It stimulated a worldwide growth of scientific research and advances, including the following: ● Research on genetic basis for mental illnesses. ● Mapping of the genes involved in Parkinson, Alzheimer’s, and epilepsy. ● Discovery of the actions and effects of neurotransmitters and cytokines. ● Advancements in neuroimaging techniques that have increased our understanding of normal brain function and pathologic states (Halter, 2018). In 1990, the Human Genome Project began to map the human genome. This 13-year project strengthened the theory that there are biological and genetic explanations for psychiatric conditions (https://www.genome.gov/human-genome-project). Although researchers have begun to identify genetic links to mental illness, research has yet to reveal the exact nature and mechanisms of the genes involved. It has been established, however, that psychiatric disorders can result from multiple mutated or defective genes.
developments, patients with psychiatric disorders began to receive needed psychiatric treatment and rehabilitation. In 1946, the United States passed the National Mental Health Act, which resulted in the establishment of the National Institute of Mental Health or NIMH. In the second half of the 20th century, equality became a central tenet in mental health treatment. Many mental healthcare consumers became advocates and began to promote the rights of those with mental illness, working to demolish stigma, discrimination, and forced treatments. In 1979, the National Alliance on Mental Illness, an advocacy group, was formed. Through the work of the alliance and other advocacy efforts, mental health patients were granted autonomy and began participating in their own care. The 1990s were known as the decade of the brain , with focus placed on neuroscience and brain research.
EPIDEMIOLOGY
of cases in each population for a specific period. According to 2019 data from the National Institutes of Mental Health (NIMH), an estimated 51.5 million adults aged 18 or older (20.6%) in the United States have been diagnosed with mental illness. Lifetime prevalence estimates 49.5% of adolescents have been diagnosed with a mental disorder and 22.2% have had severe impairment (NIMH).
Epidemiology is the scientific study of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations including neighborhoods, schools, cities, states, countries, and globally (https://www.cdc.gov/). Concepts related to epidemiology include incidence and prevalence . Applied to mental health, incidence is the number of new cases of a mental disorder in each period. Prevalence is the total number
POLICY AND PARITY
gaps in care, focusing on voluntary treatment. Additionally, this promotes a system that treats mental health issues separately from physical problems. A strong recommendation was made for equality in financial reimbursement and quality treatment. The Mental Health Parity and Addiction Equity Act of 2008 (Office of the Federal Register, 2013) sought to improve the quality of treatments for those with mental illness by advocating mental health coverage at the same annual and lifetime benefit as any medical-surgical coverage (Centers for Medicare & Medicaid Services, n.d.). This Act required any business with more than 50 employees to have mental health coverage at the same level as medical-surgical coverage (Centers for Medicare & Medicaid Services, n.d.). This includes deductibles, copayments, coinsurance, out-of-pocket expenses, and treatment limitations. The requirements under the Act are applied indirectly to small group health plans in tandem with the Affordable Care Act’s essential health benefit requirements (Centers for Medicare & Medicaid Services, n.d.).
The first Surgeon General's report on mental health was published in 1999. This landmark report, which was based on scientific literature and included a focus on mental health providers and consumers, concluded that mental health is fundamental to holistic health and that effective treatments for mental disorders are available. In 2003, the President's New Freedom Commission on Mental Health recommended that the healthcare system needed to streamline care for those suffering from mental illness. This commission advocated for early diagnosis, prevention, and treatment and set forth new expectations for recovery and assistance for those experiencing mental illness to find housing and work. In 2006, the Institute of Medicine (now the Health and Medicine Division of the National Academies) Committee on Crossing the Quality Chasm published Improving the Quality of Health Care for Mental and Substance Use Conditions. The Quality Chasm series highlights effective treatments and addresses large
PSYCHIATRIC AND MENTAL HEALTH NURSING
Society of Psychiatric Mental Health Nurses (American Nurses Association, 2014). Nurses encounter patients in crisis in many clinical settings. The crisis may be physical, emotional, mental, or spiritual. Regardless of the origin, these patients express a variety of feelings including hopelessness, helplessness, anxiety or anger, low self-esteem, and confusion. Many individuals act withdrawn, suspicious, depressed, hostile, or suicidal. Additionally, the individual may be intoxicated or withdrawing from alcohol or other substances. Knowledge of basic psychiatric concepts increases nursing competency in any clinical setting.
The psychiatric nurse promotes mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders (American Nurses Association, 2014, p. 129). Psychiatric nursing integrates the use of self, neurobiological theories, and evidence-based practice in planning treatments. Nurses work in a variety of inpatient and outpatient settings with individuals and families across the lifespan who exhibit mental health needs. Specific activities of the psychiatric nurse are defined by the Psychiatric- Mental Health Nursing: Scope and Standards of Practice, published jointly by the American Nurses Association, the American Psychiatric Nurses Association, and the International
DSM-5 NOMENCLATURE FOR DIAGNOSES AND CLASSIFICATIONS
Today, healthcare providers often use other forms of tests, such as genetic testing, computerized tomography, magnetic resonance imaging, and positron emission tomography, to detect changes in the brain and brain activity.
Blood tests, though useful for diagnosing many physical disorders, cannot diagnose all psychiatric disorders. Instead, healthcare practitioners base their diagnoses primarily on symptoms. Emil Kraepelin was the first healthcare provider to recognize and categorize patients’ symptoms into mental disorders around the turn of the 20th century (Boyd, 2018).
Book Code: ANCCUS3023
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