ppt on COMMUNITY MENTAL HEALTH NURSING.pptx

ppt on COMMUNITY MENTAL HEALTH NURSING.pptx

1. Community Mental Health Nursing The application of knowledge of psychiatric nursing in preventing, promoting and maintaining mental health of the people to help in early diagnosis and care and to rehabilitate the clients after mental illness.

2. INTRODUCTION The trend in psychiatric care is shifting from that of inpatient hospitalization to a focus of outpatient care within the community. This trend is largely due to the need for greater cost effectiveness in the provision of medical care to the masses.

3. Development of Community Mental Health In India Phase I – Colonial period prior to India’s attaining independence. Establishment of lunatic asylums in different parts of the country. Phase II – During 1950s Establishment of mental hospitals at Bangalore(1954), Amritsar(1947), Hyderabad (1953), Srinagar (1958), Jamnagar(1960) & Delhi(1966)

4. Contd ….. Phase III – During mid 1960s Growth of general hospital psychiatry units. Phase IV – During 1970s Extension of care from mental hospitals and general hospitals to the primary health care centers & the community. Bangalore & Chandigarh initiated pilot Programs to develop & evaluate an extension of mental health services for the rural underprivileged population.

5. Contd … Phase V – During 1990s Substantantial increases in funding and improvements in the conditions of many mental hospitals. Voluntary and non-governmental organizations taking an active interest in various aspects of mental health. Growth of private sector in psychiatric services. Growth of private consultant psychiatrists.

6. Organization Of Mental Health Services in India Central Level National level hospitals. Eg . NIMHANS, Bangalore State Level State level hospitals for eg . Institute of Mental Health, Dharwad , Karnataka National Mental Health Program District Level General Hospital Psychiatric units District mental health program

7. Local Level Primary health centers Community mental health centers Sub-centers

8. NATIONAL MENTAL HEALTH PROGRAM(NMHP) The first draft of National Mental Health Program, was designed by sixty eight experts from the field of mental health, general health & health administration and was accepted for implementation in the country in 1982

9. Objectives Basic mental health care to all the needy especially the poor from rural, slum & tribal areas. Application of mental health knowledge in general health care & in social development. Promotion of community participation in mental health service development & increase of efforts towards self-help in the community. Prevention & treatment of mental & neurological disorders & their associated disabilities.

10. Approaches Diffusion of mental health skills: Instead of the centralizing mental health skills and expertise in an urbanized area it should reach periphery .i.e. the primary health centre, sub-centre and village level workers. Integration of mental health care services to the existing general health services: It will enable the health workers to identify psycho social problems. Psychiatric mental health workers will be able to identify and relate psychosocial factors contributing to ill patients.

11. Contd …. Specified tasks has to be provided at all levels : The task has to be performed at each level (village workers, sub-centers, PHC, district hospital, regional hospital) will be specified and a referral system set up so that the total system works in an integrated fashion

12. Contd …. Equitable distribution of the resources to strengthen mental health care: Every efforts will be made to strengthen mental health first in those regions which are deprived of it or where it is seriously deficient. Linkage to the community development: Involvement of state, district, block, leadership in the implementation of the mental health programme to ensure community involvement in preventive efforts directed at psychosocial problems like alcohol, drug abuse.

13. Contd …. Mental retardation and drug dependence: The health workers should be able to counsel the parents, provide public education and know-how to refer such children to social welfare agencies for rehabilitation. Mental health care includes treatment, rehabilitation and prevention. Mental health training.

14. Components 1 . TREATMENT SUBPROGRAMME: Specified treatment plans and diagnostic work were implemented by personnel at all levels. The health professionals have been trained up in following areas: Management of psychiatric emergencies through medicines and crisis intervention strategies. Treatment for chronic psychiatric disorders. Diagnosis and management of epilepsy, especially in children; treatment of functional psychosis.

15. Contd ….. Counseling of addicts. Supervision of MPHW’s performance of specified mental health tasks. Management of uncomplicated psycho-social problems without use of drugs.

