2. Why the need for Behavioral Services?
Behavioral Health Services is a needed assessment because patients must be
checked to see if they are receiving the proper treatment. Treatment must be
made available for all those in need of help and assuring that the adequate
treatment is being given helps not just the individual, but the community as well
by maintaining safety. Behavioral health services surveillance is a “critically
important part of disease prevention and control” because it is often associated
with other comorbidities and chronic medical conditions (CDC Report: Mental
Illness Surveillance Among U.S. Adults, 2013).
3. Existing Behavioral Services and Health
Access in Nueces County
According to the BHCNC website, The BHCNC eligibility criteria includes the following:
Residents of Nueces County, children ages birth to three with developmental
disabilities, youth ages 3-17 with diagnosis of mental illness who exhibit serious
emotional behavioral or mental disorders, individuals with intellectual disabilities,
autism or pervasive developmental disorder, and individuals with severe and persistent
mental illness such as schizophrenia, bipolar disorder, major depression, or other. The
BHCNC is obviously an important and vital resource available to Nueces County. The
services the BHCNC provide include crisis hotline/screening intervention, mobile crisis
outreach team, assertive community treatment, assertive rehabilitation treatment,
cognitive behavioral therapy, crime victim services, medication management, mental
health first aid, patient navigation services, psychosocial rehabilitation, case
management and skills training, supported employment, veteran support services, and
youth mental health services.
4. Local (Corpus Christi) and regional (Coastal Bend Area)
statistics on bipolar disorder, major depressive disorder, suicide
rates, SIDS, and congenital defects.
The Behavioral Health Center of Nueces County 2015 annual report findings indicates a total of 5,000
adults were seen with serious mental illness including bipolar disorder and major depressive disorder. In
2015 the adult population was approximately 243,000 which means about 2.1% of the adult population
was treated in Nueces County for a serious mental illness.
About 15% of patients who have major depression or bipolar disorder complete suicide (Halter, 2013, p.
481). According to the Centers for Disease Control and Prevention (CDC), in 2015 suicide was the tenth
leading cause of death overall in the United States, claiming the lives of more than 44,000 persons.
Suicide was the third leading cause of death among individuals between the ages of 10 and 14, and the
second leading cause of death among individuals between the ages of 15 and 34. Over the past 15 years,
the total suicide rate has increased 24% from 10.5 to 13.0 per 100,000 in the United States.
Parents should be educated about factors that put a child at risk for SIDS. If the parents lose a child due
to SIDS, the nurse should expect to collaborate with a social worker and chaplain. The nurse should
provide calm and compassionate care. For the child with congenital defects, the nurse should plan to
educate the parents about the defect and management.
5. What are the nursing implications for these
statistics- both locally and nationally?
The nursing implications for these statistics locally and nationally would be a primary
and secondary intervention approach. Educating about risk factors, early detection, and
management can help prevent some of these disorders and obtain the proper care for
the disorders that are not able to be prevented. For bipolar disorder, the implications
are based on what phase of mania the patient is in which is acute, continuation or
maintenance.
The patient should be assessed for risk of suicide, risk of violence to self and others,
substance abuse and risk-taking behaviors. For patients with major depressive disorder,
the nurse must assess for suicide risk, self-care and maintenance of safe environment.
Patients that are at risk for suicide should be assessed for a suicidal ideation/plan,
stressful life events and the transition post-hospitalization after an attempt
6. Discuss the concern of specific
populations with mental illness
Young adults with mental illness
Some considerations with young adults and mental illness is that
often young adults experiencing mental illness manifestations are
dismissed or ignored as the young adult just going through puberty.
They may go undiagnosed if they do not speak up or if family
members don’t speak up for them. It is approximated that “one in
five adolescents has a diagnosable mental health disorder.”
(dualdiagnosis.org) Most of the illness’s in regards to substance
abuse and mental illness/health disorders as stated by
dualdiagnosis.org “have roots or can be identified before age 14.” It
is important as family members that we speak up and try to find help
or help the patient if mental health disorders are suspected. Lack of
knowledge on both the parents, siblings, other family members, and
the patient themselves is a big concern in that they might not be
getting the help they need. Early diagnosis will help provided and
achieve the best outcome for the patient since it will allow the
medical team to begin treatment immediately.
