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This document discusses community mental health in India. It provides definitions of community mental health, community mental health nursing, and community mental health programs. It outlines the history and development of community mental health in India from 1912 to present. It describes the objectives, components, principles, issues, and models of community mental health care. It also discusses the roles of nurses in primary, secondary, and tertiary prevention. Finally, it outlines various mental health services available in the community including partial hospitalization, halfway homes, self-help groups, and psychiatric rehabilitation.

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COMMUNITY MENTAL HEALTH PREPARED BY:- VERSHA CHAUHAN MN FINAL RAKCON
INTRODUCTION • According to the National Alliance on Mental Health, approximately 51.5 million adults in the U.S. (about 1 in 5 adults) experienced mental illness in 2019. • Community mental health centers are critical to meeting the demand for mental health treatment across the country. • Filling the gaps when individuals are unable to obtain treatment from private providers, community mental health centers operate on the front line in helping individuals contend with challenges to their mental health.
DEFINITIONS • Community mental health is the application of specialized knowledge to population and communities to promote and maintain mental health, and to rehabilitate population at risk that continue to have residual effects of mental illness. -By Sreevani
• Community mental health nursing is the application of knowledge of psychiatric nursing in promoting and maintaining mental health of people, to help in early diagnosis and care and to rehabilitate the clients after mental illness. -By Bimla Kapoor
•The community mental health programme includes all community facilities pertinent in any way to prevention, treatment and rehabilitation. By K.Park
DEVELOPMENT OF COMMUNITY MENTAL HEALTH IN INDIA • 1912- Indian Lunacy Act came to force • 1954- All India Institute of Mental Health (NIMHANS) was established • 1955- the Joint Commission on Mental illness and Health was formed to study the problem of mental health delivery • 1957- Dr Vidya Sagar, Spdnt of Amritsar Mental Hospital initiated community mental health services establishment of General Hospital Psychiatric Units (GHPO) • 1963- Community Mental Health Centers (CMHC) act was passed • 1974- Community mental health programme started at Sakkalwara of Bengaluru, and Raipur Rani block of Ambala dist, Haryana • 1975- Community Psychiatry unit was initiated at NIMHANS
• 1982- National Mental Health Programme was started. • 1987- Indian Lunacy Act was replaced by Indian Mental Health Act • 1975- Community Mental Health Construction Act was further expanded and included seven additional points • Follow up care • Transitional services • Services for children and adolescent • Services for the elderly • Screening services • Alcohol abuse services • Drug abuse services • 1980- Community Mental Health Systems Act was passed • 1980- DMHP was launched at Bellary district of Karnataka • 1982- National Mental Health Program (NMHP) was launched in Maharashtra, for the first time in India.
OBJECTIVES OF COMMUNITY MENTAL HEALTH NURSING  To promote and maintain mental health of family through preventive and promotive interventions  To enhance the potentials of community people to use their strength to provide essential competence for positive mental health  To educate the family members regarding identification of various stressors and coping mechanisms to deal with problems  To help the family members to recognize that the social, cultural and situational aspects have an influence on behaviour and how it can affect the individual person’s behaviour in the family  To teach the community people to monitor their mental health and that of community.
COMPONENTS OF COMMUNITY MENTAL HEALTH CARE  Mental health promotion  Stigma removal  Psychosocial support  Rehabilitatory services  Prevention of harm from alcohol and substance use  Treatment of the ill, using primary health care system
PRINCIPLES OF COMMUNITY MENTAL HEALTH  It is distinguished by unique conceptual framework, clinical process and intervention strategy  It must consider social setting and conditions where family members experience stress, and it should be based on the potential and capabilities for the promotion of mental health and prevention of mental disorders  It uses holistic approach  It provides special kind of mental health services as the social and professional role of nurse converges to have better outcome of services  It should have primary concern for targeted population, and social and community networks  It should have focuses on interrelationship formed in group context as they interact in daily living activities
ISSUES IN CMHS  Limited manpower  Uneven distribution of resources  Low priority in national budget for mental health  GPs are not comfortable to manage people with mental illness  Lack of awareness in the community  Poor access to care  Poverty  Poor availability of medications  Traditional healing techniques.
MODELS OF PREVENTIVE PSYCHIATRY: LEVELS OF PREVENTION  Primary Prevention (health maintenance & specific protection)  Secondary Prevention (early diagnosis & treatment)  Tertiary (rehabilitation)
ROLE OF NURSE IN PRIMARY PREVENTION (Sub centre, PHC, CMHC)  Individual centered intervention  Interventions oriented to the child in the school  Family centered interventions to ensure harmonious relationship  Interventions oriented to keep families intact  Interventions for families in crisis  Mental health education  Society centered preventive measures
ROLE OF NURSE IN SECONDARY PREVENTION (General hospitals and psychiatric units, government & Pvt. Psychiatric Hospital, voluntary organizations)  Early diagnosis and case finding  Early reference  Screening programmes  Early and effective treatment for patient  Training of health personnel  Consultation services • Crisis intervention
ROLE OF NURSE IN TERTIARY PREVENTION (Rehabilitation centres of govt. And pvt hospital, voluntary organizations, non- governmental mental health organizations)  Making family members involvement in care  Providing occupational and recreational activities  Implementing community base programmes  Bridging gap between institutionalized and deinstitutionalized care  Collaborative mental health care services  Training in Community Living (TCL)  Avoiding stigma and fostering positive attitude of people
MENTAL HEALTH SERVICES AVAILABLE FOR PATIENTS
PARTIAL HOSPITALIZATION  It is ideally suited to most of psychiatric syndromes, especially chronic psychotic disorders, neurotic conditions, drug and alcohol dependence and MR.  Day care centers, day hospitals and day treatment programs are under partial hospitalization
QUARTERWAY HOMES  This is usually located within the hospital campus, but not having the regular services of a hospital. There may not be routine nursing staff or routine rounds, most of the activities are taken care by the patient themselves.
