PERSPECTIVES OF MENTAL HEALTH NURSING: EVOLUTION OF MENTAL HEALTH SERVICES PREVALENCE AND INCIDENCE OF MENTAL HEALTH PROBLEMS

1. PERSPECTIVES OF MENTAL HEALTH
AND MENTAL HEALTH NURSING:
EVOLUTION OF MENTAL HEALTH
SERVICES AND TREATMENT
PREVALENCE AND INCIDENCE OF
MENTAL HEALTH PROBLEMS AND
DISORDERS
PREPARED BY
MRS.AKILA.A , M.Sc (N),M.Sc (PSY)
ASSOCIATE PROFESSOR

2. INTRODUCTION
Psychiatric nursing can be seen as a
dynamic interplay between the nurse
and the patient, that encompasses ,
knowledge and skilful application of the
concept of behaviour, personality, the
mind, psychopathology and most
importantly, the process of
interpersonal relationship.

3. DEFINITION
MENTAL HEALTH:
A state of well being in which an individual
realizes his or her own abilities and can
cope up with the normal stressors of life ,
can work productively and is able to make a
contribution towards his or her community.
(WHO)

4. DEFINITION
MENTAL ILLNESS :
Mental and behavioural disorders are
understood as clinically significant
conditions characterized by alterations in
thinking, mood (emotions)or behaviour
associated with the personal distress and/
impaired functioning.
(WHO,2001)

5. DEFINITION
PSYCHIATRIC NURSING:
it is a specialized area of nursing practice,
employing theories of human behaviour as it is
a science, and the purposeful use of self as it is
an art, in the diagnosis and treatment of human
responses to actual or potential mental health
problems.
(ANA – 1994).

6. DEFINITION
PSYCHIATRY:
It is a branch of medicine that deals with the
diagnosis, treatment and prevention of
mental illness.

7. PERSPECTIVES OF MENTAL
HEALTH AND MENTAL HEALTH
NURSING:
• The psychiatric nurse must use herself
and her total personality as the main
implementation for an effective care.
• Physical manipulative skills are limited
here, since the nurse meets the patient on
a communication level, social and
recreational activities serve as a bridge to
open communication.

8. • Psychiatric nursing is comprehensive
nursing care.
• This suggests that acknowledging the
patient as a total person.
• Disease and injury are crisis situations
emotionally and physically. Crisis brings
disorganisation of patient and families.
• Reactions like uncooperativeness,
aggressiveness are common due to crisis.
• Constant stress leads to psychosomatic
disorders.

9. EVOLUTION OF MENTAL HEALTH
SERVICES AND TREATMENT
• Historically mental illness was viewed as a
demonic possession, the influence of
ancestral spirits, the result of violating a
taboo or neglecting a cultural, ritual and
spiritual condemnation.
• As a result, the mentally ill were often
starved, beaten, burnt, amputated and
tortured in order to make the body an
unsuitable place for the demon.

10. Gradually, man began the inquest for
scientific knowledge and truth, which can be
traced as follows:
Period of persecution (1552 BC – 1400
AD)
Earlier, treatment of mentally ill depended on
men’s various superstitious beliefs. Patients
with mental illness were avoided, thrown out of
society and beaten up by people. Since nobody
was allowed to interact with them, it was felt
that nursing care was not needed.

11. Egyptians, Chinese and Greeks believed
that the mental illness was caused by
demons.
They were treated by exorcism (prayer,
Noise making).
Hippocrates stressed that brain pathology
led to mental illness and recommended
marriage for mental illness.
Gradually Man began the quest for scientific
knowledge and the truth.

12. Period of segregation : (1545 AD – 1800AD)
To prevent the mentally ill patients from
straying into streets they were kept
separately in asylums. In England they were
kept in Bethlam asylum for the first time.
However the living condition was not
suitable for the patients. The aim was to
segregate patients from general public.

13. Bethlehem Hospital,’Bedlem

14. Humanitarian period: (1745 AD –
1826AD)
• Philippe Pinel in France and William Tuke
in England opened the chains of mentally
ill, paving the way for humanitarian care.
At last total care was provided to the
patients without restraints or chains. In
1773, in the U.S. mental patients were
admitted to Pennsylvania Hospital. No
specially trained nurses, only General
nurses took care of the patients.

15. Beginning of Scientific Attitude:
(1796 –1878 AD)
•Gradually insanity was regarded as an
illness.
• Sigmund Freud (1856 – 1939)founder of
psycho analysis believed in hypnotism for
easing psychic tension.
• Emile krapelin (1856 – 1926) classified the
mental illness.

