Outpatient Psychiatric Care (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    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.

    About the Lecture

    The lecture Outpatient Psychiatric Care (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Accessing Acute Psychiatric Care (Nursing).

    Included Quiz Questions

    1. Psychiatrist
    2. Psychiatric nurse practitioner
    3. Psychologist
    4. Psychiatric-specialized social worker
    5. Primary care practitioner
    1. Psychiatric home care
    2. Partial hospitalization
    3. Outpatient psychiatric office
    4. Nurse practitioner-led clinic
    1. A nurse practitioner in a clinic prescribing antidepressants and assessing the mood of a client with a 20-year history of major depressive disorder
    2. A registered nurse visiting a client with schizophrenia once every two weeks to give them an antipsychotic injection and remind them of their upcoming appointments
    3. A psychotherapist visiting a client with borderline personality disorder in a group home once a week to provide cognitive behavioral therapy
    4. A health care provider in a clinic prescribing cholesterol medication and monitoring thyroid levels of a client with bipolar disorder
    5. A social worker helping a client with generalized anxiety disorder apply for housing in preparation for their discharge from the inpatient psychiatric unit
    1. Promoting recovery and continuation of treatment
    2. Prescribing medication
    3. Encouraging independence and decreased reliance on psychiatric support
    4. Providing psychotherapy

    Author of lecture Outpatient Psychiatric Care (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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