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Health Advocacy Campaign: Fighting Mental Illnesses one Day at A Time Millions of American’s are affected by mental health illnesses. As a nurse I understand that mental health illnesses have no respect of person. The National Alliance on Mental Illness reported that approximately 61.5 million Americans are affected by mental illness in a given year, and almost 13.6 million individuals live with a serious mental illness such as schizophrenia, depression, or bipolar disorder (National Alliance on Mental Illness, 2013). http://www.nami.org/factsheets/mentalillness_factsheet.pdf. Further, data revealed that 20 percent of youth ages 13 to 18 years old have experienced severe mental disorders within a given year, and about 13 percent of these populations are pediatrics patients that range between the ages of ages 8 to 15 years old.
The United States spends nearly $193.2 billion per year on mental health diseases (NAMI, 2013) proving that mental health illnesses are a major public health concern. Crises around the world have caused a greater shift in the efforts to promote wellness within communities.
Public health priorities are more geared towards communities working together to combat the devastating tragedies that continue to affect many schools and communities within the United States. It has been estimated that by the year 2020 depression will be the second largest killer, and many communities and schools have already begin to experience the horrific repercussions. Therefore, the purpose of this paper is to develop a health advocacy campaign that will more readily identify mental health illnesses as well as explore realistic methods to promote policies as well as improve community health outcomes.
Population Health Issue and Population Affected
Depression is a chronic medical condition that affects the way in which individuals feel, think, and behave. At some time in every individuals life sadness will be experienced; however, depression is far more serious. Depression is a lifelong disorder that requires ongoing medical treatment. Yearly, depression affects approximately 9.5 percent of the United States adult population, but the pediatric population has recently been identified as the fastest growing population diagnosed with clinical depression (Uplift Program, 2004). http://www.upliftprogram.com/depression_stats.html#statistics.
Research has found that depression stems from trauma, stressful life situations, and environmental exposures. Even though genetics may be a factor, depression episodes are usually trigged by some type of upsetting or traumatic event. The National Institute of Mental Health (NIMH) estimates that approximately 11 percent of adolescents are diagnosed with a depressive disorder by age of 18 years old (National Institute of Mental Health, 2014), which seems quite alarming because depression is not easily recognized in pediatric populations. Although, if close attention is paid changes can be noted in general interaction with peers such as: increased irritability, anger, aggression, social isolation, and low self-esteem.
Most recently there have been an increasing number in school shootings. Although, all the shooters except one have committed suicide the assumed causes have been linked to some type of traumatic stressful situation such as bullying or exposure to afflicted violence. Research completed by psychiatrist Meena Vythilingam found that extreme stress and trauma has effects on portions of the brain leading to improper functioning of the body’s memory and control of emotions. ( cite article ) When mental illnesses are left untreated serious impairment in daily functioning occurs. Therefore, early screenings and treatments in pediatric populations are essential. Nature Neuroscience 5, 1242 – 1247 (2002)
Published online: 15 October 2002; | doi:10.1038/nn958
Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma Mark W. Gilbertson1, 2, Martha E. Shenton2, 3, 4, Aleksandra Ciszewski4, Kiyoto Kasai4, Natasha B. Lasko1, 2, 5, Scott P. Orr1, 2, 5& Roger K. Pitman2, 5 Advocacy Programs Researched in this Area
Advocacy programs researched in mental health disorders included the Depression and Bipolar Support Alliance. The DBSA is an impactful organization that offers a multitude of support groups for youth and adults throughout the United States. The DBSA has multiple chapters and networks located within each state and are also tech savvy. Support services can be accessed through the web in real time; therefore, participants can join meetings virtually and partake in the ongoing support and promotion of wellness and recovery. The major benefits of DBSA are to enhance wellness by helping individuals that suffer from depression look at the positivity that life can offer understanding that with treatment and recovery one can live a life of joy and happiness. Additionally, the program offers a 4 week course titled Living Successfully with a Mood Disorder that can be facilitated by advocates within communities as efforts to teach individuals how to live healthy, full, meaningful lives while living with a mental health disorder.
Furthermore, if there is any reason an individual cannot attend their community facilitated session on Living successfully with a Mood Disorder the DBSA offers online courses as a way of reaching as many individuals as possible. To date the DBSA have developed a strategic plan which remolded their vision for wellness for individuals living with mood disorders as well as set innovative values that are established to support their direction of moving forward. http://www.dbsalliance.org/site/PageServer?pagename=home—citation The National Alliance on Mental Illness is another organization that advocates for community support and recovery of mental health disorders. NAMI has become known as one of the most popular organizations for supporting and advocating for mental illness throughout United States worldwide.
