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Challenges in
Mental Health (Psychiatric) Care
Dr. Riaz.K.M. MSc (N), PhD.
Assistant Professor, Govt. College of
Nursing, ...
Objectives
• Describe misconception as a challenge in mental health
• Explain scope and challenges in mental health
• List...
Why this topic
• Challenge
+
• Control for future Change in MH
+
• Commitment
Challenge
Noun
• A call to someone to
participate in a
competitive situation or
fight to decide who is
superior in terms o...
Control
• The power to influence
or direct people's
behaviour or the course
of events
• Determine the
behaviour or supervi...
“Future nursing” – challenge?
• “Transformational nursing”,
• “Translational nursing”,
• “Interdisciplinary nursing”,
• “M...
Priorities of the Helsinki Declaration
(1964 & 2013)
1. Foster awareness of the importance of mental well-
being
2. Collec...
A former student’s view
• Mr X, 29, studied mental health nursing. He now works in an
adult acute admission ward
• “Throug...
• “I think the most powerful tool we have in
changing these misconceptions is challenging
stigma as it arises. Advertising...
Scope/Challenge
• Misconceptions (both the public and fellow nursing
professionals) - fuel for stigma and discrimination
•...
Scope/Challenge
• Shift of practice from mental illness to mental health,
leaving a vacuum in the care of serious mental i...
Scope/Challenge
• Inadequate reimbursement for time-consuming “talk
therapy” without compensatory procedural
reimbursement...
Scope/Challenge
• Expansion of criteria for psychiatric disorders in
subsequent Diagnostic and Statistical Manual of
Menta...
Scope/Challenge
• Income inequality and class differences have reached
historic highs in recent years- lack of health
insu...
Scope/Challenge
• Broadening scope and the shift to community
based mental health services introduce greater
levels of com...
Challenges in
• Community characteristics
– MH configuration
– Prevalence of disorders
– Demand of services
– Demographics...
Challenges in
• Entry status
• Clinical
• Legal
• Diagnostic evaluation
• Diagnosis
• Severity
• co morbidity
• Treatment ...
Challenges in
• Specific outcomes
– Clinical
– Functioning
– Mortality
– Quality of life
– Societal costs
Challenges on
Roles and Responsibilities
1. Therapeutic role
2. Membership of multi-
disciplinary team
3. Functioning in d...
Challenges in Providing Care within
Psychiatric Wards
• Politics and Rules of Organization,
• Safety and Security Issues,
...
Challenges in
Improving Psychiatric Care
• Empowerment across
– Psychiatric Nurses,
– Mentally Ill Patients and their Fami...
Challenges in
Role of mental health nurses
Challenges in
Role of mental health nurses
• Assessment
• Care planning
• Drug administering (Even Prescribing)
• Advocacy...
Challenges towards de
institutionalization
• Reallocation of staff from hospital to
community based services
• Development...
Challenges related to
Lack of clinical guidelines
• Absence of national guidelines for mental
health nurses
• Lack of evid...
Challenges in
Creating international network
• A lack of core indicators leads to invisibility and
marginalization of peop...
Challenges in Recovery-Focused care
• Recovery-focused care gives professionals an insight
into service users’ needs
• Inv...
Challenges in Values-based education
• Acknowledging and respecting values is important
for building relationships between...
Challenge in mental health
HEALTH INSURANCE
• MULTI PAYER V/S SINGLE PAYER
• SINGLE PAYER
• poor coverage
• Cost containment
difficult
• Cost sharing high
• No choice for doctor
and hospital
• Poor...
Challenges in Future Measurement Criteria
• Utilizes ethical principles to create a system of
advocacy for access and pari...
Challenges in Future Measurement Criteria
• Provides direction to enhance the effectiveness of the
healthcare team
• Initi...
“online disinhibition effect”
• excessive Internet use may be correlated with social
anxiety, depression, and introversion...
“online disinhibition effect”
• Disclosure of patient-related information is often problematic
• health professionals “beh...
“online disinhibition effect”
• groups of health professionals with similar interests;
share resources with colleagues (e....
