mental health nursing

1. HISTORICAL
PERSPECTIVES,TRENDS,
ISSUES &MAGNITUDE OF
MENTAL HEALTH
SUBMITTED TO:
MS.RITIKA SONI
ASSISTANT PROFESSOR
MENTAL HEALTH NURSING
S U B M I T T E D B Y:
M S . S H A I L J A G U P TA
M S C . N U R S I N G
1 S T Y E A R , 2 0 1 9

2. AT THE END STUDENTS WILL BE
ABLE TO-
Understand definition of mental health and mental illness.
 Discuss the components of mental health

3. CONTD-
 Describe historical perspectives of mental
health.
 Discuss the trends and issues of mental health.
 Understand the magnitude of mental health and
illness.

4. INTRODUCTION
 Mental health is the ability of an individual to cope with
repeated stress of living and to achieve and maintain
relatively optimal adjustment.
 Mental health can be characterized in terms of
personality, interpersonal interaction abilities,
adjustment to stress and ability to wellbeing.

5. CONTINUED-
Three major mental health states exists in order to
define the mental status ,these are-
Well being
Emotional Problems
Mental illness

6. MENTAL ILLNESS-
• Mental illness is the maladjustment in the living.It
produces a disharmony in the persons ability to meet
human needs comfortably or effectively and function
within a culture.
• They are characterized by alterations in thinking
,mood or behavior associated with personal distress
and impaired thinking.

7. DEFINITIONS OF MENTAL
HEALTH
American Psychiatric Association 1994 defines
‘mental health as simultaneous success at working,
loving and creating with the capacity for mature and
flexible resolution of the conflicts between instincts,
conscience , important other people and reality’.
WHO defines mental health as a state of wellbeing in
which the individual realizes his or her own capabilities
to cope with the normal stressers of life and can work
productively and fruitfully.

8. COMPONENTS OF MENTAL
HEALTH
• Positive thoughts about self and others.
• Accepting self and others emotions.
• Building and maintaining healthy relationships.

9. DEFINITION OF MENTAL
ILLNESS
 WHO 2001 define “Mental and behavioral disorders are
understood as clinically significant conditions
characterized by alteration in thinking mood or behavior
associated with personal distress and impaired
functioning.”

10. COMPONENTS OF MENTAL ILLNESS
Dissatisfaction
with self
In-effective
interpersonal
relationships
In-effective
coping to the
events in life
Lack of
personal
growth
Low self
esteem

11. HISTORICAL
PERSPECTIVE OF
MENTAL HEALTH
SERVICES AND
TREATMENT

12. BHAGVAD GITA
(4TH CENTURY
BC)
• Probably the 1st recorded
evidence of psychotherapy
and councelling.
• Although lord Krishna
edged Arjuna onto
action(directive
psychotherapy) he didn’t
force his ideas on arjuna.
final decision was left to
Arjun. this is an example of
crisis intervention
psychotherapy.
THE INDIAN PERSPECTIVE

13. CONTD
 India- psychiatry was labelled as ‘bhut vidya’
 Three main personality types were named –Satvik, Rajasik
and Tamasik.
 King Ashoka in his rule established many hospitals in which
mentally ill were humanically treated.
 1745-Bombay asylum first to be built in India.
 Mental heath act drafted in 1949 and passes in 1987.
 1847-Banglore lunatic asylum was founded.

14. CONTINUED
• The Mysore Government hospital became the
first institute in India for postgraduate training
in psychiatry.
• ON 14NOVEMBER 1994,NIMHANS was
confered a deemed university.

15. EVOLUTION OF MENTAL HEALTH
• Historically mental illness was viewed as a demonic
possession, the influence of ancestral spirits, the results
of violating a taboo or neglecting a cultural ritual and
spiritual condemnation.

16. CONTINUED
 The origin of psychiatric concept begin with
prehistoric times when primitive people
believed that spirits possesses the body and had
to be driven out to effect a cure.

17. ROLE OF PSYCHIATRISTS IN DESCRIBING
MENTAL ILLNESS
• Pythagoras(580-510BC)
–explained that brain is
the seat of intellectually
activity.
• In 19th century terms
delirium, confusion and
clouding developed.

