Introduction of psychiatry

UNIT 1
INTRODUCTION OF PSYCHIATRY
PREPARED BY
Mrs. Divya Pancholi
M.Sc. (Psychiatric Nursing)
Assistant Professor
SSRCN, Vapi
MRS. DIVYA PANCHOLI 1

HEALTH
According to WHO ,
• “Health is a positive state of well being , people are in a
state of emotional ,physical and social well-being , fulfills
their responsibilities , function effectively in daily life
and are satisfied with their interpersonal relation and
themselves.
• It is a state of balance between the individual and the
surrounding oneself and others with a maximum and
others, a co-existence between the realities of the self
and that of other people and the enviournment.

MENTAL HEALTH
•“The adjustment of human
beings to the world and to each
other with a maximum of
effectiveness and happiness”.
–Karl Menninger

PSYCHIATRIC
•“Greek word”
•Psychiatry is that branch of medicine
dealing with mental disorder and its
treatment
•Psych : soul or mind
•Iatros : healer

DEFINITIONS
Psychiatry:
•It is a Branch of Medicine that deals with the
Diagnosis, Treatment and Prevention of Mental
illness.
Psychology:
•It is defined as the Scientific Study of behaviour and
Mental Processes. MRS. DIVYA PANCHOLI 5

INTRODUCTION

PSYCHIATRIC NURSING
•“It is a specialized area of nursing practice,
combination of science and art by employing
theories of human behavior applied in the
diagnosis and treatment of human response
to actual or potential mental health
problem”.

Cont..
It deal with:
• Promotion of mental health.
• Prevention of mental illness.
• Care of the client with mental illness.
• Cure of mental illness.
• Rehabilitation of mentally ill patients in the
hospital and in community.

COMPONENTS
OF MENTAL
HEALTH
A. THE
ABILITY TO
ACCEPT
SELF
B. THE
CAPACITY TO
FEEL RIGHT
TOWARDS
OTHERS :
C. THE
ABILITY TO
FULFILL LIFE’S
TASKS:

1. THE ABILITY TO ACCEPT SELF
•A mentally healthy individual feels comfortable
about himself. He feels reasonably secure and
adequately accepts his shortcomings. In other
words, he has self-respect.

2. THE CAPACITY TO FEEL RIGHT
TOWARDS OTHERS :
•An individual who enjoys good mental health is able to
be sincerely interested in other's welfare.
•He has friendships that are satisfying and lasting. He is
able to feel apart of a group without being submerged by
it.
•He takes responsibility for his neighbors and his fellow
members.

3. THE ABILITY TO FULFILL
LIFE’S TASKS:
•A mentally healthy person is able to think for himself,
set reasonable goals and take his own decision.
•He does something about the problems as they arise.
•He shoulders his daily responsibilities, and is not
bowled over by his own emotions of 'ear, anger, love
or guilt.

CRITERIA / INDICATORS
OF MENTAL HEALTH
1. POSITIVE ATTITUDE TOWARDS SELF
2. GROWTH , DEVELOPMENT AND
SELF – ACTUALIZATION
3. INTEGRATION
4. AUTONOMY
5. REALITY PERCEPTION
6. ENVIRONMENTAL MASTERY

1. POSITIVE ATTITUDE TOWARDS SELF
•This includes an objective view of self,
including knowledge and acceptance of
strengths and limitations.
•The individual feels a strong sense of personal
identity and security within the environment.

2. GROWTH , DEVELOPMENT AND SELF –
ACTUALIZATION
•This indicator correlates with whether
the individual successfully achieves the
tasks associated with each level of
development.

3. INTEGRATION
•Integration includes the ability to adaptively
respond to the environment and the
development of a philosophy of life, both of
which help the individual maintain anxiety at a
manageable level in response to stressful
situations.

4. AUTONOMY
•Refers to the individual's ability to
perform, in an independent self-
directed manner; the individual
makes choices and accepts
responsibility for the outcomes.

5. REALITY PERCEPTION
•This includes perception of the
environment without distortion, as
well as the capacity for empathy and
social sensitivity- a respect and
concern for the wants and needs of
others.

6. ENVIRONMENTAL MASTERY
•This indicator suggests that the
individual has achieved a satisfactory
role within the group, society or
environment.
• He is able to love and accept the love of
others.

CHARACTERISTICS OF MENATLY HEALTHY PERSON
 They possesses the ability to accept themselves, others and nature. Stated
another way, they have positive self-concept and relate well to people and their
environment.
They are able to form close relationship with others. Kindness, patience and
compassion are displayed for others.
They are able to solve their problems with their own efforts as much as possible.
They know and accept his or her strengths and weaknesses.
They have their own personal identity.
They are able to appreciate and enjoy the life.
They are independent in thought and action and rely on personal standards of
behavior and values.
They feel reasonably secure and adequate.
They are able to face the realities. MRS. DIVYA PANCHOLI 20

 They are creative utilizing a variety of approaches as they perform tasks or solve
problems.
They respect themselves.
Their behavior is consistent as they respect and appreciate the rights of others.
They develop reasonable and achievable goals in their life.
They are happy with themselves and their lives.
They do not worry excessively about the future, but they do plan ahead.
They do not spend time wondering what other people think or say about them.
They are open and friendly, and do not have any difficulty meeting new people.
They are able to work at a job successfully and support themselves.
They are able to get enough sleep.
They have a sense of worth, self-respect and dignity.MRS. DIVYA PANCHOLI 21

