NR 544 Analysis of Path to Recent Healthcare Policy - DOWNLOAD PAPER TO SCORE AN A

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Think of a current health issue. Explain the path of this issue, from conception toward being in the forefront of society. Week 4: Analysis of Path to Recent Healthcare Policy The focus of my ... healthcare policy issue since NR 506 has been societal awareness of mental health disorders, especially among adolescents, and eliminating stigmas linked to individuals suffering from mental illness. Recently, my local channel 8 news featured a week- long storyline about the teen suicide epidemic in the state of Ohio. Teen suicide and depression is a major public health crisis that can have devastating effects on individuals, families, and communities. The Ohio Department of Health (2016) reported: “in the United States, suicide is the tenth leading cause of death overall and the second leading cause of death among youth and young adults (aged 10-24 years)”. Since August 2017 there have been 6 teen suicides, ages ranging from 14 to 18, in 6 months in one Ohio school district. Policy makers have called for a more critical examination of the mental health treatment system, and advocates are rallying around federal legislation that would strengthen community-based mental health services for children and adolescents. Why is There a Rise in Teen Suicide? Health factors such as having a mental health disorder, and/or a substance use disorder are the most significant risk factors for suicidal behaviors. In the late 80s, there was a decline in teen suicide due to new antidepressants that were more effective and had fewer side effects (Bichell, 2016). So, what changed? Many experts are unclear what the exact causes are for the rise in teen suicides. Some speculations include the increased academic pressure and increased homework loads, continuing changes in family structure, patterns of substance misuse, the lack of insurance coverage, the inability to access mental health services, and the increased popularity of electronic communication (Twenge, Joiner, Rodgers, & Martin, 2017). This discussion thread will take a further look at the later four. Substance abuse in adolescence has been proposed as a relevant risk factor for suicidal behaviors. Dryer reports, that in the last five decades an increase in teen suicide coincides with enormous changes in drug use among youth in the United States (2014). Drug abuse is one of those things that can really affect the chemical balance in the brain, intensifying feelings of depression and sadness. Dependency on drugs, both legal and illegal, can lead to feelings of helplessness and hopelessness. The disorienting effects of substance use can cause them to act out in potentially fatal ways. Allowing drug dependencies to continue increases the chances things can snowball into catastrophic mental illnesses. And they often coincide with suicidal thinking or behavior. As of 2014, most individual and small group health insurance plans are required to cover mental health and substance use disorder services. The implementation of federal policies such as the Mental Health Parity and Addiction Equity Act did expand insurance coverage for mental health disorders among U.S. children, but many children and youth with mental health problems still do not receive the services they need (Murphey, Vaughn, Barry, 2013). Adolescents who lack health insurance are less likely to use mental health services than are those who have coverage. Children in the welfare system are less likely to receive needed mental health counseling than those with public insurance. Many adolescents fail to seek treatment due to social stigmas related to mental health disorders or there is a lack of access to mental health services they require. Even among those children and youth who are able to access mental health services, quality of care is often deficient due to an insufficient number of mental health providers. In the 21st century, electronic communication tools, text messaging, email, instant messaging (IM), and social networking websites have become increasingly important to adolescents in maintaining their social networks. Experts report adolescents that indulge in more screen time, five or more hours per day on electronic devices, have a 66 percent higher risk of having “at least one suicide-related outcome” in comparison to teens that indulged in less screen time and engaged in face to face social interaction (Twenge, Joiner, Rodgers, & Martin, 2017). One culprit, cyberbullying is receiving more public attention due to the harm caused to victims that can result in anxiety, depression, violence, and suicide (Carter & Wilson, 2015). Cyberbullying is an indirect form of bullying via electronic media. In an Internet-based pilot study of 571 respondents between the ages of 12 and 20 years researchers found that 29.4% of adolescents reported being victims of online bullying and more than half (56.6%) of the victims disclosed online