Mental health nursing Unit 1 Introduction

Definitions of mental health Karl Menninger (1947) defines mental health as “an adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness”. The APA(1980) defines mental Health as “Simultaneous success at working, loving and creating with the capacity for mature & flexible resolution of conflicts between instincts, conscience, important other people & reality”.

Components of mental health The ability to accept self : feels comfortable, reasonably secure and adequately accepts his shortcomings Self respect The capacity to feel right towards others: Sincerely interested in other’s welfare Friendships are satisfying & lasting He feel part of a group He takes responsibility for his neighbors & his fellow members

The ability to fulfill life’s tasks: Able to think for himself, set reasonable goals & take his own decision He does something about problems Bowled over by his own emotions

Criteria for mental health Adequate contact with reality Control of thoughts and imagination Efficiency in work and play Social acceptance Positive self concept A healthy emotional life

Indicators of mental health Jahoda (1958) – 6 indicators: A positive attitude towards self Growth, development and ability for self actualization Integration Autonomy Perception of reality Environmental mastery

Characteristics of a mentally healthy person Ability to make adjustments Sense of personal worth, feels worthwhile & important Solves his problem largely by his own efforts & makes his own decisions Sense of personal security & fell secure in a group Shows understanding of other people’s problems & motives Has a sense of responsibility

He can give & accept love Lives in a world of reality rather than fantasy Shows emotional maturity in his behavior, & develops a capacity to tolerate frustration & disappointments in his daily life Developed a philosophy of life that gives meaning & purpose to his daily activities Has a variety of interest & generally lives a well balanced life of work, rest, recreation.

Mental illness Maladjustment in living Produces disharmony in the person’s ability to meet human needs comfortably / effectively & function with in a culture. In general an individual may be considered to be mentally ill if: The person’s behavior is causing distress & suffering to self & others The person’s behavior is causing disturbances in his day – to- day activities, job & interpersonal relationships

Definition mental illness WHO, 2001, “mental & behavioral disorders are understood as clinically significant conditions characterized by alterations in thinking, mood (emotions) or behavior associated with personal distress and/ impaired functioning”.

Characteristics of mental illness Changes in one’s thinking, memory, perception, feeling & judgement resulting in changes in talk & behavior which appear to be deviant from previous personality Changes in behavior cause distress& suffering to the individual/ others/ both Changes & distress cause disturbance in day- to-day activities, work & relationship with important others(social & vocational dysfunction)

Evolution of mental health services & treatment Pythagoras (580-510BC) – developed the concept - brain is the seat of intellectual activity Hippocrates (460-370BC) –mental illness as hysteria, mania & depression Plato (427-347BC) – identified the relationship between mind & body Asciepiades(father of psychiatry)- use of simple hygienic measures, diet, bath, massage in place of mechanical restraints Aristotle(Greek philosopher) – suggested catharsis & music therapy Renaissance in Europe(1300-1600AD) – this period represented the saddest chapter in the psychiatry

Important mile stones 1773 - First mental hospital in US was built in Williamsburg, VIRGINIA 1793 –Phillip Pinel removed the chains from mentally ill patients , a hospital outside paris, First revolution in psychiatry 1812 – first American text book in psychiatry, was written by Benjamin Rush (father of American Psychiatry) 1908 – Clifford Beers, an ex-patient of a mental hospital, wrote the book, “the mind that found itself ” based on his bitter experiences in the hospital.

1912 – Eugene bleuler, a swiss psychiatrist coined the term “Schizophrenia” 1912 – Indian lunacy act was passed 1927 – Insulin shock treatment was introduced for schizophrenia 1936 - Frontal lobotomy was advocates for the management of psychiatric disorders 1938 – ECT was used for treatment of psychoses 1939 – development of psychoanalytical theory by Sigmund Freud led to new concepts in the treatment of mental illness 1946 – the bhore committee presented the situation with regard to mental health services

Five mental hospitals were set up at : Amritsar(1947), Hyderabad(1953), Srinagar(1958), Jamnagar(1960), Delhi(1966) All India institute of mental health was also set up at Bangalore. 1949 – Lithium was first used for the treatment of mania 1952 - Chlorpromazine was introduced which brought about a revolution in psycho pharmacology & changed the whole picture of mental health care 1963 – the community mental health centers act was passed.

1970 – slow & steady reduction of beds in custodial institutions 1978 –the Alma-Ata declaration of health for all 2000A.D posed a major challenge to Indian mental health professionals. 1981 – Community psychiatric centers were set up to experiment with primary mental health care approach at Raipur Rani 1982 – the focus shifted to community based care, which became the basis for the national mental health programme

1987 – the Indian Mental health act was passed 1987 – the Indian Mental health act was passed. The government of India passed two acts, Mental health act1987, person with disability act 1995 1990 – the government of India formed an action group at Delhi to pool the opinions of mental health experts about the national mental health programme. (NIMHANS, Bangalore) 2001- current situation analysis was done to evolve a comprehensive plan of action to energize the NMHP

1993 – protection of human rights act 1997 – project quality assurance in mental health institutions- 37 mental hospitals 2001 Aug. 6 – 27 mentally ill patient died

