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Subject:- Mental Health Nursing
Unit:- 1.Introduction of mental health
Nursing
Topic:- 1.Perspectives of Mental Health and Mental
Health Nursing
2.Prevelance and incidence of mental health
Problems and disorders.
3.Mental Health Act

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MENTAL HEALTH NURSING:-
Introduction:-
Perspectives of mental health and mental health
nursing:-
HISTORICAL PERSPECTIVES OF THE TREATMENTOF MENTAL ILLNESS:-
Ancient Times:-

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 People of ancient times believed that any sickness Indicated
displeasure of the gods and, in fact, was a punishment for sins and
wrong doing.
 Those with mental disorders were viewed as being either divine
or demonic, depending on their behavior.
 Individuals seen as divine were worshipped and adored; those
seen as demonic were ostracized, punished, and sometimes
burned at the stake.
 Later, Aristotle (382–322 BC) attempted to relate mental
 Disorders to physical disorders and developed his theory that the
amounts of blood, water, and yellow and black bile in the body
controlled the emotions.
 These four substances, or humors, corresponded with happiness,
calmness, anger, and sadness.
 Imbalances of the four humors were believed to cause mental
disorders, so treatment was aimed at restoring balance through
bloodletting, starving and purging.
 Such “treatments” persisted well into the 19th century (Baly,
1982).
 In early Christian times (1–1000 AD), primitive beliefs and
superstitions were strong.
 When that failed, they used more severe and brutal measures,
such as incarceration in dungeons, flogging, and starving.
 In England during the Renaissance (1300–1600), people with
mental illness were distinguished from criminals.
 Those considered harmless were allowed to wander the
countryside or live in rural communities, but the more “dangerous
lunatics” were thrown in prison, chained, and starved (Rosenblatt,
1984).
Period of Enlightenment and Creation of Mental Institutions:-
 In the 1790s, a period of enlightenment concerning persons with
mental illness began.

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 Philippe Pinel in France and William Tukes in England formulated
the concept of asylum as a safe refuge or haven offering
protection at institutions where people were whipped, beaten,
and starved just because they were mentally ill (Gollaher, 1995).
With this movement began the moral treatment of the mental ill.
 In the United States, Dorothea Dix (1802–1887) began a crusade
to reform the treatment of mental illness after a visit to Tukes’s
institution in England.
 She was instrumental in opening 32 state hospitals that offered
asylum to the suffering.
 Dix believed that society was obligated to those who were
mentally ill; she advocated adequate shelter, nutritious food, and
warm clothing (Gollaher, 1995).
 Sigmund Freud and Treatment of Mental Disorders:-
 The period of scientific study and treatment of mental disorders
began with Sigmund Freud (1856–1939) and others, such as Emil
Kraepelin (1856–1926) and Eugene Bleuler (1857–1939).
 With these men, the study of psychiatry and the diagnosis and
treatment of mental illness started in earnest.
 Freud challenged society to view human beings objectively.
 He studied the mind, its disorders, and their treatment as no one
had done before.
 Many other theorists built on Freud’s pioneering work.
 Development of Psychopharmacology:-
 A great leap in the treatment of mental illness began in about
1950 with the development of psychotropic drugs, or drugs used
to treat mental illness.
 Chlorpromazine (Thorazine), an antipsychotic drug, and lithium,
an antimanic agent, were the first drugs to be developed.