 They are able to make their own decisions.
 they exhibits emotional maturity.
They maintain their daily routines in a healthy way.
They have positive attitude towards self, others and their work.
They are usually able to give a correct reading if asked to tell someone els’s mood
or feelings.
They remain in contact with reality.
They perform their duties effectively and successfully.
They develop philosophy in their life.
 they ensure productive form of behavior.
They are able to deal with stress and frustration in a healthy way.
They are able to show genuine concern for others.MRS. DIVYA PANCHOLI 22

 They are able to maintain good relationships.
 They are able to communicate with the people you care about.
They are involved with activities that are interesting to you.
They are able to appreciate individual differences.
They are able to determine the personal values by which you want to live.
They try to enjoy life to the fullest.
They do not waste time and energy worrying.
They consider what others feel and have to say, but take actions according to
their own convictions.
They do not feel distressed when others don’t like them.
They organize their lives functionally so that important things get done on time.
They can love other people easily and without fear.MRS. DIVYA PANCHOLI 23

 They can find inner peace and strength when they need it.
They laugh a lot, and are able to find humor in most situations.
They look for solutions instead of complaining about the problems.
They act out of their own self-interest.
They have a strong and consistent set of values.
They involve themselves in social activities.
They are able to express their feelings and emotions.
They are able to face new ideas with an open minded skepticism.

MENTAL ILLNESS
• Mental illness is maladjustment in living . it produce
a disharmony in the person’s ability to meet human
needs comfortably or effectively and function
within a culture .
• A mentally ill person loses his ability to respond
according to the expectations he has for himself
and the demands that society has for him .

DEFINITION OF MENTAL ILLNESS
• “ Mental and behavioral disorders are understood as clinically
significant conditions characterized by alteration in thinking ,
mood or behavior associated with personal distress and /or
impaired functioning”.
- WHO ,2001
• “ Mental illness occurs when a state of physical ,
mental , social and spiritual well beings disturbed . In illness
the individual shows symptoms like depression , feelings of
anxiety ,physical complains without any organic cause and a
sudden change in behavior or mood”.

CHARACTERISTICS OF MENTAL ILLNESS
 Causes distress to the individual and to the entire family
Change in persons’ thinking, memory, perception and judgement
Abnormality in talking pattern
Disturbances in day to day activities
Work efficiency will be reduced
Anxious, worried
Forgetfulness
Disinterest in routine life
Neglected behavior
Sadness, weeping behavior in certain cases

Unhappiness
Unable to cope effectively with the demands
Limited ability to love, to work or find meaning to their lives
Stress related behavior episodes
Shyness, fearful
Unable to work productively
Self –centred, immature, impulsive
Rigid, moralistic
Intolerant of others, inadeaquate defeated, worthlessness
Bizarre, irrational behavior

 Lacks ego strength, flexibility and adaptability
Experiences himself as weak among powerful and uncontrollable forces
Self concept is distorted and unrealistic
Lacks self esteem
Is driven by deficiency motives
Basic drives are either acted out in raw and impulsive actions are
inhibited and blocked
Powerful and painful negative affects
Unable to be genuinely empathetic or sympathetic to others
Lower developmental levels
Incomprehensible, demanding, intrusive, isolative, hostile
No respect will be given to others or self

Disturbed psychological functioning
Hostile, pathetic, no respect
Miserable to himself and to others
Inappropriate behaviors
Basic psychological functions may be disturbed
Inability to communicate with others
Always feeling worthlessness
Dissatisfaction with one’s own characteristics, abilities and
accomplishments, place in the world
Ineffective or dissatisfying interpersonal relationships

Ineffective coping or adaptation to the situational events in one’s
own life
Lack of personal growth
Unhappiness
Lack of gratification
Feeling of stress and strain
Vulnerability feelings
Lack of self-confidence
uncertainty

DEVELOPMENT OF PSYCHIATRY
Linda Richard- First Psychiatric Nurse
1773- first mental hospital, williamsburg, Virginia.
1793- Phillip Pinel- revolution in psychiatry
1812- Benjamin Rush- 1st American textbook in
psychiatry ( father of American Psychiatry)
1908- Clifford Beers- ex- patient. Founded
American Mental Health Association

•1912- The Indian Lunacy Act passed
•1927- Insulin Shock Treatment
•1936- Frontal Lobotomy
•1938- ECT
•1939- Sigmund Freud – Psychoanalytical theory
•1946- Bhore committee- 5 mental hospitals ,
NIMHANS
•1949-Lithium used
•1952-Chlorpromazine

•1963- Community Mental Health centre
Act
•1978-Alma Ata declaration
•1981-Community Psychiatric centre
•1982- National mental health programme
•1987- National Mental health act
•1990- NIMHANS- Innovative approach

DEVELOPMENT OF PSYCHIATRIC NURSING
•1872- Linda Richard- 1st Psychiatric nurse
•1882- 1ST school for nurses
•1913- Johns Hopkins- 1st school of nursing –
psychiatric nursing
•1943- For male nurses
•1946- Health committee report
•1952- Peplau- theory
•1953- Maxwell Jones- therapeutic community

• 1956- Post certificate course – NIMHANS
• 1960 Psychiatric nursing to Mental Health Nursing
• 1963- Journal of Psychiatric Nursing & Mental Health
services was published
• 1964- Mudaliar committee- inclusion of psychiatry in the
nursing curriculum
• The Indian Nursing Council- Psychiatric Nursing B.Sc Nursing
Programme
• 1975- Psychiatry Nsg ELECTIVE SUBJECT in M.Sc Nursing
• 1986- INC – COMPONENT OF General Nursing& Midwifery
courses.
• 1994- Revision of Standards of Psychiatry and Mental Health
Nursing .

