Unit 1 mhn.pptx

INTRODUCTION TO MENTAL HEALTH NURSING

1. Unit 1 Introduction to mental health nursing

2. An ability to make adjustments . Sense of personal worth, and importance. Own decision making and problem solving. Sense of personal security and feel secure in group, understand other people problems and motives. Sense of responsibility. Give and accept love . Shows emotional maturity and tolerate frustration. Have a philosophy of life and purpose to his daily activities. Has a variety of interests and well balanced with work, rest and recreation. Lives in the world of reality not fantasy Characteristics of Mentally  Healthy Person

3. Mental Illness Mental and  behavioral disorders are clinically significant conditions characterized by alterations in thinking, mood/emotions, or behaviour associated with personal distress and impaired functioning . Characteristics; 1.Change in thinking, memory, perception, feeling, judgment and speech. 2.Disturbance in day to day activities, work and relationship with important others

4. The disease was viewed by demonic possession, influence of ancestral spirits, result of violating a taboo, neglecting ritual and cultural condemnation. As a result they were beaten, tortured, to make body unsuitable for demon. The  scientific knowledge and truth begins. Pythagoras: (580-510 BC) developed the concept that brain is the seat of intellectual activity. Hippocrates: (460-370 BC) described mental illness as hysteria, mania, and depression. Plato (427- 347 BC) identified the relationship between mind and body. Asciepiades : made simple hygienic measures , diet, bath, massage in place of mechanical restraints. Aristotle suggested release of repressed emotions for the effective treatment of mental illness. Evolution of Mental Health

5. Evolution of Mental HealthThe scientific knowledge and truth begins. Renaissances in Europe on old beliefs. The saddest period in the history of psychiatry. Demons cause hallucinations and delusions hence chain the patients.

6. Some Important Milestones 1773: The first mental hospital was set up in US, Virginia. 1793: Philippe Pinel removed the chains from mentally ill patients confined in Bicetre , Paris and brought a revolution in the country. 1812: The first American textbook in Psychiatry was written by Benjamin Rush. 1912: Eugene Bleuler , a Swiss Psychiatrist coined the term schizophrenia. 1912: The Indian Lunacy Act was passed.

7. 1927:  Insulin shock treatment was introduced for schizophrenia.  1936: Frontal lobectomy was advocated for the management of psychiatric conditions. 1938: Electroconvulsive Therapy (ECT) was used for the treatment of psychosis. 1939: Development of Psychoanalytical theory by Sigmund Freud led to new concepts in the treatment of mental illness. 1946: The Bhore committee recommended setting of five mental Hospitals in the Country.

8. 1949:  Lithium was used for the treatment of mania. Chlorpromazine was introduced in psychopharmacology. 1963: The community mental health centers Act was passed. 1978: The Alma Ata declaration of Health for All by 2000 AD posed major challenge to Indian mental health professionals. 1981: Community psychiatric centers were set up to experiment primary mental health care approach.

9. 1982:  The central council of health , India’s highest policy making body accepted the National Mental Health Policy and brought out the National Mental Health Programme in India. 1987: The Indian Mental Health Act was passed and constituted Central Mental Health Authority (CMHA) and State Mental Health Authority (SMHA). 1990: Formation of Action Group to pool opinion for National Mental Health Programme . Integration of mental health care with general health care, school mental programme , promotion of child mental health, crisis intervention of suicide prevention, halfway homes, IEC etc.

10. 2001:  Current situation analysis (CSA) was done to evolve a comprehensive plan of action to energize the NMHP. 2007: Eleventh five year plan emphasized up gradation and strengthening of mental health hospitals. 2013: WHO launched Mental Health Action Plan 2013-2020. 2013: The Mental Health Care Bill was introduced The bill abolishes the Mental Health Act 1987. Some Important Milestones

11. 2014: Government constituted a committee to create policy for the country. 1872: First training school for nurses based on the Nightingale system was established by the New England Hospital, USA. 1921: Short training courses of 3 to 6 months were conducted in Ranchi. 1943: Psychiatric nursing was started for male nurses. (Tamil Nadu) 1952: Dr. Hildegard Peplau defined the therapeutic roles of nurses in mental health setting. 1953: Maxwell Jones introduced therapeutic community.

