Community Mental Health Nursing

Afza.Malik GDA

Mental Health Nursing In Community 

Community Mental Health Nursing

Whats Is Community Mental Health,Mental Hospital  Past,Shifting From Community To Psychiatric Nursing ,Differentiation In Community Health And Psychiatric Nursing ,Autonomy for Community Psychiatric Nurses,Pivotal Role Of Psychiatric Nursing,Appreciation of the Effort.

Whats Is Community Mental Health

    Over the past 50 years, the community mental health movement has had a tremendous impact on psychiatric nursing, taking psychiatric nurses into communities and freeing them from their almost exclusive practices in large state hospitals. 

    Nursing research in the area of community mental health has steadily increased, the United Kingdom having contributed most to this body of literature, especially in recent years. 

    Historic influences in the United States (US) and United Kingdom (UK) created different climates from which nursing research emerged in each of these countries.

Mental Hospital  Past

   From the early 19th century until the 1960s, mental hospitals, or "asylums," constituted the major treatment resource for the mentally ill in both the US and UK.

    Advances in the use of psychotropic medications and government policy directives in each country spurred the movement of mentally ill patients into the community. The historic report, Action for Mental Health, presented to the US Congress in 1961, recommended a shift to community-based care. 

    This was followed in 1963 by the enactment of the Community Mental Health Centers Act, which authorized $150 million in federal funds to develop comprehensive community mental health centers (Miller, 1981). 

    The UK followed suit in 1962 when British politician Enoch Powell presented his Hospital Plan for England to Parliament; however, it was not until the publication of the 1975 White Paper, Better Services for the Mentally Ill, that any real increase in resources were initiated (Bonner, 2000).

Shifting From Community To Psychiatric Nursing 

    The shift from hospital to community posed challenges for psychiatric nursing in both countries. Most psychiatric nurses in the US were educated through hospital-based programs, making them ill equipped to take on the demands of an expanded community role. 

    Although the findings of several early descriptive studies (Hess, 1969; Hicks, Deloughery , & Gebbie , 1971) show psychiatric nurses functioning in diverse roles, nursing leaders ( Mereness , 1983. 

    During this period expressed concern that too often nurses in community mental health adopt "residual roles," resulting from their lack of education in psychiatric theory and unequal status among fellow professionals.

    In the UK, social workers were the primary professionals delivering care to mentally ill patients in the community. 

    Nursing was represented by the part-time activity of hospital-based psychiatric nurses who were seen merely as a technology through which psychiatrists could extend their authority be yond the confines of the hospital (Bonner, 2000). 

    In both countries, the main role for community psychiatric nurses during these early years was the task of administering depot injections to patients with severe mental disorders.

Differentiation In Community Health And Psychiatric Nursing 

    The 1970s and 1980s were characterized by role differentiation and expansion for community psychiatric nurses in both countries. 

    In the US, there was recognition of the need for advanced educational preparation of psychiatric nurses to meet the challenges of this evolving role (DeYoung & Tower, 1971). 

    The findings of one descriptive study (Davis & Underwood, 1976) show that, although half of the nurses employed in four community mental health centers earned a bachelor's degree and provided some consultation and counseling, most of their time was spent performing traditional functions . 

    With increased educational opportunities, funded largely by the National Institute of Mental Health (NIMH) in the 1980s, psychiatric nurses grew more sophisticated and diversified. 

    They began to function as therapists for individuals, families, and groups and to serve as case managers and coordinators of community services. Psychiatric home care nursing also began to flourish during this period as reimbursement for these services became available (Fagin, 2001). 

    Although nursing research related to community mental health was still scarce, an early intervention study ( Slavinsky & Krauss, 1982), funded by the NIMH, characterized nurses' commitment to the care of psychiatric patients in the community and their skill in developing innovative programs for this population.

Autonomy for Community Psychiatric Nurses

    The drive for autonomy for community psychiatric nurses in the UK was away from psychiatry and "general nursing."Their "professionalization" and expansion were largely achieved through their successful incursion into primary health care and distancing from mental health teams. 

