Mental Hygiene and Mental Health

• W.H.O.'s definition of Health: "A state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity."
• Mental Hygiene is defined as “a science dealing with the preservation and
promotion of mental health as well as prevention and treatment of mental
illness or abnormalities..”
• Definition of Mental hygiene
• Mental hygiene consists of measures to reduce the incidence of mental illness
through prevention and early treatment and to promote mental health.
Singh and Tiwari-1971
• 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 his or
her community.”
• Mental health is not exclusively a matter of relation between persons. It is also
a matter of relation of the individual towards the community he lives
in ,towards the society of which the community is a part.
• Mental health is a state of balance between the individual and the sorrounding
world, a state of harmony between oneself and ohers, a coexistence between the
realities of the self and other people and he environment.
• Definitions of mental health
• 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”.
• 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”.
 Concepts of Mental hygiene

• Prevention
• the measures to be followed in the prevention of mental illness are:
• Identifying the cause leading to maldjustment, whether personal or
social andtaking suitable precautions to eliminate the same.
• Suggesting ways and means for achieving emotionaland social
adjustment.
• Suggestin methods for resolving inner conflicts and frustration for
getting rid of anxieties, tension and emotional disturbances.
• Preservation
• One can enjoy good mental health if suitable care is taken for its preservation
and promotion. the following activities preserve mental health:
• Develop the inner potential of an indivdual.
• Attain emotional maturity and stability.
• Achieve personal and social security and adequacy.
• Promote healthy human relationships and group interaction.
• Curative measures

• An individual can enjoy good mental health to the extent, one is cured as early
as possible of mental illnessesand diseases he is suffering from.The following
are some curative measures:
• Adequately equip with the knowledge regarding types of mental illnesses and
disorders.
• Suggest various therapies for treatment and curing mental mental illnesses and
disorders.
• Balanced development of the personatily
• it holds the key for an individuals’s adjustment with one’s own self and the
environment. Lack of balanced development in all aspects of personality
results in maladjustment and unhappiness. Thus, all round personality
development is a prerequisite for an inividual to be emotionally stable and well
balanced.
• Leading happy and contented life
• The ability of an indiidual to lead a fullerand a happier liofe direcly
proportional to the mental health enjoyed by him. Thus, an individual must
strive to get along with himself and his environment well and avoid
unnecessary anxieties.
 Concepts of mental health-Jahoda(1958)

• A positive Attitude towards self

• A postive attitude towards self includes an objective view of self including
knowledge and acceptance of strengths and limitations. the individual feels a
strong sense of personal identity and security within the environment.
• Growth, Development and the ability for self - actualization
• Growth, development and the ability for self -actualization indicator correlates
with whether he individual sucessfully achieves the tasks associated with each
level of development.
• Integration
• Integration includes the ability to adaptively respond to the environment and
the development of a philosophy of life, both of which help the individual
maintain anxiety at a manageable level in response to stressful situations.
• Autonomy
• Autonomy refers to the individual’s ability to perform in an independent self-
directed manner; the indivdual makes choices and accepts responsibility for
the outcomes.
• Perception of reality
• Perception of reality includes perception of the environment without
distortion, as well as the capacity for empathy and social sensitivity- a respect
and concern for the wants and need of others.
• Environmental mastery
• Environmental mastery indicator suggests that the individual has achieved a
satisfactory role within the group, society or environment. he is able to love
and accept the love of others.
 Characteristics of a mentally healthy person

• 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 & accept love

• Lives in a world of reality rather than fantasy

• Shows emotional maturity in his behavior, & develops a capacity to tolerate

frustration & disappointments in his daily life
• Developed a philosophy of life that gives meaning & purpose to his daily
activities
• Has a variety of interest & generally lives a well balanced life of work, rest,
recreation.
 Warning signs of poor mental health

• Symptoms of mental disorders vary depending on the type and severity of the
condition. Some general symptoms that may suggest a mental disorder
include:
• In Younger children
• poor school performance;
• persistent boredom;
• frequent complaints of physical symptoms, such as headaches and
stomachaches;
• sleep and/or appetite problems like sleeping too much or too little,
nightmares, or sleepwalking;
• behaviors returning to those of a younger age (regressing), like bedwetting,
throwing tantrums, or becoming clingy;
• noncompliant or aggressive behaviors; and

• more risk-taking behaviors and/or showing less concern for their own safety.

