1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 36 Mental Health Issues

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Describe the history of community mental health and make predictions about the future. 2. Discuss the prevalence of mental illness in the United States and the world. 3. Describe essential mental health services and corresponding national objectives for improving mental health. 4. Discuss the health status of the population that has mental illness in the United States.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 5. Evaluate standards, models, concepts, and research findings for use in community mental health nursing practice. 6. Describe the role of the community mental health nurse with individuals and with groups at risk for psychiatric mental health problems. 7. Apply the nursing process in community work with patients diagnosed with psychiatric disorders, families at risk for mental health problems, and vulnerable populations.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 8. Examine strategies to improve the mental health of people who are at risk in a complex society.

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Scope of Mental Illness in the United States Consumer Advocacy Neurobiology of Mental Illness

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Mental Disorders  Severe mental disorders  Mental disorders are indiscriminate  Leading cause of disability in North America  57.7 million adults in the United States suffer from a mental disorder  6% suffer from a serious mental illness, such as schizophrenia  13% of children and adolescents between 8 and 15 years of age have a diagnosable mental disorder.  Impact on overall health and productivity

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Consumer Advocacy  National Alliance for the Mentally Ill (NAMI)  Community Support Program (CSP)

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Neurobiology of Mental Illness  1990s: the “decade of the brain”  Great strides occurred through research in neurology, microbiology, and genetics that led to understanding the structural and chemical complexity of the brain.  Brain is not a static organ  Both somatic and psychosocial interventions need to be used to treat mental illnesses.  Neuroradiological techniques  Angiography, CAT scans, NMR, PET, SPECT  Discoveries in psychopharmacology  SSRIs

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Systems of Community Mental Health Care  Managed care  Community mental health model  Community mental health centers

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evolution of Community Mental Health Care Historical Perspectives Hospital Expansion, Institutionalization, and the Mental Hygiene Movement Federal Legislation for Mental Health Services

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Perspectives  In ancient times, mental illness was viewed as a result of supernatural forces and those afflicted were shunned.  In the Greco-Roman era, mental and physical illnesses were seen as interrelated and resulting from physical conditions.  Humanitarian reform occurred near the end of the nineteenth century.

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hospital Expansion, Institutionalization, and the Mental Hygiene Movement  Psychiatric hospitals became overcrowded with people who had severe mental disorders, with older adults, and with immigrants who were poor or unable to speak English.  Many patients were institutionalized for the rest of their lives.  Clifford Beers urged reform and influenced the founding of the National Committee for Mental Hygiene.

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Federal Legislation for Mental Health Services  Social Security Act  National Mental Health Act of 1946  Joint Commission on Mental Illness and Health established by NIMH in 1955  Community Mental Health Centers Act passed in 1964

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Deinstitutionalization  Civil Rights Legislation for Persons with Mental Disorders  Americans with Disabilities Act of 1990  Advocacy efforts

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Conceptual Frameworks for Community Mental Health  Systems theory  Levels of prevention  Assertive community treatment (ACT) programs  Intensive case management models

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Role of the Nurse  Clinician  Educator  Coordinator

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Current and Future Perspectives  Nationally and internationally, there are too few mental health care services.  Patient Protection and Affordable Health Care Act passed in 2010

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. National Objectives  Children and adolescents  Adults  Adults with Serious Mental Illness  Wellness recovery action plans  Older Adults  Cultural Diversity  African Americans  Hispanic Americans  Asian and Pacific Islander Americans  Native Americans