Chapter 25

Chapter 25: Behavioral Health in the Community

  • Prevalence of Mental Illness

    • 1 in 4 people experience mental illness.

The New Freedom Initiative: Impediments to Mental Health Care

  • Three Major Impediments

    • Fragmented mental health service delivery system.

    • Challenges related to integration of behavioral and medical care.

    • Stigma surrounding mental illness.

Healthy People 2030: Objectives

  • National Health Promotion and Disease Prevention Objectives

    • Improving mental health through prevention and ensuring access to quality mental health services.

    • Reducing substance abuse to protect health, safety, and quality of life for all, particularly children.

    • Reducing tobacco-related illness, disability, and death due to both use and secondhand smoke exposure.

Substance Use and Disorders

  • Prevalence

    • Alcohol:

    • Highest incidence of use among young adults aged 18 to 25.

    • Tobacco:

    • Observed decline over the past decade, but trends vary across age groups and genders.

    • Marijuana:

    • Most frequently reported illicit drug.

    • Cocaine:

    • Use doubled in the last 25 years.

    • Methamphetamine:

    • Estimated costs between $25-$48 billion per year due to abuse.

    • Prescription drugs:

    • Rising use noted across all age groups, particularly among college-age students.

Incidence and Prevalence of Mental Illness

  • Global Impact

    • Mental illness accounts for more than 15% of mortality worldwide, with higher rates found in impoverished, poorly educated, and unemployed groups.

    • Many individuals with mental illness remain homeless or untreated.

    • Leading causes of disability include:

    • Depression, bipolar disorder, schizophrenia, panic disorder, and substance use disorders.

    • Gender disparities exist in the prevalence of certain mental disorders.

Trends in Mental Health and Suicide

  • Suicide Statistics

    • Healthy People 2030 goals include:

    • Reducing the suicide rate.

    • Reducing suicide attempts among adolescents.

    • Suicide is the second leading cause of death among individuals aged 10 to 34 years.

  • Interventions for Preventing Suicide

    • Strengthen economic supports, improve access and delivery of care, create protective environments, promote social connectedness, teach coping and problem-solving skills, and identify/support at-risk individuals.

Major Depressive Episode

  • Prevalence

    • Higher incidence among:

    • Adult females and individuals aged 18 to 25.

  • Interventions

    • Utilization of eHealth cognitive-behavioral programs.

    • Technology-supported interventions (structured approaches like step-by-step guides).

    • Community/Public Health Nurses (C/PHNs) facilitating navigation of online resources and enhancing engagement through personalized interactions.

Screening for Depression

  • Routine Screening Tools

    • Brief Psychiatric Rating Scale (BPRS).

    • Beck Depression Inventory.

    • Geriatric Depression Scale.

    • Patient Health Questionnaire (PHQ-9).

    • PC-PTSD (Primary Care PTSD Screen).

Beck's Depression Inventory (Verbatim Questions and Scoring)

  • Sample Questions:

    1. "I do not feel sad."

    2. "I feel sad."

    3. "I am so sad and unhappy that I can't stand it."

    • Each response is scored from 0 (not at all) to 3 (most of the time).

  • Interpretation of Scores:

    • Total scores are categorized as follows:

    • 1-10: Mild mood disturbance.

    • 11-16: Borderline clinical depression.

    • 17-20: Moderate depression.

    • 21-30: Severe depression.

    • Over 30: Extreme depression.

Generalized Anxiety Disorder (GAD-7) Assessment

  • Screening for Anxiety:

    • Questions assess frequency of symptoms such as nervousness, worry, and irritability over the last two weeks.

    • Each question is scored from 0 (not at all) to 3 (nearly every day).

  • Total Score Interpretation:

    • Higher scores indicate greater anxiety severity.

Alcohol Use and Impact

  • Consequences of Alcohol Use

    • Alcohol contributes to over 3 million deaths annually.

  • Interventions for Management

    • Early detection of at-risk alcohol use.

    • Screening methods and brief interventions, including motivational interviewing.

    • Referral to specialized treatment when necessary.

Alcohol Use Identification Test (AUDIT) (Verbatim Questions)

  • AUDIT Questions:

    1. How often do you have a drink containing alcohol?

    2. How many drinks do you typically have on drinking days?

    3. Questions assessing drinking frequency, consequences, and others with responses scored similar to previous inventories.

    • Total scores ≥ 8 indicate hazardous or harmful drinking.

Tobacco Use: Risks and Management

  • Health Impact

    • Tobacco is a leading risk factor related to disability-adjusted life years (DALYs).

  • Intervention Steps:

    • The AHRQ's 5 A's approach to treating tobacco use:

    • Ask about usage.

    • Advise patients to quit.

    • Assess readiness to quit.

    • Aid in quitting efforts.

    • Arrange follow-up support.

Substance Use and Community Health Nursing (CHN)

  • Community Needs

    • Further teaching in BSN programs on substance use disorder treatment.

    • C/PHNs should maintain a foundational understanding of specific substance issues and desired outcomes from prevention or treatment.

    • Consideration of substance use trends across various populations and communities.

    • Assessing community consequences of substance use from an environmental perspective.

Current Landscape of Marijuana Use

  • Statistics

    • 43.5 million individuals aged 12 and older reported marijuana use.

  • Educating Clients

    • CHNs should stay informed on current research and educate clients on the harms and risks associated with marijuana use.