About mental health

1. INTRODUCTION TO MENTAL
HEALTH

2. LEARNING TASKS
At the end of this session a learner is expected to be able:
 Define the following terms Mental health, mental
disorders/mental illness
 Explain the evolution of mental health services internationally
 Explain historical background of mental health services in
Tanzania
 Explain principles of mental health in the provision of mental
health care

3. Definition of the Terms
• Mental health is a successful adaptation to stressors from the
internal or external environment, evidenced by thoughts, feelings, and
behaviors that are age-appropriate and congruent with local and
cultural norms.
• Mental illness is maladaptive responses to stressors from the
internal or external environment, evidenced by thoughts, feelings, and
behaviors that are incongruent with the local and cultural norms and
interfere with the individual’s social, occupational, and/or physical
functioning.
• Mental disorder is a clinically significant behavioural or psychological
syndrome or pattern associated with present distress or disability.

4. Evolution of mental health services
 History of science of psychiatry and the procedures utilized in
the treatment and care of mentally ill patients is interesting
 It is impossible to say when exactly psychiatry began as it is
apparent that mental illness .
 The fate of the psychiatric patient remained on the human
and primitive methods full of dangers.
 This was because the mentally ill patient was considered to
be problem and disgrace to the family.
 Therefore, the patient was put into asylums far away from
their homes in the interest of the public and the family.

5.  The historical development of psychiatry falls under the
following periods:
o Demonological period
o Humanitarian period
o Political period
o Scientific period

6. i. Demonological Period
 In this period, the psychiatric patient was considered to be
possessed by the evil spirit, the demons and other super-
natural powers that attribute to their abnormal behaviors.
 To the primitive man the whole society of that time, all
illness in the patient was caused by the demons including
other forces acting outside the human body.
 The decision whether the patient is possessed good or bad
spirit depended upon the symptoms presented by the
patient.

7.  If the behavior of the patient or speech appeared to have
religions or cool significance, then it was considered that
the patient is having good spirits hence was treated with
kindness and respect, for it was thought that they had
supernatural powers.
 However, those who expressed aggression, noise,
destructiveness, and all sorts of abnormal conducts were
said to have bad spirits. They were treated harshly, beaten
and staved

8.  Methods of Treatment During Demonological Period
o Exorcism: Casting out the evil spirit from the patient by
saying long prayers, spells, offerings and doing rituals, use
of herbs, purgatives made from sheep and wines.
o Charms: The use or application of the magic. The
effectiveness of such methods rested upon the faith of the
people, patient, and the mental condition he is suffering

9. o Torture: Punishment in the most cruel and crude way, to
make the body of the patient unpleasant place for the evil
spirit to stay, so is driven out of the body of the patient. The
torture was blistering, plunging in cold water of ponds,
lakes, and rivers, starving by not giving food and water, and
beating up the patient and locking them up in dark, wet and
poorly ventilated rooms.
 Others were bounded together (particularly those who were
not responding with treatment) and transferred to forest—
left there for the mercy of the wild animals to finish them

10. ii. Humanitarian Period
 This period was also called Roman period.
 It was practiced early 860 B.C, when Greek
priests advocated kindness for mentally ill
patients and suggested for physical and
recreational activities.

11.  The Greek healers’ interest turned towards
observation and experimentation on the care of
psychiatric patients.
 The early scientific experiments movement is
well-observed in the writings of contributors to
our present knowledge on mental illness

12. Contributors in Humanitarian Period are:
 Imhotep
 An Egyptian physician of 400 B.C. treated the mentally ill
patient as those of any other physical conditions.
 He was considered as “master bringer of peace” in the life
of those suffered from psychiatric disorders.

13.  The ancient Egyptians used some form of neurosurgery in
treating mentally ill patients by opening the skull of the
patient in attempt to relieve the shut in evil spirit in the
brain.
 Evidence was from old skulls picked from the pyramids;
they made holes on the skulls and let the fluid out (bore
hole operation.)

14.  Hippocrate
 The Greek physician and philosopher of 460-357
B.C, has been called the “father of medicine.”
 He totally disagreed with the ideas of believing
that god and evil spirits had influence towards
the cause of mental illnesses.
 He believed and emphasized that the brain is
central organs of intellectual activities and that
mental illnesses was due to brain pathology.
 He initiated the classification of mental illness
into three classes: mania, melancholia, and
phrenitis (inflammation of the brain).

