MENTAL HEALTH NURSING

SEMINAR ON CURRENT ISSUES AND TRENDS IN

PSYCHIATRY. MENTAL HEALTH SERVICES IN KERALA
INDIA AND GLOBAL
INTRODUCTION

According to the National Institute of Mental Health, nearly one-fifth of adults in the
U.S. live with a mental illness. If you’re passionate about helping others, there are a number of
rewarding opportunities that could allow you to make a difference in people’s lives and help
establish the mental health trends of the future.

Mental health is gaining visibility and services are becoming more accessible, creating
a growing need for psychiatrists — medical doctors who specialize in treating mental illness
and a range of disorders that affect people of all ages. Also in high demand are the services of
non-physician providers who offer counselling and support services in areas such as
behavioural disorders, substance abuse, and other types of mental health issues

PSYCHIATRY

Mental health refers to cognitive, behavioural, and emotional well-being. It is all about
how people think, feel, and behave. People sometimes use the term “mental health” to mean
the absence of a mental disorder.

Definition

“Mental health is a state of well-being in which an individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively, and is able to make
a contribution to his or her community.” – WHO

The WHO stress that mental health is “more than just the absence of mental
disorders or disabilities.” Peak mental health is about not only avoiding active conditions but
also looking after ongoing wellness and happiness. They also emphasize that preserving and
restoring mental health is crucial on an individual basis, as well as throughout different
communities and societies the world over.

“A state of mind characterized by emotional well-being, good behavioural adjustment,

relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive
relationships and cope with the ordinary demands and stresses of life” - APA

TRENDS IN PSYCHIATRY

Many of the changes will have to do with what researchers learn about the brain. It’s
possible that the future of psychiatry will involve advanced technology and techniques such as
deep brain stimulation — implanting activated electrical nodes inside the brain — which has
already proven effective in the treatment of Parkinson’s and other movement disorders. Deep
brain stimulation, however, isn’t yet fully understood to the point where it’s ready for
psychiatric use.

1. Trends in health services

The future of psychiatry will likely be increasingly personalized — and patients may
not even need to leave their homes to access care. Already, virtual therapy websites set patients
up with online sessions, allowing them to access therapeutic support they otherwise might not
receive. This brings easily accessible therapy to rural communities and to people who may not
feel comfortable going to a therapist’s office. Many insurance policies now cover these virtual
treatments, and increased availability in internet bandwidth and camera technology means
those sessions can be just as effective as seeing a therapist in person

2. Increased mental health problem

o Mental health in younger age

Mental illness is on the rise among adolescents and young adults, and factors like social
media may be the leading cause.

According to a study published by the American Psychological Association, the rates

of mood disorders and suicide-related events have significantly increased in the last decade
within these age groups, especially among females and the wealthy.

o Effect of covid 19

The new realities of working from home, temporary unemployment, home-schooling

of children, and lack of physical contact with other family members, friends and colleagues
take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of
contracting the virus and worry about people close to us who are particularly vulnerable, are
challenging for all of us. They can be particularly difficult for people with mental health
conditions.

The new realities of working from home, temporary unemployment, home-schooling

of children, and lack of physical contact with other family members, friends and colleagues
take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of
contracting the virus and worry about people close to us who are particularly vulnerable, are
challenging for all of us. They can be particularly difficult for people with mental health
conditions.

3. Provision for quality and comprehensive services

Everyone should have access to basic mental health care that is affordable, equitable,
geographically accessible, available on a voluntary basis, and of adequate quality. Working to
improve the quality of care in both in‐ and outpatient facilities is important, not only to reform
past neglect, but to ensure the development of effective and efficient care in the future.

High quality services require the use of evidence-based practices and must incorporate
human rights principles, respect autonomy and protect people’s inherent dignity. Quality
services must also promote recovery by putting at the forefront individuals’ goals and
aspirations to lead fulfilling lives in the community.

Mental health services need to go beyond the provision of medical treatment but also
encompass the important roles of supporting individuals to access employment, housing,
educational opportunities, and to engage in community activities and programmes. Service
standards that reflect evidence, best practice and human rights standards need to be
implemented and closely monitored in order to put an end to human rights violations and
promote quality mental health care that promotes recovery and positive outcomes for people
with mental disabilities.

4. Multidisciplinary team approach

The different professions all have different areas of expertise so that they can combine
their skillsets if necessary to tackle complex and challenging mental health conditions.
The MDT meets regularly to discuss its work with individuals, so that each service user has a
care plan best suited to their individual needs.

• Medical team

Medical care team consists of consultant psychiatrists and registrar psychiatrists (these are
graduate doctors in training to become consultant psychiatrists).

A psychiatrist is a physician (a medical doctor) who specialises in the prevention, diagnosis

and treatment of mental, addictive and emotional disorders.
 • Social work

Social work help is provided through information, advice, counselling and advocacy. It is
often directed towards enabling service users to deal more effectively with matters of social
and emotional concern which may affect themselves and their dependants, and to access
potentially beneficial services and resources relevant to various aspects of life; these include
rehabilitation, social care, the protection of children and vulnerable adults, income
maintenance, accommodation and welfare rights.

• Pharmacist

Pharmacists work with our medical and nursing colleagues to promote safe and effective
use of medicines

• Occupational therapy

Occupational therapy is a profession concerned with what we do in our daily lives (our
occupation) and how this both affects and is affected by normal health

Occupation includes:

• Looking after yourself (self-care)

• Enjoying your life and being with others (leisure and social life)

• Being productive (for example, work or college activities).

The main goal of occupational therapy is to support you to take part in the everyday
activities that matter to you. Occupational therapy aims to contribute to your sense of
wellbeing, independence and satisfaction in daily life.

• Nursing

Nursing is the use of clinical judgement in the provision of care to enable people to
improve, maintain, or recover health, to cope with health problems and to achieve the best
possible quality of life, whatever their disease or disability, until death

Roles and responsibilities

 Ward-based nurses provide care and treatment 24 hours a day, seven days a week. The
type of care and level of intervention provided by nurses is individualised and dependent
upon the service user’s needs. However, the care delivered encourages independence and is
underpinned by a recovery-orientated philosophy.

Nurses provide many types of interventions at ward level including:

• Assessment

• Psychoeducation

• Supportive observation

• Supportive counselling

• Assistance with the performance of basic activities of living

• Working with you to develop your mental health literacy

• Delivery of our inpatient Wellness Recovery Action Plan (WRAP) programme

• Working with the service user on the development of their initial individual care plan.

