Clinical Nursing Expertise in the Care and Treatment of Mental Health Clients with Concurrent Disorders

Abstract:

It is estimated that approximately 50% of people with mental health disorders have substance abuse and addiction issues to cope with as well. The incidence and prevalence of concurrent disorders on the psychiatric population is an important phenomenon to address since this group represents 70-85% of total cost expended on the mental health population. Not only do they represent the greatest cost but also the greatest suffering so the need to address issues related to treatment and support of this population is imperative. “ Alcohol dependence is 21 times more likely to occur among people with antisocial personality disorders and 4 times more likely among people schizophrenia; and among those treated for alcohol-related disorders, up to 70% to 80% may have a mental disorder (Health Canada, 2002)”. Therefore if behooves nursing staff in mental health facilities to acquaint themselves with the emerging knowledge around best practice and nursing care interventions fir patients with concurrent disorders.

Empirical evidence now promotes an integrated treatment approach that emphasizes an empathic, hopeful, continuous relationship over multiple treatment episodes (Minkoff, 2006) where both disorders are treated as the primary disorder. In order for this new knowledge to be operationalized the fellow will be assisting in program development and knowledge dissemination amongst professional peers.

The clinical fellowship will involve collaboration with staff from the Newport Center for Addictions and Substance Abuse, the Clinical Manager of mental health services at GNG, the clinical staff of the in patient unit, and the Regional Director of Mental Health Services who has articulated the need for advanced nursing knowledge in concurrent disorders. The fellow will be spending one week at the Newport Centre for Addictions monitoring psycho-educational groups and job shadowing addiction counselors and will have a clinical placement at a concurrent disorders hospital. The fellow is also registered in a Cognitive Behavior Therapy Course, which will enhance required skills needed to co lead groups and individual therapy.

Time will be spent developing a reference bibliography to be shared with colleagues at the fellow’s home site but also with the other two mental health facilities within the NHS. The fellow will also be completing and on line course relevant to best practice for the assessment of patients with concurrent disorders “ Motivational Interviewing” a course offered by the centre for Addiction and Mental Health (CAMH).

The fellowship timelines are structured to best meet the educational opportunities and placement opportunities therefore will not be taken in one continuous time block but likely in two 4 week blocks and one 2 week block. All activities will be completed before of March 2007.

Positive outcomes are predicted for a number of stakeholders beginning with the patient’s with concurrent disorders. Improved therapeutic approached, care planning and psycho educational programs are anticipated, as the fellow will transfer knowledge to coworkers and assist with the development of educational programs. The fellow will experience enhanced skill level and knowledge of the care of the client with concurrent disorders.
Niagara Health System - GNG Site

The mental health system at large will benefit as the fellow rolls out “lunch and learn” sessions to the other two mental health units within the NHS. It is also hoped that the fellow will contribute to an overhaul of the NHS mental health system to becoming a welcoming place for patient’s with concurrent disorders.

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