Introduction to Psychiatric-

Mental Health Nursing

By: Dr. Muaaz Abdulghani,RN, Bsc, Msc,

PhD candidate , MHPN
 Introduction
• Mental health and mental illness are difficult to define precisely.
• People who can carry out their roles in society and whose
behavior is appropriate and adaptive are viewed as healthy.
• Conversely, those whose behavior is inappropriate are viewed as
ill.
• What one society may view as acceptable and appropriate,
another society may see as maladaptive and inappropriate.
 Mental health-ill-
ness continuum
Mental health and mental illness
are not polar opposites
But can be viewed as points on

a
continuum.
Mental health -mental illness continuum
 Definition of Mental health (WHO)

• world health organization defines as “the capacity

of an individual to form harmonious relationships
with others and to participate in , or contribute
constructively to , changes in the social
environment .
 The American Psychiatric Association
(APA, 2003) defines mental health as:

• The successful performance of mental

functions shown by:
 Productive activities,

 Fulfilling relationships with other people,

 Ability to adapt to change and to cope with

adversity.
Characteristics of a mentally health person

1.Free from internal conflicts . He is not at

war with himself.
2. he is well adjusted . He is able to get along
well with others. He is able to form effective
relationships . He accepts criticism and is not
easily upset.
3. he searches for an identity .
4. he has a strong sense of self – esteem .
5. he knows himself , his needs , problems and
goals (this is known as self actualization ).
6. He has good control over his behavior .
7. He is productive .
8. He faces problems and tries to solve them
intelligently , (has the ability to cope with
stress and anxiety .
 The American Psychiatric Association
(APA, 2003) defines mental illness as:
• Maladaptive responses to stressors from the
internal or external environment, evidenced
by:
• Abnormal thoughts, feelings, and behaviors
(that are incongruent with the local and
cultural norms),
• Interfere with the individual’s social,
occupational, and/or physical functioning.
 Introduction……
• Psychiatry is a branch of medicine concerned
with the study and treatment of disorders of
mental function.
• Psychiatric Nursing Or Mental Health
Nursing:
“Is the specialty of nursing that cares for people
of all ages with mental illness, such as
schizophrenia, bipolar disorder, psychosis,
depression or dementia”.
 History of psychiatric nursing
• Until the late 1800's, there were no formally
trained psychiatric nurses.
• Linda Richards, considered the first psychiatric
nurse in the United States.
• She opened Boston City Hospital Training School
for nurses in 1882 to train nurses specifically for
care of psychiatric patients.
• She believed that people with mental illness should
be as well cared for as those with other illness.
• In the year 1882, psychiatric nursing was
introduced into curricula of schools of
nursing, mainly focused on nutrition,
hygiene, and activity.
• By 1950, schools were required to have
psychiatric nursing in their clinical practice
to become certified by accrediting bodies.
• In 1973 the American Nurses Association
developed the first standards of care for
psychiatric nursing.
• The first graduate program in Psychiatric Nursing
was started by Hildegarde Peplau in l954 at
Rutgers University.
• In 1988, psychiatric nurses were certified by the
• And in the 1990s, psychiatric nurses earned
the privilege of prescribing medications for
people with mental illnesses.
• Presently, psychiatric nurses practice in:
 Private practice (patient services or
consultants),
 Hospitals (direct care, education of staff,
clinical liaison),
 Community Mental Health Centers,
Universities and Colleges (Educators and
Researchers).
• The ANA and the National Institute of
Mental Health joined together in 1994 to
publish the Psychopharmacologic
Guidelines for Psychiatric Mental Health
Nurses.
– It is "a description of the basic knowledge
needed in psychopharmacology practice
of nurses and skill expectations related to
neurosciences, psychopharmacology, and
clinical practice"
 History of psychiatry in Arabic area

• The first psychiatric hospitals and even

psychiatric wards in general hospitals were
built in the Middle East around the ninth and
the tenth century.
• The most important of these hospitals were in
Baghdad, Damascus and Cairo.
• The first hospital was built in Damascus
during the reign of the Omaiite Khalif El
Waleed ibn Abdel Malek .
 Egypt
• Abbasieh hospital was the first, in 1880.
• Psychiatric training is given in major medical
schools and certification is given through
national examination.
• The Institute of Psychiatry at Ain Shams
University, a WHO Collaborating Centre,
offers training in child psychiatry.
• Training in psychiatric nursing and clinical
psychology also exists.
 Iraq
• In Iraq, modern psychiatry started with a
small private unit in Baghdad in 1943.
• The main Shamaeeah hospital was built
in 1959. There are also facilities in Najaf
and Mousel.
 Lebanon
• In Lebanon, mental health as a recognized branch of
medicine dates back to the establishment of the
American University of Beirut medical school in
1866 and out- and inpatient care were provided.
• The building of Lebanon Hospital for Mental and
Nervous diseases been a very important institution for
training of nurses.
• A lmuslim hospital also opened in the 1950s.
 Jordan
• The main psychiatric facility of the country is
Al-Khoais Hospital in Amman with 220 beds.
• Training courses in mental health for general
practitioners exist and integrated services are
provided in some areas.
 Libyan

• The psychiatric hospital in Tripolis is the major

facility in the Libyan Arab Jamahiriya.
• The hospital has been active since early in the 20th
century.
• There is a psychiatric facility in Benghazi as well.
Some efforts for integration of mental health into
primary health care have been made.
 Saudi Arabia
• In Saudi Arabia, the start of modern psychiatry is
associated with the building of psychiatric hospital in
Taif in 1962.
• At present, there are hospitals in Jeddah, Riyadh and
other major cities.
• A programme for integration of mental health into
primary health care also exists.
 Syrian Arab Republic