PREVALENCE AND INCIDENCE OF MENTAL HEALTH PROBLEMS AND DISORDERS
Disorders Rates
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

MENTAL HEALTH TEAM
• A Psychiatrist
• A Psychiatric nurse
• A clinical Psychologist
• A psychiatric social worker
• An occupational therapist or an
activity therapist
• A Pharmacist and a dietitian
• A Counsellor

A Psychiatrist
•The psychiatrist is a physician certified in
psychiatry by the American Board of Psychiatry
and Neurology, which requires a 3-year residency,
2 years of clinical practice, and completion of an
examination.
•The primary function of the psychiatrist is
diagnosis of mental disorders and prescription of
medical treatments.

A Psychiatric nurse
•The registered nurse gains experience in
working with clients with psychiatric disorders
after graduation from an accredited program of
nursing and completion of the licensure
examination.

A clinical Psychologist
•The clinical psychologist has a doctorate (Ph.D.) in
clinical psychology and is prepared to practice
therapy, conduct research, and interpret
psychological tests. Psychologists may also
participate in the design of therapy programs for
groups of individuals.

A psychiatric social worker
•Most psychiatric social workers are prepared at the
master’s level, and they are licensed in some states.
Social workers may practice therapy and often have
the primary responsibility for working with families,
community support, and referral.

An occupational therapist or an activity
therapist
•Occupational therapists may have an associate degree
(certified occupational therapy assistant) or a
baccalaureate degree (certified occupational therapist).
•Occupational therapy focuses on the functional
abilities of the client and ways to improve client
functioning such as working with arts and crafts and
focusing on psychomotor skills.
•

A Counsellor
•A counsellor provides basic supportive
counselling and assists in Psychoeducational
and recreational activities.

SR
NO
PERSON TRAINING ROLES
1 Psychiatrist Licenced
physician with
at least 3 years
of residency
training in
Psychiatry,
including 2
years of clinical
psychiatric
practice.
 Provides diagnosis, treatment and
prevention of mental and emotional
disorders
 Conducts therapy sessions and serve as
leader of mental health team.
 Prescribes various therapies and
medications.
 Provides counselling to the patient and
other significant member of the family

SR
NO
2 Clinical
psychologi
st
Under graduation and
post graduation or
doctorate in clinical
psychology degree in
psychology
 Work both in hospitals and within
community mental health teams.
 Assisting in the assessment of the
mental health needs of patients
and undertaking psychological
therapies with individuals and
groups. Some also specialize in
family or marital therapy.

SR
NO
3 Ment
al
health
nurse
Staff nurses
undertake a
three or four
degree or a
diploma in
Psychiatric
nursing
 Assess and understand nursing needs of client.
 Provides holistic nursing care.
 Acts as liaison with other members.
 Nurses carryout counselling and psychotherapy
with patients.
 A charge nurse has responsibility for the nursing
staff and for the nursing care of the patients.
 Supervise the work conducted by auxiliary and staff
nurses.

SR
N
O
4 Psychiatric
social
worker
 A Psychiatric social worker
has to complete a 2 year
Diploma in social work.
 After gaining several years
of experience in mental
health, social workers can
train to become approved
social workers under the
mental health Act.
 Some social workers in
mental health choose to
train and specialize in
special therapies.
 Employed for social services work rather
than the health service.
 Uses community resources and adaptive
capacities of individuals with the
environment.
 Provide counselling advice or more specific
therapies for referred patients.
 Control access to some services such as day
centres, respite care, residential care and
other community support services, e.g.
home helps

SR
NO
5 Occupational
therapist
 An Occupational
therapist has
usually taken a
graduate and
post graduate in
occupational
therapy.
 Have specialised
experiences in
the field of
occupational
therapy.
 Help people to adapt to their
environment and to cope with their
daily life.
 Work in hospitals or in the
community.
 Work with both individuals and
groups and set goals for individuals
to encourage them to achieve more
than they have been able to do
while ill.
 Provides different types of therapy
on an individual or group basis.
 Involved in rehabilitation work to
help them reintegrate back into lifeMRS. DIVYA PANCHOLI 49

SR
NO
6 Dietician Dietician should be
bachelor or master’s
degree in the field of
nutrition
Experience in
providing therapeutic
diet for various type of
patients.
Dietician serve as a resource person to
the Psychiatric mental health team as
well as a nutritional counsellor for the
client with nutritional disorders such
as anorexia nervosa, bulimia nervosa
and pica etc.

SR
NO
10 Musical
therapist
He should be college
graduate with master’s
degree and specialized
training in musical
therapy
Focuses on the expression of self
through music.
Promotes involvement in
memory, attention span, and
concentration and provides as
opportunity for the individual to
take pride in his achievement.

NATURE OF MENTAL HEALTH NURSING
•Psychiatric nursing is a profession possessing its
unique history, ideology, knowledge and skills.
•It provides services to individuals whose primary
needs are related to mental, emotional and
developmental problems, especially serious
disorders and persistent disabilities.