Nurses also fulfil specialist and advanced practice roles in all clinical programmes, such as
assessment, psychotherapy and facilitation of therapeutic groups. These programmes include:

• Depression

• Bipolar disorder

• Anxiety disorders

• Eating disorders

• Young adult

• Care of the elderly

• Psychosis recovery.

5. Providing continuity of care

Patients are increasingly seen by an array of providers in a wide variety of organisations

and places, raising concerns about fragmentation of care. Policy reports and charters worldwide
urge a concerted effort to enhance continuity, but efforts to describe the problem or formulate
solutions are complicated by the lack of consensus on the definition of continuity.
Two core elements are seen in continuity of mental health

o care of an individual patient.

o care delivered over time

Types of continuity

There are three types of continuity

• Informational continuity—The use of information on past events and personal

circumstances to make current care appropriate for each individual

• Management continuity—A consistent and coherent approach to the management of a

health condition that is responsive to a patient’s changing needs

• Relational continuity—An ongoing therapeutic relationship between a patient and one or

more providers

6. Care provided in alternative setting

Mainly there is 12-Step Programs and Support Groups

In addition to psychotherapy and medications, there are many other types of mental
health treatment options people may want to consider. Support groups and 12-step programs
may be good complementary therapies for people who are undergoing psychotherapy and
taking medication.

These groups are available for people dealing with a wide range of mental or
behavioural health and substance abuse problems, including:

• Alcohol abuse.
• Drug abuse
• Gambling, shopping, video gaming, and other behavioural addictions.
• Anxiety and depression.
• Eating disorders.

Twelve-step programs use an approach built on the 12 steps of Alcoholics Anonymous.

Participants often work with a sponsor to complete the 12 steps, and the sponsor is available to
help the person with other issues they may be struggling with during recovery, including
cravings.
 Many programs have a spiritual component, but they do not require participants to be
religious. Participants choose a “higher power” that they can use to help guide them through
the recovery process. This higher power can be whatever the participant wants: God, music, or
nature. Though support groups and 12-step programs are free and beneficial, they do not
provide medical supervision or offer professional therapy

7. Changes in illness orientation

Mental health is the foundation for emotions, thinking, communication,

learning, resilience and self-esteem. Mental health is also key to relationships, personal and
emotional well-being and contributing to community or society.

In older days Many people who have a mental illness do not want to talk about it. But
today lots of people admitting that mental illness is nothing to be ashamed of It is a medical
condition, just like heart disease or diabetes. Most of mental health conditions are treatable.
Research in psychiatric field is continually expanding their understanding of how the human
brain works, and treatments are available to help people successfully manage mental health
conditions.

Mental illness does not discriminate; it can affect anyone regardless of your age, gender,
geography, income, social status, race/ethnicity, religion/spirituality, sexual orientation,
background or other aspect of cultural identity. While mental illness can occur at any age,
three-fourths of all mental illness begins by age 24.

And now a days the treatment of psychiatric conditions is mainly focusing on

preventive aspect rather than the curative aspect. So, the view point of society towards the
mentally illed ones are changed rapidly.

8. Standards of Mental Health Nursing

The development of standards for nursing practice is a beginning step towards the
attainment of quality nursing care. The adoption of standards helps to clarify nurses’ areas of
accountability, since the standards provide the nurse, the health agency, other professionals,
patients, and the public, with a basis for evaluating practice. Standards also define the nursing
profession’s accountability to the public. These standards are therefore a means for improving
the quality of care for mentally ill people.
 9. Development of code of ethics

This is very important for a psychiatric nurse as she takes up independent roles in
Psychotherapy, behaviour therapy, cognitive therapy, individual therapy, group therapy,
maintains patient’s confidentiality, protects his rights and acts as patient’s advocate.

10. Legal aspects in psychiatric nursing

Knowledge of the legal boundaries governing psychiatric nursing practice is necessary

to protect the public, the patient, and the nurse. The practice of psychiatric nursing is influenced
by law, particularly in its concern for the rights of patients and the quality of care they receive.
The patient’s right to refuse a particular treatment, protection from confinement,
intentional torts, informed consent, confidentiality, and record keeping are a few legal issues
in which the nurse has to participate and gain quality knowledge.

11. Promotion of research in mental health nursing

The nurse contributes to nursing and the mental health field through innovations in
theory and practice and participation in research. The nurse's function in the community-
oriented work was to act at the individual, group and society level, as well as to mobilize
resources among individuals and organizations, in order to create a favourable interaction,
resulting in health and empowerment for the individual. Pre-conditions for leading this work
were: knowledge of health and mental all health among the elderly, investigation methodology,
knowledge about the local society, as well as pedagogical, supervisory and social competence.

12. Cost effective nursing care

Studies need to be conducted to find out the viability in terms of cost involved in
training a nurse and the quality of output in terms of nursing care

13. Focus of care

A psychiatric nurse has to focus care on certain target groups like the elderly, children,
women, youth, mentally retarded and chronic mentally ill.

EMERGING TRENDS ON 2021

1. Healing the political divide

 This points out that how did we become such a divided nation, and how can psychologists
help us bridge the gap. To decrease the political divide, we must understand the various factors
that work to divide us. One thing we can do right now as individuals is pause and consider our
thoughts, feelings, and behaviours and identify the psychological factors at play. The ability to
place our own behaviours and the behaviours of others into a psychological framework can
allow us to reflect on what we are experiencing and help us to understand and shape our actions.
Psychologists, whether scientists, clinicians, educators, or otherwise, have a particular
expertise they can apply to bridging the political divide.
Advocacy is essential as well. Other countries that have made strides in addressing the
political divide relied heavily on government-led reconciliation efforts.
2. Social media increasing impact

There are 3 ways psychologists are broadening their reach via social platforms
1.Researchers are releasing results earlier
Psychologists are increasingly sharing work that’s still in progress in this area. Building
on the field’s leadership in the open science movement, psychologists are now leveraging
social media to share data sets and preliminary findings with other scientists, policymakers,
and the general public. Early insights during the pandemic have helped promote mask-wearing.
Also, they produce “the avalanche of false information” about the coronavirus, and address the
mental health challenges associated with social isolation.
2.Clinicians are sharing more mental health advice
As the pandemic unfolds, clinicians have also been sharing relevant research
and practical tips for juggling remote work and childcare and helping patients use telehealth.
Through these public interactions, “psychologists are being more vulnerable and human
3.Psychologists are reaching a diverse audience
We can use social media as a way of ‘giving psychology away’ so that it isn’t something
that only an elite educated group gets, but something that everyone has access to. More people
can get the service of psychologist and psychiatry therapy through the help of the social media
apps, or any other online websites.
3. The fight against racism must continue