HALFWAY HOME  It is a transitory residential center for mentally ill patients who no longer need the full services of hospital, but are not yet ready for a completely independent living, it helps to develop and strengthen individual capacities.
OBJECTIVES OF HALFWAY HOMES  To ensure smooth transition from hospital to family • To integrate the individual into the mainstream of life
ACTIVITIES CARRIED OUT  Clinical assessment  Social assessment  Psychological assessment  Vocational assessment  Supportive interventions
SELF HELP GROUPS  These are composed of people who are trying to cope with a specific problem or life in crisis and have improved the emotional health and well being of many people  Members have homogeneity and they work together using their strengths to gain control over their lives  They educate and support each other in solving the problems  They make others feel that they are not alone in having a particular problem  They emphasize cohesion, as they have similar problems and symptoms, they have a strong emotional bond  The strategies used by group leaders are promotion of dialogue, self-disclosure and encouragement among members  Concepts used are psycho education, self-disclosure and mutual support
PSYCHIATRIC REHABILITATION  Rehabilitation is the process of enabling the individual to return to his highest possible level of functioning.  Rehabilitation is “an attempt to provide the best possible community role which will enable the patient to achieve the maximum range of activity, interest and of which he is capable (Maxwell Jones- 1952)
PRINCIPLES OF REHABILITATION  Increasing dependence of patients  Improvement of competence and capabilities  Maximum use must be made of residual capacities  Patient’s active participation is very essential  Skill development and therapeutic environment are fundamental interventions
PSYCHIATRIC REHABILITATION SERVICES  Workplace accommodations  Supported employment or education  Social firms  Assertive community  Medication management  Housing  Employment  Family issues  Coping skills  Activities of daily living and social skills
AREAS OF WORK IN PSYCHIATRIC REHABILITATION  Psychiatric symptom management  Social area includes relationships, family, boundaries, communications and community integration  Vocational and educational area including coping skills and motivation  Basic living skills  Financial area or budgeting  Community and legal resources  Health and medical to maintain consistency of care  Housing to provide safe environments
CHARACTERISTICS  Services are provided in maximum normalized environment as possible  Emphasis is on the ‘here and now’ rather than problems of past  Work is central to rehabilitation process  Psychiatric rehabilitation services are collaborative, person directed and individualized  Emphasis is on social, rather than medical model  All people have underused skills and they can be equipped with skills  Emphasis on client’s strengths rather than on pathologies  People have the right and responsibility for self determination  Care is provided in an intimate environment without professional, authoritative shields and barriers  It is oriented toward empowerment, recovery and competency
BENEFITS OF REHABILITATION  Helps in promoting recovery and minimizing disabilities  Helps in full community integration and improved quality of life for persons with any serious mental health condition  Provides assistance in accepting the client in family and community  It assists the client in developing harmonious relationship among family members  It helps in improving their ability to lead meaningful lives in the community  Helps in developing skills and access resources needed to increase their capacity  Helps in satisfying mentally ill client in the living , working, learning and social environments of their choice  It provides assistance in vocational training and supervision
REHABILITATION TEAM  Psychiatrist Clinical psychologist  Psychiatric social worker  Mental health nurse  Occupational therapist  Recreational therapist  Counselor  Other supportive staff
STEPS IN PSYCHIATRIC REHABILITATION  Reduction of impairments  Remediation of disabilities through skill training  Remediating disabilities through supportive interventions  Remediation of handicaps
DOMAINS OF PSYCHIATRIC REHABILITATION SERVICES  Skill training  Peer support  Vocational training • Consumer - community resource development
ROLE OF NURSE IN REHABILITATION  Assessment of individual  Assessment of family  Assessment of community  Individual intervention  Inpatient rehabilitation  Community rehabilitation  Family interventions  Community interventions
INTERVENTIONS DEVELOP A STRUCTURED THERAPEUTIC COMMUNITY  Educate family members regarding disease process and communication skills  Teach problem solving skills  Change attitude of public towards mentally ill  Motivate client to be a part of self help groups  Provide assistance in vocational rehabilitation  Regularly visit family members to offer support
WELFARE AGENCIES IN COMMUNITY MENTAL HEALTH  Psychiatric emergency care  Day-treatment programs  Residential treatment programs  Psychiatric home care  Aftercare and rehabiliation
MENTAL HEALTH AGENCIES  There are 42 mental hospitals in the country with bed availability of 20,893 in the Government sector.  In private sector, there are 5096 beds.
