This document provides definitions and descriptions of mental health and mental illness from several experts and organizations. It discusses the components, criteria, and factors that influence mental health, as well as the characteristics of mentally healthy and ill individuals. General principles of mental health nursing are also outlined, including accepting patients, using self-understanding, maintaining consistency and avoiding increases in patient anxiety. The document concludes with sections on history collection in psychiatry.

1. BY-
MR. MUKESH SINGH
LECTURER
DEPARTMENT OF MHN

2. MENTAL HEALTH
Definition-
 Mental health is the simultaneous success at working
,loving ,and creating with the capacity for mature and
flexible resolution of conflicts between instincts,
conscience.(American Psychiatric Association)

3. DEFINITION-
 Mental health is defined as a dynamic state in which
thought, feeling and behavior that is age appropriate
and congruent with the local and cultural norms is
demonstrated. ( Robinson )

4. DEFINITION-
 “An adjustment of human beings to the world and to
each other with a maximum of effectiveness and
happiness.”
(Karl Menninger (1947))

5. COMPONENTS OF MENTAL HEALTH
 The ability to accept self
 The capacity to feel right towards others
 The ability to fulfill life’s tasks

6. CRITERIA FOR MENTAL HEALTH
 Adequate contact with reality
 Control of thoughts and imagination
 Efficiency in work and play
 Social acceptance
 Positive self-concept
 A healthy emotional life

7. Factors influencing of mental health

8. FACTORS INFLUENCING OF MENTAL HEALTH:
 Nutrition
 Play
 Perinatal care
 Happy home/parenting
 Good community services
 Adequate school
 Early prevention
 Treatment of physical
illness
 Life style
 Right man for right job
 Marital relationships
 Inter caste and inter
religious marriages
 Guidance and counseling
 Interpersonal relationship
with society

9. Individual factors are:
 Biological make up.
 Sense of harmony in life.
 Vitality.
 Ability to find meaning in
life.
 Emotional negligence.
 Spirituality.
Interpersonal factors:
 Effective communication.
 Ability to help others.
 Intimacy and a balance of
separateness.

10. INDICATORS OF MENTAL HEALTH
 A positive attitude towards self
 Growth, development and the ability for self
actualization.
 Integration
 Autonomy
 Perception of reality
 Environmental mastery

11. CHARACTERISTICS OF A MENTALLY HEALTHY
PERSON
 He has an ability to make adjustments.
 He has a sense of personal worth, feels worth while and
important.
 He solves his problems largely by his own effort and makes his
own decisions.
 He has a sense of personal security and feels secure in a group,
shows understanding of other people’s problems and motives.

12. CHARACTERISTICS OF A MENTALLY HEALTHY
PERSON
 He has a sense of responsibility.
 He can give and accept love.
 He lives in a world of reality rather then fantasy.
 He shows emotional maturity in his behavior, and
develops a capacity to tolerate frustration and
disappointments in his daily life.

13. CHARACTERISTICS OF A MENTALLY HEALTHY
PERSON
 He has developed a philosophy of life that gives meaning
and purpose to his daily activities.
 He has a variety of interests and generally lives a well-
balanced life of work, rest and recreation.

15. MENTAL ILLNESS
 The person’s behavior is causing distress and suffering
to self and / or others.
 The person’s behavior is causing disturbance in his day-
to-day activities, job and inter-personal relationships.

16. DEFINITION
 Mental and behavioral disorders are understood
as clinically significant conditions characterized
by alterations in thinking, mood (emotions) or
behavior associated with personal distress and /
or impaired functioning.(WHO,2001)

17. CHARACTERISTICS OF MENTAL ILLNESS
 Changes in one’s thinking, memory, perception, feeling and
judgment resulting in changes in talk and behavior which
appear to be deviant from the norms of community
 These changes in behavior cause distress and suffering to
the individual or other or both
 Changes and the consequent distress cause disturbance in
day-by-day activities, work and relationship with important
others (social and vocational dysfunction).

18. FEATURES OF MENTAL ILLNESS
 The features of mental illness are classified
under four headings
 Disturbances in bodily functions
 Disturbances in mental functions
 Changes in individual and social activities
 Somatic complaints

19. FACTORS AFFECTING MENTAL HEALTH OR THE
FACTORS CONTRIBUTING TO MENTAL ILLNESS:
There are various theories that explain the cause of
mental illness, but none is accented as definitely causing
mental illness. The various categories of affecting mental
illness:
 Biological factors.
 Psychological factors.
 Socio cultural factors.

20. BIOLOGICAL FACTORS
 Genetic illness history.
 Chromosome defect.
 Adoption studies.
 Metabolic causes.
 Toxic.
 Infection.
 Neuro-chemical changes.

