Running head: WHAT ABOUT MENTAL HEALTH CARE?

What About Mental Health Care?

Hillary Colbry
Ferris State University

Running head: WHAT ABOUT MENTAL HEALTH CARE

Abstract
This paper will address issues related to mental health care compared to physical health care. It
will identify the problems at hand along with how they relate and matter to healthcare and the
nursing practice. A relatable nursing theory will be identified along with one to explain the
importance of interdisciplinary intervention with mental health patients. Policies, resources and
quality and safety issues related to mental health will be reviewed. Then two potential
recommendations for solutions to the problem will be focused on.

Running head: WHAT ABOUT MENTAL HEALTH CARE

What about Mental Health Care?

It is not a secret that the American healthcare system is good at taking care of and
treating physical health disorders. There are urgent care centers, emergency departments [ED],
and physician offices. All of which are full of highly skilled doctors, nurses, and many other
healthcare professions. In these facilities changes are constantly being made and improvements
implemented to hasten and increase quality of a patients experience. The healthcare system is
doing a very good job at being able to treat physical disease processes, but not mental ones.
Mental health disorders are swept under the rug of crazy and I am not trained to deal
with this. Then patients are stigmatized, over looked, and, if they are lucky, sent to mental
health facilities while others are left to deal with their disorder on their own. Even with enough
money and family support those struggling with mental health disorders are not getting the same
continuity of care. This problem is not in one area of healthcare. It encompasses the healthcare
system, in every area, as a whole. That is what has made it a hard issue to address.
There are many areas that mental health treatment and physical health treatment are not
being addressed equally. This includes stigma from healthcare and the general population,
education of healthcare professionals, resources, quality, safety, and standards of care. Some of
the areas like stigma and proper education can be solved from just that, education. To empower
mental health treatment, people, health professionals or not, need to know the truth about it.
Other areas need to be addressed by policies and new implementations to make its importance to
the population known.
This issue itself is complex, but what does that mean for nurses? Nurses are considered
one of the first resources for a patients wishes and one of the last barriers to the patients safety.

Running head: WHAT ABOUT MENTAL HEALTH CARE

That means problems can start or end with nurses. Mental health treatment is an issue that
nurses can help solve. Nurses can help at the bedside and in the business of healthcare. Nursing
is a degree that is spread throughout many areas of healthcare. A nurses influence is widespread
and should not be underestimated, especially by nurses themselves.
Theory Base
The ideas behind the mental health issue can be identified in two theories. A well-known
theory by Abraham Maslow called Maslows Hierarchy of Human Needs and another by three
nurses called the Roper-Logan-Tierney Model for Nursing. Maslows Hierarchy can be applied
to any area or profession in health care related to mental health treatment. While the RoperLogan-Tierney model is strictly for nurses. Both focus of the holistic treatment of patients and
what each individuals full potential for health is.
Maslows Hierarchy of Basic Human Needs
Maslows Hierarchy Theory assumes that each person has the potential to reach selfactualization and that there are four areas of fulfillment to go through to reach it (Maltese). The
theory is set up like a pyramid with 5 levels in order of need to survival and self-actualization at
the top. So physiological needs are on the bases of the pyramid. This area includes breathing,
food, water, sex, sleep, homeostasis, and excretion (Maltese). These are the needs for basic
human existence. Above physiological is safety. Safety is security of body, employment,
resources, morality, family health, and property (Maltese). Next is loving and belonging which
is friendship, family, and sexual intimacy (Maltese). Then right before self-actualization is
esteem. Esteem includes self-esteem, confidence, achievement, respect of others, and respect by

