Overview and Summary: Emotional Health: Strategies for Nurses.

The challenges associated with mental illness and the care of persons with mental disorders have been traced through time since 400 B.C. as Hippocrates treated mental illness as a disturbance of physiology, parting ways from the belief systems of his contemporaries that attributed these disorders to demonic possession (PBS. 2014). One way to look to the advances in psychiatric nursing practice is to reflect upon where we have been.The mentally ill have suffered maltreatment from the time of Hippocrates into the present day, treated as criminals, delinquents, and defectives; burdened by atrocities of social and personal abuse. Champions mark these dark years, among which our authors march in their good company. Some I am sure are familiar to you: Dorothea Dix (1801-1887) advocate for humane treatment; Clifford Beers (1876-1943), an early founder of the client-advocate movement; and President Truman (1946) who established the National Mental Health Act and the National Institutes for Mental Health which promotes research in the field (PBS. 2014: Dix, n.d.). Along with the discovery of antipsychotic medications in the mid-1950s, the number of hospitalized mentally ill persons peaked, and by 1961, sociologist Erving Goffman identified the effects of institutionalization upon psychotic symptoms (Goffman. 1961). By the mid-1960s de-institutionalization begins, in large part because of psychopharmacological treatments. Trans-institutionalization, another cycle back into prisons begins, as the promise of community resources fails (Lamb & Weinberger. 2005). In 1979, the National Alliance for the Mentally III is formed, and by the early 1980s one-third of the homeless population is considered to have a mental disorder. Although a new generation of anti-psychotics becomes available in the early 1990s, society's tolerance for homeless persons with mental disorders has reached its limit. Over seven percent of jail intakes are persons with serious mental illness, and of those, 25% were held without charges (Lamb & Weinberger. 2005).Advocacy in mental health care has shifted toward policy initiatives since the 1990s. The Mental Health Parity Act, which broke down some of the discrimination against mental health care has been under consideration by congress since the mid-1990s (National Alliance on Mental Illness fNAMU. 2014). The Americans with Disabilities Act, which took effect in 1992, supported parents and consumers in the workplace and with public accommodations (Frank & Glied. 2007). Participation in public disability insurance programs, such as Medicare, Medicaid, Social Security Disability Insurance (SSDI) and its sister program, Supplemental Security Income (SSI), provide a stable, though often minimal, source of income for people disabled by mental illness. More recently, the Affordable Care Act promises improved access to care and parity protection through expanded insurance coverage for mental illness and substance abuse disorders (Beronio. Po. Skooec. & Glied. 2013). Today, mental health care for most people with severe mental illnesses is paid for by one or more of these programs. Mental health policymakers have come to recognize that changes in these programs can have powerful effects on the well-being of the population with mental illness and their families.Our authors for this OJIN topic recognize the effects of these policy changes upon the well-being of the mentally ill in their bracing discussion of the contemporary issues confronting mental health providers and persons with mental disorders today. The changes that author Kane highlights in her article, "The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates" are cross-cutting themes repeated in the articles submitted by the following authors, giving credence to their significance. In particular, these cross-cutting topics focus upon consumerism and recovery as an achievable goal in mental health care; the need for nurse contributions in psychiatric treatment research; and the importance of and difficulties associated with achieving prevention strategies in care at the individual or systems level. …