CONTI….
• It is both art and science.
• The science of psychiatric nursing involves understanding
and use of principles of nursing on all levels. In addition it
requires commitment to remain current in knowledge and to
practice all learned skills and procedures that ensure
patient safety and well being.

CURRENT ISSUE AND TRENDS IN CARE (SCOPE)
• Demographic Changes
• Social Changes
• Economic Changes
• Technological Changes
• Mental Health Care Changes

CURRENT ISSUE AND TRENDS IN CARE (SCOPE)
Demographic changes:
• Type of family: single
Nuclear
• Increasing number of the elderly group.
Trends in health care:
• Increased mental health problems
• Provision for quality and comprehensive services
• Multi-disciplinary team approach
• Providing continuity of care

Cont….
Social changes:
•The need for maintaining inter
group and intra group loyalties.
•Peer pressure.

Cont…
Economic changes:
•Industrialization
•Urbanization
•Raised standard of living.

Cont….
Technological changes:
•Mass media
•Electronic system
•Information technologies.

Cont…
Mental health care changes:
•Increased awareness in the public
regarding mental health.
•Need to maintain mental stability.
•Increased mental health problems.

Educational programs for the psychiatric
nurse
•Diploma in psychiatric nursing
•M.sc. in psychiatric nursing
•M phil in psychiatric nursing
•Doctorate in psychiatric nursing
•Short term training programs for both the
degree and diploma holders in nursing

Development of code of ethics
•This is very important for psychiatry.
• Nurse as she takes up independent roles in psycho
therapy, behaviour therapy, cognitive therapy,
individual therapy, group therapy, maintain
patients confidentiality protects his rights and
acts as pt. advocate.

Legal aspect in psy. Nsg.
•It is necessary to protect the public, the patients,
and the nurse.
•The practice of psy. Nsg. Is influenced by low
particularly in its concern for the rights of patient
and the quality of care they receive.
Clients rights:
• To refuse a particular treatment.
•Protection from confinement.

Cont…
•Intentional torts
•Informed consent.
•Confidentiality.
•Record keeping are a few legal issues in
which the nurse has to participate and
gain quality knowledge.

Promotion of research in mental health
nursing
•The nurse contributes to nursing
and the mental health field
through innovations in theory
and practice and participation in
research.

Cost effective nursing care
•Standards need to be conducted to find
out the viability in terms of cost
involved in training a nurse and the
quality of output in terms of nursing
care rendered by her.

Focus of care
•A psychiatric nurse has to focus care
on certain target groups like the
elderly, children, women, youth,
mentally retarded and chronic
mentally ill.

PSYCHIATRIC NURSING SKILLS
PERSONAL SKILLS
COUNSELLING SKILLS
BEHAVIOURAL SKILLS
SUPERVISORY SKILLS
CRISIS SKILLS
TEACHING SKILLS MRS. DIVYA PANCHOLI 67

PERSONAL SKILLS
• Self awareness
• Adaptability
• Care values and attitudes
• Self awareness and self esteem
• Respecting the person’s rights.
• Listening.
• Responding with care and respect.
• Supporting with trust and confidence.
• Reassuring with explanation and honesty.
• Physically nursing the helpless with compassion.
• Carrying out procedures skillfully.
• Working within personal and ethical boundaries.

COUNSELLING SKILLS
• Unconditional positive regard / non judgemental approach.
• Empathy.
• Warmth and genuineness.
• Confidentiality.
• Non verbals sensitivity, non-verbal attending, non verbal responding.
• Other inter personal skills required are paraphrasing, reflecting,
clarifying summarizing

BEHAVIOURAL SKILLS
• To increase the adoptive behaviour :
• Positive reinforcement
• Negative reinforcement
• Token economy
• To decrease maladaptive behaviour
• Extinction
• Time out
• Restraining
• Overcorrection
• To teach new behaviour
• Modelling
• Shaping
• Chaining
• Curing

QUALITIES OF A PSYCHIATRIC
NURSE
•Self awareness
•Self acceptance
•Accepting the patient
•Being sincerely
interested in patient
care
•Being available
•Empathizing with the
patient
•Reliability
•Professionalism
•Accountability
•The ability to think
critically

INTRODUCTION
• Trends and issues in the health care system
affect the roles of the psychiatric –mental
health nurse.
•Although psychiatric nurse have traditionally
worked on inpatient psychiatric units, they have
continued to expand their role into the
community .

• two levels of psychiatric –mental health nurses
• Role of generalist :
• Role of specialist : a. community mental health nurse
b. psychiatric home care nurse
c. forensic psychiatric nurse
d. psychiatric consultation
e. case manager
f. geropsychiatric nurse
g. parish nurse
h. telehealth / telenurse
i. nurses researcher
j. psychiatric nurse educator
k . nurse administrator / manager
l. psychopharmacologist

ROLE OF GENERALIST :
•The psychiatric mental health generalist nurse
is a licensed registered nurse for delivering
primary mental health care. It incorporates
both physical and mental health care . Generalist
exercise a holistic approach to practice and
performs psychiatric nursing in day treatment
centers , psychiatric rehabilitation facilities ,
homeless shelters and many other settings.

Community mental health nurse (CMHN) :
•Community mental health nursing is the
application of knowledge of psychiatric nursing
in preventing mental illness , promoting and
maintaining mental health of people in
community.
• It includes early diagnosis , appropriate
referrals care and rehabilitation of mentally ill
people.

