Mental Health Crisis And Care Essay

Mental Health Crisis And Care Essay

Americans of all ages suffer from mental unwellness and are non having proper attention. Over 40 million grownups suffer from a mental upset and many are non having any wellness attention at all. Sever depression is the taking cause of immature grownup disablement, and suicide coming in as 2nd. More so half do non have appropriate intervention. Mental Health Care professionals have concerns that proper plans and instructions are non up to day of the month with the alterations in wellness attention. Most of the mentally sick do non hold entree to cut down or free wellness attention since their upset has kept many unemployed. Mental Health Crisis And Care Essay

household. Stigma with mental upsets, many do non desire to unwrap that sort of personal information to their employer, and many do non seek intervention.

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As I researched mental wellness upset organisations, I came across one called NAMI ( National Alliance of Mental Illness ) . I learned a batch by speaking to members and their web site. NAMI members stated that wellness insurance coverage continues to be a beginning of much emphasis and unfairness for people with mental unwellness in America. Health insurance is a line of life for many people with mental unwellness as expensive medicines and legion physicians ‘ visits are normally needed to pull off their unwellness. Even though many of the persons represented in the study relied on public wellness insurance plans like Medicaid and Medic-cal, about as many-36 percent-had private wellness insurance policies, either self-paid or through their employers. Ten per centum reported no wellness insurance coverage at all. The open-ended remarks underlined the defeats of many people with mental unwellness and their households with the policies of some private wellness insurance companies that restrict entree to necessary attention. Mental Health Crisis And Care Essay

A web-based study of visitants to the NAMI web site in August 2003 confirms that private wellness insurance coverage is critically of import to many people populating with a serious mental unwellness. Fifty people answered the inquiries on wellness insurance of which 57 per centum were persons with mental unwellness and 36 per centum were household members or friends. The bulk 56 per centum was covered by private wellness insurance provided through an employer, either portion or to the full paid and an extra 18 per centum had self-paid private wellness insurance. Almost one in five respondents had no insurance at all.

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Although most of the respondents had private wellness insurance, the study information reveals major jobs with this industry. One one-fourth of respondents said they, or their loved one, had been denied private wellness insurance because of a mental unwellness, and of those that had private wellness insurance, merely 17 per centum said that it adequately covered the cost of mental wellness intervention. Disturbingly, 25 per centum of respondents besides said that they had been deterred from employment or moved to public wellness insurance plans such as Medicaid because of the deficiency of private wellness insurance coverage for mental unwellness intervention. Clearly favoritism in the field of private wellness insurance is a major job within our state ‘s troubled mental wellness system. That study was 6 old ages ago and in 2009, more so half are non covered by any insurance. Many patients are besides seeking alleviation from SSI or early disablement insurance to assist cover wellness costs and basic necessities. It can take months or old ages for patients to even cognize if they qualify for Medi-cal or Medicaid. Many members mentioned they have had to fall back to exigency hospitalization for their loved 1s that suffer from a mental unwellness ; the county mental infirmary will merely maintain them for a short clip and non the 72 clasp like stated. Due to many patients non holding any wellness insurance they are released, and at times without household cognition. Mental Health Crisis And Care Essay

I spoke with one household member that mentioned her girl was sexual harassed by another patient at the county infirmary, and hospital staff allow her sit outside without supervising so the other patient would non hassle her. Unless a individual with a mental unwellness is arrested, he may ne’er have any information for services available. There seems to be some aid out at that place but it is non being decently communicated to the populace. The options most people believe they have are: you have private wellness insurance, or

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public aid such as Medicaid/Medi-cal. If you have neither, it seems like you can non be treated. Due to miss of financess, infirmaries will non take a patient that has no wellness insurance. A mental patient should ne’er be turned off and refused wellness attention, particularly in a life endangering state of affairs. Even those with wellness insurance are merely allowed a certain sum of therapy Sessionss per twelvemonth, and are normally non sufficient to have proper intervention.

Mental wellness attention services are non covered by wellness insurance bundles and wellness programs to the same grade as physical wellness attention services. Not merely are at that place normally more services excluded as covered benefits, but those services that are covered are frequently capable to higher co-pays and are capped at a maximal figure of covered interventions. Less good known is the fact that those with terrible mental unwellness are less likely to hold wellness insurance coverage of any sort.