Psychologists are looking inward to dismantle racism within the field. in the midst of
America’s racial reckoning, psychologists are playing a key role in rethinking bias, policing,
and other issues. But psychologists say the field itself has its own systemic injustices to
dismantle. It is found that substantial racial inequality in publishing, research he hopes gains
more traction as the field takes a closer look. Others in the field are shedding light on unfair
practices in the hiring, training, and retention of faculty and practitioners of colour. In some
cases, racial inequities are even being addressed more broadly at the systemic level.
4. Psychology research is front and center

Though the COVID-19 pandemic has disrupted research, it has also highlighted the
importance of psychology. Physical distancing requirements around the COVID-19 pandemic
have created undeniable difficulties for many psychology research projects that relied on in-
person interactions, forcing academics to be flexible and creative.
In response, many researchers are moving as much work as possible online. Meanwhile,
funding agencies are supporting accommodations on existing grants where possible and will
likely be turning an eye toward research that could help prepare for the next pandemic.
5. Mental health apps are gaining traction

Self-help apps are leading more people to therapy rather than replacing it, psychologists
say. The COVID-19 pandemic could accelerate the development of mental health apps. That’s
good news for psychology because these types of apps can lead users to therapy and enhance
treatment, say psychologists.

Mental health-related self-help apps now number somewhere between 10,000 and
20,000. The number can be hard to track as new apps are constantly being developed and older
ones are taken off the market. And while some psychologists may worry that apps could replace
therapy, that’s not happening, Apps can also help patients address co-occurring problems like
insomnia or serve as booster sessions once therapy has ended.
6. COVID-19 has reshaped APA’s advocacy
New advocacy efforts may lead to positive long-term gains. For mental health
inclusion. APA has been pressing legislators to include sizable levels of mental health and
psychosocial services in federal COVID-19 relief plans and to address the disproportionate
effects of the virus on vulnerable populations, including nursing home residents, people of
colour, Native Americans, and veterans.
APA has also been addressing the psychological effects of COVID-19 on older adults.
As one example, APA submitted research-based testimony at a Senate hearing in June 2020
describing how social isolation and loneliness can harm people’s long-term health and how
psychologists can increase people’s resilience.
7. For tele mental health
 In April 2020, APA scored a major victory for psychologists and their patients by
helping expand access to, and reimbursement for, Medicare telehealth services. Specifically,
the Centres for Medicare & Medicaid Services (CMS) temporarily lifted restrictions so patients
can receive these services in any geographic location and setting, including their homes. In
addition, CMS expanded coverage of certain elemental health services and temporarily waived
certain requirements so that during the pandemic psychologists can provide most of their
typical services via audio-only telephones.
8. For evidence-based interventions
APA is ramping up efforts to educate policymakers on how psychological science can
continue to help people cope with and respond to the pandemic
APA is also advocating for research funding and more accurate data collection to study the
ways in which COVID-19 disproportionately harms racial and ethnic populations and to
determine how to target prevention and treatment in communities most at risk.
9. Other emerging trends in psychiatry

• The great distance learning experiment continues

• There’s a new push to reach underserved communities
• Psychology’s involvement in policing
• Psychologists are moving up in academia
• Online therapy is here to stay
• Advocacy will help secure expanded telehealth coverage
ISSUES

Issues facing mental health care delivery are only exacerbating the problem of mentally
affected ones.
Successful treatment of these conditions requires regular access to mental health care
professionals and various support services can accelerate the curing rate of mentally ill ones.
1. Ethical issues
o Ethical dilemmas

Ethical dilemmas are common in mental health settings. Often, they arise because the
presence of mental disorders causes many patients to lack capacity to make decisions for
themselves and to depend on clinicians to attend to their best interests in ethics and law.
However, patients are also vulnerable to clinicians as a result of their lack of autonomy, and
there is a sad history of the abuse and exploitation of patients by mental healthcare
professionals. Ethical tensions also arise because mental healthcare is delivered by clinical
teams comprising different types of people with different views, roles and responsibilities.

o The Right to Refuse Medication

The AHA’s (1992) Patient’s Bill of Rights states: “The patient has the right to refuse
treatment to the extent permitted by law, and to be informed of the medical consequences of
his action.” In psychiatry, refusal of treatment primarily concerns the administration of
psychotropic medications.

o The Right to the Least-Restrictive Treatment

Alternative Health-care personnel must attempt to provide treatment in a manner that least
restricts the freedom of clients. The “restrictiveness” of psychiatric therapy can be described
in the context of a continuum, based on severity of illness. Clients may be treated on an
outpatient basis, in day hospitals, or through voluntary or involuntary hospitalization.
Symptoms may be treated with verbal rehabilitative techniques and move successively to
behavioural techniques, chemical interventions, mechanical restraints, or electroconvulsive
therapy. The problem appears to arise in selecting the least restrictive means among involuntary
chemical intervention, seclusion, and mechanical restraints

2. Economic issues

• Industrialization
One of the things that is less well understood is how the industrialisation of mental health
work has driven this reform through the introduction of a diluted model of cognitive
behavioural therapy (CBT) through the rolling out of the UK’s largest public mental health
programme, Increased Access to Psychological Therapies (IAPT). The ‘evidence base’ for
IAPT services has been established through the introduction of performance data and
management techniques that have become highly contested within the sector
• Urbanization
Urbanisation plays an important role in the social structure of a country and in the national
and regional economy worldwide There is a strong indication that urban people were expected
to report mental illness and depressive symptoms more likely than rural, mainly because of the
cultural factors resulted from fast pace of life. The series of chaos and social deviance related
to urbanisation is enormous. Some of them are: severe mental disorders, anxiety, depression,
alienation, family disintegration etc. These mental health problems of urbanisation affect whole
of the population, especially the so-called vulnerable section: children, women and elderly.
There is a need to spread awareness about the mental illnesses across all the sections of society.
This will serve as a facilitator of change in a fast-transforming Indian society
• Raised standard of living

Poverty increases the risk of mental health problems and can be both a causal factor and a
consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics
(including inequalities) of the social, economic and physical environments in which people
live. Successfully supporting the mental health and wellbeing of people living in poverty, and
reducing the number of people with mental health problems experiencing poverty, require
engagement with this complexity.
3. Legal issues
• Informed consent

