PSYCHIATRY AND MENTAL HEALTH NURSING

1. COMMUNITY PSYCHIATRY
BY PAULINE TEMBO(RN,BSC)
NORTH WESTERN,ZAMBIA

2. OBJECTIVES
• GENERAL OBJECTIVE
• Describe care of patients with mental disorders in the community.
• SPECIFIC OBJECTIVES
• At the end of the unit the learner should be able to:
• Define key terms used in community psychiatry.
• Explain the concept of community mental health services in Zambia.
• Outline levels of intervention in mental health
• Explain the role of a Nurse

3. DEFINITION OF KEY TERMS USED IN
COMMUNITY PSYCHIATRY
• Community Psychiatry refers to Psychiatry focusing on
detection, prevention and early treatment and rehabilitation
of emotional and behavioral problems as they occur in the
community.
• Institutionalism is a pattern of passive dependent behavior
observed among psychiatric inpatients, which is
characterized by hospital attachment and resistance to
discharge

4. • De-institutionalization: De-institutionalisation is the process of replacing long-
stay psychiatric hospitals with less isolated community mental health
services for those diagnosed with a mental disorder or developmental disability.
• Mental health promotion is a means of reaching the goal of good mental health
through actions that are taken for the purpose of fostering, protecting and
improving mental health.
• Primary prevention is preventing psychiatric illness rather than treating it. This
is done by first identifying at risk groups, and then promoting their mental
health through educating them.
• Secondary prevention is reducing the number of existing mental illnesses
through screening early diagnosis, prompt treatment and education of signs and
symptoms

5. • Tertiary prevention: This is an Attempt to reduce the severity of a
mental disorder and its associated disability through rehabilitation
activities or the prevention of long term disability from chronic and
persistent severe mental illness. Such disability includes poor social
integration, aggression, indecent behaviours, among other

6. PSYCHIATRIC INSTITUTIONALISM
Dependent patients are seen as docile, timid, dull, apathetic, and weak. In
addition, dependent patients fail to take much initiative in their treatment and
show a submissive and helpless stance
Reasons for intuitionalism
• Patients have become passive
• Having an emotional attachment to medical personnel or the building
• The lack of perceived alternatives -ie Receiving the help and support of a
professional therapist, patients may start to perceive other (nonprofessional)
options, such as the support of friends and family, as less attractive or less
valuable, whereas the therapist becomes a “guide through life

7. Signs of psychiatric institutionalism
• Dependency
• lack of initiative
• inability to solve problems
• not able to make decisions

8. DE-INSTITUTIONALIZATION
• Deinstitutionalisation is the process of replacing long-stay psychiatric
hospitals with less isolated community mental health services for those
diagnosed with a mental disorder or developmental disability. In the late
20th century, it led to the closure of many psychiatric hospitals, as patients
were increasingly cared for at home, in halfway houses and clinics, in regular
hospitals, or not at all.
• Deinstitutionalisation works in two ways. The first focuses on reducing the
population size of mental institutions by releasing patients, shortening stays,
and reducing both admissions and readmission rates. The second focuses on
reforming psychiatric care to reduce (or avoid encouraging) feelings of
dependency, hopelessness and other behaviours that make it hard for
patients to adjust to a life outside of care.

9. Causes of Deinstitutionalization
• Three societal and scientific changes occurred that caused
deinstitutionalization. First, the development of psychiatric
drugs treated many of the symptoms of mental illness. These
included chlorpromazine and later clozapine.
• Second, society accepted that the mentally ill needed to be
treated instead of locked away.
• Third, federal funding went toward community mental
health centres instead of mental hospitals.

10. EFFECTS OF DEINSTITUTIONALIZATION
• Barriers of social inclusion leading to stigma and prejudice
• Poor social skills for example, inappropriate behaviours in public
places such as shops or restaurants or churches.
• Community not ready to receive patients, so they got readmitted into
state hospitals.
• Some other patients fell into the criminal justice system
• Still others became homeless or vagrants.
• Families were not prepared for the treatment responsibilities they
had to assume

11. Introduction of community mental health
services
• The plight of mentally ill people in the community world over was taken into
account during the Alma-Ata International Conference on Primary Health Care in
1978.
• In the following year, community psychiatry was introduced in Zambia.
• Measures were put in place to develop community mental health services
through integration into the existing Primary Health Care system, as proposed at
the conference.
• It was proposed that there should be a mental health component in which
Community Health Workers with support from Neighbourhood Health
Committees and technical guidance from mental health professionals would
base their work after a six week training course:

12. The roles of community Mental Health workers included the
following:
• Conducting mental health education in communities
• Identify and refer patients or persons with emotional problems,
serious mental illness, epilepsy, learning disabilities and behavioural
problems to health facilities.
• Encourage patients in the community to comply with medication
and keeping of review dates.
• Encourage acceptance of patients within the community.
• Collect and compile simple data about mentally ill individuals in the
community.

