Based in the scenario of question #1 (Jacob’s case)
Chapter 21: Community
Mental Health
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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
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Question #1
Is the following statement true or false?
Genetic, biologic, and environmental risk factors all influence the incidence of mental illness.
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Answer to Question #1
True
Rationale: Genetic, biologic, and environmental risk factors all influence the incidence of mental illness. Early intervention can minimize the morbidity associated with mental illness.
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Cultural Context of Mental Illness
Genetic, biologic, 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.
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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.
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Question #2
Is the following statement true or false?
Rationale: Adherence to psychopharmacology and psychotherapy does not enhance recovery from mental illness.
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Answer to Question #2
False
Rationale: Adherence to psychopharmacology and psychotherapy enhances recovery from mental illness.
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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.
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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
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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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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
Biologic 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.
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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.
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Question #3
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.
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Answer to Question #3
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.
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Evolution of Community Mental Health #1
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.
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Evolution of Community Mental Health #2
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.
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Question #4
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.
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Answer to Question #4
True
Rationale: The continuum of care for the chronically mentally ill includes community services, such as supportive housing and employment.
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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.
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Role and Responsibilities of the Community Mental Health Practitioner
Teacher
Clinician
Advocate
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Psychological First Aid
Populations traumatized by disasters
Populations at risk for psychological trauma
Psychological first aid is recommended to help support survivors and first responders to natural and intentional disasters.
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