Psychiatric home care nurse :
• It is one aspect of community health nursing .
psychiatric home care aspects provide holistic
psychiatric nursing care on a visiting basis to people
needing assistance .
• These nurses provide comprehensive care, including
psychiatric and physical assessment , direct nursing
care , behavioral management, crisis intervention ,
psycho education , medical management ,case
management and consultation with colleagues.

Forensic psychiatric nurse:
• It is a growing specialty in other countries around the
globe , especially in the UK , Australia , Germany
,Japan and Canada , and it is an expanded scope of
practices .
• The forensics psychiatric nurse work with individuals
who have mental health needs and who have entered
the legal systems .
• Nurse in this role perform physical and psychiatric
assessment and develop plans of care for the patients
entrusted to their care.

Psychiatric consultation-liaison nurse
(PCLN) :
• It has arisen in response to the increased recognition of the
importance of psycho-physiological inter –relationship and their
impact on physical illness ,recovery and wellness.
• It is an advanced practice nurse who have practice psychiatric and
mental health nursing in a medical setting /non-psychiatric settings
providing consultations and educations to patients, family and
health care team and the community .
• PCLN may provide assessments, recommendations and supportive
therapy to patient who are anxious , depressed or experiencing
other psychological problems or emotional distress.

Case manager :
•Nurse case managers act as
advocates for patient and their
families by coordinating care and
linking the patient with the physician ,
other members of the health care
team, resources and the prayers.

NURSE CASE
MANAGER
COLLABORATES
WITH THE
PATIENT AND
FAMILY
RESOLUTION OF
ILLNES
CO-ORDINATES
SERVICES,HOME CARE
&REHABILITATORY SERVICES
COLLABORATES WITH NURSING
:PSYCHISTRIST , PSYCHOLOGIST,
SOCIAL WORKERS ,
OCCUPATIONALIST,
ONSET OF
ILLNESS

Geropsychaitric nurse. :
•Geronursing is expanding the psychiatric
nursing practice to aged people who have
been affected by emotional and
behavioral disorders such as dementia ,
chronic schizophrenia., delirium ,etc.
•

Parish nurse :
•Parish nursing is another area of expansion of
psychiatric nurse role. Parish nursing is a program
that promotes health and wellness of body, mind
and spirit .
•the parish nurse is a pastorally called , spiritually
mature .licensed registered nurse with a desire to
serve the members and friends of his or her
congregation.

Conti….
• It is non invasive type of nursing in which no-hands-on
nursing care is provided. Rather parish nurse includes
to provide of health information, support and social
services. They evaluates the unique needs of various
age groups within the congregation ,including children
,adults and the elderly. they serves as the community
link between health institutions and home by providing
physical and mental health screenings ,outreach
educations and visits to the home , hospital or long
term care facility .
•

Telehealth /telenurse :
• Nurses engaged in telenursing practice use technologies such as
internet , computers , telephone , digital assessment tools and tele
monitoring equipment to deliver nursing care .
• In India around 10 hospitals are having tele-medicines
departments,
• for example:
• at Apollo hospital
• narayana hrudayalaya and hosmat hospital at benglurue ,
• Job opportunity are available for tele-nurse . chaithanya medical
foundations, benguluru is providing tele –nursing educations. IT
companies are recruiting tele-health nurses in Hyderabad,
bengaluru and Chennai . for example : Infosys,virus,etc…

Nurse researcher :
• Nurse researcher are scientist who seeks to find
answers to questions through methodical observations
and experimentation .
• they design studies, conduct research and disseminate
findings at professional meets and in peer reviewed
journals .
• They are doctoral or post doctorally prepared persons
who initiate or participate in all phases of the research
process. They work in a variety of settings.
•

Psychiatric nurse educator :
• The psychiatric nurse educator works in
educational institutions .
• Staff development department of health
care agencies , patient education
department .another functions of nurse
educators is planning and changing the
curriculum planning according to the needs
of the society and learner.

Nurse administrator /manager :
• A nurse manger works less directly with patients ,but
has the responsibity to provide nursing ,leaderships to
ensure that an appropriate therapeutics milieu is
maintained .
• a key responsibility Is the support and development
of nurses, representing nursing views to senior
mangers , the nurse manager play an important role in
negoating and allocating nursing resourese within
clinical directions . individauls also , assume a nurse
executive role, the serve at all management levels in
health care organizations and in the community .

Nurse pharmacologist :
•One of the latest roles is that of the
nurse psycho pharmacologist –the
psychiatrist clinical nurse specialist
with prescriptive authority .

FUNCTIONS OF MENTAL HEALTH NURSE IN VARIOUS SETTINGS
• In patient psychiatric ward
• ECT treatment setting
• Psychotherapy unit
• Day care centres or day
hospitals
• Family therapy units
• Child psychiatric ward
• Home setting
• Psychiatric outpatient
department
• Community mental health
centres
• Hospice care centres
• Emergency departments
• Medical inpatient wards
• Industrial medical centres
• Hospitals for criminal
insane, jails and prisons

In patient psychiatric ward
• Provide for environmental safety including protecting the patient and others
from injury
• Perform psychosocial, high risk and physical assessment
• Promotion of self care activities
• Medication management
• Assisting for somatic therapies
• Accurately observing and documenting the patient’s behaviour
• Providing opportunities for the patient to make his own decisions and to
assume responsibility for his life
• Providing feedback to the patient based on observations of his behaviour

