NR 305 Discussion Community Access to Mental Health Services

Opioid addiction is a prevalent crisis in my area. I live in a rural county so there is not much to do, and people turn to drugs for something to do. There are also many people who have chronic pain and will become addicted to opioids because of this. “The abuse may become the person’s priority in life, resulting in avoidance of responsibilities and leading to a physical withdrawal state” (Weber & Kelley, 2018). The addiction creates tensions in families and often leaves people estranged.
I work on a medical complexity mental health unit and we discharge many patients with referrals to TASC (Treatment Access & Services Center), which is a great program that refers patients to drug and alcohol programs. They do a clinical assessment for people who do not have insurance or have Medicaid. After the clinical assessment, they will determine the level of care the patient needs, whether it is detox, outpatient, or inpatient rehab. They also offer peer- to- peer outreach programs for support and assist in funding through collaboration with COCA (Council of Chemical Abuse) (Berks TASC Treatment Access & Services Center, 2020).
Our charting system has a Clinical Opiate Withdrawal Scale that assesses the symptoms related to opiate withdrawal, such as sweating, yawning, heart rate, restlessness, GI symptoms, anxiety/irritability, achy bones or joints, etc. It is a scoring system to help determine what level of withdrawal they are currently at. I would use this scale for anyone portraying these symptoms that has a history of substance abuse or has opiates in their urine drug screen. My unit has mental health consultants that do a further assessment that looks at how much they use, how often, and other mental health concerns they have, since mental health and substance abuse go hand in hand.

References:

Berks TASC Treatment Access & Services Center, Inc of Berks County (2020, July 23). Retrieved July 25, 2020, from https://berkstasc.org/wp/
Weber, J. R., & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

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The opioid is a type of psychoactive drug available as prescription drugs, can be beneficial in pain management but lack of knowledge on its proper consumption and misuse leads to drug addiction. I agree with your observation that most of the people who have nothing to do turn on drugs because it can give them the “high” feeling. Opioid and other drug addiction can be linked to personality disorders or behavioral problems. However, its long-term use can cause drug dependence, addiction, and affects its tolerance in the body (Hemmings and Egan, 340). It is important to have resources in the community that provides services such as programs, treatment, and rehabilitation to those patients.

Sources:

Hemmings, Hugh C. and Egan, Talmage D. Pharmacology and Physiology for

Anesthesia E-Book: Foundations and Clinical Application Edition 2 Elsevier Health Sciences, 2018

Thank you for sharing information about TASC. I am also in Berks county and I wasn’t aware of this resource. After visiting the website, I found that it also provides a free case management service is for those who are dealing with mental health issues in addition to alcohol and/or drug addiction.

On my unit we have a Medication Assisted Therapy program for pregnant women who are treated with Methadone or Suboxone. Upon admission as well as ongoing we use the COWS scale to assess for opiate withdrawal. Previous to my current position, I worked inpatient at a psychiatric hospital with children and adolescents. We would often use the CAGE substance abuse screening tool as many patients would be admitted with known history or present substance abuse issues. This screening tool has four questions and is scored based on answers of “yes” or “no”. The questions include:

Have you ever felt you should Cut down on your alcohol or drug use?
1. Have you ever been Annoyed by others criticizing you about your alcohol or drub use?
1. Have you ever felt bad or Guilty about your alcohol or drug use?
1. Have you ever used alcohol or drugs as a way to wake yourself up in the morning, calm your nerves, or get rid of a hangover? (Eye-opener)

A patient who answers “yes” to just one question requires further evaluation. This tool is used for patients of all ages but was especially useful I thought when working with adolescents.

Johns Hopkins Medicine (n.d.). www.johnshopkinsmedicine.orgLinks to an external site. retrieved on July 29, 2020 from https://www.hopkinsmedicine.org/johns_hopkins_healthcare/downloads/all_plans/CAGE%20Substance%20Screening%20Tool.pdfLinks to an external site.

Although my county has an opioid problem as well, we normally do not see it too much in my hospital. However, recently we have seen more and more people coming in with over doses. During the Covid shutdown, people were having a hard time getting their methadone buprenorphine. Also, due to the social distancing group support meeting, such as NA were cancelled which caused people to relapse (Green, Bratberg, & Finnell, 2020). It’s really great that your hospital has a place where they refer discharged patients to. Whether they use it or not, at least it gives them an option. When we admit a patient there are certain questions we ask regarding substance abuse. If they answer yes to using drugs or alcohol it automatically triggers a referral to Peer Recovery, which is a program that our hospital utilizes. The program employs former substance abusers to come and talk to the patients. It’s a really great program because they know what the patient is going through and the patients feel they can relate to them.

