The document discusses the history and development of mental health and psychiatric nursing in the Philippines. It provides statistics on the distribution of mental health diagnoses across different facility types in the Philippines. It then covers topics such as the definition of mental health, factors influencing mental health, criteria for diagnosing mental disorders, the DSM-IV classification system, and the role of the psychiatric nurse. Finally, it discusses major periods in the history of mental illness treatment in the Philippines and benchmarks in the development of psychiatric nursing education.

1. MALADAPTIVE
PATTERNS OF
BEHAVIOR
WILMA O. RIVADENERA, RN,MAN

2. Distribution of diagnosis across mental health
facilities in the philippines
DISORDERS
OUTPATIENT
FACILITIES
COMMUNITY
IN-PATIENTS
MENTAL
HOSPITAL
Schizophreni
a
57%
63%
71%
Mood
Disorder
19%
24%
18%
Substance
Abuse
8%
6%
5%
Neurotic
Disorder
6%
1%
2%
Personality
Disorder
3%
2%
0%
Others
7%
4%
4%

3. Psychiatric Nursing
O -
O
O
O
O
Interpersonal process whereby the
professional nurse practitioner through the
therapeutic use of self, * assist an individual,
family, group or community to:
1. Promote mental health,
2. Prevent mental illness and suffering,
3. Participate in the treatment and
rehabilitation of the mentally ill.
•
and if necessary find meaning in these
experiences.

4. Psychiatric Nursing
- Is both a science and
an art

5. HEALTH
O State of complete physical, mental,
and social wellness, not merely the
absence of disease or
infirmity…..(WHO)

6. Mental
Health
O A state of complete physical, mental,
and social wellness, not merely the
absence of disease or infirmity (WHO).
Criteria:
a. Satisfying interpersonal relationship;
b. Effective behavior and coping;
c. Positive self – concept; and
d. Emotional stability

7. Factors Influencing a person’s
Mental Health
O Individual or personal – biologic
make-up, autonomy and independence,
capacity for growth, vitality, ability to find
meaning in life, sense of belonging, reality
orientation and coping or stress
management abilities

8. Factors influencing a person’s
Mental health
O Interpersonal, or relationship –
effective communication, ability to help
others, intimacy and a balance of
separateness and connectedness.
O Social/cultural, or environmental
– sense of community, success to
adequate resources, intolerance of
violence, support of diversity among
people, mastery of the environment, and a
positive, yet realistic, view of one’s world

9. Mental Illness
is a mental or behavioral
pattern or anomaly that
causes distress or disabili
ty, and which is not
developmentally or sociall
y normative…. wikipedia
O

11. Criteria to diagnose Mental
Disorders
O Dissatisfaction with one’s characteristics,
abilities, and accomplishments;
O Ineffective or unsatisfying relationships;
O Dissatisfaction with one’s place in the
world;
O Ineffective coping with life events; and
O Lack of personal growth

12. Factors
 Individual – biologic make – up,
intolerable or unrealistic worries or fears,
inability to distinguish reality from fantasy,
intolerance of life’s uncertainties, a sense
of disharmony in life, and a loss of
meaning in one’s life.

13. Factor
s
O Interpersonal - - ineffective
communication, excessive
dependency on or withdrawal from
relationships, no sense of
belonging, inadequate social
support, and loss of emotional
control.

14. O Social/cultural factors – lack of
resources, violence, homelessness,
poverty, an unwarranted negative
view of the world, and discrimination
such as stigma, racism, classism,
ageism, and sexism

15. DSM-IV
(DIAGNOSTIC AND STATISITCAL MANUAL OF
MENTAL DISORDERS)
O published by the American
Psychiatric Association (APA),
provides a common language and
standard criteria for
the classification of mental
disorders.

