Home-BasedCare for Mental Health Patients
Mental disorders are some of the most common illnesses in the world.There are over 200 types of mental disorders, and the number has beengrowing with enhanced classification and diagnosis. Some of the mostcommon disorders include depression, anxiety, schizophrenia, bipolarmood disorder, personality disorders, trauma and eating disorders.About one in five adults in America (18.5% or 43.8 million people)experience mental health issues annually. About15% of them experienceco-occurring psychiatric illnesses that increase the utilization ofmental health resources. Furthermore, 24% of all health-relateddisability is linked to psychiatric disorders (National Alliance onMental Illness cited in Corrigan, Druss, & Perlick, 2014).
The federal and state governments have invested heavily in mentalhealth management to reduce the disease burden on families. Managingthe disease employs two broad approaches home health care andhospital-based. The home-based approach has been examined andassessed on its effectiveness in comparison to the hospital-basedapproach many times. The home healthcare approach is very differentfrom the hospital-based approach which requires evaluation of therole of nurses. Therefore, this paper examines the changes in theunderstanding of mental illness over time and how the new home-basedapproach in psychiatric nursing care requires the rethinking of therole of nurses in such settings.
Mental disorders have been around for a very long time. The Bible andthe Quran have in different instances mentioned cases of mentalillness in some patients. The Stone Age era that predates the Bibleand the Quran also has some evidence of mental disorders. Ancientcivilizations such as the Greek and Egyptians also have records ofmental illness. These diseases were misunderstood, and the treatmentapproaches were somehow rudimentary, and in modern view flawed.
The Stone Age period lasted roughly 3.4 million from 8700 BC to 2000BC. Archeological evidence that dates back to 5000 BC shows severaltrephined skulls from various locations in the world. Trephining wasa process used in these ancient times to treat mental disorders. Itinvolved making a hole in the head or chipping a part of the skull.Ideally, the Stone Age men believed that demons and spiritsinhabiting the mind caused mental sickness. Therefore, drilling holesin the skull using primitive tools was meant to release the offendingdemons or spirits (Foerschner, 2010).
The people of the Mesopotamian civilization believed that mentaldisorders were a result of demonic spirits. Accordingly, acombination of religious and magical approaches was used to treat thecondition. Prayers, exorcisms, incantations, atonement, and othermystical rituals were conducted by religious leaders either at homeor in religious houses to cast out the demons. The descendants ofAbraham of the Bible (Hebrews) believed mental illnesses were a formof punishment from God for sinning. Therefore, to them, God was theultimate healer, and He could be reached through prayers (Foerschner,2010).
Similarly, in the Egyptian civilization, which happened to the mostforward-thinking then, mental sickness was attributed to thesupernatural. Mystical approaches including prayer and incantationswere used in treating the disorder. Besides, therapeutic approachessuch as music, sports, painting, and dancing were employed to relievesymptoms. Thus, the family and community were mostly involved inproviding health care services for mental disorder patients(Foerschner, 2010). This claim offers a sneak preview of the rolethat family and community would play in later approaches to treatingmental health disorders.
This is the period between the 5th and 3rdcenturies BC that marked new approaches to medicine in Europe. Greekthinkers such as Hippocrates opposed the long-held view thatsupernatural forces caused mental illness. Hippocrates opined thatpathological imbalances resulted to the disease in the brain.Consequently, new approaches to treating the disease were adapted.They ranged from concoctions with laxative effects commonly made fromherbs such as aloe vera to using leeches. Later, tobacco from Americawas used to induce vomiting. Other scholars recommended special dietsto heal mental sickness (Foerschner, 2010).