12. 1956: One year post- certificate course in psychiatric nursing was started at NIMHANS. 1958: All the wards in Agra Mental Hospital were ordered to be kept open and all ward locks were removed from the charge of the ward attendant . 1963: Journal of Psychiatric Nursing and Mental Health services was published. 1965: The Indian Nursing Council included psychiatric nurse as a compulsory course in B.Sc Nursing Programme .

13. 1967: The TNAI formed a separate committee to set guidelines to conduct classes and clinical training for nursing students. 1973: Standards of Psychiatric and Mental Health Nursing Practice were enunciated to provide a means of improving the quality of care. 1975: M.Sc in Psychiatric Nursing started. 1986: Psychiatric nursing was included in GNM . 1991: Indian Society of Psychiatric Nurses started. 2010: ISPN published its journal.

14. Indian Society of Psychiatric Nurses ISPN started in the year 1991 at NIMHANS under the guidance of Dr. Reddemma . Purpose To enhance the advanced knowledge and skills in the field of psychiatric nursing. To provide a platform for discussion and deliberation on evidence based practice. To create awareness and translate the research finding into practice. ISPN publishes a journal called Indian Journal of Psychiatric Nurses. It also Organizes National and International conferences.

15. 1. Trends in Health Care: Increased mental problems. Provision of quality and comprehensive services. Multi-disciplinary team approach. Providing continuity of care. Care is provided in alternative settings. 2. Economic Issues Industrialization Urbanization Raised standard of living. 3. Changes in the Illness Orientation Shift from Illness to prevention. Quantity of care to quality of care. Specific to holistic care. 4. Changes in the Care delivery Institutional services to community services. Genetic to counseling services. Nurse patient relationship to nurse patient partnership. Current Issues and Trends Care

16. 5. Information Technology Telenursing Telemedicine Mass media Electronic Systems. Nursing Informatics. 6. Consumer Empowerment Increased consumer awareness. Increased community awareness. Demand health care at affordable cost and more humane rates. 7. Deinstitutionnalization Shifting Mental Health care from hospital to Community. 8. Physician Shortage and Gaps in service. Physician shortage provide opportunity for new roles in nursing such as Nurse Practioner . 9. Demographic Changes Increasing number of elderly group. Type of family. 10. Social Changes Intergroup and intragroup loyalty maintenance. Peer Pressure.

17. There is a lack of clearly enunciated definition of the role of a professional psychiatric nurses. Greater emphasis to encourage master degree in psychiatric nursing to encourage teaching non-professionals. Offer diploma in psychiatric nursing to avoid shortage of trained professionals. Maintain minimum standards of psychiatric nursing care in mental hospitals ie , 1:3. Fill vacant positions in concerned educational and practicing institutions. Integration of service and training. Formation of District Mental Health Team comprising of 2 psychiatric nurses and 1 Psychiatrist. Integration mental health services in PHCs and Sub centers. Joined working of hospitals and training centers to build the gap of theory and practice . If not, the hospital staff will have lack of up gradation of knowledge and training centre staff will have lack of up gradation of skills. FUTURE PROSPECTS AND CHALLENGES IN PSYCHIATRIC NURSING

18. The recent prevalence of psychiatric disorders in the country is 18 – 207 per 1000 population and the world scenario is also almost the same. Most of these patients live in rural areas . Most of the time the person visiting a general clinic is not diagnosed for his mental problems rather other diagnosis is made which cause financial burden to the patients. World Scenario (According epidemiological survey by WHO in 14 countries) (a 12 months prevalence in the year 2000-2001) Anxiety disorders : 2.4% to 18.2% Mood disorders: 0.8% to 9.6% Substance disorders 0.1–6.4% Impulse-control disorders 0.0–6.8% Indian scenario (According to an epidemiological study by Ganguli HC, 2000) All Mental disorders 73/1000 population (rural: 70.5 and urban 73) Affective disorder (depression): 34/1000 Anxiety Neurosis: 16.5/1000 Mental Retardation: 5.3/1000 Schizophrenia: 2.5/1000 Prevalence and Incidence

19. According to health information of India 2005 mental morbidity rate is not less than 18-20/1000 According to WHO studies in India the life time prevalence of mental disorders is12.2 to 48.6 %. According Ministry of Health and Family welfare, India, 10000 people every year suffer from acute psychosis. Schizophrenia and bipolar disorders is prevalent at a rate of 200/10000 population. This burden is likely to increase by 15% in 2020. ( Ghanashyan B & Nagarathinam S)

20. In April 2011 the GoI constituted a policy group. Based on the recommendations of the experts The National Mental Health Policy was considered in accordance with World Health assembly resolution. It incorporates an integrated, participatory rights and evidence based approach. VISION Promote mental health Prevent mental illness Enable recovery from mental illness. Promote destigmatization Promote desegregation Provide accessible, affordable and quality mental health and social care to all persons through life span within right based framework. National Mental Health Policy 2014

21. GOALS (LONG TERM DESTINATION) To reduce distress, disability, exclusion morbidity and premature mortality associated with mental health problems. To enhance understanding of mental health in the country. To strengthen the leadership in the mental health sector at the National, State and District Levels.