CONTI…
• Participation in various therapies. Individual interactions, formal
and informal group situations, role play, advocating on behalf of the
patient and so forth
• Delivering psycho-education
• Counselling the patient and family members
• Co-operating with other professionals in various aspects of the
patients care, thereby, facilitating and interdisciplinary approach to
care
• Teaching social skills and stress management strategies
• Discharge planning and community referral and followup care
• Supervise the work of subordinatesMRS. DIVYA PANCHOLI 92

Psychiatric outpatient department
•Performing clinical assessment
•Assisting for psychiatric assessment
•Assisting or providing psychotherapy or behaviour
therapy
•Counselling the patient and family members
•Conducting group therapy
•Delivering psychoeducation

ECT Treatment Setting
•Teaching the patient prior to ECT treatment
•Preparing the patient for ECT
•Providing care during the procedure
•Assisting with post treatment
•Providing reassurance to reduce anxiety
•Delivering psycho education regarding ECT

Psychotherapy unit
•Establishing a therapeutic relationship with the patient
•Providing an opportunity for the patient to release
tension as problems are discussed
•Assisting the patient in gaining insight about the
problem
•Providing opportunity to practice new skills
•Reinforcing appropriate behaviour as it occurs
•Providing consistent emotional support

Day care centres or day hospitals
• In day treatment programs patients return home at night.
• Performing clinical assessment
• Accurately observing and documenting the patient’s behaviour
• Teaching social skills
• Counselling patient and family members
• Delivering psychoeducation
• Proving occupational or recreational therapy and vocational
assistance MRS. DIVYA PANCHOLI 96

Family therapy units
•Psychiatric nurses’ work with families at all levels of
functioning.
•Assessing individual and family needs and resources
•Facilitation of a family’s use of positive coping
strategies.
•Promote adaptive family functioning by teaching
communication skills and problem solving skills
•Delivering psychoeducation

Child psychiatric ward
• Assessing for biological and psychological need of the child
• Determine the child’s strengths and abilities and develop a care
plan to maintain and enhance capabilities
• Monitor the child’s developmental levels and intiate supportive
interventions, such as speech, language or occupational skills as
needed
• Provide a safe therapeutic environment, including protecting
the child and others from injury
• Co-operate with other professionals in an interdisciplinary
approach to care

CONTI…
• Provide adequate environmental stimulation
• Teach the child adaptive skills, such as eating, dressing,
grooming and toileting
• Demonstrate and help the child to practice self care skills
• Provide genetic counselling if necessary
• Deliver psychoeducation
• Provide emotional support to the parents
• Participate in various therapies

Home setting
• Assessment of symptoms
• Teaching the patient and family regarding nutrition, exercises,
hygiene and the relationship between physical and emotional health
• Stress management
• Daily living skills (basic money management, e.g. bank accounts, rent,
utility bills, use of the telephone, grocery shopping etc.)
• Medication management- monitoring blood levels, signs and
symptoms of overdose or toxicity, teaching on dosage, sideeffects
and purposes

CONTI…
• Administration of parenteral injections
• Venipuncture for laboratory analysis
• Act as a case manager and coordinate an array of services that
include physical therapy, occupational therapy, social work and
community services
• Appropriate referals to community agencies
• Provide supportive counselling and brief psychotherapy
• Promotion of mental health and prevention of mental illnesses

Community mental health centres
• Identification of patients in the community
• Refer the patients to appropriate hospitals
• Home visiting and providing direct care to the patients in the community
• Follow up care with special emphasis on medication regimen, improvement
made and side effects, patient’s occupational function
• Conducting public awareness programs to remove misconceptions regarding
mental disorders
• Training of paraprofessional, community leaders, school teachers and other
care giving professionals in the community
• Management of resources planning and coordination

CONTI…
• Direct services, like care of families at risk violence, abuse and dysfunction, care
of homeless mentally ill patients, etc.
• Various roles of community psychiatric nurse:
• Addiction counselor
• Counselor
• Crisis worker
• Advocate
• Case manager
• Educator
• Researcher
• Community developer and consultant

Hospice care centres
•Helping cancer patients or terminally ill
individuals through the grieving process
•Provide supportive psychotherapy
•Provide support groups for families of
terminally ill patients

Emergency departments
•Crisis intervention during natural disasters, accidents,
unexpected illnesses causing increased anxiety, stress or
immobilization
•Obstetric nursing centres
•Helping the mother in labor and support person to cope
with anxiety/stress during labor
•Providing support to bereaved parents in the event of fetal
demise, abortion, birth of an infant with congenital
abnormalities

Medical inpatient wards
•Psychosocial intervention for chronic illnesses
with major psychological effects
•e.g. Alzheimer’s disease, HIV/AIDS, diabetes
mellitus, Parkinson’s Disease, Multiple
sclerosis, haemophilia, colostomy, amputation
etc.

