MENTAL HEALTH NURSING

PERSPECTIVES OF MENTAL HEALTH NURSING:
EVOLUTION OF MENTAL HEALTH SERVICES
PREVALENCE AND INCIDENCE OF MENTAL HEALTH PROBLEMS

1. PERSPECTIVES OF MENTAL HEALTH AND MENTAL HEALTH NURSING: EVOLUTION OF MENTAL HEALTH SERVICES AND TREATMENT PREVALENCE AND INCIDENCE OF MENTAL HEALTH PROBLEMS AND DISORDERS PREPARED BY MRS.AKILA.A , M.Sc (N), M.Sc (PSY) ASSOCIATE PROFESSOR

2. INTRODUCTION Psychiatric nursing can be seen as a dynamic interplay between the nurse and the patient, that encompasses , knowledge and skilful application of the concept of behaviour, personality, the mind, psychopathology and most importantly, the process of interpersonal relationship.

3. DEFINITION MENTAL HEALTH: A state of well being in which an individual realizes his or her own abilities and can cope up with the normal stressors of life , can work productively and is able to make a contribution towards his or her community. (WHO)

4. DEFINITION MENTAL ILLNESS : Mental and behavioural disorders are understood as clinically significant conditions characterized by alterations in thinking, mood (emotions)or behaviour associated with the personal distress and/ impaired functioning. (WHO,2001)

5. DEFINITION PSYCHIATRIC NURSING: it is a specialized area of nursing practice, employing theories of human behaviour as it is a science, and the purposeful use of self as it is an art, in the diagnosis and treatment of human responses to actual or potential mental health problems. (ANA – 1994).

6. DEFINITION PSYCHIATRY: It is a branch of medicine that deals with the diagnosis, treatment and prevention of mental illness.

7. PERSPECTIVES OF MENTAL HEALTH AND MENTAL HEALTH NURSING: The psychiatric nurse must use herself and her total personality as the main implementation for an effective care. Physical manipulative skills are limited here, since the nurse meets the patient on a communication level, social and recreational activities serve as a bridge to open communication.

8. Psychiatric nursing is comprehensive nursing care. This suggests that acknowledging the patient as a total person. Disease and injury are crisis situations emotionally and physically. Crisis brings disorganisation of patient and families. Reactions like uncooperativeness, aggressiveness are common due to crisis. Constant stress leads to psychosomatic disorders.

9. EVOLUTION OF MENTAL HEALTH SERVICES AND TREATMENT Historically mental illness was viewed as a demonic possession, the influence of ancestral spirits, the result of violating a taboo or neglecting a cultural, ritual and spiritual condemnation. As a result, the mentally ill were often starved, beaten, burnt, amputated and tortured in order to make the body an unsuitable place for the demon.

10. Gradually, man began the inquest for scientific knowledge and truth, which can be traced as follows: Period of persecution (1552 BC – 1400 AD) Earlier, treatment of mentally ill depended on men’s various superstitious beliefs. Patients with mental illness were avoided, thrown out of society and beaten up by people. Since nobody was allowed to interact with them, it was felt that nursing care was not needed.

11. Egyptians, Chinese and Greeks believed that the mental illness was caused by demons. They were treated by exorcism (prayer, Noise making). Hippocrates stressed that brain pathology led to mental illness and recommended marriage for mental illness. Gradually Man began the quest for scientific knowledge and the truth.

12. Period of segregation : (1545 AD – 1800AD) To prevent the mentally ill patients from straying into streets they were kept separately in asylums. In England they were kept in Bethlam asylum for the first time. However the living condition was not suitable for the patients. The aim was to segregate patients from general public.

13. Bethlehem Hospital,’Bedlem

14. Humanitarian period: (1745 AD – 1826AD) Philippe Pinel in France and William Tuke in England opened the chains of mentally ill, paving the way for humanitarian care. At last total care was provided to the patients without restraints or chains. In 1773, in the U.S. mental patients were admitted to Pennsylvania Hospital. No specially trained nurses, only General nurses took care of the patients.

