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Evolution of Mental Health Services

  1. Presented by: Mr. Vipin Chandran
  2. Although the concept of caring for the sick, ‘nurturing’ or ‘nursing’ existed since time immemorial, mentally ill were tortured, persecuted, ridiculed, neglected and shunned. Before 1860, the emphasis in psychiatric institutions was on custodial care, untrained people controlled the mentally ill, psychiatric care as such was non- existent.
  3. Early scripts of Chinese, Egyptians and Greek reveal that cause of mental illness was attributed by demons Mentally ill were treated by exorcism (prayer, noise making) & oral preparation of a purgative made from sheep dung and wine as well as trephining. The first ray of light in this dark history of psychiatry came with Hippocrates (460 B.C.), the great physician called as “ The Father of Modern Medicine”. He told brain pathology led to mental illness. Hippocrates classified mental illness as Mania, Melancholia & Phrenitis. He recommended marriage as a treatment for mental illness.
  4. The Great Philosopher, Plato (429 B.C.) believed that mental disorders could be due to a combination of organic, moral and divine causes. Aristotle (384 B.C.) another Greek philosopher emphasized on release of repressed emotions through catharsis and music therapy as an effective mode of treatment for mentally ill.
  5. 1) Period of Persecution (1552BC-1400AD): Patient with mental illness were avoided, thrown out of society & beaten up by people & nobody was allowed to interact with these people. 2) Period of Segregation (1545AD- 1800AD): Mentally ill patient were segregated & kept separately in asylums. These asylums were funded by government.
  6. 3) Humanitarian Period (1745AD- 1826AD): Philippe Pinel in France and William Tuke in England opened chains of the mentally ill, total care was provided to the patients without restraints or chains. 1773 in the U.S. mental patients were admitted to Pennsylvania Hospital. General nurses took care of mentally ill patients. 4) Beginning of Scientific Attitude (1796AD- 1878 AD): Insanity was regarded as an illness, Sigmund freud (1856-1939), founder of psychoanalysis, believed in hypnotism for easing psychic tension. Emile Kraeplian (1856-1926) classified mental illness.
  7. First Florence nightingale nursing school was opened at the St. Thomas Hospital in London (1860), in 1873, Linda Richards the first American psychiatric nurse, was graduated from the new England hospital for women and children. 5) Period of Prevention (1885AD- 1960AD): Between 1920-72, there was little change in the role of a psychiatric nurse because all procedure like insulin shock therapy, metrazol shock therapy, psychosurgery and electroconvulsive therapy required skilled medical surgical nurses.
  8. Harry stack Sullivan (1920) also felt that nurses have a very important role to play in the mileu tharapy. Tremendous progress in academically too. Various books and journals were published such as Journal of psychiatry nursing and mental health services, standards of psychiatric- mental health nursing practice- ANA (1973).
  9. 1) 1773: the first mental hospital in the US was built in Williamsburg, Virginia. 2) Asciepiades, is the Father of Psychiatry and in 1882 Benjamin Rush become Father of American Psychiatry. 3) 1912: Eugen Bleuler coined the term “Schizophrenia”. 4) 1912: Indian Lunancy Act passed. 5) 1927: Insulin Shock Therapy was introduced for schizophrenia 6) 1938: Electroconvulsive therapy (ECT) was used for the treatment of psychoses 7) 1946: Bhore committee presented the situation with regard to mental health services. Based on this 5 mental hospital were set up at Amritsar, Hyderabad, Srinagar, Jamnagar and Delhi. All India Institute of Mental Health was also set up at Bengaluru, currently known as NIMHANS.
  10. 8) 1949: Lithium was first used for the treatment of Mania. 9) 1963: The ‘Community Mental Health Centers’ Act was passed. 10) 1987: The Indian Mental Health Act was passed. 11) 2001: On Aug 6th 27 more mentally ill people died as they were tied to their beds when fire engulfed the roof of Moideen Badusha Mental Home at Erwadi, Tamil Nadu. 12) 2002: National Survey of Mental Health Resources carried out by the Directorate General of Health Services, ministry of health and family welfare. 13) 2007: Under the Eleventh five year plan, centre of excellence in the field of mental health were established. 14) 2013: World Health Organization launched the Mental Health Action Plan 2013-2020 on 7 October, 2013.
  11. 1) 1840: Florence Nightingale made an attempt to meet the needs of psychiatric patients. 2) 1872: First training school for nurses was established in New England. 3) 1913: Johns Hopkins became the first school of nursing to include fully course for psychiatric nursing in the curriculum. 4) 1921: Short training course of 3 to 6 months were conducted in Ranchi. 5) 1943: Psychiatric nursing course was started for male nurses. 6) 1948-50: Four nurses were sent to UK by the Government of India for training in ‘mental nurses’ diploma. 7) 1952: Dr. Hildegard Peplau defined therapeutic roles for nurses 8) 1954: Nur Manzil Mental Health Centre, Lucknow started psychiatric nursing.
  12. 9) 1956: One year post- certificate course in psychiatric nursing started. 10) 1958: All the wards at the Agra Mental Hospital were ordered to be kept open and all wards locks were removed. 11) 1965: The Indian Nursing Council included psychiatric nursing as a compulsory course in the B.Sc. Nursing Program. 12) 1967: TNAI, formed separate committee for psychiatric nursing. 13) 1973: Standards of Psychiatric and Mental Health Nursing practice were introduced. 14) 1975: Psychiatric nursing was offered as an elective subject in M.Sc. Nursing at Rajkumari Amrit Kaur CON, New Delhi. 15) 1986: The INC made psychiatric nursing a component in GNM. American Psychiatric Nurses Association was established. 16) 1991: Indian Society of Psychiatric Nurses formed at NIMHANS.
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