Caring for patients with mental health issues requires patience, compassion, empathy, and neutrality. Mental health conditions can be difficult to treat because they often have complex and multifactorial causes, cannot be easily diagnosed, and can manifest with a variety of symptoms.
Both patients and care providers can feel overwhelmed and frustrated when trying to treat mental health issues, and this can create challenges with communication and compliance. Understanding the nuances of caring for this type of patient is essential to successful long-term treatment and remission.
Identifying and assessing mental health issues
Mental health issues are not uncommon in the United States. Fortunately, there has been a decrease in stigma related to mental health problems over the last several decades. Even so, it can be difficult for many patients to reach out for help in addressing their mental health.
Primary care providers are often the first to identify and assess a mental health issue, and they can do so by offering each patient they see a clear and simple questionnaire. A positive result can trigger a conversation and referral to a mental health professional.
Some common questionnaires include:
- PHQ-9 (Depression): Scores symptoms such as lack of interest in activities, frequency of feeling sad or down, changes in sleep and appetite, poor concentration, and thoughts of self-harm.
- GAD-7 (Anxiety): Similar to the PHQ-9 questionnaire, but with a focus on anxiety symptoms such as restlessness, worry, and irritability.
- CAGE (Alcohol/Drugs): Asks patients about their feelings related to drug and alcohol use, including feeling guilty about use or needing a drink first thing in the morning.
Patients with a positive screen for depression, anxiety, or substance abuse may have trouble accepting that they need help. Stigma, family values, personal belief, self-perception, and fear of treatment are all barriers to accepting treatment. According to the National Institute of Mental Health, only about half of people with mental illness receive treatment.
Caregivers in primary care, outpatient clinics, and even hospitals can improve treatment rates by screening every patient, creating a strong referral system, and remaining supportive and nonjudgmental when addressing mental health concerns.
Related CE course for nurses: Caring for Patients with Mental Health Issues, 4th Edition
Severe mental health issues
Some patients need more than outpatient therapy and medications to manage their mental illness. Patients with active suicidal or homicidal ideation, uncontrolled delusions, substance withdrawal, or an inability to meet their own basic needs may need inpatient hospital care.
Caregivers working with these patients need a specialized skill set. Not only do they need to have patience and compassion, but they also need to be able to hold strong boundaries, de-escalate tense interactions, and identify manipulative behavior.
Patient and caregiver safety
Nurses and providers working in inpatient mental health facilities must take precautions to ensure that both faculty and staff are kept safe. Research published in Administration in Policy in Mental Health indicates that up to 55% of nurses working in these facilities experience an assault at some point, and that these caregivers report higher rates of injury than any other healthcare profession.
In addition to the risk of injury for caregivers, patients in these units are at high risk of injury from themselves and/or others. Self-harm, suicide attempts, violence, and aggression are not uncommon in patients dealing with substance abuse and mental health disorders.
Measures often taken to protect the safety of caregivers and patients include:
- Adequate hospital staffing
- Removal of all potentially dangerous items such as utensils, shoelaces, cords, and medications
- De-escalation training for all staff
- Constant observation
- Isolation
While safety should be a priority, many of these measures can feel dehumanizing. Restricted access to personal items, elimination of choice, and constant supervision reduce dignity and independence. This can exacerbate existing depression and often cause patients to lash out at their caregivers.
Nurses and direct caregivers must find a way to balance safety and autonomy for their patients. Allowing choices, using therapeutic communication, offering meaningful activities, and building personal connections help to reduce conflict.
Related CE course for nurses: Violence in the Healthcare Workplace
Nonadherence
Nonadherence is a common problem in the treatment of mental health issues. A report published by Patient Preference and Adherence states that rates of medication nonadherence are 40%–60% for antipsychotics and 63% for antidepressants. By diagnosis, nonadherence rates are between 12%–64% for patients with bipolar disorders, up to 80% for patients with schizophrenia, and between 30%–60% for patients with depression.
Therapy nonadherence rates are equally concerning, with 20-70% of patients missing appointments or terminating therapy early. Long waits, lack of transportation, stigma, and low motivation are all notable reasons for compliance issues.
Improving compliance
As the severity of mental illness increases, so does noncompliance. This can create a vicious cycle where a lack of treatment results in progression of mental illness and even worse adherence to treatment.
Many mental health centers have found successful strategies for improving compliance. These include:
- Transportation vouchers
- Virtual therapy options
- Early phone follow-up
- Home visits
- Patient-provider contracts
- Thorough orientation
- Frequent education
- Involving friends or family members
While mental illness is notoriously difficult to treat in many populations, there is hope. Decreasing stigma and increasing awareness are fantastic first steps that are becoming more common in communities around the nation.
Nurses working in mental healthcare can use resources such as the American Psychiatric Nurses Association to increase their knowledge and improve their skill set related to this unique population.
