alexa Nursing Revolution in Australian Primary Mental Health | OMICS International
ISSN: 1522-4821
International Journal of Emergency Mental Health and Human Resilience
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Nursing Revolution in Australian Primary Mental Health

Dr. Paul Brown*

The Pierre Janet Centre, 8 Sunhill Court, Victoria 3183, Australia

*Corresponding Author:
E-mail: [email protected]

Visit for more related articles at International Journal of Emergency Mental Health and Human Resilience

Abstract

In Australia, a revolution is in the offing in primary psychiatric service delivery. Mental health nurse specialists are moving out from crisis and community-care teams attached to the public hospitals and community psychiatric clinics. To-date, three levels of psychiatric nursing have evolved: traditional basic mental health nursing; novel advanced nursing; and, advanced nursing with prescribing rights (Keltner & Folks, 1999; Talley & Brooke, 1992). The advanced forms are partnering with primary care physicians in private practice (Fisher, 2005; Hurley et al., 2014). Psychiatrists are beginning to link up with these nurse specialists, at the GP clinics. They are their natural, professional partners, sharing roles and responsibilities (Elsom, Happell, Manias & Lambert, 2007) This article argues for the benefits of models of primary psychiatric care in which the psychiatric nurse is the lynchpin of service delivery.

Keywords

Nurse specialist, General practitioner, Primary psychiatric care

INTRODUCTION

In Australia, a revolution is in the offing in primary psychiatric service delivery. Mental health nurse specialists are moving out from crisis and community-care teams attached to the public hospitals and community psychiatric clinics. To-date, three levels of psychiatric nursing have evolved: traditional basic mental health nursing; novel advanced nursing; and, advanced nursing with prescribing rights (Keltner & Folks, 1999; Talley & Brooke, 1992). The advanced forms are partnering with primary care physicians in private practice (Fisher, 2005; Hurley et al., 2014). Psychiatrists are beginning to link up with these nurse specialists, at the GP clinics. They are their natural, professional partners, sharing roles and responsibilities (Elsom, Happell, Manias & Lambert, 2007) This article argues for the benefits of models of primary psychiatric care in which the psychiatric nurse is the lynchpin of service delivery.

HISTORICAL SURVEY

The requirement for specialist, mental health nurses is based in two historical developments: mid-twentieth century deinstitutionalisation of the mentally ill; and, millennial commercialisation of medical care, most notably via managed care (Krauss, 1995). One might add that devolution of the mentally ill was not only to the community, but in designated forensic cases, to the prisons. That is another domain, locally and globally, massively under-resourced vis-à-vis psychiatric service provision, in which the specialist psychiatric nurse is set to make a significant difference (About Psychiatric-Mental Health Nurses; Hucker, 2004).

In the pre-modern period the mentally ill were triaged by primary care physicians, and then managed by alienists in the lunatic asylums. This system of mental health ‘warehousing’ was most comprehensively critiqued by Michel Foucault (Foucault, 1965). Outpatient psychiatry did not become prevalent until ambulatory psychological and physical therapies were developed, most notably, psychopharmacology, from the mid-twentieth century. The health dollar did not follow the psychiatric patient into the community. Community psychiatry failed to meet the treatment needs of all but the most psychiatrically impaired: chronic psychosis, substance abuse and severe personality disorder. Today, community-based mental health services are still focused largely on those with chronic and persisting illness. Services are clustered around acute care hospitals, homelessness shelters and gaols. By far and away the major part of psychiatric illness, however, is managed in general medical practice, in primary care.

Between 1960 and 1990, nurses began to specialise in psychiatry, first in the USA, and then in the rest of the developed world, including Australia. There had always been a small number of nursing doctoral candidates, headed for academe, and a similarly small number doing MBAs, headed for managerial roles. With congressional passage of the Health Maintenance Organisation Act, 1973, in the USA, and the consequent massive introduction of managed care, the number of nursing, shared-care programs, and of articles either describing or evaluating them, grew exponentially. Reiss-Brennan, a medical anthropologist and psychiatric nurse practitioner at Intermountain Healthcare, in Utah, was one of the first to examine mental health integration of nurses and psychologists in the primary care setting (Reiss-Brennan, 2006; Reiss-Brennan, Briot, Cannon & James, 2006; Reiss-Brennan, Van Uitert & Atkin, 2007).

