Objectives.

 Describe at least two personality

traits and personal issues in
yourself that could affect your
ability to interact with clients in
the clinical setting?
 Articulate how self-awareness
can be an effective tool in the
clinical setting?

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 Questions???????????
 What was your initial reaction when you were
told that you have posting in psychiatric ward ?
How did you feel? How did you resolve your
feelings?
 Are you more comfortable performing tasks or
relating to people?
 Are you flexible or do you prefer an orderly
routine?
 Are you an introvert or extrovert?

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Question Answer?

 Your first assignment in the

psychiatric clinical setting is to
provide care for a female client
who appears sad and verbalizes
hopelessness to the staff. You are
uncertain how to approach the
client. Which of the following
actions would be the most
effective?
05/31/2024 4
a. Ask a peer to introduce you to the client.

b. Wait for the client to approach you to avoid

bothering the client.

c. Ask a staff member what approach is usually

effective with the client.

d. Discuss your feelings with your instructor

before approaching the client.
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QA?

 One of your peers states that your assigned

client looks like a drug addict. Which of the
following best describes your peer?
a. Introvert
b. Judgmental attitude
c. Extrovert
d. Prejudice

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Unit I- Topics
 Perspectives of mental health nursing, evolution
of mental health services, treatments and nursing
practices.
 Prevalence and incidence of mental health
problems and disorders
 Nature and scope of mental health nursing
 Role and function of mental health nurse in
psychiatric setting and factors affecting the level
of nursing practice
 Concepts of normal and abnormal behavior
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Introduction

Two major purposes:

 To introduce the concepts of mental health

and mental illness
 To describe the historical development of the
role of the psychiatric nurse.

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Perspectives of Mental Health
Nursing

 The concept of caring for the

sick, ‘nurturing’, or ‘nursing’
existed since times
immemorial, the mentally ill
were tortured, persecuted,
ridiculed, neglected and
shunned.
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 Before 1860, the emphasis in
psychiatric institutions was on
custodial care.
 Untrained people controlled (not
cared) the mentally ill.
 Psychiatric care as such was non-
existent.
 But psychiatry evolved through ages
and attained the stage that is today.
05/31/2024 10
Concept of mental health

 Mental health is a positive state in which one is

responsible, displays self-awareness, is self-directive,
is reasonably worry free, and can cope with usual
daily tensions.
 Such individuals function well in society, are accepted
within a group, and are generally satisfied with their
lives.
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MENTAL HEALTH- Definition

 Mental health is defined as a state of well-being in

which every individual realizes his or her own
potential, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to
make a contribution to her or his community.

WHO,2014.
05/31/2024 12
  Cultural beliefs influence
how mental health and
mental illness are
determined.
 For instance, acceptable
behavior in one cultural
group may or may not be
tolerated in another group.

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Factors Influencing Mental Health

 Inherited characteristics
 Nurturing during childhood
 Life circumstances

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INDICATORS OF MENTAL
HEALTH

 In the health care and public health arena, more

emphasis and resources have been devoted to
screening, diagnosis, and treatment of mental
illness than mental health.
 Little has been done to protect the mental

health of those free of mental illness.

05/31/2024 15
Three domains- Indicators Of
Mental Health
 Emotional well-being
 such as perceived life satisfaction, happiness, cheerfulness,
peacefulness.
 Psychological well-being
 such as self-acceptance, personal growth including openness
to new experiences, optimism, hopefulness, purpose in life,
control of one’s environment, spirituality, self-direction, and
positive relationships.
 Social well-being
 social acceptance, beliefs in the potential of people and
society as a whole, personal self-worth and usefulness to
society, sense of community.
05/31/2024 16
 Characteristics Of Mentally Healthy
Person
A mentally healthy person:

 has an ability to make adjustments.

 has a sense of personal worth, feels worthwhile and
important.
 solves his problems largely by his own efforts and
makes his own decisions.
 has a sense of personal security and feels secure in a
group, shows understanding of other people’s problems
and motives.
 has a sense of responsibility
05/31/2024 17
CONTD...
 can give and accept love.
 lives in a world of reality rather
than fantasy.
 shows emotional maturity in his
behaviour, and develops a
capacity to tolerate frustration
and disappointments in his daily
activities.
 has a variety of interests and
generally lives a well-balanced
life of work, rest and recreation.
05/31/2024 18
 MENTAL ILLNESS

 Mental illness is defined as

“collectively all diagnosable
mental disorders” or “health
conditions that are
characterized by alterations in
thinking, mood, or behaviour
(or some combination
thereof) associated with
distress and/or impaired
functioning.”
05/31/2024 19
MENTAL HEALTH NURSING
 Mental health nursing involves the diagnosis and
treatment of human responses to actual or
potential mental health problems.

