1. Mental health nursing Unit 1 Introduction

2. 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”.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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”.

11. 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)

12. Evolution of mental health services & treatment
Pythagoras ( BC) – developed the concept - brain is the seat of intellectual activity
Hippocrates ( BC) –mental illness as hysteria, mania & depression
Plato ( BC) – 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( AD) – this period represented the saddest chapter in the psychiatry

13. Important mile stones
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.

14. 1912 – Eugene bleuler, a swiss psychiatrist coined the term “Schizophrenia”
1912 – Indian lunacy act was passed
1927 – Insulin shock treatment was introduced for schizophrenia
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

15. 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
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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 1946 – health survey committee report recommended preparation of nursing personnel in psychiatric nursing .
– 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
– 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

22. 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.

23. 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.

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Thank you