15.  His method of treatment was far more from the
previous ones.
 He believed that environment matters so much
in patients’ management so he removed the
patient from their home environment and
parents to change the environment.
 He also believed that hysteria is observed in
females only and defined it as the wandering of
the uterus to different parts of the body in search
for pinning a child.

16.  For that belief, he recommended marriage as the
best treatment for hysterics.
 He also suggested that court to improve the
rights of psychiatric patients

17.  Galen
 A Roman physician, who studied the anatomy and physiology of
the nervous system and ruled out that presence of symptoms,
did not necessarily indicate that the organ or body part which
seemed to be the origin was the affected part.
 He developed a theory of rational soul, divided it into external
part consists of five senses and internal part consists of
imaginations, judgments, perception, and movement.
 Galen also believed that the brain is the centre or the source of
mental conditions; his concept was as that of Hippocrates.

18.  Plato
 He put up the ideology of studying peoples mind.
 Commencing with himself through the assistance of his
relatives to give him his own life history and later he
continued to study his family members and educators in
order to explain the theory of human behavior.
 Plato also concluded that psychiatric conditions were
centered on the brain functions; if one was not at peace
mentally, they were more likely to show psychiatric
symptoms.

19. iii. Political Period
 The first recognition of the mentally ill patient was in the 14-
17th century during the leadership of Edward II in the
England when parliament approved the bill
 Edward II passed the bill to protect psychiatric patients and
their properties including all rights
 During this period, hospital was better as compared to
prison and workshops where patients continued to be
detained.

20.  More hospitals continued to be built away from the cities
and towns because people still had stigma on mental
patients’ behaviors.
 Houses for the insane were dark, damp, and less
ventilated. Treatment at that time included charming,
beating, hard working in farms, and key and lock behind the
iron bars in well-built cells (small rooms.)
 Political period contributed very much to the present
practice of psychiatry as one can observe some of the
management tasks on the use

21. iv. Scientific Period
 During the 19th century, treatment including the
care of psychiatric patient in the hospital
improved very much.
 More modern treatment and investigations were
done in a more scientific method.
 Doctors and nurses developed more interest in
the patient care and treatment.
 Training of staff was done in order to provide the
best treatment and care

22.  Treatment includes the following:
 Electroconvulsive therapy
 Insulin therapy
 Narcotics
 Occupational therapy
 Recreational therapy
 Flow chart method (counseling)
 Psychotherapy
 Drugs e.g. antidepressants and tranquillizers
 Neurosurgery
 Auto-molecular therapy (use of vitamins)

23. Contributors in Scientific Period were:
 Phillip Pinel (1745-1826)
 He was working in the hospital Bicentre in France.
 He advocated human treatment to psychiatric patients by
removal of chains, improved treatment and recreational
facilities.
 Also improved sanitation and housing
 His practice and ideologies of care was adopted by:
Chiarugi in Italy (1959), Daniel Tuke in England (1827-
1895), Dorothea Dix in USA (1802-1887), and Frekin in
German.

24.  Ferrick
 In 1835, he strengthened the report of abolishing
the cages in which patients were exposed like
animals and people watched for fun.
 He introduced legislation for the mentally ill
patients to be admitted through legal procedures
and now was separated from criminals.

25.  Jean Charcort (1825-1893)
 He focused the interest of physician on hysteria.
He believed that hysteria is a hereditary
condition but this theory has been disrupted out
of field of psychiatry.

26.  Emil Kraepelin (1856-1926)
 He was considered “father of descriptive psychiatry.”
 He carried psychiatry from the view of relying on symptoms
to a more comprehensive reliable descriptive system.
 He set up the first research unit (institute) with a laboratory
of serology, chemistry, pathology, and experimental
psychology.

27.  He gave a proper classification of mental illness and he
believed that mental disorders were definite disease.
 He emphasized on the importance of total clinical picture
with proper diagnosis, cause, course, symptomatology, and
prognosis of the condition in general.
 He also stressed on clinical observation and research for
the physical origins of mental conditions

28.  Eugen Bleuler (1857–1937)
 He worked on mainly on schizophrenia.
 He ruled out that not all schizophrenia (dementia praecox)
ended in personality deterioration nor was the onset only
on puberty.
 He also formulated the word schizophrenia because he
considered it to be disorganization of personality. (schizen -
split and phren - mind)
 He took the interest to study/describe some symptoms; e.g.
autistic thinking, ambivalence, and schizoid personality.

