Page 498 - Encyclopedia of Nursing Research

SeRIOUS menTAl IllneSS n 465

expectations requires the development of disorders and are disabled enough to qual-
situation-specific scales with a series of activ- ify for disability benefits from the Social
ities listed in order of increasing difficulty, or Security Administration” (U.S. Department S
by a contextual arrangement in nonpsycho- of health and human Services, 1999).
motor skills such as dietary modification. It Schizophrenia is characterized by so-
is important for nurse researchers to care- called “positive” symptoms of delusions and
fully construct relevant scales and establish hallucinations and “negative” symptoms,
evidence of reliability and validity. such as apathy, social withdrawal, and amo-
There has been some evidence in nurs- tivation. mood disorders, particularly bipo-
ing research that outcome expectations lar disorders, are characterized by mood
have an important influence on behavior, in swings, negative or grandiose thinking, and
some cases may be more relevant than self- increased risk of suicide. In both groups,
efficacy expectations. Ongoing studies are social functioning is often impaired, and in
needed to continue to evaluate the impact the most severe cases, employment and inde-
of both self-efficacy and outcome expecta- pendent living are difficult if not impossible.
tions on behavior change as well as develop The illnesses can have episodic trajectories,
and test interventions that strengthen these with periods of relatively high functioning
expectations. punctuated by periods of low functioning or
lastly, self-efficacy-based interventions even crises requiring immediate treatment.
need to continually be tested and evaluated Symptoms of SmIs often make adherence to
and specifically to be considered among dif- treatment recommendations difficult.
ferent cultural groups. In so doing, nursing historically, the treatment of SmI
will be able to accrue evidence-based, theoret- changed dramatically with “de-institution-
ically driven interventions to guide practice alization” that followed the Community
across multiple settings and populations. mental health Centers Act of 1963 and
involved a large-scale shift from caring for
Barbara Resnick mentally ill persons in large state psychi-
atric facilities to more community-based
treat ment programs. One model that was
developed in the 1970s and has since been
SeriouS mental illneSS replicated in various forms across the United
States is the Assertive Community Treatment
model. The Assertive Community Treatment
Serious mental illness (SmI) is “a diagnosable delivers comprehensive 24-hour treat-
mental, behavioral, or emotional disorder of ment to clients with SmI in the community.
sufficient duration to meet diagnostic criteria Interdisciplinary teams address a myriad of
specified within the Diagnostic and Statistical clients’ needs, from basic daily requirements,
Manual for Mental Disorders (DSM) that has employment, financial assistance, and hous-
resulted in functional impairment which sub- ing to clinical interventions to enhance med-
stantially interferes with or limits one or more ication management (Stuart, 2009).
life activities” (president’s new Freedom Inpatient stays have become increas-
Commission on mental health, 2003). In con- ingly short, in some cases, only a few days.
trast, “serious and persistent mental illness” As a result, community treatment is critical
is defined as “a sub-population of patients to address residual symptoms remain that
with SmI (approximately 2.6% of all adults) must receive treatment in the community
who generally have diagnoses of schizophre- setting. Relapse is common in the first year
nia, severe depression or bipolar disorders, following initial diagnosis and readmission
obsessive-compulsive disorders and panic to inpatient treatment is a significant feature