Unit-1 Introduction, Mental Health Nursing

Introduction of mental health nursing, Perspective of mental health and mental health nursing, Evolution of mental health services, treatment and nursing practices Mental health team, Nature and scope of mental health nursing, Role & function of mental health nurse inn various settings and factors affecting the level of nursing practice, concept of normal and abnormal behavior

1. JAIPUR NATIONAL UNIVERSITY SEEDLING SCHOOL OF NURSING SIILAS SUBJECT- MENTAL HEALTH NURSING Unit(1 )- Introduction Prof. (Dr.) Rahul Sharma Professor H.O.D. of Mental Health Nursing Ph. D. Coordinator Seedling School of Nursing Jaipur National University, Jaipur

2. Evolution o f Mental Health Services & Treatment A study of history of psychiatric care. Reveal some shocking truth about past treatment of Mentally ill individual. → Primitive believe regarding mental disturbances took several views some thought that an individual with Mental illness has been dispossessed of his/ her soul and only way wellness could be achieved was if the soul was return. Other believed that evil spirit or super natural or Magical power had enter the body.

3. Evolution o f Mental Health Services & Treatment →The position of these ancient belief evolved with increasing knowledge about Mental illness and changes in cultural, religious and socio-political attitudes. →The work of Hippocrates about 400 B.C , Mental illness with an irregularity in the interaction of 4 body fluid- blood, black bile, yellow bile & Phlegm. He called these body fluids humors. (special quality) & associated with each particular deposition. Disequilibrium among these 4 humors was cause Mental illness and it was treated by induce vomiting & diarrhea with effective drug.

4. Some Important Milestone 1773- The 1st Mental hospital in the U.S. was built in Williams burg, Virginia . 1812- The 1st American textbook in Psychiatry was written by Benjamin Rush , who is referred to as the father of American psychiatry . 1912- Eugene Bleuler is a Swiss psychiatrist coined the term Schizophrenia . 1912- The Indian Lunacy act was passed. 1927- Insulin shock treatment was introduced for schizophrenia.

5. Some Important Milestone 1938- Electro convulsive Therapy (ECT) was used for the treatment of Mental illness. 1939- Development for Psycho analytic theory by Sigmund Freud to new concept in the treatment of Mental illness. 1949- Lithium was 1st used for the treatment of Mania . 1952- Chlorpromazine was introduced in which about revolution Psychopharmacology. 1981- Community psychiatric center were set up to experiment with primary health care. 1987- The Indian Mental health act was passed .

6. Mental Health A/C to W.H.O Health is a positive state of well being, human being are in a emotional, physical & social well being, fulfill their responsibilities, Function effectively in daily life and are satisfied with their interpersonal relationship. “The adjustment of human beings to be work & to each other with a maximum of effectiveness is happiness to each other" - A/c to Karl Mallinger 1983 "A Condition and level of social functioning which is socially acceptable and personal satisfying” - W.W Boehm

7. Mental Health "Is a process of adjustment which involve compromised, adaption, of growth & Continuity." - A/C to B. D Bhatia & M. Craig, 1989 “The American psychiatric association 1980 defined Mental "health" is" simultaneous success at working, loving and creating with the capacity for Maturity & flexible resolution of conflict between instinct, conscience, important other people & reality".

8. Prevalence and Incidence Of Mental Health Problem Disorder During the last 2 decades, Many epidemiological studies have been conducted in India, where we found Prevalence of Major Psychiatric disorder is about same all over the world. The prevalence Report from the study found various data from the population of 18 to 207 per 1000 with Median 65.4/1000 . A large Number of adult pt. coming to the general O.P.D are diagnosed Mentally ill . Analysis of 15th epidemiological study found Prevalence Rate is following ( gangulitic 2000). All Mental disorder 73/1000 Population (with Rural & Urban Rate of 70.5 & 73/1000.)

9. Prevalence and Incidence Of Mental Health Problem Disorder → Schizophrenia-2.5/1000 population → Affective (Depression) D/S-34/1000 → Anxiety D/S-16.5/1000 → Hysteria D/S-3.3/1000 → Mental Retardation - 5.3/1000 * Alc to Health information of India 2005, Mental Morbidity rate is not less than 18-20 per 1000.

10. National Health Policy N.H.P. was formulated in 1983 & revised in 2002. Objectives- The Main Objective of N.H.P 2002 is to achieved an acceptable standard of good health among general population in the country. It would be increase excess to the decentered public health system. by establishing new Infrastructure in deficient areas & by upgrading the Infrastructure in the existing institution.

