Challenges to the Treatment of a Vulnerable Population - Essay Example

Challenges to the Treatment of a Vulnerable Population Purpose of this Paper Patients diagnosed with different mental illnesses are treated in various types of care settings. These include full time hospitals and residential care facilities for persons with psychoses such as schizophrenia, and mental health care outpatient settings for those with mood disorders and other conditions (Aday, 2001). The purpose of this paper is to investigate the challenges presented in the treatment of this vulnerable population of mentally ill persons. These include advocacy at the legislative level, financial funding for resources, delivery of adequate mental health nursing and other interdisciplinary care, and reduction of stigma related to mental illnesss, at the local, state or national level. The Mental Health Issue The treatment of mentally ill people is confronted with numerous obstacles. These have to be overcome, to facilitate the effective and speedy treatment of the mentally disabled. “Populations at risk of poor physical, psychological or social health” (Aday, 2001, p.15) are termed as vulnerable populations, and they include the mentally ill and disabled. Those who experience neuroses and psychoses, or cognitive impairments such as mental retardation, constitute the mentally ill and disabled. Reason for Choosing the Issue The magnitude of the prevalence of mental illness in the United States is high, with almost 50 percent of Americans having experienced a mental health problem at some point in their lives. From 7 to 10 million Americans have serious mental health conditions which constitute emotional disorders that adversely affect even their primary self-care activities and inter-personal relationships, consequently requiring prolonged mental health care (Aday, 2001). The various challenges pose a threat to the treatment of the vulnerable population, and consequently prove detrimental to patient outcomes. Rationale for Position on the Issue The rationale for the psychiatric nurses’ position on overcoming the challenges to treatment is that, with increasing prevalence of mental illness, urgent action at various levels and dimensions is crucial. Effective measures are required towards ensuring beneficial outcomes for the patients, care givers as well as the society. Specific initiatives to overcome the challenges include: to improve the knowledge and advanced mental health training of nurses; ensure adequate Medicaid and Medicare reimbursements to mental health care facilities; support legislative changes helping ealier recovery of mentally ill patients; and to remove stigma associated with mental illness (Katz et al, 2003). Two Causes of the Issue Two causes are: lack of nursing staff with adequately advanced level knowledge and training (Kutney-Lee & Aiken, 2008), and legal permission for people with low levels of mental illness to continue living in their own homes within the community, with access to outpatient treatment in hospitals (Fletcher & Holt, 1995). Consequently, due to inadequate mental health nurse competency, there is a lack of adequate provision of care; and in the second case: protection of the patient’s autonomy while promoting the patient’s welfare, is difficult for nursing staff. Relevance to Nursing Practice of Overcoming Challenges to Treatment It is important to raise the effectiveness and efficiency of mental health care nursing. Kutney-Lee & Aiken (2008) studied the effect of nurse staffing and education on surgical patients with and without serious mental illness. The study examined effects of patient to nurse ratios and nurses’ education levels on the results which included death within 30 days of admission, death resulting from surgery complication, and the length of hospital stay. The authors integrated cross-sectional data from a research survey conducted on nurses, and from patient and administrative records. The evidence indicates that a higher level of nurse staffing resulted in greater prevention of death among patients with serious mental illness, than among those without it. The presence of greater numbers of baccalaureate-prepared nurses resulted in shorter hospital stays for patients with serious mental illnesses. Thus, the researchers concluded that increased staffing of nurses and higher education level successfully helped to achieve improved patient outcomes among highly vulnerable patients with serious mental illness (Kutney-Lee & Aiken, 2008). Impact on the Mentally Ill Treatment in care facilities for the mentally ill, frequently includes limiting the client’s freedom. According to Nursingtimes (1 April, 2009), the implementation of new legislation brought in, will help to protect against lack of adequate treatment, abuse and poor care, of vulnerable, mentally ill persons in hospitals and care homes. The government’s new Mental Capacity Act Deprivation of Liberty Safeguards states that a mental health care facility will be required to seek permission from their local primary care trust or council, to deprive a patient of liberty, for the individual’s own safety. Impact on Society Recent changes in health care and reimbursement have included the area of mental health treatment. Legally, the total deprivation of liberty and detention in hospital is imposed on only the very minimum number of patients. The government attempts to protect the welfare and rights of mentally ill patients, while reducing the risk posed by the clients either to themselves or to others (Fletcher & Holt, 1995). Inpatient treatment is usually the last recourse for mental illness. Contemporary treatment is increasingly based on cost effectiveness and benefits of the clients remaining in the community, and receiving out patient treatment whenever possible (Videbeck, 2005). Two Existing Services or Resources Relevant to the Issue It is essential for nurses to know about community agencies that offer a variety of health and social services for vulnerable populations such as the mentally ill. Nurses provide information and access to health services, make appropriate