According to reports on world population, the adult population is likely to increase by 2030. This research examines two articles on adult population and psychiatric conditions and the access to outpatient mental health services used by older population. The study will focus on the access of outpatient services by the elderly population suffering from psychiatric related ailments; it will determine whether the care is effective on adult population and the role nurse practitioners play in these cases. Ultimately, the core objective of this research is to expose the major issues in the provision of psychiatry services to the elderly population, to expound on the efforts to address the challenges in outpatient mental health services and the strategies applied to solve them.
Discussion of the Two Articles Chosen
The research seeks to study two articles, the first, older adults and mental health issues and opportunities and the second, outpatient mental health services used by older adults after acute psychiatric hospitalization.
The two are chosen due to the overwhelming evidence regarding psychiatric care to the senior adults in the country (World Health Organization, 2012). A survey by National Hospital discharge revealed that 9.2% of patients discharged from psychiatric facilities after the short stay was of the elderly population.
The key terms used in the analysis were searched for in different databases including World Health Organization (WHO) and MEDLINE the main terms used in the search are, "psychiatric services", "mental health services", "community mental health centres", "outpatient mental health services" and , "nurse practitioners". Articles on Global mental Health were searched to source for information on community mental health care across the world (WHO, 2012).
Furthermore, evidence also showed that older patients rarely completed full treatment in the inpatient facilities even though it is highly recommended for the favourable response to medication, many preferred to complete treatment in extended care facilities at outpatient facilities. In the second article, it is clear that issues and opportunities regarding older adults and mental health present challenges in the field of nursing specifically mental health and old age. The above reports raise the cause of concern and call for actions towards alleviating the plight of the elderly population living with mental disorders and the need for infrastructure to be put place to address the increasing numbers of the adult population that will need psychiatric services shortly. To answer this questions it is important comprehend the primary care given to elderly patients, the barriers encountered in provision of services and the contributing factors towards the sequence of service use.
Specific search strategies were applied to establish the data used for the research, a study of the report of the surgeon general on mental health and old age will be reviewed. Sampling was done to examine the access of outpatient mental health services by the elderly population, the method of sampling was done by recruiting older adults from the neuropsychiatric section of a nursing teaching hospital in the outpatient mental health service. The demographic characteristics of both articles show that there is a need for supportive services to enhance the primary care of mental health cases in the elderly adults. The results from the findings of the two cases led to the two chosen articles for research.
Method of Data Analysis
According to the Evidence Matrix table, the tool used for research was geropsychiatric approach. The demographic data and psychiatric health information of the subjects were sourced from their hospital medical records. Level of Evidence from World Health organization makes the Grade of Recommendations trusted since the source is thorough in its research, findings and recommendations, WHO (2012).
The tool used to measure access to outpatient mental health services is the Epidemiologic Catchment Area study. Nurse practitioners including psychiatrists and primary care nurses provided the information on the mental health care services provided to the elderly patients. The rationale of the evidence was based on enabling factors like marital status and the geographical location of the patients residence, and secondly the predisposing factors like the patients age and race and lastly the need factors of the patient.
The evidence was a basis for strong recommendations, the clergy in the resident location of the elderly patients need to involve in the care of the patients due to the level of trust that has been developed and the level of contact they have with the clergy. There is a need to train the clergy on treating mental ailments as this will enhance their standard of awareness and recognizing the signs of mental illness and patients that need urgent psychiatric attention ( Young et al., 2014).
The second recommendation is to engage a model that will integrate primary care and psychiatric care to create a link that will enable older patients in rural areas to access outpatient mental care through community health care centres and outpatient clinics. The primary health care system has to be overhauled to provide adequate mental health services to the elderly in the rural areas; there is the need to address the shortage of nurse practitioners in rural settings to increase access to health services to the mentally ill.
