This document outlines a course on community and hospital psychiatric nursing for third year psychiatric nursing students. It defines key concepts such as community mental health, the history of deinstitutionalization, and the roles of community mental health professionals. Specifically, it describes the multidisciplinary community mental health team and their roles in providing comprehensive, cost-effective care to clients in the community setting.

1. ADIGRAT UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH
SCIENCES
DEPRATMENT OF NURSING
COMMUNITY AND HOSPITAL PSYCHIATRIC
NURSING FOR THIRD YEAR PSYCHIATRIC
NURSING STUDENTS
BY: GESSESSEW TEKLEBRHAN
12/20/2018 1

2. Learning objectives
• After completing this course the students will be able to:-
Define community mental health.
Discuss the significant events in the history of community
mental health.
Identify the major concepts of community mental health.
Compare the different types of community support services.
Explain programs of an ideal community mental health center.
Describe the varied roles of the psychiatric practitioners in
community mental health.
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3. Teaching Methods
• Lecture
• Group discussion
• Group assignment
• Role plays
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4. DEFINITION OF COMMUNITY
• Community is a group, population, or cluster of people
with at least one common characteristic, such as
geographic location, occupation, ethnicity, or health
concern.
• Community is defined as a group of people with common
characteristics, location, or interests
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5. • Health is a state of complete physical, mental, and social
well-being, not merely the absence of disease or
infirmity (WHO).
• The concept of health is often difficult to define and
measure. It depends on:
1) The perception of individuals
2) The threshold - e.g. pain
3) The ability to recognize symptoms and signs
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6. Aspects of Health
• The well-being of a person includes the 6 aspects of health.
• Health should be explained in a holistic approach
1. Physical health
 Refers to the way that your body functions.
 It includes regular exercise and body weight.
 Physical fitness is good bodily health, and is the result of
regular exercise, proper diet and nutrition, and proper rest for
physical recovery.
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7. 2. Mental health
• Refers to the ability to recognize reality and cope
with the demands of daily life.
3. Emotional health
• Means the capability of an individual to express his/her
own feelings and develop his/her personal relationship
with others in a positive non-destructive way
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8. 4. Social health
• The ability to show concern and support to other people
• E.g. Constant communication with friends, family members, and
other people in the community.
5. Sexual health
 Refers to the capacity of an individual to accept his or her
sexuality
 Including his or her sexual preference like being a male or female,
gay or lesbian12/20/2018 8

9. 6. Spiritual health
 Refers to an individual’s capacity and ability to express
his /her spiritual maturity and moral integrity.
 We should respect the beliefs of others with regard to
their respective religious practices
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10. MENTAL HEALTH
• Mental health is defined as a dynamic process in
which a person’s physical, cognitive, affective,
behavioral, and social dimensions interact
functionally with one another and with the
environment.
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11. DEFINITION OF MENTAL HEALTH
• Mental health is ‘a state of well-being in which the
individual:
Realizes his or her own abilities;
Can cope with the normal stresses of life;
Can work productively and fruitfully;
Is able to make a contribution to his or her
community(WHO, 2009).
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12. • Mental health is defined as “the successful adaptation to
stressors from the internal or external environment, evidenced
by thoughts, feelings, and behaviors that are age-appropriate and
congruent with local and cultural norms.”
• Mental illness is defined as “maladaptive responses to stressors
from the internal or external environment, evidenced by
thoughts, feelings, and behaviors that are incongruent with the
local and cultural norms, and interfere with the individual’s
social, occupational, and/or physical functioning.”
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13. MENTALLY HEALTHY PERSON
• Has the ability to perceive reality accurately
• Modulate the way emotions are experienced and
expressed and think clearly and logically
• Communicate thoughts, feelings, needs and desires
effectively
• Anticipate events and solve problems
• Initiate and maintain meaningful relationships
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14. MENTALLY HEALTHY PERSON
• Establish and maintain boundaries
• Use resources appropriately
• Develop a positive self-concept
• In general, behave in ways that facilitate personal
growth and development
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15. PSYCHIATRIC NURSING
• It is a specialized area of nursing practice deals with:
Promotion of mental health
Prevention of mental illness
Care and rehabilitation of mentally ill individuals both
in hospital and community
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16. • Health promotion is “the process of enabling people to
increase control over, and to improve their health”
(WHO, 1986).
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17. Mental Health Promotion
• Mental health:
 Realizing one‘s own abilities
 Coping with normal stresses of life
 Working productively and fruitfully
 Contributing to one‘s community
• Mental health promotion:
 Improved physical health
 Better educational performance of children
 Better productivity of workers in business/industry
 Improved relationships within families and broader community
 Lower rates of some mental disorders
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18. COMMUNITY MENTAL HEATH
• Community Mental Heath is a decentralized pattern of
mental health, mental health care, or other services for
people with mental illnesses.
• Community-based care is designed to supplement and
decrease the need for more costly inpatient mental health
care delivered in hospitals.
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19. • Community mental health nurses, working with communities has
two important missions:
 Community directly influences the health of the individuals,
families and groups
 Provision of health services at community level.
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20. History of Community Mental Health
• Before 1840, there was no known treatment for
individuals who were mentally ill.
• Because mental illness was perceived as incurable, the
only “reasonable” intervention was thought to be
removing these ill persons from the community to a place
where they would do no harm to themselves or others.
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21. • The community mental health movement had in the
1940s.
• With establishment of the National Mental Health Act of
1946, the U.S. government awarded grants to the states
to develop mental health programs outside of state
hospitals.
• Outpatient clinics and psychiatric units in general
hospitals were open.
• Then, in 1949, as an outgrowth of the National Mental
Health Act, the National Institute of Mental Health
(NIMH) was established.
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22. • In 1955, the Joint Commission on Mental Health and
Illness was established by Congress to identify the
nation’s mental health needs and to make
recommendations for improvement in psychiatric care.
• In 1961, the Joint Commission published the report,
Action for Mental Health, in which recommendations
were made for treatment of clients with mental illness,
training for caregivers, and improvements in education
and research of mental illness.12/20/2018 22