According to law, all individuals have the right to decide whether to accept or reject
treatment. A healthcare provider can be charged with assault and battery for providing life-
sustaining treatment to a client when the client has not agreed to it. The rationale for the
doctrine of informed consent is the preservation and protection of individual autonomy in
determining what will and will not happen to the person’. Although most clients in
psychiatric/mental health facilities are competent and capable of giving informed consent,
those with severe psychiatric illness do not possess the cognitive ability to do so. If an
individual has been legally determined to be mentally incompetent, consent is obtained from
the legal guardian. A client or guardian always has the right to withdraw consent after it has
been given. When this occurs, the physician should inform (or re-inform) the client about the
consequences of refusing treatment. If treatment has already been initiated, the physician
should terminate treatment in a way least likely to cause injury to the client and inform the
client or guardian of the risks associated with interrupted treatment
• Restraints and Seclusion

An individual’s privacy and personal security are protected by the Patient Self-
determination Act of 1991. This legislation includes a set of patient rights, one of which is an
individual’s right to freedom from restraint or seclusion except in an emergency situation. The
use of seclusion and restraint as a therapeutic intervention for psychiatric patients has been
controversial and many efforts have been made through federal and state regulations and
through standards set forth by accrediting bodies to minimize or eliminate its use. Because
there have been injuries and deaths associated with restraint and seclusion, this treatment
requires careful attention when it is used. Further, the laws, regulations, accreditation standards,
and hospital policies are frequently being revised so it is important for anyone practicing in
inpatient psychiatric settings to be well informed in each of these areas.

• False imprisonment

Health-care workers may be charged with false imprisonment for restraining or secluding—
against the wishes of the client—anyone having been admitted to the hospital voluntarily.
Should a voluntarily admitted client decompensate to a point that restraint or seclusion for
protection of self or others is necessary, court intervention to determine competency and
involuntary commitment is required to preserve the client’s rights to privacy and freedom.

4. Commitment Issues
• Voluntary Admissions
Each year, more than one million persons are admitted to health-care facilities for
psychiatric treatment; of these admissions, approximately two-thirds are considered voluntary.
To be admitted voluntarily, an individual makes direct application to the institution for services
and may stay as long as treatment is deemed necessary. He or she may sign out of the hospital
at any time unless, following a mental status examination, the health-care professional
determines that the client may be harmful to self or others and recommends that the admission
status be changed from voluntary to involuntary. Although these types of admissions are
considered voluntary, it is important to ensure that the individual comprehends the meaning of
his or her actions, has not been coerced in any manner and willing to proceed with admission
• Involuntary Commitment
Because involuntary hospitalization results in substantial restrictions of the rights of an
individual. Involuntary commitments are made for various reasons.
Most states commonly cite the following criteria:
■In an emergency situation (for the client who is dangerous to self or others)
■ For observation and treatment of mentally ill persons
■ When an individual is unable to take care of basic personal needs (the “gravely
disabled”)
• Emergency Commitments
Emergency commitments are sought when an individual manifests behaviour that is
clearly and imminently dangerous to self or others. These admissions are usually instigated by
relatives or friends of the individual, police officers, the court, or health-care professionals.
Emergency commitments are time limited, and a court hearing for the individual is scheduled,
usually within 72 hours. At that time the court may decide that the client may be discharged;
or, if deemed necessary, and voluntary admission is refused by the client, an additional period
of involuntary commitment may be ordered. In most instances, another hearing is scheduled
for a specified time (usually in 7 to 21 days).
• Involuntary Outpatient Commitment
Involuntary outpatient commitment (IOC) is a court ordered mechanism used to compel
a person with mental illness to submit to treatment on an outpatient basis. A number of
eligibility criteria for commitment to outpatient treatment have been cited.
Some of these include:
■ A history of repeated decompensation requiring involuntary hospitalization
■ Likelihood that without treatment the individual will deteriorate to the point of
requiring inpatient commitment
■ Presence of severe and persistent mental illness (e.g., schizophrenia or bipolar
disorder) and limited awareness of the illness or need for treatment
■ The presence of severe and persistent mental illness contributing to a risk of becoming
homeless, incarcerated, or violent, or of committing suicide
■ The existence of individualized treatment plan likely to be effective and a service
provider who has agreed to provide the treatment
5. Nursing Liability
Mental health practitioners—psychiatrists, psychologists, psychiatric nurses, and social
workers—have a duty to provide appropriate care based on the standards of their professions
and the standards set by law
• Malpractice and Negligence
The terms malpractice and negligence are often used interchangeably. Any person may be
negligent. In contrast, malpractice is a specialized form of negligence applicable only to
professionals.
In the absence of any state statutes, common law is the basis of liability for injuries to
clients caused by acts of malpractice and negligence of individual practitioners. In other words,
most decisions of negligence in the professional setting are based on legal precedent (decisions
that have previously been made about similar cases) rather than any specific action taken by
the legislature
MENTAL HEALTH SERVICES IN KERALA, INDIA AND ABROAD

MENTAL HEALTH SERVICES IN KERALA

District mental health programme (DMHP)

The main objective of DMHP is to provide community mental health services and
integration of mental health with general health services through decentralization of treatment
from specialized mental hospital-based care to primary health care services. On the basis of
“Bellary model” district mental health program was launched in 1996 in 4 districts under
NMHP.

The program was re-strategized in 2003 to include two schemes

i. Modernization of state mental hospitals
ii. Up-gradation of psychiatric wings of medical colleges/general
hospitals.
The manpower development scheme (scheme-a & b) became part of the program in 2009.
components
• Treatment of mentally ill
Give adequate treatment to those who suffering from serious mental ill conditions in their
nearest area it self
• Rehabilitation
Provide other supportive methods to encourage the patient that cured from mental illness and
thus help them to practice normal life as much as possible
• Prevention and promotion of positive mental health.
Reduce the chance of mental disorder by identifying the cause in primary stage of disease or
identifying the predisposing and precipitating factors and reduce the risk of mental disorders
and promote positive mental health
Aims
• Prevention and treatment of mental and neurological disorders and their associated
disabilities
• Use of mental health technology to improve general health services
• Application of mental health principles in total national development to improve quality
of life
• Modernization of state mental hospitals
• IEC
 • Monitoring & evaluation
• Early detection of patients within the community itself.
Objectives
• To ensure the availability and accessibility of minimum mental healthcare for all in the
foreseeable future
• To encourage the application of mental health knowledge in general healthcare and in
social development
• To promote community participation in the mental health service development
• To enhance human resource in mental health sub- specialties.
• Up gradation of psychiatry wings of government medical colleges/ general hospitals
• To provide sustainable mental health services to the community and to integrate these
with health services.
• To see that, patients and their relatives do not have to travel long distance to go to
hospitals or nursing homes in the cities.
• To take pressure off the mental hospitals and medical colleges.
• 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
The components of DMHP
• Training of medical and paramedical personnel in mental health skills.
• Community mental health care through existing infrastructure of the health services
• Information, education and communication activities.
• Community oriented rehabilitation services. DMHP, tvpm was established in 1999
first in Kerala.
DMHP’s targeted interventions
“THALIRU” – school mental health programme
“THANAL”-geriatric mental health programme
“JEEVARAKSHA”-suicide prevention programme
“MUKTHI”-substance abuse prevention programme
“BODHANA”-stress management programme
“SANTHWANAM”- occupational therapy units
State mental health authority

