NATIONAL MENTAL HEALTH PROGRAMME.pptxppt

CMHN is the application of specialized knowledge to populations and communities to promote and maintain mental health, and to rehabilitate populations at risk that continue to have residual effects of mental illness

1. DEFINITION Community mental health- psychiatric nursing CMHN is the application of specialized knowledge to populations and communities to promote and maintain mental health, and to rehabilitate populations at risk that continue to have residual effects of mental illness.

2. Philosophy The philosophy of care is based on the belief that care directed towards the individual, the family and the group contributes to the health care of the population as a whole.

3. NATIONAL METAL HEALTH PROGRAM The Government of India has launched the National Mental Health Programme (NMHP) in 1982

4. NATIONAL METAL HEALTH PROGRAM OBJECTIVES : 1. To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population; 2. To encourage the application of mental health knowledge in general healthcare and in social development ; and 3. To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

5. AIMS 1. Prevention and treatment of mental and neurological disorders and their associated disabilities. 2. Use of mental health technology to improve general health services. 3. Application of mental health principles in total national development to improve quality of life

6. STRATEGIES FOR IMMEDIATE ACTION OF MNHP Centre to periphery strategy: Establishment and strengthening of psychiatric units in all district hospitals, with outpatient clinics and mobile teams reaching the population for mental health services. 2. Periphery to centre strategy : Training of an increasing number of different categories of health personnel in basic mental health skills, with primary emphasis towards the poor and the underprivileged, directly benefiting about 200 million people.

7. Approaches • Integration of mental health care services with the existing general health services. • Utilization of the existing infrastructure of health services and also deliver the minimum mental health care services. • Provision of appropriate task-oriented training to the existing health staff. • Linkage of mental health services with the existing community development program.

8. COMPONENTS/ SUBPROGRAMS OF MENTAL HEALTH CARE SERVICES

9. TREATMENT SUBPROGRAMME A. Village and sub-center level multipurpose workers (MPW)and health supervisors (HS), under the supervision of medical officer(MO) to be trained for: a. management of psychiatric emergencies b. administration and supervision of maintenance treatment for chronic psychiatric disorders c. diagnosis and management of grandmal epilepsy, especially in children d. liaison with local school teachers and parents regarding mental retardation and behavioural problems in children e. counseling in problems related to alcohol and drug abuse

10. TREATMENT SUBPROGRAMME B. MO of Primary Health Centre (PHC) aided by HS, to be trained for: a. supervision of MPW's performance b. elementary diagnosis c. treatment of functional psychosis d. treatment of uncomplicated cases of psychiatric disorders associated with physical diseases e. management of uncomplicated psycho-social problems f. epidemiological surveillance of mental morbidity

11. C. District hospital: There should be at least one psychiatrist attached to every district hospital as an integral part of the district health services. The district hospital should have 30-50 psychiatric beds. The psychiatrist in a district hospital was envisaged to devote only a part of his time to clinical care and a greater part in training and supervision of non-specialist health workers. TREATMENT SUBPROGRAMME

12. TREATMENT SUBPROGRAMME D. Mental hospitals and teaching psychiatric units: Major activities of these higher centers of psychiatric care include: a. help in care of 'difficult' cases b. teaching c. specialized facilities like, occupational therapy units, psychotherapy, counseling and behavioural therapy

13. Rehabilitation Subprogramme The components maintenance treatment of epileptics and psychotics at the community levels. development of rehabilitation centres at both the district level and the higher referral centres.

14. Prevention Subprogramme The prevention component is to be community-based , with the initial focus on prevention and control of alcohol-related problems . Later , problems such as addictions, juvenile delinquency and acute adjustment problems such as suicidal attempts are to be addressed.

15. PREVENTIVE PSYCHIATRY Definition: Preventive psychiatry is defined as services rendered in the community in order to prevent the mental illness and promote the mental health. Main features of preventive psychiatry Focus on prevention Rendering continuity of care Multidisciplinary approach Promotion of services Rendering care by coordinating with accessible community health services.