23. • With consideration given to these recommendations,
Congress passed the Mental Retardation Facilities and
Community Mental Health Centers Construction Act
(often called the Community Mental Health Centers Act)
of 1963.
• This act called for the construction of comprehensive
community health centers, the cost of which would be
shared by federal and state governments.
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24. • The deinstitutionalization movement (the closing of
state mental hospitals and discharging of individuals with
mental illness) had begun late 1950’s and early 1960’s.
• In 1980 the Community Mental Health Systems Act,
which was to have played a major role in renewal of
mental health care was established.
• Funding was authorized for community mental health
centers, services to high-risk populations, and for rape
research and services.
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25. • Budget cuts reduced the number of mandated services, and federal
funding for community mental health centers was terminated in
1984.
• Care for the client in the hospital has become cost too expensive,
whereas care for the client in the community is cost effective.
• The reality of the provision of health care services today is often
more of a political and funding issue than providers would care
to admit.
• Decisions about how to treat are rarely made without
consideration of cost and method of payment.
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26. • We must serve the consumer by providing the essential
services to support with health promotion or prevention,
to initiate early intervention, and to ensure rehabilitation
or prevention of long-term disability.
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27. Deinstitutionalization of the Mentally Ill
• The deinstitutionalization movement occurred throughout the late
1950’s and early 1960’s
• Communities unable to sustain care for mentally ill
• Insufficient planning
• Budget cuts reduced mandated services
• Mentally ill became homeless
• Outcome is “revolving door” syndrome
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28. The Problems That Remain
• The mentally ill comprise a great majority of the
homeless population
• Many person with chronic mental illness end up in
jails and emergency rooms.
• Not enough community services/facilities to provide
adequate care for mental illness
• Continuing stigma of mental illness12/20/2018 28

29. Multidisciplinary Mental Health Team
• Psychiatrists, social workers, psychologists, nurses and others
• Develop comprehensive therapeutic plans
• Cost-effective
• Clients and significant others contribute to the plan of care
• Remain actively involved
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30. The Community Mental Health Team (CMHT)
• The CMHT is multidisciplinary in nature, comprising of
mental health workers such as psychologists, social
workers, psychiatrists, case managers, rehabilitation
therapists, occupational therapists and nurses.
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31. Mental Health Team and their roles
Psychiatrist
• Medical doctor with special training in mental illness and
behavioral/emotional problems
• Diagnoses conditions and prescribes medical treatment
Clinical psychologist
• Provides individual and group therapy
• Performs psychiatric testing
Therapist
• Provides individual therapy
• Conducts group therapy sessions12/20/2018 31