Exercise of the powers conferred by provision to section 4 of the mental health act,
1987 the state mental health authority was constituted by government of Kerala on November
1, 1993 the state authority constituted as the above has been reconstituted several times. As per
section 55 of mental healthcare act-2017.
The following are the functions of state mental health authority
The state authority shall-

➢ Register all mental health establishments in the state except those referred to in
appropriate section and maintain and publish a register of such establishments
➢ Develop quality and service provision norms for different types of mental health
establishments in the state
➢ Supervise all mental health establishments in the state and receive complaints about
deficiencies in provision of services
➢ Register clinical psychologists, mental health nurses and psychiatric social workers in
the state to work as mental health professionals, and publish the list of such registered
mental health professionals in such manner as may be specified by regulations by the
state authority
➢ Train all relevant persons including law enforcement officials, mental health
professionals and other health professionals about the provisions and implementation
of this act
➢ Discharge such other functions with respect to matters relating to mental health as the
state government may decide
1. Envisaged role and functions

In light of the mental healthcare act, 2017, SMHA role and functions have increased
beyond the routine work of licensing as well as inspection of psychiatric hospitals / nursing
homes. Following are the envisaged roles and functions of SMHA: -

A. regulatory role
• Making guidelines for ensuring minimum standard of quality for mental health
facilities providing mental health services like long stay home (LSH) and half way
homes (HWH), general hospital psychiatric unit (GHPU) and de addiction centers
• Initiate setting of accreditation standards and processes for capacity building and
training of mental health professionals of different competencies, such as counselors,
 general practitioners etc. Facilitate and encourage the delivery of mental health training
by the NGO sector.
B. development of services
• Large scale awareness drive and sensitization about mental health problems and
remedial measures; public awareness about issues like legal rights, mental health and
illness and other related subjects
• Strengthening role in bringing about an attitudinal change among various stakeholders
on the subject and treatment of mental health problem
• Focusing on the role of NGOs in addressing homelessness problem of mentally ill with
support from government bodies, legal authorities and police agencies
• Strengthening role of NGOs as nodal agencies in monitoring, evaluation and continuous
updated surveys of mental health issues
• Facilitating legal assistance to mentally ill patients and provide legal aid in conjunction
with agencies like legal services authorities
• Sensitization/orientation drive for police and judicial officers and other regarding mental
health legislation & mental healthcare act of 2017.
• Increase awareness and support advocacy for civil and political participation of people
with mental illness in every day process of the society.
• Help the state government draft the comprehensive state mental health plan including
mental health services, human resource development and long-term system of ongoing
analysis and monitoring of mental health needs and services in the state.
2. Medical college psychiatric unit

Every medical college should ideally have a department of psychiatry with minimum of
three faculty members and inpatient facilities of about 30 beds as per the norms laid down by
the medical council of India. Out of the existing medical colleges in the country, approximately
1/3rd of them do not have adequate psychiatric services. This is a scheme for strengthening of
the psychiatric wings of government medical colleges/hospitals. The aim of the scheme is to
strengthen the training facilities for under-graduates & post-graduates at psychiatry wings of
government medical colleges/hospitals.

3. General hospital psychiatric unit

4. General hospital psychiatry units (GHPUs) are the major providers of mental health
services in India. Unlike in high-income countries, GHPUs in India are also the main
 training centres for providing postgraduate training in psychiatry and allied disciplines.
GHPUs have been a revolutionary development in India with great contribution in the field
of mental health. GHPUs have been involved in multiple roles including clinical care,
teaching, community outreach services, and research. In India, fully functional GHPUs
with both outpatient as well as inpatient setups exist mainly in the medical schools. GHPUs
in the private sector generally provide only outpatient services, with skeletal inpatient
services. GHPUs in tertiary care settings exist in medical schools, super-specialty and
multi-specialty hospitals, and hospitals attached to various public sector organizations such
as the railways, public sector undertakings (PSUs), and the armed forces. Most of the
GHPUs at the district hospital level are manned by a psychiatrist and a nurse
5. Opd and emergency services

Urgent psychiatric services provide rapid access to psychiatric assessment and short-term
treatment in an outpatient setting for patients with acute mental health needs. As an
intermediate level of care between community-based services and acute care (for example, ED
or inpatient) services, urgent psychiatric care programs may serve the dual roles of prevention
of escalation of an urgent situation to an emergency situation, and ongoing assessment and
stabilization during a period of sustained urgency after an ED visit or inpatient admission

6. Community psychiatric health services

From its start in 1999, DMHP TVM was conducting clinics directly in selected PHCS,
CHCS & thaluk hospitals. During the initial periods these clinics were conducted every two
weeks, and later on, as number of clinics increased, clinics were conducted monthly. Since
then, there has been a steady increase in number of patients, to about 2000 per month. This
amounts to 150-200 patients per clinic. This started to affect quality of care giving. It was in
this backdrop that DMHP TVM decided to integrate mental health into primary care. This
process of primary care integration started in august 2011 with training of JHIS in mental
health.

As on April 2012, DMHP TVPM has completed the 1st phase of the process of integration
of mental health into primary health care. As part of this, training in mental health skills have
been imparted to general care physicians, pharmacists, community health workers and ASHA
workers of government hospitals across the district where DMHP clinics are being conducted.

Now, weekly psychiatric clinics are conducted in government hospitals under DMHP. Of
the 4 weekly clinics every month, one clinic is directly conducted by DMHP while other 3 are
conducted by trained medical officers of the concerned institution. A case sheet has been
prepared and filled by interviewing the patient and family, for the purpose of verification and
follow up by the medical officers. DMHP clinics will examine new cases and cases referred by
medical officers conducting the other three clinics. Psychotropic medicines are provided to the
respective pharmacists, to be supplied to the patients. A register for the psychiatry op is also
provided by DMHP. The programme ensures that the patients are monitored regularly and all
medications given free of cost.

This process of integration is first of its kind in Kerala and is of immense help to mentally
ill patients, as psychiatric care and medicines become easily accessible to them. Welcoming
attitude from the medical officers is a good sign of the changing scenario of the entire health
care itself.