15. Beginning of Scientific Attitude: (1796 –1878 AD) Gradually insanity was regarded as an illness. Sigmund Freud (1856 – 1939)founder of psycho analysis believed in hypnotism for easing psychic tension. Emile krapelin (1856 – 1926) classified the mental illness.

16. First Florance Nightingale School was opened at St. Thomas Hospital in London. In 1873, Linda Richards the first psychiatric nurse was graduated from England. In 1956, an integral basic psychiatric nursing concept was introduced in General nursing programme.

17. Period of prevention: (1885 – 1960 AD) In the 20 th century, psychological clinics for problem children were established. In 1950, the National association of mental health was formed. In 1950, Paplau’s theory provided a framework for practicing psychiatric nursing. In 1960, first the first worldwide mental health year was celebrated.

18. In 1960, first Doctoral programme in psychiatric nursing was started in Boston. The role of psychiatric nursing was widened in caring mentally ill patients with Maxwell Jone’s concept of Therapeutic Community. In 1963, Journal of psychiatric nursing and Mental health services was published.

19. Some important mile stones : 1773, The first mental hospital in US was built in Williamsburg, Virginia. 1793, Phillip pinel unchained the mentally ill patients. 1812, The first American text book in Psychiatry was written by Benjamin Rush.(Father of American Psychiatry). 1912, The Indian Lunacy Act was passed.

20. 1908- Clifford Beers, an ex-patient of mental hospital, wrote the book, ‘ The mind That find itself’ based on his bitter experiences in the hospital. 1912- Eugen 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 advocated for the management of mental illness.

21. 1938- ECT was used for the treatment of Psychosis. 1946, Bhore Committee established an All India Institute of Mental Health at Bangalore.(currently known as NIMHANS). 1949- Lithium was first used for the treatment of mania. 1952- Chorpromazine was introduced which brought about a revolution in Psychophamacology

22. 1963- The Community Mental Health Centers Act was passed. 1978- The Alma –Ata declaration of “ Health for All by 2000 AD” posed a major challenge to Indian mental health Professionals. 1981- Community Mental Health Centers were set up to experiment with Primary mental health care approach at Rajpur Rani , Chandigarh and Sakalwara , Bangalore.

23. 1982- The focus shifted to community based care, which became the basis for the national Mental Health Programme. 1982- National Health Policy was accepted by the Central Council of Health and brought the National Mental Health Programme in India (NMHP). 1987- Indian Mental Health Act was Passed. 1990- Indian Government Formed the Action group at Delhi to pool the opinions of Mental health expert about NMHP.

24. 1997- National Human Rights commission prepared a Plan of action for improving the conditions in Mental hospitals in country. 2001- On August 6 th , 27 more mentally ill people died as they were tied to their beds when fire engulfed the thatched roof of the Moideen Badusha Mental Home at Erwadi . Following this incident major changes occured in mental hospitals and in the lives of mentally ill in a positive way by the Government.

25. 2002- National Survey of mental health resources carried out by the Directorate General of Health services. 2007- under the eleventh five year plan, Centers of Excellence in the field of mental health was established , there by 11 mental health institutes were funded. 2008- WHO Mental Health Gap Action Programme was launched which aims at scaling up services for mental, neurological and substance use disorders.

26. 2013- WHO launched the Mental Health Action Plan 2013- 2020 on 7 october 2013. 2013- Under the Twelfth five year plan, Government of Indian integrated different components of NMHP with National Rural health mission. 2013- The Mental Health Care bill was introduced in the rajya Sabha on 19, August 2013.

27. 2013- under central Sector, the Ministry of Social justice and Empowerment launched Deenadayal Disabled Rehabilitation Scheme and provided financial assistance to NGOs. 2014- The National Mental health Policy 2014 is in accordance with the intent of World health Assembly resolution. World Health day is observed on 10 th October every year, with overall objective of raising awareness of mental health issues and mobilising resources in support of mental health.

