Evidenced-Based Practice in Mental Health
In 2003, leaders in North Carolina’s healthcare field realized they needed to bring about changes to the services they provided in their community’s mental healthcare programs (McLaughlin & McLauglin, 2008). The North Carolina Science to Service Project (NCS2S) was implemented to bring more coordinated, quality healthcare services to their mental health patients (McLaughlin & McLauglin, 2008). The goals of the project were to better match healthcare services to their mental healthcare patient population, apply evidenced-based practice guidelines in their mental health practice, ensure proper resources were allocated for the services, and begin state-wide training programs to their healthcare professionals (McLaughlin & McLauglin, 2008). This case study examines the integration of mental healthcare services into the community setting, the use of evidence-based practice guidelines, the effect on the stakeholders, and the role of healthcare professionals in implementing change.
Why Change was Needed
The impetus for change to improve the healthcare services provided to individuals suffering from mental illness came about because the deinstitutionalization efforts begun in the 1970s were failing to properly assist this population (McLaughlin & McLauglin, 2008). McLauglin and McLauglin (2008) explain North Carolina’s four regional mental health hospitals were acting as independent entities and not working to provide better coordinated services to its’ local community mental health centers. They reveal local community mental health centers were not receiving the resources necessary to run effective rehabilitation programs for their patients (McLaughlin & McLauglin, 2008). Similar situ...
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During the 1960’s, America’s solution to the growing population of mentally ill citizens was to relocate these individuals into mental state institutions. While the thought of isolating mentally ill patients from the rest of society in order to focus on their treatment and rehabilitation sounded like a smart idea, the outcome only left patients more traumatized. These mental hospitals and state institutions were largely filled with corrupt, unknowledgeable, and abusive staff members in an unregulated environment. The story of Lucy Winer, a woman who personally endured these horrors during her time at Long Island’s Kings Park State Hospital, explores the terrific legacy of the mental state hospital system. Ultimately, Lucy’s documentary, Kings
Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation’s state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.
The Center for Disease Control and Prevention [CDC] used the U.S. Department of Health and Human Services’ definition of mental illness as “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning” (2011). Our community is exposed to a large number of individuals with mental illness. Among those individuals are the widespread homeless populations. The United States Department of Housing and Urban Development reported “twenty-five percent of the sheltered homeless report a severe mental illness (as cited in Allender, Rector and Warner 2014 p. 907).” This author found the target population to be predominantly Caucasian, Non-Hispanic, single males of thirty-one years of age and older. In reviewing the research, this author found that multiple health disparities happen in conjunction with mental health and homelessness. This includes cardiac and respiratory issues and HIV/AIDs. Without the proper healthcare services, the homeless mental health population remains vulnerable.
In the case of changing the mental health policy in North Carolina, the impetus for the change seems to be adopted by the State Auditor’s report beside other reports of many entities confirming the deviation of mental health service away from its original goal. According to these reports, mental health services are still delivered via traditional health delivery models rather than coordinated well-managed ones. Interestingly, these reports analyze the spectrum of mental health services nationwide with the exception of the State Auditor’s 2000 report Study of the Psychiatric Hospitals and the Area Mental Health Programs which was specifically designed for the North Carolina.
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Rather than preparing graduates in education or consulting as previous graduate nursing programs had done, this program educated psychiatric-mental health nurses as therapists with the ability to assess and diagnose mental health issues as well as psychiatric disorders and treat them via individual, group, and family therapy (ANA, 2014). Thus, the Psychiatric Mental Health Clinical Nurse Specialist (PMH-CNS), one of the initial advanced practice nursing roles (Schmidt, 2013), was born. After Community Mental Health Centers Act of 1963 led to deinstitutionalization of individuals with mental illness, PMH-CNSs played a crucial role in reintegrating formerly institutionalized individuals back into community life (ANA, 2014). PMH-CNSs have been providing care in a wide range of setting and obtaining third-party reimbursement since the late 1960’s. In 1974 a national certification for PMH-CNSs was created (APNA, 2010). Subsequently, PMH-CNSs began to be granted prescriptive privileges in the Pacific Northwest in the late 1970s, that practice has now spread to 37 states and the District of Columbia (APNA,
Those with mental illness would live in the community with an array of services and be able to be free from the constraints of confinement. In the early 1960’s the United States began an initiative to reduce and close publicly-operated mental hospitals. This became known as deinstitutionalization. The goal of deinstitutionalization was to allow people suffering from mental illness to live more independently in the community with treatments provided through community health programs. Unfortunately, the federal government did not provide sufficient ongoing funding for the programs to meet the growing demand. States reduced their budgets for mental hospitals but failed to increase funding for on-going community-based mental health programs. As a result of deinstitutionalization hundreds of thousands of mentally ill people were released into the community without the proper resources they needed for their treatment. (Harcourt,
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States obtain many services that fall under mental health care, and that treat the mentally ill population. These range from acute and long-term hospital treatment, to supportive housing. Other effective services utilized include crisis intervention teams, case management, Assertive Community Treatment programs, clinic services, and access to psychiatric medications (Honberg at al. 6). These services support the growing population of people living in the...
Newman, S., & Goldman, H. (2008). Putting Housing First, Making Housing Last: Housing Policy for Persons With Severe Mental Illness. American Journal of Psychiatry, 165(10), 1242-1248.
Since the beginning of deinstitutionalization in the mid twentieth century, there has been a significant need for community mental health care, which was recognized after long term institutional care was considered ineffective. One concept that arose during the community mental health movement was case management. An important goal of the community mental health movement was to create full time mental health centers throughout the United States, and case management was to provide outpatient care to those who suffered from severe mental illness. Case management is still widely recognized today, and continues to be effective in providing care to clients who suffer from mental illness. Case management is a fundamental solution to the advocacy, recruitment, treatment, and care of both the disadvantaged and mentally disabled individuals.