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 Over the following 10 years, monoamine oxidase inhibitor
antidepressants; haloperidol (Haldol), an antipsychotic; tricyclic
antidepressants; and antianxiety agents, called benzodiazepines,
were introduced
 Move Toward Community Mental Health:-
 The movement toward treating those with mental illness in less
restrictive environments gained momentum in 1963 with the
enactment of the Community Mental Health Centers Construction
Act.
 Deinstitutionalization, a deliberate shift from institutional care in
state hospitals to community facilities, began.
 Community mental health centers served smaller geographic
catchment, or service, areas that provided less restrictive
treatment located closer to individuals’ homes, families, and
friends.
 MENTAL ILLNESS IN THE 21ST CENTURY:-
 The National Institute of Mental Health (NIMH, 2008) estimates
that more than 26% of Americans aged 18 years and older have a
diagnosable mental disorder—approximately 57.7 million persons
each year.
 Further more, mental illness or serious emotional disturbances
impair daily activities for an estimated 15 million adults and 4
million children and adolescents.
 For example, attention deficit hyperactivity disorder affects 3% to
5% of school-aged children.
 More than 10 million children younger than 7 years grow up in
homes where at least one parent suffers from significant mental
illness or substance abuse, a situation that hinders the readiness
of these children to start school.
 Some believe that deinstitutionalization has had negative as well
as positive effects.

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 PSYCHIATRIC NURSING PRACTICE:-
 In 1873, Linda Richards graduated from the New England Hospital
for Women and Children in Boston.
 She went on to improve nursing care in psychiatric hospitals and
organized educational programs in state mental hospitals in
Illinois.
 Richards is called the first American psychiatric nurse; she
believed that “the mentally sick should be at least as well cared
for as the physically sick” (Doona, 1984).
 The first training of nurses to work with persons with mental
illness was in 1882 at McLean Hospital in Belmont, Massachusetts.
 The care was primarily custodial and focused on nutrition,
hygiene, and activity.
 Nurses adapted medical–surgical principles to the care of clients
with psychiatric disorders and treated them with tolerance and
kindness.
 The role of psychiatric nurses expanded as somatic therapies for
the treatment of mental disorders were developed.
 Treatments, such as insulin shock therapy (1935), psychosurgery
(1936), and electroconvulsive therapy (1937), required nurses to
use their medical–surgical skills more extensively.
 The first psychiatric nursing textbook, Nursing Mental Diseases by
Harriet Bailey, was published in 1920.
 In 1913, Johns Hopkins was the first school of nursing to include a
course in psychiatric nursing in its curriculum.
 It was not until 1950 that the National League for Nursing, which
accredits nursing programs, required schools to include an
experience in psychiatric nursing.
 MENTAL HEALTH AND MENTAL ILLNESS:-
 Mental health and mental illness are difficult to define precisely.

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 People who can carry out their roles in society and whose
behavior is appropriate and adaptive are viewed as healthy.
 Conversely, those who fail to fulfill roles and carry out
responsibilities or whose behavior is inappropriate are viewed as
ill.
 The culture of any society strongly influences its values and
beliefs, and this in turn affects how that society defines health
and illness.
 What one society may view as acceptable and appropriate,
another society may see as maladaptive and inappropriate
Mental Health:-
 The World Health Organization defines health as a state of
complete physical, mental, and social wellness, not merely the
absence of disease or infirmity.
 Mental health is a level of psychological well-being or an absence
of mental illness.
 It is the "psychological state of someone who is functioning at a
satisfactory level of emotional and behavioral adjustment".
 From the perspective of positive psychology or holism, mental
health may include an individual's ability to enjoy life, and create
a balance between life activities and efforts to
achieve psychological resilience.
"subjective well-being, perceived self-efficacy, autonomy, competence,
inter-generational dependence, and self-actualization of one's
intellectual and emotional potential, among others."
- “WHO”
COMPONENTS OF MENTAL HEALTH:-
 The ability to accept self
 The capacity to feel right towards others

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 The ability to fulfill life’s tasks
Indicatorsof mental health :-
 A positive attitude towards self
 Growth, development and the ability for self actualization
 Integration
 Autonomy
 Perception of reality
 Environmental mastery
Seven signs of mental health
 Happiness
 Control over behavior
 Appraisal of reality
 Effectiveness in work
 Healthy self-concept
 Satisfying relationships
 Effective coping strategies
CHARACTERISTICS OF MENTALLY HEALTHY
PERSON:-
They feel good about themselves:
1. They are not overwhelmed by their own emotions-fears, anger, love, jealousy,
guilt or worries.
2. They can take life’s disappointments in their stride.
3. They have a tolerant, easy-going attitude towards the selves as well as others
and they can laugh at themselves.
4. They neither underestimate nor overestimate their abilities.
5. They can accept their own shortcomings.
6. They haveself-respect.
7. They feel able to deal with mostsituations.
8. They can take pleasurein simple, everyday things.
They feel comfortablewith other people:-
9. They are able to give love and consider the interests of others.