21. PSYCHOLOGICAL FACTORS
 Mother infant interactions.
 Lack of relationship.
 Personality factor.
 Insecurity feelings.
 Marriage.
 Intolerance failures.
 Excessive anxiety.
 Severe depression.

22. SOCIO- CULTURAL FACTORS
 Socio-economic status.
 Cultural factors.
 Crisis intervention
 Group problems.
 War.
 Technological problems.
 Withdrawal from society.

23. WARNING SIGN’S OF POOR MENTAL
HEALTH

24.  Always worrying
 Unable to concentrate because of unrecognized reasons.
 Constantly unhappy without justified cause

25. CONTINUALLY DISLIKE BEING WITH
PEOPLE

26. LOSS TEMPER EASILY AND OFTEN
TROUBLED BY REGULAR INSOMNIA

28. GENERAL PRINCIPLES
OF
MENTAL HEALTH
NURSING

29. INTRODUCTION
 These principles are based on the concept that
each individual has an intrinsic worth and
dignity and has potentialities to grow
 The following principles are general in nature
and from guidelines for emotional care of a
patient

30. ACCEPTE THE PATIENT AS HE IS

31. 1. ACCEPTE THE PATIENT AS HE IS
 Acceptance conveys the feelings of being
loved and cared
 Acceptance means being non judgmental
 Acceptance does not mean complete
permissiveness but setting of positive
behaviors to convey him the respect as an
individual human being
 Acceptance is expressed in the following ways

32. BEING NON JUDGMENTAL AND NON
PUNITIVE

33. BEING NON JUDGMENTAL AND NON PUNITIVE
 The patient behaviour is not judged as right or wrong
or bad
 The patient is not punished for his undesirable
behaviour
 All direct and indirect methods of punishment must be
avoided
 A nurse who shows acceptance does not reject the
patient even when he behaves contrary to her
expectations

34. BEING SINCERELY INTERESTED IN THE
PATIENT (DEMONSTRATED BY)

35. BEING SINCERELY INTERESTED IN THE
PATIENT (DEMONSTRATED BY)
 Studying patient’s behaviour
 Allowing him to make his own choices and
decision as far as possible
 Being aware of his likes and dislikes
 Being honest with him
 Taking time and energy to listen what he is
saying
 Avoiding sensitive subjects and issues

36. RECOGNIZING AND REFLECTING ON
FEELING WHICH PATIENT MAY EXPRESS

37. RECOGNIZING AND REFLECTING ON FEELING
WHICH PATIENT MAY EXPRESS
When the patient talks it is not the
content is important to note, but the
feeling behind the conversation which has
to be recognized and reflected

38. TALKING WITH A PURPOSE

39. TALKING WITH A PURPOSE
The nurse’s conversation with a patient
must resolves around his needs, wants
and interests

40. LISTENING

41. LISTENING
 The nurse should take time and energy to
listen to what the patient is saying
 She must be a sympathetic listener and show
genuine interest

42. PERMITTING PATIENT TO EXPRESS
STRONGLY HELD FEELINGS

43. PERMITTING PATIENT TO EXPRESS STRONGLY
HELD FEELINGS
 Strong emotions bottled up are potentially explosive
and dangerous
 It is better to permit the patient to express his strong
feelings without disapproval or punishment

44. USE SELF UNDERSTANDING AS A
THERAPEUTIC TOOL

45. 02. USE SELF UNDERSTANDING AS A
THERAPEUTIC TOOL
 A psychiatric nurses should have a realistic self
concept and should be able to recognize one’s own
feelings
 Her ability to aware and to accept her own strengths
and limitation should help her to see the strength
and limitations in other people

46. CONSISTENCY IS USED TO CONTRIBUTE
TO PATIENT’S SECURITY

47. 03. CONSISTENCY IS USED TO
CONTRIBUTE TO PATIENT’S SECURITY
 There should be a consistency in the attitude
of staff, ward routine and in defining the
limitation placed on the patient

48. REASSURANCE SHOULD BE GIVEN IN A
SUBTLE AND ACCEPTABLE MANNER

49. 04. REASSURANCE SHOULD BE GIVEN IN
A SUBTLE AND ACCEPTABLE MANNER
To give reassurance the nurse needs to
understand and analyze the situation as
to how it appears to the patients

50. PATIENT BEHAVIOUR IS CHANGED
THROUGH EMOTIONAL EXPERIENCE
AND NOT BY RATIONAL
INTERPRETATION

51. 05. PATIENT BEHAVIOUR IS CHANGED
THROUGH EMOTIONAL EXPERIENCE AND
NOT BY RATIONAL INTERPRETATION
 Major focus in psychiatry is on feelings and not on the
intellectual aspects
 Advising or rationalizing with patients is not effective
in changing behaviour

