2021 COMMUNITY PSYCHIATRY-1.ppt

COMMUNITY PSYCHIATRY rehabilitation

1. COMMUNITY PSYCHIATRIC
NURSING CARE, RX &
REHABILITATION
STUDY UNIT 3.2.1
PRESENTER: MS. TC LISHIVHA

2. INTRODUCTION
Mental illness has always been a neglected area
of health care,
because its economic impact and other results are
not immediately visible
Consumer movements are not new in the field of
mental health.
Since the change in approach in health services in
this country,
which resulted in MHCUs spending most of their
time outside hospitals,

3. INTRODUCTION-CONT
Many of them are in the care of their families
Families have organized themselves to
address their common problems.
MHCUs have become more active
participants in the RX and rehab process
This has led to MHCUs forming support
groups.

4. INTRODUCTION-CONT
Only those persons who have been or who
are treated in the mental health system are
regarded as consumers.
However, families are often involved and
they can also be seen as consumers of the
care as well.

5. LEARNING OUTCOMES
In this study unit you will learn about the following:
Concepts: community psychiatry, community
psychiatric nurse and mental health.
Aims and advantages of community psychiatric
nursing care
Integration of mental health care into primary
health care.
primary, secondary and tertiary prevention of
mental illness.

6. LEARNING OUTCOMES -CONT
Community mental health care needs/profile
Aftercare services for the MHCUs
Aims, phases and characteristics of home visit

7. PRE-EXISTING KNOWLEDGE
Prevention of mental illness and promotion of
mental health in children and adolescents

8. FEEDBACK
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9. CONCEPTS
COMMUNITY PSYCHIATRY
Care and treatment outside the mental
hospital setting.
Concerned with the detection, prevention
and treatment of mental disorders.
Provided in a designated geographical area,
with emphasis on environmental factors.

10. COMMUNITY PSYCH -CONT
It comprises principles and practices needed to
provide mental health services for a local
population by:
1. Establishing population based needs for RX and
care
2. Providing a service system linking a wide range
of resources of adequate capacity, operating in
accessible locations
3. Delivering evidence based treatment to people
with mental disorders

11. CONCEPTS-CONT
COMMUNITY PSYCHIATRIC NURSE
A registered nurse who works in the community as
part of MDT,
Seeing patients with mental health needs in
various settings, e.g.
Clinic, Health Centre or a client’s home
Works closely with the community doctor and other
MDTs as well as carers
Providing practical advice, ongoing support,
supervising medications, counselling and giving
injections

12. CONCEPTS-CONT
MENTAL HEALTH
According to WHO:
A state of well-being in which a person realizes own
abilities,
Can cope with normal stresses of life
Work productively and fruitfully
Make contributions to the community
Adapt successfully to stressors from the internal or external
environment
evidenced by: thoughts, feelings and behaviors that are
age appropriate and
congruent with local and cultural norms.”

13. AIMS OF COMMUNITY PSYCHIATRIC SERVICES
To maintain MHCU in the community
Involve the community in the care and support of
its emotionally disturbed members
Assist the user and the family to function at an
optimum level in their home and in the community
Liaise with the hospital based services to provide
continuity and aftercare
Prevent hospitalization
Reduce the need for lengthy rehabilitation as the
user remains in the normal environment

14. AIMS OF COMMUNITY PSYCHIATRIC SERVICES -
CONT
Give advice and information on mental health
problems
Reduces stigma to mental health
Prevent family and work disintegration and
conversation of social priorities
Re-integrate and rehabilitate the MHCU in the
community after discharge
Prevent serious psychiatric breakdown by
attending to psychiatric emergencies and crisis
intervention
Promote MH in the community by improving
socio-economic status of community members

15. OBJECTIVES OF COMMUNITY PSYCHIATRIC
SERVICES
To prevent mental illness and promote mental
health
Promotion of community involvement
To ensure effective and continuous care
To ensure re-integration and rehabilitation of
MHCU in the community after discharge
To ensure that psychiatric services are accessible
for all community groups
To remove the stigma by maintaining the MHCU in
the community

16. OBJECTIVES OF COMMUNITY PSYCHIATRIC
SERVICES-CONT
To implement a reliable program of drug
administration and drug withdrawal
To ensure adequate and prolonged follow up
To render maximum service with minimum output
To evaluate and plan for future needs increased
accessibility to mental health care services

17. ADVANTAGES OF COMMUNITY CARE
Identify potential consumers
Problems are dealt with
in the same environment where they caused the
difficulties
and where the person will continue to live
oSocial and family networks are maintained
oIndependence and autonomy are maintained
oReduces the stigma associated with mental health
problems
It is effective , acceptable and safe compared to
hospital based care

