Ch. 25 Community Mental Health Nursing (Test 2)

Question 1

When did treatment for the mentally ill begin?

Answer 1

Before 1840, there was no known treatment for the mentally ill, who were removed from the community to a place where they could do no harm to themselves or others.

Question 2

Who is responsible for the establishment of mental hospitals?

Answer 2

In 1841, Dorthea Dix, a former schoolteacher, started a campaign that resulted in the establishment of a number of hospitals for the mentally ill.

Question 3

Mentally ill population after mental hospital establishment?

Answer 3

The mentally ill population grew faster than the number of hospitals, creating overcrowding and poor conditions.

Question 4

When were a number of federal acts passed, attempting to improve quality of care for mentally ill?

Answer 4

In the 1940s and 50s

Question 5

When was the Community Mental Health Centers Act passed? What did it call for?

Answer 5

1963. It called for the construction of community health centers

Question 6

What is deinstitutionalization? When did it occur?

Answer 6

It is the closing of state mental hospitals and discharging of mentally ill individuals. It begun in 1963 after the Community Mental Health Centers Act.

Question 7

1980s funding changes?

Answer 7

In the 1980s federal funding was reduced, and the number of community health centers was diminished.

Question 8

Cost containment- when was it initiated? what did it affect?

Answer 8

Cost containment by prospective payment was initiated in 1983, drastically affecting the amount of reimbursement for health-care services.

Question 9

What happened after cost containment?

Answer 9

Clients are being discharged from the hospital with a greater need for aftercare than in the past, when hospital stays were longer.

Question 10

Outpatient services

Answer 10

Outpatient services have become an essential part of the mental health-care system.

Question 11

What is primary prevention? (Public Health Model)

Answer 11

Defined as services aimed at reducing the incidence of mental disorders within the population

Question 12

What is nursing in primary prevention focused on? (Public Health Model)

Answer 12

Focused on targeting groups at risk and providing educational programs

Question 13

What is secondary prevention aimed at? (Public Health Model)

Answer 13

Services aimed at reducing the prevalence of psychiatric illness by shortening the course (duration) of the illness

Question 14

How is secondary prevention accomplished? (Public Health Model)

Answer 14

Through early identification of problems and prompt initiation of effective treatment

Question 15

What is tertiary prevention aimed at? (Public Health Model)

Answer 15

Services aimed at reducing the residual defects that are associated with severe or chronic mental illness

Question 16

How is tertiary prevention accomplished? (Public Health Model)

Answer 16

By preventing complications of the illness and promoting achievement of each individual’s maximum level of functioning

Question 17

What is primary prevention? (The community as a client)

Answer 17

To identify stressful life events that precipitate crises and target the relevant populations at risk, and to intervene with these high risk populations to prevent or minimize harmful consequences

Question 18

Who are populations at risk in maturational crises?

Answer 18

Individuals experiencing maturational crises: adolescence, marriage, parenthood, midlife, retirement

Question 19

Population at risk- Adolescents: What stage are they in? What issue do they have? What do they need?

Answer 19

Identity v. role confusion (Erikson). They have issues of control. They need support from parents.

Question 20

Populations at risk- Adolescents: what do their issues include?

Answer 20

Self esteem and body image, peer relationships, education and career, values and beliefs, sexuality, drug and alcohol abuse, physical appearance

Question 21

Populations at risk- Marriage: Issues include?

Answer 21

Synchronization of two lives; differences in religion, ethnicity, social status, or race; need for communication and compromise

Question 22

Populations at risk- Parenthood: Issues include?

Answer 22

Total responsibility for another human being, parent-infant bonding, changing husband-wife relationship, knowledge about stages of growth and development

Question 23

Populations at risk- Midlife: Issues include?

Answer 23

Age related physiological changes, relationship with adult children, relationship with aging parents, death of parents, empty nest syndrome

Question 24

Populations at risk- Retirement: Issues include?

Answer 24

Negative feelings related to lack of productivity, loss of self worth; depression, financial issues

Question 25

Retirement age culture

Answer 25

Higher risk of depression and suicide compared to other cultures like Native Americans or oriental cultures- because of lack of respect, elder abuse, money, etc.

Question 26

What are populations at risk in situational crises?

Answer 26

Poverty, high rate of life change events, environmental conditions, trauma

Question 27

Individuals in situational crises- Poverty

Answer 27

Direct correlation between poverty and emotional illness. May have to do with inadequate and crowded living conditions, nutritional deficiencies, medical neglect, unemployment, homelessness

Question 28

Individuals in situational crises- High rate of life change events

Answer 28

A large number of significant events occurring in close proximity decrease a person’s ability to deal with stress, including: death of a loved one or divorce, being fired from job, physical illness, change in living conditions, change in body image

Question 29

Individuals in situational crises- Environmental conditions

Answer 29

Environmental conditions can create situational crises, including: tornadoes, floods, hurricanes, earthquakes

Question 30

Individuals in situational crises- Trauma

Answer 30

Traumatic experiences outside the usual range of human experience, including: military combat, being a victim of violent personal assault, undergoing torture, being taken hostage or kidnapped, being the victim of natural or manmade disaster

Question 31

What is secondary prevention? (The community as a client)

Answer 31

Early detection and prompt intervention with individuals experiencing mental illness symptoms

Question 32

What are populations at risk regarding secondary prevention? (The community as client)

Answer 32

Individuals experiencing maturational and/or situational crises

Question 33

Secondary prevention of maturational crises in adolescence

Answer 33

Assistance required when disruptive and age inappropriate behaviors become the norm and the family can no longer cope with the situation.