In the 17th century, astrology was used to treat mentaldisease. Medicine men used astral talismans and charms made from avariety of materials with astrological signs etched in them. Usually,the patients were required to wear the charms around their neck orwrist. Years later, sedatives were introduced. Physicians visitedpatients at home and administered such drugs to manage symptoms. Inthe 18th and 19th centuries, clergies andbusinesspeople established private shelters called madhouses thatcatered to the mentally ill. The conditions in these madhouses weredire, and some owners of these houses used them as a form ofpunishment (Foerschner, 2010). The madhouses gave rise to the modernphase characterized by asylums.
The asylum period started in the late 19th century and hascontinued up to today in some countries. It is during this period andtowards the end of the 19th century that the need fornursing care for psychiatric patients was first recognized. Advancednations in recognition of patients’ rights and availability ofresources led to this new approach by training nurses accordingly.
The asylum phase
The phase involved the construction of large shelters away frommainstream societies to cater for mental health patients. Thefacilities offered necessities for survival with minimal treatmentand care. The notion of institutionalizing patients was born and manyperceived it as casting away of mental disorder patients. Thenegative effects of this approach were apparent to see including lossof life, ill-treatment of patients, and accumulation of symptoms.Based on advances in medicine and psychology in the developed world,the approach was criticized and around the mid-20thcentury, efforts to replace it started (Foerschner, 2010). This gaverise to the postmodern approaches in mental health managementinformed by new updated models.
Postmodernintegrated or balanced approaches
Integrated or balanced approaches to mental health treatment combineseveral service components as parts of the whole system of care(Jonge, Jamshed, Gilden, Kubisiak, Bruce & Taler, 2014). Thechoice of combination varies with the underlying principles. Forinstance, core guidelines for home health care include autonomy,continuity, effectiveness, accessibility, comprehensiveness, equity,accountability, coordination, and efficiency (Foerschner, 2010).Examples of integrated approaches include home-based care, casemanagement, and hospital-based care.
Hospital-based care is a system that offers medical and nursing careservices to patients in hospitals. There are two general types ofhospital-based care: outpatient and inpatient. Outpatient careinvolves patients going to hospitals to receive medical services atdifferent intervals. This means that it is the patient who goes outseeking health care services. The inpatient approach involves theprovision of health care services at hospitals. The approach is akinto the asylums or madhouses created centuries ago to cater tomentally ill patients and alienate them from society. There arespecialized institutions that provide to mental health conditionsonly.
The management of mental health cases using the hospital-basedapproach is associated with stigmatization as well as alleged casesof mistreatment. Furthermore, alienation from family and society islikely to destabilize patients and in the process hinder the recoveryprocess. Nonetheless, institutionalized care increases patients’access to mental health services (Foerschner, 2010).
Home-based health care is a system of service provided by skilledpractitioners to patients in their dwellings under the direction of aphysician. These services include both nursing care (physical,occupational, and speech therapy) and medical social services. In themanagement of mental health problems, the approach is guided by thenotion that the majority of mental disorders do not requirepsychiatrist help but instead can be managed by general practitionerswho can refer some cases to psychotherapists, home healthcareservices, and counselors. Thus, nearly all cases of home-based mentalhealth patients are referrals from qualified physicians andspecialists.
Goals ofhome-based care
To promote the client’s optimal level of well-being and to assist the patient to remain at home, avoiding hospitalization or admission to long-term care institutions.
Develop therapeutic relationships based on trust and friendship (Abuhashem, Hamed, Hassan, & Elias, 2015).
Demand forhome-based care
The majority of patients in need of home-based mental health care are elderly patients accounting for close to 30% according to Abuhashem et al., (2015). However, there has been impressive growth in demand for home healthcare with over eight million Americas receiving the service as of 2014 from over 20,000 organizations (7000 are Medicare certified and 13000 and non-certified). As of 2014, the global home healthcare industry was estimated to be worth 190 billion and is predicted to hit 300 by 2020.
Home health care enables people with mental disorders to maintain family relationships, friendships, and jobs while receiving treatment, which facilitates early treatment and rehabilitation.
Home health care is associated with continuity of care, greater users’ satisfaction, increased adherence to treatment, better protection of human rights, and prevention of stigma.
