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1. INTRODUCTION TO
MENTAL HEALTH
MODULE CODE:
IMH260S
09 May 2023
BY
N. Baloyi-Radzilani

2. RECAP FROM THE PREVIOUS ONLINE CLASS
• UNIT 4: PREVENTION OF MENTAL ILLNESS
• COMPREHENSIVE MENTAL HEALTH CARE
• PRIMARY PREVENTION
• MECHANISMS PROTECTING MENTAL HEALTH
• THE HEALTH PROMOTION APPROACH
• HIGH-RISK APPROACH
• LIFE SKILLS APPROACH
• FACTORS TO BE TARGETED IN ILLNESS PREVENTION PROGRAMMES
• SECONDARY PREVENTION
• TERTIARY PREVENTION
• CHARACTERISTICS OF RECOVERY-FOCUSED MENTAL HEALTH SERVICES
• DIFFERENCES BETWEEN REHABILITATION AND TREATMENT

3. LESSON LAYOUT
• PSYCHOSOCIAL REHABILITATION TECHNOLOGY
• Planning programmes: Ad hoc planning
• Planning programmes: Rational planning
• Planning programmes: The process of programme planning
• Planning programmes: Problem-based programme planning
• Planning programmes: Service-based programme planning
• Planning programmes: A model of a programme for battered women
• IMPLEMENTING PROGRAMMES
• Implementing programmes: Motivating forces for change
• EVALUATING PROGRAMMES
• Evaluating programmes: There are four main methods of programme evaluating
• CONCLUSION

4. PSYCHOSOCIAL REHABILITATION TECHNOLOGY
The basic elements of rehabilitation interventions can be summarized as follows:
• Increasing skills: This can refer to general life skills, or specific vocational skills, and may refer
to skills in the patient or in his/her family. And increase in skills assists the whole network to
cope better with stress and, in some instances , can prevent stress.
• Increasing support: Any action which can increase the support received by the patient and
family assist in preventing breakdown and promoting health. This refers to entitlements,
material assistance and psychosocial supports.
• Manipulating support: This may include aspects such as marketing the patient to a service, or
marketing a service to a client. But it may require going further and negotiating changes in the
service to make it more appropriate to the client. It may also mean advocating service
improvement or creation.

5. PSYCHOSOCIAL REHABILITATION TECHNOLOGY
• Optimalizing symptom control: The successful rehabilitation of the patient is very dependent on
optimal symptom control . This is usually done through medication, although psychotherapy may
play a role. Symptom control, which is adequate when staying at home, may not be suitable when
working. Therefore, the rehabilitation worker must work closely with the person who is treating the
patient.
• Education of the general public: Reintegration of the patient into society is dependent on the
attitudes of the general public, and specific groups within the general grouping, such as employers
. Changes in attitudes need to be addressed purposefully and specifically and complement
increasing support for the patient and his/her family.

6. PSYCHOSOCIAL REHABILITATION TECHNOLOGY
The magic technologies that have been developed in this field or incorporated into it are listed below.
These technologies form the basic building blocks of a community-based rehabilitation programme.
They combine the basic elements of habilitation to address the needs of the patient, often in a
specific area.
• Psychoeducation: This means that consumers (patients and their families)are taught about mental
illness, its treatment and management, so that they can cope better with community-based care .
Currently patients and their families are provided with very little information, often not even the
diagnosis. “Psychoeducation” refers to an intensive and the responsive teaching process. It
empowers the family and the patient with knowledge and skills and has been proved to make a
dramatic difference to the long-term outcomes for the patients.
• Skills teaching: This is the structured teaching of the deficient life skills required in the specific
social, vocational and living environment of the disabled person. This can be done during day
programmes or group sessions.

7. PSYCHOSOCIAL REHABILITATION TECHNOLOGY
• Case management: This is an approach to long term care which addresses all the needs of a disabled
person and is aimed at assessing such needs, linking the person to a variety of services, and
coordinating services use to achieve a successful outcome. Although they are different modes of case
management, it would seem that the generalist model is most appropriate in the South African
situations . In this model one person, who may belong to any of the helping professionals, deals with
the problem of a patient, without skipping strictly to professional boundaries.
• Vocational rehabilitation: This process enables the disabled person to secure and retain suitable
employment and to make satisfactory progress in the choose field. The aim is integrated and
competitive employment. This means that the person works for at least minimum wages (or better),
with non-disabled co-workers, at a job which offers scope for advancement in a setting that produces
valued goods and services.
• Appropriate housing: The housing of the disabled kissing should shoot his or her own needs and
lifestyle, and optimize social and vocational functioning , this necessitate a range of housing options,
from group homes to single accommodation.