bullying experiences to their friends but were reluctant to report it to an adult (Carter & Wilson, 2015). Currently, 49 states in the U.S. have enacted anti-bullying laws, while 16 states have anti-bullying laws that include the term cyberbullying or cyber-bullying (Carter & Wilson, 2015). Prevention Strategies Teen suicide is preventable. Suicide may be prevented through strategies that empower individuals, families, and communities, including improving clinical and community preventive services, enhancing treatment and support service, bolstering surveillance, research, and evaluation of existing programs (United Health Foundation, 2016). Federal and state laws can have a major impact on suicide prevention activities. State laws can provide resources for prevention, open doors to collaboration, encourage training, and help increase awareness and knowledge. For example, in 2007 the Jason Flatt Act was passed and mandates youth suicide awareness and prevention training within teacher training. The act requires that all Tennessee educators participate annually in suicide awareness and prevention training in order to maintain their teaching license. Since its passage, 16 other states have adopted this legislation. In March 2015, Jamie’s Law passed by state legislators, specifically requires West Virginia school systems to have detailed suicide awareness and prevention programs. The participation, support, and active involvement of families, schools, communities, healthcare professionals, and policy- makers are essential to the promotion of teen suicide prevention services and programs. References Carter, J. M., & Wilson, F. L. (2015). Cyberbullying: A 21st Century Health Care Phenomenon. Pediatric Nursing, 41(3), 115-125. Dyer, F. J. (2014). Adolescent Substance Abuse and Suicide. Counselor: The Magazine For Addiction Professionals, 15(4), 36-37. Murphey, D., Vaughn, B., & Barry, M. (2013). Adolescent health highlight - Access to mental health care. Retrieved from https://www.childtrends.org/wp- content/uploads/2013/04/Child_Trends-2013_01_01_AHH_MHAccessl.pdf Ohio Department of Health. (2016). Youth suicide in Ohio. Retrieved from https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/health/injury-prevention/Youth- Suicide-in-Ohio---Final.pdf?la=en Twenge, J.M., Joiner, T.E., Rodgers, M.L., & Martin, G.N. (2017). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17. https://doi.org/10.1177/2167702617723376 United Health Foundation. (2016). America’s health rankings – 2016 annual report. Retrieved from https://www.americashealthrankings.org/explore/2016-annual- report/measure/Suicide/state/OH Professor Response to Post: Carole, Very impressive post! Thank you for your passion for addressing the needs of patients with mental health disorders. You have identified many prevention and treatment interventions. What does a comprehensive model for addressing mental health for a community? Any ideal models you can adopt or adapt? I found this: http://www.who.int/mental_health/action_plan_2013/en/ (Links to an external site.)Links to an external site. Your thoughts on this? Thanks, Dr. Fildes Response to Professor: Dr. Fildes, Thank you for the link to the World Health Organization’s Mental Health Action Plan. The action plan focuses on four specific objectives: strengthening leadership in mental health, providing comprehensive mental health and social services in community-based settings, implementing prevention and mental health promotion strategies, and strengthening research, evidence and information systems for mental health (World Health Organization, 2013). The action plan promotes a holistic recovery model instead of the medical model which predominates in many healthcare systems. The plan focuses on using a comprehensive integrated approach to address educational needs, social care needs, employment needs, and housing needs in community-based settings. People with severe mental illness need access to treatment, rehabilitation, and support services within their community. These services can be provided through a variety of social, health, and mental health agencies, each with its own eligibility criteria and application and monitoring processes. Community-based services enable people with mental disorders to maintain family relationships, friendships, and jobs while receiving treatment, which facilitates early treatment and rehabilitation. Nurses are well positioned for leadership in fostering patient engagement, addressing the treatment needs of diverse and underserved populations, driving the treatment process, and reducing the harm of unmet mental health needs. Nurses are leaders and champions for mental health awareness within their countries and communities. If we are better informed on the Mental Health Action Plan and the commitments that the government has made, then we can be more effective in our advocacy and leadership role. Carole B. Reference World Health Organization. (2013). Mental Health Action Plan 2013-2020. Retrieved from