The trend in psychiatric care is shifting from that of inpatient hospitalization to a focus of outpatient care within the community. Community mental health services include all those activities in the community connected with mental health other than the institutional or hospitalized setting. The community approach focuses on the total population of defined geographical area rather than individual patient. Emphasis is mainly on preventive services which include provision of a continuous, comprehensive system of services designed to meet all mental health related needs in the community. Mental health care is provided. through education, consultation, brief psychotherapy, crisis intervention and follow up care.
COMMUNITY MENTAL HEALTH NURSING
Community mental health nursing is the application of knowledge of psychiatric nursing in Preventing, promoting and maintaining, mental health of the people and to help in early diagnosis and care and to rehabilitate the clients after mental illness. Goals of Community Mental Health Nursing
- To provide preventive activities to population and communities for the purpose of promoting mental health and securing participation in self help activities. (Primary prevention).
- To provide opportunities for interventions as early as possible when families, special groups and communities’ experiences stress, tension and lack of organization that affects their abilities to handle affairs of daily living and to work in satisfying and effective ways (secondary prevention)
- To provide corrective learning experiences for clients, groups who have deficits and disabilities in the basic competencies needed to cope in society and to help individuals to develop a sense of selfworth and independence (tertiary prevention. ).
- To anticipate when population become at risk for particular emotional problems and to identify and change social and psychological factors that affect people’s interaction with their environment.
- To develop innovative approaches to primary prevention activities.
- To assist in providing mental health education about mental health and illness and to teach peoples how to assess their mental health.
- To provide leadership in the field of community mental health nursing as, the care of the mentally ill becomes entirely a communitybased endeavor.
ROLE OF NURSE IN COMMUNITY MENTAL HEALTH NURSING
- The nurse assists in all kinds of primary socialization groups such as families, schools and work groups.
- To help family systems to, develop in their members basic social competencies and problem solving skills that is necessary to achieve satisfactory interactions and working relationships.
- To help members to develop a personal organization of self, strengthen their abilities to adapt and cope, achieve selfhood and maintain independence and autonomy in their relationships.
- Nurses may find themselves in daily contact with battered spouses, abused children, homeless persons, or substance abusers.
- The nurse will frequently find a patient in need of emotional support.
- The nurse has the responsibility of assessing, intervening and maintaining a caring relationship of trust with the patient.
- Able to manage with competency and efficiency many of the stress and trauma experienced by families and their members in the process of daily living.
- To provide mental health care and services through the use of specialized knowledge and strategies.
- Expected to play other nursing roles such as therapist, counselor, consultant, laison, client advocate, clinical researcher, and manpower facilitator.
- Provide care to much special population like homeless, individuals at high risk, rural populations, the elderly and the abused.
1) PRIMARY PREVENTION
Primary prevention means lowering the rate of new cases of mental disorders in a population by providing health education to vulnerable groups of teenages, homeless, families etc. The community mental health nurse has a significant role in primary prevention. The factors which a community mental health nurse should give emphasize are:
- Biological and Physical factors
- Psychosocial factors
- Sociocultural factors.
a)Biological and Physical factors
The community mental health nurse has a significant role especially in prenatal and postnatal care. It will help in reduction of mental retardation and organic mental disorders. Parents need to be prepared for the acceptance of a new child in the family and should provide minimum facilities for the growth of a child like food, shelter and clothing.
- Physical competencies coordination of muscles, protecting oneself from injuries.
- Emotional competencies coping alone at home in the absence of mother for 45 hours will enable the child to develop confidence.
- Social competencies opportunities need to be provided for group interaction, socialization with guest and friends so that the child learns to accept his strengths and weakness.
c) Sociocultural factors
For reducing social isolation, a social support system should be developed. Kaplan’s hypothesis is that every individual in his life from womb to tomb needs physical support, psychosocial support and sociocultural support. If he is deprived in any one of these areas there is a chance of developing mental disorders.
ROLE OF THE NURSE IN THIS ASPECTS ARE :
- To educate the individual and the family about the importance of identifying and meeting basic human needs.
- Parents have to be educated about the protection of baby from bodily injuries before, during and after birth and about prenatal and postnatal care of the child in the first two years of life.
- Identification of risk groups and provision of emotional support to mild risk and high risk groups. e. g. Adolescents, pregnant woman, physically handicapped persons and children of mentally ill parents, old people and individuals with chronic physical illness.
- Genetic counseling
2) SECONDARY PREVENTION
It consists of early diagnosis of mental illness and social and emotional disturbances through screening programmes in schools, universities, industry, recreation centers etc and provision of treatment facilities and effective community resources. In this regard, family based health services have an important role to play.
- Identify emotional problem and early symptom of mental illness.
- Help the family members to cope with overwhelming stress.
- Prepare individual and family members for psychiatric care.
- Arrange counseling services for the individuals and families with mental conflicts and disturbed parent child relationship.
3) TERTIARY PREVENTION
Tertiary prevention focuses on preventing complications of the illness and promoting rehabilitations that is directed towards achievement of the individual’s maximum level of functioning. The community mental health nurse needs to:
- Ensure the type of psychiatric drug the patient is taking.
- Individual and family therapy.
