Mental Health Guidance

[SteveDE]

I am an RN, I have worked medical floor, ER, house supervisor, and for the last 1.5 years I have worked as Diabetes educator, so I have certainly seen how mental health plays a big role in proper, overall and long-term health of all of us, whether its denial of another disease, grief, depression, bipolar, and on and on. I live and work in a rural community with very limited psych. facilities and psych. healthcare workers.

Recently I have had a new responsibility added to my hours, that is of some kind of mental health case management. I do not have any experience with actual counseling or psych. nursing, for the most part, that is not what this role will be, although it may have some education and counseling components to it. This is new role for our facility, so I am currently defining the role. For the most part the position is suppose to help our primary medical providers (who have stated they don't feel comfortable in adequately taking care of pysch. issues) and help our patients navigate through healthcare so they get the care they need. Work with them to properly take medicines regularly, get specialty help when or where needed, get labs as needed, and there for manage their mental and physical issues together. At least in our area, many of these people fall through the cracks, don't follow up properly often due to resources or lack of education on why, and then they end up in crisis, in the ER, and the ER then struggles to deal with them. So hopefully as time goes on, we can help support these people and show them why and how proper medical care is important.

Anyone advice out there would be GREAT! Anyone doing anything like this? Comments and questions PLEASE!

[WillyNilly]

Is it to promote continuity of care? Setting up case management, home care, follow up appointments, referring them out/ making appts prior to dc for them with PCP , etc?

Medication regulation with pharmacy that deliver, pharm packs/pack it for pt and send to home.

Educate with med changes, etc.

It sounds like a discharge nurse or a continuity care nurse.

[Davey Do]

I am an RN, I have worked medical floor, ER, house supervisor, and for the last 1.5 years I have worked as Diabetes educator, so I have certainly seen how mental health plays a big role in proper, overall and long-term health of all of us, whether its denial of another disease, grief, depression, bipolar, and on and on. I live and work in a rural community with very limited psych. facilities and psych. healthcare workers.

Wow! A lot of experience in a relatively short time, SteveDE! No wonder the Powers that Be added more responsibility to your workload. They're following the Concept of not giving more work to someone who is doing nothing- they're giving more work to someone who's already busy fulfilling their responsibilities!

Recently I have had a new responsibility added to my hours, that is of some kind of mental health case management. I do not have any experience with actual counseling or psych. nursing, for the most part, that is not what this role will be, although it may have some education and counseling components to it. This is new role for our facility, so I am currently defining the role.

In 1993, I had a Position as the Nursing Supervisor for a Home Health Agency and the Director wanted me to, among my other duties, initiate and Supervise an At Home Mental Health Program. Medicare had just begun benefitting Mental Health Patients for Home Health Care.

As you are, I was "blazing a trail" in providing services to Mental Health Patients. So, there's a lot of plannining, forecasting, and ad-libbing that I did, and you are currently going to be doing.

For the most part the position is suppose to help our primary medical providers (who have stated they don't feel comfortable in adequately taking care of pysch. issues) and help our patients navigate through healthcare so they get the care they need. Work with them to properly take medicines regularly, get specialty help when or where needed, get labs as needed, and there for manage their mental and physical issues together.

It sounds as though you have a good handle on the goals that need to be met. One piece of advice that I might give you is to not focus on your history of no "counseling or psych nursing". These Patients need the same thing as every Patient needs: Assessment, Planning, Intervention, and Evaluation.

Of course, it would be to your benefit to know the DSM Psychiatric Diagnosis guidelines and subsequent specific Treatment, such as Pharmacology, but the basic Nursing Approach applies here, also. A Medical Diagnosis affects primarily the Body and its Physical processes, whereas a Psychiatric Diagnosis affects the Brain's Mental, Cognitive, and Emotional processes.

Perhaps you could do a search on this forum to gain additional information.

As far as specifics, there is too much to relay in a Post. Feel free to PM me if you would like to discuss any specifics.

Also- there are other Nurses on this Website who have great experience. I hope they don't mind me mentioning their usernames, but I am complimenting their abilites and expertise. Some Members, off the top of my head, include Whispera, Meriwhen, Terpgal, and last, but certainly not least, MrChicagoRN. There are others.

Good luck to you, SteveDE, in your endeavor.

[TerpGal02, ASN]

Sounds like what we call here in these parts part of a "Health Home" (not home health) initiative. Basically trying to provide all a person's care under one roof or at least to coordinate that care. I used to work on an Assertive Community Treatment team and the larger agency I worked for became a health home and had a nurse in a similar position to what you are describing. This is the new way mental health (esp the chronic severe mental health) care is going. With good reason. Folks with severe persistent MI live an average of 25 years less than the general populace due to substandard medical care (all somatic complaints are in the person's head), and just general poor lifestyle choices, compliance, AND some psychotropic drugs interfere with people's metabolism.

The "Big 3" my agency was working on were diabetes, COPD, and CAD. Generally this entailed making sure patients were getting routine labs with hA1Cs, providing education on nutrition, exercise, and weight loss, monitoring for med compliance for those already with diabetes, and really looking at the number of antipsychotics the pt is on. There really should be a VERY good reason someone is on multiple atypical antipsychotics because they have the tejdancy to cause weight gain, increased lipid levels, and insulin resistance with probably Zyprexa and Clozaril being the biggest offenders. On the COPD front, something like 45% of cigarettes smoked in the US are smoked by mentally I'll people, there's research being done to determine if there is some secondary gain as far as symptom relief from nicotine. Encouraging not smoking, holding smoking cessation groups, etc. Making sure pts are following up with their meds, DME if they are on O2. And then the CAD really much of the same, verifying their getting their labs every year, doing blood pressure screenings, looking at meds.

It's a huge job but so helpful when a psych pt has an intermediary to advocate for them.