32. Social worker
• Community resource education
• Discharge planning
Recreation therapist
• Incorporates leisure activities in group settings to
demonstrate healthy coping mechanisms
Nurse
• Administers medications
• Conducts group education sessions
• Provides patient support and directs patient care
Psychiatric technician
• Assists nursing staff
• Provides support to client12/20/2018 32

33. THE PUBLIC HEALTH MODEL
• They include primary prevention, secondary prevention,
and tertiary prevention
• These concepts no longer have relevance only to mental
health nursing, but have been widely adapted as guiding
principles in many clinical and community settings over
a range of medical and nursing specialties.
• Prevention and mental health promotion are important
parts of psychiatric care
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34. Public Health Prevention Model
• Health promotion and illness prevention activities are
derived from a public health model of care
• In the public health prevention model the "patient" is
community rather than the individual, and the focus is
on the amount of mental health or illness in the
community as a whole, including factors that promote or
inhibit mental health.
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35. • The emphasis in the public health model is on reducing
the risk of mental illness for entire population by
providing services to high-risk groups.
• Community mental health providers might consider
adolescents in this community to be at risk for mental
health problems and target them for intervention
• “To prevent” literally means “to keep something from
happening”
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36. Intervention
• The public health model applies three levels of
preventive intervention to mental illness and emotional
disturbance :
• Primary prevention: is lowering the incidence of a
mental disorder by reducing the rate at which new cases
of a disorder develop.
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37. • Secondary prevention: involves decreasing the prevalence
of a mental disorder by reducing the number of existing
cases through early case finding, screening, and prompt,
effective treatment.
• Tertiary prevention: attempts to reduce the severity of a
mental disorder and its associated disability through
rehabilitative activities. Include interventions that reduce
disability and all forms of rehabilitation as well as
prevention of relapses of the illness.
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38. Primary Prevention
• Services aimed at reducing the incidence of mental
disorders within the population.
• Primary prevention targets both individuals and the
environment. Emphasis is twofold:
1. Assisting individuals to increase their ability to cope
effectively with stress.
2. Targeting and diminishing harmful forces (stressors)
within the environment.
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39. • Thus primary prevention activities in psychiatric
care have two basic aims:
• To help people avoid stressors or cope with them
more adaptively.
• To change the resources, policies, or agents of
the environment so that they no longer cause
stress but rather enhance people's functioning.
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40. • The following three categories of primary prevention:
A. Universal prevention:
• targeting the general public or a whole population group.
B. Selective prevention:
• targeting individuals or subgroups of the population whose
risk of developing a mental disorder is significantly higher
than that of the rest of the population.
C. Indicated prevention:
• targeting persons at high-risk for mental disorders.
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41. • Nursing in primary prevention is focused on the targeting of groups
at risk and the provision of educational programs. Examples
include:
 Teaching parenting skills and child development
 Teaching physical and psychosocial effects of alcohol/ drugs to
elementary school students
 Teaching techniques of stress management
 Teaching groups of individuals ways to cope with the changes
associated with various development stages.
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42.  Teaching concepts of mental health to various groups within the
community
 Providing education and support to unemployed or homeless
individuals
 Providing education and support to other individuals in various
transitional periods (e.g., widows and widowers, new retirees, and
women entering the work force in middle life)
• Widows a woman whose husband has died
• Widower a man whose wife has died
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43. • These services can be offered in a variety of settings that
are convenient for the public (e.g., churches, schools,
colleges, community centers, workplace of employee
organizations, meetings of women’s groups, or civic or
social organizations, and community shelters).
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44. Secondary Prevention
• Services aimed at reducing the prevalence of psychiatric
illness by shortening the course (duration) of the illness.
• It is accomplished through early identification of
problems and prompt initiation of effective treatment.
• Nursing in secondary prevention focuses on recognition
of symptoms and provision of, or referral for, treatment.
Examples include:
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45. • Ongoing assessment of individuals at high risk for illness
exacerbation
• Provision of care for individuals in whom illness symptoms have
been assessed (e.g., individual or group counseling, medication
administration, education and support during period of increased
stress [crisis intervention], staffing rape crisis centers, suicide
hotlines, homeless shelters, shelters for abused women, or mobile
mental health units)
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46. • Referral for treatment of individuals in whom illness
symptoms have been assessed.
• Referrals may come from support groups, community
mental health centers, emergency services, psychiatrists or
psychologists, and day or partial hospitalization.
• Inpatient therapy on a psychiatric unit of a general hospital
or in a private psychiatric hospital may be necessary.
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47. Tertiary prevention
• Services aimed at reducing the residual defects that are associated
with severe and persistent mental illness.
• Tertiary prevention is accomplished in two ways:
1. Preventing complications of the illness.
2. Promoting rehabilitation that is directed toward achievement of
each individual’s maximum level of functioning.
• Nursing in tertiary prevention focuses on helping clients learn or
relearn socially appropriate behaviors so that they may achieve a
satisfying role within the community. Examples include:
12/20/2018 47