- Family support needs to be identified in helping the patient.
- Crisis intervention.
- Intractional skill training social skill training can be given to develop effective interaction and communication abilities.
- Occupational training.
- The patient needs to be rehabilitated and helped to become socially productive.
FUNCTIONS OF A COMMUNITY MENTAL HEALTH NURSE
- Help the family to accept the patient’s illness
- Help the family to understand the patient’s need to be hospitalized and to remain in the hospital until the medical staff approves his discharge.
- Explain the hospital admission procedure, rules and regulations.
- Interpret the diagnosis and treatment procedures.
- Help the family to accept the patient back to home when he is ready.
- Help the family to accept the patient’s return to the hospital for further treatment when indicated.
- Direct the family to the community agencies,
- Act as a laison between the patient in the hospital and the family at home.
- Arrange for several families to meet together to discuss the community problems.
- Help the community to understand mental illness and factors which contribute to it.
- Help the community to accept the discharged patient back to community life.
- Assist in community activities to promote mental health.
- Work with local physicians, schools etc to secure early diagnosis and treatment for children and adults who are emotionally disturbed.
- Help to secure resources that are adequate for the community’s mental health needs
1. SERVICES TO THE FAMILY
- Help the family to achieve an enlightened understanding of the patient’s illness and his need for treatment in the mental hospital.
- Assist the family directly to diminish their feelings of guilt or shame regarding mental illness.
- Encourage members of family through sympathetic listening to express their feelings about the illness.
- Answer questions about the hospital environment, treatment procedures, rules and regulations, policies concerning, readmission and discharge.
- Help to secure community resources.
- Encourage the family to discuss with hospital personnel about the patient illness.
- Help the family to cooperate with hospital programmes.
- Assist the family in planning and preparing for the patients home coming.
- Maintain contact with the family to make the patients adjustment in home, and in the community generally.
- Interpret additional resources of help in the community and assist the family with referral procedures and accept the patient’s health status and behavior.
- Assist the family in using the community services as needed for all members of the family.
- Interpret and support the need for the patient to return to the hospital when is indicated and assist with his rehabilitation.
2. SERVICE TO THE PATIENT
- Convey to the patient anattitude of respect, acceptance and recognition of his importance as a person regardless of his behaviour, physical appearance, dress or unpleasant characteristics.
- ‘Listen’ selectively and skillfully to help the patient to drain off his tension and help him to understand that she is interested in him and his problem.
- Understand and utilize the resources within the patient’s family and the community to aid in his total adjustment.
- Assist the patient to maintain contact with his family physician and other helping persons and resources.
3. SERVICES TO THE MENTAL HOSPITAL
In cooperation with the family physician the CHN:
- Supply the hospital with data about the patient, his life history etc.
- Provide information derived from the physician and his previous knowledge of the patient and his family during his hospitalization.
- Notify the hospital of changes in the family situations and attitudes which may influence the patient readjustments.
- Inform the hospital regarding the family and the community readiness for the patients to return home.
4. SERVICES TO THE FAMILY PHYSICIAN
- Describe about the home and family environment and changes in the family situation observed during the home visit.
- As directed by the physician, supervise drug therapy, keep the physician informed of the use, abuse or neglect of drug therapy observed during home visit.
- Assist the physician by aiding and encouraging the patient and family to carryout general medical directions.
- Inform the physician about the patient’s and the family’s contact with community services.
Mental health care within the community targets primary prevention which includes reducing the incidence of mental disorders within the population, secondary prevention includes reducing the prevalence of psychiatric illness by shortening the course of illness and tertiary prevention includes reducing the residual defects that are associated with severe or chronic mental illness.
Nurses serve as providers of psychiatric /mental health care in the community setting. Nurses provide outpatient care for chronically mental ill individuals in community, mental health centers, day and evening treatment programmes, partial hospitalization programmes, in community residential: facilities and with psychiatric home health care settings. RESEARCH STUDY A challenge for community psychiatric nursing: is there a future in primary health care?
Certificate in Counseling Skills Lecturer in Nursing Studies, University of Wales College of. Medicine, Heath Park, Cardiff CF4 4XN, Wales. The growing debate surrounding the role of the community psychiatric nurse (CPN) in the United Kingdom is reviewed. Issues which have attracted significant interest and which form the focus of this paper are the prioritization of CPN services, CPN attachment to primary health care (PHC), and the effectiveness of clinical interventions.
The requirement for, CPNs is now to concentrate services on people experiencing severe and enduring mental health problems. Innovative and effective clinical and social interventions for this client group are beginning to disseminate into everyday CPN practice. Problemsolving family interventions, cognitive therapies and case management. are three such examples. The past, present and possible future role for CPNs working in primary health care settings with people experiencing nonpsychotic mental health problems is a particular focus in this paper.
Drawing on the relevant literature, central issues addressed are the process and outcome of CPN work with nonpsychotic service users, reasons for the growth of CPN involvement in PHC, and the overall expansion of interest in mental health interventions within the primary health care environment. The literature suggests that this expansion has been strategically unplanned, but that mental health need amongst primary health care service users is significant. The concluding contention of this paper is that a future role for CPNs in primary care does exist.
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