Running head: WHAT ABOUT MENTAL HEALTH CARE

others (Maltese). Each level builds to the next and the ones above cannot exists without the ones
below.
Between the hospitals themselves and social services they cover physiologic needs,
security of body and resources. There are programs are set up to help with safety of employment
and property. Love and belonging as well as esteem can be helped by different types of therapy
if available and affordable.
Right now only 24% of those with common mental disorders are receiving treatment
(Bailey, 2014). It is not that the healthcare system does not have resources, it is that they are not
being used. So if the resources are not being used and only 24% of common mental health
disorders are being treated, what parts of Maslows pyramid are not being fulfilled for a patient
with a common mental health disorder like depression? Many areas of esteem are effected, like
confidence, achievement, and perceived respect by others. Friendships, family, and sexual
intimacy are definitely effected from the symptoms of depression (DSM-5, 2014). Safety issues
can result from depression if the person has suicidal ideation or if their will to go to work and
participate in society is too depleted. Part of some mental health disorders processes can cause
secondary physical health problems or feed into primary ones which effects physiologic health.
Maslows Hierarchy covers a vast expanse of healthcare which means many health
professionals would need to be involved to help a patient achieve self-actualization.
Physiological and safety aspects can be helped by physical therapy, occupational therapy,
pharmacy, doctors, nurses, social workers, and care managers. Love and belonging and esteem
can be helped from family and friend support, psychiatrists, psychologists, and therapists. These
are just small lists of the main professions to help in each area to show that interdisciplinary care
is needed for a patient to reach self-actualization.

Running head: WHAT ABOUT MENTAL HEALTH CARE

Roper-Logan-Tierney
The Roper-Logan-Tierney Model for Nursing is a theory based around nurses creating
interventions for patients to increase their independence of activities of daily living [ADLs]
based around what living means to the patient. The purpose is to identify how the patient has
changed due to illness, injury, or admission to the hospital (Nursing, 2013). The theory is very
holistic. It covers a wide range of areas in a patients life but condenses them down to five topics
to help facilitate interventions and organization for the nurse.
The nurse bases her interventions on the response of the patient on five aspects that
influence ADLs (Nursing, 2013). The first is biological aspects. Biological aspects include
anything that has an impact on overall health. The second is psychological which is anything
that impacts emotion, cognition, spiritual beliefs, or ability to understand. Ability to understand
is an important area because if a patient does not understand their mental illness then treatment
may not be possible. The third area is sociocultural. Sociocultural encompasses the impact of
society and culture as experienced by the individual (expectations, values related to class or
status as well as ones the individual holds for themselves) (Nursing, 2013). Related to mental
health, how aspects are perceived by the individual is important for the nurse to note. It may
change interventions like resourcing the family or not depending on how the patient perceives
his/her family. The fourth is environment, which is the impact of the environment on the patient
and the patient on the environment. The fifth is Politicoeconomic. This area includes the impact
of the government, funding, interest rates, availability of resources, and programs.
The nurse will evaluate all of these areas and come up with interventions to improve
independence and meaning of life for the patient. This theory is important to consider because of
how it individualizes the patients. It recognizes that each person is unique and perceives things

Running head: WHAT ABOUT MENTAL HEALTH CARE

differently. Nurses are in the position to facilitate individuality as they advocate for patients
treatment and rights. Mental health of the patient needs to be advocated for as well.
Assessment of the Healthcare environment
Currently in the healthcare system there are not well practiced standards for a diagnosis
or history of mental health disorders, compared to physical. That is until a patient is presenting
with suicidal or homicidal ideation. The healthcare system does not wait until a patient with
congestive heart failure [CHF] is close to dying before intervening. There are protocols,
standards, monitoring, and interventions in place before it is severe. Depression does not have
this, bipolar does not have this, and neither does schizophrenia. These disorders are all
categorized into their severest form of mental health cases and treated once severe. Not every
depressed patient is untreated and trying to commit suicide. Some people are being treated with
medication and living well will their disorder, but health care workers should be aware of
comorbid disease processes and keeping up with the patients medications, just like they would a
CHF patient. The incidence of obesity and metabolic syndrome in the mentally ill is known to
be two to three times higher than in the general public (Stanley, 2011). Shouldnt the nurses
caring for a patient with a metabolic syndrome be aware if the patient has a history of bipolar
then?
Lack of education is a main starting point in a root cause analysis of the mental health
treatment problem. Lack of education includes consumers, healthcare professionals, and the
general public. This feeds into a lack of social awareness and understanding by all previously
mentioned parties. No demand for levels or standards of care comes from lack of awareness and
understanding. This then creates poor mental health which leads to social instability. Social
instability can include increased rates of suicide, crime, homelessness, prison populations,

