Optimizing Mental Health in an Academic NurseManaged Clinic
Authors: Sousa Karen H. , Zunkel Gretchen M. 
Published: February 2008

Purpose

To evaluate the initial results of tracking the health outcomes, specifically mental health outcomes, for clients at an academic nursing clinic and to describe an approach to mental health treatment in this setting.

Data Sources

Descriptive‐survey design with convenience sampling of patients from a nurse‐managed, clinic (N= 151). As part of the routine documentation for clinic clients, the Medical Outcomes Study Short‐Form 36–Item Health Survey (SF‐36) was selected to monitor client health outcomes.

Conclusions

This health status evaluation indicated that the mental health scores for clinic clients were lower than national normed data. This result could reflect unmet mental health needs in clinic clients. Mental health reasons for the visit were reported in only 3% of the sample. Most clients in this sample sought treatment in the clinic for physical health screening and episodic health problems.

Implications for Practice

Integration of mental health interventions in primary care settings may help providers to optimize the management of clients' overall health status.

Projections for depressive disorders alone suggest that the burden of illness will increase by at least 50% by 2020. The Global Burden of Disease (GBD) study identified depressive disorders as one of the most important targets for intervention in the 21st century (Uestuen, 2001). Targets include expanding the role of primary care providers in treating depressive disorders and other mental health problems, the role of evidence‐based guidelines in developing care and policy, and education about the fact that relapses and chronicity of depressive disorders can be prevented. Additional measures include workplace prevention programs, consumer involvement, and self‐help techniques. Overall, research must also address the efficacy, effectiveness, and cost‐effectiveness of mental health interventions.

Nurse‐managed clinics are an increasingly important and effective way of delivering primary care in underserved populations, particularly in a managed‐care environment. Improved use of mental health assessment and intervention with an integrated model will improve client health status. Optimizing mental health intervention is a top priority for improved health care outcomes.

Our data indicate that undetected mental health problems are present in our clinic population. Identifying this unmet need is the first step to improving patient outcomes. Alerting NPs to the presence of potential mental health disorders in the clinic will increase their awareness of these health concerns. Providing on‐site consultation with a psychiatric CNS will facilitate the process of consultation for the primary care providers.

This endeavor began for the purpose of tracking health outcomes in an academic nurse‐managed clinic and evolved into providing NPs with strategies for improving the mental health care of the clinic population. Clinic personnel will continue to track outcomes to see if there is improvement in the mental health of the clients at this clinic after implementing an integrated model of care.