Psychiatric Mental Health Nursing by Videbeck

of mental illness among the homeless population are
that one-third of adult homeless persons have a seri-
ous mental illness and more than one-half also have
substance abuse problems (DHHS, 2002). Those who
are homeless and mentally ill are found in parks, air-
port and bus terminals, alleys and stairwells, jails,
and other public places. Some use shelters, halfway
houses, or board-and-care rooms; others rent cheap
hotel rooms when they can afford it (Haugland et al.,
1997). Homelessness worsens psychiatric problems
for many people with mental illness who end up on
the streets, which contributes to a vicious cycle.
Many problems of the homeless mentally ill, as
well as those who pass through the revolving door of
psychiatric care, stem from the lack of adequate com-
munity resources. Money saved by states when state
hospitals were closed has not been transferred to
community programs and support. Inpatient psychi-
atric treatment still accounts for most of the spend-
ing for mental health in the United States, so com-
munity mental health has never been given the
financial base it needs to be effective. In addition,
mental health services provided in the community
must be individualized, available, and culturally rel-
evant to be effective (Lamb & Bachrach, 2001). Only

15% of people with mental illness appear to be get-

ting minimally adequate treatment, which is a pre-

scription for medication and four or more visits with

a psychiatrist or eight visits with any kind of mental

health specialist (Wang, 2002).

In 1993, the federal government created and

funded Access to Community Care and Effective Ser-

vicesand Support (ACCESS) to begin to address

the needs of people with mental illness who were

homeless either all or part of the time. The goals of

ACCESS were to improve access to comprehensive

services across a continuum of care, reducedupli-

cation and cost of services, and improve the efficiency

of services (Randolph et al., 1997). Programs such as

these provide services to people who otherwise would

not receive them.

Objectives for the Future

Unfortunately only one in four affected adults and

one in five children and adolescents receive treat-

ment (DHHS, 2002). Statistics like these underlie

the Healthy People 2010objectives for mental health

proposed by the U.S. Department of Health and

Human Services (Box 1-1). These objectives, originally

1 FOUNDATIONS OFPSYCHIATRIC-MENTALHEALTHNURSING 7

Box 1-

➤ HEALTHYPEOPLE2010 MENTALHEALTHOBJECTIVES

• Reduce suicides to no more than 6 per 100,000 people


• Reduce the incidence of injurious suicide attempts by 1% in 12 months for adolescents ages 14–


• Reduce the proportion of homeless adults who have serious mental illness to 19%


• Increase the proportion of persons with serious mental illnesses who are employed to 51%


• Reduce the relapse rate for persons with eating disorders including anorexia nervosa and bulimia nervosa


• Increase the number of persons seen in primary health care who receive mental health treatment screening
  and assessment


• Increase the proportion of children with mental health problems who receive treatment


• Increase the proportion of juvenile justice facilities that screen new admissions for mental health problems


• Increase the proportion of adults with mental disorders who receive treatment by 17%
  
  
  • Adults 18–54 with serious mental illness to 55%
  
  
  • Adults 18 and older with recognized depression to 50%
  
  
  • Adults 18 and older with schizophrenia to 75%
  
  
  • Adults 18 and older with anxiety disorders to 50%
  
  
  
  


• Increase the population of persons with concurrent substance abuse problems and mental disorders who
  receive treatment for both disorders


• Increase the proportion of local governments with community-based jail diversion programs for adults with
  serious mental illness


• Increase the number of states that track consumers’ satisfaction with the mental health services they receive
  to 30 states


• Increase the number of states with an operational mental health plan that addresses cultural competence


• Increase the number of states with an operational mental health plan that addresses mental health crisis inter-
  vention, ongoing screening, and treatment services for elderly persons

U.S. Department of Health and Human Services. (2000). Healthy people 2010: National health promotion and disease prevention

objectives.Washington, DC: DHHS.