Implementation of the Victorian Emergency Department Mental Health Triage Tool

In 2005, the Department of Human Services (Victoria) commissioned the National Institute of Clinical Studies (NICS) to develop and implement a statewide emergency department triage tool to improve the ED triage processes for mental health presentations to Victorian Emergency Departments. The project was undertaken over a 7-month period from September 2005 to March 2006. This paper describes the implementation approach undertaken by NICS and the outcomes of the project.     

Trends in mental health: implications for advanced practice nurses

PURPOSE: To examine current trends in mental health care for vulnerable populations and suggest how advanced practice nurses (APNs) can incorporate mental health care into primary care practice. DATA SOURCES: Original research and evidence-based clinical articles, government publications, and professional practice guidelines. CONCLUSIONS: Vulnerable populations, such as racial and ethnic minorities, adults with chronic mental illness, the elderly, the incarcerated, and those living in rural areas have long been ignored as recipients of quality, integrated health care services. There is a compelling need for APNs to participate in the integrated delivery of physical and mental health care to all Americans, especially to vulnerable populations. IMPLICATIONS FOR PRACTICE: Under the umbrella of advanced practice nursing, a variety of nurse practitioners (NPs) and clinical nurse specialists (CNSs) can offer a holistic approach to the provision of evidence-based health care in a wide variety of settings to an array of vulnerable and underserved people. By serving on provider panels, partnering with consumer groups, and advocating for the unmet health needs of vulnerable populations, APNs can have a positive impact on the health care delivery system.     

Community mental health nurses, primary care and the National Service Framework for Mental Health

The National Service Framework for Mental Health focuses on the mental health needs of adults up to the age of 65. Susan Plummer and Richard Gray discuss standard two by focusing on depression.     

Mental health services for persons with mental retardation: role of the advanced practice psychiatric nurse

The term dual diagnosis is frequently used by mental health professionals to refer to people who have mental illness complicated by substance abuse. A less commonly recognized population are those individuals who have the dual diagnosis of mental retardation and mental illness. In this paper the author discusses (1) the mental health needs of persons with mental retardation and (2) the current state of services for them. There is a significant lack of appropriately trained professionals to help address the needs of this population. Traditionally, nurses have primarily been identified as providers of physical care. Advanced practice psychiatric nurses, however, are an underutilized group of professionals who have the capacity to assume a leadership role in clinical care, service coordination, and advocacy for individuals and families affected by mental illness and mental retardation.     

Evaluating an Alternative to the Emergency Department for Adults in Mental Health Crisis

Adults with mental health issues lack clinically indicated options when in crisis. Historically, the emergency department (ED) has been the primary source of intervention largely due to funding cuts and decreased community resources in the USA. The literature highlights drastic mental health funding cuts alongside an increased prevalence of mental illness. A community-based alternative for adults in mental health crises was subsequently developed as a model of crisis care. The program has demonstrated impressive short-term outcomes, typically avoiding ED admissions in over 95% of the clients. This number benefits both the consumers who otherwise rely on the ED and the State of Illinois in terms of cost savings for avoidable ED visits. The current deflection rate only reflects ED admissions deflected on the day of the visit to the crisis respite program. To establish the long-term outcomes for this model, follow-up phone calls were conducted to determine whether or not the individual required an ED visit for a psychiatric reason within 30 days of utilization of the program. The follow-up phone calls began in May and continued for eight weeks. At this time, the data collected were analyzed and the outcomes of the program were further evaluated. Based on the follow-up survey results, the positive long-term outcomes validate this model as a cost-saving and clinically indicated alternative to the ED. Establishing such outcomes was necessary to ensure continued funding and to support establishment of similar models of crisis care.     

Exploring the scope of the Emergency Department mental health nurse practitioner role

The mental health nurse practitioner (MHNP) role in the Emergency Department is focused on assessing and intervening to assist people in mental distress. The skills and expertise associated with this role are also compatible with the provision of short-term outpatient care. This scoping study investigated the potential for a MHNP outpatient service for patients presenting through the Emergency Department with a range of undifferentiated mental health concerns. The specific aim of this study was to explore the feasibility, structure, and potential outcome measures that may be used to evaluate a MHNP outpatient service. Data for the study were gathered via an extensive literature review and two separate focus group interviews. A series of semistructured interviews conducted with key informants were also undertaken to incorporate a range of clinical, academic, health manager, consumer, and carer perspectives. Findings from the study including prospective benefits and barriers associated with the implementation of this new service are highlighted and discussed. These findings indicate that a structured and formalized MHNP outpatient service has the potential to address a current deficit in the health-care system by providing timely, accessible, primary prevention, and early intervention mental health care that better meets the needs of the public and is consistent with the Australian National Mental Health Plan (2003-2008). A MHNP outpatient service also provides an important opportunity to explore, expand, and more clearly define the unique and valuable contribution of advanced mental health nursing practice to contemporary health care.     

Toward an integration of competencies for advanced practice mental health nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of boundaries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic programs. The purposes of this article are to discuss the need for a blended clinical specialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners.     

The developing role of transition to practice programs for newly graduated mental health nurses

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Profiling Frequent Presenters to the Emergency Department for Mental Health Complaints: Socio-Demographic,Clinical, and Service Use Characteristics

Background

A small subset of individuals makes a disproportionate number of ED visits for mental health complaints.

Study Objectives

To explore the population profile and associated socio-demographic, clinical, and service use factors of individuals who make frequent visits (5 + annually) to hospital EDs for mental health complaints.

Methods

Case-control study using electronic health record data.

Results

Frequent presenters represented 3% of mental health ED patients and accounted for 18% of visits. Several factors were significantly associated with frequent ED use, including limited social support, documented personality disorder/traits, regular antipsychotic use, self-reported alcohol use, and having multiple referral sources.