Green, T. C., Bratberg, J., & Finnell, D. S. (2020). Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment. Substance Abuse, 41(2), 147–149. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1080/08897077.2020.1752351

Depression can affect anyone at any time in their lives and everyone must be screened for depression. Some subjective findings that would indicate the need for further assessment would be despair, anhedonia, a decrease in appetite, insomnia, overwhelming sadness, fatigue, and inability to concentrate. Some objective findings would be anxiety, muscle tension, inability to sit still, unkempt appearance. I would use a personal history assessment, Depression Questionnaire, and SAD PERSONS Suicide Risk Assessment (Weber, 2018, p 82). It is important to check for substance abuse problems as people often self-medicate, I would ask about alcohol and drug abuse using the AUDIT (Weber, 2018 p 76).

I live in a smaller rural community but there are resources in the area for help with depression. Helping Hand Behavioral Health is located in the neighboring town. They have a variety of programs and both in and outpatient services to help with mental illness and depression. They have evaluation and counseling services, group therapy, living skills, nutrition, and also provide transportation. They also have pet therapy and exercise programs. I am happy to see that they have a very well-rounded program that not only offers mental health services but promotes whole-body wellness.

References:

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

Helping Hands Behavioural Health (2020, July 27) www.helpinghandsbehavioralhealth.comLinks to an external site.

My patient has had long term pain management issues. There are multiple injuries that have occurred over the years. The patient was in a few car accidents and has multiple healed fractures and chronic back pain. However, this admission has occurred because the patient overdosed on her hydrocodone. Doctors on her team are now admitting her for opiate withdrawal and pain management. The patient is currently refusing physical therapy.

Questions for the patient:

Why are you refusing physical therapy?
1. What other methods besides prescription medications have you tried to alleviate pain? Has anything worked?
1. What was your goal in overtaking your medications? (If suicidal I would want to further explore).

Assessment tool:

I would want to explore more about whether the person is at high risk for suicide. The assessment tool I would use would be the SAD PERSONS suicide risk assessment as mentioned in Weber, et al (2018). The tool gives a score of 1 to each positive in the acronym of SAD PERSONS to total the score – higher scoring meaning higher risk (Warden, et al, 2014). SAD PERSONS would help explore any other substance use; what family life is like in a nutshell; and a lot of the information is objective and already available from the chart (Warden, et al, 2014). “SAD PERSONS” includes “Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness” (Warden, et al, 2014). However, this is a very basic assessment tool to kind of check in and once it is used to gather information, more exploration should be done by another department that is better suited to care for a depressed/suicidal patient as professionals recognize this is a limited tool (Warden, et al, 2018).

Community Resources I found to help outpatient in Skokie, IL:

Heartland Health Centers in Skokie: https://www.heartlandhealthcenters.org/locations/hhc-turning-point/Links to an external site.

Heartland provides income-based services and some of the providers specialize in addiction, but the providers are not specific to addiction issues.

Behavior Services Center:

https://www.opiates.net/center/behavior-services-center-skokie-il/Links to an external site.

This site offers cognitive behavioral therapy and addictions counseling specifically although the focus is heroin and alcohol detox/counseling. Also privately owned and therefore, likely to be expensive.

Although my community has a lot of resources, the questions always lies: what is affordable and available? How long is the wait list? I am pleased the online search was fairly easy and I enjoy that the link for Behavior Services Center also included area clinics that offer similar services if this site is unable to accommodate.

References

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

Warden, S., Spiwak, R, Jitender, S., Bolton, J. M. (2014). The SAD PERSONS scale for suicide risk assessment: A systemic review. Archives of Suicide Research 18(4): pp. 313-326. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1080/13811118.2013.824829

Depression

Mental health applies to a person’s level of cognitive functioning and emotional functioning. No one can be completely healthy without “mental health.” (Weber, Kelley, 2018) I have chosen depression as the mental health topic I would like to address this specific topic as this is something that hits close to home. I have struggled with depression off and on for a while now as well as have family history, as I remember as a child my Mom struggled with it as well.

Depression is one of the most common mental health disorders in the United States. Many Americans who could benefit from treatment do not seek out treatment, those that do usually go through outpatient services of counseling and medication. (Alang, McAlpine, 2020)

When completing a web search regarding access to health care services for depression google came up with a list of many different groups that offer counseling and mental health services for the community. They have counselors, psychologists and psychiatrists. There are also inpatient services through Unity Point Hospital called Robert Young. During nursing school I did get the opportunity through our mental health rotation to have clinicals at Robert Young which provided so much hands on knowledge and educational opportunity. Robert Young inpatient services offered for both adults and adolescents covers the entire mental health spectrum as well as alcohol and drug treatment.