“online disinhibition effect”
• “Twenty-first century
psychiatric nurse should be able
to be a cautious but vigorous
parti...
The giant ship engine that failed?
• The ship’s owners tried one expert after another, but
none of them could figure but h...
The giant ship engine that failed?
• Two of the ship’s owners were there, watching this
man, hoping he would know what to ...
The giant ship engine that failed?
• A week later, the owners received a bill from the old
man for ten thousand dollars.“W...
• The man sent a bill that read:
• Tapping with a hammer …………………
$ 2.00
• Knowing where to tap ……………………….
$ 9998.00
• Effo...
Take home message
• Misconception is a major challenge in mental health
even today.
• Priorities set in Helsinki Declarati...
Challenges in Mental Health Nursing
Challenges in Mental Health Nursing
Challenges in Mental Health Nursing
Challenges in Mental Health Nursing
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Challenges in Mental Health Nursing

Challenges in Mental Health Nursing

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Challenges in Mental Health Nursing

  1. 1. Challenges in Mental Health (Psychiatric) Care Dr. Riaz.K.M. MSc (N), PhD. Assistant Professor, Govt. College of Nursing, Thrissur, Kerala riazmarakkar@gmail.com
  2. 2. Objectives • Describe misconception as a challenge in mental health • Explain scope and challenges in mental health • Lists the priorities of the Helsinki Declaration • Lists the challenges on Roles and Responsibilities • Explain Challenges in Providing Care within Psychiatric Wards for Improving Psychiatric Care • Explain the challenges related to Role of mental health nurses and Lack of clinical guidelines • Explain the challenges in Creating international network of mental health nurses, Recovery-Focused care and Values- based education
  3. 3. Why this topic • Challenge + • Control for future Change in MH + • Commitment
  4. 4. Challenge Noun • A call to someone to participate in a competitive situation or fight to decide who is superior in terms of ability or strength. • A call to prove or justify something Verb • Dispute the truth or validity of. • Invite (someone) to engage in a contest
  5. 5. Control • The power to influence or direct people's behaviour or the course of events • Determine the behaviour or supervise the running of Commitment • The state or quality of being dedicated to a cause, activity, etc • A willingness to give your​ ​ ​ time and energy to​ something that you ​ believe in, or a promise or​ ​ firm decision to do​ something
  6. 6. “Future nursing” – challenge? • “Transformational nursing”, • “Translational nursing”, • “Interdisciplinary nursing”, • “Multidisciplinary nursing”, • “Multileveled nursing,” • “Integrative nursing”,
  7. 7. Priorities of the Helsinki Declaration (1964 & 2013) 1. Foster awareness of the importance of mental well- being 2. Collectively tackle stigma, discrimination and inequality 3. support people with mental health problems and their families to be actively engaged in treatment process 4. Design and implement comprehensive, integrated and efficient mental health systems (promotion, prevention, treatment and rehabilitation) 5. Address the need for a competent workforce, effective in all settings and areas
  8. 8. A former student’s view • Mr X, 29, studied mental health nursing. He now works in an adult acute admission ward • “Throughout my studies and career so far it has been clear there are still many misconceptions of mental health nursing and patients - the expectation of violence as a daily feature of my job is still, without a doubt, a strong one. • In my spare time I practice kung fu and during one training session received a black eye; I was surprised by how many people assumed I’d received the injury at work.
  9. 9. • “I think the most powerful tool we have in changing these misconceptions is challenging stigma as it arises. Advertising campaigns are all very well, but it’s in conversation with the general public that, as professionals, we can address these misconceptions and negative stereotypes.”
  10. 10. Scope/Challenge • Misconceptions (both the public and fellow nursing professionals) - fuel for stigma and discrimination • The mental health nursing profession- subject of many misconceptions • The mental health nursing profession - “brand” • The responsibility for challenging misconceptions lies with each member of the mental health nursing community
  11. 11. Scope/Challenge • Shift of practice from mental illness to mental health, leaving a vacuum in the care of serious mental illness. • Deinstitutionalization of mental illness care, with emptying out or closure of many public mental hospitals. • Limited access to urgent psychiatric care • Marked decline in hospital stays for patients with psychiatric disorders.
