Transcript Inpatient Mental Health Care

Rebecca Sposato MS, RN
MENTAL HEALTH CARE
SETTINGS
The Stats

Ambulatory care
◦ Number of ambulatory care visits (physician offices,
outpatient centers, and emergency departments) with
mental disorders as primary diagnosis: 58.2 million
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Hospital inpatient care
◦ Number of discharges with mental disorders as firstlisted diagnosis: 2.4 million
◦ Average length of stay for mental disorders: 7.1 days
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Nursing home care
◦ Number of residents with mental disorders: 996,000
◦ Percent of residents with mental disorders: 67%
◦ (http://www.cdc.gov/nchs/fastats/mental.htm, 2011)
Diagnostic and Statistic Manual for
Mental Health Disorders-IV
Describes the main features and specific
criteria for mental illness
 Multi-Axis System
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◦ Axis 1 - Clinical Conditions (ex. depression)
◦ Axis II - Personality and Intellectual Disorders
(ex. borderline personality)
◦ Axis III - Medical Conditions ( ex. Diabetes)
◦ Axis IV – Psychosocial or environmental
problems (homeless, estranged from family)
◦ Avis V – Global Functioning (100-0)
Global Assessment of Functioning
100: no symptoms, well-adjusted and
content with life, can take care of problems,
close and meaningful relationships
 75: Symptoms mildly affect quality of life,
problems occasionally emerge, socially
awkward
 50: Symptoms impair quality of life, conflict
with peers, legal/employment issues
 25: Symptoms impair basic life skills, at risk
for danger to self/others, impaired
communication
 1: Hurts self/others, absent life skills unable
to address or communicate basic needs
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Mental Health Professionals
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Registered Nurse◦ care for patient and unit
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Advance Practice Mental Health
Nurse/Clinical Specialist◦ Graduate level education and clinical
◦ Ensure protocols and staff training are up to
date and comply with regulation
◦ Consult for complicated patients
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Nurse Practitioner◦ Manages the physical health and needs of
patients
Mental Health Professionals

Clinical Psychologist◦ Graduate level education and clinical training
◦ Evaluate patients, conduct mental health tests
◦ Direct individual and group counseling
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Psychiatrist: medical doctor
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Prescribes medications and ECT
Referrals for therapy and counseling
Determines admission/discharge
Advocates for legal status
Mental Health Professionals

Case Managers/Social Workers –
◦ Undergraduate and graduate education
◦ Liaisons for patients to obtain and maintain
social services, financial aid, outpatient care
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Therapist /Counselors
◦ conduct treatment sessions, education,
counsel groups, addiction management,
rehabilitation services
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Mental Health Technicians
◦ Assist patients under nursing supervision
Dorothea Dix (1802-1887)
Originally a school teacher
who in 1841 became a
reformer for treatment of
the mentally ill
 Within 10 years visited
>300 jails and >500
almshouses
 Advocated for mentally ill
persons to be removed
from jails/almshouses and
be placed in public hospitals

By 1880, <1% of
prison population
were the mentally ill
http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special, 2011
Deinstitutionalization
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>80% Reduction in state
psychiatric facilities for the
community level
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Contributors
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1950s: anti-psych meds
1960s: civil rights values
1965: Medicare/Medicaid
Kennedy/Carter passed laws
stipulating community
programs
Consequences:
◦ Advent of outpatient mental
health centers and programs
◦ Increase mental illness in
homeless and prison
populations and ED visits
Community Based Mental Health

Biopsychosocial Assessment
◦ Family/Friend resources
◦ Ability to obtain/maintain housing, food,
hygiene, income, employment
◦ Adhere with outpatient mental health
treatment, sobriety, medication schedule, MD
appointment
◦ Plan B for mental illness symptoms
Community Based Mental Health
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Most Acute
Least Acute
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Admission/Observation for crisis
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Partial Hospital Programs
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Psychiatric home care
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Assertive Care Treatments
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Community Mental Health Care Centers
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MD or counselor office level care
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Support Groups
Levels of Preventions

Primary: maintain the mental health of
person and population.
◦ Educate teens about drugs/alcohol
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Secondary: screen and intervene for
impaired mental health
◦ Detox center
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Tertiary: recover and rehabilitate towards
mental health
◦ Support groups for alcoholics
Inpatient Admission

Majority of patients enter mental health
care through the emergency room
◦ Self Referral
◦ Friend/Family
◦ Professional

Criteria
◦ Imminent harm to self
◦ Imminent harm to other
◦ Gravely disabled in care of basic needs
Types of Admission

Voluntary:
◦ patient complies and consents with inpatient
status
◦ Patient may choose to leave prior to completion
of therapy regimen

Involuntary:
◦ Patient may not leave facility
 72hr Mental Health Hold: initiated by police, Clin. Psych,
MD, SW, LPC, APN, BSN (1yr in mental health)
◦ Short Term Certification: up to 60 days
◦ Long Term Certification: up to 90 days
◦ Legal Guardian/Ward of the State
Inpatient Protocols
 Suicide
Precautions and Elopement
Precautions
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Levels of Restriction
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Day passes (overnight passes void inpatient status)
Unaccompanied on grounds
Accompanied by staff
Restricted to unit
Line of sight
Seclusion
Restrained
Inventory Belongings
◦ No weapons, pills, powders, open liquids, cords,
strings, belts, plastic bags, sharp objects
Rights of Mental Health Patients

Additional levels of confidentiality
◦ Exceptions:
 1. warning a third party of intended harm by patient
 2. reporting abuse of a vulnerable person
Right to stay informed/involved in
treatment
 Right to contest care/provider
 Right to humane conditions, recreation,
social interaction, vote, enter contracts
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References

Centers for Disease Control (2011)
www.cdc.gov/nchs/fastats/mental.htm,

Diagnostic and Statistic Manual for Mental
Disorders - IV – Text Revision
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Public Broadcasting Service: Frontline (2011)
www.pbs.org/wgbh/pages/frontline/shows/asylu
ms