The case management practices of community mental health nurses: 'Doing the best we can'

The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand

This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.

Development, validation and initial outcomes of a questionnaire to investigate the views of nurses working in a mental health setting regarding a cardiometabolic health nursing role

People with serious mental illness experience disparities in primary health care. One solution is a specialist nursing position responsible for the coordination of the primary care of people with serious mental illness. However the views of nurses regarding this proposed role are only beginning to emerge. This study reports the readability, factorability, internal consistency and responses from a questionnaire regarding the views of nurses working in a mental health setting regarding the proposed role. The questionnaire was determined to have adequate readability, and internal consistency. Nurses are positive towards the development of the role however the cost-effectiveness should be considered.

The activities that nurses working in community mental health perform: a geographical comparison

Objective. The primary aim of the present study was to identify the activities that nurses in community mental health services undertake. Method. A dataset containing records of the community and ambulatory interventions involving the nursing staff of 252 mental health facilities was analysed. Results. Nurses spend most of their time performing clinical care (78%), followed by clinical organisation (12%), mental health administration (6%) and integration activities (4%). There were minimal differences between treating units located in metropolitan, rural and remote areas in terms of the numbers of consumers receiving care, the time nurses spent with consumers, the types of nursing activities undertaken and the amounts of time spent on each of the four types of nursing activities. Conclusions. These findings suggest that nurses in mental health community settings spend more time in clinical care than nurses in other healthcare settings. What is known about the topic? Community settings are increasingly becoming the primary focus for mental health care in Australia. Nurses are providing community-based care for consumers with increased levels of acuity. There is a paucity of documented evidence about the activities nurses perform in community mental health settings. What does this paper add? This study provides a comprehensive understanding of the activities undertaken by nurses in community mental health settings. The findings presented emphasise the high proportion of clinical care performed by nurses in community mental health settings. No significant differences were noted in the provision of clinical care between metropolitan, rural and regional mental health services. What are the implications for practitioners? A comprehensive understanding of the activities of nurses in community mental health settings provides the basis for understanding the important role nursing plays in this area of care delivery.

Should we or shouldn't we? Mental health nurses' views on physical health care of mental health consumers

People diagnosed with a mental illness experience poorer physical health than the general population. Nurses have been identified for their potential role in addressing physical health needs of consumers of mental health services. This paper reports on preliminary findings of a qualitative study on health-care services for physical and mental health in a regional area in Australia. A key purpose of the study was to explore the perceptions of nurses working in mental health settings of their physical care with consumers. A qualitative, exploratory approach was undertaken. Semi-structured focus groups were conducted with 38 nurses from one mental health service. Nurse participants described a common co-occurrence of physical problems and mental illness and expressed the importance of health-care services to treatment and prevention. Participants expressed divergent views on nurses' capacity to contribute to better health-care processes.

Models of case management for working with young children: implications for mental health nurses

The care of children with behavioural disorders/mental illnesses is an important and emerging role for mental health nurses. Unfortunately, there is little evidence on which to base their practice. Children, because of their rapid emotional, physical, and cognitive development, and their dependence on their families, need special consideration in their mental health care. The limited evidence available indicates that this special consideration should include a focus, not only on the child, but also on the parents and social and school networks of the child. Evidence from the adult literature indicates the most effective case management models are the ones in which the case manager offers as many services as possible, including talking therapies. This also seems to be true when working with children. Mental health nurses, because of their background and commitment to holistic care, are ideally suited to offer this type of service. However, mental health nurses have not been good at articulating what they do. This can limit the recognition of the contribution they make and their opportunities.

Community mental health nurses, caseloads, and practices: a literature review

Deinstitutionalization, and more recently, earlier discharges from psychiatric inpatient units, have created and intensified the need for case management in community mental health. Nurses have been at the forefront of providing this case management. This literature review provides a synthesis of research and policy on the contribution of mental health nurses to community case management. The focus of this review is on the proportion of case management that mental health nurses undertake, the caseloads of case managers, and the interventions that mental health nurses most frequently perform in the community. The professional compositions of mental health case management workforces have been associated with economic imperatives, professional priorities, and the choice of case management models. The influence of mental health nurses in the case management workforce is particularly strong in the U.K. and Australia, but less so in the U.S.A. where social workers and people without mental health qualifications perform similar roles. Although heavy caseloads seem to be common among case managers, the research in this area is quite weak. The interventions that mental health nurses perform most often include case management (e.g., coordinating care), counselling, and medication management. Caring for the physical health of consumers might often be overlooked.

The characteristics of consumers receiving case management in the community: a review of literature

Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.

A role for mental health nursing in the physical health care of consumers with severe mental illness

There is extensive international evidence that people with severe mental illness have a lower standard of physical health than the general population. This leads to higher morbidity and mortality rates. Many of the causes for this poor physical health are modifiable. Yet the physical needs of this consumer group are neglected by healthcare systems in Australia, and elsewhere. While medical specialists are clearly integral to remedying this, nurses are well placed to play a key role in focused prevention and early intervention in the physical well-being of consumers with mental health problems. This paper outlines the specifics on how mental health nurses can be sensitized, prepared and empowered to help turn this serious health issue around. In particular, mental health nurses could be trained in and then utilize a new physical health check and response system in the UK (called the Health Improvement Profile) if adapted for use within Australia. This profile will be briefly introduced, and then its value to improving health care discussed.

The subjective experiences of people who regularly receive depot neuroleptic medication in the community

Little has been written on the subjective experiences of people who receive depot injections in the community. The authors of this paper have identified distinct gaps in the literature in terms of the views of service users regarding this particular intervention. Existing studies tend to focus upon the side effects of depot neuroleptic medication and the attitudes of Community Mental Health Nurses (CMHNs) towards administering depot medication and issues of compliance and non-compliance. Mental health nurses are frequently perceived as adhering solely to a biomedical approach to patient care in their practice and the therapeutic aspects of their role is frequently unacknowledged. This paper explores how, within the process of giving a depot injection, CMHNs are able to carry out an assessment of their client's needs as well as being someone who is consistent, reliable and supportive. This means that the process of giving a depot injection may be considered as a therapeutic intervention. Qualitative data were obtained through the administration of a semi-structured interview schedule that was constructed and consisted of a range of questions that elicited service users views and opinions related to their experiences of receiving depot neuroleptic medication in the community. The relationship between patient and nurse, as this study reveals, was one that was not only therapeutic, but also provided a forum where psychosocial and clinical issues could be discussed and explored. Crucially, the service users felt they did have a role and an influence in the delivery of their care.