Monthly DMHP clinics

referral for follow up

Medical officers concerned PHCs, CHCs

bringing them to reporting drop out cases

reporting
Health workers (JHI, JPHN, HI,
LHI)
Asha and Case
anganwadi detection ensuring regular follow ups
workers and helping in rehabilitation

Mental health issues and cases in

community

HEALTH SERVICES IN KERALA

National mental health act 2017

On April 7 2017, the president gave his vote to the mental healthcare bill and with that the
mental health care act 2017 came to existence. This act provides for the persons who are
suffering with mental illness with healthcare and services to protect their rights

Prohibited procedures
'Few procedures which seems barbarian and clearly against human rights are prohibited
exclusively. These procedures make mental healthcare seem to be an entirely gruesome
experience but these patients need to be aware that these procedures are forbidden and that they
need not be scared and come forth with the treatment in a positive attitude.

• Electro-convulsive therapy without the use of muscle relaxants and anaesthesia,

• Electro-convulsive therapy for minors,
• Sterilization of men or women, when such sterilization is intended as a treatment for
mental illness,
• Chained in any manner or form whatsoever.
• No psychosurgery shall be performed until:
• The informed consent of the patient on whom surgery is being performed.
• Approval from the concerned board to perform the surgery.

Role of central mental health authority

It will enlist and register all the mental healthcare institutions under the control of the
central government, and will fund and direct quality services that need to be maintained for
different types of mental institutions and list of all the medical professionals which are to be
contacted in case of emergency.

Decriminalisation of attempt to suicide

The appropriate government shall have a duty to provide care, treatment and
rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce
the risk of recurrence of attempt to commit suicide.

This shows how the formation of the act has allowed the sensitive care that has to be taken to
such victims of suicide who are mentally stressed and unaware about their wellbeing, this act
has allowed now to take special care to such cases wherein the victim has attempted suicide
due to stress or mental illness and has provided provisions through which they cater to the
needs of mentally unhealthy or unfit personnel.

National mental health programme 1982

One in four families is likely to have at least one member with a behavioural or mental
disorder (who 2001). These families not only provide physical and emotional support, but also
bear the negative impact of stigma and discrimination. Most of them (>90%) remain un-treated.
Poor awareness about symptoms of mental illness, myths & stigma related to it, lack of
knowledge on the treatment availability & potential benefits of seeking treatment are important
causes for the high treatment gap.

the government of India has launched the national mental health programme (NMHP) in 1982,
with the following objectives:

• 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
• To encourage the application of mental health knowledge in general healthcare and in
social development

The NMHP was re-strategized in the year 2003 (in x five-year plan) with the following
components:

1. Extension of DMHP to 100 districts

2. Up gradation of psychiatry wings of government medical colleges/ general hospitals

3. Modernization of state mental hospitals

4. IEC

5. Monitoring & evaluation

DMHP

Based on the evaluation conducted by an independent agency in 2008 and feedback

received from a series of consultations, it was decided by the government of India that DMHP
should be revised and consolidated assistance on new pattern with added components of life
skills education & counselling in schools, college counselling services, work place stress
management and suicide prevention services should be provided. These components are in
addition to the existing components of clinical services, training of general health care
functionaries, and IEC activities in DMHP. The team of workers at the district under the
program consists of a psychiatrist, a clinical psychologist, a psychiatric social worker, a
psychiatry/community nurse, a program manager, a program/case registry assistant and a
record keeper.

HEALTH CARE DELIVERY SYSTEM IN INDIA

1. Institutional Care
Forty-one mental hospitals with 20,000 beds offer institutional care for the severely
mentally ill. Most states have at least one such institution. Initially planned for long term
inpatient care, these centres provide special clinics and outpatient care. The availability of most
beds gets blocked by long-stay patients and much of the mental health budget is spent on
maintaining the infrastructure. Health planners therefore discourage further mushrooming of
such centres.
2. Aftercare Options
Few organised services exist for the rehabilitation of the mentally ill in India. The
centrally supported institutes, such as National Institute of Mental Health & Neurosciences
(NIMHANS), Bangalore and Central Institute of Psychiatry (CIP), Ranchi, have well organised
industrial, occupational and recreational services. Apart from government agencies, a few
voluntary organisations provide aftercare facilities for the mentally ill. The Schizophrenia
Research Foundation (SCARF) established in Madras is a pioneering effort in this direction.
Other institutions of a similar kind are Sanjeevini in Delhi and Abaya in Trivandrum. These
primarily deal with severe mental illness in contrast to those involved with addiction, alcohol
and suicide prevention, and mental retardation.
3. General Hospital Psychiatric Units
4. Outpatient and Emergency Services
5. Staffing Patterns
Within state differences. The staff in an institution or a general hospital psychiatric unit
is comprised of psychiatrists, clinical psychologists, social workers, nurses, and trained
attendants. The number varies according to the size, capacity and roles of the treatment setting.
Recent staff mental health translates to;

• One nurse to 4/6 patients during the day

• One nurse to 7 patients overnight.
 • India has 0.75 psychiatrists per 100,000 people.