NATIONAL AGENCIES S.NO. AGENCIES AREA OF WORK 1. The Eclat Society for the Welfare of Mental Retarded MR 2. Association of social health in India Drug Deaddiction counselling centers 3. Association of National Brotherhood for Social Welfare Drug deaddiction, MR 4. Parents association for the welfare of mentally handicapped MR 5. Youth and masses Drug abuse 6. Servants of the people society MR 7. Society for social services Day care centrer for aged 8. Asha kiran Mentally ill 9. Abhilasha special education center Mentally ill, speech disorder 10. Nav Jyothi center Mentally ill 11. National institute for mentally handicapped Mentally ill 12. Model school for mentally deficient children MR
INTERNATIONAL AGENCIES 1. WHO 2. UNESCO 3. WFMH (World Federation for Mental Health) • Goals of WFMH  To promote mental health and optimal functioning  To prevent mental, neurological and psychosocial disorders  To heighten public awareness on mental health  To improve the care and treatment 4. ISMO ( The Society for Mental Health Online – 1997) 5. NAMI (National Alliances for the Mentally Ill – 1979)
VOLUNTARY/ NGO MENTAL HEALTH AGENCIES  They are strongly committed to innovation and change  They fill gap between community needs and available community services  They play an important role in suicide prevention and crisis support and many other essential mental health services
Lists of MHNGOs  Alzheimer and Related Disorders Society of India (ARDSI- Kochi)  Sangath Society (Goa)  The Research Society (Mumbai)  Samadhan (New Delhi)  Schizophrenia Research Foundation (SCARF – Chennai)  Medico – Pastoral Association (Bengaluru)  T.T. Krishnamachari Foundation (Chennai)  Total Response to Alcohol and Drug Abuse (TRADA- Kerala & Karnataka)
ACTIVITIES OF MHNGOS CLINICAL CARE AND REHABILITATION  Community outreach programmes  Support groups  Training  Advocacy and building awareness  Research • Networking
SPECIAL POPULATIONS- MENTAL HEALTH ISSUES
PROBLEMS OF ADOLESCENTS  Anxiety disorders  Conduct disorders  Mood disorders  Schizophrenia  Eating disorders  Deliberate self-harm  Alcohol and substance abuse • Sexual problems
NURSING RESPONSIBILITY  Assessment for high risk behavior  Provide medical treatment as ordered  Give support and behavioral therapies  Establish a therapeutic relation with client  Involve family members in planning and implementing therapies  Plan for appropriate referral services  Treat adolescent as individual client  Educate family on communication pattern
PROBLEMS OF WOMEN PREMENSTRUAL SYNDROME POSTPARTUM DEPRESSION  Puerperal psychosis  Maternity blues  Menopause
PREMENSTRUAL SYNDROME SYMPTOMS  Breast swelling and tenderness  Acne  Food cravings  Irritability  Mood swings  Cry spells, depression
MANAGEMENT  Diuretics  Analgesics  OCPs  Ovarian suppressors (danocrine)  Anti-depressants
GENERAL MANAGEMENT  Provide exercise Provide emotional support  Provide enough sleep  Adequate nutrition  Avoid salt before menstrual period • Avoid caffeine and alcohol
POSTPARTUM DEPRESSION  Can occur during pregnancy or within one year of delivery  Causes  History of depression  Positive family history of depression  Anxiety about fetus  Problems with previous pregnancy  Young age of mother  Low thyroid levels  Stress from work or home  Broken sleep patterns
SYMPTOMS  Feeling irritable Sadness, hopelessness Crying spells  Avolition  Eating too little or too much  Withdrawal from friends and family  Sleep disturbances  Less interest in baby
POSTPARTUM PSYCHOSIS  Usually begins within 1-3 months of delivery • Symptoms  Auditory / visual hallucinations  Delusions  Insomnia  Sleep disturbances  Obsessed thoughts of baby  Agitation  Anger  Irrational guilt  Mood swings
MATERNITY BLUE  Occurs mostly on 4th or 5th day after delivery in % women  Causes  Prenatal depression  Low self esteem  Child care stress  Low social support  Poor marital relationship  Unplanned pregnancy
SYMPTOMS  Dysphoria  Mood liability  Irritability  Hypochondriasis  Anxiety  Insomnia  Impaired concentration  Isolation
MANAGEMENT  Antipsychotic drugs  Mood stabilizers  Supportive intervention  CBT  Reassurance  Monitor and supervision  Healthy diet  Suicidal precautions
PROBLEMS OF ELDERLY (Developmental tasks)  Establishing satisfactory living relationship  Adjusting to retirement income  Establishing comfortable routines  Maintaining love, sex, and marital relationship  Keeping active and involved  Staying in touch with other family members  Sustaining and maintaining physical and mental health  Finding meaning of life
COMMON MENTAL HEALTH PROBLEMS  Depression  Dementia  Delirium  Paranoid disorders
VICTIMS OF VIOLENCE • Forms of domestic violence  Physical aggression  Threats  Sexual abuse  Emotional abuse  Controlling or domineering  Intimidation  Neglect  Financial deprivation
EFFECT OF VIOLENCE  Physical, social, emotional effects  Lowering self esteem  Loss of confidence  Avoidence  Mutism  Depression  Suicidal ideation
PREVENTION OF VIOLENCE  Learn about type of violence that may occur  Recognize early warning signs of violence  Work on low self-esteem issues  Recognize obstacles to responding to violence  Build support systems  Open communication
VICTIMS OF ABUSE • Types  Physical abuse  Emotional abuse  Sexual abuse  Neglect
CAUSES  Family violence  Unsatisfactory schooling, housing and environment  Parental factors  Mental illness  Marital disharmony  Crime  Chronic illness  Poverty  Poor interpersonal interactions
CLINICAL FEATURES  Multiple bruising  Burns  Abrasions  Bites  Torn upper lip  Subdural hemorrhage  Fracture  Genital bleeding  Crying spells  New sexual behaviors in child  Depression, anxiety, nightmares  Suicidal tendency
MANAGEMENT  Reassurance  Talk to parents regarding abuse  Treat external injuries  Help family to modify behavior  Never blame parents  Provide legal counseling to victim and family  Counseling and guidance  Provide reinforcement of healthy traits  Treat if venereal diseases present
