Treating Mental Health Illness – A Literature Review
ABSTRACT
The following literature review explores the capabilities of the nurse practitioner treating varieties of mental disorders as comorbidities of primary care patients. The NP interface with the primary care and outpatient services of different people living on the fringe of society with specific barriers to quality health care connected to mental illness proves valuable. The efficacy of the NP in treating mental illness in patients according to the literature emerges as a valuable intervention with screening, diagnosing, and therapy options for specific patients often isolated from medical care access with mental illness including homeless, geriatric, pediatric, and the under an uninsured. The literature also provides positive reasons for countering a controversial legislation barring NPs from prescribing a specific mental illness drug.
Key Words: nurse practitioner, mental illness, efficacy, autonomy, interventions
Treating Mental Health Illness – A Literature Review
Introduction
Nurse practitioner capabilities treating mental health illness exemplifies the role as an example of the flexibility of this healthcare professional. Investigating the literature on significant clinical problems in the area of mental health illness underpins the focus of this literature review emphasizing the efficacy of nurse practitioner abilities. The following provides summaries of direct mental health studies with both contrast and comparisons of each. In addition, this discourse provides identified strengths/limitations of these studies as well as any controversies. Finally, this academic investigation discusses the implications for practice with discussion for and against the proposed intervention(s).
Summary of Findings from Each Study
Primary Care-Based Guided Self-Help for Depression Provided By a Nurse Practitioner:
A Pilot Evaluation
Philp, Lucock, and Wilson (2006) completed an original pilot study focused on nurse practitioners guiding self-help intervention for both anxiety and depression sufferers at the primary care level. The clinical outcomes revealed significant patient improvement using the cognitive behavior treatment underpinning the self-help delivery model in practice. Since this remained an uncontrolled study, directly attributing the patient improvements aligned to the intervention do not hold.
Medication Adherence among Homeless Patients: A Pilot Study of Cell Phone Effectiveness
Burda, Haack, Duarte, and Alemi (2012) report on their findings testing the effectiveness of using cellphones for monitoring homeless patients adhering to their medication schedules when not in the medical facility. Use of the automated calls over cellphones among the 10 participating homeless patients diagnosed with psychiatric disorders as well as co-occurring substance use reached them 93 percent of the daily 30-day program. Reported adherence to the prescribed regimes proved 100 percent among the 10 participants with none dropping out of the program. All participants reported finding the calls important in helping remember taking the mediation(s).
Outcomes from the Evaluation of an Emergency Department-Based Mental Health Nurse Practitioner Outpatient Service in Australia
Wand, White, Patching, Dixon, and Green (2011), report on the abilities of a nurse practitioner working with outpatients aligned to an emergency department-based mental health service in Australia. The focus to include the NP professional in this study looks at the recent identification of the multidiscipline abilities of the NP. Data findings drew from combining several tools. These included the follow-up outpatient waiting time for appointments, use of both the General Self-efficacy Scale and the K-10 measure of psychological distress as self-report measures. In addition, interviews using random selection from outpatients, and a stratified, purposive sample of ED staff completed the data gathering. The outcomes proved the benefit of such a program for a previously underserved patient population.
Screening for Depression in Patients with Diabetes: Addressing the Challenge
Described by authors, Hill, Vorderstrasse, Turner, Pereira, and Thompson (2013) as a quality improvement study, they screened for depression among 115 randomly participating patients with diabetes, in a primary care practice. The goal for the participating primary care patients using the Patient Health Questionnaire-9 voided any barriers of implementation. Review of a retrospective chart showed a statistically significant difference in the incidence and diagnosis of several new cases of depression. However, among those identified, many rejected treatment of any kind, requiring future research in the area of patient with diabetic related depression and barriers managing this debilitating comorbidity of diabetes.
Postpartum Depression Screening by Family Nurse Practitioners
In this study, Goldmith (2006) looked at identifying whether and the manner nurse practitioners (NPs) screened for new mothers' with post-partum depression including identifying any factors concerning the screening used. Goldsmith's (2006) data resource relied on patient self-reporting from 159 completed questionnaires using a convenience sampling of family NPs in both Wisconsin and Illinois of July 2002. The outcome of the sampling revealed even though 84 percent of the NPs responding to the questionnaire treated at least one postpartum mother yearly, only half of them screened for postpartum related depression.
