Eliminating Abuse of People with Mental Illness in Group Homes

By: Beatrice Cabrera, MSN, APRN-BC, FPMHNPEliminating Abuse of People with Mental Illness in Group HomesEffects of Mental Illnessability / manner of thinking and behavingability to protect self interestsability to make own decisionsability to attain what they needhigh risk of having civil, political, economic, social, and/or cultural rights violated (WHO, 2003)Financial / Housing Challengesaverage of 1/3 less money in a year compared to people without a mental illness (Levison, et al., 2010)lack of funds for safe housingcommunity resistance for housing for the mentally ill (Finkler & Grant, 2011)stigma & discrimination lead to worst living conditions legislation does not guarantee protection of rights of people with mental illnesses in group homes (WHO, 2003)Residential Careany place that provides residential social and personal care for any of the following: children, the aged, and special categories of people that have diminished ability for self-care (such as people with mental illnesses)medical care is not a major element (United States Department of Labor, 2008)Times of Institutionalizationbefore 1950speople with mental disabilities were deliberately separated from society in isolated psychiatric institutionsmain reason: fear of and social stigma associated with disabilities (Riley, 2011)Deinstitutionalizationduring 1950ssociety recognized poor conditions & inhumane treatmentsociety to provide housing to allow for increased autonomy, privacy, individualized treatment, and not be segregated from societystates downsized public institutionsfrom 1955 to 1994, number of people in institutions decreased by about eightfold (Riley, 2011)Rise of Private Group Homesgoal: provide community-based places to live and provide treatment for individuals with mental disabilities (Riley, 2011)cutting edge effect of deinstitutionalization for many years (Stawar, 2010)problem: many operate under abusive conditions (Riley, 2011)Examples -- Abusein England and Wales: male staff taking a picture of a female patient using his cell phone while the patient was naked in the bathrooma patient being restrained by three staff members by holding a towel across his moutha staff member dismissing a female patients complaints of sexual abuse from male patients without investigation (Allen, 2008)Example -- Negligencein Atlanta, Georgia one person wandered streets dailyparents paid over $25,000 to a group home thinking he was receiving psychotherapy, 1:1 support, and other servicesactually was being dropped off at homeless shelters because he had failed to follow rules of group home (Willmsen, 2012)Example -- Exploitation in New York City, residents with mental illnesses in an adult home were having unnecessary surgery performed on themophthalmologist surgeon billed government thousandsresidents had never complained about vision or eye problems prior to surgeries (Levy, 2002)Example -- Sardine Treatmentin La Mesa, California, treatment clinic was opened with 5 homes nearbycompany filled homes with people with schizophrenia, bipolar disorder, and drug addictions or other mental illnessescompany charged $100,000 a yearnearby residents complained about inadequate careowners said treatments were done at the clinicsaid no professional, licensed staff needed at homes because no treatment being done there (Willmsen, 2012)Example -- Safety Violationsin San Antonio, TX 4 men with mental illnesses died in a fire in an unregulated group homeonly years earlier, TX officials had proof of owner neglecting clients and breached health and safety codesin 2010 TX removed any licensing requirements for group homes such as this (Willmsen, 2012)Regulation of Group Homes Neededdirector of NAMI for policy and legal affairs says without regulation mandating licensure theres no way to independently determine if they provide quality care (Willmsen, 2012)HB 1168 in TX (not enforced): regulation of boarding homes (Stoeltje, 2012)no precedent to draw from in any state that has been effective and can be used as an example (Stoeltje, 2012)Interdisciplinary Planfederal government will require via legislation licensure and regulation of group homes; a person who is trained in mental illnesses such as a psychiatric NP, an RNC, or a psychiatrist must be responsible for overseeing care of people in group homesstate governments will establish committees to make regular on-site visits to group homes to ensure safety, ethical, and health codes being followedgroup home owners will keep homes current on health safety certifications and licensure (as done with hospitals and clinics)Interdisciplinary Plan (cont.)group home owners will employ an LVN/RN at least part-time in group homenurse will oversee medication administration, clients visits to providers, medical recordsstaff of group homes will be trained in CPR/First Aidstaff of group homes will monitor clients in group homes for any health problems, altercations, needed assistance with ADLs and report to nurseInterdisciplinary Plan (cont.)nurse will ensure clients have routine office visits to nearest provider who will manage psychotropic medicationsNP or psychiatrist will manage medications for clients in group homeclients and families of clients will have opportunity to attend regular council meetings to voice any concerns regarding care of clientsCompetencies for DNPthis population cannot make informed choices themselves about where they live, who they live with, or how they are supported to live their life (Fyson, 2010)facilitate empowerment by ensuring healthcare workers are aware of legislation that affects them, by advocating for rights of people with mental illnesses, by advocating for organizations to be more receptive to client needsprovide ongoing support from research findings for need for regulation of group homes (Stanhope & Lancaster, 2012)Competencies for DNP (cont.)DNP needs to have critical thinking skillsmust first assess current laws pertaining to group homes in his/her area, identify stakeholders involved in advocating for legislation, collaborate with stakeholders in executing plan for legislation and how it will be carried out in statesrecognize need and develop plans for communities to be educated on mental illnesses and how to support community programs for this population (Stanhope & Lancaster, 2012)Competencies for DNP (cont.)DNP will need to employ decision making skills to decide on steps toward establishing legislation regarding group homeswill need to assist in problem solving as various team members in interdisciplinary plan may run into obstacles (Stanhope & Lancaster, 2012)Evaluation of Planturn each step in interdisciplinary plan into a questionIs regulation of group homes mandated?Can group home owner procure evidence of on-site visits from state agencies? (can be a notebook containing survey results)Is each team member in group home (owner, nurse, staff) carrying out his/her role as said in interdisciplinary plan?Evaluation of Plan (cont.)Is there evidence in medical records of clients that client is being seen regularly by an NP or psychiatrist for medication management? (may be progress notes of providers)Is there evidence of clients and clients families having regular council meetings? (may be a notebook with minutes of meetings)ReferencesAllen, D. (2008). Compassion and care overshadowed by abuse: the mental health act commission reports that despite improvements, there remain too many incidents of abusive and negligent care. Mental Health Practice, 11(7), 8Finkler, L. & Grant, J. (2011). Minimum separation distance bylaws for group homes: the negative side of planning regulation. Canadian Journal of Urban Research, 20(1), 33-56ReferencesFyson, R. (2010). Group homes for people with intellectual disabilities: encouraging inclusion and participation. British Journal of Social Work, 40(7), 2350-2352Levinson, D., et. al. (2010). Associations of serious mental illness with earnings: results from the WHO World mental health surveys. The British Journal of Psychiatry, 197, 114-121. doi: 10.1192/bjp/bp.109.073635ReferencesLevy, C. (2002). Voiceless, defenseless and a source of cash. New York Times, 151(52104), 1Riley, G. (2011). The pursuit of integrated living in Fair housing Act as a sword for mentally disabled adults residing in group homes. Columbia Journal of Law and Social Problems, 45(2), 177-224ReferencesStanhope, M. & Lancaster, J. (2012). Public Health Nursing: Population-Centered Health Care in the Community. Maryland Heights, MO: ElsevierStawar, T. (2010). The war against group homes and day treatment. Behavioral Healthcare, 30(7), 37ReferencesStoeltje, M. (2012). People with mental illness alone get little housing help. San Antonio Express NewsU.S. Department of Labor. (2008). Fact sheet #33: residential care facilities (group homes) under the fail labor standards act. Retrieved from http://www.dol.gov/whd/regs/compliance/whdfs33.pdf

ReferencesWillmsen, C. (2012). High-cost home puts mentally ill client in shelter. The Seattle News. Retrieved from: http://seattletimes.com/html/localnews/2019234919_mentally_ill_homes23.htmlWorld Health Organization. (2003). Mental Health Legislation and Human Rights. Retrieved from http://www.who.int/mental_health/policy/services/7_legislation%20HR_WEB_07.pdf