Applicability of the Findings
The results from the first article Older adults, mental health: Issues and Opportunities show that the nursing fraternity especially nurse practitioners are likely to face challenges related to policy and infrastructure. First, there is a shortage of mental health staff and professionals to address the increasing cases of mental health in the older generation (Zhang, 2013). The federal governmental has to discuss means of improving the pool of mental health personnel by providing funds for training opportunities. Extensive research is to be carried out that will be evidence based on qualitative on ways of integrating content regarding mental health and the aging population in the curriculum of nursing studies as well as engaging practitioners in interdisciplinary practice and cross-training on matters involving mental health and old adults. A second finding revealed that access to quality mental health care was determined by the patient and his family. The level of consumer involvement in the provision of primary care determined their response to treatment and improvement. Nurse practitioners have to encourage families of the older adults to be involved in the primary care of the patient when they are discharged or when they have to access outpatient facilities ( Bragstad, 2015).
There were findings in the second article, outpatient mental health services used by older adults after acute psychiatric hospitalization. The results reveal that most old adult patients visited the hospital consistently for six weeks after they were discharged, but a fifth of the elderly population did not visit mental health facilities, a worrying trend for practitioners since this is usually a sign that the patient needs urgent medical care.
Distributive justice. It is widely discussed; medical benefits and the costs they accrue are spread equally to ensure all sectors of government are funded. Nurse practitioners are urged to treat all patients equally especially older adults since the government has made sure costs of mental health care have been distributed based on patients ability to pay (Murray, 2015).
Beneficence, this ethical principle has impacted the care given to older adults undergoing mental primary care, as nurse practitioners have been compassionate towards them. Positive action is towards elderly patients and a positive attitude towards them has enabled practitioners to reach out and do good in the spirit of patient advocacy ( Murray, 2015).
Evidence Based Practise Model (EBPM)
There is an urgent need for the elderly population to access mental health facilities, for practitioners to meet this objective they will need to apply the collaborative care model. The model will assist in integrating both behavioural and physical health services that can be initiated in primary care based psychiatric home model and other medical facility settings. ( Boyer et al., 2014).The implementation of the collaborative care models in primary care settings comes as a relief to the older adults. Studies indicate that there is a rise in health care costs especially chronic medical conditions which keep growing ( Gallo et al., 2013). Integrating the model in psychiatric care programs helps those who are dually eligible to access primary care and Medicaid.
The analysis of the two articles in this research has revealed some challenges that need to be addressed regarding access to outpatient psychiatric facilities by the elderly population. A collaborative effort will be required from parties involved in the provision of primary care for mental health patients especially the older patients. Nurse practitioners in both the private and public sector together with other stakeholders will have to put concerted efforts to address the significant challenges that impact the mental health sector. All indicators prove that the aging population is likely to overwhelm the service system shortly (Bragstad, 2015). More models and strategies need to be adopted that will spread the cost of primary care as well as integrate systems that will point out the needs of older adults living with mental health ailments.
Boyer, C. A., McAlpine, D. D., Pottick, K. J., & Olfson, M. (2014). Identifying Risk Factors and Key Strategies in Linkage to Outpatient Psychiatric Care. American Journal of Psychiatry.American Journal of Party-history; 157:1592-1598.
Bragstad, L. K. (2015). Indispensable intermediaries. The role of informal caregivers in the discharge process of older relatives.
Gelenberg, A. J., Freeman, M. P., & Markowitz, J. C. (2014). American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder.
Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., ... & McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine, 363(27), 2611-2620.
Gallo, J. J., Morales, K. H., Bogner, H. R., Raue, P. J., Zee, J., Bruce, M. L., & Reynolds III, C. F. (2013). Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ, 346.
McCall N, Cromwell J. Results of the Medicare Health Support Disease Management Pilot Program.The New England Journal of Medicine. November 3 2011;365(18):1704-1712.
Murray, J. S. (2015). Ethical considerations: pediatric short-term medical missions in developing countries. Issues in comprehensive pediatric nursing,...
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