Home health care has been recognized as the best strategy to effectively and efficiently address the reduction of the burden of mental disorders and the promotion of mental health of populations.
The model is best suited for the physically challenged patients and the elderly. This is very relevant to the issue of mental illness given that the majority of mental health patients are the elderly.
More cost effective to national governments and even families. A comprehensive study by Jonge and colleagues (2014) showed that the costs of home-based general primary health for the elderly revealed that costs reduced by 17% over a two-year period.
Best suited for addressing stigmatization associated with institutionalization and seeking medical care for mental illness (Corrigan, et al., 2014).
Low political priority. The fact that the approach does not demand huge investments and political mileage means that it is not prioritized.
Insufficient and inadequate funding. Mental health services account for only about 1% of Medicare expenditures which is significantly low considering the number of people affected and the burden of disease of mental illness (Bartels 2013).
Lack of consensus among stakeholders.
Shifts burden of care to families and communities.
Others argue that deinstitutionalization has simply become “trans-institutionalization,” a phenomenon in which state psychiatric hospitals and criminal justice systems are “functionally interdependent.” According to this theory, deinstitutionalization, combined with inadequate and under-funded home health care mental health care programs, has forced the criminal justice system to provide the highly structured and supervised environment required by a minority of the severely mentally ill population (Prins, 2011).
Criminalization of mental disorder patients. Although a recent study by Peterson, Kennealy, Skeem, Bray and Zvonkovic (2014) indicated that there is no correlation between mental health and crime, other studies suggest that mental health patients pose a danger to others and unto themselves (Jonge et al., 2014).
Nurses have a unique role to play in the management of mental illnessunder the home health care approach. Mental health nursing orpsychiatric nurse training was first established in 1913. Nurses wererecognized to play an important role not limited to promotingrecovery from mental illness but also prevent mental illness throughthe educative aspects of nursing care.
Under home-based care for mental illness, nurses are tasked with screening, assessment, medication management, and patient/family education.
Nurses must ensure that their practice remains within the boundaries as defined by their state practice acts. Individual nurses are accountable for ensuring that they practice within the limits of their competence, professional code of ethics and professional practice standards.
Nurses must learn to work more independently and past of teams. This is because nurses work as part of teams while they conduct their home visits independently.
Retain the right attitude to develop therapeutic relationships. For most mental health approaches, the therapeutic relationship option explored and thus nurses need to be competent in that area (Corrigan, et al., 2014).
As aforementioned, mental disorders commonly occur in tandem with other illnesses. Thus, it is the role of nurses to develop multiple skills where appropriate to nursing care specific to various conditions.
Develop enhanced communication skills. Such skills involve patient listening skills and understanding
Instilling hope to the hopeless. This is necessary given that most depressed patients may feel hopeless. Nurses should learn to put forward positive affirmation.
Reduce stigma in society. Nurses can achieve this by assuring patients about their behavior. Usually, ordinary people tend to stay away from people exhibiting odd behavior, but nurses should be there always.
Supporting and fitting with the family. While nurses are required to fit in with colleagues in wards in hospital-based settings, in the home health care model, they have to fit in the patient’s family and way of life.
The discussion above has portrayed the evolution of the understandingof mental health from the Stone Age to postmodern times that embracehome health care. In all this, nurses have had to fit and delivernursing care in light of the new approaches to healthcare and also inlight of new evidence-based knowledge and practice on mentaldisorders. It is evident from the analysis that nurses have torethink their roles and adapt accordingly. From perceiving mentaldisorders as spiritual matters to understanding the role of day today activities, nurses are required to impart such knowledge tofamily and community to create awareness. Again, nurses are mandatedto take up more therapeutic ideals in dealing with mental disorderpatients in the dwellings. Thus, as new knowledge on managing mentaldisorders is discovered, nursing educators and nursing carepractitioners have to adjust accordingly.
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