16. • First Florance Nightingale School was
opened at St. Thomas Hospital in London.
• In 1873, Linda Richards the first psychiatric
nurse was graduated from England.
• In 1956, an integral basic psychiatric
nursing concept was introduced in General
nursing programme.

17. Period of prevention: (1885 –
1960 AD)
In the 20th century, psychological clinics for
problem children were established.
In 1950, the National association of mental
health was formed.
In 1950, Paplau’s theory provided a
framework for practicing psychiatric nursing.
In 1960, first the first worldwide mental
health year was celebrated.

18. In 1960, first Doctoral programme in
psychiatric nursing was started in Boston.
The role of psychiatric nursing was widened
in caring mentally ill patients with Maxwell
Jone’s concept of Therapeutic Community.
In 1963, Journal of psychiatric nursing and
Mental health services was published.

19. Some important mile stones:
•1773, The first mental hospital in US was
built in Williamsburg, Virginia.
•1793, Phillip pinel unchained the mentally ill
patients.
•1812, The first American text book in
Psychiatry was written by Benjamin
Rush.(Father of American Psychiatry).
•1912, The Indian Lunacy Act was passed.

20. • 1908- Clifford Beers, an ex-patient of
mental hospital, wrote the book, ‘ The
mind That find itself’ based on his bitter
experiences in the hospital.
• 1912- Eugen Bleuler, a Swiss Psychiatrist
coined the term ‘ Schizophrenia’.
• 1912- Indian Lunacy act was passed.
• 1927, Insulin shock treatment was
introduced for Schizophrenia.
• 1936-Frontal Lobotomy was advocated for
the management of mental illness.

21. • 1938- ECT was used for the treatment of
Psychosis.
• 1946, Bhore Committee established an All
India Institute of Mental Health at
Bangalore.(currently known as
NIMHANS).
• 1949- Lithium was first used for the
treatment of mania.
• 1952- Chorpromazine was introduced
which brought about a revolution in
Psychophamacology

22. • 1963- The Community Mental Health
Centers Act was passed.
• 1978- The Alma –Ata declaration of
“ Health for All by 2000 AD” posed a major
challenge to Indian mental health
Professionals.
• 1981- Community Mental Health Centers
were set up to experiment with Primary
mental health care approach at Rajpur
Rani, Chandigarh and Sakalwara,
Bangalore.

23. • 1982- The focus shifted to community
based care, which became the basis for
the national Mental Health Programme.
• 1982- National Health Policy was
accepted by the Central Council of Health
and brought the National Mental Health
Programme in India (NMHP).
• 1987- Indian Mental Health Act was
Passed.
• 1990- Indian Government Formed the
Action group at Delhi to pool the opinions
of Mental health expert about NMHP.

24. • 1997- National Human Rights commission
prepared a Plan of action for improving the
conditions in Mental hospitals in country.
• 2001- On August 6th, 27 more mentally ill
people died as they were tied to their beds
when fire engulfed the thatched roof of the
Moideen Badusha Mental Home at Erwadi.
Following this incident major changes occured
in mental hospitals and in the lives of mentally
ill in a positive way by the Government.

25. • 2002- National Survey of mental health
resources carried out by the Directorate
General of Health services.
• 2007- under the eleventh five year plan,
Centers of Excellence in the field of mental
health was established , there by 11
mental health institutes were funded.
• 2008- WHO Mental Health Gap Action
Programme was launched which aims at
scaling up services for mental,
neurological and substance use disorders.

26. • 2013- WHO launched the Mental Health
Action Plan 2013- 2020 on 7 october
2013.
• 2013- Under the Twelfth five year plan,
Government of Indian integrated different
components of NMHP with National Rural
health mission.
• 2013- The Mental Health Care bill was
introduced in the rajya Sabha on 19,
August 2013.

27. • 2013- under central Sector, the Ministry of
Social justice and Empowerment launched
Deenadayal Disabled Rehabilitation Scheme
and provided financial assistance to NGOs.
• 2014- The National Mental health Policy 2014
is in accordance with the intent of World
health Assembly resolution.
• World Health day is observed on 10th October
every year, with overall objective of raising
awareness of mental health issues and
mobilising resources in support of mental
health.