Industrial medical centres
•Implementing or participating in industrial
substance abuse programs for employees
•Providing crisis intervention during
accidents or the acute onset of a physical
or mental illness
•Teaching stress management

Hospitals for criminal insane, jails and prisons
•Forensic psychiatric nurses assist patients with self care,
administration of medications and monitor the effectiveness
of the treatment
•Promote coping skills
•Advanced nurses are able to diagnose and treat individuals
with psychiatric disorders and are allowed to prescribe
medications
•Provide psychotherapy and act as consultants
•Forensic evaluation for legal sanity
•Assessment of potential for violence

CONTI…..
•Parole/probation considerations
•Assessment of racial/cultural factors during crime
•Sexual predator screening and assessment
•Competency therapy
•Formal written reports to court
•Review of police reports
•On scene consultation to law enforcement

TWO LEVELS OF PSYCHIATRIC NURSES
Basic level psychiatric nurse Advanced level psychiatric nurse
They are registered nurses.
Their duties are:
 Develop nursing care plans
 Provide direct nursing care
 Administer medications
 Carryout treatment strategies as ordered by
physicians
 Teach family members about the patient’s disorder
and needs
 Determine the community’s mental health needs
and assist with crisis intervention and counselling
 Help plan community programs
They have master’s degree in psychiatric mental health
nursing.
Their duties are:
 Assess patients using a variety of methods
 Make a diagnosis based on the assessment
 Develop a plan of care and treatment
 Prescribe medications (in most states)
 Provide counselling
 Provide psychotherapy (in most states)
 Conduct research
 Serve as an administrator
 Teach in universities

CONCEPTS OF NORMAL AND ABNORMAL BEHAVIOR
Introduction
• Psychiatry is evident from the above is concerned
with abnormal behaviour in its broadest sense, but
defining the concepts of normal and abnormal
behaviour as such has been found to be difficulty.
These concepts are much under the influence of
socio-cultural factors.
• Several models have been put forward to explain
the concept of normal and abnormal behaviour.

MODELS
Medical model
Statistical model
Socio-cultural model
Behavior model

Medical model
•Medical model considers organic pathology as the
definite cause for mental disorder.
• According to this model abnormal people are the
ones who have disturbances in thought, perception
and psychomotor activities.
•The normal are the ones who are free from these
disturbances.

Statistical model
•It involves the analysis of responses on a test or a
questionarrie or observations of some particular
behavioural variables.
•The degree of deviation from the standard norms
arrived at statistically, characterizes the degree of
abnormality.
•Statsitically normal mental health falls within two
standard devaitions (SDs) of the normal distribution
curve.

Socio-cultural model
• The beliefs, norms, taboos and values of a
society have to be accepted and adopted by
individuals.
• Breaking any of these would be considered as
abnormal.
• Normalcy is defined in context with social
norms prescribed by the culture.

Behaviour model
•Behaviour that is adaptive is
normal, maladaptive is abnormal.
Abnormal behaviour is a set of
faulty behaviours acquired through
learning.

MENTAL HEALTH ACT
• Indian lunacy act (1912) replaced the Indian lunatic asylums
act, of 1858.
• Mental health act passed in 1987.
• Came into force in 1993.
• It is an act to consolidate and amend the law relating to
the treatment and care of mentally ill persons.
• The act is divided into 10 chapters consisting of 98
sections.

NATIONAL MENTAL HEALTH POLICY (NMHP -2001)
According to WHO,
•“Mental health policies describe the values,
objectives, and strategies of the government to
reduce the mental health burden and to improve
mental health.
• They define a vision for the future that helps to
establish a blueprint for the prevention and
treatment of mental illness, the rehabilitation of
treatment of mental illness, the rehabilitation of
people with mental disorders, and the promotion of
mental health in the community.

CONTI…
• Policies specify the standards that need to be
applied across all programs and services,
linking them all with a common vision,
objectives and purpose. Without this overall
coordination, programs and services are likely
to be inefficient and fragmented.”
• The first draft of national mental health policy
(NMHP) was prepared in late 2001 and came
into existence in 2003.

POLICY OBJECTIVES
• The district mental health program (DMHP) is redesigned around a
nodal institution, where most instances will be the zonal medical
college. School mental health programs and dementia care services
may be gradually integrated with the DMHP.
• Strengthening the medical college psychiatry departments with a
view to develop psychiatric manpower, improve psychiatric
treatment facilities at secondary level and to promote the
development of general psychiatric hospitals in order to reduce
and eventually to eliminate, to a large extent the need for big
mental hospitals with all their attendant infirmities.

CONTI…
• Streamlining and modernization of mental hospitals to transform
them from the present, mainly custodial mode to tertiary care
centers to excellence with a dynamic social orientation for
providing leadership to research and development in the field of
community mental health.
• Strengthening of central and state mental health authorities in
order that they may effectively fulfill their role of monitoring
ongoing mental health programs, determining priorities at the
central/state level and promoting intersectoral collaboration and
linkages with other national programs.

CONTI…
• Research and training aimed at building up an extensive database of
epidemiological information relating to mental disorders and their
course/outcome, development of better and more cost effective
intervention models, promotion of intersectoral research and
providing the necessary inputs/conceptual framework for health
and policy planning.
• Focused information, education and communication (IEC) activities
with the active collaboration of professional agencies such as the
Indian institute of mass communication and directed towards
enhancing public awareness and eradicating the
stigma/discrimination related to mental illness, will form an
important component of this policy objective.

PRIORITIZED GOALS
TENTH FIVE YEAR PLAN (2002-2007)
• District mental health program will be extended to one district
attached to each of the 100 medical colleges in the country, thereby
covering 100 districts in the first phase, and there after expanding to
100 districts more in the second phase, thus making a total of 200
districts across the country.
• Strengthening of medical colleges with allocation of Rs. 50 lakhs each
to 100 medical colleges, for upgrading departments of psychiatry.
• Streamlining and modernization of mental hospitals with the aim of
reduction in chronicity through intensive therapeutic intervention
using non-conventional antipsychotic medication, promoting care of
chronically mentally ill patients in the community using outreach
maintenance modalities.