18. CONTD
Plato (427-347BC)
identified the relationship
between mind and body.
Aristotle described
various emotions in his
book “DE ANIMA”

19. CONTD
 Hippocrates(480-370BC)-described mental illness as hysteria,
mania and depression. He explained body has four humours-
phelgam, yellow bile, black bile and blood.
 Brain function depend on these humors
 EXCESS BLACK BILE----------MELANCHOLIA
 EXCESS YELLOW BILE---------MANIC RAGE
 Excess phelgam--------dementia
 Hippocrates explained personality into
 Phlegmatic
 Choleric
 Sanguine

20. CONTD
Greeks developed three psychological
treatments:
 Methods of induced sleep
 Interpreting dreams
 Use of words to persuade and gain knowledge
of illness.

21. EVOLUTION IN MENTAL
HEALTH ACCORDING TO
AGES

22. 1) (PRE-AGES)SOCIAL CHANGE
BEFORE 1773
• During 5th century BC, mental disorders,
especially those with psychotic traits,
considered supernatural throughout Greece and
Rome.
• First hospitals for curing mental illness were
established during 3rd century BC.

23. 2) MIDDLE AGES 1773-1879
 Specialist hospitals were built in
Baghdad in 705AD
 Specialist hospitals were built in
medieval Europe from 13th
century to treat mental disorders
as custodial institutions and did
not provide any kind of treatment.
 During middle ages mentally ill
patients suffered a setback as
they excluded from the society
and confined in asylums or
institutions.

24. CONTINUED
• Persons with abnormal behavior were called as lunatics.
• Superstition, mysticism, magic and witchcraft prevailed
as patients were logged to asylums, flogged, starved,
tortured or subjected to blood letting, beheading
hanging and burning .

25. • Exorcism was practiced
in some monasteries.
• During this period
physicians described
symptoms,depression,
• paranoia,hysteria and
nightmares.
CONTINUED

26. RENAISSANCE AND
WITCHCRAFT
• Malleus prescribed death by torture for the
witches and they were killed.
• These were the women who showed psychotic
or hysterical symptoms and sexual delusions
• It was continued for next 150 years.

27. CONTD
• Before 1860 psychiatric institutions was on
custodial care, attendents were hired to maintain
control of the patients.
• In 1842 first law was maintained to create
asylums in the USA.
• The lunacy act 1845 was an important landmark
in the treatment of mentally ill.

28. 3) (LATE AGES) AFTER 1879
 In 1953,the therapeutic community was developed
encouraged patient’s social environment to provide a
therapeutic experience
 In 1950,psychotropic drugs were came in existence and
with their use more people became treatable.
 Role of psychiatric practitioners and nurses were
expanded.

29. HISTORICALLY IDENTIFIED
CATEGORIES OF PERIODS
1. The period of persecution -1545BC-1545AD
2. The period of segregation -1546-1745AD
3. The humanitarian period -1746AD-1825AD
4. Beginning of scientific attitude -1826AD-1875AD
5. The period of prevention -1879AD-1960AD

30. 1) THE PERIOD OF
PERSECUTION
• Mentally ill patients were inhumanly treated.
Treatment of the mentally ill depended on
men’s with various superstitious beliefs like
Black spirit of black magic was harmful and
white magic and good spirit didn’t bring illness.

31. 2) THE PERIOD OF
SEGREGATION
• “Bethlem Asylum” in England was developed
for mentally ill patients to prevent the mentally
ill patients from straying into streets.
government funded these hospital but patients
didn’t have adequate conditions to live

32. 3) THE HUMANITARIAN
PERIOD
 Phillipe Pinel in france and William Tuke
opened chains of the york retreat hospital in
England. Patients were treated humanically.
more patients were taken care in the
humanitarian ground.
 Also called as father of modern psychiatry

33. 4) BEGINNING OF SCIENTIFIC
ATTITUDE
 Sigmund freud(1856-1936) founder of
psychoanalysis believed that hypnotism was
best to treat psychic tensions.
 Emile kraeplian classified mental illness.
.

34. CONTD
 In 1860 - 1st Florence nightingale nursing
school was opened at st.thomas hospital in
london.
 In 1873-linda richards the first american
psychiatric nurse was graduated from the new
england hospital for women and children

35. • PAULOZAKHIA
Suggested that a physician
rather than a priest or
lawyer should evaluate
patients responsibility for
abnormaL behaviour.
CONTD

36. 5) PERIOD OF PREVENTION
 Between 1920-1972,there were little changes in
the role of psychiatric nurses because all
complex procedures like insulin shock therapy
etc. required skilled medical surgical nurses.
 In 1946 psychiatric nursing was added as a
subject in the nursing curriculum in many
schools of nursing.
 In 1950 the national association of mental
health was formed.