Nurse specialists have cost-effectively (Baradell, 1994; NACNS, 2013; Kilpatrick et al., 2014) relieved the burden of pressure on primary medical care. They are set to make their mark in primary psychiatric practice. The most comprehensive review of research studies of nurse specialists overall was recently carried out by Donald et al. (2014) She and her co-workers surveyed 43, post-1980, randomised controlled trials (RCTs), evaluating the cost-effectiveness of US nurse practitioner (NP) and clinical nurse specialist (CNS) roles. The former prescribe medications, the latter mostly not. T h e survey covered outpatient, transition, and inpatient care. It found “fair-to-high quality evidence” for improvement of health system utilization (length of stay, re-hospitalization, costs of healthcare eg hospital, professional, and family costs), health resource use (eg diagnostic tests and prescriptions), and for positive patient outcomes (eg mortality, morbidity, quality of life, and satisfaction with care) and provider outcomes (quality of care and job satisfaction).

In this article, we suggest that nurse specialists add matchless clinical and fiscal value to general medical practice. This is because GPs attract by far and away the greatest burden of responsibility for psychiatric care, but are insufficiently qualified and resourced to fulfil this remit. In short, nurse specialists are set to step into the breach.

General Practitioners

Psychiatric disorder is the principal cause of medical disability in Australia (Whiteford, 2010). However, it attracts only 4.9% of Australian, government, health expenditure (AU$906 million, out of AU$18.6 billion) (DHS, 2013). Most psychiatric disability is triaged by GPs in the community. (Lowinsky, 2014; Britt et al., 2014)Since the introduction of managed care, psychiatric patients have increasingly been retained in general practice. About one-third of GP consultations are primarily psychiatric (Wittchen, Muhlig & Beesdo, 2003). GPs were encouraged to pursue psychiatric care by the introduction of safer antidepressants (SSRIs), by positive expectations generated by patient (consumer) literacy, and by the stigma of psychiatric illness and psychiatrists.

To assist GPs, and offset costs of psychiatric care, GPs were mandated by Medicare to generate and implement psychiatric treatment plans, in conjunction with allied carers. Typically, GPs manage physical treatments; psychologists provide counselling, notably CBT, DBT, and mindfulness therapies. General practice was even provided with item numbers for longer psychological consultations. In busy practice, these could rarely be taken up. GPs were unprepared for this increased psychiatric workload both in terms of time or training (Leigh, Stewart & Mallios, 2006). They were plied with screening tools, structured assessments, checklists, guidelines and manuals, without palpable benefit. The adaptation of the DSM to primary care (DSM-IV-PC) had a very low rate of acceptance. Psychiatric liaison was trialled, but in the absence of third party funding, did not find a following (Creed & Marks, 1989)

Primary care remained under resourced and underfunded. GPs managed most of their mental health cases but attracted only 21.4% (AU$194 million out of AU$906 million) of the mental health budget. Psychiatrists fared a little better at 33.2% (AU$301 million). Australian psychologists, however, attracted a staggering 43.1%. By and large, they treat anxiety and depression. (Pirkis et al., 2006; Morley et al., 2007)They are anti-medical model, preferring individualised psychological therapies over either biological or social therapies. They are as costly as physicians, but narrower in the range of therapeutic options offered or conditions addressed. Nevertheless, as a powerful lobby group, they managed to convince Australian governments that via GP plans they could service primary mental health more effectively, clinically and fiscally, than psychiatrists. Psychologists however, are generally not able to address Serious Mental Illness (SMI) with complex comorbidity, notably substance abuse. Nor do they assist in the actual preparation of GP mental health treatment plans. These are the very areas of psychiatry which psychiatric nurses excel.

