Page 318 - Encyclopedia of Nursing Research

MENTAL HEALTH IN PUBLIC SECTOR PRIMARy CARE n 285

disparities, including those with severe Nurse researchers have the potential to
forms of co-occurring physical and men- make significant contributions to services
tal disorders (Committee on Crossing the and interventions research for a redesigned M
Quality Chasm, 2006; U.S. Department of primary care mental health services in two
Health and Human Services, 2001). specific areas. The first area concerns testing
A central goal of contemporary mental interventions and models of care with well-
health services research is to generate new documented effectiveness for common men-
knowledge directed to the transformation of tal health issues within the primary care and
mental health services to achieve high-qual- other community-based settings where peo-
ity, accessible, recovery-oriented care for all ple obtain health care services, but these are
(The President’s New Freedom Commission tailored in innovative ways to be acceptable
on Mental Health, 2003). In recent decades, for various high-need patients populations
tests of interventions for primary care men- and which can be shown to be both effec-
tal health care have evolved from primar- tive and cost-effective in nontraditional set-
ily efficacy assessments to effectiveness tings of care. Consistent with the literature
assessments, with the most recent empha- in medicine and other fields, the nursing
sis on research to foster implementation of literature on managing mental health issues
effective interventions and service delivery in primary care and community-based set-
models to alter usual care (Chambers, 2008; tings has grown over the past two decades.
Mental Health America, 2010). As primary However, there are still relatively few tests
care research continues to evolve to better of nursing interventions using advanced
address issues of health disparities and men- practice nurses (such as nurse practitioners
tal health care delivery models for primary and mental health clinical nurse specialists)
care settings, there are key opportunities for to manage mental health issues in “usual
nurse researchers in context of health care care” primary care and community-based
reform legislation. The Patient Protection and settings. This is especially so for public sec-
Affordable Care Act (HR 3590) will expand tor primary care with populations that are
health care coverage, including building the most underserved and which experience
infrastructure for colocated integrated physi- health disparities. Some recent examples
cal and mental health care delivered by com- of research with underserved populations
munity health teams (Hanrahan et al., 2003; include testing a nursing intervention for
National Alliance on Mental Illness, 2010; managing major depression in rural women
Sundarandam, 2009). The health care reforms (Hauenstein, 1996), participation of urban
also are projected to increase research that is nurse-managed center in a depression col-
focused on Medicare/Medicaid patients and laborative to improve care for depression
their service utilization, such as provider (Torrisi & McDanel, 2003), testing the effect
and treatment approaches, and optimized of a motivational group intervention on exer-
payment options. Mental health research cise self-efficacy and outcome expectations
is now situated within the top tiers of pri- for exercise in community-dwelling adults
orities for comparative effectiveness health with schizophrenia spectrum disorders
care research (Institute of Medicine, 2009a). (Beebe et al., 2010), and testing an in-home
Related reform legislation such as the Melanie intervention to reduce depressive symptoms
Blocker Stokes Postpartum Depression Act among Latina mothers of infants and tod-
(Section 2942) has direct relevance to pri- dlers enrolled in Early Head Start programs
mary care research in terms of interven- (Beeber et al., 2010). Within these types of
tions to reduce the rates of undiagnosed and nursing intervention studies, there is a well-
untreated postpartum depression (National matched opportunity to include aspects that
Alliance on Mental Illness, 2010). foster high-level recovery of people who