The young chronic client in mental health today

Due to the nature of the work with this demanding population, who, in spite of all efforts, demonstrates only minimal changes at best, nurses need aggressive management of their own lives. Burnout is rampant. Work with this type of client is not for everyone. Programs need to offer staff the opportunity to work with these clients only if the staff is capable and desires the challenge. It is necessary to set realistic goals and expectations with clients and to learn to accept tiny changes. Nurses must help the client become more realistic in their expectations of what will be achieved. It is important to note that the therapist may scare the client into regressed behavior by being too hopeful, by pushing them too far too fast, and by allowing them to go too fast. Caution should be taken with respect to encouragement and expectations of normalcy. If goals are too high and the client "fails," the therapist perceives that he/she is the one who failed. The patient who manages to achieve a level of functioning that enables him to interface with the outside often finds a world that is cold, demanding, and cruel--one that is easier to escape from than to deal with. One must be flexible and accessible to the client--involved with honest detachment. For the nurse therapist to serve this population requires sophistication in the theories of child and adolescent suicide, crisis intervention, aggression management, chemical abuse and use, and the ability to negotiate housing, money, food, services--things which have previously been the domain of others.(ABSTRACT TRUNCATED AT 250 WORDS)