Community mental health nursing Homeless; mental
health system/serious mental illness
Monday, January 25, 2021 12:42 AM
• Objectives
○ Discuss the changing focus of care in mental health with concepts of
case management in community mental health nursing
○ Discuss the role of the staff psychiatric nurse and the advanced practice
psychiatric nurse
○ Discuss primary, secondary, and tertiary prevention of mental illness in
the community and the role nursing plays in prevention
○ Identify treatment alternatives for care for seriously mentally ill and
homeless mentally ill within the community
• Stigma and challenges in accessing/navigating care system
○ Stigma - the perception that someone is flawed, one of the many
changles of people livuing with MI are faced with
○ How to seek care?
○ Hidden/embarrassment
○ Anosognosia - inability to recognize illness due to the illness itself
§ Nonadherence - trigger likelihood of relapse (quadrouples
liklihood)
○ Motivation/anergia
○ Somatic confusion
○ Treatment inadequacy (inadequately funded services, inadequate
housing, excessive institutionalization)/medication side effects
(involuntary movements, increased RF diabetes) /residual symptom
(those that don’t improve completely over time or with treatment due
to waxes and wanes - pt often feels they will never get better or that tx
isnt working)
§ Discussing SE is important to promote adherence and maximize
QOL
• Deinstitutionalization
○ Led to 90% reduction in the amount of mentally ill people
institutionalized in mentally ill hospitals between the early 1960s and
mids 1980s
, mids 1980s
○ Also lead to many more severrely ill people needing care in the
community which overwhelmed local services and left patients without
adequate care
§ In turn, led to increased amount of homelessness and
incarceration
• Continuum of care
○ Primary care - first choice for most people when they are sick; but
what about psychiatric symptoms?
§ Seeking help for psychiatric problems from PCP is common
○ Specialized psychiatric care providers
□ Have specialized background and experience in care for
psychiatric problems and mental health
§ Psychiatrist
□ Meds
§ Psychiatric-mental health advanced practice nurses
□ NP/CNS - some do meds
§ Psychologists
§ Social workers
§ Counselors
§ Occupational / recreational / art / music / dance therapists
§ Mental health technicians
○ Patient centered medical homes and community mental health centers
§ Developed due to fragmented care that result in services never
being delivered while others are duplicated
§ Focus of care is pt centered and provides access to physical
health, behavioral health, and supportive community and social
services
§ Pts are provided with a range of support for preventative care,
acute care, chronic disease management, and end of life issues
§ Community mental health centers - provide more emergency,
home, services
○ Coordinate care - psychiatric case managers
○ Extended hours/services
○ Emergency services/ outpatient services
○ Psychiatric home care
§ Must be homebound (inability to leave home independently due
to physical or mental conditions)
§ Community based treatment modality
health system/serious mental illness
Monday, January 25, 2021 12:42 AM
• Objectives
○ Discuss the changing focus of care in mental health with concepts of
case management in community mental health nursing
○ Discuss the role of the staff psychiatric nurse and the advanced practice
psychiatric nurse
○ Discuss primary, secondary, and tertiary prevention of mental illness in
the community and the role nursing plays in prevention
○ Identify treatment alternatives for care for seriously mentally ill and
homeless mentally ill within the community
• Stigma and challenges in accessing/navigating care system
○ Stigma - the perception that someone is flawed, one of the many
changles of people livuing with MI are faced with
○ How to seek care?
○ Hidden/embarrassment
○ Anosognosia - inability to recognize illness due to the illness itself
§ Nonadherence - trigger likelihood of relapse (quadrouples
liklihood)
○ Motivation/anergia
○ Somatic confusion
○ Treatment inadequacy (inadequately funded services, inadequate
housing, excessive institutionalization)/medication side effects
(involuntary movements, increased RF diabetes) /residual symptom
(those that don’t improve completely over time or with treatment due
to waxes and wanes - pt often feels they will never get better or that tx
isnt working)
§ Discussing SE is important to promote adherence and maximize
QOL
• Deinstitutionalization
○ Led to 90% reduction in the amount of mentally ill people
institutionalized in mentally ill hospitals between the early 1960s and
mids 1980s
, mids 1980s
○ Also lead to many more severrely ill people needing care in the
community which overwhelmed local services and left patients without
adequate care
§ In turn, led to increased amount of homelessness and
incarceration
• Continuum of care
○ Primary care - first choice for most people when they are sick; but
what about psychiatric symptoms?
§ Seeking help for psychiatric problems from PCP is common
○ Specialized psychiatric care providers
□ Have specialized background and experience in care for
psychiatric problems and mental health
§ Psychiatrist
□ Meds
§ Psychiatric-mental health advanced practice nurses
□ NP/CNS - some do meds
§ Psychologists
§ Social workers
§ Counselors
§ Occupational / recreational / art / music / dance therapists
§ Mental health technicians
○ Patient centered medical homes and community mental health centers
§ Developed due to fragmented care that result in services never
being delivered while others are duplicated
§ Focus of care is pt centered and provides access to physical
health, behavioral health, and supportive community and social
services
§ Pts are provided with a range of support for preventative care,
acute care, chronic disease management, and end of life issues
§ Community mental health centers - provide more emergency,
home, services
○ Coordinate care - psychiatric case managers
○ Extended hours/services
○ Emergency services/ outpatient services
○ Psychiatric home care
§ Must be homebound (inability to leave home independently due
to physical or mental conditions)
§ Community based treatment modality