22. To provide universal access to mental health care. To increase access and utilization of comprehensive mental health care services. To increase the access of the said services to vulnerable groups including homeless, remote areas, deprived (education, economy and socially) sections To reduce prevalence and risk factors of mental problems. Reduce suicide and its attempts. Respect the rights of mentally people and protect them from harms. Reduce stigma associated. Equitable distribution of skilled human resources. Enhance financial allocation and utilization in the sector. Identify and address the social, biological and psychological determinants of mental health problems. Objectives (Short term steps for reaching goal.)

23. Effective governance and delivery mechanisms for mental health Develop policies, programmes , laws regulations and budget. Motivate society and other administrative machineries to implement and monitor the plans. Strategic Actions

24. 2. Promotion of Mental Health Redesign Anganwadi centers and train the workers and teachers to protect children from developing abnormal behaviour . Offer (LSE) Life Skill Education programme to school children. Life-Skills-Education-in- India.pdf Individual attention by teachers for early symptoms. Improve teacher student relationship for free communication. Assist adults in handling stressful life circumstances. Use mass media to disseminate mental health information. Improve life conditions such as homelessness, overcrowding, water, toilets, sanitation and nutrition to prevent mental illness. Improve women mental health and prevent harm to women. Use Ayurveda and Yoga to promote mental Health. Involve mentally ill people in social, economical and other activities, do not discriminate

25. Actions 3. Prevention of mental illness, reduction of suicide ant attempted suicide. Implement programs to address alcohol and other drug abuse. Restrict the distribution of specific drugs and highly toxic pesticides. Frame guidelines for media reporting suicide. Decriminalize attempted suicide. Train community leaders to prevent it.

26. Actions 4. Universal access to mental health services. All multispecialty govt. hospitals should provide family centric mental health services. Increase community based rehabilitation services like day care centers, short stay facilities etc. Caregivers should be given professional inputs and promoted for personal growth. Screening and early detection. Resolve shortage psychiatric beds in hospitals. Improve infrastructure . Improve monetary benefits and tax benefits to care givers. Provide assisted home living and also care homeless patients.

27. 5. Availability of Trained professionals Reduce the gap between requirement and availability of psychiatrists, nurses, psychologists etc. Improve number and quality of the training programmes . Training programmes must incorporate biomedical and psychosocial interventions in the interventions for the patients.

28. 6. Community participation for mental health and development. Simplify procedures for disability certification of persons with mental illness. Protect the rights of mentally ill and modify the legislations accordingly. Promote participation in life activities of mentally ill such as education, housing, employment and social welfare. Involve them in community programmes such as village health, sanitation, water etc and public activities. Provide opportunity for mentally ill for feedback in mental health services.

29. 7. Research More investment and fund allocation in building research capacity for both new and existing organizations. Foster partnership between centers of excellence for mental health and medical colleges and district centers to promote research. Evaluate the potential of traditional, alternative therapies to address mental health problems. Facilitate dissemination of research findings and translate it into action.

30. NHP  formulated in 1983 and revised in 2002 . Objectives To achieve an acceptable standard of good health amongst the general population. Increase approach to decentralized public health system. Establish new infrastructure and update existing infrastructure. National Health Policy

31. Recommendations for Mental Health Upgrade infrastructure of institutions at central government expense to protect the rights of vulnerable group of the society. Promote decentralization of mental health services for more common categories of disorders.