11. National Mental Health Programme The govt of India launched N.M.H.P in 1982, keeping in view give heavy burden of Mental illness in the community and complete inadequacy of Mental health care infrastructure in the country to deal with it . Aim - Prevention and treatment of Mental Neurological disorder & their associated disabilities. Use of Mental health technology to improve general health services. Improve the quality of life.

12. National Mental Health Programme Objectives- To ensure the availability & accessibility of Minimum mental health care for all in the future. To encourage application of Mental health knowledge in general health care & social development. To promote community participation in the Mental health services development and to stimulate efforts toward 's self care in the community.

13. National Mental Health Programme Approaches - Integration of Mental health care services. with the existing general health services. Utilization of the existing infrastructure of health services & 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 .

14. Mental Health Team- Psychiatrist Psychiatrist Nurse Clinical Psychologist Psychiatric Social Worker Occupational therapist or activity therapist Pharmacist Dietitian Counsellor Multidisciplinary approach refers to collaboration b/w Member of different discipline who provide specific services to the Patient, the Multidisciplinary team include-

15. Mental Health Team- Psychiatrist - Psychiatrist is a Medical doctor with special training in Psychiatry. He is accountable for the Medical diagnosis treatment of the Patient. →Other Important function are – Admit the Patient into Acute care setting. Prescribing & Monitoring psychopharmacological drugs. Administer electroconvulsive therapy. Conducting individual & family therapy & Participating in Inter disciplinary team Meeting. He/she is having legal power to prescribe and to write order, psychiatrist functions of the leader of the team.

16. Mental Health Team- 2. Psychiatric Nurse - is a registered Nurse with specialized training in the care & treatment of psychiatric Patient. →He/she May have a diploma , M.Sc., M.Phil., P.HD on psychiatric Nursing. → He/she is accountable for the psychosocial nursing care of pt.'s. other functional include – Administer & Monitoring Medication. Assisting in psychiatric & physical treatment. Participate in interdisciplinary team Meeting. Teach Pt.'s families. Take responsibility for pt's record’s. Act as pt. advocate.

17. Mental Health Team- 3. Clinical Psychologist – He/she should have a Master degree in Psychology or PhD in clinical psychology with specialized training in Mental health setting. His accountable for psychological assessment, testing & Treatment. He offer direct services such as individual, family or Marital Therapies. Psychiatric Social Worker – He/she should have a Master degree in social Worker PH.D degree with specialized training in Mental health setting. He is accountable for family Care Work & Community Placement of Pt. he conduct group therapy session.

18. Mental Health Team- 5 . Occupational Therapist Or Activity Therapist – He/she is accountable for recreational, occupational & activity programme. He assist the Pt. to gain skills that help then Cope More effectively to gain environment to Use leisure time Pharmacist – He/she is accountable for provide the Medicine those prescribe by the psychiatrist. Dietician – He/she is accountable for education the Pt.’s family Member did what diet should be taken according to Pt. Counsellor –P rovide basic supportive Counselling & assist in psychoeducational & Recreational activity.

19. Scope of Mental Health Nursing- Mental health Nursing is a specialized area of Nursing practice committed to promote mental health. → The Mental Health Nursing Include the following aspects Psychiatric Nurse - M.H.N is skillful, competent Nurse, who is directly involved in client Care by Implementing Various Nursing Interventions She/he also actively involved in creating & Maintain therapeutic milieu Therapy in psychiatric setting. Establishing client Nurse Relationship in Assessment, planning, Implementations evolution of Nursing action.

20. Scope of Mental Health Nursing- 2. The MHN & Specialist- He/she Nurse with past graduation degree who demonstrate knowledge & skills greater depth. He/she is accountable for providing quality Nursing Care Psychiatric setting by directly involve client, supervision. administration & Training of psychiatric Nurses. He/also administer psychological therapeutic intervention. 3. Conduct of psychotherapy- The M.HN Specialist is actively involve in psychological therapeutic interventions, helping the client in his/her early Recovery.

21. Scope of Mental Health Nursing- 4. Consultation Liaison – Activities in M.HN include helping in emotional, spiritual, developmental, Cognitive or behavioral Response of Client who enter any setting of the health care system with actual or potential psychological dysfunction. The psychiatric liaison also include counselling of health care providers of other clinical specialist area to help them in quality health Care. 5. Case Management – Mental health nursing is also involved in management of client irrespective of setting like a case of lithium overdose in community. The nurse plan and implement program to identified the needs, population at risk and intervention adequately

22. Scope of Mental Health Nursing- 6. Clinical Supervision – The mental health nurse provide clinical supervision to assist other nurses to further develop their practice skills . This process is an educative process focused on professional growth and development 7. Crisis Intervention(Psychiatric Emergency Services) – Unit may be found in the emergency department of a general or psychiatric hospital or with in center in the community. Medical health nurse can work effectively in helping the client who are in crisis.

