Psychiatric Mental Health Nursing by Videbeck

4 TREATMENTSETTINGS ANDTHERAPEUTICPROGRAMS 77

included under the “medically necessary” services

funded under managed care. He identified 10 reasons

(listed in Box 4-4) why comprehensive services for

people with mental illness should include community

support.

Psychiatric rehabilitation has improved client

outcomes by providing community support services to

decrease hospital readmission rates and increase com-

munity integration (Mallik et al., 1998). At the same

time, managed care has reduced the “medically nec-

essary” services that will be funded. For example,

because skills training was found to be successful in

assisting clients in the community, managed care or-

ganizations defined psychiatric rehabilitation as only

skills training and did not fund other aspects of reha-

bilitation such as socialization or environmental sup-

ports. Clients and providers identified poverty, lack of

jobs, and inadequate vocational skills as barriers to

community integration, but because these barriers

were not included in the “medically necessary” defini-

tion of psychiatric rehabilitation by managed care,

Box 4-3

➤ GOALS OFPSYCHIATRICREHABILITATION

• Recovery from mental illness


• Personal growth


• Quality of life


• Community reintegration


• Empowerment


• Increased independence


• Decreased hospital admissions


• Improved social functioning


• Improved vocational functioning


• Continuous treatment


• Increased involvement in treatment decisions

Adapted from Wilbur, S., & Arns, P. (1998). Psychosocial
rehabilitation nurses. Journal of Psychosocial Nursing,
36 (4), 33–41; and Hughes, W. C. (1999). Managed care,
meet community support. Health & Social Work, 24(2),
103–110.

Box 4-4

➤ TENREASONS TOINCLUDECOMMUNITYSUPPORT INEVERYBEHAVIORALHEALTHPLAN

1. Decreased hospitalization means lower cost of care. Clients who have access to more intensive support are
   less likely to decompensate to a point where they require inpatient hospitalization.


2. Normalization. Clients respond favorably to community interactions that are more “normal” and not
   directly treatment related such as pursuing a hobby or joining the YMCA or YWCA with the help of their
   community support worker.


3. Linkage to resources. Community support workers can identify and access resources for the client when he
   or she may be unable to do so.


4. Effective advocacy. Community support workers can confront individuals or institutions in a professional
   manner to resolve any attempts to prevent a client from reaching goals.


5. Improved quality of life. Because clients often survive on SSI benefits, they need assistance to access such
   services as food pantries, energy grants, and weatherization programs to help make ends meet.


6. Respite for natural caregivers. Community support workers can arrange doctor’s appointments and lab
   work, pick up drugs, and monitor compliance with medications to alleviate the stress of these tasks on
   the client’s caregiver. They also can provide direct support and information to caregivers to make their
   tasks easier.


7. Consolidated funding. Services in the community are often provided and funded by a variety of programs
   and agencies. Community support workers can advocate for the enhancement of community support
   services and improved, adequate funding of these services.


8. Equalization of a two-tiered system. Private sector mental health care is often limited when the illness is
   persistent and severe. Consequently, clients revert to care provided through public funds. All payers, public
   or private, could benefit from community support programs to promote wellness and manage crises or
   serious mental illness.


9. Flexibility. Community support employs a variety of persons at different skill levels to provide assistance
   with everything from daily activities to psychiatric care, depending on the needs of the client.


10. Continuum of care. Community support provides the opportunity for clients to move along a continuum of
    services without repeated transfers to different programs with unfamiliar staff.

Hughes, W. C. (1999). Managed care, meet community support. Health & Social Work, 24(2), 103–110.