Harmonizing to a recent study by the federal Substance Abuse and Mental Health Services Administration, the taking ground that people with mental wellness issues do n’t seek intervention is cost. They fear the fees. “ There ‘s a misperception that attention is ever expensive, but that ‘s non the regulation, ” said John Draper, a psychologist and the undertaking manager of the National Suicide Prevention Lifeline, a free 24-hour service supported by the federal authorities. “ There are plentifulness of ways to acquire aid, ” he said. “ Some of them are really low-cost. ” But while low-cost mental attention exists, it ‘s non ever easy to happen or acquire immediate entree to. Delay in intervention is besides another ground why many merely walk off from being treated. They estimate a average hold of 10 old ages after onset until the first contact with a general medical physician and 11 old ages until the first contact with a

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head-shrinker. Even though more terrible mental upsets were associated with shorter holds, the mean hold between oncoming and first intervention contact for even the most terrible upsets was 5 old ages.Mental Health Crisis And Care Essay

Therefore, a big organic structure of grounds supports the statement that people with mental unwellness, particularly those with more serious and relentless jobs, necessitate entree to general wellness attention every bit good as mental wellness attention. The findings point to a serious job in our wellness attention system.

Crisis And Acute Care In Mental Health

Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of UK Essays.

The aim of this assignment is to demonstrate an understanding on the nature of risk and risk assessment in relation to suicide. There are various risk assessments used within the field of mental health; this assignment will focus specifically on evaluating the actuarial and clinical approaches when assessing suicidal clients. To conclude it will explore some of the challenges faced by nurses when assessing suicidal clients in crisis and acute care settings.

It is well established that people who have mental health problems are a high risk group for suicide (The National Suicide Strategy for England 2006). Predominantly these are people who have experienced depression, alcohol disorders, abuse, violence, loss, and consider their cultural and social background (World Health Organisation (WHO) 2011). Suicide is recognized as a severe worldwide public health dilemma. It is one of top 20 leading causes of death internationally for all ages. A considerable number of suicides have occurred during an episode of in patient care (Bertolote et al 2003). Mental Health Crisis And Care Essay

The Department of Health (DOH 2002) issued the report saving lives: Our Healthier Nation (DOH 1999a), within this clear targets were set to reduce the death rates of suicide by a fifth by 2010. The national strategy highlighted that there needs to be a systematic approach to reduce suicide. Standard 7 of The National service framework for mental health (DOH 1999) puts emphasis on local trusts to implement policies to reduce the rates of suicide. All individual Trusts have developed a toolkit to work towards a trust wide suicide prevention framework. According to Morgan (2007) mental health services have become ‘operationalized’ through practice guidance from the National Health Service’s National Service Framework (DOH 1999) and provide a particular emphasis within the Care Programme Approach (DOH 2008), although Anderson & Jenkins (2006) argue that even though comprehensive strategies need to be in position the rate of suicide continues to be a concern. However recent figures show a decrease in suicide rates in mental health patients this is predominantly among

young men within an in patient setting. (National Confidential Enquiry into Suicide and Homicide by people with Mental illness 2010).

Risk assessment and risk management are very familiar to mental health nurses and play an imperative part in their role as a health care professional. However these concepts are taken for granted within mental health nursing as they play a central role in the defence against potential litigation (Crowe & Carlyle 2003). According to Tummey & Turner (2008) the concept of risk has displaced care when defining the significance of patient contact. Beck (1999) suggests that risk assessment is not in the best interest of the patient it is an attempt for the organisation to control the behaviour of patients and staff.

There are three types of risk assessment: the unstructured clinical approach, the actuarial approach and the structured clinical approach (DOH 2007). Historically mental health practitioners used the unstructured clinical approach this was guided by intuition, experience and their clinical judgment to asses the severity of risk. However this approach has been criticized for being unstructured and subjective leading to inconsistency and unreliability. (Tummey & Turner 2008).

The drive to towards evidenced-based practice as a more objective and reliable means of risk assessment has led to the development of actuarial risk assessment tools (Tummey & Turner 2008). This approach was derived from the insurance industry; it uses mathematical means to establish the outcome. Actuarial risk assessments are based on statistical probability. They produce an estimate of risk collated from group data. They attempt to predict an individuals risk based on their future actions and look at the behaviour of others in comparable situations (Hart & Kirby 2004). According to Szmukler (2003) the actuarial approach eliminates the problem of subjective clinical judgement and focuses on the actuarial risk assessment to inform the decision making process, although Tummey & Turner (2008) would argue that an actuarial approach can create a deceptive sense of proficiency within clinicians particular for those who.Mental Health Crisis And Care Essay

are less experienced. Therefore it could be argued that actuarial approaches can be subjective in their outcomes depending on the skills of the clinician. The scientific validity of this approach is open to criticism; Hart & Kirby (2004) argue that humans act in very individual and random ways therefore the scientific principles do not work. Bouch & Marshall (2005) recognises that the problem with this approach is that it focuses on the statistical outcomes rather than on gaining an understanding the severity and circumstances of the suicide. Silver & Miller (2002) affirms that an actuarial risk assessment is more constructive in labelling an individual rather than considering why they are behaving in a particular way. According to Tummey & Turner (2008) actuarailism reduces an individuals risk to a range of changeable variables encompassed within a sequence of tick boxes. Research acknowledges that the use of an actuarial approach over the clinical approach can cause considerable discussion. However Little child & Hawley (2009) suggest there must be a mix of actuarial and clinical risk assessments to guide the nurse to form an accurate risk assessment.