Nurses and General Practice

In the developed world, routine psychiatric nurse training is scaling down. It is briefer, and more integrated with general nursing training. By way of contrast, specialist mental health nursing is developing in Australia (The department of Health, 2012), and in the USA (AACN, 1993; Puskar, 1996; Roberts, Robinson, Stewart & Smith, 2009; Butler et al., 2008). Nonetheless, it is still an under-utilized resource. Today, the expectation is that those nurses intent on working in the mental health field will go the extra training ‘yard.’ A bachelor’s degree is no longer sufficient. A master’s degree or equivalent is expected. Psychiatrists, and latterly psychologists, have been reluctant to share their practice with specialist nurses. They argue that the latter are insufficiently prepared, and require supervision. They regard them as competitive, rather than collaborative. It is further asserted that clinical responsibility remains with the GP, and with the supervisor (Elsom, Happell, Manias & Lambert, 2007). The evidence does not support these assertions.

Specialist mental health nurses possess knowledge and skills to-date deficient at the primary, mental health coalface. Over and above all other allied mental health workers, nurses are best set to assist GPs in the generation and implementation of mental health care plans, and to take team-leadership roles (Pringle, 2009). They are well-qualified to assist GPs with the management of at-risk (Puskar & Bernardo, 2002), patient populations, in both urban, and rural and remote settings (Jameson & Blank, 2010). Specialist nurses are sensitive to the needs of the poor and unemployed, the young and the elderly, rural and remote populations (Odell, Kippenbrock, Buron & Narcisse, 2013), and refugees and immigrants.

Most importantly, specialist nurses are able to bridge the dual, diagnostic and therapeutic gap between medicine and psychiatry (Blythe & White, 2012; Hardy & Thomas, 2012; McConnell, Inderbitzin & Pollard, 1992; Worley, Drago & Hadley, 1990). They are trained to manage both medical and psychiatric illness, reducing illness risk, and promoting health and wellbeing (Burman et al., 2009) especially in the long-term, physically and mentally ill (Vousden, Drago & Hadley, 1990; Smith, Allwright & O’Dowd, 2007). They have made inroads, for example, in the management of comorbid diabetes and depression (Astle, 2007; Ciechanowski, 2006 ; Katon et al., 2006; 2005). Nurses can assist with management of the metabolic syndrome that frequently accompanies long-term use of anti-psychotic medications. They can work towards smoking reduction, and are experienced in all aspects of the management of drug and alcohol abuse. Specialist nurses assist in the management of depression (Swindle, 2003),especially depression in the elderly (Skultety & Zeiss, 2006; Unutzer et al., 2008). They are familiar with the management of personality disorder and the functional psychoses, especially with complex psychiatric comorbidity. Nurses are able to work with veterans, forensic patients, and in matters of worker’s compensation. They are effective at assessing and managing psychiatric emergencies and crises, especially where there is risk of harm to self and/or others. In the therapeutic arena specialist nurses are more flexible, and less school-bound. They can augment cognitive and behavioural therapies with treatments based in psychodynamics, family dynamics, and sociodynamics (Stein, 2012; Wheeler, 2013).

In the relatively new profession of specialist mental health nursing, role definition is paramount for all parties: patients, physicians, psychiatrists, and third-party payers and policy makers. Most of all role clarity is essential for the practitioner themselves. Associated with this is titling, practice standards, models of collaboration, prescriptive authority etc. Partly this is externally defined by third parties. The USA is leading the way in specify the range and limits of specialist psychiatric nursing care (Oleck et al., 2011). In Australia regulation is covered by Federal and State legislation. Primary care is funded by Federal and private sources. Public facilities both inpatient and outpatient, are funded by combined Federal and State sources. Health, and especially mental health, often finds itself caught between these two stools, Federal and State (Rattan, 2012).

The field of training competencies was best systemised in the Dreyfus model of skill acquisition (Wikipedia, 2015). Their model proposed that a student passes through five stages: novice, competence, proficiency, expertise, and mastery. These have been applied conceptually to specialist nursing training (McHugh & Lake, 2010). The nursing novice with little or no specialist mental health experience needs extensive supervision; the beginner merely needs assistance; the competent practitioner is partially safe on their own; the proficient nurse has a high level of independence. The expert is able to show initiative and to pass on skills.