32.   Indian mental health act (MHA) was drafted by the parliament in 1987 but it came into effect in all states & union territories of India in April 1993. This act replaces the Indian lunacy act of 1912. REASONS FOR ENACTMENT The attitude of the society towards the mentally ill has changed considerably & it is now realized that no stigma should be attached to such illness, as it is curable practically when diagnosed at an early stage. Thus the mentally ill individuals should be treated like any other sick persons & the environment around them made as normal as possible. The experience of working of the indian lunacy act,1912 has revealed that it has become outmoded with rapid advancement of medical science & the understanding of nature of malady. It has therefore become necessary to make fresh legislation in accordance with the new approach. Indian mental health act (MHA)

33. OBJECTIVES OF MENTAL HEALTH ACT To regulate admission into psychiatric hospitals & psychiatric nursing homes. To protect society from the presence of mentally ill persons. To protect citizens form being detained in psychiatric hospitals/ nursing homes without any sufficient cause. To regulate maintenance charges of psychiatric hospitals/ nursing homes. To provide facilities for establishing guardianship of mentally ill persons who are incapable of managing their own affairs. To establish central & state authorities for mental health services. To regulate the power s of the government for establishing licensing & controlling psychiatric hospitals /nursing homes. To provide legal aid to mentally ill persons at state expense in certain cases.

34. Multidisciplinary approach to provide service to mentally ill persons. A psychiatrist A psychiatric Nurse A clinical Psychologist A psychiatric social worker An occupational therapist/activity therapist A pharmacist and a dietician. A counselor. A psychiatrist: MD/DNB Psychiatry. Medical diagnosis and treatment. Admission/discharge Psychopharmacology Administer ECT Psychotherapy Team meetings Legal responsibilities.   Mental Health Team

35. A psychiatric Nurse: RN with specialized training. Administer and monitor medications. Assist in physical and psychiatric treatment Interdisciplinary team meeting. Health Education Patients Records Advocate of patient. Relationship with patient’s family.

36. A Clinical Psychologist: Masters/ Doctorate in human psychology. Accountable of psychological assessments/testing. Individual, family and marital therapy. A Psychiatric Social worker: Masters/ Doctorate. Family case work and community placement of patients. Group therapy sessions. Social intervention at patient social environment.

37. Concerned training. Accountable for recreational, occupational and activity programmes . Assist the patients in gaining skills that help them cope more effectively, retain employment and use their leisure time. A Counselor: Concerned training. Provides basic supportive counseling and assists in psycho educational and recreational activities An Occupational Therapist:

38. Nurse Generalist: a licensed nurse providing primary mental health care. Holistic approach, prevention programmes , community and day care centers, psychiatric rehabilitation facilities, homeless shelters etc. Nurse Specialist: Psychiatric Clinical Nurse Specialist (CNS): have a master degree in mental health nursing. Autonomous functioning, prescription privileges, manages overall care of emotional and psychiatric problems. Eg . Crisis interventio0n specialists, Milieu Specialists, Psychotherapists etc. Community Mental Health Nurse (CMHN): Diagnosis, appropriate referrals, care and rehabilitation of mentally ill people in the community. Psychiatric Home Care Nurse: direct patient care, behavioral management, crisis intervention, psycho education, detoxification, medication etc. Forensic Psychiatric Nurse: works with individuals who have entered the legal system. Psychiatric Consultation – Liaison Nurse PCLN: Psychiatric nurse who work in non- psychiatric setting and provide necessary support, guidance and counseling for those affected with anxiety, depression and other psychological problems. Scope of Mental Health Nursing

39. Case Manager: Nurse manager acts as advocates by coordinating care and linking patient with physician and other members of health care team. Works in community and helping in daily living of a mentally ill person such as transportation, managing money, buying things etc. Gero Psychiatric Nurse; Parish Nurse: An RN with spiritual mature. Supports health education, social services, and carry out non-invasive nursing care. Common in US. Tele health / Tele nurse: Nurses engaged in tele -nursing practice use technologies such as internet, computers, telephones, digital assessment tools & tele -monitoring equipment to deliver nursing care. In India around 10 hospitals are having telemedicine departments. Eg . Apollo hospitals, Narayana Hrudayalaya .