• Examples of risk-taking behaviors include running into the street, climbing too
high, engaging in physical altercations, or playing with unsafe items.
• In older children and adolescents

• Abuse of drugs and /or alcohol

• inability to cope with daily problems and activities

• Changes in sleeping and/ or eating habits

• Defying authority, skipping school,stealing or damaging property

• Excessive complaints of physical problems

• intense fear of gaining weight

• Long-lasting negative mood,often along with poor appetite and thoughts death

• Frequesnt outbursts of anger

• In adults
• Excessive worrying or fear
• Feeling excessively sad or low
• Confused thinking or problems concentrating and learning
• Extreme mood changes, including uncontrollable “highs” or feelings of
euphoria
• Prolonged or strong feelings of irritability or anger
• Avoiding friends and social activities
• Difficulties understanding or relating to other people
• Changes in sleeping habits or feeling tired and low energy
• Changes in eating habits such as increased hunger or lack of appetite
• Changes in sex drive
• Difficulty perceiving reality (delusions or hallucinations, in which a person
experiences and senses things that don't exist in objective reality)
• Inability to perceive changes in one’s own feelings, behavior or personality
(”lack of insight” or anosognosia)
• Overuse of substances like alcohol or drugs
• Thinking about suicide
• Multiple physical ailments without obvious causes (such as headaches,
stomach aches, vague and ongoing “aches and pains”)
• Inability to carry out daily activities or handle daily problems and stress
 Promotive an preventive mental health
strategies
• In the 1960s, Psychiatrist Gerald Caplan describes levels of prevention specific
to psychiatry. He described primary prevention as an effort directed towards
reducing the incidence of mental disorders in a community. Secondary
prevention refers to decreasingthe duration of disorder while territary
prevention refers to reducing the level of impairment.
 Primay prevention

• Primary preventionseeks to prevent the occurance of mental disorders by

strengthning individual, family and group coping abilities.
• Role of a Nurse in Primary prevention

• Community mental nurses are in a key position to identify individual, family

and grop needs, conflicts and stressors. Thus, they play a major role in
identifying high risk groups and prteventing the occurence of mental illness in
them. Some interventions include:
• Individual centered intervention:

• Antenatal care to the mother and educating her regarding the adverse effects
of irradiation, certain drugs and prematurity.
• Ensuring timely and efficient obstetrical assistance to guard against the ill
effects of anoxia and injury to the newborn at birth.
• Dietary corrections to those infants suffering from metabolic disorders.

• Correction of endocrine disorders.

• Liberalization of laws regading termination of pregnancy, when it is unwanted.

• Training programs for physically and mentally handicapped children like blind ,
deaf, mute and mentaly subnormal.
• Counselling the parents of Physically and metally handicapped children with
particular referene to the nature of defects. The parents need to accept and
emotionally support the child.
• Interventions oriented to the child in the school:

• Teaching growth and development to the parents and teachers.

• Identifying the prolems of scholastic performance and emotional disturbances

among school children and giving timly intervention.
• Family centered interventions to ensure harmonious relationship:

• Consulting with parents about appropriate disciplinary meaures .

• Promoting open health communication in families.

• Ensuring harmonious relationship among menmbers of the family and teaching

healthy adapive techniques.
• Interventions oriented to keep families intact:
• Extending mental health education services at child guidance clinics about child
rearing practices.
• Strengthening social support for the frustrated aged and helping them to retain
their usefulness.
• Providing marital counselling for those having marital problems.
• Interventions for families in crisis:
• In developmental crisis ,situations such as the child passing through
adolescence, birth of a new baby, retirement or menopause. crisis intervention
can be give at:
• Mental hygiene clinics
• Psychiatric first-aid centres
• Walk-in clinics.
• Mental health education:
• Conduct mass health education programs through film shows, flash cards and
appropriate audio-visual aids regarding the prevention of mental illness and
promoting mental health in the community.
• Educate health workers regarding prevention of mental illness.
• Society-centered preventive measures:
• Community development
• providing biological and psychoogical supplies to culturally deprived families by
assisting them with better hygenic living conditions,proper food,education,
health facilities.
 Secondary prevention

• Secondary prevention targets people wh show early symptoms of mental

health disruption, but regain premorbid level of functioning through aggressive
treatment.
• Role of a nurse in secondary prevention:

• Early diagnosis and case finding:

• By educating public,community leaders, mahila mandals on how to recognize

early symptoms of mental illness.
• Case finding through screening and periodic examination of population at risk,
monitoring of patients.
• Early reference: public should be educated to refer these cases to proper
hospitals.
• Screening programs:
• developing simple questionnaires to identify the symptoms of mental illness
and administration of the samein the community for early identification of
cases.
• Training of health professionals

• Conultation servces:

• Nurses working in general hospitals come across such patients dealing

with anxiety , peptic uncer, psychosis. These basic care providers need
guidance and consultation to deal with such conditions in an effective
manner.
• Crisis intervention:

• Anticipating the crisis ituation and guiding the individual in time help
them to cope with the crisis situation in a better way.
 Tertiary Prevention

