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Chapter 4

Chapter 4. Psychiatric Mental Health Nursing in Acute Care Settings. Inpatient Psychiatric Care. Admissions reserved for Suicidal Homicidal or Extremely disabled in need of short-term acute care. Funding Psychiatric Mental Health Care. Private pay insurance Managed care plans

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Chapter 4

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  1. Chapter 4 Psychiatric Mental Health Nursing in Acute Care Settings

  2. Inpatient Psychiatric Care • Admissions reserved for • Suicidal • Homicidal or • Extremely disabled in need of short-term acute care

  3. Funding Psychiatric Mental Health Care • Private pay insurance • Managed care plans • Health maintenance organizations (HMOs) • Preferred provider organizations (PPOs) • Managed behavioral health care organizations (MBHOs) • Medicaid • Medicare

  4. Mental Health Funding Legislation • Paul Wellstone and Peter Domenici Mental Health and Addiction Equity Act of 2008 • Restricts insurance companies from requiring higher co-payments or higher deductibles for mental health or substance abuse

  5. Uninsured Patients • Medicare • Medicaid • Social Security • Social Security Disability Income (SSDI) • Supplemental Security Income (SSI) • Veterans Administration

  6. Inpatient Psychiatric Care • Admission options • Direct admission • Hospital emergency department • Criteria to justify admissions • Danger to self or others or unable to care for basic needs • Voluntary or involuntary

  7. Patient Rights • Hospitalized patients retain their rights as citizens • Obligation to balance patient's needs for safety with patient's rights as a citizen • Mental health facilities have written statements of patient's rights and applicable state laws

  8. Multidisciplinary Treatment Team • Meet within 72 hours of patient's admission • Multidisciplinary treatment plan or clinical pathway is guideline for patient’s care during hospital stay

  9. Nursing Care • Admission assessment • Ensuring safety • Physical health assessment • Milieu management

  10. Nursing CareContinued • Structured group activities • Documentation • Medication administration • Medication adherence

  11. Nursing CareContinued • Pain management • Crisis management • Medical crises • Behavioral crises • Preparation for discharge to community

  12. Chapter 5 Psychiatric Mental Health Nursing in Community Settings

  13. Community Mental Health Nursing Movement • 1963 • Community Mental Health Centers Act (Kennedy) • Shift care from institution to the community • Deinstitutionalization • 1960s • Federal entitlement programs • Social Security Disability • Supplemental Security Income • Medicaid • Medicare • Housing assistance • Food stamps

  14. Community Mental HealthNursing MovementContinued • Challenges • Few choices for outpatient treatment • Limited funding • More clients than resources • Resistance of seriously mentally ill patients to treatment • 1980s • Commission on Mental Health (Carter)

  15. Roles and Functions of Community Mental Health Nurse • Biopsychosocial assessment • Negotiating flexible and resourceful treatment goals and interventions • Member of a multidisciplinary team • Biopsychosocial Care Manager • Promoting continuation of treatment • Providing care in a variety of settings

  16. Continuum of Psychiatric Treatment Most acute treatment (short-term) Intensive outpatient treatment (usually short-term) Transitional outpatient treatment (usually long-term) Ongoing outpatient treatment (long-term)

  17. Community Settings • Partial hospitalization program (PHP) Intensive, short-term treatment with patient able to return home each day • Patients receive 5 to 6 hours of treatment daily • Typically 5 days a week • Average length of stay 2 to 3 weeks • Multidisciplinary team (psychiatrist, RN, and social worker)

  18. Community SettingsContinued • Psychiatric Home Care • Four requirements • Homebound status of patient • Presence of psychiatric diagnosis • Need for skills of RN • Plan of care under physician

  19. Community SettingsContinued • Assertive Community Treatment (ACT) • For clients with repeated hospitalizations, severe symptoms, or inability to participate in traditional treatment • Multidisciplinary team • Work with patients in homes, agencies, hospitals, or clinics • ACT team provides support and resources; on call 24 hours a day

  20. Community SettingsContinued • Community Mental Health Centers Emergency, adult, and children’s services for those who have no access to private care Provide • Medication administration • Individual therapy • Psychoeducational and therapy groups • Family therapy • Dual-diagnosis treatment

  21. Resolving Ethical Dilemmas • Role of nurse • Act in the best interests of the patient and society to the degree possible • Resources for consultation • Hospital ethics committee • Agency ethics consultant • Professional nursing organizations • State board of nursing

  22. Barriers to Mental Health Treatment • Stigma associated with mental disorders • Scarcity of care in rural areas • Inability to afford health insurance • Fragmented care for children and adults with serious mental illness • High unemployment and disability among seriously mentally ill • Undertreatment of older adults • Lack of national priority for mental health

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