13. Community mental health services in Zambia
today
The community mental health services are provided in line with The Mental
Health Services Bill, (2006) . The following services are provided:
• Home visits
• Mental health corners in PHC clinics,
• Outreach clinics
• Assessment of new cases at UTH clinic 6 and review of old cases as well at
Chainama OPD
• Counseling for emotional, substance abuse problems, mental disorders

14. LEVELS OF INTERVENTION IN MENTAL HEALTH
• Levels of intervention or acting and taking a definite step to reduce
symptoms or keep mental illness from occurring include
• mental health promotion,
• prevention which can be primary, secondary and tertiary.

15. Mental health promotion
• Mental health promotion is any action taken to maximize mental health and
well being among populations and individuals.
• Mental health promotion involves actions to create living conditions and
environments that support mental health and allow people to adopt and
maintain healthy lifestyles. These include :
Early childhood interventions (e.g. home visits for pregnant women, pre-
school psycho-social activities, combined nutritional and psycho-social help for
disadvantaged populations);
Support to children (e.g. skills building programmes, child and youth
development programmes);

16. Socio-economic empowerment of women (e.g. improving access to education
and microcredit schemes);
Social support for elderly populations (e.g. befriending initiatives, community
and day centres for the aged);
Programmes targeted at vulnerable groups, including minorities, indigenous
people, migrants and people affected by conflicts and disasters (e.g. psycho-
social interventions after disasters)
• Mental health promotional activities in schools (e.g. child-friendly schools);
• Mental health interventions at work (e.g. stress prevention programmes);

17. PREVENTION
• Mental health Prevention means preventing mental illness from occurring.
This can be carried out through specific promotional activities and reducing
risk factors in the lives of individuals, families and communities.
• In the community, mental health prevention occurs at three levels: Primary,
secondary and tertiary.
Primary Prevention
• Primary prevention involves both mental health promotion and prevention of
disorders (reducing risk factors) in the lives of individuals.
• Promotional and preventive activities in mental health care delivery are
targeted towards:
A) Assisting individuals to increasingly cope effectively with stress.
B) Target and diminish stressors in the environment.

18. This is done through educating at risk groups in the following ways:
• Teaching parenting skills and child development to prospective new
parents.
• Teaching physical and psychological effects of alcohol, drugs to
primary and secondary pupils.
• Teaching techniques of stress management to anyone who desires to
learn.
• Teaching groups of individuals ways to cope with the changes
associated with various maturational changes (adolescence,
motherhood, menopause, retirement) etc
• Teaching the concepts of mental health to various groups within the
community.
• Providing education and support to unemployed or homeless
individuals.

19. SECONDARY PREVENTION (TREATMENT)
• It is in the secondary level of prevention that treatment takes place to
reduce the severity of mental illness as follows:
• This is decreasing or reducing the prevalence of psychiatric illness by
shortening the course of the illness. This is accomplished through early
identification of problems and effective treatment.
• Ongoing assessment of individuals at high risk of mental illness, is done
during home visits, day care, PHC clinics, or any setting where
screening of high risk individuals may occur.
• Provision of care for individuals in whom illness symptoms have been
assessed eg: counseling, medication, support during high levels of
stress
• Referral for investigations and treatment of individual in whom illness
symptoms have been identified.

20. TERTIARY PREVENTION
• Tertiary prevention aims to limit or reverse the impact of already
existing health conditions and impairments; it
includes rehabilitation services and interventions that aim
to prevent activity limitations and to promote independence,
participation and inclusion.

21. NURSES’ ROLE IN TERTIARY PREVENTION
• Teaching the client daily living skill
• Encouraging independency his/her inability
• Through social skills training
• Assertiveness training
• Anger management techniques
• Referring clients to various aftercare services after discharge
• Aftercare homes such as Chawama old people’s home, support
groups(alcoholics anonymous groups), and day treatment programmes
• Monitoring effectiveness of aftercare services through home visits

22. AFTERCARE
• Upon discharge, persons recovering from mental illness need
continuing care to prevent relapse and other complications occurring.
These include:
• After homes
• Halfway homes
• Self helpgroups

23. ROLES OF A NURSE IN THE DELIVERY OF MENTAL
HEALTH SERVICES IN THE COMMUNITY
• Consultative role – Giving advice to other professionals in the community about the type and
level of nursing care required for given client groups.
• Clinical role – Providing direct nursing care to the patients in the community through home
visits.
• Therapeutic role – Employing psychotherapeutic and behavioral methods for management of
patients.
• Assessor / Researcher – The nurse may assess the care given to clients and may also assess
the outcome of ongoing care programmes.
• Educator – Creating awareness in the community about mental health and mental illness
with special focus on vulnerable groups
• Trainer / facilitator – Training of other professional community leaders, school teachers and
other care giving professionals in the community.
• Manager/Administration – Manager of the resources, planning and co-ordination.
• Liaison role
• Advocacy – Nurses speak out for the rights and interests of clients in the community by
raising awareness of clients’ needs in places of employment, school and markets.

24. THE END