HANDICAPPED  They try to excel by compensation  They usually are victims of teasing, bullying, casting, insulting remarks, and avoidance by others  They experience, low self-esteem and disturbed body image  Only few copes with disability and ignore it
STRATEGIES TO HELP  Focus on what they can do at times  Identify child’s strength and capitalize them  Keep expectations high, the child is capable of achieving  Never accept rude or negative remarks towards these children  Give compliment and positive encouragement for their achievements  Make adjustments and accommodations when ever possible, for the child to participate in  Never pity them  Encourage independent activities  Ensure safety measures for the child
HIV/ AIDS PSYCHOSOCIAL ISSUES RELATED TO THE DIAGNOSIS  Behavioural  Fear  Loss  Isolation  Resentment  Depression  Anxiety  Anger  Suicidal thoughts  Low self esteem
PSYCHIATRIC SYNDROMES DUE TO HIV/ AIDS  Depression  Anxiety  Paranoia  Mania  Irritability  Psychosis  Substance abuse  Insomnia  Suicidal ideation
NURSING MANAGEMENT  Multidisciplinary team approach  Detailed neuropsychiatry assessment  Help patient change risky behavior  Provide counseling  Clarify doubts if needed  Explain window period  Review patient’s assessment for own risk
 Provide risk reduction information  Build rapport  Explore patients’ feelings  Implement psychosocial interventions  Provide safe sex information  Advise for regular medical monitoring  Teach about ART and nutritious diet • Enable social support networks for patient
ROLE OF COMMUNITY HEALTH NURSE IN PROVIDING MENTAL HEALTH SERVICES • The community mental health nurse performs various functions to help individuals recover from mental health issues, including depression, anxiety, isolation, and serious persistent mental illness. • The major tasks, duties, and responsibilities performed by a community mental health nurse are listed in the job description example below:
 Administer medications, document response, maintain accurate medication lists, and document and report medication errors  Utilize a motivational approach to engage individuals in treatment consistent with their stage of change and develop therapeutic relationships with individuals that respect boundaries  Assess the individual’s medical and nursing needs and make recommendations for an individual-centred service plan  Provide education regarding mental illness, physical health concerns, chronic disease management, wellness, relapse prevention and medications to patients, families, care givers and team members
 Advocate for individuals to assure implementation of appropriate interventions; assure protection of rights and privacy, and assure that individuals understand the complaint and grievance procedures  Refer and connect individuals with medical, psychiatric, and other healthcare providers relevant to managing their case  Coordinate with pharmacies to ensure timely delivery of appropriate medications  Evaluate the effectiveness of all medical and psychiatric services and provide additional coordination, advocacy, or intervention when necessary  Talk to patients about their problems and discuss the best strategy to deliver their care  Develop rapport with patients to build trust, while listening to and interpreting their needs and concerns correctly
 Empathize with distressed patients and attempt to understand the source of their discomfort  Help patients manage their emotions through the application of de-escalation techniques  Provide evidence-based individualized therapy, such as cognitive behavior therapy for depression and anxiety  Liaise with mental health agencies, social workers, and primary care practitioners as needed  Organize social events aimed at developing patients’ social skills and help reduce their feelings of isolation
 Ensure that the legal requirements appropriate to a particular setting or group of patients are observed and adhered to  Maintain medication inventory, review patient care plans, and monitor progress  Help patients and their families in combating stigma associated with mental illness  Render advice and arrange support for patients, relatives, and care givers  Assess treatment success at case conferences and meetings
 Prepare and update patient records  Encourage patients to take part in therapeutic activities, including art and role play  Assess and plan nursing care requirements  Visit patients in their home to monitor progress and perform risk assessments with regards to their safety and welfare, and identify when patients are at risk of harming themselves or others.
SUMMARY  Mental health condition is stigmatizing.  Wide spectrum of disorders.  Multifactorial with psychosocial and environmental determinants.  Scientific basis and Community approach for drug dependence
CONCLUSION • Community mental health is the application of specialized knowledge to population and communities to promote and maintain mental health, and to rehabilitate population at risk that continue to have residual effects of mental illness. And community health nurse plays an important role in prevention of mental health in community.
BIBLIOGRAPHY 1. Park, K. Park‘s Text book of Preventive and Social Medicine, M/S Banarsidas Bhanot Publishers, Latest Edn. 2. Gulani K, K. Community Health Nursing:Principles and practices. Latest Edn. 3. Bimala Kapoor “ Text book of psychiatric nursing”;volume- 2;kumar book publishers, volume-2 new delhi. 4. Kamalam.S.(2005)Essentials of Community Health Nursing Practices,2nd Edition,Jaypee brothers,New Delhi 5. Swarnkar K. Community Health Nursing, Latest Edn. 6. Asma Rahim(2008),Principles and Practices of Community Medicine,1st Edition,Jaypee Publishers,New Delhi. 7. www.google.com/books/communityhealthnursing 8. www.wikipedia.com 9. www.nrhm.gov.in 10. www.arogykeralam.gov.in 11. https://jobdescriptionandresumeexamples.com/community-mental-health-nurse-job-description-duties-and- responsibilities/#:~:text=Community%20mental%20health%20nurses%20are%20also%20responsible%20for,experience %2C%20professional%20certification%2C%20and%20a%20registered%20nurse%20license.