8. PLANNING PROGRAMMES:
AD HOC PLANNING
• In this planning decisions are made only when problems have actually occurred and the decision is then
made instantly, based on the information that is superficially available.
• An example of ad hoc programme planning would be a unit in which there are increasing problems with
patient violence.
• The registered nurse in charge mentions this in a discussion with the nurse administrator and they decide to
change one single room into a seclusion room.
• In this planning there is no thorough collection of data about the problem and no serious consideration of
different possible causes or solutions.
• The less forward planning there is in a service, the more instant decisions have to be made every day.
• Since there decisions are often not good ones, they lead to increased resistance to change in the system.

9. PLANNING PROGRAMMES:
rational planning
• This means that systematically data collection is done in regard to possible alternatives and probable effects
are intelligently anticipated before decisions are made.
• Taking the above example, rational planning means that the incidents of violence would be carefully
documented for a specific period, noting that type of violence, who is involved, what the content was, and
which intervention were used.
• Possible alternatives, such as increasing the opportunities for gross motor activities in the daily programmes of
patients, giving stuff in-service trainings in the prevention of violence, increasing or changing medication or
establishing a behavior modification programme with the use of a seclusion room, would be investigated in
literature and through local discussions and needs assessment.
• In the light of all this information a decision would be made, involving as far as possible those who would
actually implement the plan.
• when a planner plans programmes, a while range of factors influence the decisions to be made, but the main
areas of influence are political factors and clinical factors.

10. PLANNING PROGRAMMES:
rational planning
 Idealistic nurse planner often think that only clinical factors, those which are best for patients,
should be considered.
 That is not possible, however, since administrative factors must be taken into account, such as
weather resources necessary for the implementation of a plan has been budgeted for, whether
enough staff can be made available when needed for implementation, or whether agency policies
allow this kind of programme.
 Even when a proposed program is administratively possible and clinically desirable, however, it
may still be doomed by political factors. This means that powerful individuals or groups might
oppose it because they see it as a threat to their interest.
• A planner therefore needs to look at every alternative, not only in terms of whether it is good for
the patients and whether it is administratively possible but also in terms of weather in enough
support can be lobbied for it from people in power to get it approved.
• Consultation with people for whom the program is being planned is also important, especially in
community programmes. People are more likely to support the program if they are actually
involved in its planning.

11. PLANNING PROGRAMMES:
THE PROCESS OF PROGRAMME PLANNING
Nurses encounter the task of programme planning in one of two circumstances:
1. They can be faced with a specific problem and decide to plan a programme to address the problem. For
instance, a psychiatric community nurse finds that a service is continually being asked to assist with chronic
alcoholic patients who have been treated repeatedly by all the available services.
None of these services now want to be involve with these patients, because they see situation as useless and a
waste of resources. Instead of continually going through the motions and getting frustrated by the lack of a
satisfactory answer, the nurse decides to initiate a programme for this kind of patient. The kind of a programme
planning is problem based.
2. Nurses can do programme planning for any service that they are allocated to in order to enhance the
effectiveness of the service. For instance, a nurse who is put in charge of an outpatient clinic can plan to bring a
range of programmes into being to ensure that the unit reaches its goals. This approach is service based.
The process of programme planning differs for the two types of approaches, although, in many respects, there is some
similarities.

12. PLANNING PROGRAMMES:
PROBLEM-BASED PROGRAMME PLANNING
1. Define the problem optionally so that everybody concerned understand it in the same way. In the example mentioned above,
the problem can be defined is that of alcoholics who are not acceptable to the main treatment, or assistance programmes for
alcoholics because of their repeated relapses. This definition makes it clear that the patients are a problem due to their labelling
by the main service and not merely due to their relapse rate. This kind of definition makes it easier to get clarity on exactly what
the problem is.
2. Do a needs assessment to establish the extent of the problem. This includes a survey of how many patients are involved over
specific period of time and perhaps also what percentage they form of the total patient population. The severity of the problem
also needs to be outlined in terms of current outcomes. What are the results of non-intervention? Sometimes a thorough needs
assessment indicates that the problem is not large enough to warrant special attention, while in other cases it might underline
the need for action.
3. Survey existing services to establish which of them currently addresses the problem and to what extent and in what way they
do so. In order to prove that a gap exists in the service, it is essential that you thoroughly check what is already available .
Sometimes relevant programmes are available, but they might not be able to cater for the numbers involved or they might be
inaccessible. The survey should make all this clear.

