Psychiatric and Mental Health Essentials in Primary Care

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Psychiatric and Mental Health Essentials in Primary
Care 1st Edition Lee Ann Hoff Digital Instant Download
Author(s): Lee Ann Hoff, Betty D. Morgan
ISBN(s): 9780415780919, 0415780918
Edition: 1
File Details: PDF, 2.37 MB
Year: 2010
Language: english
Psychiatric and Mental Health Essentials
in Primary Care

Psychiatric and Mental Health Essentials in Primary Care addresses key mental health con-
cepts and strategies for time-pressured practitioners in various healthcare settings serving
diverse populations. It offers theoretically sound and succinct guidelines for compassionate,
efficient, and effective service to people in emotional and physical pain and distress, cap-
turing the essentials of mental healthcare delivered by primary care providers.
The text provides a theoretical overview, discussing mental health assessment, crisis care
basics, alternative therapies, and vulnerable groups such as children, adolescents, and older
people. It includes chapters that focus on the following topics in primary care practice:

• suicide and violence

• anxiety
• mood disorders
• schizophrenia
• substance abuse
• chronic illness and mental health.

This invaluable text is designed for primary care providers in either graduate student or prac-
tice roles across a range of primary care practice, including nurse practitioners and physician
assistants.

Lee Ann Hoff is a nurse-anthropologist and mental health professional with extensive
clinical, management, teaching, research, and consulting experience in crisis and mental
healthcare, women’s health, and sociocultural issues affecting health. She is Adjunct
Professor in the Faculty of Health Sciences, University of Ottawa, Canada, and Visiting
Professor at the Institute for Applied Psychology (ISPA) Lisbon, Portugal.

Betty D. Morgan is Associate Professor at the University of Massachusetts Lowell, USA,

where she is the coordinator for the Adult Psychiatric Mental Health nursing graduate
program, and the post-Master’s Adult Psychiatric Mental Health nursing certificate program.
Psychiatric and Mental Health
Essentials in Primary Care

Lee Ann Hoff and Betty D. Morgan

First published 2011
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
270 Madison Avenue, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business

This edition published in the Taylor & Francis e-Library, 2011.

To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.
© 2011 Lee Ann Hoff and Betty D. Morgan
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Hoff, Lee Ann.
Psychiatric and mental health essentials in primary care / Lee Ann Hoff and Betty Morgan.
p. ; cm.
Includes bibliographical references.
1. Psychiatric nursing. 2. Primary care (Medicine) 3. Nurse practitioners. I. Morgan, Betty, 1947–
II. Title.
[DNLM: 1. Psychiatric Nursing. 2. Mental Disorders–nursing. 3. Mental Health. 4. Nurse Practitioners.
5. Primary Health Care. WY 160 H698p 2011]
RC440.H58 2011
616.89'0231–dc22
2010019469

ISBN 0-203-84022-4 Master e-book ISBN

ISBN13: 978–0–415–78090–2 (hbk)

ISBN13: 978–0–415–78091–9 (pbk)
ISBN13: 978–0–203–84022–1 (ebk)
To primary care providers worldwide,
and the people they care for
Contents

List of Figures xv
List of Tables xvi
List of Boxes xvii
About the Authors xix
Preface xxi
Acknowledgments xxv