23. Scope of Mental Health Nursing- 8. Tele Health – Mental health nurse utilize electronic means of communication such as telephone consultation, computers, electronic mail, image transmission and video conferencing and maintain to establish therapeutic relationship with client 9. Self Employment – Mental health nurse can offer direct mental health services to the client who is in need in mental health services. It is not common in country like India. Mental health nurse can provide services to individual, group, community, employee working in organization, industry health department, home care agencies & other services delivery arrangement.

24. Role of Mental Health Nurse in Various Setting Nurse as creator of therapeutic environment- Mental health nurse is required to develop a warm home like atmosphere in the hospital. Providing the client feeling of security, safety in warm, friendliness and relaxation create a therapeutic environment. b. Nurse as A socializing agent- The mental health nurse helped the client in participating in successfully Group activity, Ward Activities Utilizing hidden talent on patient. A skillful nurse utilize the client capacities and abilities in a meaningful way

25. Role of Mental Health Nurse in Various Setting c. Nurse as a counsellor- Mental health nursing is provide adequate counseling regarding every aspect of client in providing holistic care. Some qualities required by the nurse to be a good counsellor or good listener and ability to form good interpersonal relationship d. Nurse as a Teacher- A mental health nurse help the client to dress Appropriately, to eat adequately, to do activities of daily living independently

26. e. Nurses Role in Cure of the Client Disease- The nurse play a significant role in cure of the disease by making yearly diagnosis of the disease so that yearly treatment can be started. She/he is involved in administration of medication helping in ECT and other therapies observing and recording client behavior. f . Nurse as a psychotherapist- A nurse continuously observe and record the client behavior. She listened to the client feeling and a care of his/her needs. Mental health nurse is also carried out session of counseling.

27. g. Role of the Nurse in Rehabilitation of Client- Rehabilitation is a process minimizing psychiatric improvement, social disadvantages and adverse personal reaction so that the disabled client is helped to use his her talent and experience success in social roles. For Rehabilitation the client nurse need to understand clients capacity, needs, limitation.

28. h. Role of the Nurse in Prevention of Mental Illness- Nurses work at primary secondary and tertiary level to prevent mental illness. Primary Prevention can be done by lowering the rate of occurrence new cases. This may include genetic counseling, crisis counseling, medical health teaching family members and community, extend medical health education to school, home and workplace. Secondary prevention can be done by early detection and promote treatment or referral of mental disorder. Tertiary prevention aim at reducing the rate of reoccurrence mental disorder and rehabilitation

29. i . Role of the Nurse in Research- Mental health nurse can play an important role in research for improving the care of the client and helping research by various professional. J. Role of the Nurse in Nursing Education- Mental health nurse play in important role in educating new generation, nursing students so that they can provide quality nursing care to the client. k. Miscellaneous Role- Administration of Wards. Supervision of subordinate. Safe custody of clients etc.

30. Mental Health Act - Mental Health Act was introduced in Rajya Sabha 1981. Mental health bill number XLI Act 14, came into practice as a mental Health Act from 22 may 1987. Mental Health Act has been derived from mental Health Act of England and Wales’ 1959 a amended in 1982. It includes 10 chapters. Reason for Enactment- The attitude of society towards the mentally ill changed consider and stigma associated with it is overcoming. Mental sickness is curable if in is diagnosed early, mentally sick has to be treated like any other sickness and environment has to be normal as possible.

31. Mental Health Act - Objectives- To formulate rules and regulatory procedure related to admission and discharge of client in psychiatric hospital. To protect the society from the mentally ill who have become danger to others. To establish and coordinate the central and state authority's for mental health services. To regulate the power of Govt. for establishing licensing and controlling psychiatric hospitals. To provide legal aid to mentally ill person add state expensive in limited cases.

32. Chapter 1 Describe the terminology related to mental health practice . Mentally ill person- An individual who is suffering with mental disorder and in need of treatment. Licensed psychiatric hospitals- Psychiatric hospital will be inspected and if it is appropriate to have the psychiatric unit facilities will be given permission to treatment the psychiatric people. Medical officer- Gazette medical officer appointed by the state government and permitted to practice. Psychiatrist- Postgraduate holder or diploma holder in Psychiatry recognized by Medical Council of India can be permitted to practice. Reception order- Order made provision for the admission and retention of a mentally person in a psychiatric unit person.

