For patients diagnosed with serious mental illness, what is the ...

[Hungry!]

For patients diagnosed with serious mental illness, what is the major advantage of case management?
 
  a. The case manager can modify traditional psychotherapy.
  b. With one coordinator of services, resources can be more efficiently used.
  c. The case manager can focus on social skills training and esteem building.
  d. Case managers bring groups of patients together to discuss common problems.

Question 2

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? Select all that apply.
 
  a. Maintain stable and consistent staff.
  b. Increase the length of medication education groups.
  c. Stress that without treatment, illnesses will worsen.
  d. Prescribe drugs in smaller but more frequent dosages.
  e. Make it easier to access prescribers and pay for drugs.
  f. Require adherence in order to participate in programming.

[Liddy]

Answer to Question 1

ANS: B
The case manager coordinates the care and multiple referrals that so often confuse the seriously mentally ill patient and the patient's family. Case management promotes efficient use of services. The other options are lesser advantages or are irrelevant.

Answer to Question 2

ANS: A, E
Trust in one's providers is a key factor in treatment adherence, and mentally ill persons can sometimes take a very long time to develop such trust; therefore, interventions which stabilize staffing allow patients to have more time with staff to develop these bonds. Ready access to prescribers allows medicine-related concerns to be addressed quickly, reducing obstacles to adherence such as side effects or ineffective dosages. Medication costs can be obstacles to adherence as well. Many SMI patients have anosognosia and do not adhere to treatment because they believe they are not ill, so telling them nonadherence will worsen an illness they do not believe they have is unlikely to be helpful. Increasing medication education is helpful only when the cause of nonadherence is a knowledge deficit. Other issues that reduce adherence, particularly anosognosia and side effects, are seldom helped by longer medication education. Requiring medication adherence to participate in other programs is coercive and unethical. Smaller, more frequent doses do not reduce side effects and make the regimen more difficult for the patient to remember.