28. DEVELOPMENT OF MODERN PSYCHIATRIC NURSING Some important Miles stones : 1840s- Florence Nightingale made an attempt to meet the needs of Psychiatric patients with Proper hygiene, better food, light and Ventilation and use of drugs to Chemically restrain the violent and aggressive Patients. 1872- First training School for nurses, based on the Nightingale System was established by the New England Hospital. Linda Richards, the first nurse to graduate one-year course developed 12 training schools in USA.

29. 1882- First School to prepare nurses, to care for the mentally ill was opened at McLean Hospital in Waverly. 1913- John Hopkins became the first school of nursing to include a fully developed course for Psychiatric nursing in the curriculum. Major growth in Psychiatric nursing occurred after World war-II, because of the emergence of Services related to Psychiatric Problems.

30. 1921-short training courses of 3 to 6 months were conducted in Ranchi. 1943- Psychiatric nursing course was started for male nurses. 1946- Health Survey Committee’s report recommended preparation of nursing personnel in Psychiatric nursing also. 1948-1950- Four nurses were sent to UK by the Government of India, for training in mental health nursing

31. 1952- Dr. Hildegard Peplau defined the therapeutic roles that nurses might play in the mental health setting. 1953- Maxwell Jones introduced therapeutic community. 1953-1954: The urgent need for nurses trained in psychiatric care was felt by the Government of India. 1954- Nur Manzil Mental Health centre, Lucknow , started psychiatric nursing orientation courses of 4-6 weeks duration.

32. 1956- One year post- certificate course in Psychiatric nursing orientation couses of 4-6 weeks duration. 1958- All the wards at the Agra Mental Hospital were ordered to be kept open and ward locks were removed from the charge of the ward attendant. 1960-the focus began to shift to primary prevention and implementing care and consultation in the community.

33. 1960- the focus began to shift to primary prevention and implementing care and consultation in the community. The name ‘psychiatric nursing’ was changed into psychiatric and mental health nursing, further it was renamed as Psycho social nursing in 1970s. 1963- Journal of Psychiatric nursing and Mental health services was Published. 1964- Mudaliyar committee felt the need for preparing a large number of psychiatric nurses and recommended inclusion of psychiatry in the nursing curriculum

34. 1965- The Indian nursing Council included Psychiatric nursing as a compulsory course in the B.sc Nursing Programme. 1967- TNAI, formed a separate committee for psychiatric nursing to improve the perception of psychiatric nursing as well as to set guidelines for nursing teachers to conduct theory and practical sessions. 1973- Standards of psychiatric and mental health nursing practice were enunciated to provide a means of improving the quality of care.

35. 1975- Psychiatric Nursing was offered as an elective subject in MSC Nursing at the RAK college of nursing, Newdelhi . 1986- The Indian nursing Council (INC) made psychiatric nursing a component of General nursing and Midwifery course. American Psychiatric nurses association was established. 1990-ICN declared 1990 as the year of mental health nursing.

36. 1991- Indian society of Psychiatric nurses formed at NIMHANS, Bangalore. 1994- Standards of Psychiatric Nursing was revised. 1995- Journal of American Psychiatric Nurses association was formed. 2000- American Nurses association Published the Scope and standards of mental health nursing. 2003- ANA began certifying psychiatric mental health Practioners . 2010- ISPN published journal titled Indian Journal of Psychiatric Nurses.

37. INDIAN PSYCHIATRIC ASSOCIATION It is a professional body of Psychiatry in india . Largest association of Indian Psychiatrists. 1929- Berkeley Hill of Ranchi founded the Indian Association for Mental Hygiene . 1935- the Indian division of the royal medico Psychological association was formed. 1946- The Indian Psychiatric Society was inaugurated.

38. Aims of this Association: Promotion of mental health and mental health education Promote and advance the subject of Psychiatry. Formulation and advise on the standards of education and training in Psychiatry. Promote research in the field of Psychiatry. Deal with matters relating to mental health concerning the country and promote ethics in practice of Psychiatry in india .