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community mental health ppt.pptx

  • 1.
    COMMUNITY MENTAL HEALTH PREPARED BY:-VERSHA CHAUHAN MN FINAL RAKCON
  • 2.
    INTRODUCTION • According tothe National Alliance on Mental Health, approximately 51.5 million adults in the U.S. (about 1 in 5 adults) experienced mental illness in 2019. • Community mental health centers are critical to meeting the demand for mental health treatment across the country. • Filling the gaps when individuals are unable to obtain treatment from private providers, community mental health centers operate on the front line in helping individuals contend with challenges to their mental health.
  • 3.
    DEFINITIONS • Community mentalhealth is the application of specialized knowledge to population and communities to promote and maintain mental health, and to rehabilitate population at risk that continue to have residual effects of mental illness. -By Sreevani
  • 4.
    • Community mentalhealth nursing is the application of knowledge of psychiatric nursing in promoting and maintaining mental health of people, to help in early diagnosis and care and to rehabilitate the clients after mental illness. -By Bimla Kapoor
  • 5.
    •The community mentalhealth programme includes all community facilities pertinent in any way to prevention, treatment and rehabilitation. By K.Park
  • 6.
    DEVELOPMENT OF COMMUNITYMENTAL HEALTH IN INDIA • 1912- Indian Lunacy Act came to force • 1954- All India Institute of Mental Health (NIMHANS) was established • 1955- the Joint Commission on Mental illness and Health was formed to study the problem of mental health delivery • 1957- Dr Vidya Sagar, Spdnt of Amritsar Mental Hospital initiated community mental health services establishment of General Hospital Psychiatric Units (GHPO) • 1963- Community Mental Health Centers (CMHC) act was passed • 1974- Community mental health programme started at Sakkalwara of Bengaluru, and Raipur Rani block of Ambala dist, Haryana • 1975- Community Psychiatry unit was initiated at NIMHANS
  • 7.
    • 1982- NationalMental Health Programme was started. • 1987- Indian Lunacy Act was replaced by Indian Mental Health Act • 1975- Community Mental Health Construction Act was further expanded and included seven additional points • Follow up care • Transitional services • Services for children and adolescent • Services for the elderly • Screening services • Alcohol abuse services • Drug abuse services • 1980- Community Mental Health Systems Act was passed • 1980- DMHP was launched at Bellary district of Karnataka • 1982- National Mental Health Program (NMHP) was launched in Maharashtra, for the first time in India.
  • 8.
    OBJECTIVES OF COMMUNITY MENTALHEALTH NURSING  To promote and maintain mental health of family through preventive and promotive interventions  To enhance the potentials of community people to use their strength to provide essential competence for positive mental health  To educate the family members regarding identification of various stressors and coping mechanisms to deal with problems  To help the family members to recognize that the social, cultural and situational aspects have an influence on behaviour and how it can affect the individual person’s behaviour in the family  To teach the community people to monitor their mental health and that of community.
  • 9.
    COMPONENTS OF COMMUNITY MENTALHEALTH CARE  Mental health promotion  Stigma removal  Psychosocial support  Rehabilitatory services  Prevention of harm from alcohol and substance use  Treatment of the ill, using primary health care system
  • 10.
    PRINCIPLES OF COMMUNITY MENTALHEALTH  It is distinguished by unique conceptual framework, clinical process and intervention strategy  It must consider social setting and conditions where family members experience stress, and it should be based on the potential and capabilities for the promotion of mental health and prevention of mental disorders  It uses holistic approach  It provides special kind of mental health services as the social and professional role of nurse converges to have better outcome of services  It should have primary concern for targeted population, and social and community networks  It should have focuses on interrelationship formed in group context as they interact in daily living activities
  • 11.
    ISSUES IN CMHS Limited manpower  Uneven distribution of resources  Low priority in national budget for mental health  GPs are not comfortable to manage people with mental illness  Lack of awareness in the community  Poor access to care  Poverty  Poor availability of medications  Traditional healing techniques.
  • 12.
    MODELS OF PREVENTIVE PSYCHIATRY:LEVELS OF PREVENTION  Primary Prevention (health maintenance & specific protection)  Secondary Prevention (early diagnosis & treatment)  Tertiary (rehabilitation)
  • 13.
    ROLE OF NURSEIN PRIMARY PREVENTION (Sub centre, PHC, CMHC)  Individual centered intervention  Interventions oriented to the child in the school  Family centered interventions to ensure harmonious relationship  Interventions oriented to keep families intact  Interventions for families in crisis  Mental health education  Society centered preventive measures
  • 14.
    ROLE OF NURSEIN SECONDARY PREVENTION (General hospitals and psychiatric units, government & Pvt. Psychiatric Hospital, voluntary organizations)  Early diagnosis and case finding  Early reference  Screening programmes  Early and effective treatment for patient  Training of health personnel  Consultation services • Crisis intervention
  • 15.
    ROLE OF NURSEIN TERTIARY PREVENTION (Rehabilitation centres of govt. And pvt hospital, voluntary organizations, non- governmental mental health organizations)  Making family members involvement in care  Providing occupational and recreational activities  Implementing community base programmes  Bridging gap between institutionalized and deinstitutionalized care  Collaborative mental health care services  Training in Community Living (TCL)  Avoiding stigma and fostering positive attitude of people
  • 16.