• The first modern psychiatric hospital in the

Syrian Arab Republic, called Ibn Sina, was
built near Damascus in 1929.
• There is psychiatric training in medical schools
run with the help of the military hospital.
 current situation
• the current situation of mental health services in the
Arab world.
• Out of 20 countries for which information is
available, six do not have a mental health legislation
and two do not have a mental health policy.
• Three countries (Lebanon, Kuwait and Bahrain) had
in 2007 more than 30 psychiatric beds per 100,000
population, while two (Sudan and Somalia) had less
• The highest number of psychiatrists is found in Qatar,
Bahrain and Kuwait, while seven countries (Iraq,
Libya, Morocco, Somalia, Sudan, Syria and Yemen)
have less than 0.5 psychiatrists for 100,000
population.
• ) Okasha, A., Karam, E. and Okasha, T., 2012. Mental health
services in the Arab world. World Psychiatry, 11(1), pp.52-54.(
Famous psychiatrist
Hippocrates (450-355 B.C):
Greek physician – father of medicine – he call
diseases caused by imbalance in four humors
(blood. plasma, yellow bile and black bile)and
melancholia caused by excess black bile ,and
hysteria caused by wandering uterus.
Bleuler,Eugen (1857-1939):
Swiss psychiatrist introduce the term schizophrenia
for dementia praecox because onset was not
always early .he put emphasis on disharmony or
split (schizo) between associations (thought and
affect) he gave 4As of SZP.
Cerletti ,Ugo (1877-1963):

Italian physician who first used ECT .

Alois Alzheimer(1864-1915):

He reported the first causes of progressive

dementia In 1906.
 Sudan Mental Health

• Prof. Eltigani Elmahi

(1911----1970)

• Nick name
• The Father Psychiatry
in Africa
• Born in the village in the area of the White Nile

(called Elkoa) in April 1911 .

• 1959 to 1969 a consultant in a regional WHO.

• Founder of the African Society of Psychiatry

• Named the first hospital held for mental health

in Sudan.
 Treatment Facilities in Sudan

• It is extremely limited mental health care facilities in the country.

• El Tigani El Mahi psychiatric hospital is the main facility in Sudan.

• The admissions constitute about 1/3 of the total inpatient care in the
country.

• The main psychiatric disorders encountered were schizophrenia,

mania, depression, toxic psychosis, stress situations and drug
addiction.
• Services are provided in 12 psychiatric wards attached to the general hospitals .

• Khartoum, Khartoum North, Military Hospital, Medani, Port Sudan, Kassala,

Atbara, Gedaref,

• Kosti, El Obeid, El Fashir and Sennar. Patients are usually admitted for a short
stay for

• management and rehabilitation. Co-patients are allowed to remain besides beds

for family

• support and creation of homely atmosphere.

• There are three outpatients units in Khartoum state –

Khartoum, Omdurman and Khartoum North.

• In addition to 9 urban clinics in Medani, Atbara, Post Sudan,

ElObeid, Kosti, Sennar, Kassala El Fashir and Gedarif.

• Involuntary Custodial Care is provided at Kober, Kassala, Port

Sudan, institutions and also reserved places attached to the

general prisons.

• Admission is based on court order and patients in these

settings receive service similar to in-patient case management.

 Classification Of Psychiatric Disorders

• Psychiatric classifications have traditionally divided into neuroses and

psychoses.

• Neuroses are illnesses in which symptoms vary only in severity from

normal experiences.
– E.g. ( Anxiety Disorders).

• Psychoses are illnesses in which symptoms are qualitatively different

from normal experience, with little or lack of insight into their nature.
– E.g. ( schizophrenia).
 Psychosis, or a psychotic disorder :

• It is refers to any mental state that impairs thought,

perception, and judgment.
• It is used to describe symptoms characterized by loss of
contact with reality, such as:

-hallucinations:(false perceptions occurring in the absence

of an external stimulus),&

- dellusions (fixed false beliefs).

 Neurotic disorder or neurosis :

• Is a less precise term that in the past described

all non-psychotic illnesses(the patient’s
personality is relatively undamged , and
contact with reality is unimpaired).
 Classification Of Psychiatric Disorders
According to (DSM-IV-TR)
• The Diagnostic and Statistical Manual of mental disorders - fourth edition

text revision (DSM-IV-TR) of the American Psychiatric Association (APA

2000) provides descriptions of diagnostic categories into five axes:

I. Psychiatric disorders

II. Personality disorders, learning difficulty

III. General medical conditions

IV. Psychosocial and environmental problems

V. Overall level of functioning or Global assessment of functioning (GAF)

 Classification Of Psychiatric Disorders
According to (ICD)
• Another classification system - the International Classification of
Mental and Behavioral Disorders (ICD-10) -has been published
by the World Health Organization.
• This system has largely abandoned the traditional division
between neurosis and psychosis, although the terms are still used.
• The disorders are arranged in groups according to major common
themes (e.g. mood disorders, schizophrenia and other delusional
disorders).
 International classification of psychiatric
disorders (ICD-10)
• Organic disorders

• Mental and behavioral disorders due to psychoactive

• substance use

• Schizophrenia and delusional disorders

• Mood (affective) disorders

• Neurotic, stress-related and somatoform disorders

• Behavioral syndromes Disorders of adult personality and behavioral

Mental retardation
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