CONTI…
• Strengthening of central and state mental health
authorities by facilitating the establishment of
permanent secretaries and networking of state
authorities with national level to ensure effective co-
ordination in all areas of activity.
• IEC (information, education and communication) training
and research by sponsoring relevant community based
research projects and building up extensive data base
which will form the basis for development of models and
policy planning.

ELEVENTH FIVE YEAR PLAN (2007-2012)
• The DMHP will be extended to another lot of 200
districts while consolidating same in 200 districts
covered at the end of 10th plan.
• Qualitative as well as quantitative improvement will be
introduced in the areas of research, training and IEC,
with more focused attention on epidemiological
catchment area surveys on a larger scale.

TWELTH FIVE YEAR PLAN (2012-2017)
• The DMHP will be extended to the remaining 193
districts and the gains made in the previous plans will be
consolidated, further upgradation of the psychiatric
departments in medical colleges will be undertaken and
20 mental hospitals will be reconstructed.
• IEC activities will be augmented to cover all sections of
the population across the whole country.
•

SPECIAL ISSUES
• Senior citizens suffering from severely disabling diseases
such as Alzhemier’s and other types of dementia,
Parkinson’s disease, depression of late onset and other
psycho geriatric disorders.
• Victims of child sexual abuse, marital/ domestic violence,
dowry related ill treatment, rape and incest.
• Children and adolescents affected by problems of
maladjustments or other scholastic problems,
depression/psychosis of early onset, attention deficit
hyperactivity disorders and suicidal behavior resulting
from failure in examination or other environmental
stressors. MRS. DIVYA PANCHOLI 127

CONTI…..
• Victims of poverty, destitution and
abandonment such as women thrown out of the
marital home or old and infirm parents left to
fend for themselves.
• Victims of natural or man-made disasters such
as cyclones, earthquakes, famines, war,
terrorism, communal/ethnic strife, with special
attention to the specific needs of children
orphaned by such disasters.

NATIONAL HEALTH POLICY (NHP)
• NHP was formulated in 1983 and revised in 2002.
OBJECTIVES
• The main objective of NHP -2002 is to achieve an
acceptable standard good health amongst the general
population in the country.
• The approach would be to increase access to the
decentralized public health system by establishing new
infrastructure in deficient areas and by upgrading the
infrastructure in the existing institutions.

Specific recommendation with regard to mental
health
•Upgrading infrastructure of institutions
at central government expense so as to
secure the human rights of this vulnerable
segment of society.
•Provide a network of decentralized
mental health services for ameliorating
the more common categories of disorders.
•

NATIONAL MENTAL HEALTH PROGRAMME
(NMHP)
• Government of India launched the national mental
health program (NMHP) in 1982.

AIMS OF NMHP
•Prevention and treatment of mental disorders
and their associated disabilities.
•Use of mental health principles in total
national development to improve quality of
life.
•Application of mental health principles in total
national development to improve quality of
life.

OBJECTIVES
• To ensure availability and accessibility of minimum
mental health care for all in the foreseeable future,
particularly to the most vulnerable and under
privileged sections of population.
• To encourage application of mental health knowledge
in general health care and in the social development.
• To promote community participation in mental health
services development , and to stimulate efforts
towards self help in the community.

STRATEGIES
•Integration of mental health with primary
health care through the national mental health
program.
•Provision of tertiary care institutions for
treatment of mental disorders.
•Eradication stigmatization of mentally ill
patients and protecting their rights through
regulatory institutions like the central mental
health authority, and state mental health.

APPROACHES
• Intergration of the mental health
care services with the existing
general health services.
• To utilize the existing infrastructure of health
services and also to deliver the minimum mental
health care services.
• To provide appropriate task oriented training to
the existing health staff.
• To link health services with the existing
community development program.

COMPONENTS OF PROGRAM
•TREATMENT: MULTIPLE LEVELS
-village and sub center
-Primary health center
-District hospital
-Mental hospital and teaching
psychiatric units.
• REHABLITATION
• PREVENTIONMRS. DIVYA PANCHOLI 136

TREATMENT: MULTIPLE LEVELS
VILLAGE AND SUB CENTER : At this level multipurpose
workers and health supervisors, under the supervision of medical
officer to be trained for:
• Management of psychiatric emergencies
• Administration and supervision of maintenance treatment for
chronic psychiatric disorders.
• Diagnosis and management of grandma epilepsy, especially in
children.
• Liaison with local school teachers and parents regarding mental
retardation and behavioral problems in children.
• Counselling problems related to alcohol and drug abuse.
• MRS. DIVYA PANCHOLI 137

CONTI…
• PRIMARY HEALTH CENTER: MO of Primary health centre
(PHC) aided by HS, to be trained for:
• Supervision of MPW’s performance.
• Elementary diagnosis.
• Treatment of functional psychosis
• Treatment of uncomplicated cases of psychiatric disorders
associated with physical diseases.
• Management of uncomplicated psychosocial problems.
• Epidemiological surveillance of mental morbidity.

REHABLITATION
•The components of this sub-program include
treatment of epileptics and psychotics at the
community level and development of
rehabilitation centers at both the district
level and higher referral centers.

PREVENTION
•The prevention component is to be
community based, with initial focus on
prevention and control of alcohol related
problems.
• Later on, problems like addictions, juvenile
delinquency and acute adjustment problems
like suicidal attempts are to be addressed.

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