MENTAL HEALTH NURSING UNIT 1

DEFINITION OF MENTAL HEALTH NURSING

1. Karl Menninger (1947) defines mental health as “an adjustment of human

beings to the world and to each other with a maximum of effectiveness and
happiness”.
2. The APA (1980) defines mental Health as “Simultaneous success at
working, loving and creating with the capacity for mature & flexible
resolution of conflicts between instincts, conscience, important other people
& reality”.

COMPONENTS OF MENTAL HEALTH NURSING

1. The ability to accept self: feels comfortable, reasonably secure and

adequately accepts his shortcomings self respect
2. The capacity to feel right towards others: Sincerely interested in other’s
welfare Friendships are satisfying & lasting
3. He feel part of a group He takes responsibility for his neighbors & his
fellow members

THE ABILITY TO FILL THE TASKS

 Able to think for him, set reasonable goals & take his own decision
 He does something about problems
 Bowled over by his own emotions

CRITERIA OF MENTAL HEALTH

 Adequate contact with reality

 Control of thoughts and imagination
 Efficiency in work and play
 Social acceptance
 Positive self concept healthy emotional life

INDICATION OF MENTAL HEALTH

 Jahoda (1958) – 6 indicators:

 A positive attitude towards self Growth, development and ability for self
actualization
 Integration
 Autonomy Perception of reality
 Environmental mastery

CHARACTERSTICS OF MENTAL HEALTH NURSING

 Ability to make adjustments

 Sense of personal worth, feels worthwhile & important
 Solves his problem largely by his own efforts & makes his own decisions
 Sense of personal security & fell secure in a group
 Shows understanding of other people’s problems & motives Has a sense of
responsibility

HE CAN GIVE AND ACCEPT LOVE

1) Lives in a world of reality rather than

2) Fantasy Shows emotional maturity in his behavior, & develops a capacity to
tolerate frustration & disappointments in his daily life
3) Developed a philosophy of life that gives meaning & purpose to his daily
activities
4) Has a variety of interest & generally lives a well balanced life of work, rest,
recreation.

MENTAL ILLNESS AND MALADJUSTMENT

Produces disharmony in the person’s ability to meet human needs

comfortably / effectively & function within a culture.
In general an individual may be considered to be mentally ill if:
The person’s behavior is causing distress & suffering to self & others
The person’s behavior is causing disturbances in his day – to- day activities,
job & interpersonal relationships

DEFINITION OF MENTAL ILLNESS

 WHO, 2001, “mental & behavioral disorders are understood as clinically

significant conditions characterized by alterations in thinking, mood
 (emotions) or behavior associated with personal distress and/ impaired
functioning”.

CHARACTERSTICS OF MENTAL ILLNESS

 Changes in one’s thinking, memory, perception, feeling & judgment

resulting in changes in talk & behavior which appear to be deviant from
previous personality
 Changes in behavior cause distress& suffering to the individual/ others/ both
 Changes & distress cause disturbance in day- to-day activities, work &
relationship with important others(social & vocational dysfunction)

EVALUTION OF MENTAL HEALTH SERVICES

 Pythagoras ( BC) – developed the concept - brain is the seat of intellectual

activity
 Hippocrates ( BC) –mental illness as hysteria, mania & depression
 Plato ( BC) – identified the relationship between mind & body
Asciepiades(father of psychiatry)- use of simple hygienic measures, diet,
bath, massage in place of mechanical restraints
 Aristotle(Greek philosopher) – suggested catharsis & music therapy
 Renaissance in Europe( AD) – this period represented the saddest chapter in
the psychiatry

IMPORTANT MILES STONES

 First mental hospital in US was built in Williamsburg, VIRGINIA

 1793 –Phillip Pinel removed the chains from mentally ill patients, a hospital
outside Paris, First revolution in psychiatry
 1812 – first American text book in psychiatry, was written by Benjamin
Rush (father of American Psychiatry)
 1908 – Clifford Beers, an ex-patient of a mental hospital, wrote the book,
“the mind that found itself” based on his bitter experiences in the hospital.