37. EVOLUTION AFTER 19TH AND
EARLY 20TH CENTURY
 Towards the end of century harsh treatment was changed by
reforms that abolished most restraints and mental patients were
considered as a human being.
 Jean esquirol differentiated between illusions and hallucinations.
 Proposed that criminally insane should be treated rather than
punished.
 In 1853,the british journal of psychiatry was first published.

38. CONTD
 Benjamin rush The most
famous American psychiatrist
of his time
 Father of American
psychiatry.
 Johann Cristian.reil 1st to use
the word ‘psychiatry’
 E.F.VON
FEUCHTERSLEBEN coined
the word ‘psychosis’.

39. THEORY OF DEGENERATION
Mental illness maybe congentitally transmitted and
activated by the influence of alcohol, syphilis etc.
BENEDICT MOREL

40. CLASSIFICATION OF FUNCTIONAL
PSYCHOSIS
• Emil kraeplin-classified functional
psychosis into manic depressive illness
with good prognosis and dementia
praecox which deteriorated into
dementia.
• Eugene bleuler-coined the term
‘schizophrenia’for dementia praecox
and said that it did not always
deteriorate.
• Introduced 4A’s of schizophrenia
association,affect,autism,ambivalence
.

41. PAUL BROCA
• Discovered a speech area in the brain called
broca’s area by examining the brain of a patient
of aphasia at postmortem.

42. SHOCK TREATMENTS
• Lucio bini ,an Italian psychiatrist and ugo
cerletti, a neuro psychiatrist, together
researched and discovered the method of
electro-shock treatment which later came to be
known as electroconvulsive therapy.

43. INVENTION OF
PSYCHOTHERAPIES
• COGNITIVE THERAPY-AARON BECK
• INTERPERPERSONAL PSYCHOTHERAPY-
WEISSMAN,KLERMAN
• PSYCHODRAMA-JACOB MORENO
• TOKEN ECONOMY-ALLYON,AZRIN
• SYSTEMIC DESENSITIZATION-WOLPE

44. NOBEL PRIZES IN PSYCHIATRY AND RELATED
FIELDS
 Ivan pavlov(1904)-classical conditioning
 Egaz moniz(1949)- prefrontal lobotomy
 Konrad lorenz(1973)-ethology (imprinting
in animal behaviour)
 Eric kandel(2000)-physiological basis of
memory storage in neurons

45. IMPORTANT MILESTONES
 The first mental hospital in the US was built in Williumsburg
Virginia-1773.
 Father of psychiatry-benjamin rush
 Father of modern psychiatry-Phillipe Pineal
 Term psychiatry coined by-Johaan Cristian Reil.
 1912 - eugen bleuler a swiss psychiatrist coined the term
‘schizophrenia’.
 1st mental health nursing course-males,1943
 1912 - The indian lunacy act was passed.
 1927 - insulin shock treatment was introduced for schizophrenia
.
.

46. CONTD
 1938 - electroconvulsive therapy (ect) was used for the treatment
of psychiatric disorders in Rome..
 2013 – WHO launched the mental health action plan 2013-2020 on
october,2013.

47. IMPORTANT MILESTONES OF MENTAL HEALTH
IN INDIA
• Father of indian psychiatry-
Dr.vidyasagar
• 1st mental hospital-CIP
,ranchi(1925)
• 3month certificate course-madras
• 1year post certificate course-
NIMHANS(1956)
• Mental health as a subject in
BSc.Nursing by INC-1965

48. CONTD…
• 1st MSc.Nursing course in psychiatry—
rajukumari amrit kaur college ,new delhi-1976.
• Pgi chandigarh-1978
• Cmc vellore-1987
 National institute of mental health &sciences-
19881987 – The Indian Mental health act was
passed.
• The government has passed two acts :
Mental health act 1987.
Person with disability act 1995.
• Revised mental health act passed on 7th
april,2017
Implement on-7th july ,2018

49. TRENDS AND ISSUES OF MENTAL
HEALTH
pics

50. UNDER THIS SECTION COMES
General trends and issues
Current trends and issues

51. A) GENERAL TRENDS AND
ISSUES INCLUDES
I. Globalization era
II. Changes and challenges in mental health
III. Cost effective nursing care
IV. Focus of care
V. Legal aspects of psychiatric nursing
VI. Educational programme for psychiatric nursing
VII. Development of code of ethics