28. DEVELOPMENT OF MODERN
PSYCHIATRIC NURSING
Some important Miles stones:
• 1840s- Florence Nightingale made an attempt to
meet the needs of Psychiatric patients with Proper
hygiene, better food, light and Ventilation and use
of drugs to Chemically restrain the violent and
aggressive Patients.
• 1872- First training School for nurses, based on
the Nightingale System was established by the
New England Hospital. Linda Richards, the first
nurse to graduate one-year course developed 12
training schools in USA.

29. • 1882- First School to prepare nurses, to
care for the mentally ill was opened at
McLean Hospital in Waverly.
• 1913- John Hopkins became the first
school of nursing to include a fully
developed course for Psychiatric nursing
in the curriculum.
• Major growth in Psychiatric nursing
occurred after World war-II, because of the
emergence of Services related to
Psychiatric Problems.

30. • 1921-short training courses of 3 to 6
months were conducted in Ranchi.
• 1943- Psychiatric nursing course was
started for male nurses.
• 1946- Health Survey Committee’s report
recommended preparation of nursing
personnel in Psychiatric nursing also.
• 1948-1950- Four nurses were sent to UK
by the Government of India, for training in
mental health nursing

31. • 1952- Dr. Hildegard Peplau defined the
therapeutic roles that nurses might play in
the mental health setting.
• 1953- Maxwell Jones introduced
therapeutic community.
• 1953-1954: The urgent need for nurses
trained in psychiatric care was felt by the
Government of India.
• 1954- Nur Manzil Mental Health centre,
Lucknow , started psychiatric nursing
orientation courses of 4-6 weeks duration.

32. • 1956- One year post- certificate course in
Psychiatric nursing orientation couses of
4-6 weeks duration.
• 1958- All the wards at the Agra Mental
Hospital were ordered to be kept open and
ward locks were removed from the charge
of the ward attendant.
• 1960-the focus began to shift to primary
prevention and implementing care and
consultation in the community.

33. • 1960- the focus began to shift to primary
prevention and implementing care and
consultation in the community. The name
‘psychiatric nursing’ was changed into
psychiatric and mental health nursing, further
it was renamed as Psycho social nursing in
1970s.
• 1963- Journal of Psychiatric nursing and
Mental health services was Published.
• 1964- Mudaliyar committee felt the need for
preparing a large number of psychiatric
nurses and recommended inclusion of
psychiatry in the nursing curriculum

34. • 1965- The Indian nursing Council included
Psychiatric nursing as a compulsory
course in the B.sc Nursing Programme.
• 1967- TNAI, formed a separate committee
for psychiatric nursing to improve the
perception of psychiatric nursing as well
as to set guidelines for nursing teachers to
conduct theory and practical sessions.
• 1973- Standards of psychiatric and mental
health nursing practice were enunciated to
provide a means of improving the quality
of care.

35. • 1975- Psychiatric Nursing was offered as
an elective subject in MSC Nursing at the
RAK college of nursing, Newdelhi.
• 1986- The Indian nursing Council (INC)
made psychiatric nursing a component of
General nursing and Midwifery course.
American Psychiatric nurses association
was established.
• 1990-ICN declared 1990 as the year of
mental health nursing.

36. • 1991- Indian society of Psychiatric nurses
formed at NIMHANS, Bangalore.
• 1994- Standards of Psychiatric Nursing was
revised.
• 1995- Journal of American Psychiatric Nurses
association was formed.
• 2000- American Nurses association
Published the Scope and standards of mental
health nursing.
• 2003- ANA began certifying psychiatric
mental health Practioners.
• 2010- ISPN published journal titled Indian
Journal of Psychiatric Nurses.

37. INDIAN PSYCHIATRIC ASSOCIATION
• It is a professional body of Psychiatry in india.
• Largest association of Indian Psychiatrists.
• 1929- Berkeley Hill of Ranchi founded the
Indian Association for Mental Hygiene .
• 1935- the Indian division of the royal medico
Psychological association was formed.
• 1946- The Indian Psychiatric Society was
inaugurated.

38. Aims of this Association:
- Promotion of mental health and mental health
education
- Promote and advance the subject of
Psychiatry.
- Formulation and advise on the standards of
education and training in Psychiatry.
- Promote research in the field of Psychiatry.
- Deal with matters relating to mental health
concerning the country and promote ethics in
practice of Psychiatry in india.

39. INDIAN SOCIETY OF
PSYCHIATRIC NURSES
• Indian society of psychiatric nurses was
started in 1991 at NIMHANS, Bengalaru
under the guidance of Dr.Reddemma with
the motive of enhancing the advanced
knowledge and skills in the field of
Psychiatric nursing.
• ISPN is publishing its own journal –Indian
Journal of Psychiatric Nurses.