Development of modern psychiatric nursing Some important milestones: 1840 – Florence nightingale made an attempt to meet the needs of psychiatric in patients with proper hygiene, better food, light & ventilation & use of drugs to chemically restrains violent & aggressive patients 1872- first training school for nurses was established by the new England hospital for women & children, USA. Linda Richards, the first nurse to graduate from the one year course, developed 12 training schools in the USA

1882 – first school to prepare nurses to care for the mentally ill was opened at Mc lean hospital in Waverly. 1913 – Johns Hopkins became the first school of nursing to include a fully developed course for psychiatric nursing in the curriculum. Emergence of various somatic therapies – insulin shock therapies, (1927), psychosurgery (1936), & ECT (1938). 1921 –short training courses of 3-6 m were conducted in Ranchi 1943- psychiatric nursing course was started for male nurses The Chennai govt organized a 3 month psychiatric nursing course for male nursing students

1946 – health survey committee report recommended preparation of nursing personnel in psychiatric nursing . 1948-50 – four nurses were sent to UK by the govt of India , for training in mental nurses Diploma. 1952- Dr. Hildegard Peplau defined the therapeutic roles that nurses might play in the mental health settings Book - Interpersonal relation s in nursing – it was the first systematic theoretical frame work developed for psychiatric nursing 1953- Maxwell Jones introduced therapeutic community 1953-54 – need for nurses trained in psychiatric care was felt by the Govt of India 1954 – Nur Manzil Mental health center, Lucknow, started psychiatric nursing orientation courses of 4-6 weeks duration

1956 – one year post certificate course in psychiatric nursing started at NIMHANS, Bengaluru. 1958 – all the wards at the Agra mental hospital were ordered to be kept open & all ward locks were removed from the charge of the ward attendant. 1960 – the name ‘psychiatric nursing’ was changed to ‘psychiatric & mental health nursing’ & second change was made in the 1970’s when it was know as ‘psychosocial nursing’. 1963 – journal of psychiatric nursing & mental health services was published. Mysore Govt started a nine month course in psychiatric nursing for male nursing students, in lieu of midwifery.

1964 – mudalidar committee felt the need for preparing large number of psychiatric nurses 1965 – the Indian nursing council included psychiatric nursing as a compulsory course in the Bsc nursing progrmme. 1967 – TNAI formed a separate committee for psychiatric nursing 1973 – standards of psychiatric & mental health nursing practice were enunciated 1975 – psychiatric nursing was offered as an elective subject in M.Sc Nursing at the Rajkumari Amrit Kaur College of Nursing, New Delhi. Now various colleges offer psychiatric nursing as an elective subject in M.Sc nursing.

1980 – shift from psychodynamic models to more balanced psychobiological models of psychiatric care. 1986- INC made psychiatric nursing a component of general nursing & midwifery course 1990 – international council of nurses declared 1990 as the year of mental health nursing 1991 – Indian society of psychiatric nurses formed at NIMHANS, Bengaluru. 1994 – changes led to the revision of standards of psychiatric & mental health Nursing

Current issues, future prospects & challenges - India There is a lack of clearly enunciated definitions of the roles of professional psychiatric nurses Greater emphasis should be given to encourage a masters degree in psychiatric nursing Offer diploma in psychiatric nursing courses in more colleges To maintain the minimum standards of psychiatric nursing care in mental hospitals, the recommended psychiatric nurse: patient ratio as per the INC is 1:5 in non teaching & 1:3 in teaching hospitals

High priority needs to be given to increase psychiatric nursing man power at the diploma, masters & doctorate levels. There is a crucial need to create proper jobs at par with other professionals, particularly in the community High priority must be given to fill vacant positions in educational institutions An integrated & coordinated role, both in service & training is essential in maintaining the quality & standard of psychiatric nursing

Most psychiatric centers do not have qualified psychiatric nurses, even today. High priority should be given to place qualified psychiatric nurses in counseling centers, community mental health & school mental health programme. The national mental health programme for India (1982)recommended the formation of a district mental health team (DMHT) in order to decentralize mental health care at the district level, with two qualified psychiatric nurses & one psychiatrist

The role psychiatric nurses in the district mental health programme is to provide care to the inpatients The qualified psychiatric nurses will actively participate in decentralized training to professionals & nonprofessional working at taluk & PHC s Supervise the task of multipurpose workers in mental health care delivery. They will assist psychiatrist in research activities in monitoring mental health care at district & PHCs levels. Nurses active participation in mental health education to the public will go a long way in creating public awareness in the care of individuals with various mental disorders

Prevalence & incidence of mental health problems & disorders Prevalence of mental disorders: all mental disorders – 73/1000 population Schizophrenia -2.5 / 1000 population Affective disorder (depression) – 34/ 1000 population Anxiety neurosis – 16.5 / 1000 population Hysteria – 3.3/1000 population Mental retardation – 5.3/ 1000 population

National prevalence rates for specific disorders Schizophrenia – 2.3 /1000 population Affective disorder – 31.2/1000 population Anxiety neurosis – 18.5/ 1000 population Hysteria – 4.1/ 1000 population Mental retardation – 4.2/1000 population

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