Vulnerable Population – Mental Health Patients and Mental Health Patients with Substance Use Disorder
The resolve to better community health has been earmarked by considerable emphasis on lessening healthcare disparities. Notwithstanding, significant disparities are still apparent among vulnerable populations. To these populations, traditional healthcare problems such as poor access to healthcare, risk of disease, and mortality are still imminent. Mental health patients and mental health patients with substance use disorders are just but a fraction of populations affected by healthcare inequalities and other health-related problems (Diaz et al., 2021). In the pursuit of better communities, a close look at this population is necessitated. This paper reports an interview with a caregiver handling mental health patients, emphasizing the needs of these patients, interactions with these patients, therapeutic approach for these populations, and available local resources valuable in their management process.
Overview and Roles of the Interviewee
The interviewed person is William Bomar. He is a social worker at an outpatient mental health clinic for veterans. He noted that his roles include coordinating care for these patients, holding individual and group counseling sessions, and conducting psychosocial and cognitive assessments with other caregivers.
Development of Needs Assessment
Needs assessment remains integral to comprehensive and quality mental healthcare. It provides a framework for identifying services that address patient suffering. As per the interviewee’s reports, the development of needs assessment starts by establishing what is going on with the patient. This initial process utilizes diverse mental health screening tools such as the patient health questionnaire (PHQ-9), general anxiety disorder assessment tool (GAD7), brief addiction monitor (BAM), and other screening tools valuable in aiding the diagnosis of various mental health illnesses.
Holistic and psychosocial approaches to mental health disorders assessment are a central feature of comprehensive mental healthcare. Psychosocial assessment evaluates individual mental health, functional capacity within society, and social status. As Bower retorted, psychosocial assessment often comes after caregivers have a baseline of what is happening to the patient. It is intended to evaluate the client’s physical, mental, and emotional health. While various screening tools provide a pathway for understanding these elements, they may not be sufficient in giving the actual position of the patient’s mental health status, and caregivers have to ask a series of questions to get a clear picture of what is happening to the patients.
Findings from various screening tools, along with the subjective findings from the patients, may point towards a specific diagnosis and guide the therapeutic interventions done on the patient. Several therapeutic interventions are available for patients with mental health illnesses. Psychotherapeutic interventions and pharmacotherapeutic approaches have been used adjunctively in managing many mental health illnesses. Cognitive behavioral therapy (CBT), dialectical behavior therapy, and contingency management therapy, among other options, are effective in lessening symptom severity and improving the quality of life of persons with mental health disorders.
Approach to Patients
Approaching patients with mental health illnesses may be challenging for some caregivers. Central to caregiver-patient interactions during healthcare engagement in mental healthcare setup is the ability of caregivers to have contextual awareness of the patients they are dealing with (Muhorakeye & Biracyaza, 2021). As the interviewee reported, successful interaction with clients with mental health illnesses is centered on the fundamental principles of respect, caring, and effective communication. Acknowledging that these patients are human beings is key. Accordingly, this will allow caregivers to treat them with the same respect and consideration as they would have treated other groups of patients. Additionally, it will eliminate an element of bias that may cloud caregivers’ judgment when treating them.
The first step when approaching these patients is to create a positive therapeutic environment. A positive therapeutic environment promotes healing for the patients and supports the needs of healthcare professionals and the client. This can be attained by ensuring the room is exposed to nature and maintains freedom from noise and interruptions. Optimizing seat arrangement in the room by ensuring the chairs are similar and comfortable, the lighting is welcoming, and the temperature is comfortable may also help create a positive therapeutic environment. This is then proceeded by creating a good therapeutic relationship with the client. Tolosa‐Merlos et al. (2022) note that a therapeutic alliance with the patient is an enabler of patient-centered care and a determiner of successful clinical outcomes.
The first step in establishing a healthy therapeutic alliance with the client is to develop rapport and trust with them. This encompasses showing genuine interest in their suffering, demonstrating empathy, and giving them a guarantee of confidentiality by communicating to them ethical guidelines surrounding their privacy. Involving the clients in important decisions, such as the timing of the therapy, is also important. Fostering effective communication with the clients by employing best practices in therapeutic communication is also important. This includes active listening, using open-ended questions, and employing non-verbal communication cues during the communication process may be helpful. All these strategies will help in enabling seamless communication with the clients.