6. Centre-state differences
A similar disparity exists between centrally sponsored institutions such as National
Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Central Institute of
Psychiatry (CIP), Ranchi, and state hospitals. While the central organizations are well funded
and staffed, the others are inadequately supported. Latest estimates on all mental health services
place the number of psychiatrists in India around 2,000, clinical psychologists around 600, and
social workers around 1,000
7. City-district differences.
The districts which have a population of 2 or more million have the administrative
capability and the infrastructural support to cater to clients from a large number of towns and
villages. However, a few districts have psychiatric units functioning with one psychiatrist and
no other members of the mental health team. Efforts have been made to strengthen the District
or Block level hospital psychiatric units from which outreach programs can be extended into
the community. No psychiatric staff are available beyond the district setting.
8. District-primary health centre differences.
The Primary Health Centre (PHCs), with its subhealth centres are the most peripheral
health posts catering to a few villages. Recently a few PHCs have been upgraded to form the
Community Health Centres (CHC) to look after 100,000 people. Each PHC looks after 30,000
people and has a staff of 2 doctors, 1 pharmacist and 1 auxiliary nurse supervisor. The
Subhealth Centre (SHC) looks after 5,000 people in a group of villages called collectively the
'Panchayat'. The SHC has a Multipurpose Health Worker (MPW) who is a person with school
education and an 18-month midwifery in service training. No mental health care is available
beyond the districts, and it is in the villages that most Indians live.
9. Treatment Modalities
Facilities for Electro-Convulsive therapy (ECT) and pharmacotherapy exist on a pattern
similar to western countries. The dosage requirement of neuroleptics is, however, much lower.
ECT is known to provide quick results with judicious use. Among the psychosocial therapies,
family therapy has been found to be most relevant and useful in India. Behaviour Journal of
Sociology & Social Welfare therapy is beneficial particularly in neuroses and psychosomatic
disorders. Psychoanalytic therapy has not taken root in India, due to concepts alien to the
culture, the high-cost factor, and reluctance on the part of clients and families to seek this mode
of treatment. Yoga as an adjunct to these therapies has enhanced mental health and contributed
to a reduction of psychosocial stress thereby improving the general adaptations of the
individual.
10. Yoga Therapy
Yoga means "Yoking of all the powers of the body, mind and soul to God" and facilitates
a person practising it to function at the peak of his potential and harmony in his everyday
transactions. The essential purpose of Yoga is therefore to control the mind, maintaining it in
a state of tranquillity and peace. To many Indians, Yoga is a way of life and not merely a form
of treatment. Consisting as it does of 8 steps, it encompasses physical, mental and social
behaviour.
11. Community Services
Services for the community have been initiated by both the government and voluntary
sector, particularly after the national mental health program (NMHP) was drawn up in 1981.
The main objective of NMHP is to provide basic mental health care at the grassroots level,
apart from ensuring availability and accessibility of services to the most vulnerable and
underprivileged sections. The specific approaches involve diffusing mental health skills to the
peripheral health service system, territorial distribution of resources, and integration of mental
health care with general health services.
MENTAL HEALTH SEERVICES IN GLOBAL

WPO (THE WORLD PSYCHIATRIC ASSOCIATION)

The World Psychiatric Association is a global association representing 145 psychiatric

societies in 121 countries, and bringing together more than 250,000 psychiatrists. It has
developed ethical guidelines for psychiatric practice and position statements on topics relevant
to psychiatric practice and the role of psychiatrists. The World Psychiatric Association was
first established in 1950 as an association for the organisation of World Congresses of
Psychiatry. With Jean Delay as its President and Henry as its Secretary General, its creation
must be appreciated within the context of world events and developments in the health field.
The Second World War had only recently ended and the World Health Organisation’s Sixth
Revision of the International Classification of Diseases for the first time included a section
devoted to mental, psychoneurotic and personality disorders. the challenges facing WPA
remain great and the tasks ahead formidable. Embracing its rich history of vitality and action,
and the legacy of the inspired physicians who recognised the benefits of bringing together
psychiatric societies from all over the world, will be key to its continued success. WPA forges
ahead as a society committed to promoting the highest levels of scientific, humanistic and
ethical psychiatric care around the world.
ACTION PLAN
The WPA Action Plan for 2020-23 defines emerging needs and priorities, from a
worldwide perspective, in some specific areas of mental health. Given that globally, only a
minority with mental disorder receive any treatment, there is an outstanding need to improve
access to high quality mental health care in all countries and to support psychiatrists and other
mental health professionals in their important roles as policy makers, direct service providers,
trainers and supporters of health care workers in primary and community health care systems.
The rapid spread of COVID-19 around the world is further increasing risk of developing mental
disorder, relapse of existing mental disorder and poor mental wellbeing which requires action
at a population level.
The key features of the Action Plan are
• To promote psychiatry as a medical specialty in clinical, academic and research areas and to
promote public mental health as a guiding principle.
• To highlight the specific role of psychiatrists in working with other professionals in health,
public health, legal and social aspects of care
• To ensure WPA’s positive engagement with member societies and WPA components, mental
health professionals & general health care workers
WHO (WORLD HEALTH ORGANISATION)

When diplomats met to form the United Nations in 1945, one of the things they
discussed was setting up a global health organization. WHO’s Constitution came into force
on 7 April 1948 – a date we now celebrate every year as World Health Day. the Conference
established also an Interim Commission to carry out certain activities of the existing health
institutions until the entry into force of the Constitution of the World Health Organization.
The preamble of the Constitution of WHO provide that WHO should be a specialized agency
of the UN. Also provides that the Constitution would come into force when 26 members of
the United Nations had ratified it. The Constitution did not come into force until 7 April
1948, when the 26th of the 61 governments who had signed it ratified its signature. The first
Health Assembly opened in Geneva on 24 June 1948 with delegations from 53 of the 55
Member States. It decided that the Interim Commission was to cease to exist at midnight on
31 August 1948, to be immediately succeeded by WHO.
COMPREHENSIVE MENTAL HEALTH ACTION PLAN 2013–2020

1. In May 2012, the Sixty-fifth World Health Assembly adopted resolution on the global
burden of mental disorders and the need for a comprehensive, coordinated response from
health and social sectors at the country level. It requested the Director-General, inter
alia, to develop a comprehensive mental health action plan, in consultation with Member
States, covering services, policies, legislation, plans, strategies and programmes.
2. This comprehensive action plan has been elaborated through consultations with Member
States, civil society and international partners. It takes a comprehensive and
multisectoral approach, through coordinated services from the health and social sectors,
with an emphasis on promotion, prevention, treatment, rehabilitation, care and recovery.
It also sets out clear actions for Member States, the Secretariat and international, regional
and national level partners, and proposes key indicators and targets that can be used to
evaluate levels of implementation, progress and impact. The action plan has, at its core,
the globally accepted principle that there is “no health without mental health”.
3. The action plan has close conceptual and strategic links to other global action plans and
strategies endorsed by the Health Assembly, including the global strategy to reduce the
harmful use of alcohol, the global plan of action for workers’ health,

2008–2017, the action plan for the global strategy for the prevention and control of
noncommunicable diseases

2008–2013, and the global action plan for the prevention and control of noncommunicable
diseases

2013–2020, It also draws on WHO’s regional action plans and strategies for mental health and
substance abuse that have been adopted or are being developed. The action plan has been
designed to create synergy with other relevant programmes of organizations in the United
Nations system, United Nations interagency groups and intergovernmental organizations.

World Mental Health Day 2021, Mental health care for all: let's make it a reality

The COVID-19 pandemic has had a major impact on people’s mental health. Some
groups, including health and other frontline workers, students, people living alone, and those
with pre-existing mental health conditions, have been particularly affected. And services for
mental, neurological and substance use disorders have been significantly disrupted.

Yet there is cause for optimism. During the World Health Assembly in May 2021,
governments from around the world recognized the need to scale up quality mental health
services at all levels. And some countries have found new ways of providing mental health care
to their populations.