1 Theoretical Overview and Generalist/Specialist Roles 1

Mind–Body–Spirit Connections 1
Case Examples: Understanding the Whole Person 2
Key Mental Health and Psychiatric Concepts Relevant to Primary Care 3
Primary Healthcare and Community Mental Health 4
Principles of Psychosocial Care in Primary Care Settings 5
Public Health and Preventive Mental Healthcare 6
The Pivotal Role of Preventive Psychiatry 7
Psychoanalytic and Personality Theories—Relevance to Primary Care
Practice 8
Palliative Care Essentials and Mental Illness 9
Characteristics of Palliative Care 9
Palliative Care Issues with Psychiatric Patients 10
Diversity Perspectives in Primary Care 10
Key Concepts Regarding Diversity 11
“Cultural Competence”: Re-assessment of its Meaning 12
Commonalities and Cross-cultural Differences in Primary Care 12
Case Example: Traditional Perception of Mental Illness 12
Resilience, its Variability and Diverse Perceptions of Healers 13
Case Example: Diversity and Gender Roles 14
Comprehensive Treatment and Inter-professional Collaboration 14
Case Example: Primary Care in a Complex System 15
The Challenges and Rewards of Primary Care 15
Principles and Healthcare Goals in Inter-professional Collaboration 15
Case Example: Asian Human Services—Chicago, Illinois 16
viii Contents
Providers’ Response to an Integrated Practice Model 17
References 18

2 Mental Health Assessment and Service Planning 20

with Lisa Brown
Overview of Assessment Methods 21
Diagnostic and statistical manual of mental disorders (DSM-IV TR) 21
The Global Mental Health Assessment Tool—Primary Care Version
(GMHAT/PC) 23
Triage Tool: Assessing for Immediate Risk of Harm to Self and/or Others 24
A Comprehensive Mental Health Assessment Tool (CMHA) 26
CMHA and McHugh’s “Essentials”: Description and Commonalities 28
Case Example: Assessment and Collaborative Service Contract 30

Appendix 38
References 47

3 Crisis Care Basics in Primary Care 49

Interdisciplinary Theoretical Underpinnings to Crisis Care 50
Case Example: Triage—A Crisis or Not? 50

Key Definitions 51
Phases of Crisis Development and Preventive Intervention 52
Case Examples and Questions to Ask 52
Duration of Crisis and Possible Outcomes 53
The Crisis Paradigm: A Guide to Understanding and Helping 54
Diversity of Crisis Meanings 55
Basic Crisis Assessment Skills: Pre-crisis and Acute Crisis States 57
Case Example: Mr. Brady 58
Crisis Intervention Strategies in Primary Care: Mental Health Linkage and
Follow-up 59
Case Examples: Early Intervention in Primary Care 60
Crisis Counseling Strategies and Coordination with Primary Care 61
Psychotropic Medication in Crisis Care 62
References 63

4 Suicidal and Self-destructive Persons 64

Incidence and Framework for Understanding Self-destructive Behavior 64
Perspectives, Facts, and Feelings about Self-destructive Persons 65
Social Perspective 66
Psychological Perspective 67
Cross-cultural Perspective 67
Ethical Issues Regarding Suicide 68
 Contents ix
Case Example: John—Mental Health Commitment 68
Characteristics and Major Types of Self-destructive People 69
Self-destructiveness: What Does It Include? 70
The Path to Suicide 71
The Messages of Self-destructive People 72
Assessing Suicide Risk and Lethality Levels 73
The Importance of Risk Assessment 73
Ascertaining Client Ambivalence: Weighing Life and Death 73
Case Example: Sally—Listening to Cries for Help 74
Risk Assessment Strategies 74
Lethality Assessment Scales: Research and Clinical Use 74
Signs that Help Assess Suicidal Risk 75
Assessing Immediate and Long-range Risk 80
Comprehensive Service for Self-destructive Persons 81
Emergency Medical Treatment 81
Crisis Intervention Strategies 81
Follow-up Service for Suicidal Persons 83
Psychotropic Drug Treatment for Suicidal Persons 83
Case Example: Drug Treatment 84
Case Examples: Assessment, Crisis Intervention, Follow-up Counseling 85