16. THE PUBLIC HEALTH MODEL(MODEL OF PREVENTIVE PSYCHIATRY) The model of public health is based largely on the concepts set forth by Gerald Caplan (1960) during the initial community mental health movement. Concepts include:

17. Levels of prevention are classified as primordial, primary, secondary and tertiary. The primordial prevention denotes the prevention of modifiable and non-modifiable risk factors. The modifiable risk factors are smoking, alcoholism, continuous stressors, lack of exercise/ yoga/meditation, obesity, eating junk foods etc. The non- modifiable risk factors have genetic history/family history of mental illness. Primary prevention denotes the promotion of health status and specific protection by immunization. Secondary prevention denotes the early diagnosis and treatment. Tertiary prevention is focussed on the rehabilitation and limitation of disability

18. Primary Prevention Primary prevention seeks to prevent the occurrence of mental disorders by strengthening individual, family and group coping abilities. POPUATION AT RISK Adolescence Marriage Midlife Retirement

19. Individual centered intervention Antenatal care to the mother and educating her Ensuring timely and efficient obstetrical assistance Dietary corrections to those infants suffering from metabolic disorders. Correction of endocrine disorders. Liberalization of laws regarding termination of pregnancy, when it is unwanted. Training programs for physically, and mentally handicapped children Counseling the parents of physically and mentally handicapped Fostering bonding behaviours.

20. Contd … Interventions oriented to the child in the school Teaching growth and development to parents and teachers. Identifying the problems of scholastic performance and emotional disturbances among school children and giving timely intervention. School teachers can be taught to recognize the beginning symptoms of problems and referring to appropriate agencies.

21. Contd.. Family centered interventions to ensure harmonious relationship Consulting with parents about appropriate disciplinary measures. Promoting open healthy communication in families. Rendering crisis counseling to the parents of physically and mentally handicapped children. Ensuring harmonious relationship among members of the family and teaching healthy adaptive techniques at the time of stress producing events.

22. Contd.. Interventions oriented to keep families intact Extending mental health education services at Child Guidance Clinics Strengthening social support for the frustrated aged and helping them to retain their usefulness. Promoting educational services in the field of mental health and mental hygiene. Developing parent-teacher associations. Providing marital counseling for those having marital problems.

23. Contd … 5. Interventions for families in crisis In developmental crisis situations such as the child passing through adolescence, birth of a new baby, retirement or menopause, death of a wage earner in the family, desertion by the spouse etc. crisis intervention can be given at • Mental hygiene clinics • Psychiatric first-aid centers • Walk-in clinics

24. Contd.. 6 . Mental health education Conduct mass health education programs regarding prevention of mental illnesses and promotion of mental health in the community. Educate health workers regarding prevention of mental illness so that they can function effectively in all the areas of prevention.

25. Contd … 7. Society-centered preventive measure Community development Culturally deprived families need biological and psychosocial supplies. They need better hygienic living conditions, proper food, education, health facilities, and recreational facilities. Otherwise, psychopathy, alcoholism, drug addiction, crime and mental illness, will result in such situations. • Collection and evaluation of epidemiological, bio-statistical data.

26. ROLE OF NURSE IN PRIMARY PREVENTION 1.Individual centered intervention 2. Interventions oriented to the child in the school 3. Family centered interventions to ensure harmonious relationship 4. Interventions oriented to keep families intact 5. Interventions for families in crisis 6. Mental health education 7. Society-centered preventive measures

27. Secondary Prevention Secondary prevention targets people who show early symptoms of mental health disruption but regain premorbid level of functioning through aggressive treatment.