http://www.who.int/mental_health/publications/action_plan/en/ Response to Peers: Martha and Amy, Thank you for your informative responses. Today, I read that scientists are discovering that changes in the body leading to mental illness may start much earlier before any symptoms appear. Therefore, helping young children and their parents manage difficulties early in life may prevent the development of disorders. Once mental illness develops, it becomes a regular part of the child's behavior and more difficult to treat. Martha, I do agree there is a lack of resources for child mental health treatment services. According to World Health Organization, "in developed countries, there are problems of maldistribution, a declining enrollment in child psychiatry training programs, and a recent reduction in those working in community settings" (2003). According to an article I read, in the state of Texas for every public-school counselor there are almost 450 students and the American School Counselor Association recommends a ratio of 250 to one (Phillips, 2018). This is an alarming student load for counselors when most of their time can be taken up with academic tasks such as aptitude tests, course recommendations, and any additional duties that principals may request of them. School counselors were once a safety net for identifying and helping troubled children, but their additional responsibilities have them stretched. This is why I advocate for placing other mental health professionals such as social workers and child and adolescent psychiatrists in public schools to help counselors reach out to troubled students and identify early mental health distress. However, the shortage of child and adolescent psychiatrists are profound. There are an estimated one child and adolescent psychiatrist per 1,807 children who need services in the United States (American Academy of Child & Adolescent Psychiatry, 2013). Factors attributing to the shortage include the significant amount of time in training, limited money for fellowships, and child and adolescent psychiatry exclusion from loan forgiveness programs (Associated Press, 2006). Residents that consider a career in child and adolescent psychiatry must complete an extra two-year fellowship in child and adolescent psychiatry along with four years of medical school and four years of general psychiatry. The extra two years of training that delays a career with a paycheck and incurs even more debt. The Balanced Budget Act of 1997 set a limit on the number of federally funded residency slots and cut funding for subspecialties' such as child and adolescent psychiatry (Associated Press, 2006). Recommendations to ease the shortage is shorten the psychiatry program or enable students interested in child psychiatry to begin working with children sooner in their training (Associated Press, 2006). Providing loan repayment and scholarships for all children’s mental health professionals. The American Academy of Child & Adolescent Psychiatry recommends, "Support funding for an Accreditation Council for Graduate Medical Education approved program that would allow pediatricians to complete 36 months of additional training to be eligible for specialty certification in both adult psychiatry and child and adolescent psychiatry" (2016). References American Academy of Child & Adolescent Psychiatry. (2016). Child and adolescent Psychiatry workforce crisis: Solutions to improve early intervention and access to care. Retrieved from https://www.aacap.org/AACAP/Resources_for_Primary_Care/Workforce_Issues.aspx Associated Press. (2006). Shortage of child psychiatrist taking a big toll. Retrieved from http://www.nbcnews.com/id/12190434/ns/health-childrens_health/t/shortage-child- psychiatrists-taking-big-toll/#.WrVsmWeou00 Phillips, C. (2018). Texas schools lack sufficient number of mental health professionals, experts say. Retrieved from https://www.houstonpublicmedia.org/articles/news/2018/03/15/273686/texas-schools- lack-sufficient-number-of-mental-health-professionals-experts-say/ World Health Organization. (2003). Caring for children and adolescents with mental disorders. Setting WHO directions. Retrieved from http://www.who.int/mental_health/media/en/785.pdf Week 4 Summary After this week’s lesson and reading all of the informative discussion thread I’ve learned that nurses bear witness to inadequacies in the health care delivery system and the negative effects that social issues have on their community’s health status. Policy implementation in the political arena relies upon the nurse’s commitment to change. Political objectives alone are inadequate to change practice. Nurses need to be committed with the intent of the policy and they need to value, support, and act on the policy. Timing is also a crucial aspect in politics. For example, if a group of nurses want to introduce legislation supporting prevention of teen suicide, the time to press forward on the issue has created social visibility. [Show More]

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