    Government initially supported community psychiatric nurses' efforts in building new relationships with general practitioners, and even funded their training (Godin, 2000). Community psychiatric nurses expanded in number, and also in the range of therapeutic approaches used in their practices. 

    As their self-image as professionals and their relationships with general practitioners grew, however, their caseloads became comprised of patients with less severe problems (Godin, 1996). 

    The findings of one UK study (Barratt, 1989) show community psychiatric nurses' self-perceived roles becoming more differentiated, emphasizing prevention, counseling, and a variety of therapies for certain patient populations. 

    Another study (Wetherill, Kelly, & Hore , 1987), investigating the effectiveness of a structured home intervention to improve patient compliance in alcohol treatment and recovery, demonstrates the growing ability of community psychiatric nurses in the UK to develop innovative interventions and expand their practices to include a varied clientele base.

Pivotal Role Of Psychiatric Nursing 

    In the US, psychiatric nurses continued to develop pivotal roles in a variety of community treatment modalities. In one national survey of assertive outreach programs, findings show that 88% had a psychiatric nurse as an integral member of the treatment team (Deci, Santos, Hiott , Schoenwald , & Dias, 1995). 

    Over time, psychiatric clinical nurse specialists became recognized as independent practitioners, eligible for third-party reimbursement, and active in caring for seriously mentally ill patients (Iglesias, 1998; White, 2000); however, research addressing specific psychiatric nursing interventions for this population was still quite limited (Beebe, 2001; Rabbins et al., 2000). 

    The "Decade of the Brain" in the 1990s brought the medicalization of psychiatric practice. In response to the challenge of integrating biologic knowledge into clinical practice, psychiatric nurses working in community mental health centers and in private practice in the US sought prescriptive authority. 

    Current nursing research reflects efforts to understand prescribing practices of advanced-practice psychiatric nurses (Talley & Richens, 2001) and identify barriers to prescriptive practice (Kaas, Dahl, Dehn , & Frank, 1998).

    By the 1990s, community psychiatric nurses in the UK were numerically the most dominant occupational group within community mental health care; however, this also meant that they were perceived as responsible for many of its failures. 

    Criticism was primarily directed toward their decision to shift focus away from the care of patients with severe mental illnesses in favor of work in primary health care. 

    Many also questioned the effectiveness of their work in primary care, contending that counseling based interventions were of unproven worth with people experiencing minor, self-limiting problems, and were not cost effective (Hannigan, 1997).    

    Not only were community psychiatric nurses directed to reappraise the value they placed upon serving those with severe mental illness, they were also directed to develop and apply evidence-based interventions with this population.

Appreciation of the Effort

    One needs only to scan recent reviews of nursing research to gain an appreciation of the effort that has and is being put forth by psychiatric nurses in the UK to meet this mandate. 

    The nursing literature is replete with studies investigating the clinical impact of specific interventions with severely mentally ill patients. 

    Examples include nursing interventions for early detection of medication side effects (Jordan, Tunnicliffe , & Sykes, 2002), for identifying psychiatric illness in the elderly ( Waterreus , Blanchard, & Mann, 1994), for providing sex education to mentally ill patients (Woolf & Jackson, 1996).

    For delivering a "psychosocial intervention" to families caring for a relative with schizophrenia (Brooker & Butterworth, 1991), and for using an "insight program" with patients diagnosed with schizophrenia (Pelton, 2001). 

    While psychiatric nurses throughout the world can use the wealth of knowledge gained from these studies, it is equally important that research be directed toward testing nursing interventions within the context of specific communities and different cultures, and that nursing research in this area become more interdisciplinary in nature. 

    It is also important that nurse researchers study the effects of disparity and stigma in access to community mental health care across the life span.

Post a Comment


Give your opinion if have any.

Post a Comment (0)

#buttons=(Ok, Go it!) #days=(20)

Our website uses cookies to enhance your experience. Check Now
Ok, Go it!