
service users in making decisions about their care

31. Challenges in Values-based education
• Acknowledging and respecting values is important
for building relationships between staff and patients
• Training to improve values-based practice has been
developed in Scotland
• Providing training outside a clinical environment
helps reduce distractions
• Group discussion helps increase awareness
• Evidence on how mental health nurses are applying
values-based care should be collected

32. Challenge in mental health
HEALTH INSURANCE
• MULTI PAYER V/S SINGLE PAYER

33. • SINGLE PAYER
• poor coverage
• Cost containment
difficult
• Cost sharing high
• No choice for doctor
and hospital
• Poor quality of care
possible
• Sustainable
• MULTIPAYER
• Good coverage
• Cost containment easy
• Cost haring low
• Free choice to select
doctor and hospital
• High quality of care
• Not sustinable

34. Challenges in Future Measurement Criteria
• Utilizes ethical principles to create a system of
advocacy for access and parity for mental health
problems, psychiatric disorders, and addiction
services.
• Influences health policy to reduce the impact of
stigma on services for prevention and treatment of
mental health problems and psychiatric disorders.
• Works to influence decision-making bodies to improve
patient care
• Provides direction to enhance the effectiveness of the
healthcare team

35. Challenges in Future Measurement Criteria
• Provides direction to enhance the effectiveness of the
healthcare team
• Initiates and revises protocols or guidelines to reflect
evidence-based practice, to reflect accepted changes in care
management, or to address emerging problems.
• Promotes communication of information and advancement of
the profession through writing, publishing, and presentations
• Designs innovations to effect change in practice and improve
health outcomes.

36. “online disinhibition effect”
• excessive Internet use may be correlated with social
anxiety, depression, and introversion
• Examinations of Facebook pages
– detailed, publically accessible postings describing depressive
symptomatology and ongoing patterns of substance abuse
STUDY among aged between 10-17 found that the 5% of subjects
who reported symptoms of major depression spent more time
online and were more likely to post identifiable information (if
they were male) and pictures (if they were female)

37. “online disinhibition effect”
• Disclosure of patient-related information is often problematic
• health professionals “behaving badly” may call their clinical
judgment into question, raising doubts in patients' minds
about the quality of the treatment they will receive.
• Unreflective and excessive self-disclosure by nurses, especially
when they are engaged in psychotherapy, is another concern
inherent in their use of social media.- “black state”
• breakdown of boundaries in the nurse-patient relationship

38. “online disinhibition effect”
• groups of health professionals with similar interests;
share resources with colleagues (e.g., the SlideShare
website, which allows users to upload and share
Powerpoint presentations and other educational
materials)

39. “online disinhibition effect”
• “Twenty-first century
psychiatric nurse should be able
to be a cautious but vigorous
participant in the social media
revolution”

40. The giant ship engine that failed?
• The ship’s owners tried one expert after another, but
none of them could figure but how to fix the engine.
Then they brought in an old man who had been
fixing ships since he was a youngster. He carried a
large bag of tools with him, and when he arrived, he
immediately went to work. He inspected the engine
very carefully, top to bottom.

41. The giant ship engine that failed?
• Two of the ship’s owners were there, watching this
man, hoping he would know what to do. After
looking things over, the old man reached into his bag
and pulled out a small hammer. He gently tapped
something. Instantly, the engine lurched into life. He
carefully put his hammer away. The engine was fixed

42. The giant ship engine that failed?
• A week later, the owners received a bill from the old
man for ten thousand dollars.“What?!” the owners
exclaimed. “He hardly did anything!”
• So they wrote the old man a note saying, “Please
send us an itemized bill.”

43. • The man sent a bill that read:
• Tapping with a hammer …………………
$ 2.00
• Knowing where to tap ……………………….
$ 9998.00
• Effort is important, but knowing
where to make an effort in your life
makes all the difference.

44. Take home message
• Misconception is a major challenge in mental health
even today.
• Priorities set in Helsinki Declaration are still remains
• Future Roles and Responsibilities are challenge in
psychiatric wards
• There is a Lack of clinical guidelines in mental health
• International network among mental health nurses is a
challenge
• Recovery-Focused care and Values-based education
will helps to overcome challenge in mental health