18. COMMUNITY MENTAL HEALTH CARE
NEEDS ASSESSMENT
1.SOCIAL INDICATORS
Statistics found in public records and report,
correlated to poor mental health outcomes
Income determining financial status suggesting
the community in poverty
Marital status suggesting the need for marriage
guidance services incase of divorce, separation
and single parents
Population density suggesting overcrowding
which needs housing service

19. COMMUNITY MENTAL HEALTH CARE
NEEDS-CONT
Crime and substance abuse suggesting youth
service, preventive programs and education to
reduce these problems
2. KEY INFORMANTS SURVEY
People who are knowledgeable about community
needs-public officials-sw, phcp
They determine the need for services and
programmes for the community
May suggest programme development and
interventions for people at risk -elderly

20. COMMUNITY MENTAL HEALTH CARE
NEEDS-CONT
3. COMMUNITY FORUMS
Are invited to public meetings for mental health
needs in the community suggesting services such
P,S and T prevention services for high risk groups
like adolescents, children and elderly
4. EPIDEMIOLOGICAL STUDIES
Determine the incidence and prevalence
Extent of impairment which indicate the number of
people affected and those at risk is determined

21. COMMUNITY MENTAL HEALTH CARE NEEDS -CONT
The study may suggest:
high risk group
Programme development
interventions needed like services for:
elderly living alone
Pre-adolescent females living in single parent
household and poverty
Corrections of poverty, single parent problems
oIntervention may need primary, sec and tertiary
prevention activities

22. INTEGRATION OF COMMUNITY PSYCH
SERVICES INTO PHC
BENEFITS OF INTEGRATING MENTAL HEALTH INTO PHC
Improve coverage of population
Reduce health care costs since it will be
provided by clinic staff
Service will be close to consumers
More accessible and economical
Rehabilitation of MHCU will improve as
families will be involved in RX

23. CURRENT ISSUES IN THE PROVISION OF
PSYCHIATRIC SERVICES
In most setting these services are provided by
specialized team visiting clinics on specific days
The team is based at the hospital
In other settings CHN offer the psychiatric
services, but at specific times
The social worker may assist in disability grant
Services consist of medication supply for the
MHCU, to assess its effectiveness and refer for
admission if necessary
No case finding, rehab or primary prevention
activities are involved

24. CURRENT ISSUES IN THE PROVISION OF
PSYCHIATRIC SERVICES -CONT
If the MHCU comes outside the times set for
psychiatric services, he/she attended or not since
the team will be gone
When a new MHCU come to the clinic, he/she is
referred to the hospital for assessment

25. PROBLEMS RELATED TO TRANSFORMATION
Current staffs’ lack of skills & knowledge esp
community based approach
Inadequate primary health care system
Poor provision of quality psychiatric care in
hospitals (understaffed, far from homes)
MHCU receives only custodial and chemical RX
Patient-staff ratio is high in our country
Staff negative attitudes towards MHCUs and their
care. Cooperation of users may be difficult
Difficult to convince policy makers of the
importance of additional resources into MHC
Scope of practice of a professional nurses

26. COMPREHENSIVE MENTAL HEALTH CARE
DEF:
Refers to the services that address all the health
problems of persons in terms of lifespan
From the person is born till death
It also looks into perspective of the process of
illness
It is in terms of from before illness comes to after it
has disabled a person
It includes primary, secondary and tertiary
prevention

27. LEVELS OF PREVENTION
1.PRIMARY PREVENTION
DEFINITION
Aimed at decreasing the incidence of psychiatric
morbidity in the community
This includes illness prevention for people who
are healthy

28. MECHANISMS PROTECTING MENTAL
HEALTH
1.Those that involve a reduction in the personal
impact of risk experiences
E.g. the risk that divorce holds for children can be
diminished by not drawing them into the conflict
around the marriage break-up
2. Those that reduce negative chain reactions
E.g. debriefing of a group after a traumatic
experience
Teaching adolescents social skills, which allows
them to deal with conflict by using humor

29. MECHANISMS PROTECTING MENTAL HEALTH -
CONT
3. Those that promote self-esteem and self-efficacy
E.g. feeling good about yourself
Ability to handle life
4. Those that open up positive opportunities
E.g. opportunities for education and sports that
takes young people away from stressful, deprived
and crime ridden environment
5. Those that develop and maintain healthy
communities
E.g. living in safe environment, with good
employment and minimal violence

30. THREE APPROACHES TO PRIMARY PREVENTION
1.THE HEALTH PROMOTION APPROACH
It targets the total population of a region
Aims to deliver a message in measures to prevent
a disease or promote health
Appropriate in the FF circumstances
When there is reliable evidence that the target
factor causes at least one disease
e.g. smoking causes lung cancer
When the disorder either affects a large number of
people e.g. Ebola
Or it affects a relatively small number of people, but
it is usually fatal. E.g. swine flu

