Continuum of Treatment

Acute psychiatric hospitalization for

a pt who is experiencing disruption in mental health and is in a mental health crisis

Mental health disruption

Difficulty to function in everyday actives bc of the way an individual thinks, feels, or behaves

Outpt services, ex. Meeting w/a psychiatric health care practitioner

a pt who demonstrates minimal mental health disruptions

disparities

negative differences in the outcomes and experiences of different groups

Mental health

a state of well-being in which individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

mental health continuum

a range of mental well-being, w/excellent mental health at one end and poor mental health, or mental illness, at the other end

excelling

the peak of well-being on the mental health continuum

what are the five zones of the mental health continuum?

1. excelling

2. thriving

3. surviving

4. struggling

5. crisis

The excelling zone

• pt experiences highest lvl of well-being and is at peak functioning

• experienced during joyful events or top lvl of functioning

• nurses must educate and encourage pt to have a SENSE of positive well-being, even if they feel low

• still important to practice self-care and have a healthy support system for stressors

Thriving zone

pt has a satisfactory lvl of mental well-being and is able to function normally

• manage stress with healthy coping mechanisms

• important for pt to learn how to cope w/stressors to not regress down

surviving zone

refers to an unsettled state of mind and indicates that problems may worsen

• pt may experience bothersome worries, increased negative thoughts, problems w/sleep and appetite, difficulty in concentrating, or feeling on edge

• action must be taken, ex. psychiatric care, professional counseling

struggling zone

signifies trouble in mental health; may experience anxiety and depression, poor concentration, low energy, and struggles w/work.

• negative thoughts, or physical and emotional pain or numbness

• require professional methos of treating and managing their condition

  • medication, partial inpatient hospitalization, or further counseling or therapy

• can easily slip into in-crisis zone

in crisis zone

indicates when a pt is in a state of emergency w/their mental health and require immediate health.

• suicidal ideation, severe anxiety, and depression to the point where social isolation and lack of self-care are present

• if pt poses a danger to themselves or other, the situation is emergent

• requires placement in an inpatient setting (psychiatric hospital)

  • learns healthy coping mechanisms and ways for improved self-care

Healthy (healthy functioning) category

pts are happy and satisfied w/their life circumstances

• are emotionally well-balanced and use healthy coping mechanisms when facing normal daily stressors

• experience normal fluctuation in mood, personal performance is consistent, healthy sleep patterns are present, and self-confidence is evident

• pt comfortable and confident in their relationships

reacting (common and reversible stress) category

pt experiencing acute stress (ex. death of a loved one, divorce, or issues at work)

• will need self-care and social support to improve & stabilize mental well-being

• may have difficulty coping w/stressor, BUT can still perform their functions of daily living

• will exhibit several manifestation: irritability, impatience, nervousness, sadness, worry, procrastination, increased forgetfulness, sleep impairment, intrusive thoughts, and social withdrawal

injured (significant functional impairment) category

pt has deteriorated and can quickly turn into an emergency

• impaired ability to perform daily living functions

• exhibits anger, anxiety, prolonged sadness, helplessness, hopelessness, worthlessness, decreased in academic or professional performance, disturbed sleep, and avoidance of social situations

• require professional care, can quickly turn to an emergency

ill (clinical disorder, severe and persistent functional impairment) category

• REQUIRES emergency attention; professional treatment may be required for improvement

• pt demonstrate inability to cope with stress, characterized by extreme changes in thoughts, behaviors, and actions

• trouble controlling emotions, severe anxiety along w/panic attacks, deep depression, feeling overwhelmed, persistent fatigue, disturbed perceptions of reality, and suicidal ideation

who requires an inpt setting?

pts whose symptoms cause severe dysfunction in daily functioning or cause acute safety concerns

• to receive intense care and constant supervision

who receive care in an outpt setting?

pt whose symptoms cause a need for assistance w/medication management, social support, or a structured treatment environment

examples of community-based care

primary care provider’s office or private practice, outpt mental health clinic, case management, home-based services, mobile crisis teams, day treatment, family services, peer services, or teletherapy and telepsychiatry

what is another way to referred to outpt mental health services?