  • 17.
    PARTIAL HOSPITALIZATION  Itis ideally suited to most of psychiatric syndromes, especially chronic psychotic disorders, neurotic conditions, drug and alcohol dependence and MR.  Day care centers, day hospitals and day treatment programs are under partial hospitalization
  • 18.
    QUARTERWAY HOMES  Thisis usually located within the hospital campus, but not having the regular services of a hospital. There may not be routine nursing staff or routine rounds, most of the activities are taken care by the patient themselves.
  • 19.
    HALFWAY HOME  Itis a transitory residential center for mentally ill patients who no longer need the full services of hospital, but are not yet ready for a completely independent living, it helps to develop and strengthen individual capacities.
  • 20.
    OBJECTIVES OF HALFWAYHOMES  To ensure smooth transition from hospital to family • To integrate the individual into the mainstream of life
  • 21.
    ACTIVITIES CARRIED OUT Clinical assessment  Social assessment  Psychological assessment  Vocational assessment  Supportive interventions
  • 22.
    SELF HELP GROUPS These are composed of people who are trying to cope with a specific problem or life in crisis and have improved the emotional health and well being of many people  Members have homogeneity and they work together using their strengths to gain control over their lives  They educate and support each other in solving the problems  They make others feel that they are not alone in having a particular problem  They emphasize cohesion, as they have similar problems and symptoms, they have a strong emotional bond  The strategies used by group leaders are promotion of dialogue, self-disclosure and encouragement among members  Concepts used are psycho education, self-disclosure and mutual support
  • 23.
    PSYCHIATRIC REHABILITATION  Rehabilitationis the process of enabling the individual to return to his highest possible level of functioning.  Rehabilitation is “an attempt to provide the best possible community role which will enable the patient to achieve the maximum range of activity, interest and of which he is capable (Maxwell Jones- 1952)
  • 24.
    PRINCIPLES OF REHABILITATION Increasing dependence of patients  Improvement of competence and capabilities  Maximum use must be made of residual capacities  Patient’s active participation is very essential  Skill development and therapeutic environment are fundamental interventions
  • 25.
    PSYCHIATRIC REHABILITATION SERVICES  Workplaceaccommodations  Supported employment or education  Social firms  Assertive community  Medication management  Housing  Employment  Family issues  Coping skills  Activities of daily living and social skills
  • 26.
    AREAS OF WORKIN PSYCHIATRIC REHABILITATION  Psychiatric symptom management  Social area includes relationships, family, boundaries, communications and community integration  Vocational and educational area including coping skills and motivation  Basic living skills  Financial area or budgeting  Community and legal resources  Health and medical to maintain consistency of care  Housing to provide safe environments
  • 27.
    CHARACTERISTICS  Services areprovided in maximum normalized environment as possible  Emphasis is on the ‘here and now’ rather than problems of past  Work is central to rehabilitation process  Psychiatric rehabilitation services are collaborative, person directed and individualized  Emphasis is on social, rather than medical model  All people have underused skills and they can be equipped with skills  Emphasis on client’s strengths rather than on pathologies  People have the right and responsibility for self determination  Care is provided in an intimate environment without professional, authoritative shields and barriers  It is oriented toward empowerment, recovery and competency
  • 28.
    BENEFITS OF REHABILITATION Helps in promoting recovery and minimizing disabilities  Helps in full community integration and improved quality of life for persons with any serious mental health condition  Provides assistance in accepting the client in family and community  It assists the client in developing harmonious relationship among family members  It helps in improving their ability to lead meaningful lives in the community  Helps in developing skills and access resources needed to increase their capacity  Helps in satisfying mentally ill client in the living , working, learning and social environments of their choice  It provides assistance in vocational training and supervision
  • 29.
    REHABILITATION TEAM  PsychiatristClinical psychologist  Psychiatric social worker  Mental health nurse  Occupational therapist  Recreational therapist  Counselor  Other supportive staff
  • 30.
    STEPS IN PSYCHIATRIC REHABILITATION Reduction of impairments  Remediation of disabilities through skill training  Remediating disabilities through supportive interventions  Remediation of handicaps
  • 31.
    DOMAINS OF PSYCHIATRIC REHABILITATIONSERVICES  Skill training  Peer support  Vocational training • Consumer - community resource development
  • 32.
    ROLE OF NURSEIN REHABILITATION  Assessment of individual  Assessment of family  Assessment of community  Individual intervention  Inpatient rehabilitation  Community rehabilitation  Family interventions  Community interventions
  • 33.
    INTERVENTIONS DEVELOP ASTRUCTURED THERAPEUTIC COMMUNITY  Educate family members regarding disease process and communication skills  Teach problem solving skills  Change attitude of public towards mentally ill  Motivate client to be a part of self help groups  Provide assistance in vocational rehabilitation  Regularly visit family members to offer support
  • 34.
    WELFARE AGENCIES INCOMMUNITY MENTAL HEALTH  Psychiatric emergency care  Day-treatment programs  Residential treatment programs  Psychiatric home care  Aftercare and rehabiliation
  • 35.
    MENTAL HEALTH AGENCIES There are 42 mental hospitals in the country with bed availability of 20,893 in the Government sector.  In private sector, there are 5096 beds.
  • 36.
