Evaluation and treatment of the mentally ill population has developed from confinement of the mad during colonial times, into the biomedical balancing of neurological impairment seen in these modern times. There were eras of mental health reform, medicalization, and deinstitutionalization sandwiched in between (Nies & McEwen, 2011). Regardless of the stage of understanding and development, communities have not been completely successful in dealing with and treating persons who are mentally unwell.
Fortunately, treatment has become more compassionate; social and professional attitudes have morphed into more humanistic and neuro-scientific approaches. Throughout the history of mental health management, the cause for most mental illnesses is still not well understood. National and Community Statistics and Comparisons It is estimated that more than 26% of the American adult population has a diagnosable mental disorder (“NIMH,” 2013).
In Louisiana, 25%, or more than 650,000 adults, have a diagnosable mental condition. In Ouachita parish, which is home for this student, an estimated 3,702 adults live with a severe psychiatric disorder, which includes schizophrenia, bipolar disorder, psychotic disorder and major depression. It is estimated that only one in three of those with psychiatric disorders receive appropriate treatment (“DHH,” 2005).
At the time of the most recent census, Ouachita parish had 142 people in halfway houses, 71 people in homes for the mentally retarded, 51 people in schools, hospitals or wards for the mentally retarded, 35 people in psychiatric hospitals, and 14 people in homes and halfway houses for drug and alcohol abuse (“City Data,” 2012). Federal and State Policies As part of his plan to eliminate inequality for disabled Americans, President Bush implemented the New Freedom Commission on Mental Health.
The Commission was directed to find avenues at the Federal, State, and local evels to utilize existing resources to effectively coordinate treatments and services for adults with mental illness and children with emotional disturbances. Subsequently, in 2003 a report from the Commission was published which delineated six goals. These goals were to assist Americans in understanding that mental health is essential in achieving overall health, to emphasize that mental health care is consumer and family driven, to eliminate disparities in mental health services, and to assure that mental health assessment, screening and referrals are common practice.
Goal five called for the delivery of excellent mental health care and the acceleration of related research. Goal number six directed that electronic technology be used to access mental health care and information. Other programs developed by the commission were related to suicide prevention, employment for people with mental illness, providing school-based centers for low income children, creating nurse-family partnerships for pregnant women, screening for mental illness in school children and providing collaborative treatment for late life depression (“NAMI,” n. . ). The New Freedom Commission called for an overhaul of mental health care and provided a platform for reform. This author has found evidence that the Freedom commission was effective. Many agencies used the Freedom Commission as a framework for advocacy efforts. The Substance Abuse Mental Health Services Administration (SAMHSA) along with 19 other federal agencies created the Federal Action Agenda as a first step in the reform process.
The Campaign for Mental Health Reform was comprised of 16 national mental health advocacy groups and issued a publication that has been called a roadmap for action for the American health crisis (Hunt & Osher, 2006). There is another federal piece of legislation that combines federal and state efforts to provide better care for the mentally ill, as well as other initiatives, and that is the controversial Patient Protection and Affordable Care Act (PPACA). The piece of this health reform act related to mental health stipulates that there be state laws mandating or regulating mental health benefits (“NCSL,” 2012).
This author has found no literature that indicates the effectiveness of the PPACA. Perhaps it is too early to determine the success or failure of the PPACA. At the state level, the Department of Health and Hospitals of the State of Louisiana (DHH) is the primary policy maker and provisionary for mental health care. The DHH sponsors a highly effective Office of Behavioral Health, which supports mental health programs and treatment facilities for Louisiana residents with mental disabilities.
The programs provide crisis intervention, psychosocial rehabilitation, and family support services, as well as 3 inpatient treatment facilities. Healthy People 2020 Objectives The Healthy People 2020 initiative is a government-sponsored program designed to use science-based, 10-year national objectives to improve the health of all Americans. Healthy People 2020 encourages collaboration across communities, empowers individuals to make informed health decisions, and measures the impact on health of these activities (“2020,” 2013).
The goals of 2020 related to mental illness are to improve mental health by assuring access to quality mental health services, to reduce the suicide rate, to increase the number of homeless persons who need and also receive mental health services, to reduce the number of adolescents who have eating disorders, to increase accessibility of treatment for children and adults with mental problems and to increase depression screening by primary care providers.
The Role of Nurses in Providing Care for the Mentally Ill Health care providers can assist the mentally ill patient in a multitude of ways. A nurse’s powers of perception can be invaluable when recognizing symptoms of depression and referring the patient to appropriate treatment. A community health nurse’s assistance during times of disaster is important not only during the initial response, but also in years to come in an effort to maintain support and vigilance for post traumatic stress disorder.
Nurses should be alert for patients who exhibit warning signs for suicidal tendencies and be ready to intervene on behalf of the vulnerable patient. An astute nurse will monitor patients who use psychopharmacological therapies for signs of therapeutic effectiveness, as well indications for the need for adjustments in therapy. During all of the community nurse’s assessment, planning and implementation processes, it is important that the nurse be mindful of cultural beliefs and be ready to interact within context of the patient’s culture (Nies & McEwen, 2011).
One of the goals of the community health nurse who assists in caring for persons with mental illness should be to establish a therapeutic nurse-patient relationship. In doing so, the nurse cultivates a climate of trust. The presence of this trust could be the difference between a patient succumbing to the overwhelming storm of mental illness versus surviving to become the best version of themselves.
January 9, 2018
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