16. Contd …. Mental hospitals and teaching psychiatric units: Major activities of these higher centers of psychiatric care include: Help in care of ‘difficult’ cases. Teaching Specialized facilities like occupational therapy units, psychotherapy, counseling and behavioral therapy are provided in these hospitals

17. 2. REHABLITATION SUBPROGRAMME: Treatment of epileptics and psychotics at community level is an important rehabilitative activity. Development of rehabilitation centers both at district level and the higher referral centre.

18. 3.PREVENTION SUBPROGRAMME: The prevention component is to be community-based, with the initial focus on prevention and control of alcohol-related problems. The problems such as addictions, juvenile delinquency and acute adjustment .i.e. suicidal attempts are to be addressed.

19. Barriers Shortage of trained psychiatric manpower. Lack of awareness regarding treatment. The medical care in mental hospitals is custodial in nature and this need to be changed to a more rehabilitative approach.

20. Activities Planned For Implementation Of NMHP Community mental health programs at PHC level in states & union territories, with a plan to cover a population of about 3-5 lac in the 7 th five-year plan. Training of existing PHC personnel for mental health care delivery, with no additional staff. Development of a state level Mental Health Advisory Committee & identification of a state level program officer(preferably a psychiatrist).

21. Contd …. Establishment of regional centres of community mental health( atleast 1 during the plan period). Formation of National Advisory Group on Mental Health. Task force for mental health education for UG medical students. Mental health training of atleast 1 doctor at every district hospital during the next 5 years. Provision for atleast 3 to 4 essential psychotropic drugs in adequate quantity, at the PHC level.

22. Contd …. An important example of the District Mental Health Program is at Bellary district, Karnataka. Started in 1985, it reached to a population of 1.5 million. District hospital psychiatry units have been opened in every district of Kerela & Tamil Nadu.

23. Progress Between 1982 & 2002 Since the adoption of NMHP in following areas the progress is very significant: Development of models for the integration of mental health with primary health care(Raipur Rani model in north & sakalawara in south India). In 1984, the district model for mental healthcare was initiated by NIMHANS, Bengaluru . It identified the practicability of the district mental health team initiating mental health care. This was extended to 25 districts in 20 states between 1995 & 2000.

24. Contd …. Legislations supporting mental health care are developed namely, the Narcotic Drugs & Psychotropic Substances(NDPS) Act 1985, the MHA 1987 & persons with Disability Act 1995. All of these legislations have changed the mental health care approach. Recognition of human rights of the mentally ill by the National Human Rights Commission. The National Health Policy 2002 clearly recognized mental health as a part of general health & specified how mental health has to be included as a part of general health services & the importance of human rights of mentally ill.

25. District Mental Health Program(DMHP) Govt. of India has launched a scheme of DMHP under NMHP in 1996 by assisting the state govt. to implement the program in one district. Rs. 28.5 lakhs are given to each state for a period of 5 years with the following objectives: To provide sustainable basic mental health services to the community and to integrate these services with other health services. Early detection and treatment of patients within the community itself. To see that patients and their relatives do not have to travel long distances to go to hospitals or nursing homes in the cities.

26. District Mental Health Program(DMHP) To take pressure off the mental hospitals. To reduce the stigma attached towards mental illness through change of attitude and public education. To treat and rehabilitate mental patients discharged from the mental hospital within the community. At the end of 2002,28 districts in 25 states are having DMHP. In October 2003, Govt. of India launched a program with Rs.190 crores which includes implementation of DMHP in 100 districts.

27. CONCLUSIONS: Community-based rehabilitation is a feasible and acceptable intervention with a beneficial impact on disability for the majority of people with psychotic disorders in low-resource settings. The impact on disability is influenced by a combination of clinical, programme and social determinants.

28. THE COMMUNITY AS CLIENT Primary Prevention Primary prevention within communities encompasses the two fold emphasis. These include: 1. Identifying stressful life events that precipitate crises and targeting the relevant populations at high risk. 2. Intervening with these high-risk populations to prevent or minimize harmful consequences.

