The role of the case manager has become increas-
ingly important with the proliferation of managed care
and the variety of services that clients need. No stan-
dard formal educational program to become a case
manager exists, however, and people from many dif-
ferent backgrounds may fill this role. In some set-
tings, a social worker or psychiatric nurse may be the
case manager. In other settings, people who work in
psychosocial rehabilitation settings may take on the
role of case manager with a baccalaureate degree in
a related field, such as psychology, or by virtue of their
experience and demonstrated skills. Liberman, Hilty,
Drake, & Tsang (2001) identify three distinct sets of
competencies necessary for effective case managers:
clinical skills, relationship skills, and liaison and advo-
cacy skills. Clinical skills include treatment planning,
symptom and functional assessment, and skills train-
ing. Relationship skills include the ability to establish
and maintain collaborative, respectful, and therapeu-
tic alliances with a wide variety of clients. Liaison and
advocacy skills are necessary to develop and maintain
effective interagency contacts for housing, financial
entitlements, and vocational rehabilitation.
As clients’ needs become more varied and com-
plex, the psychiatric nurse is in an ideal position to
fulfill the role of case manager. In 1994, the American
Nurses Association stated that the psychiatric nurse
can assess, monitor, and refer clients for general med-
ical problems as well as psychiatric problems; admin-
ister drugs; monitor for drug side effects; provide drug
and client and family health education; and monitor
for general medical disorders that have psychological
and physiologic components. Registered nurses bring
unique nursing knowledge and skills to the multi-
disciplinary team (Wilbur & Arns, 1998).
PSYCHOSOCIAL NURSING IN
PUBLIC HEALTH AND HOME CARE
Psychosocial nursing is an important area of public
health nursing practice (Collins & Diego, 2000) and
home care. Public health nurses working in the com-
munity provide mental health prevention services to
reduce risks to the mental health of persons, families,
and communities. Examples include primary preven-
tion such as stress management education; secondary
prevention such as early identification of potential
mental health problems; and tertiary prevention such
as monitoring and coordinating rehabilitation ser-
vices for the mentally ill.
Finkelman (2000) identifies the need to provide
self-management skills training to mental health
home care clients in addition to support and treat-
ment to facilitate recovery. The clinical practice of
public health and home care nurses includes caring
for clients and families with issues such as substance
abuse, domestic violence, child abuse, grief, and de-
pression. In addition, public health nurses care for
children in schools and teach health-related subjects
to community groups and agencies. Mental health
services that public health and home care nurses
provide can reduce the suffering that many people
experience as a result of physical disease, mental dis-
orders, social and emotional disadvantages, and other
vulnerabilities.SELF-AWARENESS ISSUES
Psychiatric-mental health nursing is
evolving as changes continue in health care. The focus
is shifting from traditional hospital-based goals of
symptom and medication management to more client-
centered goals, which include improved quality of life
and recovery from mental illness. Therefore, the nurse
also must expand his or her repertoire of skills and
abilities to assist clients in their efforts. These chal-
lenges may overwhelm the nurse at times, and he or
she may feel underprepared or ill equipped to meet
them.
Mental health services are moving into some non-
traditional settings such as jails and homeless shel-
ters. As nursing roles expand in these alternative set-
tings, the nurse does not have the array of backup
services found in a hospital or clinic such as on-site
physicians and colleagues, medical services, and so
forth. This requires the nurse to practice in a more
autonomous and independent manner, which can be
unsettling.
Empowering clients to make their own decisions
about treatment is an essential part of full recovery.
This differs from the model of the psychiatrist or treat-
ment team as the authority on what is the best course
for the client to follow. It is a challenge for the nurse
to be supportive to the client when the nurse believes
the client has made choices that are less than ideal.
The nurse may experience frustration when work-
ing with mentally ill adults who are homeless, incar-
cerated, or both. Typically these clients are difficult to
engage in a therapeutic relationship and may present
great challenges to the nurse. The nurse may feel re-
jected by clients who do not engage readily in a rela-
tionship, or the nurse may feel inadequate in attempts
to engage these clients.Points to Consider When Working
in Community-Based Settings- The client can make mistakes, survive them,
and learn from them. Mistakes are a part
of normal life for everyone, and it is not the
nurse’s role to protect clients from such
experiences.
4 TREATMENTSETTINGS ANDTHERAPEUTICPROGRAMS 83