31. THE HEALTH PROMOTION APPROACH -CONT
When the disease is serious and the necessary
prevention strategy is simple enough and cheap
enough to be implemented on a wide scale. E.g.
stopping smoking
When those not at risk will not be harmed by the
prevention strategy. E.g. not wearing protective
clothing does not harm anybody

32. HIGH RISK APPROACH
It targets individuals who may be susceptible to a
specific disorder, and identified by etiological
research
Appropriate in the FF circumstances
The important risk factors for a disorder are known
The group at risk can be identified relatively
cheaply and easily
The prevention strategy is too difficult or too
expensive for the whole population

33. LIFE SKILLS APPROACH
Focuses on the transition from one life stage to
another
Strives to help people cope with demands of each
successive stage
E.g. preschool to adolescence, leaving home and
young adulthood, parenting, retiring
A teaching approach which can be used
successful with the total population or with the
high risk approach

34. SECONDARY PREVENTION
Aims to decrease the prevalence of psychiatric
disease through early diagnosis and effective
treatment
Gate keeper approach used to teach the public
Nurses working in PHC setting help in case finding
Referrals are made for people with possible
psychiatric problems

35. TERTIARY PREVENTION
It involves recovery and rehabilitation
Intensive and sustained efforts are necessary to
rehabilitate MHCUs
Psychosocial rehab is of utmost importance to
improve the normal functioning of MHCUs
Central to rehab is the re-integration of MHCU into
the community

36. MEANINGS OF RECOVERY
1. Clinical recovery
The patient is in a long-term remission
Symptoms are greatly reduced or even removed,
the person being functional
Can be measured, between 46% and 68% of
schizophrenia
2. Personal recovery
Deeply personal, unique process of changing
one’s attitude, value, feelings, goals, skills
and roles so that one can live a satisfying hopeful
and contributing life even with limitations caused
by illness

37. SERIES OF STAGES INVOLVED IN THE RECOVERY
PROCESS
Moratorium-the person is confused, in denial and
withdraws to protect himself
Awareness-the first glimmer of hope of recovery
is triggered by a role model, a clinician, a
significant other or from within
Preparation-the person decides to work towards
recovery
Finding his own pathway and doing what is
necessary
Rebuilding-the person forges a new identity
Sets new goals and strives towards them
Reassesses old values

38. SERIES OF STAGES INVOLVED IN THE RECOVERY
PROCESS-CONT
Takes responsibility for managing the illness and
controlling life
There is a growing acceptance of risks and
setbacks
Growth-the person manages the illness
Has a positive view of self and hope for the future

39. CHARACTERISTICS OF RECOVERY -FOCUSED MH
SERVICES
A TABLE-PRINCIPLES AND DESCRIPTION -G1
PAGE 52 UYS & MIDDELTON
A TABLE-DIFFERENCES BETWEEN
REHABILITATION AND TREATMENT -G2
PAGE 53 UYS & MIDDELTON

40. PSYCHOSOCIAL REHAB TECHNOLOGY
-REHAB INTERVENTIONS -G3
Increasing skills-general life skills or specific
vocational skills for patient or family to prevent
stress
Increasing support-material assistance and
psychosocial support from the family to prevent
breakdown
Manipulating resources-advocating for patient
so that changes are made for services to fit the
patient or marketing the patient to the service
Optimizing symptom control-through
medication and psychotherapy

41. PSYCHOSOCIAL REHAB TECHNOLOGY REHAB
INTERVENTIONS-CONT
Education of the general public
reintegration of the patient into the society
depends on the public attitudes
Changes in attitude need to be addressed to
increase support for the patient and family by the
society

42. BASIC ELEMENTS OF REHAB -G4
Psycho-education-an intensive and responsive
teaching process
Taught about illness, its RX and management to
cope better with community-based care
Case management-aimed at assessing the
needs, linking the person to services and
coordinate those services
There are different models of case management
Skills teaching-teaching of skills required in
social, vocational and living environment of the
patient

43. BASIC ELEMENTS OF REHAB -CONT
Vocational rehab-enables the person to secure
and retain suitable job with satisfactory progress
Works for minimum wages with non-disabled co-
workers
With ongoing support and a negotiated working
conditions
Appropriate housing-should suit the person’s
needs and lifestyle
From group homes to single accommodation

44. IMPORTANCE OF TERTIARY SERVICES TO A
DISCHARGED MHCU
To ensure supervision and support to MHCU to
take RX, prevent relapse and early diagnosis of
relapse
To improve the MHCU’s self-esteem and
independence, ability to manage own problems,
develop coping skill and cooperation with others
To improve MHCU’s physical, social and emotional
well-being i.e. involve in activities like cleaning and
recreation to improve self-concept