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10. They have personalrelationships that are satisfying and lasting.
11. They like and trust others, and feel that others will like
And trust them.
12. They respect the many differences they find in people.
13. They do not take advantage of others nor allow others to take advantage of
them.
14. They feel they can be part of a group.
15. They feel a senseof responsibility to fellow human beings.
MENTAL ILLNESS:-
 Mental illnesses are health conditions involving changes in emotion,
thinking or behavior (or a combination of these). Mental illnesses are
associated with distress and/or problems functioning in social, work or
family activities.
 Mental and behavior disorders are understood as clinically significant
conditions characterized by alterations in thinking, mood(emotions)or in
behavior associated with personal distress and/or impaired functioning
- “WHO”
Characteristics of Mental illness:-
 Feeling sad or down
 Confused thinking or reduced ability to concentrate
 Excessivefears or worries, or extreme feelings of guilt
 Extreme mood changes of highs and lows
 Withdrawalfromfriends and activities
 Significant tiredness, low energy or problems sleeping
 Detachment fromreality (delusions), paranoia or hallucinations
 Inability to cope with daily problems or stress
 Trouble understanding and relating to situations and to people
 Alcohol or drug abuse
 Major changes in eating habits

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 Sex drive changes
 Excessiveanger, hostility or violence
 Suicidal thinking
MENTAL HEALTH ACT
 Indian Lunacy act (ILA), act 4 of 1912 replaced the Indian lunatic asylum act,
act 36 of 1858.
 It was enacted to govern reception, detention and care of lunatics and their
property and to consolidate and amend the laws relating to lunacy.
 The act was divided into 4 parts and 8 chapters consisting of 100 sections.
 In 1946, theBhore committee submitted its recommendations.
 The Indian psychiatric society, established in January 1947.
“Act to consolidate and amend the law relating to the treatment and care
of mentally ill person, to make better provision with respect to their property
and affairs and for matters connected those with or incidental there to”.
The MentalHealth Care Bill, 2013
 The Mental Health Care Bill, 2013 was introduced in the Rajya Sabha on
August19, 2013. TheBill repeals the Mental Health Act, 1987.
 The Statements of Objects and Reasons to the Bill, state the government
ratified the United Nations Convention on the Rights of Persons with
Disabilities in 2007.
 The Convention requires the laws of the country to align with the
Convention.
 The new Bill was introduced as the existing Act does not adequately
protect the rights of persons with mental illness nor promote their access
to mental health care.
 The key features of the Bill are:-
 Rights of persons with mental illness
 AdvanceDirective
 Central and State Mental Health Authority
 Mental Health Establishments
 Mental Health Review Commission and Board
 Decriminalizing suicide and prohibiting electro-convulsivetherapy

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Chapters:-
Chapter 1:-Preliminary information on definitions, shorttitles, extent and
Commencement.
Chapter 2:- Mental illness and capacity to makemental health care and
Treatment decisions.
Chapter 3:-Advancedirective.
Chapter 4:- Nominated representative.
Chapter 5:- Rights of persons with mental illness.
Chapter 6:-Duties of appropriate Government.
Chapter 7:- Central mental health authority.
Chapter 8:- State mental health authority.
Chapter 9:- Finance, accounts and audit.
Chapter 10:- Mental health establishments.
Chapter 11:- Mental health review commission.
Chapter 12:- Admission, treatment and discharge.
Chapter 13:-responsibilities of other agencies.
Chapter 14:- Restriction to dischargefunctions by professionals not
Covered by profession.
Chapter 15:- Offences and penalties.
Chapter 16:- Miscellaneous.