52. I) IN THE GLOBALIZATION ERA

53. II) CHANGES AND CHALLENGES
IN GENERAL TRENDS AND
ISSUES

54. A) DEMOGRAPHIC CHANGES
• Types of family
• Increased number of elderly group.

55. B) SOCIAL CHANGES
• The need for maintain intergroup &intragroup
loyalities
• Peer pressure.

56. C) ECONOMIC CHANGES
• Industrialization
• Urbanization
• Raised standard of living

57. D) TECHNOLOGICAL CHANGES
Mass media
Electronic system
Information technology

58. E) MENTAL HEALTH CARE CHANGES
 Increased awareness in the public regarding
mental health
 Need to maintain mental stability
 Increased mental health problems.

59. III) COST EFFECTIVE NURSING
CARE
• Studies need to be conducted to find out the
viability in terms of cost involved in training a
nurse &the quality of output in terms of nursing
care rendered by her.

60. IV) FOCUS OF CARE
• Care Of elderly,children,women,youth,mentally
retarded &chronic mentally ill.

61. V) LEGALASPECTS OF PSYCHIATRIC
NURSING
 The practice of psychiatric nursing is influenced by
law, particularly in its concern for the rights of patients
& quality of care they receive.
 The client rights to refuse a particular treatment,
intentional torts ,informed consent ,confidentiality
&record keeping are few legal issues in which the
nurse has to participate & gain quality knowledge.

62.  Diploma in psychiatric
nursing (the first program
was offered in 1956 at
(NIMHANS,banglore).
 M.sc in psychiatric nursing
(the 1st program was
offered in 1976 at
Rajkumari amrit kaur
college of nursing,new
delhi).
VI).EDUCATIONAL PROGRAMS FOR
THE PSYCHIATRIC NURSE

63. CONTINUE
• M.phil in psychiatric nursing (1990,M.G.
UNIVERSITY,KOTTAYAM).
• Doctorate in psychiatric nursing (offered at MAHE
manipal;RAK CON,delhi,NIMHANS,banglore).
• Short –term training for both the degree &diploma
holders in nursing

64. VII) DEVELOPMENT OF CODE OF
ETHICS
• This helps to maintain patient’s confidentiality ,
protection of rights & patient advocation.
• It includes-
Standard of mental health nursing
Quality nursing care
Accountability.

65. CONTINUE
Promotion of research in mental health nursing.

66. B) CURRENT TRENDS IN MENTAL
HEALTH CARE
• Educational programmes for psychiatric nurse
• Development of code of ethics
• Legal aspects in psychiatric nursing
• Promotion of research in mental health nursing
• Cost effective nursing care
• Focus of care
• World health day
• Mental health global action program
• Health and human rights
• Revision of hospital medical code

67. CURRENT TRENDS IN THE ROLE OF
PSYCHIATRIC NURSE

68. CONTD

69. CURRENT ISSUES IN INDIA
 Most psychiatric centres do not have qualified
psychiatric nurses, high priority should be given to
place qualified psychiatric nurses in psychiatric
hospitals.
 There is crucial need to create proper jobs at par with
other professionals, particularly in community
.
 To maintain minimum standards of psychiatric nursing
care in mental hospitals, the recommended psychiatric
nurse: patient ratio as per INC is1:5in non teaching and
1:3 in teaching hospitals.

70. CONTINUE
 Individual with lower levels of education, low household
income ,lack of access to basic amenities are at high risk
of mental disorder.
 Suicidal behavior was found to have relation with female
gender, working condition, independent decision making,
premarital sex, physical abuse and sexual abuse.
 Living alone and continous break in a steady relationship
within the past year were also significantly associated with
suicide

72. CONTINUE
 Poorer women are more likely to suffer from adverse life events
to live in a crowded or stressful conditions.
 Psychological factors such as headache and body ache, sensory
symptoms and non specified symptoms such as tiredness and
weakness also make people vulnerable to mental disorders.
 Biological factors like genetic factors, abnormal physiology and
congenital defect plays a major role.
 Disasters leads to violent encounters with natureA meta-anlysis
showed that posttraumatic stress disorder, generalized anxiety
disorder and panic disorder are common among disaster victims.

73. CONTINUE
 A meta-anlysis showed that post traumatic
stress disorder,generalized anxiety disorder and
panic disorder are common among disaster
victims.

