During the 1960s and 1970s, there was a movement to move mental health treatment from primarily inpatient to primarily outpatient community mental health centres. Between 1965 and 1995, nearly 700,000 patients were discharged or diverted from state hospitals to community mental health resources. Community psychiatric nurses work with mentally ill individuals who live in the wider community as well as with the wider community to educate and assist in the treatment and integration of the mentally ill.
Community psychiatric nurses work primarily with severely mentally ill patients in various community settings, including partial hospitalisation, day treatment centres, mobile treatment units, psychiatric home care and community mental health centres. The term severely mentally ill describes patients with schizophrenia, major affective disorders like depression and bipolar disorders, and organic disorders arising from trauma or substance abuse.
Scope of Practice and Qualifications
There are two basic levels of mental health nursing, basic and advanced. At the basic level, the registered nurse has completed a nursing program and holds a valid RN license. In the community mental health setting, they are staff nurses, case managers and nurse managers. Advanced practice registered nurses in psychiatric mental health (APRN-PMH) have both a valid RN license and at least a master's degree. They assess, diagnose and treat mentally ill patients and their families. They conduct individual and group therapy. Certification in psychiatric nursing is available at all levels from the American Nurses Credentialing Center.
Community psychiatric nurses may work as case managers. Case managers assess the needs of the patient, compile a care plan, connect the client with needed services and monitor delivered services for quality and appropriateness. They also act as advocates for the mentally ill.
For community integration to be successful, it is necessary to educate patient, family and community. The nurse educates on the facts of the illness, medication issues, necessary communication and relational skills, drug and alcohol prevention, stress management and any other issues that may arise as the patient lives in the community.
Community psychiatric nurses also provide crisis intervention services such as suicide prevention, facilitating emergency hospital admissions for mental health issues as diverse as drug and alcohol treatment, medication stabilisation, suicidal behaviour and co-morbid conditions such as diabetes.
It is possible to specialise within community psychiatric nursing. Specialities include substance abuse, child and adolescent mental health nursing and geriatrics, among others. Some community psychiatric nurses with advanced degrees also act as community consultants and liaisons.