  12. 12. Scope/Challenge • Inadequate reimbursement for time-consuming “talk therapy” without compensatory procedural reimbursement. • Lack of parity of coverage for physical and mental illness. • Rapid decline of psychotherapy and shift toward drug therapy and “med checks” practice.
  13. 13. Scope/Challenge • Expansion of criteria for psychiatric disorders in subsequent Diagnostic and Statistical Manual of Mental Disorders editions. • Growth of various mental health professions in practices not supervised by psychiatrists. • Criminalization of the seriously mentally ill, with misuse of jails as mental hospitals.
  14. 14. Scope/Challenge • Income inequality and class differences have reached historic highs in recent years- lack of health insurance • we can no longer afford the waste, duplication, and profits of private payers. • Public payers are more efficient, provide more value, and control costs better than private payers • a larger role of government and public financing of health care • Progress of single-payer initiatives
  15. 15. Scope/Challenge • Broadening scope and the shift to community based mental health services introduce greater levels of complexity, affecting the role • Planning and management will take a more central place, and accountability is likely to become more transparent.
  16. 16. Challenges in • Community characteristics – MH configuration – Prevalence of disorders – Demand of services – Demographics • Institutional characteristics – Ownership – Facility type – Organization of services – Size and occupancy – Staff patient ratio – Source of payment • Provider characteristics – Demographics – Specialty training – Method of payment • Patient characteristics – Demographics – Insurance coverage – Risk factors – Protective factors
  17. 17. Challenges in • Entry status • Clinical • Legal • Diagnostic evaluation • Diagnosis • Severity • co morbidity • Treatment approach • style of treatment • intensity • frequency • appropriateness • Treatment response • Compliance • Change in symptoms • Medication effect • complication • Disposition • Clinical • Legal • Follow up / Placement
  18. 18. Challenges in • Specific outcomes – Clinical – Functioning – Mortality – Quality of life – Societal costs
  19. 19. Challenges on Roles and Responsibilities 1. Therapeutic role 2. Membership of multi- disciplinary team 3. Functioning in diverse roles and settings 4. Broadening societal scope of psychiatric nursing 5. Partnership working 6. Leadership 7. Information systems 8. Research 9. Competence 10. Career development 11. Status and funding 12. Legislation 13. Stigma
  20. 20. Challenges in Providing Care within Psychiatric Wards • Politics and Rules of Organization, • Safety and Security Issues, • Uncertainty about the Role, • Lack of Trained Staff, • Socio cultural Issues, • Limited resources, • Complexities in role, • Pre- licensure, post-licensure challenges, • Professional obstacles, • Public perception
  21. 21. Challenges in Improving Psychiatric Care • Empowerment across – Psychiatric Nurses, – Mentally Ill Patients and their Families, – The Psychiatric Mental Health System, and – the Cultural Context.