39. INDIAN SOCIETY OF PSYCHIATRIC NURSES Indian society of psychiatric nurses was started in 1991 at NIMHANS, Bengalaru under the guidance of Dr.Reddemma with the motive of enhancing the advanced knowledge and skills in the field of Psychiatric nursing. ISPN is publishing its own journal –Indian Journal of Psychiatric Nurses.

40. Conferences by ISPN: The first national conference theme(2002) was ‘ Child Psychiatric nursing’. The First international conference theme (2005) ‘ Adolescent Mental Health issues. In 2005, ISPN became a member of Indian Confederation of Health Accreditation.

41. PREVALENCE AND INCIDENCE OF MENTAL HEALTH PROBLEMS AND DISORDERS The WHO declared the World Health day theme for the year 2001 as “ Mental Health: Stop Exclusion- Dare to Care”, in order to focus global public health attention on this neglected problem. The Bhore committee Concluded that mental patients requiring institutional treatment would be 2 per 1000 in the country.

42. The prevalence reported from the epidemiological studies stated that, range from the population of 18 to 207 per 1000 with the median 65.4 per 1000.Most of these patients lives in rural areas remote from any modern mental health facilities. Large number of adults coming to general OPD are diagnosed mentally ill.

43. MENTAL HEALTH PROBLEMS

44. Global Disability adjusted life years estimation : 10% of world population are having mental illness(2010) world wide 700 million people suffering with mental health problems (2010) 7.4% world population struggled with mental Health Problems. 0.5 % world population suffering with Schizophernia Prevalence of unipolar depressive episodes to be 1.9% for men and 3.2% for women ,and the one year prevalence be 5.8% for men and 9.5% for women

45. Proportion of Mental Illness (world wide )

46. PREVALENCE OF MENTAL DISORDERS (analysis of 15 epidemiological studies- Ganguli HC, 2000) All mental disorders- 73/1000 Population ( with rural and urban rates of 70.5 and 73/1000, respectively) 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

47. NATIONAL PREVALENCE OF MENTAL DISORDERS (analysis of 10 epidemiological studies- Madhav MS, 2001) 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

48. COMMUNITY BASED EPIDEMIOLOGICAL STUDIES UNDER THE WHO MENTAL HEALTH ACTION P ROGRAMME In I ndia the estimated life time prevalence of mental disorders ranges from 122.2 to 48.6%. The ministry of health and Family welfare Suggests that 6-7% of India’s People suffer from mental disorders with about 1% suffering from severe mental disorders while 3 in 10,000 people experience an episode an episode of acute psychosis every year, about 25% of mentally ill people are homeless.

49. Mental Illnesses like schizophrenia and Bipolar disorder are prevalent in about 200 cases per 10,000 People. The burden of these disorders is likely to increase 15% by 2020. The prevalence of Psychiatric illness is 58.2 per thousand which means that there are about 5.7 crore people suffering from some sort of Psychiatric illness.

50. Out of this 5.7 crore , 4 lakh People- Organic Psychosis 26 lakh People- Schizophrenia 1.2 Crore People- Affective Psychosis 1.5 Crore People- Severe mental disorders 12,000 patients- Government mental hospitals - Reddy.1991.

51. MINISTRY OF HEALTH AND FAMILY WELFARE, ANNUAL REPORT -2012-2013 Various Community based surveys show the Prevalence of mental disorders in India as 6-7% for common mental disorders and 1-2% for severe mental disorders. In I ndia, the rate of Psychiatric disorders in children aged between 4 to 16 years is about 12% Treatment gap for severe mental disorders is approximately 50% and in case of Common Mental Disorders it is over 90%.

52. Common Psychiatric illnesses in General Hospital: Neurotic disorders Psychosomatic disorders Functional Psychosis In Child Guidance Clinic: Mental retardation Conduct disorder Hyperkinetic disorder Enuresis

53. In Geriatric clinic: Depression Dementia Delusional disorders In Psychosexual Clinic: Dhat Syndrome Premature ejaculation Erectile Impotence

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