Running head: WHAT ABOUT MENTAL HEALTH CARE

disease processes, and decreased quality of life. Social instability feeds the history and stigma
already around mental illness which then leads right back into lack of education.
Policies
After the passing of the Patient Protection and Affordability Care Act [PPACA] in 2010
there were changes seen not only in general health care but also mental health care. Rachel
Garfield explains in an article from 2010 called, Health Reform and the Scope of Benefits for
Mental Health and Substance Use Disorder Services that under the PPACA there was a mandate
for coverage under employees, along with penalties for employers who had uncovered workers.
Eligibility was broadened and the dependent coverage extended to age 26. Just from these three
areas of the PPACA this means there will be people getting insurance which means more people
utilizing its resources. Another big portion of this act is that the ratio for what insurance
companies pay for physical health has to equal behavioral health payment. This means that if
insurance says they will pay 80% for an ED visit, they are not allowed to discriminate between if
the visit is for physical or behavior health reasons. Before the act was in place insurance could
and was paying less for behavior health services. For nurses this means more patients in general
and more mental health patients within all nursing fields.
Resources
The largest and most well-known resource for mental health patients are mental health
facilities. Patients can go to these facilities, get prescribed medication, therapy sessions, all
while the family and/or the patient can know they are in a safe environment while getting
treatment. These are great resources for patients if they can afford them and if there are beds
open. If beds are not open the facility can contact the patient when there is one open. This

Running head: WHAT ABOUT MENTAL HEALTH CARE

delays treatment for any patient and for the homeless mentally ill population does not facilitate
treatment well.
The Mental Health Services Block Grant is a service provided by the federal government.
It works with existing programs made for the mentally ill (Garfield, 2010). Programs like
income and housing assistance are linked in with the grant which can provide financial assistance
to those in need of it and mental health services (Garfield, 2010). Even with both of these
resources available the percent of those with mental health disorders being treated is still only
24%.
Quality and Safety
Quality and safety care is a goal of every healthcare profession and institute and with the
education of workers and their knowledge base of disorders it could be thought that
discrimination would be worse of the outside of the hospital. A study done in 2014 by S. Bailey
says otherwise. Bailey found that 8/10 people with a diagnosis of depression reported
discrimination in at least 1 area of life, including healthcare, which has shown the least
improvement (2014). This may be surprising to some healthcare workers and especially nurses.
Nurses are taught to be un-judgmental, unbiased, and equal in all care. Yet Baileys statistic
exists. Not all solutions have to come from up above or from the outside, some are right at the
center of the problem, and maybe where no one is looking.
Safety of patients is the number one goal of nurses and healthcare workers but mental
health and its relation to safety is overlooked in the broad spectrum of health care. The life
expectancy of an individual with a severe mental illness is on average 20 years less for men and

Running head: WHAT ABOUT MENTAL HEALTH CARE

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15 years less for women (Bailey, 2014). The healthcare system has not kept these patients safe
and something needs to be done about it.
Inferences Implications and Consequences
The inequality of mental health treatment has one main area identified under inferences
and implications. The healthcare system and mental health itself needs education. Education of
health professionals, because as evidenced earlier health professionals are not above the
discrimination of mentally ill individuals. Nurses need to be educated so that they are aware of
opportunities for all patients struggling with any mental illness. Nurses also need to know so
that they can fully take care of their patients. One in four adults experiences mental illness in a
given year (NAMI, 2013). Statistics like that one need to be known by consumers, health
professionals, and the general public to kick the stigma and the cycle of unawareness.
Knowledge can lead to standards, which can lead to more treatment, and then equal treatment. It
needs to be OK to have a mental illness and OK and possible to get treatment; just like many
other disease processes.
The consequences of the issue related to mental illness treatment has already been laid
out. Many more statistics from the National Alliance on Mental Illness in 2013 outline these
consequences and are as follows, individuals living with serious mental illness face an increased
risk of having chronic medical conditions; suicide is the 10th leading cause of death in the U.S
and nearly 90% of those who committed suicide had one or more mental disorders; serious
mental illness costs America $193.2 billion in lost earnings per year; and from Stanley in 2011
Individuals with a mental illness are two and half times more likely to die from all main causes
of death when compared to the general public. The statistics speak for themselves in the results
of not treating mental health disorders as serious as they are.