 Comprehensive services focus on prevention of

mental illness, health maintenance, management
of and referral for mental and physical health
problems, diagnosis and treatment.

05/31/2024 20
Historical Development

 The origins of most of psychiatry's

concepts begin with prehistoric
times when primitive people
believed spirits possessed the body
and had to be driven out to effect a
cure.

 Before the 5th century BC, the

Greeks, Romans, and Arabs believed
that emotional disorders were an
organic dysfunction of the brain.
05/31/2024 21
 Pythagras (580-510BC)- concept
that brain is the seat of intellectual
activity.
 Hippocrates (460-375 BC)
described a variety of personalities,
or temperaments, and proposed that
mental illness was a disturbance of
four body fluids, or humours.
05/31/2024 22
 Aristotle (382 -322 BC)
concluded that the mind
was associated with the
heart.
 Galen (130-200 AD), a
Greek physician, stated
that emotional or mental
disorders were associated
with the brain.
05/31/2024 23
Asclepiades- Father of Psychiatry

 Treatment approaches- good

nutrition, good physical hygiene,

music, and recreational activities

such as riding, walking, and listening

to the sounds of a waterfall.

 Fresh air, sunshine, and pure water

were thought to promote healing for

the mentally ill.

05/31/2024 24
Middle Ages to 1773:

 suffered a setback as mentally ill

individuals were excluded from
society and confined in asylums or
institutions.
 Various theories- pertaining to
demonic possession also were
advanced.
 Specifically, persons who displayed
abnormal behaviour were considered
lunatics, witches, or demons
possessed by evil spirits.
05/31/2024 25
 Superstition, magic, and witchcraft prevailed as
patients were locked in asylums, flogged,
starved, tortured, or subjected to bloodletting.
 Beheading, hanging, and burning at the stake
were common occurrences.
 During this same period, physicians described
symptoms of depression, paranoia, delusions,
hysteria, and nightmares.

05/31/2024 26
 Persons displaying such symptoms were
thought to be incompetent and potentially
dangerous.
 The first mental hospital, Bethlehem
Royal Hospital, opened in England in
1403.
 Harmless inmates sought charity on the
streets.
 1773- The first mental hospital in Virginia,
US.
05/31/2024 27
 1793- Philip Pinel- first revolution in
Psychiatry( removed the chains of mentally
ill)
 1812- Benjamin Rush(father of American
psychiatry) first American textbook of
psychiatry.
 1908- Clifford Beers- The Mind That Found
Itself- book changed conditions of mental
hospital.
05/31/2024 28
 1912- Eugene Bleuler- Swiss Psychiatrist
coined the term Schizophrenia.
 1938- ECT used
 1939- Sigmund Freud- Theory and therapy of
psycho analysis.
 1949- Lithium used for Mania
 1952- Chlorpromazine- Revolution in
Psychopharmacology

05/31/2024 29
 Psychiatric Nursing History-1773 to 1956:

 The 18th century is regarded as

an era of reason and observation.
 According to Peplau (1956), the
historical development of
psychiatric nursing began in
1773.
 Peplau- Mother of Psychiatric
Nursing

05/31/2024 30
 Phase 1: The Emergence of
Psychiatric Nursing (1773 to 1881)
 Special institutions for
individuals with psychiatric
disorders were built.
 Benjamin Rush wrote the first
American textbook on
psychiatry.
 Attendants were hired to
socialize with patients.
 Philippe Pinel classified clients
according to their observable
behaviors.
05/31/2024 31
 Schools of nursing were
established in Boston and
Philadelphia by 1872.
 Dorothea Lynde Dix devoted
time to improving conditions
for the mentally ill.