29.  Pierre Janet (1859-1947)
 He formulated that many sexual disturbances are result
and not the cause of nervous disorders.
 He differed from Freud about the aetiology of anxiety. He
believed the inadequacies can lead to anxiety.
 He grouped obsessive compulsive neurosis and phobia.
 He also stated the theory of psychic tension, which
personality function occurred when different elements
dissociated away or split off from the stream of
consciousness.

30.  Great Contributors to the Development of Modern
Psychiatry
 The following scientists established definite
school of thought in psychiatry:
Sigmund Freud (1856-1909) established
psychoanalytic school.
Carl Jung (1875-1961) established the analytical
school of psychology.
Alfred Adler (1870-1937) established schools of
individual psychology and existential analysis.

31. Historical background of mental health services in
Tanzania
 Tanzania, like any other countries all over the world, mental
health has been a long standing history in a mankind and
people from our ancestors.
 People have different feelings toward its causes and the
management.
 Early in history, most Tanzanians had similar beliefs relating
to demons and evil spirits being responsible for mental
disorders.
 How to get rid of these demons, the mentally disturbed
person had to be taken to a traditional healer who will perform
the healing.

32.  Traditional healers took interest in treating patient suffering,
considerable social danger and more exploiters in the society;
also cases of neuroses benefited more as compared to
psychoses
 Some people believed that mentally ill patients in the mental
hospital are badly treated and confined in the cell, once you
get into mental hospital you will never get out, and they
regarded mental hospital as something between a person
and a concentration camp, something which is not true.

33.  Up to now, there is still a stigma and discrimination among
people towards the mentally ill persons and mental hospital.
 When visiting the psychiatric hospital to see their patients,
they feel oversensitive and not at easy.
 Lutindi was the first hospital to care for psychiatric patients in
Tanzania, followed by
 Irente at Lushoto and later Mirembe psychiatric hospital
which was established/ built in 1927

34.  Since then various psychiatric units and rehabilitation
villages were established at least in each region to make
sure psychiatric services runs smoothly.
 Community psychiatry was introduced by Dr. Rugeiyamu in
1973 at Mirembe hospital with an objective caring patients on
their own environment, so that families, relatives, friends, and
community provides adequate support to the psychiatric
patients and thus reducing stigma and discrimination also
facilitating healing process.

35.  Mirembe psychiatric school was opened in 1973 to
train nurses for six months on psychiatric nursing
with an award of certificate in psychiatric nursing.
 The aim of the program was to increase knowledge,
skill, and attitudes of staffs who will provide care
to psychiatric patients in respective to various
health facilities. (Community, dispensary, health
center, district, and regional levels).

36.  The school is supported directly by the Ministry of
Health Community Development Gender Elderly
and Children.
 Later 1983-1996, the program changed from
certificate to diploma in psychiatric nursing. The
program was for 18 months. In 1996, the program
changed to 2 years.

37.  In 1994, the advanced diploma in mental health
program was established by the ministry of health
for two years of studies.
 All effort was made in order to increase more
competent staff for care of mentally ill patients and
improving mental health services in different
health facilities

38.  The current curricula of nursing have made effort for mental
health to be among subjects to be taught in all schools of
nursing
 Community psychiatry is practiced nearly all over the country
at the community, district and regional levels.
 The mental health coordinator coordinates the mental health
services in their respective areas.

39.  Functionally, the mental health services is operated with six
specialized facilities such as psychiatric crisis services,
psychological testing and referral service, research and
education services which are decentralized unit without
patients clinics, centralized hospital, and a day hospital
program.

40.  In Tanzania, there are various health facilities that render
mental health services:
 Psychiatric hospitals
o Mirembe hospital is currently a major psychiatric hospital
which care for large number of patients all over Tanzania.
o Isanga institution is a forensic hospital, established by law
primarily for custodial care.

41.  Psychiatric units
o There are numerous Psychiatric units scattered at least in
all regions and district hospitals; for example Morogoro
psychiatric unit, Mawenzi hospital, Kitete-Tabora hospital,
and Muhimbili psychiatric unit- Mbeya.
o These treat and care for the patient at the possible near
homes to reduce the burden of Mirembe hospital.