1912 – EUGENE BLEULER, A SWISS PSYCHIATRIST COINED THE

TERM “SCHIZOPHRENIA”
 1912 – Indian lunacy act was passed
1927 – Insulin shock treatment was introduced for schizophrenia Frontal
lobotomy was advocates for the management of psychiatric disorders
1938 – ECT was used for treatment of psychoses
1939 – development of psychoanalytical theory by Sigmund Freud led to
new concepts in the treatment of mental illness
1946 – the bhore committee presented the situation with regard to mental
health services
Five mental hospitals were set up at : Amritsar(1947), Hyderabad(1953),
Srinagar(1958), Jamnagar(1960), Delhi(1966)
All India institute of mental health was also set up at Bangalore.
1949 – Lithium was first used for the treatment of mania
Chlorpromazine was introduced which brought about a revolution in psycho
pharmacology & changed the whole picture of mental health care
1963 – the community mental health centers act was passed.

1970 – SLOW & STEADY REDUCTION OF BEDS IN CUSTODIAL

INSTITUTIONS

 1978 –the Alma-Ata declaration of health for all 2000A.D posed a major
challenge to Indian mental health professionals.
 1981 – Community psychiatric centers were set up to experiment with
primary mental health care approach at Raipur Rani
 1982 – the focus shifted to community based care, which became the basis
for the national mental health program me

1987 – THE INDIAN MENTAL HEALTH ACT WAS PASSED

 1987 – The Indian Mental health act was passed.

 The government of India passed two acts, Mental health act1987, person
with disability act 1995
 1990 – the government of India formed an action group at Delhi to pool the
opinions of mental health experts about the national mental health
programme. (NIMHANS, Bangalore)
 2001- current situation analysis was done to evolve a comprehensive plan of
action to energize the NMHP
 1993 – PROTECTION OF HUMAN RIGHTS ACT

 1997 – Project quality assurance in mental health institutions- 37 mental

hospitals
 2001 Aug. 6 – 27 mentally ill patient died

DEVELOPMENT OF MODERN PSYCHIATRIC NURSING

Some important milestones:

1840 – Florence nightingale made an attempt to meet the needs of
psychiatric in patients with proper hygiene, better food, light & ventilation
& use of drugs to chemically restrains violent & aggressive patients
1872- first training school for nurses was established by the new England
hospital for women & children, USA.
Linda Richards, the first nurse to graduate from the one year course,
developed 12 training schools in the USA
1882 – First school to prepare nurses to care for the mentally ill was opened
at Mc lean hospital in Waverly.
1913 – Johns Hopkins became the first school of nursing to include a fully
developed course for psychiatric nursing in the curriculum. Emergence of
various somatic therapies – insulin shock therapies, (1927), psychosurgery
(1936), & ECT (1938).
1921 –short training courses of 3-6 m were conducted in Ranchi
1943- psychiatric nursing course was started for male nurses
The Chennai govt organized a 3 month psychiatric nursing course for male
nursing students
1946 – health survey committee report recommended preparation of nursing
personnel in psychiatric nursing .
– four nurses were sent to UK by the govt of India , for training in mental
nurses Diploma.
1952- Dr. Hildegard Peplau defined the therapeutic roles that nurses might
play in the mental health settings
Book - Interpersonal relation s in nursing – it was the first systematic
theoretical frame work developed for psychiatric nursing
1953- Maxwell Jones introduced therapeutic community
– need for nurses trained in psychiatric care was felt by the Govt of India
 1954 – Nur Manzil Mental health center, Luck now, started psychiatric
nursing orientation courses of 4-6 weeks duration

1956 – ONE YEAR POST CERTIFICATE COURSE IN PSYCHIATRIC

NURSING STARTED AT NIMHANS, BENGALURU.