28. Role of Nurse in Secondary Prevention

29. Role of Nurse in Secondary Prevention Early diagnosis and case finding: This can be achieved by educating the public, community leaders, industrialists, Mahila mandals , Balwadis etc. in how to recognize early symptoms of mental illness. Case finding through screening and periodic examination of population at risk, monitoring of clients etc. Thus in clinics, schools, home health care and the work place, community mental health nurses detect early signs of increased levels of anxiety, decreased ability to cope with stress and failure to perceive self, the environment and/ or reality accurately, and provide direct services as appropriate

30. Contd … Early reference : The public should be educated to refer these cases to proper hospitals as soon as they recognize early symptoms of mental illness. Screening programs : Simple questionnaires should be developed to identify the symptoms of mental illness, and administration of the same in the community for early identification of cases. These questionnaires can be simplified in local languages, and used widely in the colleges, schools, industries etc

31. Contd.. Early and effective treatment for patient, and if necessary, to family members as relevant; providing counseling services to caregivers of mentally ill patients. Training of health personnel : Orientation courses should be provided to health workers to detect cases in the course of their routine work. Consultation services Crisis intervention :If crisis is not tackled in time it may lead to suicide or mental disorders. Sometimes anticipating the crisis situation and guiding the individual in time can help them to cope with the crisis situation in a better way

32. Tertiary Prevention Tertiary prevention targets those with mental illness and helps to reduce the severity, discomfort and disability associated with their illness. In these terms community mental health nurses play a vital role in monitoring the progress of discharged patients in halfway homes, houses etc., especially with regard to their medication regimen, coordination of care etc.

33. Role of a Nurse in Tertiary Prevention Family members should be involved actively in the treatment program so that effective follow-up can be ensured. Occupational and recreational activities should be organized in the hospital Community based programs launched through meeting with the family members when the need for discharge from the hospital should be emphasized. implemented through day hospitals, night hospitals, after care clinics, half-way homes, ex-patient hostels, foster care homes etc. Follow up care can be handed over to community health nurses. constant communication between the community health nurses and the mental health institution regarding the follow up is mandatory.

34. Contd.. The ultimate aim is to re-socialize and re-motivate the patient for a functional role in the community, consistent with his resources. Nurses need to be familiar with the agencies in the community that provide these services. Collaborative relationships between mental health care providers and community agencies are essential.

35. Contd.. Training in Community Living (TCL)program, designed by 'Stein and Test'. In this model when a person is referred for a hospital admission the staff goes to the community with him rather than his going to the hospital to be with the staff. This enables the nurse to assess accurately the skills that the person needs to learn and to mutually agree on realistic goals

36. Contd.. Nurses in the community are in a key position to monitor community attitudes and help in fostering a realistic attitude towards the mentally ill.

37. Community mental health centers Features Commitment : need assessment & accessibility Services : integrated & balanced Long-term care : care transition Case management : continuity of care Community participation : decision making about mental health care needs and programs Evaluation and research

38. Community Mental Health Practice Sites • Community mental health centers • Youth centers • Private practice office • Crisis centers • Shelters • Clients' homes • School and day care centers • Nursing homes • Day hospital facilities • Emergency department of community hospitals • Churches, temples, mosques

39. Available community facilities Psychiatric hospitals Partial hospitalization Quarterway homes Halfway home Self help groups Suicide prevention centers Others

40. Psychiatric hospitals Hospitals have become part of a continuum of mental health services available to patients and their families, and offer a variety of treatments for psychiatric disorders.

41. Partial hospitalization Partial hospitalization is an innovative alternative to hospitalization. It is ideally suited to most of the psychiatric syndromes, particularly chronic psychotic disorders, neurotic conditions, personality disorders, drug and alcohol dependence and mental retardation. Day care centers, day hospitals and day treatment programs come under partial hospitalization.

42. Partial hospitalization Advantages lesser separation from families, more involvement in the treatment program and lessening of patient's preoccupation with the illness, which may be intensified by full hospitalization.