referrals, and also ensure that the required outcomes are achieved by following up on the client’s case. Two of the numerous resources available are: community mental health centres, and church sponsored health and social service assistance (Stanhope & Lancaster, 2004). Recommendation for Nursing Practice Case management in nursing involves linking vulnerable clients with services, and providing direct nursing services such as teaching, counseling, screening, and immunizing. “Nurses should work with clients to help them identify their own personal strengths” (Stanhope & Lancaster, 2004, p.767), and educate patients on using their own strengths to manage their health needs. Personal coping skills and social supports are important resources that the client needs to use. Nurses can offer guidance and teach resourcefulness and creativity to develop and maintain these resources. This can be done, although social isolation is a problem for vulnerable mentally ill clients, since non-availablility of help should not be assumed by nurses. Recommendation to Benefit the Mentally Ill The mental health care system emphasizes service quality, for the benefit of the clients. Howard et al (2007, p.257) conducted a study to measure “service satisfaction, perceptions of service quality and general health, and overall quality of care” among 787 mentally ill clients who received treatment from Medicaid mental health services. Though the survey respondents were satisfied with consumer-provider relationships, they were dissatisfied with functional outcomes resulting from treatment. Functioning that sustains employment and promotes social connectedness is a crucial outcome of recovery from serious mental illnesses such as schizophrenia (Schooler, 2006). Coordination of services is recommended, to benefit the mentally ill by promoting patient functioning. Integration of service components such as family and community resources in an outpatient setting is required to help clients “function adequately at school, at work and in social situations” (Howard et al, 2007, p.267). The measurement of client satisfaction would be taken as an indicator of quality. Recommendation to Benefit Society It is recommended that program development and practice approaches towards treatment and care of the mentally ill, should involve a multidisciplinary team including nurses and social workers (Koppelman, 2004). This will ensure best outcomes in terms of patient satisfaction and integration into society. Such a measure would ultimately lead to a normal, peaceful society composed of contributing members including those recovered from mental conditions. This would promote savings in terms of nursing care, social service, family responsibilities towards their patient’s care, and support provided by local organisations/ resources for the mentally ill placed in a community setting. How the Nurse and Interdisciplinary Team Can Address this Recommendation Medication management is an important aspect of advanced mental health nursing practice. However, further collaboration with other members of the treatment team “such as social workers and case managers” (Howard et al, 2007, p.267), as well as medical practitioners, and psychiatrists is vital. Collaboration promotes optimal client functioning in all aspects of working, social and home environments, towards client satisfaction. Specific Recommendations to Improve all Aspects of Mental Health Care Both administrators and policy makers in the government should focus on developing outcome monitoring systems that measure quality of service in a systematic and reliable way (IOM, 2006). It is equally important to establish models that identify standards for progress, at treatment delivery sites. The basic criteria to measure quality of service should include symptom changes, quality of life, cost of care, functional status, consumer satisfaction, and comorbid medical problems. Instruments such as the KY-CSI (Continual Service Improvement) and the MHSIP (Mental Health Statistical Improvement Project) when used in combination, measure important outcomes, such as “complex dimensions of treatment environment, affiliation/ esteem, goal attainment, accessibility, appropriateness, and other outcomes” (Howard et al, 2007, p.268). References Aday, L.A. (2001). At risk in America: the health and health care needs of vulnerable populations in the United States. Edition 2. Jossey-Bass Health Series. New York: John Wiley and Sons. Fletcher, N. & Holt, J. (1995). Ethics, law and nursing. The United Kingdom: Manchester University Press. Howard, P.B., Rayens, M.K., El-Mallakh, P. & Clark, J.J. (2007). Predictors of satisfaction among adult recipients of Medicaid Mental Health Services. Archives of Psychiatric Nursing, 21(5): pp.257-269. Institute of Medicine (IOM). (2006). Improving the quality of health care for mental and substance use conditions. Washington, DC: National Academies Press. Katz, P.R., Mezey, M.D. & Kapp, M.B. (2003). Vulnerable populations in the long term care continuum. The United States of America: Springer Publishing Co. Koppelman, J. (2004). The provider system for children’s mental health: Workforces capacity and effective treatment. National Health Policy Forum, Issue Brief No. 801, Washington, DC. Kutney-Lee, A. & Aiken, L.H. (2008). Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness. Psychiatric Services, 59: pp.1466-1469. Nursingtimes. (1 April, 2009). New legislation aims to protect vulnerable people with mental health problems. Retrieved on 2nd October, 2009 from: http://www.nursingtimes.net/whats-new-in-nursing/mental-health/new-legislation-aims-to-protect-vulnerable-people-with-mental-health-problems/2007755.article Schooler, N.R. (2006). Relapse prevention and recovery in the treatment of schizophrenia. Journal of Clinical Psychiatry, 67(Supplement 5): 19-23. Stanhope, M. & Lancaster, J. (2004). Community and public health nursing. Edition 6. The United States of America: Elsevier Health Sciences. Videbeck, S.L. (2005). Psychiatric mental health nursing. Edition 3. The United States of America: Lippincott Williams & Wilkins. Read More