Question 34

Secondary prevention of maturational crises in adolescence- inpatient care required for?

Answer 34

Conduct disorders, adjustment disorders, eating disorders, substance related disorders, depression and anxiety disorders

Question 35

Secondary prevention of maturational crises in marriage- common problems?

Answer 35

Common problems in marriage include: substance abuse, disagreements (sex, money, children, gender roles, infidelity)

Question 36

Examples of reasons for intervention at the secondary level of prevention with parents include?

Answer 36

Physical, emotional, or sexual abuse of a child, physical or emotional neglect of a child, birth of a child with special needs, diagnosis of a terminal illness in a child, death of a child

Question 37

Secondary prevention of maturational crises in midlife

Answer 37

Individual may be unable to integrate all the changes that are occurring during this period, resulting in depression, anxiety, and substance abuse

Question 38

Secondary prevention of maturational crises in retirement

Answer 38

When individuals are unable to successfully grieve for this part of their lives, it can result in depression and suicidal ideation

Question 39

When do individuals need secondary prevention with situational crises?

Answer 39

When intervention at the primary level has failed and the individual is unable to function socially or occupationally

Question 40

Where may secondary prevention with situational crises occur?

Answer 40

In an inpatient or outpatient setting

Question 41

Who is tertiary prevention for? (Community as a client)

Answer 41

Individuals with severe and persistent mental illness

Question 42

Historical and epidemiological aspects of individuals with severe and persistent mental illness

Answer 42

Approximately 100,000 persons with mental illness reside in public mental hospitals. Deinstitutionalization of persons with chronic mental illness began in the 1960s. Large segments of people with chronic mental illness are left untreated.

Question 43

Barriers to care of individuals with severe and persistent mental illness? (Under tertiary prevention and the community as a client slides)

Answer 43

Fragmentation and gaps in care for children, fragmentation and gaps in care for adults with serious mental illness, high unemployment and disability for people with serious mental illness, older adults with mental illnesses not receiving care, mental health and suicide prevention are not yet national priorities

Question 44

Goals for mental health reform? (Under tertiary prevention and community as client)

Answer 44

1. Americans will understand that mental health is essential to overall health, 2. mental health care will be consumer and family driven, 3. disparities in mental health services will be eliminated, 4. early mental health screening, assessment, and referral to services will be common practice, 5. excellent mental health care will be delivered and research will be accelerated, 6. technology will be used to access mental health care and information

Question 45

Tertiary prevention treatment alternatives (Community as client)

Answer 45

Community mental health centers, Program of Assertive Community Treatment (PACT), day-evening treatment/partial hospitalization programs, community residential facilities, psychiatric home health care

Question 46

Tertiary prevention- Care for the caregiver? (Community as a client)

Answer 46

Primary caregivers require support and assistance in providing round the clock care to their loved one with a severe and persistent mental disorder

Question 47

Number of US homeless?

Answer 47

Estimated at between 250,000 and 4 million

Question 48

How many homeless are under 18?

Answer 48

39%

Question 49

How many homeless between ages 25 and 34?

Answer 49

25%

Question 50

How many homeless are ages 55-64?

Answer 50

6%

Question 51

What gender are most homeless?

Answer 51

Men

Question 52

How much do families compromise of the homeless?

Answer 52

33%, more in rural areas

Question 53

Percentage of A.A., Hispanic, Caucasian, Asian, and Native American homeless?

Answer 53

42% A.A., 39% Caucasian, 13% Hispanic, 4% N.A., 2% Asian

Question 54

How many homeless suffer from some sort of mental illness?

Answer 54

26%

Question 55

What is the most common mental illness among the homeless?

Answer 55

Schizophrenia

Question 56

Types of mental illness of homeless?

Answer 56

Schizophrenia, bipolar affective disorder, substance abuse disorder, depression, personality disorders, organic mental disorders

Question 57

Contributing factors to homelessness among the mentally ill

Answer 57

Deinstitutionalization, poverty, a scarcity of affordable housing, lack of affordable health care, domestic violence, addiction disorders

Question 58

Community resources for homeless?

Answer 58

Interfering factor- residential instability. Health issues- alcoholism is common, thermoregulation, tuberculosis is on the rise, dietary deficiencies, STDs, special health needs of homeless children

Question 59

Types of resources available for homeless

Answer 59

Homeless shelters, health care centers and store front clinics, mobile outreach units