29. Populations at Risk One way to view populations at risk is to focus on types of crises that individuals experience in their lives. Two broad categories are: Maturational crises Situational crises.

30. Contd … Nursing interventions with adolescents at the primary level of prevention focus on providing support and accurate information to ease the difficult transition they are undergoing. Educational offerings can be presented in schools, churches, youth centers or any location in which groups of teenagers gather.

31. Marriage Too many people enter marriage with the notion that, as sure as the depth of their love, their soon-to-be husband or wife will discontinue his or her “undesirable” traits and change into the perceived ideal spouse

32. Contd …. Nursing interventions at the primary level of prevention with individuals in this stage of development involve education regarding what to expect at various stages in the marriage. Encouraging honest communication. Determining what each person expects from the relationship.

33. Ascertaining whether or not each individual can accept compromise. This type of intervention can be effective in individual or couple’s therapy.

34. Parenthood The coming of the child is a crisis, a turning point in the couple’s life in which old patterns of living must be changed for new ways of living and new values. With the advent of parenthood, a couple is embarking on a journey from which there is no return. To put it simply, parents cannot quit. The child’s birth brings finality to many highly valued privileges and a permanence of responsibilities.

35. Contd …. Nursing intervention at the primary level of prevention with the developmental stage of parenthood must begin long before the child is even born. Nurses can provide the information to help ease the transition into parenthood.

36. Information can be provided regarding: Parent–infant bonding . Changing husband–wife relationships . Clothing and equipment . Other expectations . Stages of Growth and Development.

37. Midlife. Nursing intervention at the primary level of prevention with the developmental stage of midlife involves providing accurate information regarding changes that occur during this time of life and support for adapting to these changes effectively.

38. Situational Crises Situational crises are acute responses that occur as a result of an external circumstantial stressor. The number and types of situational stressors are limitless and may be real or exist only in the perception of the individual.

39. Parenthood. Nursing intervention with parents may include teaching effective methods of disciplining children, aside from physical punishment. Methods that emphasize the importance of positive reinforcement for acceptable behavior can be very effective. Family members must be committed to consistent use of this behavior modification technique for it to be successful.

40. Situational Crises Nursing care at the secondary level of prevention with clients undergoing situational crises occurs only if crisis intervention at the primary level failed and the individual is unable to function socially or occupationally. Exacerbation of mental illness symptoms requires intervention at the secondary level of prevention.

41. Tertiary Prevention It attempts to reduce the severity of a disorder and associated disability. Nursing care at the tertiary level of prevention can be administered on an individual or group basis and in a variety of settings, such as inpatient hospitalization, day or partial hospitalization, group home or halfway house, shelters, home health care, nursing homes and community mental health centers.

42. Contd … Referring clients for various aftercare services (e.g., support groups, day treatment programs, partial hospitalization programs, psychosocial rehabilitation programs, group home or other transitional housing). Monitoring effectiveness of aftercare services (e.g., through home health visits or follow-up appointments in community mental health centers). Making referrals for support services when required

43. 4. EDUCATOR : Organizes community awareness campaigns, specific focus to vulnerable groups on health promotion and health maintenance and community action.

44. 5 . COORDINATOR: Psychiatric care is based on multidisciplinary team approach and the nurse has to coordinate between all team members; follows the therapeutic team members; advices and implements necessary care related activities informs to the team members whatever observations made helping in planning therapeutic activities.

45. 6. DOMICILIARY CARE: Community mental health nurse visits the houses and assess the health status, coping strategies utilized by the family members, psychological functioning of individuals; supportive systems etc. and plans, implements necessary care for them

46. 7. RESEARCHER: Plans and conduct research activities, minor projects, submits its report to authorities, publishes articles based on the results. 8.THERAPEUTIC ROLE: Plans and assists psychotherapeutic activities for improvement in the clients condition, encourages family members.

47. Mental Health Services Available PARTIAL HOSPITALIZATION:- Day care centers ,day hospitals and day treatment programs come under this. They have advantages of less separation from families, more involvement in treatment program and a lessening of patient’s preoccupation with the illness ,which may be intensified by hospitalization.

