Chapter 1: Me, Meds, Milieu

1 PSYCHOTHERAPEUTIC MANAGEMENT

Use of words
Use of drugs
Use of environment
Somatic therapies
Behavioral conditioning

2 MILIEU MANAGEMENT

Safety: keeping the patient free from danger or harm

Structure: they physical environment, regulations, and schedules
Norms: specific expectations of behavior
Limit setting: clear and enforceable limitations on behaviors
Balance: negotiating the line between dependence and independence
Environmental modification: changing the environment to promote mental
health

3 CONTINUUM OF CARE

Suspected mental problem

Problem confirmation
Risk Assessment:
o Danger to self or others
o Gravely disabled
o Acutely psychotic
o Suicidal or homicidal
Hospital or community based care

3.1 HOSPITAL BASED CARE

Length of stay 3-5 days

Goals: crisis intervention and safety
Discharge planning begins immediately

3.2 RESIDENTIAL SERVICES

Help people who need temporary or long term housing

3.2.1 Extended Care Facilities

People who require 24 hour supervision, medical care, and nursing care

For people with dementia, acute and chronic mental illnesses

3.2.2

Group Homes
Temporary or permanent housing for people with chronic mental disorders
Staff may be there 24 hours or less
Schedule activities or laundry
Meals and beds

3.2.3

Halfway Homes
People recovering from chemical dependency
Residents expected to seek employment, participate in cooking, and cleaning
Attend self-help groups

3.2.4

Apartment Living Programs

Varying degrees of supervision and programs
Staff on a daily basis for group sessions
Visit periodically for medication assistance

3.2.5 Foster Care and Boarding Homes

Staffed by nonprofessionals with professional supervision on an intermittent
basis
3.2.6 Shelters
Provide room and board to homeless people

3.3 TRADITIONAL OUTPATIENT SERVICES

Clinics and private offices

Number of visits per week or month

3.4 DAY TREATMENT PROGRAMS

People who need minimal supervision, structured activities, and ongoing

treatment
May be 4-8 hours a day and 1-5 days a week
Can be day, evening, or night
Might provide treatment for specific people based on age or type of problem

3.5 SELF-HELP GROUPS

Meetings conducted by members and may be weekly basis

3.6 OTHER OUTPATIENT PROGRAMS

3.6.1 Psychiatric Home Care
Provides mental health services to people who are homebound due to their
illness or disability

3.6.2 Community Outreach Programs

Reach people where theres a lack of traditional medical and social services
3.6.3 Mobile Crisis Teams
Seek to reach people who are homeless or transient
3.6.4 Assertive Community Treatment
Mobilizes interprofessional teams responsible for providing services 24/7
Can go anywhere and provide mental health care or services such as helping
with shopping, laundry, or transportation

3.7 PRIMARY CARE

People with mental health problems like anxiety and depression seek help in
primary care offices and clinics due to
o Stigma of mental health care
o Lack of knowledge about who to see
o Reduced access to care