Follow-up Questions:

Subjective information that may need further in-depth assessment would be: family history, their current lifestyle and health practices (if alcohol is consumed and if so how much/frequency, sleep patterns, energy levels, current medications, use of any recreational drugs, etc.) as well as the persons support systems. Objective information would be: vital signs outside of normal limits, assessing the information received by having the patient complete the quick inventory of depressive symptomatology screening tool (Weber, Kelley, 2018) for any concerns, any abnormality within the head-to-toe physical assessment.
1. Using the quick inventory of depressive symptomatology (Weber, Kelley, 2018) would definitely cover many of the basic foundation questions/concerns to assessing the patient for depression and the level of severity of the depression.
1. As stated above I found multiple locations that offer counseling, psychologists, as well as psychiatrists that are able to offer expert medical services both outpatient and inpatient to be able to address a person’s depression. Honestly I feel that my current geographical location has much more availability for mental health treatment than most areas within the midwest. Considering I have had to seek out assistance for myself as well as for my son, I did not have a difficult time locating the services both of us needed. Not to mention it helps that my insurance covers mental health as that is a concern/issue for many that if they do not have insurance coverage they are not able to get the mental health help they need.

References:

Weber, J., Kelley, J., (2018). Assessing mental status including risk for substance abuse. Health Assessment in Nursing 6th ed., 6, 70-80.

Alang, S., McAlpine, D., (2020). Treatment modalities and effectiveness of treatment among adults with depression. Health Services Insights. 13, 1-7. Retrieved from: https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=4&sid=63442c3f-9dcb-4aa6-acd8-d2e5ce5baab9%40pdc-v-sessmgr01Links to an external site.

Google search: “quad city health care services for depression” https://www.google.com/search?q=quad+city+health+care+services+for+depression&rlz=1CAPPDO_enUS782US785&oq=quad+city+health+care+services+for+depression&aqs=chrome..69i57.6515j0j8&sourceid=chrome&ie=UTF-8Links to an external site.

Depression

1. While reviewing a client’s history and physical, there are a few different ways to monitor them for depression. Objectively, you should review the reason for the visit, home medications, and past history. You should also overlook how the patient is acting overall, whether they are withdrawn, sad, or even have a flat affect. Some subjective findings may include something as straight forward as a patient stating they would like to harm themselves. However, you may need to ask certain questions such as, if they have felt depressed within past two weeks, did they have a feeling to harm themselves, or if they have thought of a plan to harm themselves. It is also very important to review and past medications, if needed to ask specifically if they have ever been treated for a mental illness.

2. The Quick Inventory of Depressive Symptomatology is a self-reporting questionnaire that ask specific questions to evaluate how at risk someone would be for depression. At the end of the questionnaire, there is a grading system that places someone between no risk to very severe risk of depression. This assessment tool can either be used for everyone during admission, or only if you would like to further assess someone from potentially being at risk or suffering from depression.

3. There are many support groups, therapists, and psychiatrists in my community that specialize in helping people who suffer from depression. A certain resource that I found that may be useful to someone with depression is Live Well. Live well is a website that offers many support groups all over the US. Live well is available either by in person walk ins or zoom video chat. It is led by volunteer peers whom are trained in the area of depression following evidenced based strategies. The peers are people whom had suffered from depression, and have been properly treated for it. The idea of being helped by someone whom have felt the feeling they are currently experiencing could be a reason some would seek their help. The best part is that it is free to anyone that decides to seek their help. As we all know, something free when it comes to your health is huge! When it comes down to seeking help the resources are limited if someone does not have health insurance. Many people may delay treatment, or not seek help at all due to this reason. I honestly wish I was able to find many more resources like this.

References:

https://www.livewell-foundation.org/depressionsupport Retrieved July 26, 2020.

Weber, J. R., & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

Depression

2. The Quick Inventory of Depressive Symptomatology is a self-reporting questionnaire that ask specific questions to evaluate how at risk someone would be for depression (Weber, 2018). At the end of the questionnaire, there is a grading system that places someone between no risk to very severe risk of depression. This assessment tool can either be used for everyone during admission, or only if you would like to further assess someone from potentially being at risk or suffering from depression.

3. There are many support groups, therapists, and psychiatrists in my community that specialize in helping people who suffer from depression. A certain resource that I found that may be useful to someone with depression is Live Well. Live well is a website that offers many support groups all over the US. Live well is available either by in person walk ins or zoom video chat. It is led by volunteer peers whom are trained in the area of depression following evidenced based strategies. The peers are people whom had suffered from depression, and have been properly treated for it (Live Well Foundation). The idea of being helped by someone whom have felt the feeling they are currently experiencing could be a reason some would seek their help. The best part is that it is free to anyone that decides to seek their help. As we all know, something free when it comes to your health is huge! When it comes down to seeking help the resources are limited if someone does not have health insurance. Many people may delay treatment, or not seek help at all due to this reason. I honestly wish I was able to find many more resources like this.

References:

https://www.livewell-foundation.org/depressionsupport Retrieved July 26, 2020.

Weber, J. R., & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

NR 305 Discussion Community Access to Mental Health Services