• Tertiary Prevention Targets those with mental illness and helps to reduce the
severity, discomfort and disability associated with their illness.
• Nurse’s Role – • Involve family members • Address the stigma issues &
concealment • Help cope with guilt and improve self-esteem • Foster healthy
attitudes
• Role of a Nurse in Tertiary Prevention-  Family
member should be involved actively in the treatment
program. 
• Occupational and recreational activities should be
organized in the hospital. 
• Community based programs can be launched by
meeting the family members when the need for
discharge from the hospital. These program can be
implemented through day hospitals, night hospitals,
after care clinics, half way homes, ex-patient hostels,
foster care homes etc.  There should be constant
communication between community health nurse
and mental health institution regarding the follow up
• Nurses need to be familiar with the agencies in the
community that provide these services. Collaborative
relationship between mental health care providers and
community agencies are essential. 
• An important intervention in the maintenance of patients
as their own homes in the community is the training in
community living. 
• Another aspect of community life that is more difficult to
assess accurately and deal with effectively, is the stigma
attached to mental illness.
• MENTAL HEALTH SERVICES- Mental Health Agencies- Government at
National Level- There are 47 mental hospitals in the country . Lancent
Psychiatry 2020 study statess that in 2017 there were 197.3 millioneople
with mental disorders in India,comprising 14.3% of the total population of
the country.
• Mental Health Agencies- Voluntary Voluntary organizations are a valuable
community resource for mental health. It is play an important role in
developing suicide prevention and crisis support, formation of self help of
families, organizing community based housing facilities for short term and
long term care of persons with chronic illness, day care centers, sheltered
employment facilities, life skill programs for school drop out children and
public mental health education.
• Non- Governmental Organizations- It is recognized by government as non
profit or welfare oriented organizations, which play a key role as advocate,
service providers, activist and researchers on a range of issues pertaining
to human and social development. Mental Health non-governmental
organizations are located throughout India. While many are formed in
urban areas, have begun to extend services in rural areas too.
• Partial Hospitalization-
• It is an innovative alternative to hospitalization. It is ideally suited to
most of the psychiatric syndromes, chronic psychotic disorder,
neurotic conditions, personality disorders, drug and alcohol
dependence and mental retardation. Day care centers, day hospitals
and day treatment programs come under partial hospitalization.
Partial hospitalization has the advantage of lesser separation from
families, more involvement in the treatment program.
• Quarter way Homes- It is a place usually located within the hospital
campus itself, but not having the regular service of a hospital. There
may not be routine nursing staff or routine rounds and most of the
activities of the place are taken care of by the patients themselves.
• Halfway Homes- It is a transitory residential center for mentally ill
patients who no longer need the full services of a hospital, but are
not yet ready for a completely independent living. It attempts to
maintain a climate of health rather than of illness and to develop
strength individual capacity.
• Self Help Groups- Self help Groups are composed of people who are
trying to cope with a specific problem or life crisis and have improved the
emotional health and well being of many people.
• Suicide Prevention Centers- There are many suicide prevention centers in
India in the voluntary sector doing good work and helping those in need.

• Helping Hands and medico-Pastoral Association in Bangalore.
•  Sneha in Chennai. 
• Sahara In Mumbai. 
• Sanjivini and Sumaitri in New Delhi.
• Other Mental Health Services- 
• Community group homes
•  Large homes for long term care
•  Hostels 
• Home care programs 
• District rehabilitation centers
• Ego Defence Mechanisms :
• Ego defence mechanisms are methods of attempting to protect
self cope with basic drives or emotionally painful thoughts, feelings
or events.
• Ego defence mechanisms also referred to as defence mechanisms,
are considered as protective barriers to manage instinct and affect
in stressful situations (Freud, 1946) 
• Purposes: The purpose of Defence mechanisms is to reduce or
eliminate anxiety. They may be used to resolve a mental conflict, to
reduce anxiety or fear, to protect one’s self-esteem or to protect
one’s sense of security. Depending upon their use, they are
therapeutic or pathological. They can be helpful when used in very
small doses and if overused, become ineffective and can lead to a
breakdown of the personality. Most defence mechanisms operate
at the unconscious level of awareness .
• Types of Defence Mechanisms Defence mechanisms can be divided into
adaptive and maladaptive mechanisms (refer book)
• Implications  Defence mechanisms enable a person to resolve conflicts.
They are essential to the maintenance of normal equilibrium. 
• Difficulties only occur if the defence mechanisms are inadequate to deal with
anxiety or inappropriate to the situation in which they are used.  Many
mental mechanisms are a means of compromising with forbidden desires,
feeling of guilt, etc. 
• When mental mechanisms are used moderately they are harmless and help
to face conflicts and frustrations easily and protect ego and also help to
relieve tensions and feel comfortable.
 Excessive and persistent use of these defence mechanisms is harmful. They do
not solve the problems, but only relieve the related anxiety. Too much
dependence makes us unable to face problems. For example, if a student is
unable to face the examination and withdraws from taking it, he may experience
greater difficulty in the next attempt. Hence, it is better to learn to face the
problems instead of resorting to these mechanisms.  Many times more than
one mechanism may operate in the process of adjusting to the situation.