“Our Most Vulnerable Clients…”

Article Outline

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One in 17 Americans suffers from a serious mental illness. For persons who are diagnosed with a serious and persistent mental illness (SPMI), the consequences are grave and effective treatments have been elusive. For psychiatric nurses who care for these patients, either during an acute crisis or in a community setting, the challenges of finding an intervention that works can test the commitment and the staying power of even the most dedicated nurse. The health problems of these patients are made even more complex by the deleterious effect of the treatment themselves: weight gain, metabolic syndrome, diabetes, and cardiovascular effects. Some problems may quite frankly be due to neglect by a health care system: shorter life span resulting from neglected needs for primary health and preventive care. Depression and suicide are also significant concerns.

Despite the severity and urgency of these problems for patients with serious mental illnesses, there is surprisingly little nursing research that focuses on interventions for the seriously mentally ill population. This is the challenge: more psychiatric nurse researchers who will provide leadership in intervention research with this very ill and often neglected group of patients are needed. We need expert clinicians and advanced practice nurses who will document the work that they do with seriously mentally ill patients, and we need nurse researchers who will partner with them to conduct the clinical trials of the outcomes of those interventions in clinical settings.

Nurses are in an ideal position to develop and test interventions that not only improve client self-care but also provide patients with skills for coping with symptoms, for managing their medications, and for becoming engaged in treatment partnerships. Cognitive interventions are showing some promise as are new and innovative ways to support patients in the community, such as transitional models of care for patients being discharged from inpatient settings. The revolving door syndrome should be a focal point for nurses who are so well positioned to break the cycle for our most severely ill clients.

What are the challenges? We need to be diligent in recognizing SPMI early and in devising early interventions. We need to understand cultural differences in symptom presentation and acceptability of treatment approaches to an increasingly diverse population. Disparities continue to exist in mental health care, especially in the realm of SPMI. Care for these clients tends to be minimal, fragmented, and episodic. Family interventions that benefit the patient as well are seriously lacking. We are making progress in all of these areas, but still most patients with SPMI are likely to suffer lifelong impairment, deteriorating physical health, and a reduced life span. Future research that focuses on these issues for patients with SPMI holds promise for alleviating the burden to patients, families, and society by reducing length of stay, reducing the risk of relapse, and increasing patients' capacities to cope with their illness.

Thus, this special issue, focusing on seriously and persistently mentally ill patients, was conceived. It is a revisit, if you will, to the roots of psychiatric nursing, to the need to examine what we are doing or not doing to meet the needs of our most vulnerable and often most challenging clients. It is a call to the psychiatric nurses who are doing excellent work with these clients to write about it, to share your successes with your colleagues in journals such as this one. It is also a challenge to researchers to focus their efforts on ways to improve care for patients with schizophrenia, major depression, and other serious mental illnesses.

Major breakthroughs are occurring everyday in pharmacological and genetic research in the field of serious mental illnesses. We are forever hopeful that the definitive medication or the one gene that will help us cure these devastating illnesses will be discovered, but for the moment, that seems unlikely. The task of psychiatric nurse clinicians and researchers therefore is increasingly important in helping patients manage their illnesses and achieve a meaningful quality of life. This is our charge, and I hope that the articles in this issue inspire readers to join in the task.