05/31/2024 32
 Phase 2: Development of the Work Role of
the Psychiatric Nurse (1882 to 1914)

 Training schools for nurses in the psychiatric setting were

established at McLean Hospital in Belmont, Massachusetts
and at Buffalo State Hospital in New York (1882).
 Trained nurses were employed in state mental hospitals
(1890).
 First undergraduate psychiatric nursing program was
established.
 National Society for Mental Hygiene was founded in 1909.
 Large state mental hospitals were built in rural areas.
05/31/2024 33
Phase 3: Development of Undergraduate Psychiatric Nursing Education (1915
to 1935)

 Linda Richards, the first graduate nurse in the United States,

suggested that mentally ill clients receive the same quality
care as physically ill clients.
 Harriet Bailey wrote the first psychiatric nursing textbook,
Nursing Mental Diseases.
 John Hopkins- First school of nursing had fully developed Psychiatric
nursing course
 Insulin shock therapy, electroconvulsive therapy, and prefrontal
lobotomy were introduced in the psychiatric clinical setting.
05/31/2024 34
 Phase 4: Development of Graduate Psychiatric
Nursing Education (1936 to 1945)
 Approximately half of all nursing
schools provided psychiatric nursing
courses;
 The National League of Nursing
Education developed curriculum
guidelines for psychiatric nursing
graduate education.
 By 1943, three university-sponsored
graduate programs existed.
05/31/2024 35
 Phase 5: Development of Consultation and
Research in Psychiatric Nursing Practice (1946
to 1956)
 1952- Hildegard Peplau- Interpersonal relations
in nursing
 1953- Maxwell Jones- Therapeutic Community

05/31/2024 36
 Mental Health Services in India
 BRITISH ERA:

 Indian mental health is a child born to British parents

and bred in Indian culture.

 The Indian Lunacy Act (1912) was based on the

British legislation then in force.

 The history of Indian psychiatry runs parallel to

British Psychiatry and the basic structure remains the
same even to this day.
05/31/2024 37
 Before British rule
 During the reigns of King Ashoka,
many hospitals were established for
mentally ill.
 A temple of Venkateswara at
Tirumukkudal, Chingleput District,
Tamil Nadu, contains inscription on
the walls belonging to Chola period.
 The inscription mentioned a hospital
and a school. The hospital was
named as Sri Veera Cholaeswara
hospital and contained 15 beds.
05/31/2024 38
 The first Indian mental
asylum, i. e. Mandu Hospital
opened by Mahmood Khilji
(1436-1469) at Dhar, M. P.
 First lunatic Asylum, Bombay
Asylum, was built in modern
India in approximately 1750
A. D. at the cost of 125/-, no
traces of it is present today.

05/31/2024 39
 In 1794, a private lunatic
asylum was opened at
Kilpauk, Madras.
 The central mental
hospital, Yerwada, Pune
was opened in 1889.
 First asylum for insane
soldiers was started at
Monghyr, Bihar(1795).
05/31/2024 40
 The British established this
hospital on 17 May 1918 with the
name of 'Ranchi European Lunatic
Asylum'. It had then a capacity of
174 patients (92 males and 82
females).

 Later the Hospital for Mental

Diseases and The Central Institute
Of Psychiatry, Ranchi - for
European patients and was staffed
by British Army doctors.
05/31/2024 41
 The history of the institute dates
back to 1847, when the Bangalore
Lunatic Asylum was founded.
 In 1925, the Government of
Mysore rechristened the asylum as
the Mental Hospital.
 The Mysore Government Mental
Hospital became the first institute
in India for postgraduate training
in psychiatry.
 All India Institute of Mental
Health -1954
 NIMHANS-1974
05/31/2024 42
 The first Indian Psychiatrist
to be recognized by the
Royal College of
Psychiatrists is Prof.
Narendra Wig.
 Bhore committee report,
1946

05/31/2024 43
Independent India

 Mental hospital @five places

in India
 Amristar-1947
 Hyderabad-1953
 Srinagar-1958
 Jamnagar-1960
 Delhi-1996

05/31/2024 44
 1954- Nur Manzil Mental Health Centre started
orientation courses in Psyc.Nursing
 1956- 1 year diploma in Psy. Nsg @ NIMHANS
 1963- Community mental health centres act
passed.
 1982- National Mental Health Programme
 1986-INC included Psy. Nsg in GNM syllabus.
 1987- Indian Mental Health Act

05/31/2024 45
 Mental Health Services as on
Today in India
 Institutionalization Vs
Deinstitutionalization
 Focus shifted to Community
Based Care
 District Mental Health
Programme
 National Mental Health Policy
 Revision Of Mental Health
Act
05/31/2024 46
 Current Issues & Trends in Care

Demographic Changes
 Type of the family(increased number of nuclear families)
 Increasing number of the elderly people.
Social Changes
 The need for maintaining intergroup and intragroup
loyalties.
 Peer pressure
Economic Changes
 Industrialization
 Urbanisation
 Raised standard of living
05/31/2024 47
Contd…
Technological Changes
 Mass media
 Electronic systems
 Information technology
Mental Health Care Changes
 Increased awareness in the public regarding
mental health
 Need to maintain mental stability
 Increased mental health problems.