  22. 22. Challenges in Role of mental health nurses
  23. 23. Challenges in Role of mental health nurses • Assessment • Care planning • Drug administering (Even Prescribing) • Advocacy • Case management • Community care • Psycho education • Psychotherapy
  24. 24. Challenges towards de institutionalization • Reallocation of staff from hospital to community based services • Development of new set of competencies is needed
  25. 25. Challenges related to Lack of clinical guidelines • Absence of national guidelines for mental health nurses • Lack of evidence based practice • Lack of research • Activity of professional bodies
  26. 26. Challenges in Creating international network • A lack of core indicators leads to invisibility and marginalization of people affected by mental disorders • Mental illness is not perceived as amenable to quick solutions • Human resource planning • Integration of mental health into the social development sector • Avoiding a narrow focus on psychosocial issues • Access to mental health interventions
  27. 27. Challenges in Recovery-Focused care • Recovery-focused care gives professionals an insight into service users’ needs • Involving family members in care and discussing how mental illness affects all areas of a person’s life can help to build trust • A lack of time is often cited as a reason for nurses not focusing on recovery • Nurses can provide person-centred care by involving service users in making decisions about their care
  28. 28. Challenges in Values-based education • Acknowledging and respecting values is important for building relationships between staff and patients • Training to improve values-based practice has been developed in Scotland • Providing training outside a clinical environment helps reduce distractions • Group discussion helps increase awareness • Evidence on how mental health nurses are applying values-based care should be collected
  29. 29. Challenge in mental health HEALTH INSURANCE • MULTI PAYER V/S SINGLE PAYER
  30. 30. • SINGLE PAYER • poor coverage • Cost containment difficult • Cost sharing high • No choice for doctor and hospital • Poor quality of care possible • Sustainable • MULTIPAYER • Good coverage • Cost containment easy • Cost haring low • Free choice to select doctor and hospital • High quality of care • Not sustinable
  31. 31. Challenges in Future Measurement Criteria • Utilizes ethical principles to create a system of advocacy for access and parity for mental health problems, psychiatric disorders, and addiction services. • Influences health policy to reduce the impact of stigma on services for prevention and treatment of mental health problems and psychiatric disorders. • Works to influence decision-making bodies to improve patient care • Provides direction to enhance the effectiveness of the healthcare team
  32. 32. Challenges in Future Measurement Criteria • Provides direction to enhance the effectiveness of the healthcare team • Initiates and revises protocols or guidelines to reflect evidence-based practice, to reflect accepted changes in care management, or to address emerging problems. • Promotes communication of information and advancement of the profession through writing, publishing, and presentations • Designs innovations to effect change in practice and improve health outcomes.
  33. 33. “online disinhibition effect” • excessive Internet use may be correlated with social anxiety, depression, and introversion • Examinations of Facebook pages – detailed, publically accessible postings describing depressive symptomatology and ongoing patterns of substance abuse STUDY among aged between 10-17 found that the 5% of subjects who reported symptoms of major depression spent more time online and were more likely to post identifiable information (if they were male) and pictures (if they were female)
  34. 34. “online disinhibition effect” • Disclosure of patient-related information is often problematic • health professionals “behaving badly” may call their clinical judgment into question, raising doubts in patients' minds about the quality of the treatment they will receive. • Unreflective and excessive self-disclosure by nurses, especially when they are engaged in psychotherapy, is another concern inherent in their use of social media.- “black state” • breakdown of boundaries in the nurse-patient relationship
  35. 35. “online disinhibition effect” • groups of health professionals with similar interests; share resources with colleagues (e.g., the SlideShare website, which allows users to upload and share Powerpoint presentations and other educational materials)
  36. 36. “online disinhibition effect” • “Twenty-first century psychiatric nurse should be able to be a cautious but vigorous participant in the social media revolution”
  37. 37. The giant ship engine that failed? • The ship’s owners tried one expert after another, but none of them could figure but how to fix the engine. Then they brought in an old man who had been fixing ships since he was a youngster. He carried a large bag of tools with him, and when he arrived, he immediately went to work. He inspected the engine very carefully, top to bottom.
  38. 38. The giant ship engine that failed? • Two of the ship’s owners were there, watching this man, hoping he would know what to do. After looking things over, the old man reached into his bag and pulled out a small hammer. He gently tapped something. Instantly, the engine lurched into life. He carefully put his hammer away. The engine was fixed
  39. 39. The giant ship engine that failed? • A week later, the owners received a bill from the old man for ten thousand dollars.“What?!” the owners exclaimed. “He hardly did anything!” • So they wrote the old man a note saying, “Please send us an itemized bill.”
  40. 40. • The man sent a bill that read: • Tapping with a hammer ………………… $ 2.00 • Knowing where to tap ………………………. $ 9998.00 • Effort is important, but knowing where to make an effort in your life makes all the difference.
  41. 41. Take home message • Misconception is a major challenge in mental health even today. • Priorities set in Helsinki Declaration are still remains • Future Roles and Responsibilities are challenge in psychiatric wards • There is a Lack of clinical guidelines in mental health • International network among mental health nurses is a challenge • Recovery-Focused care and Values-based education will helps to overcome challenge in mental health

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