16. Purposes of DSM-IV-TR
O To provide standardized nomenclature
and language for all mental health
professionals
O To present defining characteristics or
symptoms that differentiate specific
diagnoses.
O To assist in identifying the underlying
causes of disorders

17. The DSM-IV organizes each psychiatric diagnosis
into five dimensions (axes) relating to different
aspects of disorder or disability:
Axis I: All psychological diagnostic categories
except mental retardation and personality disorder
Axis II: reporting of Personality disorders and
mental retardation
Axis III: General medical condition; acute medical
conditions and physical disorders
Axis IV: Psychosocial and environmental factors
contributing to the disorder
Axis V: Global Assessment of
Functioning or Children's Global Assessment
Scale for children and teens under the age of 18

18. BENCHMARK IN
PSYCHIATRIC NURSING

19. ANCIENT TIMES
-
Punishments for sins and wrong doing
Viewed as either divine or demonic, depending on
their behavior
Aristotle (383-322 BC) – relate disorders to
physical disorders and his theory that amounts of
blood, water and yellow and black bile in the body
controlled the emotions (corresponds with
happiness, calmness, anger and sadness).
O Treatment: blood-letting, starving, and purging (till
19th century)

21.  Early Christian Times (1-1000
AD)
- Mentally ill were viewed as
possessed
- Tx: Priests performed exorcism.
When failed they used more
severe and brutal measures
such as incarceration in
dungeons, flogging and starving

22.  Rennaisance (1300-1600)
- Distinguished from criminals
 1547 – Hospital of St. Mary of Bethlehem was
officially declared as hospital for the insane.
 1775 – Charged for a fee for a privilege of
viewing and ridiculing the inmates who were
seen as animal rather than human.

23. Benchmark Period in
Psychiatric History
PERIOD
KEY PEOPLE
OR
DEVELOPMEN
TS
SIGNIFICANT
CHANGE IN
THINKING
RESULT/S
Enlightenment • Philippe Pinel • Insane no longer • Asylum move
, - 1790
(1745- 1826)
treated as less
ment
• William Tuke
than human
developed
(1732 – 1822) • Human dignity
upheld

24. “ To consider madness
incurable…is constantly refuted
by the most authentic facts”
Philippe Pinel, Dec. 11, 1794

25. Asylum (Sanctuary)

26. O Dorothea Dix
O
(1802-1887)- one of the
first major reformers in
the United States, was
instrumental in
developing the concept
of asylum.

27. PERIOD
Scientific
Study
(1870’s)
KEY PEOPLE OR
DEVELOPMENTS
s
• Sigmund Freud
(1856-1939) –
emphasized the
importance of early life
experiences; studied
the mind, its disorders
and their treatment
• Emil Kraepelin (1856
– 1926)- Studied the
brain; classify mental
illness according to
their symptoms
• Eugene Bleuler (1857
– 1939); was optimistic
about treatment;
coined the term
SIGNIFICANT
CHANGE IN
THINKING
RESULT/S
• Mental
• Study of the
Illness could
mind and
be studied
treatment
approaches to
psychiatric
conditions
flourished
• Decade of the
brain can be
traced back to
Kraepelin’s
thinking.

28. PERIOD
KEY PEOPLE OR SIGNIFICANT
DEVELOPMENTS CHANGE IN
THINKING
g
RESULT/S
Psychotropic
Drugs –
1950’s
• Lithium (1949)
• First
antipsychotic
(1950)
• Monoamine
oxidase
inhibitors
(MAOI’s) 1952
• Haloperidol
(1957)
• Tricyclic
antidepressant
s (TCAs) 1958
• Benzodiazepin
es (1960)
• If some
mental
disorders
are caused
by chemical
imbalances
then
chemicals
could
restore the
balance;
people
would no
longer need
to be
confined
• A
destigmatizatio
n of mental
illness
occurred;
parents and
others not
blame; term
least restrictive
environment
evolved from
this discovery

29. PERIOD
KEY PEOPLE
OR
DEVELOPMEN
TS
SIGNIFICANT
CHANGE IN
THINKING
RESULT/S
Community
Mental
Health ,
1960s
Community
Mental Health
Centers Act
(1963)
Individuals do
 Advantage:
not need to be
Intervention in
hospitalized
familiar
away from family
sorroundings
and community,
has helped many
people have the
people, is less
right to be
expensive
treated in their
• Disadvantages:
own community  Homelessness
linked to
disinstitutionaliza
tion; many
people “slip
through the
cracks” of the
system