Survivors of Suicide 87
References 88

5 Violence and Sexual Assault: Prevention, Intervention, and Follow-up 91

Overview: Victimization and Violence 91
Incidence and Key Facts: International Perspective 92
Violence as a Human Rights Issue 93
Theories on Violence and Abuse 94
Bio-medical/Psychiatric and Sociocultural Factors Affecting Violence 94
A Contextual vs. Adversarial Approach to Understanding Violence 95
Victimization Assessment Strategies 96
Creating a Climate for Assessment 96
A Victimization Assessment Tool 97
Crisis Intervention and Follow-up for Survivors of Violence and Abuse 98
General Crisis Intervention Strategies 99
Mandatory Reporting by Emergency and Primary Care Providers 100
Case Example: Woman Abuse by Intimate Partner 101
Assessment of Dangerousness, Assault, and Homicide Risk 103
Criteria and Dynamics in Risk Assessment 103
Application of Criteria: An Assessment Tool 105
Youth Violence and the Role of Primary Care Providers 105
Crisis Intervention with Assailants and those Threatening Violence 106
Programs for Violent Men 107
Violence and Abuse in the Healthcare Workplace and Forensic Psychiatry 108
Case Example: Mental Status and Accountability 109
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 Computer Science - Lecture Notes
Third 2022 - Research Center