74. COMMON CHALLENGES /ISSUES OF
MENTAL HEALTH IN INDIA
 Stigma related to mental disorders
 Lack of awareness among people
 Delayed treatment seeking behaviour
 Lack of low cost diagnostic test
 Lack of easily available treatment
 Misconception regarding mental illness and its treatment
 Non communicable disease aggravating the load of mental
disorders
 Lack of political commitment

75. CONTINUE
 Lack of manpower and other resources
 Increasing elderly population
 Treatment non-compliance revolving door
phenomenon
 Women health
Other issues like-
 Lack of education
 Labour injustice
 Poor transport

76. REMEDIES TO MENTAL HEALTH
PROBLEMS
• To promote mental health it is necessary to create a
stress free enviornment where everyone is respected,
anyone has right to come forward and make some
step towards cultural, political and civil rights of the
patient.
• Society needs to be free from discrimination and
violence.
• Social support for elderly must be there.

77. MAGNITUDE OF MENTAL HEALTH
PROBLEMS AND DISORDERS
• Currently mental and behavioral disorders account for
about 12 percent of the global burden of diseases.
• This is likely to increase to 15 percent by 2020.
• Major proportions of mental disorders come from low and
middle income countries.
• More than one people in three from worldwide show
criteria for at least one psychiatric condition during their
life.
• Anixiety disorders are on the top followed by mood
disorders, substance abuse and impulse control disorders.

78. • Depression
• Bipolar affective diosorder.
• Schizophrenia
• Commonest mental
disorder. Estimated 300
million people are
affected by depression.
• BPAD affects about 60
million people
worldwide.
• Affecting about 23
million people world
wide.
MENTAL DISORDER; KEY
FACTS(WHO 2018)

79. • Dementia
• Epilepsy
• Alcohol or drug use
disorder
• Suicide
• Worldwide,
approximately 50
million people have
dementia.
• Approximately,38
million suffer with
epilepsy.
• 90 million
• 1 million.
CONTINUE

80. • Attempt to suicide
• Interpersonal
violence
• One in four person
• One in 5 women
• One in 3 women
• 5 to 10 million
• 475000 homicides
• Physically abused as
childern
• Sexually abused as
children
• Victims of physical and
sexual intimate partner
violence in their
lifetime.
CONTINUE

81. RAPE

82. PREVALENCE OF MENTAL
DISORDERS
 Average lifetime prevalence of schizophrenia is 0.4%
 Approximately 7% of preschool children were given a
psychiatric diagnosis and approximately 10% of 1 and 2 year old
receiving developmental screening have been assessed as having
significant emotional problems.
 Women have twice the rate of depression than men.
 73million women are affected with major depression.

83. CONCLUSION
• Burden of mental illness seen by the world as
tip of iceburg only,but in actual its very intense
in nature
• To promote mental health there is a need to
create such living conditions and enviornment
that support mental health and allow people to
adopt healthy lifestyle.
• India needs to aim at improving child
development by early preschool psychosocial
activities,nutritional and psychosocial help to
give roots for a healthy community.

84. CONTINUE
• There is a need to improve women
empowerment by increasing access to education
and employment.
• Society needs to be free from discrimination
and voilence.
• WHO and mental health gap action programme
aims at scaling up services for
mental.neurological and substance use
disorders.

85. SUMMARIZATION
 Historical perspectives including era
 Periods of development of psychiatric
development
 Trends in psychiatric nursing
 Issues & challenges in psychiatric nursing
 Magnitude of mental health problem.

86. RECAPTULIZATION
 What is the definition of mental health?
 Who is the father of American psychiatry?
 What are the periods in history of mental health?
 What are the current trends in psychiatric nursing?

87. REFERENCES
BOOK REFERENCES:-
Pareek Bharat,“textbook of psychiatric nursing”,published by bharat
pareek, Edn;1st 2019,pp 2-14
Sreevani R,“a guide to mental health & psychiatric
nursing”,published by jaypee brothers medical
publishers,edn;4th2016,pp 2-14
NET REFERENCES:-
www.bcmj.org/mds-be/historical-perspectives-theories-diagnosis-
and-treatment-mental-illness ,viewed on 4/12/2019.
 https://www.slideshare.net/NorthTecNursing/mental-health-
historical-timeline,viewed on 9/12/201
https://samples.jblearning.com/0763744344/44344_CH02_021_038.
pdf ,viewed on10/12/2019
https://www.slideshare.net/kmpradeepkm/trends-and-issues-
24145577,viewedon10/12/2019.