The organization prides itself on its commitment to campaigning for access to services, treatment, and continuing research as they raise community awareness for individuals in need. Because NAMI understands the damaging and devastating effects that mental illnesses can create within communities the organization works diligently to make sure lives are saved daily. Furthermore, NAMI has also been a big influence politically. They have made national investment in lifesaving research and have rallied for the equality of mental health care. Additionally, the organization prides itself on successfully addressing the stigmas of mental illnesses through social media and signature educational programs that can be viewed as symbols of help and hope for communities, families, and individuals. Promoting public awareness will always be their main objective as they passionately work to ensure positive outcomes for all American youth and adults.
Effective Attributes of the Programs
To date both programs are currently meeting todays societal needs, outreaching through social media, as well as having tangible advocate that can be contacted for support and help in times of need. There compassion and commitment to increasing and promoting community awareness have included outreach efforts worldwide. Moreover, NAMI has even further extended their efforts to address the challenges of our changing world through supporting virtual communities of help and hope to millions through social media channels such as Facebook, Twitter, Instagram and their very own website titled NAMI.org.
Health Advocacy Plan
According to the U.S. Surgeon General 11 percent of youth have been diagnosed with a mental health illness and more alarming statistics reveals that two-thirds of America’s youth who have a condition have not been identified nor have they received mental health services (Cite http://www.mentalhealthamerica.net/legislative-priorities). My health advocacy plan focuses on the early identification, treatment, and recovery of mental health illnesses within pediatric populations proposing a policy addition to the Mental Health Awareness and Improvement Act of 2013 (S. 689). Currently the Act addresses the country mental health crises from an educational and public health standpoint. The educational standpoint focuses on promoting school-wide prevention through the development of positive behavioral supports and encouraging school-based mental health partnerships.
The public health standpoint focuses on suicide prevention, helping children recover from traumatic events, mental health awareness for teachers and other individuals, and assessing barriers to integrating behavioral health and primary care ( cite). In addition to the current Act there needs to be an increase in efforts towards earlier identification of behavioral and emotional problems so that appropriate referrals for mental health can be assessed as early as possible facilitating ongoing follow up care and treatment for identified disorders. Efforts will include screening pediatric patient’s ages 3 to18 years for during well child exams. Local Health Departments, Pediatric offices, and Family Care Practices should be required to utilize The Pediatric Symptom Checklist (PSC-17) screening tool during well child exams. The PSC-17 screening tool which is recommended by the AAP will be completed by the parent or adult that the child lives with if the child is between ages 3 to 11 years old. Children between the ages of 12 to 18 years will complete to form by themselves with parental supervision.
It will be explained to parents/adults and teens that the enactment of the Affordable Care Act have encouraged a greater focus on preventive screenings; therefore, the visit today will encompass a comprehensive level of care that includes screenings to identify any risk factors that children may be subjected too. Parents/adults and teens will further be provided with clear directions on how to complete the form to determine the child’s risk for mental health problems in three different categories. The form will then be assessed and evaluated by the Physician/Practitioner or Registered Nurse based on the parents/adults or teens responses, determining the child’s risk and further needs for evaluation of care. If results are within normal limits the parents/adults and teen will be provided with positive reinforcements; however, if the results are abnormal the Physician/Practitioner will provide positive reinforcements along with a referral if the parent/adult consents for further evaluation and ongoing care by a pediatric psychiatrist.
Additionally, because we have a team of school nurses that work directly with children daily within the school systems this tool will further be utilized to recognize cognitive, emotional, and behavioral problems so that a greater percentage of the pediatric populations are reached and screened. In efforts to address ongoing follow up care and treatment, collaboration has been established with a local outpatient mental health and rehab center that provides comprehensive services to children and adults. All positive results and referrals will be forwarded and communicated with a designated nurse at the outpatient center and contact will be made with families from the designated nurse within 1-2 business days. The two entities which are the Richland Public Health Department and Catalyst Life Services will maintain ongoing communication regarding the child’s and families continuing progress, along with providing and directing needed resources as the needs arise.
Objectives for the Policy Implemented:
By January 1, 2015 at the end of the child’s well child visit parents or the adult that the child is living with will understand the significance and importance of early screening for pediatric depression and ongoing services if needed. By January 1, 2015 all children screening positive for depression will receive ongoing treatment and services that are evidence based incorporating therapeutic knowledge that is individualized to each child’s specific needs within 30 days from the initial well child visit.
By January 2015, Yearly well child exams will be scheduled and kept by the parents with reminder calls and/or letters sent out in the mail 30 days before scheduled appointment, then again 1 week before scheduled appointment. By January 2015, Communication between RPH and Catalyst regarding status/progress updates will be documented in the child’s EMR every other month documenting how the child and family are doing with treatment and follow up care. Data and Evidence to Substantiate Proposed Need— http://jpepsy.oxfordjournals.org/content/37/3/348.full citation
In a 2011 study published in the Journal of Pediatric Psychology many physicians cited several barriers as reasons for not assessing and screening pediatric patients for psychosocial concerns, with the biggest barrier being time constraints. The study also found that during a National survey 29-50% of parents reported that their child’s pediatrician was not screening their child/children for mental health issues or concerns. So, the AAP has been diligent, formulating and designing a pediatric symptom checklist scoring tool that has a moderate to high sensitivity and specificity in efforts to address cited barriers for physician neglecting to screen pediatric populations during well child exams. The PSC-17 checklist and screening tool is a quick, easy, and effective way to identify cognitive, emotional, and behavioral which facilitates the initiation of interventions as soon as possible for identified mental health problems.