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Mental illness effects individuals, family, friends, the healthcare system, and even
America as a whole. Yet in the education of doctors, nurses, and patients, most are lacking in it
and its importance. If the healthcare system remains the same it will keep costing America
money and lives. Both of which can be treated with some standards of care.
Recommendations for Quality and Safety Improvements
Recommendations
Recommendations for quality and safety improvements range from complex to simple.
Two recommendations have been identified here, one as a system intervention and one as a
nursing interventions. The first recommendation is a study done in 2015 by Andrew Tomita.
The study was a time-limited care coordination model made to prevent homelessness and
unfavorable outcomes from transition periods for mentally ill individuals. During the study a
critical time intervention worker [CTI worker] (usually from social services) took the patient
from hospital discharge and helped them through three phases which included identifying
support networks, direct assistance to support networks, and termination of the intervention
(Tomita, 2015). The CTI workers works to build and fortify roads to long-term community and
personal support networks around the patient. The results of the study showed that the first nine
months is crucial during transition for mental health patients (Tomita, 2015). The study is
showing that early intervention needs to happen and it is all about the support networks built
around the patient. With help from the health care system patients can achieve more independent
care of themselves to become fuller members of society.
On a closer front, a nursing led initiative about improving physical health of mental
health patients was done by nurses for nurses. The nurses identified areas of improvement, do-

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able interventions for any nurse interacting with mentally ill patients, along with suggestions for
those specifically in the nursing for the mentally ill (Happell, 2014). Simple interventions
included encouraging healthier lifestyle, screening for physical health problems, and
coordinating physical health services between primary and mental health care (Happell, 2014).
These actions can be done by any nurse and are already in the criteria for what nurses jobs are.
For nurses with a strong specialty in mental health, nurses actions include reducing use of
antipsychotic meds, linking together a range of services for the consumer, and increasing public
awareness of the physical ill-health of consumers (Happell, 2014).
Using the idea of Critical-Time Intervention and the realistic recommendations from
nurses the quality and safety of mental health patients could increase. Without it the
consequences mentioned above will keep occurring. There is evidence about the
recommendations suggested here, the healthcare system just has to become actively aware of it.
Nurses can take control to some extent on their own. It is a nurses job to be the front line of
defense and offense for a patient and with these recommendations nurses can have another
weapon under their belt to help keep the patient safe while maintaining their wishes.
American Nurses Association Standards and QSEN competencies
The Quality and Safety Education for Nurses [QSEN] identifies requirements on areas of
quality improvement and patient centered care. The two recommendations mentioned apply to
both. Nurses are taught from school how to apply quality improvement into practice for patient
centered-care. The recommendations have evidence to support their interventions to help
maintain and improve care to mentally ill patients. Patient centered care is all about revolving
care around the patient and advocating for them. Implementing CTI and some basic additions to
nursing care can improve mentally ill patient populations, and caters to the patient centered care.

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The American Nurses Association [ANA] identifies sixteen standards of nursing practice
in the Scope and Standards of Practice book (2010). Three of them apply to the
recommendations suggested. Standard 1 is assessment and mentions collecting comprehensive
data while honoring the uniqueness of the person (ANA, 2010). Helping a patient maintain a
healthy lifestyle and asking simple questions about any mental health medications easily fulfills
this standard. Standard 5D is prescriptive authority and treatment which involves the nurse that
has prescriptive authority using it, along with referrals and treatments in accordance with state
and federal laws (ANA, 2010). This ties in with coordinating physical and mental health care
based on what the state and federal law has available. The nurse needs to know what can and
cannot happen because of law. It also includes facilitating medications for the patient in the way
that is best for the patient using the prescriptive authority given to the nurse. Standard 13 is
collaboration. This standard really clicks in with using the resources nurses have to their
disposal which can include care managers, social work, and specialty care providers all who can
work together to help a patient get care they may need.
Conclusion
Mental health patients are not getting the treatment they need now compared to physical
health. Nurses need to step up and take control where they can and advocate where they cannot.
Mental health is just as important as physical health on a spectrum from life and death to quality
of life. Mental and physical health are both needed for quality of life and health care and nurses
should not be undermining the relationship.

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