05/31/2024 48
Educational programmes for the
psychiatric nurse
 Diploma in Psychiatric nursing (started in
NIMHANS in 1956)
 MSc in Psychiatric Nursing (started in RAK,
1976)
 M.Phil. in Psychiatric nursing (started in MG
University, Kottayam in 1990)
 PhD in Psychiatric nursing

05/31/2024 49
Nursing Service
 Expanded roles
 Advanced practice roles
 Independent practice

05/31/2024 50
 Prevalence and incidence of mental
health problems and disorders

05/31/2024 51
Meaning Of Incidence &
Prevalence:
 Incidence is ‘the number of instances of
illness commencing, or of persons becoming
ill’ (or dying or being hurt in injuries, or
whatever) ‘during a given period in a
specified population’.
 Incidence can tell us how many new cases of a
particular illness have been suffered by a
community,

05/31/2024 52
 Prevalence is a frequently used
epidemiological measure of how commonly a
disease or condition occurs in a population.
 Prevalence measures how much of some
disease or condition there is in a population at
a particular point in time.

05/31/2024 53
Prevalence Of Mental Illness In
Abroad
 Mental disorders are common in India and
internationally.
 One in 10 children have a diagnosable mental
disorder in a given year. One in four families
has at least one member with a mental
disorder.

05/31/2024 54
Prevalence Of Mental Disorders In
India:
 The all-India national rate (rural + urban) to
be 65.4/1000, rural rate as 64.4 and urban rate
as 66.4.
 Thus the urban rate is marginally higher than
the rural rate.

05/31/2024 55
05/31/2024 56
All mental disorder (national):

 For schizophrenia, the national rate observed

was 2.3 per 1000.
 The category - affective disorders incorporates
data regarding all depressive disorders,
neurotic and psychotic. The all India value
observed was 31.2 per 1000.
 Mental retardation was observed to
 have national rate of 4.2 per 1000.

05/31/2024 57
 The most widely prevalent disorders were
observed to be depression and anxiety, in that
order (18.5 per 1000 for the later).
 Rural-urban difference: The urban morbidity
rate was observed to be 2 per 1000 higher than
the rural morbidity rate (66.4 and 64.4
respectively).

05/31/2024 58
 Studies reported prevalence rates of
psychiatric disorders among children ranging
from 13 to 94 per 1000. Since children and
adolescent form 40% of the total population of
India, approximately four crores of the
population requires professional help.

05/31/2024 59
Uttarkhand – State mental health
system overview
 Uttarakhand has neither a mental hospital nor a community
mental health facility.
 There is no specific mental health related information system
in the state.
 The state does not have a separate mental health act however
the Mental Health Act 1987 applies to the entire country.
 For implementation of the Mental Health Act, the government
has constituted (June 2005) a State Mental Health Authority
(SMHA) is yet to start regular functioning.

05/31/2024 60
 The state does not have a mental health
outpatient facility in the public sector.
 The only mental health outpatient facility and
day treatment facility is available at the
Himalayan Institute Trust Hospital near
Dehradun and AIIMS, Rishikesh.

05/31/2024 61
Population subgroups at high risk
of developing mental illness

05/31/2024 62
Economic cost of treating
psychiatric patients in India
 Prevalence of mental illness is approximately
200/1000 population.
 In simple words, approximately 20 crores of
the population requires professional help.
 Each mentally ill patient requires Rs. 500 per
month for mental healthcare.
 This includes medication cost, doctor's fees
and travelling cost to meet the doctor.

05/31/2024 63
 It is high time to stop the long-term debate
about the prevalence rate of mental illness in
India and move forward to actual actions that
call for investing and improving the mental
health services in India.

05/31/2024 64
ANY QUESTIONS?????

05/31/2024 65
CONCLUSION

05/31/2024 66
THANK YOU

05/31/2024 67