All professions and all professionals encounter barriers. Some barriers are extrinsic; some are intrinsic. Achieving targets, both personal and in collaborative, service delivery, precisely depends upon addressing and then overcoming these barriers. Hence it is essential to specify barriers as a prelude to advancing and sustaining service delivery. Corrections can then be made, outcomes evaluated, and services and their providers, improve (Blasinsky, Goldman & Unutzer, 2006; Lee et al., 2007).

Change in the service arena is a challenge both for the nursing practitioner and for the general physician, psychiatrist and other allied health workers. Nurses must match the role they were prepared for with the role expectations they encounter (Delaney, 2009). Barriers from fellow professionals come less from GPs, who relate to nurses as facilitators easing the burden, and more from psychiatrists, psychologists and others in allied health. Tensions can be eased and collaboration fostered by regular peer review and joint training. Most important is transformative leadership from within the nursing professional and from without, in the primary practice arena.

Paradoxically, greater knowledge and experience with advanced nursing practice is accompanied by greater nursing, clinical uncertainty. Barriers to be overcome are both substantive and procedural. The former are usually specified; the latter, less commonly so. Substantive barriers are in the areas of training, maintenance of practice standards and quality assurance. The greatest attention must be paid to preparation, supervision and role clarity. In procedural terms, speciality nursing in primary care entails management of patient urgency, severity, and complexity. Nurses must think and act under time pressure. Logic must be accompanied by lateral thinking (Trimmer, 2013)

The community mental health hub

Most psychiatric nurse specialists in primary care work from GP offices. Psychologists are just as likely to work in their own rooms as those of the collaborating GP. Psychiatrists make practice visits, but generally do not provide clinical services outside their own clinics. The next step in primary health service delivery is to trial a community mental health hub. In this the core human resources constituency would be the psychiatric nurse specialist. They would be fed with patients by GPs, and would work collaboratively with psychiatrists and psychologists. They would engage in continuous service assessment, and would engage with tertiary academic centres to carry out empirical research. Ideally the service should be manualised so that it can be scaled.

There are two further potential tiers of psychiatric care: virtuality; and aides. To date, virtuality has mostly focused on off-site telemedicine for diagnosis, treatment and management. There has been very little use of internet virtuality. The potential for intra-nets to provide emergency and ongoing support and guidance has yet to be tested.

Mental health support workers could act as the go-betweens in the system. As culture carriers they would advocate for clients, help them with their complex financial, occupational, social and housing, inter-sectoral needs, promote health, and provide informal support and guidance eg with grief. A proportion would have had previous experience of mental illness. In the UK, MIND (http://www.mindaustralia.org.au/about-mind/community-education/mental-health-peer-work-5-day-training-program.html) operates a 5-day community mental health worker training programme. In Australia, training is more extensive. A tertiary certificate is offered to those with suitable life and work experience, who are looking for an opportunity to care for the mentally ill, without undergoing specialist professional training.

CONCLUSION

Blood pressure measurement was extended to nurses’ scope of practice in the 1920s. Nearly a century later, Clozapine prescription is on the horizon in Australia and New Zealand (Edwards, 2013), The role of nurse mental health specialists is advancing rapidly. The next step in Australia is for specialist nurses to revolutionise primary psychiatric care, not only in diagnosis and treatment, but also in its leadership and organisation.

REFERENCES

About Psychiatric-Mental Health Nurses. www.apna.org/i4a/pages/index.cfm?pageid=3292

American Association of Colleges of Nursing. (1993). Position Statement. Nursing Education’s Agenda for the 21st Century. Washington, DC.

Astle, F. (2007). Diabetes and depression: a review of the literature.Nursing Clinics of North America, 42, 67-78.

Baradell, J.G. (1994). Cost-effectiveness and quality of care provided by clinical nurse specialists. Journal of Psychosocial Nursing and Mental Health Services, 32, 21-24.

Blasinsky, M., Goldman, H.H., & Unutzer, J. (2006). Project IMPACT: a report on barriers and facilitators to sustainability.Administration & Policy in Mental Health,33, 718-729.