    NATIONAL AGENCIES S.NO. AGENCIESAREA OF WORK 1. The Eclat Society for the Welfare of Mental Retarded MR 2. Association of social health in India Drug Deaddiction counselling centers 3. Association of National Brotherhood for Social Welfare Drug deaddiction, MR 4. Parents association for the welfare of mentally handicapped MR 5. Youth and masses Drug abuse 6. Servants of the people society MR 7. Society for social services Day care centrer for aged 8. Asha kiran Mentally ill 9. Abhilasha special education center Mentally ill, speech disorder 10. Nav Jyothi center Mentally ill 11. National institute for mentally handicapped Mentally ill 12. Model school for mentally deficient children MR
  • 37.
    INTERNATIONAL AGENCIES 1. WHO 2.UNESCO 3. WFMH (World Federation for Mental Health) • Goals of WFMH  To promote mental health and optimal functioning  To prevent mental, neurological and psychosocial disorders  To heighten public awareness on mental health  To improve the care and treatment 4. ISMO ( The Society for Mental Health Online – 1997) 5. NAMI (National Alliances for the Mentally Ill – 1979)
  • 38.
    VOLUNTARY/ NGO MENTALHEALTH AGENCIES  They are strongly committed to innovation and change  They fill gap between community needs and available community services  They play an important role in suicide prevention and crisis support and many other essential mental health services
  • 39.
    Lists of MHNGOs Alzheimer and Related Disorders Society of India (ARDSI- Kochi)  Sangath Society (Goa)  The Research Society (Mumbai)  Samadhan (New Delhi)  Schizophrenia Research Foundation (SCARF – Chennai)  Medico – Pastoral Association (Bengaluru)  T.T. Krishnamachari Foundation (Chennai)  Total Response to Alcohol and Drug Abuse (TRADA- Kerala & Karnataka)
  • 40.
    ACTIVITIES OF MHNGOSCLINICAL CARE AND REHABILITATION  Community outreach programmes  Support groups  Training  Advocacy and building awareness  Research • Networking
  • 41.
  • 42.
    PROBLEMS OF ADOLESCENTS Anxiety disorders  Conduct disorders  Mood disorders  Schizophrenia  Eating disorders  Deliberate self-harm  Alcohol and substance abuse • Sexual problems
  • 43.
    NURSING RESPONSIBILITY  Assessmentfor high risk behavior  Provide medical treatment as ordered  Give support and behavioral therapies  Establish a therapeutic relation with client  Involve family members in planning and implementing therapies  Plan for appropriate referral services  Treat adolescent as individual client  Educate family on communication pattern
  • 44.
    PROBLEMS OF WOMEN PREMENSTRUALSYNDROME POSTPARTUM DEPRESSION  Puerperal psychosis  Maternity blues  Menopause
  • 45.
    PREMENSTRUAL SYNDROME SYMPTOMS  Breastswelling and tenderness  Acne  Food cravings  Irritability  Mood swings  Cry spells, depression
  • 46.
    MANAGEMENT  Diuretics  Analgesics OCPs  Ovarian suppressors (danocrine)  Anti-depressants
  • 47.
    GENERAL MANAGEMENT  Provideexercise Provide emotional support  Provide enough sleep  Adequate nutrition  Avoid salt before menstrual period • Avoid caffeine and alcohol
  • 48.
    POSTPARTUM DEPRESSION  Canoccur during pregnancy or within one year of delivery  Causes  History of depression  Positive family history of depression  Anxiety about fetus  Problems with previous pregnancy  Young age of mother  Low thyroid levels  Stress from work or home  Broken sleep patterns
  • 49.
    SYMPTOMS  Feeling irritableSadness, hopelessness Crying spells  Avolition  Eating too little or too much  Withdrawal from friends and family  Sleep disturbances  Less interest in baby
  • 50.
    POSTPARTUM PSYCHOSIS  Usuallybegins within 1-3 months of delivery • Symptoms  Auditory / visual hallucinations  Delusions  Insomnia  Sleep disturbances  Obsessed thoughts of baby  Agitation  Anger  Irrational guilt  Mood swings
  • 51.
    MATERNITY BLUE  Occursmostly on 4th or 5th day after delivery in % women  Causes  Prenatal depression  Low self esteem  Child care stress  Low social support  Poor marital relationship  Unplanned pregnancy
  • 52.
    SYMPTOMS  Dysphoria  Moodliability  Irritability  Hypochondriasis  Anxiety  Insomnia  Impaired concentration  Isolation
  • 53.
    MANAGEMENT  Antipsychotic drugs Mood stabilizers  Supportive intervention  CBT  Reassurance  Monitor and supervision  Healthy diet  Suicidal precautions
  • 54.
    PROBLEMS OF ELDERLY(Developmental tasks)  Establishing satisfactory living relationship  Adjusting to retirement income  Establishing comfortable routines  Maintaining love, sex, and marital relationship  Keeping active and involved  Staying in touch with other family members  Sustaining and maintaining physical and mental health  Finding meaning of life
  • 55.
    COMMON MENTAL HEALTH PROBLEMS Depression  Dementia  Delirium  Paranoid disorders
  • 56.
    VICTIMS OF VIOLENCE •Forms of domestic violence  Physical aggression  Threats  Sexual abuse  Emotional abuse  Controlling or domineering  Intimidation  Neglect  Financial deprivation
  • 57.
    EFFECT OF VIOLENCE Physical, social, emotional effects  Lowering self esteem  Loss of confidence  Avoidence  Mutism  Depression  Suicidal ideation
  • 58.
