Chapter 4

Settings for Psychiatric Care

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1950s: Thorazine 1960s: Community Mental Health Centers Act—

deinstitutionalization 1980s: Carter’s Commission on Mental Health—

recommended more community-based care

Social Influences on Psychiatric Care Settings

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George W. Bush’s New Freedom Commission on Mental Health

2010—Affordable Care Act

Social Influences (Cont.)

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Primary prevention Secondary prevention Tertiary prevention

Prevention Strategies

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Primary care providers Specialty psychiatric care providers Patient-centered health/medical homes Community clinics Psychiatric home care Assertive community treatment (ACT)

Outpatient Psychiatric Mental Health Care

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Partial hospitalization programs (PHPs) Other outpatient venues for psychiatric care

Telephone crisis counseling Telephone outreach Internet Telepsychiatry

Outpatient Psychiatric Mental Health Care (Cont.)

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Strong problem-solving and clinical skills Cultural competence Flexibility Knowledge of community resources Autonomy

Psychiatric Nursing in Outpatient and Community Settings

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Biopsychosocial assessment Case management Promoting continuation of treatment Teamwork and collaboration

Psychiatric Nursing in Outpatient and Community Settings (Cont.)

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You are working with a patient who will be discharged into the community soon. What are some problems that may affect the success of treatment?

Case Study

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Comprehensive emergency service model Hospital-based consultant model Mobile crisis team model Crisis stabilization/observation units

Emergency Care and Crisis Stabilization

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Admission reserved for individuals who are Suicidal Homicidal Extremely disabled and in need of short-term acute

care

Inpatient Psychiatric Care

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Admission options Direct admission Hospital emergency department

Criteria to justify admissions Danger to self or others or Unable to fulfill basic needs

Voluntary or involuntary

Inpatient Psychiatric Care (Cont.)

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Hospitalized patients retain their rights as citizens

Patient’s need for safety must be balanced against patient’s rights as a citizen

Mental health facilities have written statements of patient’s rights and applicable state laws

Patients’ Rights

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Members of each discipline are responsible for gathering data and participating in the planning of care

Treatment plan or clinical pathway provides a guideline for patient’s care during hospital stay

Multidisciplinary Treatment Team

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Surroundings and physical environment Managing behavioral crises Safety Suicide risk

Therapeutic Milieu

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Admission assessment Physical health assessment Therapeutic groups Documentation

Nursing Care

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Medication management Medical emergencies Preparation for discharge to community

Nursing Care (Cont.)

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1. An occupational health nurse screens factory workers for depression. Which level of prevention is applicable to this activity?

A. Primary

B. Secondary

C. Tertiary

D. Not sure

Audience Response Questions

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2. A hospitalized client diagnosed with major depression tells the nurse, “I need my belt to keep my pants up. They keep falling down.” Which response should the nurse provide?

A. “Your belt is locked in the business office for safekeeping, along with all your other valuables.”

B. “For safety reasons, hospitalized clients are not allowed to keep certain personal possessions.”

C. “I cannot provide your belt, but I will help you get some pants with an elastic waistband.”

D. “I will ask the psychiatric technician to get your belt for you.”

Audience Response Questions

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