With the fact there exists no guidelines screening for this type depression lends to how the NPs tend to follow established guidelines aligned with their work gives the best indicator why the screening does not take place at this level of professional health care among new mothers. With this convenience-sampling, revealing the extent of how new mothers with possible symptoms of postpartum depression exist, the implications show the logistics of preparing advanced NP for such training.
Cost-Efficient Treatment for Uninsured or Underinsured Patients with Hypertension, Depression, Diabetes Mellitus, Insomnia, and Gastroesophageal Reflux
Luthy, Peterson, and Wilkinson (2007) report on their evidenced-based study of the nurse practitioner (NP) balancing quality of care to uninsured and underinsured patients with hypertension, depression, diabetes mellitus, insomnia, and gastro esophageal reflux and prescribing the most cost-efficient medication of these diagnoses by NPs. The outcomes of the study indicate the urgency of NPs having first hand familiarity with cost-efficient treatment options as part of providing quality care to these types of patients easing their economic burdens.
Bipolar Disorder: Etiology, Diagnosis, and Management
Nurse Practitioners’ Inability to Prescribe Buprenorphine: Limitations of the Drug Addiction Treatment Act of 2000
Family nurse practitioner O'Connor (2010) conducted a study identifying the limitations of the 2000 Drug Addiction Treatment Act limiting NPs from the ability prescribing buprenorphine to patients identified as drug addicts. The outcomes of the study determined the limitation to physicians only having the ability for prescribing the buprenorphine measurably reduces the effect on patient access to treatment in an often life-threatening illness.
The Experiences of Nurse Practitioners Providing Health Care to the Homeless
Using open-ended interviews and audiotaping participants' answers, Sieler and Moss (2010) studied the experiences of NPs providing healthcare to the homeless. Their findings of this particular experience of nine NPs interviewed revealed 5 themes and 13 sub themes indicating the necessary characteristics of the NP professional applications to providing much-needed health care to this portion of the population of today's society.
Nurse Practitioners: Integrating Mental Health in Pediatric Primary Care
Van Cleve, Hawkins-Walsh, and Shafer, (2013) report on their study of the growing demand for pediatric primary care providers having the ability for attending to behavioral, developmental, and mental health needs of children and adolescents. Their findings look at integrating nurse practitioners as a solution to this growing need for integrating accessible, quality mental health services for this type of patient within primary care.
A Challenge in Academia: Meeting the Healthcare Needs of the Growing Number of Older Adults
Scherer, Bruce, Montgomery, and Ball (2007) report on the outcomes of their qualitative study for determining the comfort level of 500 randomly chosen New York State NPs' knowledge about providing health care to patients 65 years and older even though they are not gerontology experts. Using the Geriatric Curriculum Survey, the respondents answered the questions developed by the American Association of Colleges of Nursing's 47 "Older Adult Care" competencies. A 44 percent return on the 500 mailed surveys reported the majority of the NPs have the necessary confidence in their professional abilities for assessing medical issues of patients 65 years and older except where ethnic/cultural aspects emerge.
Knowledge of Alzheimer's disease, dementia, delirium, polypharmacy, neurological, and sleep issues revealed over half of the respondents were only "somewhat comfortable". Respondents' rating of their knowledge comfort level centered on treating patients 65 years and older on topics aligned to psychosocial and physical issues showed they felt only ‘somewhat comfortable’ with eight of the nine items listed in this category. Over 50 percent felt their training and practice made them very knowledgeable concerning disease prevention and promoting healthy life practices. Ninety-five percent of the respondents reported had their required program of study included a didactic course in geriatrics they would have better preparation for caring for 65 years and older patients.
Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV
In their four year random controlled study of 238 community-dwelling HIV and seriously mental ill patients, Hanrahan, Wu, Kelly, Aiken and Blank (2011) looked at the barriers existing in current healthcare systems these patients face in conjunction with having a higher risk of contracting multiple morbidities, HIV, and dying by 25 years or younger in comparison to the general population. The study tested and concluded that advanced practice psychiatric nurse intervention provides the necessary model of care promising this vulnerable population of mentally ill a higher quality of care and outcomes than they experience. With the interventions by the advanced practice psychiatric nurse group in the study significant improvement of their depression as well as physical aspects of their illness improved and raised their quality of life.
Comparing and Contrasting the Studies
Comparing these studies looks at the focus on NPs as capable mental health care professionals. Each of these, studies' intention spotlighting the efficacy of NPs' training as multifaceted as well as flexible health care professionals underpins a growing realization among the health care field how the proficiencies of NPs increasingly fill gaps in socially marginalized patient populations with mental health issues too often not receiving the quality health interventions mental illness requires.
