A Nurse-Led, Needs-Based Psycho-Education Intervention for Chinese Patients with Fi Rst-Onset Mental Illness
Chien, Wai-Tong, Leung, Sau-Fong, Chu, Cecilia S. K., Contemporary Nurse : a Journal for the Australian Nursing Profession
People with mental health problems often present to mental health care many months or years after the onset of symptoms. There appears to be a significant negative relationship between the duration of untreated mental illness and its outcome (Frank, Howard, & McGuire, 2009); the longer the duration of the untreated symptoms, the more negative the eventual health outcome. There is a need for care prior to the symptoms becoming severe and sustained. Otherwise, the rate and length of patients' hospitalizations increase (Aron et al., 2009). Since the early 1990s, a variety of national and international efforts have been made in developed Western countries such as the United States (US) and United Kingdom (UK) to reform mental healthcare services and treatment approaches, setting the scene for much more attention and greater emphasis on early diagnosis and intervention for people with mental health problems. As a result, some of those with less severe mental health problems and/ or considerable community and family support need not be admitted into psychiatric hospitals for inpatient treatment. Triage and subsequent mental healthcare services provided by psychiatric outpatient clinics, such as continuous mental status assessment, psychiatrist consultation and first-line psycho-education and illness management become important in treating people with first-onset mental illness in the community.
However, due to limited resources and manpower, long waiting lists of newly referred cases for psychiatrists' first consultation and treatment can be found, particularly among those presenting with mild to moderate levels of psychiatric symptoms or those with a relatively stable mental state and adequate family support (Chien, 2006). Recently, the development of advanced practice nurses (APNs), formerly nurse specialists, in psychiatric care in the US and other Western countries has attempted to address this service need and purported to protect those with first-onset mental illness from hospitalization and/or relapse from illness (Tucker, Sandvik, Clark, Sikkink, & Stears, 1999). As expected by mental health care services and consumers, psychiatric APNs are employed to address the psychiatric symptoms of patients with first-onset mental illness and noticeable mental health problems, seeking high quality and timely care for those health problems and needs. Nevertheless, very few controlled trials and thus little clinical evidence have been found to prove the effectiveness of the nurse-led psychosocial interventions designed and provided by psychiatric APNs for these patients newly known and referred to psychiatric care. Therefore, this controlled trial was the first one conducted in an Asian country to test the effectiveness of a nurseled, needs-based psycho-education program for Chinese people with first-onset, moderately severe mental health problems.
In the past, people who presented with severe psychiatric symptoms or the first-episode of psychosis associated with schizophrenia or bipolar disorder needed to be hospitalized for diagnostic and safety reasons. However, with much better understanding of mental illness and the importance of early intervention in the illness, people with first-onset mental illness or less severe mental health problems can be treated and receive care from community mental healthcare services. Recently, even without psychiatric hospitalization or inpatient care, the treatment success rate for the first-episode of schizophrenia has been found to be up to 60%; for bipolar disorder, it can be 80%; and for major depression, it ranges from 65 to 70% (Harrison et al., 2001; Tohen et al., 2003).
However, community mental healthcare services in most developed countries do not have adequate resources for or are not appropriately responsive to the care of people with first-onset, noticeable mental health problems (Mosman & Van Meijel, 2008). This inadequacy in early psychiatric care and psychosocial intervention hinders the provision of efficient and quality mental healthcare prior to their mental health problems becoming severe and sustained. …