Mental health disorders are increasingly common in today’s society. Recent research estimates that 20% of adults in the United States experience mental illness at some point in their lifetime (National Institute of Mental Health, 2022). Mental health disorders can negatively impact both the physical and psychosocial well-being of individuals. This preliminary care plan provides an overview of considerations for coordinating care for patients with mental health disorders to improve outcomes through a holistic, patient-centred approach.
Physical Considerations
Individuals experiencing mental illness often have accompanying physical symptoms as well that impact health and quality of life. Mental health disorders are associated with higher risks of chronic physical conditions like cardiovascular disease, diabetes, obesity, and asthma (Scott & Happell, 2011). Common physical symptoms include headaches, gastrointestinal issues, fatigue, and general aches and pains. These physical symptoms can be related to the mental disorder itself, medication side effects, higher rates of other illnesses, or lifestyle factors like poor nutrition and lack of exercise. Assessing and addressing physical concerns is an important component of caring for those with mental illness.
Some best practices for managing the physical health of mental health patients include regular screening and treatment of co-occurring medical issues, patient education, use of a holistic care team, maximizing adherence to medication and treatment plans, promoting healthy lifestyle behaviours, and managing side effects appropriately (Happell et al., 2012). For example, diabetic patients with depression need coordinated care to promote diet, exercise, and medication adherence. Special attention should be paid to the metabolic side effects of psychiatric medications as well. Early recognition and management of physical symptoms can help avoid exacerbations and complications of existing diseases. Ongoing reassessment and adaptation of the care plan is key, as physical status can fluctuate.
Psychosocial Considerations
Mental illness has a profound effect on psychosocial status and quality of life. Due to emotional or cognitive impairments, Individuals often struggle with normal daily activities or self-care. Maintaining relationships can also be difficult. The social stigma surrounding mental health issues frequently leads to isolation or family conflicts as well (Latalova et al., 2014). Providing psychosocial support is thus integral when coordinating care.
Evidence-based psychosocial interventions include patient counselling and education, cognitive behavioural therapy, social skills training, family psychoeducation programs, peer support services, vocational rehabilitation programs, and facilitated access to community resources (Pharoah et al., 2010). For example, connecting patients with local support groups can help reduce isolation while teaching coping strategies. Goals should address improving function, reducing hospitalizations, and enhancing overall wellness and ability to self-manage illness impacts. Care teams can collaborate to determine the most appropriate psychosocial interventions for each unique patient. Cultural aspects that affect self-image and willingness to participate in psychosocial services must also be factored in.
Cultural Considerations
A person’s cultural background, like their ethnicity, religion, or where they grew up, shapes how they think about mental health issues. Cultures have different beliefs about illness, spirituality, social rules, stigma, and communication. For example, some cultures rely more on family or community support rather than formal mental health treatment from doctors or therapists. Other cultures may see mental illness as taboo or shameful, so people are hesitant to admit they have a problem.
To provide good care, providers need to understand how a patient’s culture impacts their beliefs about mental illness. They need to notice if there are gaps between the patient’s cultural beliefs and Western medical practices. They may need to use interpreters to bridge language barriers. It is also helpful to connect patients with cultural organizations, religious leaders, or support groups from their community in addition to formal therapy. People who can explain cultural differences to the patient and provider can improve participation in treatment. For instance, an Asian-American immigrant patient might benefit a lot from also talking to leaders at their temple or cultural centre, not just doctors. Working with their culture, not against it, leads to better outcomes.
Goals and Patient-Centered Planning
Coordinating care for people with mental illness involves looking at the whole person. Mental health issues can cause physical problems like headaches or stomachaches. They can also make it hard for people to do everyday tasks or connect with others. Different cultures see mental illness in different ways. Some cultures are more private about mental health, while others rely on family support (Simpson et al., 2016).
Care coordination should involve shared decision-making processes between the patient, providers, and family. Specific, measurable and achievable goals will be different for each patient. For example, a middle-aged depressed patient may want to improve relationships with his children and gain control over suicidal thoughts before focusing on other goals like work performance. On the other hand, an anxious young woman prioritizing school functioning may need to target rumination patterns first. Coordinated speciality care models that incorporate patient voices and choices through comprehensive treatment teams produce better service satisfaction and tenure (Goldberg et al., 2013). Looking at the whole person and not just the diagnosis facilitates more holistic, relevant care coordination.
Community Resources
Leveraging community resources is vital for promoting mental health patients’ well-being and continuity of care between providers and settings. Useful resources include:
- Mental health clinics – Provide ongoing medication, counselling, and therapy groups. Offer services for different age groups and illness types.
- Case managers – help patients coordinate care from different providers.
- Peer supports – Offer mentoring and help accessing services from people with lived experience.
- Support groups – Run by agencies like NAMI, provide education and structured groups for patients and families.
- Clubhouses – Supply job skills training, support groups, and classes.
- Psychiatric urgent care – Offer crisis care without needing the ER.
- Inpatient psychiatric hospitals/rehab centres – Short-term care for acute issues.
Conclusion
Mental illness is a huge public health problem that impacts well-being in many ways. By understanding patients’ physical, emotional, cultural, and coordination of care needs, nurses can help create customized, whole-person care plans matched to what each patient finds important.
Attention should be paid to handling other physical conditions, improving the ability to function, addressing cultural beliefs, setting patient goals, and using community resources. With good assessment, planning, and teamwork across areas of expertise, caregivers can partner with patients to work towards realistic, patient-centred goals. Nurses play key roles in sticking up for and participating in groups working to better serve this vulnerable group of people. By working together, nurses help provide care that improves the quality of life and continuity of care for those with mental illness.
References
Goldberg, R. W., Dickerson, F., Lucksted, A., Brown, C. H., Weber, E., Tenhula, W. N., … & Dixon, L. B. (2013). Living well: An intervention to improve self-management of medical illness for individuals with serious mental illness. Psychiatric Services, 64(1), 51-57.
Happell, B., Davies, C., & Scott, D. (2012). Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: A systematic review. International Journal of Mental Health Nursing, 21(3), 236–247.
Latalova, K., Kamaradova, D., & Prasko, J. (2014). Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatric disease and treatment, 10, 1399.
National Institute of Mental Health. (2022). Mental illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness
Pharoah, F., Mari, J. J., Rathbone, J., & Wong, W. (2010). Family intervention for schizophrenia. Cochrane database of systematic reviews, (12).
Scott, D., & Happell, B. (2011). The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues in mental health nursing, 32(9), 589-597.
Simpson, A., Hannigan, B., Coffey, M., Barlow, S., Cohen, R., Jones, A., … & Haddad, M. (2016). Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. BMC Psychiatry, 16(1), 1–18.
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