Blythe, J., & White, J. (2012). Role of the mental health nurse towards physical health care in serious mental illness: an integrative review of 10 years of UK literature. International Journal of Mental Health Nursing, 21, 193-201.

Britt, H., Miller, G.C., Henderson, J., Bayram, C., Harrison, C., Valenti, L., et al. (2014). General practice activity in Australia. Sydney: Sydney University Press. http://ses.library.usyd.edu.au/bitstream/2123/11882/4/9781743324226_ONLINE.pdf

Burman, M.E., Hart, A.M., Conley,V., Brown, J., Sherard, P., & Clarke, P.N. (2009). Re-conceptualizing the core of nurse practitioner education and practice. Journal of the American Association of Nurse Practitioners, 21, 11-17.

Butler, M., Kane, R.L., McAlpine, D., Kathol, R.G., Fu, S.S., Hagedorn, H., (2008). Wilt TJ. Integration of mental health/substance abuse and primary care. Evidence report/technology assessment (Full Rep), 173,1-362.

Ciechanowski, P.S., Russo, J.E., Katon, W.J., Von Korff, M., Simon, G.E., Lin, E.H., et al. The association of patient relationship style and outcomes in collaborative care treatment for depression in patients with diabetes.Medical Care, 44, 283-291.

Creed, F., & Marks, B. (1989). Liaison psychiatry in general practice: a comparison of the liaison-attachment scheme and shifted outpatient clinic models. Journal of the Royal College of General Practitioners, 39, 514-517.

Delaney, K.R., Hamera, E., & Drew, B.L. (2009). National survey of psychiatric mental health advanced practice nursing: the adequacy of educational preparation: voices of our graduates. Journal of the American Psychiatric Nurses Association, 15, 383-392

Department of Human Services annual report (2013). Canberra: Department of Human Services. http://www.humanservices.gov.au/spw/corporate/publications-and-resources/annual-report/resources/1213/resources/dhs-annual-report-2012-13-web.pdf

Donald, F., Kilpatrick, K., Reid, K., Carter, N., Martin-Misener, R., Bryant-Lukosius, D. et al. (2014). A systematic review of the cost-effectiveness of nurse practitioners and clinical nurse specialists: what is the quality of the evidence? Nursing Research and Practice, 2014, 896587.

Dreyfus model of skill acquisition. Wikipedia, last modified on 25th June 2015.

Edwards, R. (2013). Feedback to the Nursing Council of New Zealand on the two proposals for registered nurse prescribing. RANZCP New Zealand National Committee. https://www.ranzcp.org/Files/Resources/Submissions/RANZCP-feedback-on-proposals-for-registered-nurse.aspx

Elsom, S., Happell, B., Manias, E., & Lambert, T. (2007). Expanded practice roles for community mental health nurses: a qualitative exploration of psychiatrists’ views. Australias Psychiatry, 15, 324-328.

Elsom, S., Happell, B., Manias, E., & Lambert, T. (2007). Expanded practice roles for community mental health nurses: a qualitative exploration of psychiatrists’ views. Australasian Psychiatry, 15, 324-328.

Fisher, J.E. (2005). Mental health nurse practitioners in Australia: improving access to quality mental health care. International Journal of Mental Health Nursing, 14, 222-229.

Foucault, M. (1965). Madness and civilization: a history of insanity in the age of reason. Translated by Howard, R., London: Tavistock.

Hardy, S., & Thomas, B. (2012). Mental and physical health co-morbidity: political imperatives and practice implications. International Journal of Mental Health Nursing, 21, 289-298.

http://www.mindaustralia.org.au/about-mind/community-education/mental-health-peer-work-5-day-training-program.html.

http://www.nacns.org/docs/CNSOutcomes131204.pdf.

https://en.wikipedia.org/.../Dreyfus_model_of_skill_acquisitio...

Hucker, S.J. (2004). Risk & Risk Management in Forensic Psychiatric/Mental Health Nursing: A Brief Annotated Bibiliography, Forensic sychiatry.ca. http://www.forensicpsychiatry.ca/print/nurse_bib.pdf.