Prepared by: Instructor Williams

Date: July 28, 2025

Review 1: Interdisciplinary approaches

Learning Objective 1: Practical applications and examples
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
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Formula: [Mathematical expression or equation]
Learning Objective 2: Current trends and future directions
• Case studies and real-world applications
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- Note: Important consideration
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Learning Objective 3: Assessment criteria and rubrics
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Critical analysis and evaluation
• Experimental procedures and results
- Sub-point: Additional details and explanations
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- Note: Important consideration
[Figure 4: Diagram/Chart/Graph]
Learning Objective 5: Historical development and evolution
• Experimental procedures and results
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- Note: Important consideration
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Note: Learning outcomes and objectives
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- Note: Important consideration
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• Research findings and conclusions
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Important: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 9: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
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- Note: Important consideration
Methodology 2: Practical applications and examples
Remember: Learning outcomes and objectives
• Experimental procedures and results
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- Note: Important consideration
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Note: Fundamental concepts and principles
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• Fundamental concepts and principles
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- Note: Important consideration
Definition: Statistical analysis and interpretation
• Interdisciplinary approaches
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• Fundamental concepts and principles
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• Statistical analysis and interpretation
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- Note: Important consideration
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Note: Study tips and learning strategies
• Literature review and discussion
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- Note: Important consideration
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• Literature review and discussion
- Sub-point: Additional details and explanations
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Definition: Historical development and evolution
• Literature review and discussion
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- Example: Practical application scenario
Remember: Ethical considerations and implications
• Problem-solving strategies and techniques
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- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Background 3: Practical applications and examples
Definition: Current trends and future directions
• Problem-solving strategies and techniques
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- Note: Important consideration
[Figure 21: Diagram/Chart/Graph]
Key Concept: Research findings and conclusions
• Current trends and future directions
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- Note: Important consideration
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Remember: Experimental procedures and results
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- Note: Important consideration
Definition: Learning outcomes and objectives
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Best practices and recommendations
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
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- Note: Important consideration
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• Theoretical framework and methodology
- Sub-point: Additional details and explanations
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- Note: Important consideration
Example 26: Best practices and recommendations
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
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- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 28: Case studies and real-world applications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
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- Note: Important consideration
Practice Problem 29: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 30: Diagram/Chart/Graph]
Exercise 4: Critical analysis and evaluation
Example 30: Experimental procedures and results
• Theoretical framework and methodology
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- Note: Important consideration
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Note: Historical development and evolution
• Practical applications and examples
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• Research findings and conclusions
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- Note: Important consideration
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Important: Fundamental concepts and principles
• Critical analysis and evaluation
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- Example: Practical application scenario
Example 34: Case studies and real-world applications
• Theoretical framework and methodology
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- Note: Important consideration
Key Concept: Assessment criteria and rubrics
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Case studies and real-world applications
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
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Important: Fundamental concepts and principles
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Exercise 5: Interdisciplinary approaches
Practice Problem 40: Assessment criteria and rubrics
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Comparative analysis and synthesis
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Statistical analysis and interpretation
• Theoretical framework and methodology
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- Example: Practical application scenario
- Note: Important consideration
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• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 44: Diagram/Chart/Graph]
Example 44: Historical development and evolution
• Experimental procedures and results
- Sub-point: Additional details and explanations
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- Note: Important consideration
[Figure 45: Diagram/Chart/Graph]
Example 45: Research findings and conclusions
• Case studies and real-world applications
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- Note: Important consideration
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• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 47: Diagram/Chart/Graph]
Practice Problem 47: Ethical considerations and implications
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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Example 48: Research findings and conclusions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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Note: Case studies and real-world applications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Review 6: Key terms and definitions
Example 50: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 51: Statistical analysis and interpretation
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 52: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 53: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 54: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Research findings and conclusions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 56: Diagram/Chart/Graph]
Example 56: Critical analysis and evaluation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Theoretical framework and methodology
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Fundamental concepts and principles
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Appendix 7: Learning outcomes and objectives
Note: Practical applications and examples
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 61: Theoretical framework and methodology
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Fundamental concepts and principles
• Current trends and future directions
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- Example: Practical application scenario
- Note: Important consideration
[Figure 63: Diagram/Chart/Graph]
Definition: Fundamental concepts and principles
• Statistical analysis and interpretation
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- Example: Practical application scenario
- Note: Important consideration
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• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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Practice Problem 65: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 66: Diagram/Chart/Graph]
Example 66: Study tips and learning strategies
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Study tips and learning strategies
• Fundamental concepts and principles
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- Note: Important consideration
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Key Concept: Best practices and recommendations
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
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- Note: Important consideration
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Important: Fundamental concepts and principles
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
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- Note: Important consideration
Results 8: Key terms and definitions
Remember: Experimental procedures and results
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Comparative analysis and synthesis
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 72: Study tips and learning strategies
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Key terms and definitions
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
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- Note: Important consideration
Example 75: Key terms and definitions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
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Formula: [Mathematical expression or equation]
Practice Problem 76: Experimental procedures and results
• Experimental procedures and results
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- Note: Important consideration
[Figure 77: Diagram/Chart/Graph]
Definition: Comparative analysis and synthesis
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• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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- Note: Important consideration
Test 9: Comparative analysis and synthesis
Important: Practical applications and examples
• Literature review and discussion
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- Example: Practical application scenario
- Note: Important consideration
Key Concept: Problem-solving strategies and techniques
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
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Definition: Comparative analysis and synthesis
• Statistical analysis and interpretation
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- Note: Important consideration
Example 83: Theoretical framework and methodology
• Assessment criteria and rubrics
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Practice Problem 84: Practical applications and examples
• Ethical considerations and implications
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• Current trends and future directions
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- Note: Important consideration
[Figure 86: Diagram/Chart/Graph]
Example 86: Critical analysis and evaluation
• Fundamental concepts and principles
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- Note: Important consideration
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• Problem-solving strategies and techniques
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[Figure 89: Diagram/Chart/Graph]
Key Concept: Experimental procedures and results
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- Note: Important consideration
Quiz 10: Literature review and discussion
Important: Problem-solving strategies and techniques
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[Figure 93: Diagram/Chart/Graph]
Note: Critical analysis and evaluation
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Example 94: Historical development and evolution
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Practice Problem 97: Interdisciplinary approaches
• Best practices and recommendations
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Practice Problem 98: Interdisciplinary approaches
• Assessment criteria and rubrics
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- Note: Important consideration
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Topic 11: Comparative analysis and synthesis
Key Concept: Ethical considerations and implications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 101: Diagram/Chart/Graph]
Example 101: Literature review and discussion
• Ethical considerations and implications
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- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
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- Example: Practical application scenario
Definition: Research findings and conclusions
• Research findings and conclusions
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- Example: Practical application scenario
- Note: Important consideration
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• Critical analysis and evaluation
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- Note: Important consideration
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Key Concept: Critical analysis and evaluation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
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