Seniors (age 65+) who often
suffer with mental illness
Considerations for the elderly have a wide range of variety of mental
illness that can occur. Some stemming from childhood, genetics, and
others developed later with age, illness, comorbidities, or
environmental/situational triggers. A few mental illness to name
would be dementia, depression, anxiety, substance abuse, delirium,
and Alzheimer's. With elderly adults it is also best to diagnose asap to
be able to provide care to achieve the best therapeutic outcome for
the patient while maintaining their safety and the safety of others.
Many of the challenges the elderly face is their loss of independence,
needing assistance to perform ADL’s/ IADL’s, having to adjust to new
lifestyle changes, no support system, and living at home alone. Any
mental illness can further contribute to the patient isolating
themselves. If the patient is already isolated or has no support system
they may go undiagnosed and untreated from a lack of unreported
issues. They may neglect their needs and resulting in further
deterioration of their mental health.
7. What is the nurses’ role in working
with these populations?
Working in the mental health setting as nurses we should be able to provide nursing care for our patients as well
as respecting their biological, social, psychological, and spiritual needs when caring for our patients. Our
assessments should consists of subjective/objective data, physical exams, observation of patient interactions with
others, P&H, and assessing their mood and affect. Many “young adults experience some of the same mental
illness as adults but are not always easily diagnosed due to lack of the ability or necessary skills to describe what is
happening (ATI, 2016, p6)
For young adults when assessing for risk for mental illness as stated by ATI, the nurses should be using HEADSS
which is assessing their Home, Education/Employment, Activities, Drug and substance abuse, Suicide/depression,
Savagery. (ATI, 2016, p4) This assessment will help the health-care team have a better understanding of the
patient and what risk factors they may have for mental illnesses. For the elderly some of the assessment tools that
a nurse can use is the “Geriatric Depression Scale, CAM, Mini Mental State Exam, and for pain they can use Pain
Assessment in Advanced Dementia Scale.” (ATI, 2016, p5) It is important that if the nurse suspects a mental illness
that she/he is an advocate for the patient and voice their concern to the PCP. As nurses we also want to help
provide information support groups, home health if needed, patient care, nursing home setting, social worker, and
help meet any other need the patient may require.
8. Who are the stakeholders (those who care about the issue)
regarding access to mental health care for community
members, and what do they care about?
Stakeholders are organizations or
professionals who strive to make a
difference. If you have a mental health
illness, you can refer to online resources
such as DBSA, NAMI, and Mental Health
America to name a few or call for any
guidance or help. They focus on the care
not only of the patient, but of the families
of the patient and their well being.
Prioritized populations and subgroups
that stakeholders intend to benefit from
the effort
There are two categories the stakeholders
generally benefit from. Those that are
directly experiencing the problem and
those at risk and who contribute to the
problem through their actions or lack of
actions. It’s important to see it from the
patient’s point of view and what they are
experiencing and feeling through their
illness and what their family or friends
experience from that person’s illness.
9. Barriers or resistance to solving the problem or achieving the
goal (e.g., denial or discounting of the problem) and how they
can be minimized (e.g., reframing the issue).
Barriers to Mental Health Treatment: Results from the National Comorbidity
Survey Replication, was a study conducted to identify existing barriers and
resistance for individuals with mental health disorders. The barriers noted in the
survey included low perceived need for treatment, down playing illness, stigmas,
negative experiences with treatment and providers; perceived lack of response to
treatment modalities; lack of time and resources (Mojtabai et. al, 2011). To address
these barriers public education initiatives should be implemented to increase
mental health awareness. In addition to these programs, efforts to reduce societal
stigmas, time and financial restraints should be addressed (Mojtabai et. al, 2011).
10. Community context or situation that might
make it easier or more difficult to address this
issue.
Stigma can make it difficult for someone to address the issue because they may feel
embarrassed or ashamed of their symptoms and choose not to seek help. They may
also be in a financial situation and are unable to afford treatment because therapy can
be costly; however, some community health centers offer therapy at little or no cost
making it easier for the individual to address their issue. Clients in need of mental
health services may avoid seeking treatment due to the fear of being labeled or being
treated differently due to their mental health issues.
However, if the community is open to the patient’s situation and there is no
discrimination or unfair treatment, this barrier would not exist. Education from the
community health center about mental health should be provided not only to those
with mental health needs, but also those who are considered mentally healthy. By
understanding the mental health diagnoses and symptoms, people will see the disease
and treat the patient without discrimination