48. • Consideration of the rehabilitation process at the time of initial
diagnosis and treatment planning
• Teaching the client daily living skills and encouraging
independence to his or her maximum ability
• Referring clients for various aftercare services (e.g., support
groups, day treatment programs, partial hospitalization programs,
psychosocial rehabilitation programs, group home or other
transitional housing)
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49. • Monitoring effectiveness of aftercare services (e.g., through home
health visits or follow-up appointments in community mental
health centers)
• Making referrals for support services when required.
• Nursing care at the tertiary level of prevention can be administered
on an individual or group basis and in a variety of settings.
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50. Community Mental Health
• Can best be described as a movement, an ideology, or a
perspective that promotes early comprehensive mental health
treatment in the community, accessible to all, including children
and adolescents.
• It derives its values, beliefs, knowledge and practices from the
behavioral and social sciences
WHO: Defined the components of community mental health as:
 Outpatient treatment
 Partial hospitalization
 Rehabilitation
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51. •Mental health services provided in the community include:
Emergency psychiatric care and crisis intervention
Partial hospitalization/day-treatment programs
Case management
Community-based residential treatment programs, rehabilitation,
consultation and support, and psychiatric home care
• The primary goal of community mental health is to deliver
Comprehensive care by a professional multidisciplinary team using
modern treatment approaches.
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52. Concepts of Community Mental Health
•Eight fundamental concepts that are the foundation for community
mental health:
A multidisciplinary team, consisting of psychiatrist,
psychologist, social workers, nurses, and mental health
counsellors
Prevention of mental illness
Early detection and treatment
Comprehensive treatment program
Continuity of care
Group and family therapy
Environmental and social support
Community participation, support and control12/20/2018 52

53. Components of Community Mental Health:
• Psychiatric emergency care
• Day treatment / partial hospitalization
• Psychiatric service in long term care
• Residential programs
• Psychiatric home care
• Rehab and aftercare(follow-up care provided after a medical
procedure or treatment program) in mental health center.
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54. Psychiatric Emergency Care
• Community mental health administrators and clinicians
should respond either by establishing an emergency clinic
at the local mental health center or by contracting with a
general hospital in the same community to provide
emergency care on a 24-hour-per-day basis.
• The psychiatric emergency room is often located in a
separate room section of the hospital emergency
department.
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55. Triage: is the process of determining the priority of patients
treatments based on the severity of their condition.
The triage staff may include:
Psychiatrists
Psychiatric nurses
Social workers
Mental health counselors
Marriage and family therapists
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56. Functions of head nurse
• Collaborative agreement with a consulting psychiatrist to prescribe
necessary psychotropic medication
• To support admission to a psychiatric inpatient unit
• The staff who provide these critical services:
• Must be knowledgeable and skillful in the areas of psychiatric
assessment
• Including complete mental status examination
• Application of crisis intervention
• Individual and family counseling
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57. Day-evening Treatment Programs
• Day-treatment programs are also known as partial
hospitalization programs .
• Day-treatment programs are usually located in or near an
inpatient treatment facility such as a psychiatric hospital
• Is designed to prevent institutionalization
• This program offers medication administration for
individuals on long-term psychopharmacological therapy.
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58. • Partial hospitalization programs generally offer a
comprehensive treatment plan formulated by an
interdisciplinary team of psychiatrists, psychologists,
psychiatric nurses.
12/20/2018 58

59. • Day-treatment programs include:
Physical examination
Complete psychiatric evaluation
Nursing assessments
A substance abuse assessment
Psychosocial history
12/20/2018 59