13. PLANNING PROGRAMMES:
PROBLEM-BASED PROGRAMME PLANNING
4. Survey similar programs nationally and internationally. It is not necessary to reinvent the wheel. If your service is
experiencing a problem, chances are very good that some other services has had a similar problem and has experimented with
solutions. Contact other services in the country by letter or by phone and ask about the problem and possible solution. Do a
literature review to see how it has been tackled overseas.
5. Based on the information gathered, develop a model that includes:
a) The aims and objectives of the programme
b) The activities included in the programme
c) The resources necessary (cost, staff in space)
d) Proposals for finding the resources
You have already considered the different alternatives at this stage and have made a selection based on clinical, administrative
and political consideration. You can include different alternatives in a program proposal.
6. Plan for the evaluation of a program . Unless evaluation is part of the initial planning, it may be impossible later , since the
necessary data may not have been collected appropriately.

14. PLANNING PROGRAMMES:
SERVICE-BASED PROGRAMME PLANNING
1. In this case the first step is to analyse the situation. In a community service this includes a community profile as well as a
service profile, while in an inpatient service includes only a service profile. A service profile consists of a numerical
description of the service (including admission, discharge and readmission figures, demographics of the patients
population, staff figures and all other relevant statistics), as well as an anecdotal description of the main features of a
service.
2. Analyse the data to answer the following questions:
a) “is the service addressing the most serious problems of the community or patients population?”
b) “is the service sensitive to the needs around it?”
c) “Are there any gaps in the service?”
d) “Could the task be done more effectively or efficiently?”
This step corresponds roughly with step 2 of the problem-based approach to planning. If you experience problems, follow
steps of that approach.

15. PLANNING PROGRAMMES:
A MODEL OF A PROGRAMME FOR BATTERED WOMEN
Programme aims
• To enable battered women to handle the situation in a way that increases both their own and their
children’s well-being.
Programme objectives
• To increase community knowledge of the programme
• To increase patient knowledge of how to improve their own and their family’s health in relation to
family violence
• To increase the patient’s ability to solve problems of family violence

16. PLANNING PROGRAMMES:
A MODEL OF A PROGRAMME FOR BATTERED WOMEN
OBJECTIVES ACTIVITY RESOURCES
 Increase patient numbers  Design handbill
 Send to gatekeepers
 Organize radio interviews with all stations
stations
 Make personal contact with police and
casualty wards
 Staff time
 Printing cost
 Graphic art cost
 Increase knowledge and skills Teach patients about:
 Family violence in relation to family
health, community resources and legal
issues
 Problem solving skills
 Staff time to prepare teaching material
and to teach
 Outside lecturers
 Decreased anxiety and depression
 Increased self-confidence
Provide social support through:
 Encouraging extended family interviews
 Teaching in groups, allowing exploration
of feelings
 Group time
 Staff time for family interviews

17. IMPLEMENTING PROGRAMMES
• The implementation of anything new in service is always a difficult task. It is not enough to have
a good plan and enthusiasm. Great skill and wisdom and carefully planning are imperative in
order to achieve change in a system. The more bureaucratic the system, the more difficult it is to
effect change.
• The process of change in such a situation consists of:
1. Unfreezing the forces that preserve the status quo
2. implementing the change process by which the current system is changed to the future system, and
3. freezing the situation, so that the new system becomes the accepted routine
• During the phase of unfreezing, efforts are made to weaken support for the status quo by raising
the consciousness of the people in the system about limitations of the present situation and
possibilities for change. This involves specifically strengthening the forces for change, while at the
same time decreasing the strength of the restraining forces.