The structured clinical assessment utilises both the actuarial and clinical approaches. It draws on the science of actuarial approaches but attempts to take advantage of an informed clinical judgement through patient assessment (Conroy & Murrie 2007). According to Doyle & Dolan (2002), this approach is based upon gaining the individuals history; present mental state and other relevant information to establish the risks for the individual. Gathering this information is imperative in order to gain a thorough risk assessment. Haques et al (2008) consider structured clinical risk assessments to be evidence-based, transparent and flexible and they encompass a collaborative approach. Crowe & Carlyle (2003), reports that structured clinical risk assessessments help clinicians to avoid missing potential information as they offer a means of clinical thinking. However Harrison et al (2004) argues that risk assessments are only of good quality if the information is present and this is only possible if the clinician is competent in risk assessing. Evidence suggests that there are no research instruments, scales or scores that can predict the risk with total precision. Research suggests that a combination of actuarial and clinical approaches

enhance the vigorous and continuous process of risk assessment and form the bases of a validated risk assessment tool (Doyle & Dolan 2002).Mental Health Crisis And Care Essay

Beck et al (1979) developed a categorization system of suicidal behaviours, and assessment scales to assess suicidal intent. According to Anderson & Jenkins (2006) professional’s world wide used these scales as they are reliable and have validity. The Beck Suicide Intent scale (SIS; Beck et al 1974) is a 15- item questionnaire intended to assess the severity of suicidal intent linked with an episode of self harm. Each item scores 0-2, with the total score ranging to 30. It is divided into two parts: the first 8 items focus on the circumstances of the act. The remaining items are part of the self report section this is based on the patient’s account of the event and incorporates their feelings and thoughts at the time of the act (Harriss & Hawton 2005). Harriss & Hawton (2005) carried out a study which looked a number of patients who self harm between 1993 and 1997. It established that the suicide intent scale could not determine who would commit suicide but recognised the information gained about ideation and intent would be effective within a clinical risk assessment. Suominem et al (2004) argues that the scale is time consuming therefore a shortened version of the scale would be far more beneficial to use in clinical practice. Research suggests that this scale has some weaknesses over the value of self report. There may be bias within this section due to the fact that people may be ambivalent when answering questions this could due to their mental illness or that they are embarrassed when discussing their suicidal ideation. The dilemma is that their reflective account of the situation may not be precise therefore it may be difficult for the clinician to gain a true and accurate picture based on the subjective account provided (Barker 2004).

Competent risk assessment, communication and management within an acute mental health setting can be a major challenge for nurses (Harrison et al 2004). According to

Anderson & Jenkins (2006) it is crucial that nurses are able to assess people who may be at risk of suicide. However Barr et al (2005) argues that for nurses to be able to risk assess effectively resources need to be in place. The DOH (2001) recommends that staff participate in risk assessment training at least every three years. Mental Health Crisis And Care Essay

The trusting relationships between nurses and patients are vital when assessing a suicidal patient. However there a various factors which need to considered for this to happen. When people are acutely unwell it may be difficult for them to establish a rapport with staff. This may due to the nature of their illness or it could a cultural belief that prohibits them from discussing the topic of suicide (Tummey & Turner 2008). Therefore it is imperative that nurses use the correct risk assessment that is flexible and personal to the patient encompassed with good effective verbal and non verbal communication skills. Otherwise it will prove difficult for the nurse to illicit information to form an accurate risk assessment. When patient’s risks are considered to be high a multi disciplinary team will determine what the levels of observations to place them. Bouch & Marshall (2005) maintains that promoting the dignity, privacy and autonomy of the patient will endeavour to sustain the therapeutic relationship. However Harrison et al (2004) argue that the close monitoring of a patient continues to be a challenge for nurses as it can be perceived by patients as a policing exercise and could exacerbate their anxiety and have detrimental effect on the therapeutic relationship. Consequently this will have a negative impact on the consistency and validity of the risk assessment.

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In conclusion this assignment has demonstrated that risk assessment continues to a complex process for mental health nurses. It has demonstrated that there are a number of positive and negative aspects for both the actuarial and clinical approaches when assessing risk. Research illustrates that using a combination of actuarial and clinical risk tools will demonstrate a more versatile and reliable approach when assessing suicidal patients. Finally this assignment has discussed various challenges that nurses faces when risk assessing in acute care settings. Mental Health Crisis And Care Essay