60. Examples of Day-Treatment Program Interventions
Family therapy, Client and family psycho-education
Individual therapy and Group therapy
Therapeutic education or vocational training
Drug and alcohol education
Recreational therapy
Expressive therapies (eg, art, movement, psychodrama)
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61. Residential Treatment Programs
Clients with a diagnosis of:
Chronic schizophrenia
Severe affective disorder
Borderline personality disorder
Mental retardations
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62. The goals of these programs are:
To improve self-esteem and social skills
Promote independence
Prevent isolation
Decrease hospitalization
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63. Residential treatment program offers different support
services.
 Shelter, food
 Personal care and supervision
 Health care, individual or group counseling
 Vocational training or employment
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64. Examples of Residential Treatment Programs
• Group homes: Halfway houses, therapeutic
community homes
• Personal care homes: Boarding homes, social
rehabilitation residential programs
• Foster homes: group foster homes, transitional
care facilities
12/20/2018 64

65. Psychiatric Home Care
• With the increased emphasis on community mental health in
the 1960s, programs were established to treat psychiatric
client at home with a visiting nurse providing care.
• The client must show that he or she is unable to leave the
home without the assistance of another person
• Homebound clients most often have diagnoses of
depression, dementia, bipolar affective disorder, and
schizophrenia.
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66. • Nurses who provide psychiatric home care must have an in-
depth knowledge of psychopathology, psychopharmacology,
and how medical problems can be influenced by psychiatric
impairments
• Another important job of the psychiatric home care nurse is
monitoring compliance with the regimen of psychotropic
medications.
• Some clients who are receiving injectable medications remain
on home health care only until they can be placed on oral
medications.
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67.  Clients that benefit from psychiatric home health care
nursing include:
Elderly clients. These experiencing emotional difficulties
that have arisen from medical illness. Depressed mood
and social isolation are common
 Persons with severe and persistent mental illness And
hospitalization. They require long-term medications
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68.  Common diagnoses include recurrent major depression,
schizophrenia, and bipolar disorder.
 Individuals in acute crisis situations. These individuals
are in need of crisis intervention
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69.  The psychiatric home health nurse provides
comprehensive nursing care, incorporating interventions
for psychosocial problems into the treatment plan.
 The interventions are based on the client’s mental and
physical health status
 Nursing diagnoses are presented, along with outcome
criteria, appropriate nursing interventions
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70. Hospital psychiatry
• Role of a hospital in the treatment of mental
illness:
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71. Inpatient care
• Is care given to a patient admitted to a hospital,
extended care facility, nursing home or other
facility.
• Long term care is the range of services typically
provided at skilled nursing, intermediate-care,
personal care or eldercare facilities.
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72. INPATIENT PSYCH CARE
 safe environment
 focuses on working with problems
 continued emotional support
 intensive inpatient therapy
 monitoring treatment, medications
 opportunities for resolving interpersonal issues
 new coping skills tried
 detox from chemicals
12/20/2018 72

73. In order to be considered eligible for admission to an acute
inpatient psychiatric unit, an individual must meet one or
more of the following criteria:
• The client is an imminent threat to himself/herself
• The client create an imminent threat to the safety and/or
well-being of others
• The client is unable to provide for his/her basic needs in
spite of having adequate resources
• The client is out of control
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74. Admission criteria's for mental disorders
• Hospitalization is indicated if there :
Neglect of food and water intake
Danger to self or others
Poor drug compliance
Significant neglect of self care
Lack of social support
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75. Inpatient Admission
• Majority of patients enter mental health care through the
emergency room
Self Referral
Friend/Family
Professional
• Criteria
Harm to self
Harm to other
seriously disabled in care of basic needs
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76. Types of Admission
• Voluntary Hospitalization:
Patient complies and consents with inpatient status
Patient may choose to leave prior to completion of
therapy regimen
client originates or agrees with
Admission process similar to medical hospitalization
Patient may stay as long as treatment is consider necessary
Patient can leave at any time12/20/2018 76