33. Chapter 2 It is deal with establishment of Central and state authorities for development regulation and coordination of mental health services. The authority supervised the functioning of psychiatric unit. It will renew or cancel the license Chapter 3 It provide guideline for establishment and maintenance of psychiatric hospital for example admission procedure, treatment and care of clients and discharge procedure etc.

34. Chapter 4 It described the procedure for admission and detention of the client in psychiatric unit. Chapter 5 It deal with the procedure to be followed for discharge of mentally ill person from a mental hospital . Chapter 6 Judicial injury regarding mentally ill person possessing property their custody and management of property, court may appoint Guardian to look after self and properly.

35. Chapter 7 It deal with cost of maintenance of mentally ill person detected in psychiatric hospital government have the authority to bear the cost of maintenance of mentally ill person. Chapter 8 Describe the protection of human rights mentally ill person. person under treatment cannot be used for research process. Consent has to be obtained either from client (Volunteer admission) or from relatives (involved involuntary admission) for discharge. No communication or no letter which has to be sent to mentally ill, cannot be read or interpreted or destroyed

36. Chapter 9 Establishment and maintenance of mental hospital and penalties procedure also mention. Higher authority be punishable and imprisonment for may extend to six months or fine may extend ₹100 per both. Fine of rupees 100 every day after their first day diving which be found contravention continuous. for improper retention of mentally ill, imprisonment up to two years or five year and rupees 1000 or both.

37. Chapter 10 It’ll deal with clarification pertaining to certain procedure to be followed by the medical officer in charge of these psychiatric officer. The medical officer prepared the report of the hospital every 6 months and will send it to the authorities. In charge medical officer is responsible for the supply of recruitments requirement like food sanitization, medicine etc. in psychiatric hospital.

38. Function of Mental Health Nurse in Various Setting - Inpatient psychiatric ward- Provide for environmental safety including protecting the patient and other from injury. Medication administration accurately observed and document patient behavior. Deliver Psychoeducation. Counselling the patient family member. Teaching social skill & stress management. Discharge planning and community referral and follow up care. Supervised the work of sub ordinates. Maintained cleanliness.

39. Function of Mental Health Nurse in Various Setting - 2. Outpatient psychiatric department- Performing clinical assessment. Providing psychotherapy and behavior therapy. Counseling the patient and family member. Conducting group therapy. Delivered Psychoeducation.

40. Function of Mental Health Nurse in Various Setting - 3. ECT Treatment Setting- Teaching the Patient to ECT Treatment Preparing the patient for ECT. Providing care during the procedure. Assessed with post treatment. Providing the reassurance to reduce anxiety. Deliver psychoeducation regarding ECT.

41. Function of Mental Health Nurse in Various Setting - 4 . Psychotherapy Unit- Clinical nurse specialist may conduct individual and group. Established therapeutic relationship with the patient. Providing opportunity to practices new skills. Providing consistent emotional support .

42. Function of Mental Health Nurse in Various Setting - 5 . Day Care- in day treatment program patient return home at night. Performing clinical assessment. Adequately observe and document patient behavior. Medication administration. Teaching social skills. Counseling the patient and family member.

43. Function of Mental Health Nurse in Various Setting - 6. Family Therapy Unit- Psychiatric nurse work with family at all level of functioning. Assess individual and family needs and resources. Deliver Psychoeducation .

44. Function of Mental Health Nurse in Various Setting - 7. Child Psychiatric Ward- Assess for biological and psychological needs of the child. Provide a safe therapeutic environment include protect the child. Demonstrate and help the child to practices self care skills. To give the instructions regarding living standard. Medication administration. Provide emotional support to patient .

45. Function of Mental Health Nurse in Various Setting - 8. Emergency Department- Crisis intervention during natural disaster, accident, unexpected illness causing increased anxiety and stress. Helping the mother in labour and support person to cope with stress anxiety during labour .

46. Function of Mental Health Nurse in Various Setting - 9. Home Setting- Assessment of symptoms Teaching the patient’s family member regarding nutrition, exercise, hygiene etc. Medication administration. Stress management. Laboratory analysis. Appropriate referral to community agencies. Provide supportive therapy and counseling. Promotion of mental health and Prevention of mental illness .

47. Function of Mental Health Nurse in Various Setting - 10 . Industrial Medical Centre- Implementing and participating in industrial substance abuse program for employ. Provide crisis intervention during accident acute onset of physical or mental illness. Teaching stress management .

48. Concept of Normal & Abnormal Behavior Normal Behavior- When the individual is able to function adequately and perform his daily living activities efficiently and satisfied with his lifestyle. Abnormal Behavior- Disturbance seen in thinking behavior knowledge intelligence, level emotional, or feeling and by doing or acting psychomotor activity.

49. Thank you