40. Nurse Researcher: Nurse researchers design, conduct & disseminate findings of research at professional meets & in peer reviewed journals. They are doctorally or post- doctorally prepared persons who initiate or participate in all phases of the research process. Psychiatric Nurse Educator: Nurse Administrator/Manager Nurse Pharmacologist: The psychiatric clinical nurse specialist with prescriptive authority. Holistic Nurse: Integrates complementary and alternative modalities such as relaxation,

41. INPATIENT PSYCHIATRIC WARD … Provide for environment safety including protecting the patient & others from injury. Perform psychosocial, high risk & physical assessment. Promotion of self care activities. Medication management. Assisting for somatic therapies. Accurately observing & documenting the patient’s behavior. Providing opportunities for the patient to make his own decisions & to assume Provide safe environment and protect from injury. Perform psychosocial, high risk & physical assessment. Promotion of self care activities. Medication management. Documentation of behaviour . Providing opportunities for the patient to make his own decisions & to assume responsibility for his life. Functions of Mental Health Nurse

42. Participation in various therapies, individual interactions, formal & informal group situations, role play, advocating on behalf of the patient & so forth. Delivering psycho-education, social skill and stress management strategies. Counseling the patient & family members.  Interdisciplinary approach to care. Discharge planning & community referral & follow up care.

43. PSYCHIATRIC OUTPATIENT DEPARTMENT Performing clinical assessment. Assisting for psychometric assessment. Assisting or providing psychotherapy or behavior therapy. Counseling the patient & family members. Conducting group therapy. Delivering psycho education. ECT TREATMENT SETTING Preparing the patient for ECT. Providing care during the procedure. Assisting with post treatment. Providing reassurance to reduce anxiety. Delivering psycho education regarding ECT.

44. PSYCHO THERAPY UNIT Establishing a therapeutic relationship with the patient. Providing an opportunity for the patient to release tension as problem are discussed. Assisting the patient in gaining insight about the problem. Providing opportunity to practice new skills. Reinforcing appropriate behavior as it occurs. Providing consistent emotional support. DAY CARE CENTERS OR DAY HOSPITALS Performing clinical assessment /observation/ documentation. Medication management. Teaching social skills. Counseling patient & family members. Delivering psycho education. Providing occupational or recreational therapy & vocational assistance.

45. CHILD PSYCHIATRIC WARD Assessing the child and understand his strengths and abilities. Monitor the child’s developmental levels & initiate supportive interventions such as speech, language or occupational skills as needed. Provide a safe therapeutic environment. Interdisciplinary approach to care. Teach the child adaptive skills such as eating, dressing, grooming & toileting. Deliver psycho education and Medication management, participate in therapies.

46. HOME SETTING Assessment of symptoms. Teaching the patient & family regarding nutrition, exercise, hygiene & the relationship between physical & emotional health. Stress management and Daily living kills (bank accounts, rent, utility bills, use of the telephone, grocery shopping). Medication management Oral/IV– monitoring blood levels, toxicity, side effects & purposes. Acts as a case manager & coordinate an array of services such as therapies.

47. COMMUNITY MENTAL HEALTH CENTERS Identification and referral of patients to appropriate hospitals. Home visiting & providing direct care to the patients in the community. Follow up care with special emphasis on medication regimen, & side effects, patient’s occupational function. Conducting public awareness programs to remove misconceptions regarding mental disorders. Training of other care giving professionals in the community.

48. HOSPICE CARE CENTERS Helping cancer patients or terminally ill individuals through the grieving process. Provide supportive psychotherapy and support their families. EMERGENCY DEPARTMENTS Crisis intervention during natural disasters, accidents, unexpected illnesses causing increased anxiety. Helping the mother in labor & to cope with stress. Providing support to bereaved patients in the event of fetal demise, abortion, birth of an infant with congenital abnormalities.

49. HOSPITALS FOR CRIMINAL INSANE, JAILS & PRISONS Forensic psychiatric nurses assist patients with self care, administration of medications & monitor the effectiveness of the treatment. Provide psychotherapy & act as consultants. Assessment of potential for violence. Parole / probation considerations. Assessment of racial / cultural factors during crime. Formal written reports to court.

50. Nurse Practice acts. Professional Practice Standards Nurse’s Qualification. Philosophy of health Care Organization. The person competence and initiatives of the individual nurse. Factors affecting Level of Mental Health Practice

51. Behaviour is the manner in which a person behaves, whether they can conform to the standards, or not. Types Of Behaviour 1. NORMAL BEHAVIOUR:- Normal is seen as a good thing, something that is natural, regular, or routine. 2. ABNORMAL BEHAVIOUR:- Abnormal is any kind of activity that a person sees as bad behaviour or something that is not common, it can be defined as a birth defect to a mental illness. CONCEPT OF NORMAL AND ABNORMAL BEHAVIOUR

52. NORMAL BEHAVIOUR:- Word normal derived from latin word norma means rule . means followed the rule or pattern or standards. Definition:- when the individual is able to function adquately and performs his daily living activities efficiently and feel satisfied with his life style called as normal behaviour . ABNORMAL BEHAVIOUR :- The word abnormal with prefix , ’ ab ’(away from) means away from normal. Abnormality is negetive concept it means deviation from norm or standard or rules . Definition :- disturbances seen in behaviour which menifests in cognitive domain( thinking,knowing,memory ) affecti ve domain (emotion and feeling ) and conative domain (psychomotor activity) individual express his mental distress through thought, feeling and action .

