A patient diagnosed with serious mental illness was living successfully in a group home but wanted an apartment. The prospective landlord said, "People like you have trouble getting along and paying their rent."
The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? Select all that apply.
a. Coach the patient in ways to control symptoms effectively.
b. Seek out landlords less affected by the stigma associated with mental illness.
c. Threaten the landlord with legal action because of the discriminatory actions.
d. Encourage the patient to remain in the group home until the illness is less obvious.
e. Suggest that the patient list a false current address in the rental application.
f. Have the case manager meet with the landlord to provide education about mental illness.
ANS: A, B, F
Managing symptoms so that they are less obvious or socially disruptive can reduce negative reactions and reduce rejection due to stigma. Seeking a more receptive landlord might be the most expeditious route to housing for this patient. Educating the landlord to reduce stigma might make him more receptive and give the case manager an opportunity to address some of his concerns (e.g., the case manager could arrange a payee to assure that the rent is paid each month). However, threatening a lawsuit would increase the landlord's defensiveness and would likely be a long and expensive undertaking. Delaying the patient's efforts to become more independent is not clinically necessary according to the data noted here; the problem is the landlord's bias and response, not the patient's illness. It would be unethical to encourage falsification and poor role modeling to do so; further, if falsification is discovered, it could permit the landlord to refuse or cancel her lease. See related audience response question.
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