00:00
In 2016, there was the drop
in state psychiatric hospitals.
00:06
From 322 psychiatric hospitals
that we saw in 1950,
to 195 in 2016.
00:16
Now, when we say that there is
the drop in psychiatric hospitals,
that also reflects that there is
going to be a major drop in beds
that are specific for
persons with mental illness.
00:29
So then how are we able
to treat mental illness?
Well, there are still.
00:35
Some hospitals that are only
psychiatric hospitals beds.
00:39
But we also have psychiatric units
in multiple hospitals.
00:44
So those beds are reserved for
our patients with mental illness.
00:48
And those patients
get to be treated
by nurses who are specializing
in psychiatric nursing.
00:55
And then, they also have outpatient
situations where they can go.
01:01
There are group homes,
there are outpatient day programs.
01:05
And there are also
community programs.
01:08
And we're going to go over
a lot of these as we discuss
admissions in psychiatry.
01:17
So, who takes care of the patient
when the patient is an outpatient,
and has mental health needs?
Well, the primary care providers
are usually the first person
who sees this patient.
01:31
Now, this treatment choice
might feel familiar to the patient.
01:36
They'll go to their PCP
or Primary Care Provider.
01:42
And that reduces their stigma,
to be able to go to their
local nurse practitioner,
for example.
01:49
and say, "I have not been feeling
very happy.
01:52
For the past six months,
it's been getting worse and worse."
So that primary care provider
can then discuss what's going on,
and then refer them
for some psychotherapy
or engage them in psychotherapy,
and put them on some medication.
02:09
But the timing and the training
limitations of that PCP
can impact a complete
mental assessment.
02:18
Because most PCPs are not
psychiatric NPs, or psychiatrists,
or psychotherapists.
02:27
Most primary care providers
are internists.
02:30
And the likelihood that an internist
is going to have
more than 15 to 20 minutes
to spend with any one of the
patients while making a diagnosis
is highly unlikely in this
care delivery environment.
02:47
So we want to look at specialty
psychiatric care providers.
02:51
So who would that be?
Those are people who have
education and experience
who are working
specifically and solely
with the psychiatric and
mental health environment.
03:06
So that might be a psychiatrist,
a psychiatric nurse practitioner,
a psychologist, a social worker
who is focused on
psychiatric mental health care.
03:18
We also have patient-centered
health in medical homes.
03:23
So that is integrating mental and
other physical care in one area.
03:30
So if you have, for example,
a person who is recovering
from a stroke,
who also has a mental illness,
they can be in an environment
that is patient centered
and meets the needs both of
their psychiatric needs,
as well as their medical needs.
03:53
And then we have community clinics,
which provide a wide range
of mental health services
for persons who lack
the funding for care.
04:03
We also have psychiatric homecare.
04:06
And those would be
registered nurses or social workers
that provide psychiatric home care
for individuals who are homebound.
04:14
So they go into the person's house.
04:17
We also have group homes.
04:19
A person has to be able to apply to
and be accepted to a group home.
04:24
But within a group home,
they are able to have someone
who is watching over them,
making sure they're taking
their medication,
perhaps bringing them
to a day program
or letting them get
to their work on time.
04:39
There are intensive
outpatient programs.
04:42
They're also what we call
partial hospitalization.
04:45
A step down unit
from an inpatient care,
like, we want to make sure
that we are providing
the person with mental illness,
the least restrictive
environment possible.
04:58
And so a partial hospitalization
may mean
that they are coming
to the psychiatric hospital
from 9 to 4 during the day
and being treated,
and then maybe they're going back
to their group home in the evening.
05:15
But it is less restrictive
than having them be an inpatient
in a mental health facility.
05:24
Other outpatient venues that
person can receive psychiatric care
would be
telephone crisis counseling,
maybe telephone outreach.
05:35
We have a lot of virtual therapy
that is going on now.
05:40
The internet also
and telepsychiatry.
05:45
So what is the role of the nurse
when the patient
is not in the hospital?
This is something I love to speak to
because it's my role.
05:56
Most of my patients
are not in the hospital.
06:00
And so what we're able to give them
if they're going to
an outpatient setting,
is working with them to
develop problem solving skills.
06:11
Clinical skills that allow them to
engage in activities
of daily living.
06:18
We want to make sure that
we have cultural competence
when we're working
with our patients.
06:26
Our patients have come from
every cultural background
you can consider.
06:31
And before we walk into
an outpatient setting,
we want to make sure that we
check our bias at the door.
06:40
We need to be flexible.
06:42
Nurses must be flexible
when working with men,
patients with mental illness.
06:51
We also really need to know, what's
in our community for these patients?
How can we get them to the
community resources that they need?
Our role as psychiatric nurses is to
help someone towards their recovery.
07:08
It is to help facilitate them
getting to independence.
07:13
And so we want to make sure
we know,
what are those resources once
that person is not in our setting?
We want that person
to be autonomous.
07:26
We want them to know
what to do for themselves,
because we are there
to promote their recovery
and make sure that they continue
with their treatment.
07:39
And if we are
culturally insensitive,
if we are
trying to take over their lives,
if we think we know better
than they know
about what they should be doing,
they are not going to continue
their treatment.
07:55
And without treatment, their
mental illness will come up again.
07:59
So in order to improve recovery,
we want to make sure
that we have continuity
and continuation of treatment,
which then reduces the likelihood
of losing that patient
when they feel that
we are not listening.
08:15
I always say, "The patient
is the expert on him or herself."
They may have mental illness,
but they are the
expert on themselves
and we have to respect
that expertise.