Another study published in the American Academy of Pediatrics found that pediatricians and other primary care clinicians have only focused their attention on meeting the primary care needs of the child, forgoing evaluation of mental health disorders. The article further explored the values of the AAP policy statement which addresses the importance of improving pediatric populations’ health services as well as community services. Researched data has revealed that mental health concerns not only exist within the child, but includes all aspects of the child’s life such as family, school, community, and many other exposures they child may be vulnerable to. With the increasing number of school shootings communities as well as primary care providers have shown an interested in advocating and enhancing mental services within communities as well as outreaching and forming partnerships with local mental health agencies, community health activists, child protective and juvenile justice, local health departments, and schools.
Improving patient’s health outcomes by shifting the health care system towards quality over quantity is imperative. Section 2713 titled Coverage of Preventive Health Services requires all healthcare plans to cover preventive services, as well as pediatric preventive services and screenings recommended by the Health Resources and Services Administration. HRSA works in connection with the U.S. Department of Health and Human Services, whose main goal is improving access to health care by strengthening the health care workforce, building healthy communities, and achieving health equity (Health Resources and Services Administration, 2014). Therefore, HRSA provides grants to multiple organizations as efforts are implemented towards improving and expanding health care services for underserved communities throughout the United States.
How Attributes of Effective Advocacy Programs Researched Can Be Applied to this Proposed Campaign
Attributes of effective advocacy programs researched can be applied to the proposed campaign by networking and outreaching with organizations and individuals that share the same compassion and commitment towards increasing and promoting community awareness about mental health illnesses. Further attributes include creating partnerships that fosters marketing skills that capitalize on combining resources to increase greater support and power than on organization would have alone. The DBSA and NAMI also have multiple chapters and networks located within each state; therefore, the utilization of trusted organization could also be utilized as conglomerates for regular contact, name recognition, and credibility in efforts to promote ongoing care and support of wellness and recovery through screening pediatric population.
All nurses should be familiar with the basic legal concepts of nursing practice acts and laws. Nursing practice is governed by many laws; therefore, it is essential that nurses assume accountability for their professional nursing judgments and actions.
Enactment of Policy through Modification of Existing Policy OR Creation of New Legislation
Policies to address the mental health crisis throughout America has become of great concern for today’s youth. In April of 2013 the Mental Health Awareness and Improvement Act of 2013 (S. 689) was submitted to Congress to reauthorize and improve programs related to mental health and substance use disorders. Because of the identified risk from 2011 statistical data within my own community (13% of 6th -12th grade youth had seriously considered suicide and 6% of youth had attempted suicide. Further finds found that 265 of youth reported feeling sad or hopeless almost every day for two weeks or more which stopped them from doing regular activities and 41% of youth reported they would seek help for sadness and 14% did not know where to seek help) professional self-regulation needs to occur.
According to Milstead, legislators may make adjustments to bills during several points of review so it is important that Advanced Practice Nurses monitor bills during this process so they can apply influences for positive outcomes ( Milsted, 75). Although, the bill addresses the use of positive behavioral interventions and supports, early intervening services, and school-based mental health programs to improve academic achievement and reduce disciplinary actions (cite https://www.govtrack.us/congress/bills/113/s689/text); however, further modifications should be considered to further improve this existing policy.
Pediatric screenings for mental health disorders should be mandatory for all office and clinic based physicians/practitioners/providers that provide well child exams to children ages 3 to 18 years old. This will ensure that all pediatric populations are being reached and early identification of behavioral problems can be addressed as soon as possible as efforts to prevent, promote, and protect communities.
How Existing Laws or Regulations could Impact My Advocacy
The Patient Protection and Affordable Care Act is one law that could positively impact my advocacy. The ACA requires coverage of preventive health services as well as all healthcare plans to cover preventive services such as pediatric preventive services and screenings, which are recommended and supported by the Health Resources and Services Administration. Because the HRSA works in connection with the U.S. Department of Health and Human Services efforts are focused on building healthier communities and achieving health equality.
Therefore, the HRSA provides grants to organizations as efforts are implemented towards improving and expanding health care services for underserved communities throughout the United States and as a result, nurses are capable of outreaching and marketing to form relevant political relationships to assist in supporting and backing legislation. According to Milsted (p.49) nurses utilize persuasion to achieve desired goals because policy makers not know everything about nursing specialties; therefore, nurses can utilize performance measures to showcase continuous monitoring when reporting progress and ongoing efforts to improve organizational programs. Moreover, the main goal is to report to policy makers what has been contributed and how it has positively affected community health outcomes.
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