NR 305 Community Access to Mental Health Services

NR 305 Community Access to Mental Health Services

NR 305 Community Access to Mental Health Services

Opioid addiction is a prevalent crisis in my area. I live in a rural county so there is not much to do, and people turn to drugs for something to do. There are also many people who have chronic pain and will become addicted to opioids because of this. “The abuse may become the person’s priority in life, resulting in avoidance of responsibilities and leading to a physical withdrawal state” (Weber & Kelley, 2018). The addiction creates tensions in families and often leaves people estranged.
I work on a medical complexity mental health unit and we discharge many patients with referrals to TASC (Treatment Access & Services Center), which is a great program that refers patients to drug and alcohol programs. They do a clinical assessment for people who do not have insurance or have Medicaid. After the clinical assessment, they will determine the level of care the patient needs, whether it is detox, outpatient, or inpatient rehab. They also offer peer- to- peer outreach programs for support and assist in funding through collaboration with COCA (Council of Chemical Abuse) (Berks TASC Treatment Access & Services Center, 2020).
Our charting system has a Clinical Opiate Withdrawal Scale that assesses the symptoms related to opiate withdrawal, such as sweating, yawning, heart rate, restlessness, GI symptoms, anxiety/irritability, achy bones or joints, etc. It is a scoring system to help determine what level of withdrawal they are currently at. I would use this scale for anyone portraying these symptoms that has a history of substance abuse or has opiates in their urine drug screen. My unit has mental health consultants that do a further assessment that looks at how much they use, how often, and other mental health concerns they have, since mental health and substance abuse go hand in hand.

References:

Berks TASC Treatment Access & Services Center, Inc of Berks County (2020, July 23). Retrieved July 25, 2020, from https://berkstasc.org/wp/
Weber, J. R., & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

You have several valuable points throughout your answer to these questions. I am familiar with the assessment scale you mention and it is helpful that you outline the symptoms you see. As far as the TASC program–this sounds really beneficial. I am curious if Medicaid patients or patients with no insurance are given a different treatment than those who provide insurance.

You are very knowledgable on this topic so I thank you for sharing all you have with myself and the class!

Thank you for sharing information about TASC.  I am also in Berks county and I wasn’t aware of this resource.  After visiting the website, I found that it also provides a free case management service is for those who are dealing with mental health issues in addition to alcohol and/or drug addiction.

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On my unit we have a Medication Assisted Therapy program for pregnant women who are treated with Methadone

NR 305 Community Access to Mental Health Services
NR 305 Community Access to Mental Health Services

or Suboxone.  Upon admission as well as ongoing we use the COWS scale to assess for opiate withdrawal.  Previous to my current position, I worked inpatient at a psychiatric hospital with children and adolescents.  We would often use the CAGE substance abuse screening tool as many patients would be admitted with known history or present substance abuse issues.  This screening tool has four questions and is scored based on answers of “yes” or “no”.  The questions include:

  1. Have you ever felt you should Cut down on your alcohol or drug use?
  2. Have you ever been Annoyed by others criticizing you about your alcohol or drub use?
  3. Have you ever felt bad or Guilty about your alcohol or drug use?
  4. Have you ever used alcohol or drugs as a way to wake yourself up in the morning, calm your nerves, or get rid of a hangover? (Eye-opener)

A patient who answers “yes” to just one question requires further evaluation.  This tool is used for patients of all ages but was especially useful I thought when working with adolescents.

Johns Hopkins Medicine (n.d.). www.johnshopkinsmedicine.orgLinks to an external site. retrieved on July 29, 2020 from https://www.hopkinsmedicine.org/johns_hopkins_healthcare/downloads/all_plans/CAGE%20Substance%20Screening%20Tool.pdfLinks to an external site.

I really found your post very intriguing. I absolutely feel that the opiode crisis is expanding to so many areas. While working on a med-surg unit there are many patients that I notice returning back to hospital and are consistently wanting pain medications around the clock. Unfortunately,  there is not a specific treatment center we are recommending for these patients. This causes a constant revolving down with the patients coming in and out of the hospital. I think that is amazing that your hospital offers that recommendation to the patients that would need help. I especially like that even if they have issues with insurance that it would not be a problem. I also find it interesting that as a unit you screen each patient for withdrawal. My unit uses a scale called  CIWA which is only in place when someone admits to drinking more often or have a high blood alcohol level at time of admission.

Although my county has an opioid problem as well, we normally do not see it too much in my hospital. However, recently we have seen more and more people coming in with over doses. During the Covid shutdown, people were having a hard time getting their methadone buprenorphine. Also, due to the social distancing group support meeting, such as NA were cancelled which caused people to relapse (Green, Bratberg, & Finnell, 2020). It’s really great that your hospital has a place where they refer discharged patients to. Whether they use it or not, at least it gives them an option. When we admit a patient there are certain questions we ask regarding substance abuse. If they answer yes to using drugs or alcohol it automatically triggers a referral to Peer Recovery, which is a program that our hospital utilizes. The program employs former substance abusers to come and talk to the patients. It’s a really great program because they know what the patient is going through and the patients feel they can relate to them.

Green, T. C., Bratberg, J., & Finnell, D. S. (2020). Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment. Substance Abuse, 41(2), 147–149. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1080/08897077.2020.1752351

Depression can affect anyone at any time in their lives and everyone must be screened for depression.  Some subjective findings that would indicate the need for further assessment would be despair, anhedonia, a decrease in appetite, insomnia, overwhelming sadness, fatigue, and inability to concentrate.  Some objective findings would be anxiety, muscle tension, inability to sit still, unkempt appearance.  I would use a personal history assessment, Depression Questionnaire, and SAD PERSONS Suicide Risk Assessment (Weber, 2018, p 82).  It is important to check for substance abuse problems as people often self-medicate, I would ask about alcohol and drug abuse using the AUDIT (Weber, 2018 p 76).

I live in a smaller rural community but there are resources in the area for help with depression.  Helping Hand Behavioral Health is located in the neighboring town.  They have a variety of programs and both in and outpatient services to help with mental illness and depression.  They have evaluation and counseling services, group therapy, living skills, nutrition, and also provide transportation.  They also have pet therapy and exercise programs.  I am happy to see that they have a very well-rounded program that not only offers mental health services but promotes whole-body wellness.

 

References:

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

Helping Hands Behavioural Health (2020, July 27) www.helpinghandsbehavioralhealth.comLinks to an external site.