42.  Within the regional, district, Non-governmental hospitals,
health centers and dispensary, there are clinics/ ward/ units
where mentally ill are attended or referred to for special
treatment and care

43.  In conjunction to mental health units, the Social support
system available in the community include:
o Religious groups
o Family members and Relatives
o Community social groups with specific activities
o Non-governmental organizations e.g. Basic Needs
o Social welfare/social work
o Primary healthcare committee
o Village government
o Social clubs

44. . Principles of mental health in the provision of
mental health care
 Principles refer to rules or laws that have proved to be
applicable in most, if not all situations.
 Mental health nursing is the process whereby the nurse
assists persons, individuals or in groups, in developing a
more positive self-concept, a more harmonious pattern of
interpersonal relationships, and a more productive role in
society.
 Principles of psychiatric nursing provide general guidelines
that should be used in the nursing care of all mentally ill
people unless the assessment data indicate otherwise

45. The Principles of mental health includes:
o The nurse must view the client as a holistic being
with a multiplicity of interrelated and interdependent
needs. It directs a nurse psychiatrist who must
become skilled in understanding the
interrelatedness of all the client’s subsystems.

46. o The nurse can be most helpful to the client by focusing
on his strengths and assets, not on his weaknesses and
liabilities.
• Each individual has a potential for growth; the
strengths the clients have should be built on to
encourage their emotional growth.
o The nurse needs to accept the client as a human being
who has value and worth exactly as he/she is.
 Each individual is unique and has inherent value, i.e. call
the patient by name, Mr.…, convey acceptance to the
patient.

47. o The nurse needs to make effort to convey to the client
her understanding of this fact and her willingness to
help the client meet the need or communicate the
message in a socially acceptable way to meet the
client’s needs.
o The nurse must view the client’s behaviour as
designated to meet a need or to communicate a
message. All behaviour has meaning.

48. o The nurse has the potential for establishing a
relationship with most, if not all, clients.
All human beings are sufficiently similar so that
there is a basis, no matter how small, for
understanding and communicating with one
another

49. o Nurse should interact with every client in a helpful way.
 The quality of interaction in which the nurse engages with the
client is a major determinants of the degree to which the
client will be able to alter his behaviour in the direction of
more satisfying and satisfactory interpersonal relationships.
 An individual learns behavioral responses primarily in
interaction with significant people in his environment. In most
settings, the nurse has the opportunity of spending the
greatest amount of time with the client through therapeutic
interaction and helping him to effect behavioral change.

50. o The nurse needs to view the client’s behaviour as the best
possible adaptation he is capable of making at the time.
 All behaviour is a learned response based on the individual’s
perceptions of past events and maladaptive behaviour
represents an adaptation to previous unhealthy or unique
situations.
 If maladaptive behaviour was learned, it can be unlearned
and more adaptive behavior can be learned in response to
healthier and more usual situations.
 This belief is one of the bases of the nurse-client relationship

51. Key Points
 People have different feelings towards causes of mental
illness.
 Stigma and discrimination still exist.
 Various health facilities offer mental health services in
Tanzania from lower to upper level. Such services include
identification, treatment, referral, and mental health
promotion.
 A well-organized and well-functioning social support is of vital
for the care, treatment, and rehabilitation of mentally ill
patients.

52. Evaluation
 What are the periods of historical development of
psychiatry?
 What is the historical background of mental health
services in Tanzania?
 What are the principles of mental health in the
provision of mental health care?

53. References
 DSM – VTM (2005). Diagnostic and Statistical Manual of Mental Health
Disorders, Washington
 Habber, J, Leah, A and Schudy, S. (2000). Comprehensive Psychiatric Nursing.
McGraw Hill book Company
 Keltner, N.L., and Steel, D. (2015). Psychiatric Nursing. (7th Ed). Elsevier.
 Mbatia, J, Kilonzo G, and Hauli, J (2004). Mental Health; A Basic Manual for
General Health Workers in Primary Health Care. MEHATA Publication,
Dar es Salaam
 Ndetei, D (2006). Clinical Psychiatry and Mental Health. AMREF, Nairobi
 Townsend, M.C., (2013). Essentials of Psychiatric Mental Health Nursing.
Concepts of Care in Evidence – Based Practice. (6th Ed). F.A. Davis Company
 WHO (2000). Collaborating Centre for Mental Health Disorders; Australia