CHAPTER 31

Serious Mental Illness

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Those most deeply affected by psychiatric

d.o.s

Severe forms of depression

Panic disorder

OCD

Schizophrenia

Schizoaffective d.o.

Bipolar d.o.

SERIOUS MENTAL ILLNESS

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Affects 5% to 7% of U.S. population

Presents difficulties in multiple areas

Chronic or recurrent

Patients at risk for multiple physical, emotional,

and social problems

Difficulties in a wide range of functions

SERIOUS MENTAL ILLNESS

(SMI)
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Before deinstitutionalization, psychiatric

hospitals were long-term residences

Patients became dependent on services and

structure and were unable to function
independently

OLDER ADULTS WITH SMI

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Limited experience with formal treatment

Contribute to a cycle of treatment, brief

recovery, and relapse

Additional problems, such as increased

frequency of relapse, legal difficulties,
homelessness, substance abuse, and
unemployment

YOUNG ADULTS WITH SMI

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Rehabilitationfocuses on

Managing patients deficits

Helping them learn to live with their illness

Recoveryfocuses on

Achieving goals of patients choosing

Leading increasingly productive and meaningful

lives

REHABILITATION VERSUS
RECOVERY
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Establishing a meaningful life

Comorbid conditions

Physical disorders

HTN, obesity, cardiovascular disease, diabetes

Increased risk for premature death

Depression and suicide

Substance abuse

ISSUES CONFRONTING THOSE

WITH SMI
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ISSUES CONFRONTING THOSE WITH SMI

(CONT.)

Social problems

Stigma: the proprensity to view and respond to others

negatively based on a belief that they possess undesirable
traits

Isolation and loneliness

Victimization

Economic challenges

Unemployment and poverty

Housing instability

Caregiver burden

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

ISSUES CONFRONTING THOSE WITH SMI

(CONT.)

Treatment issues

Nonadherence

Anosognosia: the inability to recognize ones deficits due to

ones illness

Medication side effects

Treatment inadequacy

Residual symptoms

Relapse, chronicity, and loss

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Comprehensive community treatment

Community services and programs

Psychiatric or medical-somatic services

Case management

Medication monitoring

Assertive community treatment (ACT)

Day programs

Crisis intervention services

RESOURCES FOR PERSONS

WITH SMI
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RESOURCES FOR PERSONS WITH SMI

(CONT.)

Community services and programs

Emergency psychiatric services

Group and individual psychotherapy

Housing services

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Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

RESOURCES FOR PERSONS WITH SMI

(CONT.)

Partial hospitalization programs (PHPs)

Guardianship

Community outreach programs

Substance abuse treatment

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Assertive community treatment (ACT)

Cognitive-behavioral therapy (CBT)

Cognitive-enhancement therapy (CET)

Family support and partnership

EVIDENCE-BASED TREATMENT
APPROACHES
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EVIDENCE-BASED TREATMENT
APPROACHES (CONT.)

Social skills training

Supportive psychotherapy

Vocational rehabilitation and related services

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OTHER POTENTIALLY BENEFICIAL

SERVICES OR TREATMENT
APPROACHES

Advance directives

Consumer-run programs

Wellness and recovery action plans (WRAP)

Technology

Exercise

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Assessment strategies

Nursing diagnoses (Table 31-1)

Intervention strategies (Box 31-2)

NURSING CARE OF PATIENTS

WITH SMI
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Mandatory outpatient treatment

Outpatient commitment

Criminal offenses and incarceration

Transinstitutionalization the shifting of a person or

population from one kind of institution to another (ie from
state hospital to jails, prisons, nursing homes, or shelters

CURRENT ISSUES
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1.

James Holmes was the shooter at the Batman

premiere in Aurora, Colorado, in 2012. Do
you think this incident contributes to the
stigma of mental illness in our society?

A. Yes
B. No
C. Not sure

AUDIENCE RESPONSE
QUESTIONS
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Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2.

The focus of the clubhouse model of treatment is

A. stabilizing and preventing crises.

B. conducting research studies in the
community.
C. providing socialization and building
independence.
D. intensive treatment of severe and
persistent mental illness.

AUDIENCE RESPONSE
QUESTIONS
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19

3.

Can we, as a society, conclude that the

deinstitutionalization movement related to care
of persons with serious mental illness was
successful?

A. Yes
B. Partially
C. No
D. Not sure

AUDIENCE RESPONSE
QUESTIONS
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