53. Jahoda (1958) attempted to establish what is abnormal by identifying the characteristics of people who are normal. She identified six characteristics of mental health. Efficient self-perception Realistic self-esteem and acceptance Voluntary control of behavior True perception of the world Sustaining relationships and giving affection Self-direction and productivity Characteristics Of Normal Behaviour

54. Characteristics Of Abnormal Behaviour The 4 "D's" of Abnormality:- D – dysfunction , D – distress, D – deviance , D – dangerousness 1. Dysfunctional: Behaviors and feelings are dysfunctional when they interfere with person's ability to function in daily life, to hold a job, or form relationships. 2. Distress: Behaviors and feelings that cause distress to the individual or to others around him or her are considered abnormal. 3. Deviant: Highly deviant behaviors like chronic lying or stealing lead to judgements of abnormality. 4. Dangerous: Behaviors and feelings that are potentially harmful to an individual or the individuals around them are seen as abnormal.

55. Physiological or Biological Model Behavioural Models Psychodynamic Models Cognitive Model Models Of Normal And Abnormal Behaviour

56. The biological model of abnormality (the only model not based on psychological principles) is based on the assumptions that if the brain, neuro -anatomy and related biochemicals are all physical entities and work together to mediate psychological processes, then treating any mental abnormality must be physical/biological. Part of this theory stems from much research into the major neurotransmitter, serotonin , which seems to show that major psychological illnesses such as bipolar disorder and anorexia nervosa are caused by abnormally The model also suggests that psychological illness could and should be treated like any physical illness (being caused by chemical imbalance, microbes or physical stress) and hence can be treated with surgery or drugs. Biological Model

57. The behavioural model to abnormality assumes that all maladaptive behaviour is essentially acquired through one's environment. Therefore, psychiatrists practising the beliefs of this model would be to prioritise changing the behaviour over identifying the cause of the dysfunctional behaviour . The main solution to psychological illness under this model is aversion therapy, where the stimulus that provokes the dysfunctional behaviour is coupled with a second stimulus, with aims to produce a new reaction to the first stimulus based on the experiences of the second. Behavioural model

58. The psychodynamic model is the fourth psychological model of abnormality, and is based on the work of Sigmund Freud. It is based on the principles that psychological illnesses come about from repressed emotions and thoughts from experiences in the past (usually childhood), and as a result of this repression, The patient is believed to be cured when they can admit that which is currently being repressed Psychodynamic Model

59. The cognitive model of abnormality focuses on the cognitive distortions or the dysfunctions in the thought processes and the cognitive deficiencies, particularly the absence of sufficient thinking and planning. This model holds that these variables are the cause of many psychological disorders and that psychologists following this outlook explain abnormality in terms of irrational and negative thinking with the main position The cognitive model of abnormality is one of the dominant forces in academic psychology beginning in the 1970s and its appeal is partly attributed to the way it emphasizes the evaluation of internal mental processes such as perception, attention, memory, and problem- solving. The process allows psychologists to explain the development of mental disorders and the link between cognition and brain function especially to develop Cognitive model

60. Medical model considers organic pathology as the definite cause for mental disorder. According to this model abnormal people are the ones who have disturbances in thought, perception and psychomotor activities. The normal are the ones who are free from these disturbances. MEDICAL MODEL

61. It involves the analysis of responses on a test or a questionnaire or observations of some particular behavioral variables. The degree of deviation from the standard norms arrived at statistically, characterizes the degree of abnormality. Statistically normal mental health falls within two standard deviations (SDs) of the normal distribution curve. STATISTICAL MODEL

62. The beliefs, norms, taboos and values of a society have to be accepted and adopted by individuals. Breaking any of these would be considered as abnormal. Normalcy is defined in context with social norms prescribed by the culture. Thus cultural background has to be taken into account when distinguishing between normal and abnormal behavior. SOCIOCULTURAL MODEL