30. PERIOD
Decade of the
Brain
KEY PEOPLE
OR
DEVELOPMEN
TS
SIGNIFICANT
CHANGE IN
THINKING
RESULT/S
• Congression • If we can
• An increase
al Mandate
understand
in funding for
the brain, we
brain
can help
research
millions of
lead to new
people
treatment
suffering
strategies;
from mental
has
disorders.
increased
our
understandin
g of mental
disorders

31. Six Major Periods of Mental Ilness
Treatment in Philippine History
1. Pre-Spanish Regime
- During this period, believed in a world that
is equally material and spiritual.
- Relied on healers called babylan
(shaman) and sorcerer healing.
- Rituals and ceremonies

32. 2. Spanish Rule
- Filipinos accepted that mental illness was
caused by an act of sorcery
(mangkukulam or witches and
manggagaway or the devil men)
Treatment:
- Herbmen (herbolarios)
- Brought to church for exorcism or ritual
cleaning

33. Early Nineteenth Century
- Organized care and treatment for
individuals with mental illness was
established at the Hospicio de San Jose
- Spanish naval authorities requested for a
place of confinement for their mentally ill
sailors.

34. The American Era
- Two Americans provided treatment for
mentally ill patients of the Civil Hospitals
located in Calle Iris (now known as Claro
M Recto Avenue)
- In 1904, the insane department was
opened at the San Lazaro Hospital.
- The first physician to attain formal training
in psychiatry in the US is Dr. Elias
Domingo.

35. Japanese Occupation
- World War II
- National Psychopathic Hospital continued
to operate
- The Japanese Army donated an
electroshock apparatus to the hospital.

36. The Liberation Period and the Era of the
Republic
- The National Psychopathic Hospital was
renamed National Mental Hospital, with Dr.
Jose A. Fernandez designated as officer in
charge from Oct 1946 to April 1961

37. Present Day Psychiatry
O The use of SOMATIC
Therapies became most
popular.

38. Psychiatric Nursing
Education: THREE FIRSTS
 Linda Richard – the first American
Psychiatric Nurse
 Nursing Mental Disease – the first
psychiatric nursing book wrote by Harriet
Bailey
 Hildegard Peplau – first psychiatric
nursing theorist

39. Development of Psychiatric
Education in the Philippines
 An Outline of Psychiatric Nursing – the
first textbook wrote by Jesusa Bagan Lara
in 1973
 Nenita Yasay-Davadilla – the first
psychiatric nurse to be sent abroad to
obtain MSN under WHO scholarship
program.
 Magda Carolina Go Vera Llamanzares –
first Filipino child psychiatric nurse
 Sotera Capellan – the first chief nurse of a
Mental Hospital

40. Role of Mental Health
Nurse
 Ward manager- creates a
therapeutic environment
 Socializing agent- assists the
patient to feel comfortable with
others
 Counselor- Listens to the
patient’s verbalization
 Parent surrogate- assists the
patient in the performance of
ADL

41. Role
 Patient advocate- enables the
patient and his relatives to
know their rights and
responsibilities
 Teacher- assists the patient to
learn more adaptive ways of
coping
 Technician- facilitates the
performance of nursing
procedures

42. Role
 Therapist- explores the
patient’s needs, problems and
concerns through varied
therapeutic means.
 Reality base- enables the
patient to distinguish objective
reality and subjective reality.
 Healthy role model-acts as a
symbol of health by serving as
an example of healthful living.
 Stranger- Offering the client
the same acceptance and
courtesy that the nurse would
do to any strangers.

43. Essential Qualities
 Empathy – ability to see beyond outward
behavior and sense accurately another
person’s inner experiencing.
 Genuineness- ability to use therapeutic
tools appropriately.
 Unconditional positive regard - respect

44. Decision Tree for
Continuum of Care

45. Continuum of Care
O A complete range of programs and
services that treats the whole person from
wellness to illness to recovery within the
community
Green and Lyndon, 1998

46. Decision Tree for Continuum of Care

47. Parameters in Decision Tree
O Safety requirements
O Intensity of supervision needed
O Severity of symptoms
O Level of functioning
O Type of treatment needed