77. • Involuntary Hospitalization:
Admission process is initiated by someone other than the client
Initiated by police
Client is hospitalized without consent
Situation must be considered an emergency
Client receives observation and treatment for mental illness
May occur when an individual is unable to take care of his/her
basic needs in spite of having adequate resources to do so.
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78. OUTPATIENT CARE
• allows mentally ill persons to live and work within
their own communities within a “least restrictive
setting”
• Outpatient care: Is any health care service provided
to a patient who is not admitted to a facility.
• Outpatient care may be provided in a doctor's office,
clinic, the patient's home or hospital outpatient
department
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79. SETTINGS
• community hospital emergency rooms
• residential programs
• partial hospitalization programs
• psychiatric home care visits
• community mental health centers
12/20/2018 79

80. MENTAL HEALTH TEAM MEMBERS
Psychiatrist
Clinical Psychologist
Psychiatric Clinical Nurse Specialist
Psychiatric Nurse
Mental Health Technician
Psychiatric Social Worker
Occupational Therapist
Recreational Therapist
Music Therapist
Art Therapist
Dietician
Chaplain
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81. CONCEPTS / TERMS ON THE CARE OF
PSYCHIATRIC PATIENT
1.Alteration in Speech / Communication
Mutism : poverty of words; unable to speak: not trying to speak.
Neologism: new, foreign-sounding words only the patient can
understand.
Echolalia : repeating /saying words as exactly heard.
Word salad : mixing of unrelated words.
Palilalia : defined as the repetition of sounds and words.
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82. Clang Association/Rhyming – use of words with the
same sound.
Perseveration – using of pattern of words/phrases
repeatedly.
Verbigeration – meaningless or stereotyped response to
questions
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83. II. Alteration in Mood/Affect
Apathy/Flat affect – absence of emotional response.
Inappropriate affect – emotional response which is not in harmony
with the content of the statement.
Emotional blunting – emotions lacking in intensity ; dulling of
emotions.
Labile Affect – quick, unpredictable change in mood
Mania – state of extreme hyperactivity, excitability and sometimes
aggression
Euphoria – extreme feeling of happiness, excitement, emotional
well-being12/20/2018 83