Hurley, J., Browne, G., Lakeman, R., Angking, D.R., & Cashin, A. (2014). Released potential: a qualitative study of the Mental Health Nurse Incentive Program in Australia. International Journal of Mental Health Nursing, 23, 17-23.

Jameson, J.P, & Blank, M.B. (2010). Diagnosis and treatment of depression and anxiety in rural and non-rural primary care: national survey results. Psychiatric Services, 61, 624-627.

Katon, W., Unutzer, J., Fan, M.Y., Williams, J.W. Jr., Schoenbaum, M., Lin, E.H., et al. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression.Diabetes Care, 29(2), 265-270.

Katon, W.J., Schoenbaum, M., Fan, M.Y., Callahan, C.M., Williams, J. Jr., Hunkeler, E., et al. (2005). Cost-effectiveness of improving primary care treatment of late-life depression.Archives of General Psychiatry,62, 1313-1320.

Keltner, N.L., & Folks, D.G. (1999). Prescriptive authority. Perspectives in Psychiatric Care, 127, 34-36.

Kilpatrick, K., Kaasalainen, S., Donald, F., Reid, K., Carter, N., Bryant-Lukosius, D., et al. (2014). The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review. Journal of Evaluation in Clinical Practice. 20, 1106-1123.

Krauss, J. (1995). Editorial. Managing costs and managing care: managing to make our systems humane. Archives in Psychiatric Nursing, 1, 309-310.

Lee, P.W., Dietrich, A.J., Oxman, T.E., Williams, J.W. Jr., & Barry, S.L. (2007). Sustainable impact of a primary care depression intervention. Journal of the American Board of Family Medicine, 20, 427-433.

Leigh, H., Stewart, D., & Mallios, R. (2006). Mental health and psychiatry training in primary care residency programs. Part I. Who teaches, where, when and how satisfied? General Hospital Psychiatry, 28, 189-194.

Leigh, H., Stewart, D., & Mallios, R. (2006). Mental health and psychiatry training in primary care residency programs. Part II. What skills and diagnoses are taught, how adequate, and what affects training directors’ satisfaction? General Hospital Psychiatry, 28, 195-204.

Lowinsky, J. (2014). Why build a primary care psychiatry workforce? http://www.bloomingtonmeadows.com/core/fileparse.php/97018/urlt/PRESENTATION6_Joshua_L.pdf.

McConnell, S., Inderbitzin, L., & Pollard, W. (1992). Primary health care in the CMHC: a role for the nurse practitioner. Hospital and Community Psychiatry, 43, 724-727.

McHugh, M.D., & Lake, I.T. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in Nursing & Health, 33, 276–287.

Morley, B., Pirkis, J., Sanderson, K., Burgess, P., Kohn , F., Naccarella, L., et al. (2007). Better outcomes in mental health care: impact of different models of psychological service provision on patient outcomes. Australian and New Zealand Journal of Psychiatry, 41, 142-149.

National Association of Clinical Nurse Specialists (2013). Impact of the clinical nurse specialist role on the costs and quality of health care.

Odell, E., Kippenbrock, T., Buron, W., & Narcisse, M.R. (2013). Gaps in the primary care of rural and underserved populations: the impact of nurse practitioners in four Mississippi Delta states. Journal of the American Association of Nurse Practitioners, 25, 659-666.

Oleck, L.G., Retano, A., Tebaldi, C., McGuinness, T.M., Weiss, S., & Carbray, J., et al. (2011). Advanced practice psychiatric nurses legislative update: state of the States, 2010. Journal of the American Psychiatric Nurses Association, 17, 171-188.

Pirkis, J., Burgess, P., Kohn, F., Morley, B., Blashki, G., & Naccarella, L. (2006). Models of psychological service provision under Australia’s Better Outcomes in Mental Health Care program. Australian Health Review, 30, 277-285.

Pringle, D. (2009). Expanding nurses’ scope of practice. Nursing Leadership, 22, 1-4.