Community-based care

What is Assertive Community Treatment (ACT)?

a home-based treatment model that provides pts w/serious and persistent mental health conditions w/comprehensive mental health care within their homes

• provides services of an inpt psychiatric treatment w/medical staff trained WHILE pt is in their own homes

inpt or residential facilities

for pts who require intensive care, treatment, and supervision of their mental health condition

• provide high0intesity care that operates around the clock

ex. crisis stabilization beds, community-based hospital beds, state hospital beds, transitional or respite beds, long-term beds, and substance use disorder treatment centers

crisis stabilization unit

provides monitoring and support for a pt who is having a mental health emergency

• not in hospital, but in a smaller inpt facility

• pt stay in a few hours to a few days

state hospital facility

for pts who have a mental illness and who meet state criteria for commitment to an inpt facility

• have a diagnosis of a serious mental ilness and may be involved w/criminal justice system

• determined by a judge in a court of law after hearing pt treatment and history

• lasts months to years; will remain if pt continues meeting the criteria for court-ordered hospitalization

transitional or respite unit

pt requires continous nonmedical monitoring or support AFTER discharge from a hospital

• for pt at risk for hospitalization due to mental health concerns or decline

• two or four weeks stay

long-term care facility

for pts w/chronic mental health conditions who are unable to live independently in the community

• require assistance w/activities of daily living (adhering to med regimen, eating, and hygiene)

• stay indefinitely

Substance use disorder treatment centers

for pt requiring treatment for substance use disorder

Medication-assisted treatment (MAT)

used to manage the pharmacologic treatment of substance use disorder

• prescriptions for methadone, buprenorphine, naltrexone, or other meds may be prescribed to pt

Veterans Administration (VA) care

provided through a government health program for veterans of military and their family members

• access to mental health care

• symptoms: posttraumatic stress disorder and military sexual trauma

Pediatric and adolescent care

focus on helping children and their caregivers struggling w/mental health conditions

Geriatric care

targeted at older adults and their unique mental health needs

Forensic care

specialty mental health care for pts convicted of criminal offense

• a balance between public safety and comprehensive mental health care

• aimts to rehabilitate pts and decriminalize mental health disorderse

ex. Diversion programs

• work to promote public safety and connect ppl who aren’t receiving adequate mental health care to resources

• help prevent the criminalization of illness, reducing unecessary incarceration

any mental illness (AMI)

a mental, behavioral, or emotional disorder that can vary at different levels

serious mental illness (SMI)

a severe functional impairment, resulting in possible permanent disability

deinstituionalized

released from institutions into the community

Populations at risk for mental illness

• underserved individuals in the community

  • children, adolescents, older adults, non-white, ppl who live in rural communities, veterans, and ppl w/out housing

  • arise from: social determinants, adverse childhood events (ACEs) geographical settings, marginalization

• incarcerated individuals

  • individuals w/mental illness can sometimes be criminalized

  • criminal justice environments exacerbate pt’s manifestations of mental illness

    • social disconnection, loss of purpose, and motivation, unpredictable routines, poor facility conditions

• houseless community

Levels of prevention using the public health model

• primary: focuses on the prevention of a mental illness by focusing on both the individual pt and their environment

• secondary: involves minimizing the early symptoms of a mental illness. early intervention may mitigate the impact of a mental health disorder

• tertiary: concentrates on reducing any long-term or debilitating effects of severe and chronic mental illness

Primary preventions

community and public health nursing provide education and teaching materials

• provides the foundation for health promotion, maintenance, and community care

ex. teaching parenting skills to expectant parents

Secondary Prevention

involves a nurse recognizing and addressing any early manifestation of a mental health disorder

ex. ongoing mental health screening of individuals @ high risk and helping them manage manifestations

Tertiary Prevention

once the mental health disorder has been diagnosed, the focus is on treatment and preventing any further complications

• help them manage their disorder and function in society to reduce any debilitating effects as much as possible

ex. support group referrals

Barriers for mental health care

• Lack of available treatment options or providers

• Inadequate transportation, childcare, or unable to take time off work.

• Held belief that mental health treatment “does not work”

• High level of mental health stigma in cultural or ethnic group

• Racism, bias, and discrimination in treatment settings

• Language barriers or lack of providers who speak languages other than English

• Lack of adequate health insurance coverage