Working with Patients with Mental Illnesses Assessments, Communication Tools & Resources

1. Working with Patients with Mental Illnesses Assessments, Communication Tools & Resources Tiffany Smith-Fromm, MN, RN

2. What is Mental Health? • Definition: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

3. State of Mental Health • According to Mental Health America, in the U.S. • 1 in 5 adults have a mental health condition • Youth mental health is worsening • Depression: 5.9% in 2012 and 8.2% in 2015 • 76% of youth with severe depression go without sufficient help • Nearly half of youth ages 8-15 receive no services (NAMI) • 56% of adults with mental illness do not seek treatment • Nearly half have a co-occurring substance abuse disorder. • 9.6 million experience suicidal ideation http://www.mentalhealthamerica.net/issues/state-mental-health-america http://namieasysite.com/wp-content/uploads/sites/2/2013/05/mentalillness_factsheet.pdf

4. State of Mental Health cont… • There is a mental health workforce shortage • However, • More Americans have access to services due to Medicaid expansion • Improvement in youth coverage • Fewer un-insured adults with mental illness (decreased by 5%) • Less access to care means more incarcerations

5. State of Mental Health Cont. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154785

6. State of Mental Health- Washington • MHA – Washington ranked 34 in the US overall • Adult Data – ranked 38 • Youth Data – ranked 35

7. State of Mental Health – Washington State • Washington is fifth highest percent of adults reporting poor mental health in the US. • 38.6% of adults report poor mental health in Washington, compared to a national average of 35.6%. (KCMU analysis of the CDC’s BRFSS 2012 Survey Results).

8. Social Justice and Mental Health • About 26% of homeless adults in shelters have a SMI or substance disorder • ~ 20% of states prisoners and 21% local jail prisoners have recent MH condition • 70% of youth in the juvenile system have at least one mental health condition • 20% live with SMI

9. Consequences of No Treatment • Serious mental illness costs America $193.2 billion in lost earnings per year.15 • Mood disorders (major depression, dysthymic disorder and bipolar disorder) - third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.16 • Individuals living with serious mental illness have increased risk of chronic medical conditions.17 • Adults with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.18 • About 37% of students with a mental health condition age 14­–21 and older who are served by special education drop out—the highest dropout rate of any disability group.19 https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

10. Consequences of No Treatment • Suicide is the 10th leading cause of death in the U.S.,20  • the 3rd leading cause of death for people aged 10–1421  • the 2nd leading cause of death for people aged 15–24.22 • More than 90% of children who die by suicide have a mental health condition.23 • Each day an estimated 18-22 veterans die by suicide https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

11. One Story…

12. Reality at the Bedside • What is your experience at the bedside with patients who are experiencing a mental health issue? • What training have you had and did you feel prepared to address the needs of that patient? • Think, Pair, Share: 10 - 15 minutes

13. Reality at the Bedside, Cont. • Data • In 2012, there were over 8.5 million (32.3%) IP stays. Agency for Healthcare Research and Quality – Statistical Report #191

14. Most common M/SUD diagnoses among adult inpatient stays by age group, 2012 Top five MD diagnosis TopfiveSUD diagnoses 100% 90% 35.1 80% 50.6 50.3 43.4 55.4 70% 56.3 56.4 69.5 60% 77.4 72.7 18 – 44 50% 45 – 64 Percentage of All Inpatient Stays 65+ 40% 56.7 46.7 39.1 33.6 30% 32.7 35.1 34.8 20% 24.7 22.9 16.9 10% 17.1 10.3 9.5 5.9 9.9 10.0 5.7 8.9 8.2 4.4 0% Agency for Healthcare Research and Quality: Statistical Brief #191

15. Cost of this Reality Table 2. Characteristics of adult inpatient stays with a primary mental or substance use disorder diagnosis, 2012 Agency for Healthcare Research and Quality – Statistical Report #191

16. How Nurses Feel… • According to a 2017 article by Margo Halm, RN, PhD, NEA-BC: • Nurses’ attitudes • Illness caused • Confidence or anxiety regulation did not predict performance • How the nurse related to the aggressor interpersonally played the critical role.

17. How Do Others Feel? • Stigma: endorsing prejudicial attitudes about mental illness leading to discriminatory behaviors • Health care professionals have these attitudes • Have you seen it? • Could this be you? • What are the consequences of this?

18. Breaking the Stigma and Shame of Mental Illness

19. Tools in our Tool belts! • Columbia Suicide Severity Rating • Generalized Anxiety Disorder • Mood Disorder Questionnaire • Mental Health Screening Tools - MHA

20. How to Educate Yourself • Mental Health First Aid • NAMI • Mandatory Suicide Prevention Course for nurses • MAD IN AMERICA • American Psychiatric Nurses Association • SAMHSA – Recovery to Practice • National Institute of Mental Health

21. Can Recovery Happen? • Yes, recovery may happen wherever the person is at the moment • It doesn’t just happen because it is talked about • Can happen inside and outside of treatment • All clinicians should view this as the end-game

22. Attributes of A Leader • Ability to remain calm during crisis • Confidence in clinical decision-making • Ability to manage unexpected or unpredictable situations

23. Guiding Principles • Demonstrate and convey respect for person’s dignity and worth as a fellow human being • Ensure the person’s safety and other basic needs are being addressed and offer him/her hope that things can get better • Strive to reach, access, identify, and promote the person’s sense of self

24. Words from a Colleague • Get to know YOUR patient • Stigma – what can you do about it? • Step in their shoes • Build Trust • Treat them like humans • Recognize medications have side effects, but medications are important

25. Resources in Our Communities • National Suicide Prevention Lifeline at 1-800-273-TALK (8255) is a confidential service available to anyone 24 hours a day, 7 days a week. http://www.suicidepreventionlifeline.org • Crisis Clinic at KING COUNTY 2-1-1: DIAL 2-1-1, 1-800-621-4636 offers telephone-based crisis intervention and information and referrals to community services for youth and adults in Seattle-King County, WA. https://crisisclinic.org/ • Teen Link at 1-866-833-6546 is a teen-answered help line. https://866teenlink.org/ • Washington Recovery Help Line at 1-866-789-1511 is a statewide service offering emotional support and linkage to substance abuse, problem gambling and mental health services to anyone in Washington state. https://www.warecoveryhelpline.org/ • Washington Warm Line at 1- 877-500-WARM (9276) is a peer-answered help line for people living with mental health challenges. https://crisisclinic.org/find-help/washington-warm-line/ • Crisis Text Line is a free, 24/7 support for those in crisis. Text HOME to 741741 from anywhere in the U.S. to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. www.crisistextline.org • Substance Abuse and Mental Health Services Administration - SAMHSA’s National Helpline at 1-800-662-HELP (4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. https://www.samhsa.gov/find-help/national-helpline

26. Activity • Language of Cultural Narratives: • The language that pervades an organization cannot help but shape its culture. As we live our lives, we also continually “tell stories” about our lives, even though we don’t always share our narratives with others. Because our individual stories play such a big part in our lives, it’s quite possible that we create our life experiences just as much by what we say as by what we do

27. Discussion/Questions