Mental Illness and Nursing Care Serious Mental Illness

Serious mental illness (SMI) refers to a range of mental health disorders that persist over time and cause substantial functional impairment in daily living. These impairments affect social interactions, interpersonal relationships, and work skills (Johnson, 1997). Common disorders classified under SMI include schizophrenia, schizoaffective disorder, recurrent major depression, and bipolar disorder (Lyon, 2001). According to the National Institutes of Mental Health (NIMH, 1994), about 2.8% of the adult population in the United States experiences one of these disorders within a given year.

SMI is often characterized by lifelong conditions that result in varying levels of disability. These conditions can significantly reduce an individual’s quality of life and render them vulnerable to poor health outcomes. Symptoms associated with SMI include cognitive dysfunction, social skills deficits, impaired emotional and behavioral responses, and challenges in communication and self-care.

Cognitive Impairment

Cognitive impairment is a common feature among individuals with chronic mental illnesses. This impairment encompasses difficulties in conceptualization, information processing, attention, executive functioning, and memory. More severe impairments include problems with problem-solving and processing complex information. Additionally, insight and judgment are often severely limited, leading to an inability to recognize the existence of illness or the need for treatment, deficits in self-awareness, and poor decision-making abilities.

These cognitive deficits are associated with poor functional outcomes and variations in adaptive functioning. Individuals with SMI often struggle with decision-making due to impaired information processing and response abilities. They may also have difficulty meeting basic needs such as food, shelter, and financial stability, increasing their vulnerability to risk-taking behaviors. It is not uncommon for individuals with SMI to engage in unsafe sexual practices or barter sexual favors for basic necessities (Carey et al., 1997). A study conducted by Carey and colleagues (1997) involving 60 adults with SMI revealed that 48% of men and 37% of women engaged in at least one high-risk behavior that could lead to HIV transmission.

Social Skills Deficit in Mental Illness

Social skills deficits are another significant challenge faced by individuals with SMI. These deficits can lead to changes in self-concept, reduced stress response, and an underassessment of personal resources. Social skills deficits can include impairments in conversational capacity and difficulties processing interpersonal stimuli, such as eye contact or assertiveness. Many individuals with SMI may appear eccentric or disheveled, have poor hygiene, and wear inappropriate or bizarre clothing.

Other behaviors, such as aggression, psychomotor retardation, and regression, are often present and may be misinterpreted by others. These social impairments can lead to decreased financial status, stigma, social isolation, financial disparities, and homelessness. Deficits in coping skills further exacerbate self-concept changes, reduced stress response, and underutilization of personal resources.

Individuals with SMI often experience the loss of family support and relationships. As the symptoms of SMI progress, individuals tend to become increasingly isolated. Borge et al. (1999) found that the degree of loneliness, engagement in meaningful leisure activities, and satisfaction with one’s living environment were critical factors influencing the perceived quality of life in individuals with SMI. As social support and factors related to quality of life diminish, individuals with SMI become more susceptible to negative health outcomes.

History of Psychiatric Illness and Health Care

The history of psychiatric care for individuals with SMI reveals a significant shift from institutionalization to community-based care. In the 1960s, deinstitutionalization became a national objective in the United States as the deplorable conditions in state-run psychiatric facilities were exposed. However, many communities were unprepared to care for individuals with SMI who were discharged into the community. This lack of preparedness led to increased rates of homelessness and incarceration among individuals with SMI.

Despite these challenges, the shift towards community-based care has resulted in the emergence of various treatment and rehabilitation services, such as case management and residential services. Community programs now provide a range of support options that enable individuals with SMI to live more independently and integrate into society. In addition, numerous advocacy groups, such as the National Alliance on Mental Illness (NAMI), have emerged to advocate for the rights of individuals with SMI at local, state, and national levels.

Although there have been significant advances in understanding and treating SMI, including the development of more effective medications and community-based services, individuals with untreated SMI are still frequently encountered in various healthcare and community settings. Nurses are often on the front lines in these encounters and play a critical role in assessing, intervening, and evaluating individuals with SMI to provide holistic care.

Nursing Care for Individuals with Severe Mental Illness

Nursing care for individuals with SMI involves addressing both the physical and psychological needs of the patient. Nurses must adopt a holistic approach that considers the unique challenges and vulnerabilities of individuals with SMI. This approach includes:

1. Comprehensive Assessment: A thorough assessment of the patient’s mental, physical, and social health is essential. This includes evaluating cognitive functioning, social skills, emotional responses, and the ability to perform daily activities. Nurses should assess the patient’s level of insight into their condition, decision-making capabilities, and risk for self-harm or harm to others.
2. Promoting Safety and Reducing Risk: Individuals with SMI may engage in high-risk behaviors due to impaired judgment and decision-making abilities. Nurses play a crucial role in identifying these behaviors and implementing strategies to reduce risks, such as providing education on safe practices, facilitating access to harm reduction resources, and connecting patients with appropriate support services.
3. Developing a Therapeutic Relationship: Building trust and rapport with patients is fundamental to effective nursing care for SMI. A therapeutic relationship helps patients feel safe and supported, which can encourage them to engage in their treatment plan. Nurses should use active listening, empathy, and non-judgmental communication to build trust and encourage open dialogue.
4. Encouraging Medication Adherence: Many individuals with SMI require long-term medication management to control symptoms and prevent relapses. Nurses must educate patients about their medications, including potential side effects, benefits, and the importance of adherence. They should also work with patients to identify and address barriers to medication adherence, such as financial constraints, side effects, or lack of understanding.
5. Facilitating Access to Community Resources: Nurses should help individuals with SMI connect with community resources, such as housing assistance, employment programs, and social services. Access to these resources can improve the patient’s quality of life, reduce social isolation, and promote stability.
6. Promoting Social Skills Development: Given the social skills deficits commonly associated with SMI, nurses should encourage patients to engage in social skills training programs. These programs can help individuals develop effective communication, assertiveness, and problem-solving skills, improving their ability to navigate social situations and build meaningful relationships.
7. Supporting Family Involvement: Family support can be a vital component of recovery for individuals with SMI. Nurses should involve family members in the care plan when appropriate, providing education and support to help them understand the patient’s condition and how they can contribute to their recovery.
8. Providing Psychoeducation: Educating patients and their families about SMI, its symptoms, and the available treatment options can empower them to make informed decisions about their care. Psychoeducation can also help reduce stigma and promote a better understanding of the patient’s experience.
9. Encouraging Self-Care and Wellness: Nurses should promote self-care activities that contribute to overall well-being, such as regular exercise, healthy eating, adequate sleep, and stress management techniques. These activities can help improve mood, enhance cognitive functioning, and reduce the risk of comorbid physical conditions.
10. Advocating for Patient Rights: Nurses play a critical role in advocating for the rights and dignity of individuals with SMI. This advocacy may involve supporting patients in accessing necessary services, challenging discriminatory practices, and promoting policies that enhance the quality of care and access to resources for individuals with SMI.

Conclusion

Nursing care for individuals with severe mental illness requires a comprehensive, patient-centered approach that addresses the unique challenges associated with cognitive impairment, social skills deficits, and the history of psychiatric care. By promoting safety, supporting medication adherence, facilitating access to community resources, and fostering a therapeutic relationship, nurses can significantly enhance the quality of life and health outcomes for individuals with SMI.

Given the prevalence of untreated SMI in Mental Illness and Nursing Care  healthcare and community settings, nurses must be equipped to assess, intervene, and evaluate these individuals to provide holistic care. Continued advancements in understanding and treating SMI, along with advocacy efforts and community-based services, will further support the well-being and recovery of individuals living with severe mental illness.