Local Resources
Several community resources are available for patients with mental health illnesses. The Alabama Department of Mental Health (ADMH) and NAMI Alabaman are some of the community resources that can benefit patients with mental health illnesses in the state. These organizations comprise caregivers and persons with mental health illnesses and are geared towards promoting the health and wellness of persons with mental health illnesses. Patients with mental health illnesses and their caregivers can benefit from mental health associations such as Mental Health America Etowah and Montgomery counties. These associations provide referrals and education support for healthcare professionals and persons with mental health illnesses.
Interprofessional Collaboration
Comprehensive management of mental health disorders utilizes a collaborative paradigm, drawing caregivers from different cadres. These include mental health nurses, social workers, psychologists, psychiatrists, pharmacists, and physicians (DeNisco & Stewart, 2019). Mental health nurses play a role in administering medications, monitoring patients’ progress, assessing the patients, and educating them and their families on the disease process. Social workers and psychologists are involved in counseling, helping the clients cope with various stressors and helping clients overcome addictions. Psychologists can also help in diagnosing various mental health illnesses. Physicians may play a role in identifying and treating underlying illnesses, while pharmacists help provide medical information to other caregivers and patients. These professionals work concertedly to provide care to their patients. Their success depends on their ability to demonstrate teamwork, accountability, and responsibility toward effective patient care.
Conclusion
Mental health patients and mental health patients with substance use disorders remain a population of concern in healthcare. Addressing their needs is necessary and provides a pathway toward better community health. As evident in the interview, assessment and treatment areas are some of the care needs for these patients. These processes draw caregivers from diverse cadres and implore them to work collaboratively towards improving clinical outcomes.
References
DeNisco, S. M., & Stewart, J. G. (2019). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.
Diaz, A., Baweja, R., Bonatakis, J. K., & Baweja, R. (2021). Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic. World Journal of Psychiatry, 11(4), 94–108. https://doi.org/10.5498/wjp.v11.i4.94
Muhorakeye, O., & Biracyaza, E. (2021). Exploring barriers to mental health services utilization at Kabutare District Hospital of Rwanda: Perspectives from patients. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.638377
Tolosa‐Merlos, D., Moreno‐Poyato, A. R., González‐Palau, F., Pérez‐Toribio, A., Casanova‐Garrigós, G., & Delgado‐Hito, P. (2022). Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study. Journal of Clinical Nursing, 32(1–2), 253–263. https://doi.org/10.1111/jocn.16223
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Question 
Mental Health Patients and Mental Health Patients with Substance Use Disorder
Vulnerable Population:
Mental health patients and Mental health patients with substance use disorder (SUD)
Individual Interviewed:
William Bomar, LCSW (Social Worker)- works in an outpatient mental health clinic for veterans.
Interview Questions:
How do you develop a needs assessment on this particular population?
Mr. Bomar states, “To develop a needs assessment, I utilize assessment screening tools such as the brief addiction monitor (BAM), general anxiety disorder-7 (GAD7), and the patient health questionnaire (PHQ-9). These assessments help me to establish a baseline of what is going on with the patient. I generally start with the psychosocial assessment, which evaluates the individual’s mental, physical, and emotional health. From the information that I gather from the screening tools and the psychosocial assessment, I can then determine if the patient can benefit from psychotherapy treatments such as cognitive behavioral Therapy (CBT), dialectical behavior therapy (DBT), contingency management therapy (CMT) or eye movement desensitization and reprocessing (EMDR).”
How do you approach/interact successfully with this population of patients?
Mr. Bomar states, “I treat this population of patients with the same respect and consideration that I would show anyone else. I will say that creating an environment that is patient, nonjudgmental, and understanding aids in establishing a therapeutic relationship with your client. I have taken measures to ensure that my office is a clean, calm, and welcoming space to interact with my patients.
Information on resources available for mental health and substance use disorders. Please focus resources on the Tuscaloosa, Al. Area if possible. I have provided a link to some resources, but please look for other available resources.
https://mh.alabama.gov/individuals/
*Please follow the rubric provided to complete this paper. Please feel free to add/subtract what you need to Mr. Bomar’s statements to ensure the paper flows well*
Required Textbook:
- DeNisco, S.M., (2021) Role Development for the Nurse Practitioner (3rd). Jones & Bartlett Learning. ISPN-13 978-1284234305
- Sommers-Flanagan, J., & Sommers-Flanagan, R., (2016) Clinical Interviewing (6th). Wiley. ISPN-13 978-1119215585.