    PREVENTION OF VIOLENCE Learn about type of violence that may occur  Recognize early warning signs of violence  Work on low self-esteem issues  Recognize obstacles to responding to violence  Build support systems  Open communication
  • 59.
    VICTIMS OF ABUSE •Types  Physical abuse  Emotional abuse  Sexual abuse  Neglect
  • 60.
    CAUSES  Family violence Unsatisfactory schooling, housing and environment  Parental factors  Mental illness  Marital disharmony  Crime  Chronic illness  Poverty  Poor interpersonal interactions
  • 61.
    CLINICAL FEATURES  Multiplebruising  Burns  Abrasions  Bites  Torn upper lip  Subdural hemorrhage  Fracture  Genital bleeding  Crying spells  New sexual behaviors in child  Depression, anxiety, nightmares  Suicidal tendency
  • 62.
    MANAGEMENT  Reassurance  Talkto parents regarding abuse  Treat external injuries  Help family to modify behavior  Never blame parents  Provide legal counseling to victim and family  Counseling and guidance  Provide reinforcement of healthy traits  Treat if venereal diseases present
  • 63.
    HANDICAPPED  They tryto excel by compensation  They usually are victims of teasing, bullying, casting, insulting remarks, and avoidance by others  They experience, low self-esteem and disturbed body image  Only few copes with disability and ignore it
  • 64.
    STRATEGIES TO HELP Focus on what they can do at times  Identify child’s strength and capitalize them  Keep expectations high, the child is capable of achieving  Never accept rude or negative remarks towards these children  Give compliment and positive encouragement for their achievements  Make adjustments and accommodations when ever possible, for the child to participate in  Never pity them  Encourage independent activities  Ensure safety measures for the child
  • 65.
    HIV/ AIDS PSYCHOSOCIAL ISSUESRELATED TO THE DIAGNOSIS  Behavioural  Fear  Loss  Isolation  Resentment  Depression  Anxiety  Anger  Suicidal thoughts  Low self esteem
  • 66.
    PSYCHIATRIC SYNDROMES DUETO HIV/ AIDS  Depression  Anxiety  Paranoia  Mania  Irritability  Psychosis  Substance abuse  Insomnia  Suicidal ideation
  • 67.
    NURSING MANAGEMENT  Multidisciplinaryteam approach  Detailed neuropsychiatry assessment  Help patient change risky behavior  Provide counseling  Clarify doubts if needed  Explain window period  Review patient’s assessment for own risk
  • 68.
     Provide riskreduction information  Build rapport  Explore patients’ feelings  Implement psychosocial interventions  Provide safe sex information  Advise for regular medical monitoring  Teach about ART and nutritious diet • Enable social support networks for patient
  • 69.
    ROLE OF COMMUNITYHEALTH NURSE IN PROVIDING MENTAL HEALTH SERVICES • The community mental health nurse performs various functions to help individuals recover from mental health issues, including depression, anxiety, isolation, and serious persistent mental illness. • The major tasks, duties, and responsibilities performed by a community mental health nurse are listed in the job description example below:
  • 70.
     Administer medications,document response, maintain accurate medication lists, and document and report medication errors  Utilize a motivational approach to engage individuals in treatment consistent with their stage of change and develop therapeutic relationships with individuals that respect boundaries  Assess the individual’s medical and nursing needs and make recommendations for an individual-centred service plan  Provide education regarding mental illness, physical health concerns, chronic disease management, wellness, relapse prevention and medications to patients, families, care givers and team members
  • 71.
     Advocate forindividuals to assure implementation of appropriate interventions; assure protection of rights and privacy, and assure that individuals understand the complaint and grievance procedures  Refer and connect individuals with medical, psychiatric, and other healthcare providers relevant to managing their case  Coordinate with pharmacies to ensure timely delivery of appropriate medications  Evaluate the effectiveness of all medical and psychiatric services and provide additional coordination, advocacy, or intervention when necessary  Talk to patients about their problems and discuss the best strategy to deliver their care  Develop rapport with patients to build trust, while listening to and interpreting their needs and concerns correctly
  • 72.
     Empathize withdistressed patients and attempt to understand the source of their discomfort  Help patients manage their emotions through the application of de-escalation techniques  Provide evidence-based individualized therapy, such as cognitive behavior therapy for depression and anxiety  Liaise with mental health agencies, social workers, and primary care practitioners as needed  Organize social events aimed at developing patients’ social skills and help reduce their feelings of isolation
  • 73.
     Ensure thatthe legal requirements appropriate to a particular setting or group of patients are observed and adhered to  Maintain medication inventory, review patient care plans, and monitor progress  Help patients and their families in combating stigma associated with mental illness  Render advice and arrange support for patients, relatives, and care givers  Assess treatment success at case conferences and meetings
  • 74.
     Prepare andupdate patient records  Encourage patients to take part in therapeutic activities, including art and role play  Assess and plan nursing care requirements  Visit patients in their home to monitor progress and perform risk assessments with regards to their safety and welfare, and identify when patients are at risk of harming themselves or others.
  • 75.
    SUMMARY  Mental healthcondition is stigmatizing.  Wide spectrum of disorders.  Multifactorial with psychosocial and environmental determinants.  Scientific basis and Community approach for drug dependence
  • 76.
    CONCLUSION • Community mentalhealth is the application of specialized knowledge to population and communities to promote and maintain mental health, and to rehabilitate population at risk that continue to have residual effects of mental illness. And community health nurse plays an important role in prevention of mental health in community.
  • 77.
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