Mental Health Care in the Community

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Mental Health Care in the Community

• Chapter 5

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Continuum of Care

• Ongoing clinical treatment and care matched with
  intensity of professional health services
• Care provided over time
• Facilitates stability, continuity and
  comprehensive services
• Achieve the highest level of functioning possible
  within the context of the illness and in the
  least restrictive environment

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Coordination of Care

• Integration of appropriate services
• Services tailored to clients strengths and
  limitations
• No duplication of services
• Collaboration among services
• Case management, often by a nurse

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Generalist Case Management Services

• Brokerage service
• Does not necessarily provide the needed services
• Links the individual with the services
• Patients are usually outpatients with high-level
  service use.
• Staff-to-patient ratio is about 130.

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Case Management Services

• Therapeutic tool in providing clinical services
  or as a brokerage system for coordinating care
• Goal To act as a patient advocate by increasing
  access through coordinated efforts

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Nurse as a Case Manager

• Community knowledge necessary
• Special training in psychopharmacology, therapies
  and psychosocial rehabilitation
• Skills needed include
• collaboration
• teaching
• management
• leadership
• group
• research

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Components of CareInpatient Care

• Crisis Interventions
• Acute Inpatient Care
• Partial Hospitalization
• Residential Services
• Respite Residential Care
• In-home Mental Health Care
• Outpatient Care

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Other Services

• Outpatient Detoxification
• In-home Detoxification
• Assertive Community Treatment
• Psychiatric Rehabilitation
• Clubhouse Model
• Relapse Prevention
• Alternative Housing Arrangements
• Board-and-care homes

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Assertive Community Treatment

• Interdisciplinary team approach that provides a
  comprehensive range of treatment, rehabilitation
  and supportive services
• Goal To reduce recurrences of hospitalization
• Core elements include
• interdisciplinary team responsible for a small
  group of patients (110)
• assertive outreach treatment to patients ADLs,
  grocery shopping, etc.
• treatment plan of care
• ongoing treatment and support

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Alternative Housing Arrangements

• Personal Care Homes
• Board-and-care Homes
• Therapeutic Foster Care
• Supervised Apartments
• Clubhouse Models
• Relapse Prevention After-care Programs

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Managed Care

• Efforts to coordinate patient care efficiently
  and cost-effectively
• Goals To increase access to care and provide the
  most appropriate level of services in the least
  restrictive environment
• Typical services provided
• utilization management
• care management
• employee assistance program

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Managed Care

• Public and private collaboration
• Role of nurse
• Maximize time with patient.
• Focus on teaching social skills and prevention of
  relapse.
• Teach self-reliance, and create empowering
  environments.
• Provide crisis intervention and case management.

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Psychiatric Rehabilitation

• Reintegration of persons with mental illnesses
  into the community
• Focus on increased functioning of persons with
  mental illness
• Structured program emphasizes acquiring skills
  such as communication or vocation skills.

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Psychiatric RehabilitationRole of Nurse

• Adapt to the changing needs of persons with
  mental illness.
• Match the symptoms with an accurate diagnosis,
  and engage the patient in an appropriate trial of
  medication.
• Monitor target symptoms.
• Assess and educate on compliance issues, lab
  work, environment and lifestyle.

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Discharge Planning

• Begins when an individual enters the setting
• All activities recorded
• Discharge Checklist
• Text Box 5.2