The extent of recognized mental health issues in today's society at the primary care level in particular, emerge from this body of literature presented in this academic investigation. Comparing the outcomes shows quality improvement of intervention treatments by NPs for the numerous mental health issues of primary care patients of all ages and socio-economic backgrounds as another aspect of the reason for the research of each study.
In particular, statistics show 85 percent of Australia's homeless remain afflicted with some form of mental illness (sane.org, 2012). With this staggering number, these studies comparably relate to the need for the disenfranchised homeless population having access to quality mental health care where NPs have the aptitude filling this direly needed health care service. Nurse professionals conducted all of these studies providing a particular perspective on the outcomes aligned to the realistic underpinnings of the efficacy of NPs practicing mental health interventions in primary care for the varieties of patient populations presented in this academic investigation.
While primary care was the fundamental comparison of the studies, at the same time, the studies focused on mental health needs of varieties of people living on the peripheral of society with specific mental health issues. This comparison points to the increasing numbers of people in society experiencing barriers to the existing health care system failing assuring opportunities for immediate diagnosis and care for their mental health issues with some even life threatening.
In contrast to the other studies using specific numbers of participants, the Philip, Lucock, and Wilson (2006) research outcomes while positive as connected to their intention, they admitted not using a control for determining the efficacy of the outcomes. Thus, their pilot study focusing on NP guiding self-help interventions for both anxiety and depression sufferers at the clinical primary care level remains theoretical more than statistically supported.
Strengths/Limitations
The strengths of each of these studies looks at the fact they arose from the desire of practicing NPs and NP instructors assessing their own value as health care professionals in the field of mental health interventions. As part of the NP protocols, there exists the ongoing evaluation of how this field of medical care continues evolving among peers and that peer analysis of medical care gaps where NP training can make a difference in closing those gaps holds true. Increased populations increases the number of primary care patients where the NP interfaces.
As revealed in the studies, the varieties of comorbidity in the form of mental illness connected with other patient diagnosis become problematic for the patients when their conditions remain undiagnosed by the GP physician. Using the skills of the NP as these studies show for early diagnosis of mental illness at the primary care stage of health care interventions promotes faster healing and comfort for the patients.
As already pointed out in the contrast section of this discourse the Philip, Lucock, and Wilson (2006) research also, provides the only study with significant limitations as connected to the outcomes. Again, they admitted not using a control for determining the efficacy of the outcomes. Thus, their pilot study focusing on NP guiding self-help interventions for both anxiety and depression sufferers at the clinical primary care level remains theoretical more than statistically supported.
Controversies/ Implications for Practice
Clearly, the study by O'Connor challenging the limitations on NPs prescribing buprenorphine results from government passing the Drug Addiction Treatment Act of 2000 is the most controversial of the research literature presented in this academic investigation. The implications of the findings intentionally discuss allaying the problematic characteristics of this legislation limiting prescribing of the drug to opioid-dependent outpatients to physicians only. The fact this is a chronic condition connects to the fact NPs remain a highly effective healthcare provider of chronic illnesses in general, and creating this legal barrier so the NP cannot prescribe the necessary and sometimes lifesaving medicine. Allowing NPs authority in prescribing buprenorphine provides improved treatment and outcomes for the patient. In addition, granting this ability enhances the authority and autonomy of the NP with particular focus on those states where independent NP practice takes place.
Over All Implications of the Body of Literature
Successfully treating the varieties of mental health disorders afflicting today's society largely relies on the earliest diagnosis. The body of literature presented in this document specifically provides the implication for practice of NPs in the primary care position effectively diagnosing the varieties of mental illness discussed including BP disorder, postpartum depression; age related mental illness including pediatric and geriatric. At the same time, the NPs' abilities in screening for mental illness as a comorbidity of diseases including HIV, diabetes, and hypertension as discussed in the literature summaries keeps this health professional focused on current diagnostics of the mental illnesses described here.
In the case of the pilot study of using cell phones effectively for monitoring homeless psychiatric and substance abuse patients' in managing their medications, the implications of the successful outcomes looks to the feasibility of this as a method for contacting hard to reach patients as this population represents. Burda et al (2012) also emphasized the implication for this technology as a means for gathering research data in other studies of the homeless mentally ill patient.