48. Day care centers in India Sanjivini ,New Delhi SCARF (Schizophrenia research Foundation) Chennai started day care center –BAVISHYA in 1985 Association of Friends of Mentally Ill, Mumbai Institute of Mental Health ,Ahmadabad Psychiatric center ,Kolkata NIMHANS ,Bangalore Anugraha Day care centre, Mumbai DAY CARE CENTERS

49. QUARTER WAY HOMES Quarter way 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 activities of place are taken care by patient themselves . Eg.In NIMHANS

50. Halfway homes in India Medico-pastoral Association ,Bangalore Richmond Fellowship ,Bangalore Society for mental health , Kerala Delhi Psychosocial Rehabilitation Society Paripurnata Halfway Home ,West Bengal Sowkya Halfway Home at Madurai Raju Rehabilitation Foundation ,Bangalore YWCA Halfway Home for mentally ill, Chennai Halfway home

51. 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. SELF-HELP GROUPS

52. Characteristics Homogeneity :The members have the same disorders and share their experiences good or bad ,successful or unsuccessful ,with one another. Demonstrate to individuals that they are not alone in having a particular problem. SELF-HELP GROUPS

53. Self-help groups emphasize cohesion which is strong in these groups because of having similar problems and symptoms. Strategies include self-disclosure , psycho education and mutual support. SELF-HELP GROUPS

54. Processes in self group include social affiliation ,learning self control and modeling methods to cope with stress and acting to change social environment. Prevent physical , emotional and social problems and breakdowns. Improve an individual’s or a family’s quality of life. SELF-HELP GROUPS

55. Community group homes Large homes for long term care Hostels Home care programs District rehabilitation centre’s Others

56. GROUP HOMES 15-20 recovered clients with significant mental illness will be placed in a home. It may or may not belong to hospital. They will live like a society, provides moral, emotional and support to each other.

57. FOSTER HOMES Client will get home like environment; placement may be a temporary or permanent. To receive services like family care, social agencies will appoint certain volunteer families to take care of the client in post recovery period.

58. AL-ATEEN Al- ateen is for teenage relatives and friends of alcoholics. Al- ateen is part of Al-Anon.

59. NARCOTICS ANONYMOUS NA is a nonprofit Fellowship or society of men and women for whom drugs had become a major problem. We are recovering addicts who meet regularly to help each other stay clean. This is a program of complete abstinence from all drugs. There is only one requirement for membership, the desire to stop using.

60. NARCOTICS ANONS Nar-Anon is a twelve-step program for friends and family members of drug addicts . NARCOTICS ATEEN Narcotic ateen is for teenage relatives and friends of drug addicts.

61. WHO Mental Health Gap Action Programme (mhGAP) On 9th October, 2008, WHO has launched its action programme in Geneva, the mental health Gap Action Programme (mhGAP) which aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income. The programme asserts that with proper care, psychosocial assistance and medication, millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce.

62. ATHMA - De Addiction Centre (ADC) ATHMA has a full-equipped de-addiction centre with a residential care capacity up to 25 patients. It has a well experienced medical staff and offers de-addiction programs. The treatment procedures include exclusive intensive program, Detoxification, individual & group therapy, relaxation techniques with yoga, meditation, individual follow up and management of co-morbid psychiatric illness. Over the past decade, ATHMA has one of the highest success rates in de-addiction and many success stories of the cured persons from ATHMA will stand testimony to this fact.

63.   ATHMA - Counseling and Education Guidance Centre (ACE) The ATHMA INSTITUTE OF MENTAL HEALTH AND SOCIAL SCIENCES (AIMSS) had been striving hard to promote mental health, create awareness, remove the stigma and marginalization of the mentally ill. The efforts have paid great reward by the number of people seeking psychiatric care. ATHMA is the only private institution in Tamilnadu having the maximum number of beds, psychiatrists, clinical psychologists, counselors, occupational therapist and social workers. The vision of our Director Dr. KK. Ramakrishna is achieved by the dedication of staff and professionals in his team.