43. Day care centres in India Sanjivini , New Delhi SCARF (Schizophrenia Research Foundation), Chennai, has started a day care center called " BAVISHYA"in 1985 Association of the Friends of Mentally Ill, Mumbai Institute of Mental Health, Ahmedabad Psychiatric Center, Kolkata NIMHANS, Bangalore Krupamayie Institute of Mental Health, Miraj Anugraha Day Care Center, Chennai The Richmond Fellowship Society, Bangalore

44. Quarterway homes This is a place usually located within the hospital campus itself, but not having the regular services of a hospital. There may not be routine nursing staff or routine rounds, and most of the activities of the place are taken care of by the patients themselves Examples of such homes are 13thand 14th psychiatric wards of NIMHANS at Bangalore

45. Halfway home A halfway home is a transitory residential center for mentally ill patients who no longer need the full services of a hospital, but are not yet ready for a completely independent living. It attempts to maintain a climate of health rather than of illness, and to develop and strengthen individual capacities. At the same time it enables the recognition of problems that require medical attention, and permits the discovery of conditions in the community which are acting adversely on the individual. Thus, halfway homes have a major role in the rehabilitation of the mentally ill individual

46. Objectives • To ensure a smooth transition from the hospital to the family. • To integrate the individual into the mainstream of life.

47. Activities Assessment: Clinical assessment Social assessment psychological vocational assessment

48. Activities Reduction of impairments: This includes reduction or elimination of the symptoms and cognitive impairments that interfere with social and vocational performance. These impairments are eliminated for the greater part by various psychotropic agents.

49. Activities Remediation of disabilities through skill training : Skill training is used to remediate disabilities in social, family and vocational functioning Remediating disabilities through supportive interventions : These strategies aim at helping the individuals compensate for handicaps by learning skills in living and working environments, adjusting the individual and family expectations to a level of functioning that is realistically attainable

50. halfway homes available in India • Medico-Pastoral Association, Bangalore • Atmashakti Vidyalaya , Bangalore • Richmond Fellowship, Bangalore • Puraskara Aftercare Home, Bangalore • Cadabam's Home for the Mentally Disabled, Bangalore • Family Fellowship Society for Psychosocial Rehabilitation, Bangalore • Raju Rehabilitation Foundation, Bangalore

51. halfway homes available in India • YWCA Halfway Home for Mentally Ill, Chennai • Dr. Boaz's Rehabilitation Center, Chennai • Dr. Dhairyan's Psychotherapy and Rehabilitation Center, Chennai • Sowkya Halfway Home at Madurai • Delhi Psychosocial Rehabilitation Society • Paripurnata Halfway Home, West Bengal • Societyfor Mental Health, Kerala

52. Self-help groups Self-help groups are composed of people who are trying to cope with a specific problem or life crisis, and have improved the emotional health and wellbeing of many people. Usually organized with a particular task in mind, such groups do not attempt to explore individual psychodynamics in great depth or to change personality functioning significantly.

53. Characteristics Homogeneity Strong cohesion Emotional bonding Mutual trust Sharing Enhance quality of life

54. Strategies: The strategies used by group leaders include promotion of dialogue, self-disclosure and encouragement among members. Concepts used in support groups include Psycho-education, self-disclosure, and mutual support Examples of self-help groups are Alcoholics Anonymous (AA),Association for Mentally Disabled (AMEND)

55. Self help group- functions demonstrate to individuals that they are not alone in having a particular problem. Sharing each others' experiences not only helps the members by providing mutual support, but also by generating alternate ways to view and resolve problems. help in overcoming maladaptive patterns of behaviour or states of feeling that traditional mental health professionals have not generally dealt with successfully.

56. Process –self help groups social affiliation; learning self control; and modeling methods to cope with stress and acting to change the social environment.

57. Suicide prevention centres There are many suicide prevention centers in India in the voluntary sectors doing good work and helping those in need. Some of them are: • Helping Hands and MPA in Bangalore • Sneha in Chennai • Sahara in Mumbai • Sanjivini and Sumaitri in New Delhi

58. Others • Community group homes • Large homes for long-term care • Hostels • Home care programs • District rehabilitation centers