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NR 305 Week 4 Discussion, Community Access to mental Health Services
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NR 305 Week 4 Discussion, Community Access tomental Health Services
Week 4: Community Access to Mental Health Services
Conduct a web search to identify health care services within your community aimed specifically at addressing this condition.
Choose one:
Depression, Suicidal ideation, Opioid addiction
Answer the following questions in your post:
1. When reviewing a client's health history and physical examination record, what are some findings (subjective and objective) that may indicate a need
for further in-depth assessment for the condition you selected above?
2. Describe a focused specialty assessment tool you could use to screen the client for this condition.
3. What resources did you find in your community that address this issue? What type of services do they provide? Were there specific resources or
services you were hoping to locate, and could not? Please explain.
I have chosen depression for this weeks discussion topic.
1. When reviewing a client's health history and physical examination record, what are some findings (subjective and objective) that may indicate a need
for further in-depth assessment for the condition you selected above?
When completing a health history on a patient, objective findings that I may find include disheveled appearance including poorly fitting clothes (too
large), unclean or poorly groomed hair and nails, poor eye contact or engagement, uncooperative or argumentative behavior, inattentive to
discussion, slow speech, repeating answers (for example, I don't care when asking if they would be ok with me talking to their doctor about concerns
identified during my intake), and flat affect during discussions. A few subjective findings that may be detected include patients reporting they've "had
enough", "don't care", patients reporting they have lost interest in things that they normally enjoy, reporting sad mood, reporting poor appetite or
weight loss, or binge eating, trouble sleeping or sleeping too much, fatigue and loss of energy. Patients may also report passive death wishes or
statements such as "I wish I would just disappear; no one would notice I'm gone."
2. Describe a focused specialty assessment tool you could use to screen the client for this condition.
In my current employment position, we complete a PHQ-2 assessment on every member that we meet with. If the results of the PHQ-2 are over 3,
which may indicate an increased risk of depression, we then move into the PHQ-9 assessment. The first two questions assess how often the person
has felt down, depressed or hopeless over the last 2 weeks, with scores from 0 (for no days) to 3 (nearly every day). The second question assesses
how often the person feels a loss of pleasure or interest in things that they usually enjoy, with scores from 0 (for no days) to 3 (nearly every day). A
score of three or higher flags me to proceed in the PHQ-2 assessment. "PHQ-2 is a reliable method of screening, but not diagnosing, depression"
(Wilson & Agius, 2017, p. 234). Our text this week explains that "using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in
more depressed patients being correctly identified" (Weber & Kelley, 2018, p. 87). When I complete a PHQ-9 assessment, I am then required to
report the information gathered to the hospitalist or attending physician at the hospital. A score of 10 or more on the PHQ-9 may indicate a stronger
indication for depression and should be evaluated by the doctor. Often, the doctor caring for the patient in the hospital will consult the behavioral
health team to come and to assess the patient further to complete a formal screening.
In my current position, I also work with insurance members that have complex mental health conditions. I have a partner team within the insurance
company that helps to manage these cases. They are known as the "SMI Team," which stands for Serious Mental Illness. These diagnoses include
bipolar disorder, schizophrenia, personality disorders, major depressive disorder, and previous suicide attempt. This team is specially trained to help
our insurance members manage their mental health conditions along with their physical health issues. These case managers work with the medical
and behavioral providers in coordinating care for these members that can be very vulnerable.
3. What resources did you find in your community that address this issue? What type of services do they provide? Were there specific resources or
services you were hoping to locate, and could not? Please explain.
I live in a more rural area of western Pennsylvania. Surprisingly, for the area that I'm in, we have several locations that can help patients manage
depression. Family Counselling Center is one location that has several offices in the local area. They have multiple offices in our county and help to
service the surrounding 3 counties. Family Counselling Center provides services to all patients, from children to geriatrics. They offer daily group
therapies, individual counseling, family therapy, and school-based therapy. They also provide mobile psychiatric medication services, where a mental
health assistant will go to your home to administer your medicine or coordinate with local pharmacies to prepackage your medications to help with
compliance. This service offers many other options to help those patients deal with mental health conditions.
We also have HAVIN. This stands for "Helping All Victims In Need." HAVIN helps all people that are dealing with abuse of any form. When people
contact HAVIN, they are connected to a specially trained person who helps evaluate the situation, and can locate safe living arrangements, arrange
for inpatient hospital care, and connect to mental health providers if needed. It is indeed a great service for my community.
We also have the Armstrong Indiana BDHP (behavioral and development health program). This service offers inpatient, outpatient, partial rehab
program, residential and housing services to adults in Armstrong and Indiana County. They also manage child services including Early Intervention,
intellectual and mental health services. They provide a free crisis line to all residents in both counties that connects them to a trained professional to
help manage the crisis and ensure the safety of the patient when they call.
Weber, J.r. & Kelley, J.H. (2018). Health assessment in nursing (6 thed.). Philadelphia, PA: Wolters Kluwer
Wilson, R., & Agius, M. (2017). Is there good evidence that the two Questions in PHQ-2 are useful questions to use in order to screen for
depression? Psychiatria Danubina, 29(Suppl 3), 232–235. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=28953768&site=eds-
live&scope=site
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