During this year’s World Mental Health Day campaign, we will showcase the efforts
made in some of these countries and encourage you to highlight positive stories as part of your
own activities, as an inspiration to others.

APA (AMERICAN PSYCHIATRIC ASSOSIATION)

APA is the leading scientific and professional organization representing psychology in

the United States, with more than 133,000 researchers, educators, clinicians, consultants and
students as its members.

MISSION
APA’s unique role in creating that change. To promote the advancement,
communication, and application of psychological science and knowledge to benefit society and
improve lives
GUIDING PRINCIPLES
The core values that must inform and infuse everything APA does. They apply equally
across all areas of psychology including practice, basic and applied research, applied
psychology, and education and training.
» Build on a foundation of science. Ensure that the best available psychological science
informs policies, programs, products, and services.
» Advocate for psychology and psychologists. Demonstrate an unwavering commitment to
promoting the field while supporting and unifying those who make it their profession. »
Champion diversity and inclusion. Further the understanding and appreciation of differences
and be inclusive in everything we do.
» Respect and promote human rights. Focus on human rights, fairness, and dignity for all
segments of society.
» Engage with and deliver value to members. Provide resources, opportunities, and networks
that help all members at every stage of their careers.
» Lead by example. Serve others, model integrity, and demonstrate the highest ethical
standards in all our actions.
OPERATING PRINCIPLES
How all parts of APA will work together to execute the plan.
» Make an impact. Focus on efforts with the scale and scope to significantly advance the
interests of the public, the field, and psychology professionals.
» Embrace a global perspective. Advance psychology globally through international
engagement, association efforts, and meaningful collaborations
» Build a stronger association. Collaborate across APA to align resources, decision-making,
and the contributions of governance, advisory groups, staff, and the broader membership with
the strategic plan.
» Increase organizational effectiveness. Focus on the future, make data-informed decisions,
invest in strategic priorities, create capacity for new initiatives, and emphasize outcomes.

DEVELOPMENT PROCESS

As an organization that represents the entire field of psychology, APA must focus on
overarching issues that affect the discipline and profession and engage in activities that have
broad impact. APA’s new strategic plan—only the second in the association’s 126-year
history—is a three-to five-year blueprint that reflects the best thinking of its governance,
members, collaborators, and staff on how to succeed in the current environment and thrive in
the coming years. It is intended to be a living document that is flexible and responsive to the
emerging needs of society, as well as APA’s diverse constituencies. Rather than being an
endpoint, the plan is the first step in a process designed to ensure that APA becomes an even
more relevant, effective, and sustainable voice for psychology

WFMH (WORLD FEDARATION FOR MENTAL HEALTH)

The World Federation for Mental Health (WFMH) is an international, multi-

professional non-governmental organization (NGO), including citizen volunteers and former
patients. It was founded in 1948 in the same era as the United Nations (UN) and the World
Health Organization (WHO).
AIMS
The goal of this international organization includes;

• The prevention of mental and emotional disorders;

• The proper treatment and care of those with such disorders;
• And the promotion of mental health
THE MISSION
World Federation for Mental Health is to promote the advancement of mental health
awareness, prevention of mental disorders, advocacy, and best practice recovery focused
interventions worldwide.
Mental health day is celebrated at the initiative of the World Federation of Mental
Health and WHO supports this initiative through raising awareness on mental health issues
using its strong relationships with the Ministries of health and civil society organizations across
the globe.
Mental Illness Awareness Week (MIAW) is an annual national public education
campaign designed to help open the eyes of Canadians to the reality of mental illness. The
week was established in 1992 by the Canadian Psychiatric Association, and is now coordinated
by the Canadian Alliance on Mental Illness and Mental Health (CAMIMH) in cooperation with
all its member organizations and many other supporters across Canada.
MENTAL HEALTH DAY -Mental Health in an Unequal World: Together we can make
a difference.

This years theme “Mental Health in an Unequal World: Together we can make a
difference” was chosen by a global vote reflecting the feelings, views and concerns of the
global community about the position of mental health in our world today. Historically, mental
health has been less favoured and under-prioritised creating huge treatment gaps and disparities
in mental health care. Inequalities in mental health have deprived many people with a lived
experience of mental disorders from living fully integrated and dignified lives. The relationship
between equity and mental health is well understood however little has been done to address
the inequities and disparities. The world is increasingly polarised, with the wealthy becoming
wealthier while the number of people living in poverty notably increasing. The increase in
poverty and its devastating social determinants for mental health has been further exacerbated
by the socio-economic impact of the COVID-19 pandemic. Growing inequalities due to race
and ethnicity, sexual orientation and gender identity, lack of respect for human rights and,
stigma and discrimination against people with mental health conditions have created visible
societal divide and injustices. Such inequalities have had a direct impact on peoples’ mental
health in every country.
CONCLUSION

The consideration of mental health and mental illness has its basis in the cultural beliefs
of the society in which the behavior takes place. Some cultures are quiet liberal in the range of
behaviors that are considered acceptable whereas others have very little tolerance for behaviors
that deviate from the cultural norms. During the study of psychiatry revels some shocking truth
about individual with mental illness by means that could be considered less than humane.
Mental health and mental illness are defined by various peoples and considered the mental
health as a one of the most important aspects of human health.

REFERENCE

• Mary c Townsend Karyn I Morgan, psychiatric mental health nursing, 9th edition
(2020), Jaypee publications(pet) ltd. New Delhi, 90-100
• Morrison Valfre, foundation of mental health care, 5th edition (2013), Elsevier
publications (pvt) ltd. USA 11-37
• R.K Gupta, New approach to mental health nursing, 1st edition (2011), s. Vikas and
company publications, Jalandhar 22-29, 38-40
• B T Basavanthappa, essentials of mental health nursing 1st edition (2011), Jaypee
publications (pvt) ltd. New Delhi 17-23

Online sources

• World Health Organization (WHO), mental health during covid 19, available from
https://www.who.int/campaigns/connecting-the-world-to-combat-
coronavirus/healthyathome/healthyathome---mental-
health?gclid=EAIaIQobChMIsNaE6NfM9gIVI5lmAh3BugpXEAAYAiAAEgJlwvD
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• American Psychiatric Association (APA), mental illness available from, What Is
Mental Illness? (psychiatry.org)
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Health: A Critical Appraisal by Dr. Sumanth S. Hiremath Department of Sociology,
Rani Channamma University, Belagavi, Karnataka State, India available from Impact
of Urbanisation on Mental Health: A Critical Appraisal (scientonline.org)
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from https://www.apa.org/monitor/2021/01/trends-report
• World Health Organization, History and contributions in mental health available from
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