Goldsmith (2007) sees the implications of her study for NPs screening new mothers for postpartum depression justifying developing graduate curricula with postpartum depression units for specific training in recognizing at risk patients. In addition, creating clinical practice guidelines for NPs could prove beneficial for earlier and better diagnosis and treatment of this mental illness. This is the same reasoning with the need for NP training curricula including geriatric instruction. Looking at the implications of NP screening diabetic patients for depression initiates the conversation with patient about treatment options whether agree at the time or not. This establishes the comorbidity and builds a framework for future decisions about his/her medical options.
Particular to the Luthy et al (2007) study, the implication for the need for all NPs acquiring knowledge for cost effective treatment of uninsured and underinsured patients in general arises from their findings. Having this type of knowledge provides the NP an important tool for encouraging patient cooperation for treating this faction of the population in need of quality health care services.
Conclusion
As stated in the introduction, this literature review identified and discussed the capabilities of the NP in treating varieties of mental health illnesses from the primary care point of contact in screening, diagnosing, and intervention treatment options. The outcomes frame the desirability of increased specific training as part of the graduate academic criteria in curriculum development. The NP flexibility as a healthcare professional according to the intentions and outcomes of studies presented in each of the literature in this discourse emphasizes the efficacy of nurse practitioner abilities in treating a broad variety of mental illness.
References
Burda, C., Haack, M., Duarte, A. C., & Alemi, F. (2007). Medication Adherence among Homeless Patients: A Pilot Study of Cell Phone Effectiveness. Journal of the American Academy of Nurse Practitioners © 2011 American Academy of Nurse Practitioners.
Goldsmith, M. E. (2006). Postpartum Depression Screening by Family Nurse Practitioners. Journal of the American Academy of Nurse Practitioners © 2007 American Academy of Nurse Practitioners.
Hanrahan, N. P., Wu, E., Kelly, D., Aiken, L.H., & Blank, M. B. (2011). Randomized Clinical Trial of the Effectiveness of Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV. Nursing Research and Practice. Volume 2011, Article ID 840248
Hill, R.R., Vorderstrasse, A., Turner, B. Pereira, K. & Thompson, J. (2013). Screening for Depression in Patients with Diabetes: Addressing the Challenge. The Journal of Nurse Practitioners. 9(4).
Luthy, K.E., Peterson, N. E., & Wilkinson, J. (2007). Cost-Efficient Treatment for Uninsured or Underinsured Patients with Hypertension, Depression, Diabetes Mellitus, Insomnia, and Gastroesophageal Reflux. Journal of the American Academy of Nurse Practitioners © 2008 American Academy of Nurse Practitioners.
Miller, K. (2006). Bipolar Disorder: Etiology, Diagnosis, and Management. Journal of the American Academy of Nurse Practitioners © 2006 American Academy of Nurse Practitioners.
O'Connor, A. B. (2010). Nurse Practitioners' Inability to Prescribe Buprenorphine: Limitations of the Drug Addiction Treatment Act of 2000. Journal of the American Academy of Nurse Practitioners © 2011
Philp, F., Lucock, M. P., & Wilson, A. R. (2006). Primary Care-Based Guided Self-Help for Depression Provided by a Nurse Practitioner: A Pilot Evaluation. Primary Care Mental Health 4:159–64
Sane.org. (2012). Facts and Figures about Mental Illness. Retrieved from
http://www.sane.org/information/factsheets-podcasts/204-facts-and-figures
Scherer, Y. K., Bruce, S. A., Montgomery, C. A. & Ball, L. S. (2011). A Challenge in Academia: Meeting the Healthcare Needs of the Growing Number of Older Adults. Journal of the American Academy of Nurse Practitioners © 2012 American Academy of Nurse Practitioners.
Seiler, A., & Moss, V. A. (2010). The Experience of Nurse Practitioners Providing Health Care to the Homeless. Journal of the American Academy of Nurse Practitioners © 2012 American Academy of Nurse Practitioners.
Van Cleve, S. N., Hawkins-Walsh, E., & Shafer, S. (2013). Nurse Practitioners: Integrating Mental Health in Pediatric Primary Care. The Journal for Nurse Practitioners. 9(4).
Wand, T., White, K., & Green, T. (2011). Outcomes from the Evaluation of an Emergency Department-Based Mental Health Nurse Practitioner Outpatient Service in Australia. Journal of the American Academy of Nurse Practitioners © 2012 American Academy of Nurse Practitioners.