45. IMPORTANCE OF TERTIARY SERVICES TO A
DISCHARGED MHCU -CONT
To provide social skills training to improve
symptoms and negative behavior like anger,
aggression and manipulation
To provide social support to the MHCU and the
family e.g. assist with social grant, food parcels
and housing if needs be
To reduce long term hospitalization and promote
home-based and community care
To provide vocational training and prepare the
user for employment opportunities to improve
user’s economic independence

46. AFTERCARE SERVICES -GROUP 5
1.Half-way house
Situated outside a hospital to prepare the user for
discharge after long term hospitalization
To improve social skills by interacting with fellow
users, community members and volunteer workers
Benefit in self-help skills .i.e. cleaning, ironing,
gardening and painting
Involved in self-care habits-to organize their living
environment, arranging furniture etc.

47. AFTERCARE SERVICES -CONT
It boosts the user’s self-worth as he becomes able
to initiate and finish self-allocated tasks
Training in vocational skills is offered e.g.
woodwork, shoe repair in order to gain economic
independence
2. Day Care Centre
A center rendering aftercare service for discharged
user form the hospital or halfway house
For a user who sleep at home and come to the
Centre during the day only

48. AFTERCARE SERVICES -CONT
Help in rendering psychotherapy, occupational
therapy, socialization and observation by staff
User interact with staff, to improve their emotional
well-being, learn to love and tolerate others
Foster compliance to RX and self-management of
medication side effects
Improves vocational skills. e.g. beadwork,
woodwork in preparation for employment
It modifies negative self-perception and improves
self-control
Improves self-knowledge, self-esteem and
independence

49. AFTERCARE SERVICES -CONT
3. Night Care Centre
Accommodates the user at night while during the
day they are at work to generate income
4. Foster family care
Temporary placement by social welfare or by a
child welfare agency
5. Outpatient clinic
For referral for assessment, diagnosis and RX
Render follow up services for recently discharge
user

50. AFTERCARE SERVICES -CONT
6. Community mental health clinic
Provide diagnosis and treatment
Assist with the orientation of the user into the
community
7. Sheltered workshop-for ID persons
8. Homeless shelters
9. Health care centers and warehouse
10.Mobile outreach clinic

51. HOME VISIT
AIMS/OBJECTIVES OF HOME VISIT -GROUP 6
To assess the mental state of the user
To assess the general health care of the user
To assess user’s compliance to treatment
For appraisal of the user’s and his family’s socio
economic position
To assess the user’s functioning in the family
To assess any communication problem
If the user’s behavior is dangerous to self, family
and community

52. AIMS/OBJECTIVES OF HOME VISIT -CONT
To check the available community resources to the
family
To identify if the user has defaulted
To offer support to the family regarding MHCU
To identify if there is a crisis to intervene
To encourage and motivate the user and his family
to participate in RX programme
To educate family and public to understand, accept
& cope with mental illness
For continuity of care
To clarify any myths
To assess acceptance by the family

53. PHASES OF HOME VISIT-GROUP 7
Orientation phase
Working phase (identification)
Working phase (utilization)
Resolution phase
A TABLE-PAGE 302 UYS & MIDDLETON

54. CHARACTERISTICS OF HOME VISIT -G7
It must take place according to a protocol, which
should be developed based on the objectives of
services and the need of the user
It should make provision for adequate
communication and empathy
The visit should be client centered and
individualized
If possible it should include family or caregiver
There should be follow up to monitor compliance
with advice and referrals
Client’s privacy should be maintained

55. SUMMARY
Community psychiatric services involve identifying
individuals, and groups of people who are at risk
to develop mental disorders for early detection and
RX.
Interventions for these groups by means of mental
health promotion programs which assist in
promoting and preventing mental illness

56. GROUP WORK -G8
The procedure for conducting a home
visit concentrating on:
1. Preparation
2. On arrival at the visit
3. On arrival back at clinic
Study advantages of home visit-G6

57. REFERENCES
Townsend MC. Psychiatric Mental Health Nursing.
Concepts of care. Philadelphia : F.A Davis
Company.
UysL & Middleton L. Mental Health Nursing.A
South African Perspective. Cape Town: Juta.
Stuart, G.W. and Sudeen, S.J.The Principles of
Psychiatric Nursing.
Taylor, C.M. Essentials of Psychiatric Nursing
NB: USE LATEST EDITION

58. THANK YOU!
NOW THAT MY JOB IS DONE, YOU
SHOLD DO YOURS!!
SEE YOU IN THE NEXT CLASS!!!