Puskar, K.R. (1996). The nurse practitioner role in psychiatric nursing. Online Journal of Issues in Nursing, 1. www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume/No1June96/NursePractitionerRole.aspx.

Puskar, K.R., & Bernardo, L. (2002). Trends in mental health: implications for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 14, 214-218.

Rattan, R. (2012). Five views of the Roadmap for National Mental Health Reform. The Conversation. http://theconversation.com/five-views-of-the-roadmap-for-national-mental-health-reform-11216.

Reiss-Brennan, B. (2006). Can mental health integration in a primary care setting improve quality and lower costs? A case study. Journal of Managed Care Pharmacy. 12(2), 14–20.

Reiss-Brennan, B., Briot, P., Cannon ,W., & James, B. (2006). Mental health integration: rethinking practitioner roles in the treatment of depression: the specialist, primary care physicians, and the practice nurse. Ethnicity & Disease, 16(2,3), S3:37-43.

Reiss-Brennan, B., Van Uitert, D., & Atkin, Q. (2007). The Role of the Psychologist in Intermountain's Mental Health Integration Program. The Register Report, 33, 37-39.

Roberts, K.T., Robinson, K.M., Stewart, C., & Smith, F. (2009). An integrated mental health clinical rotation. Journal of Nursing Education, 48, 454-459.

Skultety, K.M., & Zeiss, A. (2006). The treatment of depression in older adults in the primary care setting: an evidence-based review. Health Psychology, 25, 665-674.

Smith, S.M., Allwright, S., & O’Dowd, T. (2007). Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database of Systematic Reviews, 3, CD004910.

Stein, K.F. (2012). A pressing question: is there a place for psychotherapy in PMHNP practice? Journal of the American Psychiatric Nurses Association, 18, 324-325.

Swindle, R.W., Rao, J.K., Helmy, A., Plue, L., Zhou, X.H., Eckert, G.J., et al. (2003). Integrating clinical nurse specialists into the treatment of primary care patients with depression.International Journal of Psychiatry in Medicine, 33, 17-37.

Talley, S., & Brooke, P.S. (1992). Prescriptive authority for psychiatric clinical specialists: framing the issues. Archives of Psychiatric Nursing, 6, 71-82.

The department of Health (2012). Evaluation of the Mental Health Nurse Incentive Programme. http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-e-evalnurs

Trimmer, W., Laracy, K., & Love-Gray, M. (2013). Seeing the bigger picture through context-based learning. Last updated by Ako Administrator on 10 January. https://akoaotearoa.ac.nz/ako-hub/good-practice-publication-grants-e-book/resources/pages/seeing-bigger-picture-through-contex

Unutzer, J., Katon, W.J., Fan, M-Y., Schoenbaum, M.C., Lin, E.H., Della Penna, R.D., et al. (2008). Long-term cost effects of collaborative care for late-life depression.American Journal of Managed Care. 14, 95-100.

Vousden, N.K., Drago, L., & Hadley, T. (1990). Improving the physical health-mental health interface for the chronically mentally ill: Could nurse case managers make a difference? Archives of Psychiatric Nursing, 4, 108-113.

Wheeler, Ka.(2nd eds.) (2013). Psychotherapy for the advanced practice psychiatric nurse: a how-to guide for evidence-based practice. New York: Springer Publishing Company.

Whiteford, H., Degenhardt, L., Rehm, J., Baxter, J.A., Ferrari, J.A., Erskine, E.H., et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382, 1575-1586.

Wittchen, H-U., Muhlig, S., & Beesdo, K. (2003). Mental disorders in primary care. Dialogues in Clinical Neuroscience, 5, 115-128.

Worley, N.K., Drago, L., & Hadley, T. (1990). Improving the physical health-mental health interface for the chronically mentally ill: could nurse case managers make a difference? Archives of Psychiatric Nursing, 4, 108-113.

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Article Usage

  • Total views: 12135
  • [From(publication date):
    September-2015 - Dec 14, 2017]
  • Breakdown by view type
  • HTML page views : 8224
  • PDF downloads : 3911
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version