18. IMPLEMENTING PROGRAMMES:
MOTIVATING FORCES FOR CHANGE
HINDDRANCE
FORCES
RESISTANCE FORCES
CHANGE
FORCE

19. IMPLEMENTING PROGRAMMES:
motivating forces for change
CHANGE FORCES
• Internal dissatisfaction
• Obvious discrepancies
• External pressure
• Needs of people in the system
HINDDRANCE FORCES
• Task inherent in the change too difficult
• System too rigid
• People have few skills, ideas for knowledge
RESISTANCE FORCES
• General resistance to change
• Specific resistance to change
• Resistance to person introducing change
• Loyalty to resistance group
• cost

20. EVALUATING PROGRAMMES
It is necessary to evaluate current and innovative new programs for many reasons. amongst these
are:
• evaluating helps staff to identify weaknesses in programmes, and these can then be corrected
• it identifies strong programmes, which can then be duplicated in other settings
• positive evaluations act as rewards for staff involved, it assists in making effective planning
decisions
• results can be used to support request for increased resources
• evaluation is part of being accountable for public money spent, as well as being a part of a
professional accountability
Evaluation of a whole programme is not an easy task . And programme often consists of a complex
series of activities that takes place over a long period of time, often involving more than one
service setting and a changing staff component. Furthermore, evaluation takes time and money,
and these commodities are always in short supply. Nevertheless, evaluation of one's own practice is

21. EVALUATING PROGRAMMES:
THERE ARE FOUR MAIN METHODS OF PROGRAMME
EVALUATING
1. Recipient judgement. In this recipients of the programme are asked to evaluate the programme, usually by means of a
questionnaire or an interview. This could involve patients, their families or community groups.
The problem with this method is that people are often dependent on the service and therefore reluctant to criticize it, or that
they give the answers that they think are expected, instead of saying what they really think. The results of this kind of evaluation
may therefore not be valid.
2. Expert judgement. There are different ways in which a person or persons can be used to evaluate a programme. One of these
is called peer review, which means that the people running the programme select people from outside their group or system
whom they see their peers to come in and evaluate what they have done.
They supply the peer evaluators with a written material on the programme and the group also conducts an on-site visit to look
at programme activities. A discussion is then held between the peer evaluators and programme staff to discuss findings and
recommendations. A written report is provided after the discussion. This method is often chosen by staff because they can select
the evaluators and, since the evaluators are peers, they are in a similar situation to the programme staff and can evaluate with
understanding.
A different form of expert judgement involves choosing a person to persons who are expert(s) in the field and then going
through the same process as with the peer group. In this case the judges have much more knowledge and experience than the
programme staff and might therefore give useful advice. However, this can of evaluation can be very threatening to staff.

22. EVALUATING PROGRAMMES:
there are four main methods of programme evaluating
3. Quality assurance process. This process consists of the following steps:
 Settings standards for a programme or service
 Identifying ways in which the standards can be measured
 Doing the measurements
 Identifying problem areas and implementing remedial action, and
 Repeating the measurement
This methodology has been used extensively in nursing and is useful in that the programme is
measured against standards set by the staff themselves or by a peer group. It is also more structured
than the peer review and staff know in advance against which standards they will be evaluated

23. EVALUATING PROGRAMMES:
There are four main methods of programme evaluating
4. Research approach. In this method the programme is evaluated by using the steps of the research
process. This can be either a qualitative or a quantitive approach. In the qualitative approach an in-
depth analysis is done of the programme by describing how it actually functions.
In a quantitive approach different forms of numeric data and statistics are used to analyze how the
programme is working. This could include morbidity data, utilization statistics or need/demand
statistics.
Morbidity does not include primary impairment in the form of physical or psychological symptoms and
signs, but also secondary impairment in terms of quality of life and productivity.
Secondary impairment can be measured through diagnostic survey, attitude surveys and functional
assessment scales. This is a very useful method and to a certain extent it is part of every other method.
It is becoming increasingly difficult to claim that one is delivering a quality service without some form
of evaluation being done. Such unsubstantiated claims are seen as both unscientific and
unprofessional.

24. CONCLUSION
• It is an important role of the nurse to develop new programmes. This includes the planning,
implementation and evaluation of such programmes. Without this skill it is impossible for the
nurse to lead in nursing team or to run a health service.
• The total role of the nurse in a Primary Health care setting can really be summed up by saying
that primary, secondary and tertiary prevention programmes should be planned ,
implemented in evaluated.
• In actual fact this is a massive task , involving many sectors of society, many professionals and
lay people, and demanding great skill and knowledge.
• However, having a program forecast in the service allows the practitioner to plan actions
programme by programme, and to take small steps to achieve the overall goals.

25. Thank you