84. Elation : feeling of happiness more intense than euphoria.
Depression: all-consuming, morbid feeling of sadness,
negative sadness.
Melancholy : form of depression usually occurring at the
age of 45 and above
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85. III. Alteration in Movement/Motor Control
Psychomotor agitation – restlessness; unable to sit still; pacing back
and forth.
Psychomotor retardation – slowing down of movements.
Catatonia – state of muscular rigidity and physical immobilization
Forms of Catatonia:
1. Waxy Flexibility (Cerea flexibilities) – Patient tends to stay in
one position for a long period of time in which he/she is placed.
2. Suggestibility – muscular rigidity but patient may assume position
as suggested.
Echopraxia – mimicking or following the action/s of another person.
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86. IV. Alteration in Perception
Hallucination – perception of an object, person or event without any
stimulus or that is not actually present in reality.
• May be Auditory, Visual, Olfactory, Gustatory or Tactile in nature.
• Auditory hallucination – common in schizophrenia.
• Visual hallucination – common in alcoholics.
Illusion – wrong perception of an event, object or persons thus the
stimulus is present but mistakes it for something else.
Déjà vu – strange perception or feeling that an experience or event
presently occurring has happened in the past.
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87. V. Alteration in Cognition or Thinking
Ambivalence: Presence/existence of two strong yet opposite
feelings at the same time; person unable to decide. E.g. are love-
hate feelings
Autism: Extreme interest/preoccupation of oneself and own
experiences; persons is creating a world of fantasy and has no
contact with reality.
Blocking: Interruption or stoppage in the expression of thoughts/ideas
due to emotions, delusions, etc.
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88. Circumstantiality: going away from the original idea to
some unrelated idea but still completes the idea in the
end; also called “beating around the bush”
Confabulation: saying made-up or fabricated/fantastic
responses to fill in memory lapses to avoid shame.
Delusion : fixed, false beliefs which can’t be corrected or
changed by reason, logic, or scientific evidence.
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89. Forms of Delusion
• Delusion of grandeur/grandiosity – wrong belief that one is
rich, powerful, famous…
• Delusion of persecution – baseless belief that others are
planning to harm, hurt, humiliate, or kill the person.
• Delusion of idea of reference – false belief that certain
remarks, behavior or ideas are intended or directed to the
persons.
• Delusion of influence – untrue belief that the person can
control another person’s action, ideas or behavior
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90. • Alien or Cosmic Control – false idea that a supernatural power,
person, or object is in control of the person’s thoughts, behavior
or actions.
• Somatic delusion – belief that a body part or the whole body is
sick or abnormal.
• Nihilistic delusion – wrong belief that the self –is not existing or
has stopped existing.
• Thought Broadcasting – false idea that one think or says can be
heard or known to everybody.
• Erotomania – wrong belief that somebody is madly in love with
the person. De Clérambault syndrome
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91. • Delirium – state of confusion accompanied by fear,
restlessness, hysteria, and emotional lability.
• Depersonalization – odd strange feeling of oneself, the
body and the environment.
Ex. There are wires inside my body
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92. • Flight of ideas – fast shifting or changing from one topic
to another but has some relationship with each other.
• Loose Association – connecting of unrelated or
disconnected thoughts/ideas or sentence.
• Hypochondriasis – exaggerated or too much concern on
ones own health; persons thinks he is ill but upon
laboratory procedures or physical exam there is no
evidence of damage to the organ.
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93. • Mental Retardation – slowing down of thoughts and difficulty in
expressing them.
• Obsession – persistent and unwanted thoughts, ideas or impulse
that cannot be eliminated from awareness or logical thinking.
• Compulsion – uncontrollable, persistent urge or need to perform
an act or carry out the obsession which is actually against the
person’s will or standards.
-the act is often referred to as “Ritual” and is repeatedly done
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94. • Paranoia: extreme suspiciousness and misinterpretation
of another person’s act as threatening or harmful.
• Anhedonia: person is not able to feel/experience
pleasure.
• Fugue: unconscious or unintended forgetting or erasing
of one’s past life, experiences and associations. May
change one’s identity, name and appearance
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95. Barriers to Treatment
 Stigma : Stops patients and their families from
approaching mental health services
 Lack of manpower : Lack of trained personnel,
uninteresting administrative and policy matters and
understaffing
 Geographical factors: Poor coverage of rural areas,
distance, the need to travel and time constraint
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96.  Financial factors: Cost of travel to get services and loss
of salary
 Programme factor: Fragmented services for various age
groups, administrative and policy problems, neglect of
the elderly and lack of national priorities for mental
health
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97. Stigma
• Stigma is defined as "a cluster of negative attitudes and
beliefs that motivate the general public to fear, reject, avoid,
and discriminate against people with mental illness.“
• For the psychiatrically ill, stigma is a barrier that separates
them from society and keeps them apart form others.
• They are the result, in part, of the cultural stigma against
mental illness that is prevalent in contemporary society.
• For example, one study found that 39% of all newspaper
stories related to mental illness focused on dangerousness and
violence.
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98. • The impact of this stigma is huge.
• Nearly two thirds of people with diagnosable mental disorders do
not seek treatment, and stigma related to mental illness is one of
the major barriers that discourages people from seeking needed
care.
• Another sign of stigma is evident in the public's unwillingness to
pay for mental health services and to provide the same coverage
for physical and mental health care.
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99. • Patients and their families often report that the
diagnosis of a mental illness is followed by
increasing isolation and loneliness as family and
friends withdraw.
• Patients feel rejected and feared by others, and their
families are met by blame.
• Stigma against mental illness is a reflection of the
cultural biases of current society that are shared by
consumers and health care providers alike.
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100. The health consequence of stigma are as follows:
• Stigma leads to concealment or denial of symptoms.
• Stigma discourages adherence to effective treatments.
• Stigma isolates the individual an family.
• Stigma inaccurately affects patients' beliefs about what is wrong
with their health
• Stigma lowers self-esteem and negatively affects self-perception
and self-care.
• Stigma limits access to quality health care.
• Stigma leads to less desirable treatment settings
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101. • Stigma negatively affect the attitudes of health care
providers.
• Stigma contributes to the economic conditions that
influence poor outcomes.
• Stigma limits the community's response to illness.
• Stigma limits the formation of nonprofit groups and
discoveries
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102. • Reducing stigma must involve programs of public
advocacy, public education on mental health issues, and
contact with persons with mental illness through schools
and other social institutions.
• Another way to reduce stigma is to find causes.
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103. • Finally, it must be understood that everyone encounters
stress and that all people are subject to maladaptive
coping responses.
• Mental health professional can educate the public and
teach them that mental health is a field and mental
illness is caused by a complex combination of factors.
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104. Thank you !!!!
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