Harkness2e chap21 ppt
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Transcript of Harkness2e chap21 ppt
Chapter Highlights
• Epidemiology of mental illness from a public health
perspective
• Early intervention in the treatment of schizophrenia
• Strategies to enhance treatment adherence
• Public health implications for children with behavioral
disorders
• Evolution of community mental health
• Policy development and legislation for mental health
services
• Role and responsibilities of the community mental health
practitioner
Copyright © 2016 Wolters Kluwer • All Rights Reserved 2
Question
Is the following statement true or false?
Genetic, biological, and environmental risk
factors all influence the incidence of mental
illness.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 3
Answer
True
Rationale: Genetic, biological, and
environmental risk factors all influence the
incidence of mental illness. Early
intervention can minimize the morbidity
associated with mental illness.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 4
Cultural Context of Mental Illness
• Genetic, biological, and environmental risk
factors all influence the incidence of
mental illness.
• Mental health and, conversely, mental
illness are concepts bound by culture.
• Understanding of what connotes mental
health is shaped by social norms that
evolve from generation to generation.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 5
Definitions of Mental Health
• No universally accepted definition of
mental health; for practical purposes,
widely accepted parameters for what
behaviors connote psychopathology must
be used to measure
• Incidence
• Morbidity
• Mortality
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Scope of Mental Illness
• There is no difference in lifetime prevalence
rates of major mental illness between developed
and developing countries.
• The projected lifetime risk of developing a major
mental illness is highest in countries where the
population is subject to sustained violence.
• Psychiatric disorders are the leading cause of
disability worldwide.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 7
Question
Is the following statement true or false?
Rationale: Adherence to psychopharmacology
and psychotherapy does not enhance
recovery from mental illness.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 8
Answer
False
Rationale: Adherence to psychopharmacology
and psychotherapy enhances recovery from
mental illness.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 9
Schizophrenia
• Epidemiology
• Early intervention programs for first-
episode psychosis
• Primary prevention programs
• Enhancing treatment adherence in
schizophrenia
• Role of community mental health teams in
treatment of schizophrenia
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Epidemiology of Schizophrenia
• About 1% of the world’s population suffers
from schizophrenia.
• Symptoms of schizophrenia typically first
appear in late adolescence or young
adulthood and persist throughout a
person’s life, causing significant
impairment in all aspects of a person’s
psychosocial functioning.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 11
Early Intervention Programs for First-Episode Psychosis
• Early intervention programs—specialized
teams of professionals whose primary goal
is to maintain the individual’s current level
of educational and vocational functioning
through early treatment
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Enhancing Treatment Adherence in Schizophrenia
• Nonadherence to medication is the most
common factor associated with relapse and
recurrence of psychotic symptoms.
• Nursing interventions to enhance
medication adherence applicable to those
with chronic mental illness
Copyright © 2016 Wolters Kluwer • All Rights Reserved 13
High-Risk Populations• The unemployed, the poor, and the
homeless all report higher levels of
depression, anxiety, schizophrenia, and
substance abuse than do the general
population.
• The number of mentally ill clients who are
homeless has steadily increased in the
United States as state governments
embarked on a systematic plan to
“deinstitutionalize” the mentally ill.
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Deinstitutionalization
• The phenomenon of allowing patients to
leave care in large, complex healthcare
systems in order to receive care in
neighborhoods and communities on an
outpatient basis
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Role of Community Mental Health Teams in Treatment of Schizophrenia
• Respite services, day treatment facilities, and
sheltered workshops are a few of the outpatient
services that help alleviate the daily burden of
care for families.
• To address these shortcomings in the delivery of
care, community mental health teams coordinate
both the psychosocial and the
psychopharmacological needs.
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Mood and Anxiety Disorders
• Epidemiology
• Social factors
• Biological theories of depression and anxiety
• Nursing interventions
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Attention-Deficit/Hyperactivity Disorders and Emotional Disorders in Children
The main characteristics that help healthcare
practitioners, including school nurses, differentiate
ADHD from bipolar disorder are the pervasiveness of
the symptoms and the predominant symptoms.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 18
The Precipitous Rise in Autism—A Public Health Crisis
• Long-term outcomes of children with autism are
improved with early identification and
treatment.
• Screening tools for autism have been developed,
but most are for use in toddlers and not in
infants.
• Screening for prodromal symptoms in infancy;
some of the more debilitating features of the
disorder might be mitigated with early
intervention and treatment.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 19
Question
Is the following statement true or false?
Public health initiatives to educate
communities about mental health can be
effective in lowering the incidence of high-
risk behaviors such as alcoholism.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 20
Answer
False
Rationale: Public health initiatives to educate
communities about mental health can be
effective in lowering the incidence of high-
risk behaviors such as suicide.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 21
Evolution of Community Mental Health
• Community-based treatment of the mentally ill gained
momentum as World War II veterans returned home
exhibiting the symptoms of posttraumatic stress disorder.
• Aided by advances in the development of pharmacologic
treatment of the mentally ill, the numbers of patients
treated in state mental hospitals precipitously declined.
• The continuum of care for the chronically mentally ill
includes community services, such as supportive housing
and employment.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 22
Evolution of Community Mental Health (cont.)
• Since deinstitutionalization began, there
has been an outcry of frustration from
nurses in the community about the lack of
supportive services to meet the needs of
people with chronic mental illness.
• Public health initiatives to educate
communities about mental health can be
effective in lowering the incidence of high-
risk behaviors such as suicide.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 23
Question
Is the following statement true or false?
The continuum of care for the chronically
mentally ill includes community services,
such as supportive housing and employment.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 24
Answer
True
Rationale: The continuum of care for the
chronically mentally ill includes community
services, such as supportive housing and
employment.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 25
Legislation for Parity in Mental Health Insurance Benefits
• All health insurance coverage, including
deductibles, copays, coinsurance, and out-
of-pocket expenses, as well as all
treatment limitations, including frequency
of treatment, number of visits, days of
coverage, or other similar limits, will be
the same regardless of health need or
diagnosis.
Copyright © 2016 Wolters Kluwer • All Rights Reserved 26
Role and Responsibilities of the Community Mental Health Practitioner• Teacher
• Clinician
• Advocate
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