40. Conferences by ISPN:
• The first national conference theme(2002)
was ‘ Child Psychiatric nursing’.
• The First international conference theme
(2005) ‘ Adolescent Mental Health issues.
In 2005, ISPN became a member of
Indian Confederation of Health
Accreditation.

41. PREVALENCE AND INCIDENCE OF
MENTAL HEALTH PROBLEMS AND
DISORDERS
• The WHO declared the World Health day
theme for the year 2001 as “ Mental
Health: Stop Exclusion- Dare to Care”, in
order to focus global public health
attention on this neglected problem.
• The Bhore committee Concluded that
mental patients requiring institutional
treatment would be 2 per 1000 in the
country.

42. • The prevalence reported from the
epidemiological studies stated that, range
from the population of 18 to 207 per 1000
with the median 65.4 per 1000.Most of
these patients lives in rural areas remote
from any modern mental health facilities.
Large number of adults coming to general
OPD are diagnosed mentally ill.

43. MENTAL HEALTH PROBLEMS

44. Global Disability adjusted life years
estimation:
• 10% of world population are having mental
illness(2010)
• world wide 700 million people suffering with
mental health problems (2010)
• 7.4% world population struggled with mental
Health Problems.
• 0.5 % world population suffering with
Schizophernia
• Prevalence of unipolar depressive episodes to be
1.9% for men and 3.2% for women ,and the one
year prevalence be 5.8% for men and 9.5% for
women

45. Proportion of Mental Illness
(world wide )

46. PREVALENCE OF MENTAL DISORDERS
(analysis of 15 epidemiological studies-
Ganguli HC, 2000)
• All mental disorders- 73/1000 Population
( with rural and urban rates of 70.5 and
73/1000, respectively)
• Schizophrenia- 2.5/ 1000 Population
• Affective disorder (Depression)- 34/1000
Population
• Anxiety Neurosis- 16.5/1000 Population
• Hysteria- 3.3/1000 Population
• Mental retardation- 5.3/1000 Population

47. NATIONAL PREVALENCE OF MENTAL
DISORDERS
(analysis of 10 epidemiological studies-Madhav
MS, 2001)
• Schizophrenia- 2.3/1000 population
• Affective disorder- 31.2/ 1000 population
• Anxiety Neurosis- 18.5/ 1000 population
• Hysteria – 4.1/ 1000 Population
• Mental Retardation- 4.2/ 1000 Population

48. COMMUNITY BASED EPIDEMIOLOGICAL
STUDIES UNDER THE WHO MENTAL HEALTH
ACTION PROGRAMME
• In India the estimated life time prevalence of
mental disorders ranges from 122.2 to
48.6%.
• The ministry of health and Family welfare
Suggests that 6-7% of India’s People suffer
from mental disorders with about 1%
suffering from severe mental disorders while
3 in 10,000 people experience an episode an
episode of acute psychosis every year, about
25% of mentally ill people are homeless.

49. • Mental Illnesses like schizophrenia and
Bipolar disorder are prevalent in about 200
cases per 10,000 People.
• The burden of these disorders is likely to
increase 15% by 2020.
• The prevalence of Psychiatric illness is
58.2 per thousand which means that there
are about 5.7 crore people suffering from
some sort of Psychiatric illness.

50. • Out of this 5.7 crore,
- 4 lakh People- Organic Psychosis
- 26 lakh People- Schizophrenia
- 1.2 Crore People- Affective Psychosis
- 1.5 Crore People- Severe mental
disorders
- 12,000 patients- Government mental
hospitals - Reddy.1991.

54. MINISTRY OF HEALTH AND FAMILY
WELFARE, ANNUAL REPORT -2012-2013
• Various Community based surveys show the
Prevalence of mental disorders in India as 6-
7% for common mental disorders and 1-2%
for severe mental disorders.
• In India, the rate of Psychiatric disorders in
children aged between 4 to 16 years is about
12%
• Treatment gap for severe mental disorders is
approximately 50% and in case of Common
Mental Disorders it is over 90%.

55. • Common Psychiatric illnesses in General
Hospital:
- Neurotic disorders
- Psychosomatic disorders
- Functional Psychosis
• In Child Guidance Clinic:
- Mental retardation
- Conduct disorder
- Hyperkinetic disorder
- Enuresis

56. • In Geriatric clinic:
- Depression
- Dementia
- Delusional disorders
• In Psychosexual Clinic:
- Dhat Syndrome
- Premature ejaculation
- Erectile Impotence

57. THANK YOU