Japanese expert public health nurses empower clients with schizophrenia living in the community

1. Home visiting psychiatric public health nurses are integral to expanding community-based mental health services for Japanese citizens living with schizophrenia and other mental illnesses. 2. Interviews with experienced psychiatric public health nurses revealed empowerment as the basic social process that guides their practice. Five empowering practice domains foster client autonomy. 3. Psychiatric public health nurses work with families, neighbors, educators, and employers to enable their clients' healthy living in the community.     

Predicting program success for adult offenders with serious mental illness in a court ordered diversion program

ABSTRACT

Individuals with mental illnesses are disproportionately involved with the criminal justice system and are now being diverted from jails to community-based supervision. This study examines secondary data from a state hospital, mental health diversion program. Logistic regression was used to examine risk factors that best predicted successful program completion. Results indicate that non-whites are more likely to complete. Participants in supervised housing, ever been re-hospitalized, diagnosed with a depressive or psychotic disorder or who had their probation revoked were less likely to complete. Findings indicate practitioners should provide a holistic and individually oriented treatment approach for success.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

Cognitive therapy: a training model for advanced practice nurses

1. Mental health needs exist in medically underserved areas and can be addressed in nurse-managed, community-based health centers. 2. Cognitive therapy techniques can be used in community-based health centers to intervene and alleviate patients' distress and improve their adherence to treatment. 3. A training program in cognitive therapy can help advanced practice nurses and other health care providers implement the techniques needed to address many behavioral and mental health problems.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

The Mark of Madness

Abstract

Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Helping parents with mental illnesses and their children: a call for family-focused mental health care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.     

The Role of a Psychiatric Pharmacist in College Health

Abstract

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

Nursing care partnerships with women leaving jail. Effects on health and crime

Crime is a significant and complex social issue with profound health consequences for individuals, families, and communities. Conceptualizing criminal behaviors as health behaviors reflects the potential for innovative interdisciplinary approaches and alliances to interrupt cycles of crime as a way to improve health. Incarcerated populations have extremely high rates of undiagnosed and undertreated infectious diseases and mental illnesses. Nursing is uniquely positioned to develop prevention, intervention, and treatment strategies for individuals involved in criminal activities before, during, and after incarceration.     

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.     

Integrating creative art into a community-based mental health program for Asian American transition age youth

This paper advocates for the use of creative art as an adjunct in the delivery of mental health care for Asian American transition age youth in the United States. A case study of a participant in a community-based mental health program called Project FOCUS in Orange County, California details how art was used to assist a young woman to identify and achieve her personal goals, mitigate her emotional and behavioral problems, and reach a sense of overall well-being. The findings in this paper lay the groundwork for future research into how art can be systematically incorporated into community-based mental health programs to facilitate service utilization. Further, this study demonstrates that Asian American transition age youth face mental health challenges typical of their cohorts, despite being putative members of a “model minority.” The use of creative art transcends cultural and language barriers, and empowers Asian American transition age youth to explore their identity and express their emotions, which ultimately promotes their mental well-being.     

Teaching Note—Oppression of People With Mental Illnesses: Incorporating Content Into Multiple-Issue Diversity Courses

Many social workers practice in settings serving people with mental illnesses, but social work education in the United States has given minimal attention to helping students understand the systemic nature of prejudice and discrimination experienced by this population. Some courses address prejudice (stigma) toward people with mental illnesses, but a critical consideration of systemic oppression appears to be lacking. We explain how an oppression framework used to understand the systemic nature of racism, sexism, and other forms of oppression is useful in illuminating experiences related to (perceived) mental health status. We offer suggestions for incorporating content into courses that focus on diversity and oppression with the goal of preparing students to engage in antioppressive practice with people who have mental illnesses.     

Balanced on the Horns of a Dilemma: Observations on Work with Chronic Depression

There are patients who present in treatment with depression that is chronic and unmoving over many years. This article proposes that this type of patient is attached to and defensively uses the symptom in a way that may be described as narcissistic. The amelioration of the symptom is experienced as a threatened loss that must be defended against, despite the patient's unbearable suffering. This dynamic is illustrated as it appeared in three cases treated at a community-based mental health clinic. In each, modification of the symptom was aggressively resisted, creating an insurmountable impasse in the guise of seeking treatment.     

Using a NIATx based local learning collaborative for performance improvement

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.