 1958 – all the wards at the Agra mental hospital were ordered to be kept
open & all ward locks were removed from the charge of the ward attendant.
 1960 – the name ‘psychiatric nursing’ was changed to ‘psychiatric & mental
health nursing’ & second change was made in the 1970’s when it was known
as ‘psychosocial nursing’.
 1963 – journal of psychiatric nursing & mental health services was
published.
 Mysore Govt started a nine month course in psychiatric nursing for male
nursing students, in lieu of midwifery.

1964 – MUDALIDAR COMMITTEE FELT THE NEED FOR PREPARING

LARGE NUMBER OF PSYCHIATRIC NURSES

 1965 – the Indian nursing council included psychiatric nursing as a

compulsory course in the Bsc nursing progrmme.
 1967 – TNAI formed a separate committee for psychiatric nursing
 1973 – standards of psychiatric & mental health nursing practice were
enunciated
 1975 – psychiatric nursing was offered as an elective subject in M.Sc
Nursing at the Rajkumari Amrit Kaur College of Nursing, New Delhi.
 Now various colleges offer psychiatric nursing as an elective subject in
M.Sc nursing.

1980 – SHIFT FROM PSYCHODYNAMIC MODELS TO MORE

BALANCED PSYCHOBIOLOGICAL MODELS OF PSYCHIATRIC CARE.

 1986- INC made psychiatric nursing a component of general nursing &

midwifery course
 1990 – international council of nurses declared 1990 as the year of mental
health nursing
 1991 – Indian society of psychiatric nurses formed at NIMHANS,
Bengaluru.
 1994 – changes led to the revision of standards of psychiatric & mental
health Nursing

CURRENT ISSUES, FUTURE PROSPECTS & CHALLENGES – INDIA

There is a lack of clearly enunciated definitions of the roles of professional

psychiatric nurses
Greater emphasis should be given to encourage a masters degree in
psychiatric nursing
Offer diploma in psychiatric nursing courses in more colleges
To maintain the minimum standards of psychiatric nursing care in mental
hospitals, the recommended psychiatric nurse: patient ratio as per the INC is
1:5 in non teaching & 1:3 in teaching hospitals
High priority needs to be given to increase psychiatric nursing man power at
the diploma, masters & doctorate levels.
There is a crucial need to create proper jobs at par with other professionals,
particularly in the community
High priority must be given to fill vacant positions in educational
institutions An integrated & coordinated role, both in service & training is
essential in maintaining the quality & standard of psychiatric nursing
Most psychiatric centers do not have qualified psychiatric nurses, even
today.
High priority should be given to place qualified psychiatric nurses in
counseling centers, community mental health & school mental health
programmers.
The national mental health programmer for India (1982) recommended the
formation of a district mental health team (DMHT) in order to decentralize
mental health care at the district level, with two qualified psychiatric nurses
& one psychiatrist
The role psychiatric nurses in the district mental health programme is to
provide care to the inpatients
The qualified psychiatric nurses will actively participate in decentralized
training to professionals & nonprofessional working at taluk & PHC s
Supervise the task of multipurpose workers in mental health care delivery.
 They will assist psychiatrist in research activities in monitoring mental
health care at district & PHCs levels.
Nurse’s active participation in mental health education to the public will go
a long way in creating public awareness in the care of individuals with
various mental disorders

PREVALENCE & INCIDENCE OF MENTAL HEALTH PROBLEMS &

DISORDERS

 Prevalence of mental disorders:

 all mental disorders – 73/1000 population
 Schizophrenia -2.5 / 1000 population
 Affective disorder (depression) – 34/ 1000 population
 Anxiety neurosis – 16.5 / 1000 population
 Hysteria – 3.3/1000 population
 Mental retardation – 5.3/ 1000 population

NATIONAL PREVALENCE RATES FOR SPECIFIC DISORDERS

 Schizophrenia – 2.3 /1000 population

 Affective disorder – 31.2/1000 population
 Anxiety neurosis – 18.5/ 1000 population
 Hysteria – 4.1/ 1000 population
 Mental retardation – 4.2/1000 population
REFERENCES:- https://slideplayer.com/slide/5901902/