52. UNNECESSARY INCREASE IN PATIENT’S
ANXIETY SHOULD BE AVOIDED

53. 06. UNNECESSARY INCREASE IN PATIENT’S
ANXIETY SHOULD BE AVOIDED
 The following approaches may increase the
patient anxiety and should therefore avoided
 Showing nurse’s own anxiety
 Showing attention’s to the patient’s deficits
 Making the patient to face repeated failures
 Placing demands on patient which he
cannot meet
 Direct contradiction on psychotic ideas

54. OBJECTIVE OBSERVATION OF
PATIENT TO UNDERSTAND HIS
BEHAVIOUR

55. 07. OBJECTIVE OBSERVATION OF
PATIENT TO UNDERSTAND HIS
BEHAVIOUR
 It is the ability to evaluate exactly what the
patient want to say and mix up one’s own
feelings, opinion or Judgment

56. MAINTAIN REALISTIC NURSE
PATIENT RELATIONSHIP

57. 08. MAINTAIN REALISTIC NURSE
PATIENT RELATIONSHIP
 Professional relationship focuses upon the
personal and emotional needs of the patient
and not on nurse’s needs
 The nurse should have a realistic self-concept
and should be able to empathize and
understand the feelings of the patient and the
meaning of his behaviour

58. AVOIDE PHYSICAL AND VERBAL
FORCE AS MUCH AS POSSIBLE

59. 09. AVOIDE PHYSICAL AND VERBAL
FORCE AS MUCH AS POSSIBLE
All methods of punishment must be
avoided

60. NURSING CARE IS CENTERED ON THE
PATIENT AS A PERSON AND NOT ON THE
CONTROL OF SYMPTOMS

61. 10. NURSING CARE IS CENTERED ON THE
PATIENT AS A PERSON AND NOT ON THE
CONTROL OF SYMPTOMS
 Analysis and study of the symptoms is
necessary to reveal their meaning and their
significance to the patient
 Two patients showing the same symptoms
may be expressing two different needs

62. ALL EXPLANATION OF THE PROCEDURE
AND OTHER ROUTINES ARE GIVEN
ACCORDING TO THE PATIENTS LEVELS
OF UNDERSTANDING

63. 11. ALL EXPLANATION OF THE
PROCEDURE AND OTHER ROUTINES ARE
GIVEN ACCORDING TO THE PATIENTS
LEVELS OF UNDERSTANDING
 The extent of explanation that given to a
patient depends on his attention span, level
of anxiety and level of ability to decide
 It should never be withheld

64. MANY PROCEDURE ARE MODIFIED
BUT BASIC PRINCIPLES REMAIN
UNALTERED

65. 12. MANY PROCEDURE ARE MODIFIED
BUT BASIC PRINCIPLES REMAIN
UNALTERED
 In psychiatry many procedures are modified
but the underlying nursing principles remain
the same

66. HISTORY COLLECTION

67. HISTORY COLLECTION
 The technique of psychiatric assessment is important
not only for the psychiatrist but also for a medical
specialist or practitioner, since large percentage (more
than one third) of medical patients have psychiatric
disorders.

68. A. PSYCHIATRIC HISTORY
Identification data
 It is best to start the interview by obtaining the
identification data, i.e.
 Age
 Sex
 Marital status
 Education
 Occupation
 Income
 Residential address
 Official address
 Religion
 Socio economic background

69.  Informants: - Since some times the history provided by a
psychiatric patient may be incomplete due to factors like
absent insight or uncooperativeness, it is important to
take the history from the patient’s relatives or friends or
acting as informants. Their identification data should be
recorded along with their relationship to the patient,
whether they stay with the patient or not, and the
duration of stay together. Finally, a comment should be
added regarding reliability of the information in
percentage, provided by the informants.

70. PRESENTING CHIEF COMPLAINTS
 Presenting complaints and /or reasons for consultation
should be recorded. Both the patient’s and the
informant’s version should be recorded separately. Use
the patient’s own words while recording patient’s
version and note the duration of each presenting
complaint. Finally students have to record the psychotic
and associative symptoms separately with the duration
in a chronological order.

71. EXAMPLE:
Psychotic symptoms:
Auditory Hallucinations since 15 days
Delusions since 10 days
Aggressiveness since 5 days
Associative symptoms:
Decreased appetite since 10 days
Decreased sleep since 10 days

72. Additional points to be recorded by the students are:
 Onset of present illness
 Duration of present illness
 Course
 Precipitating factors including life stressors if any
 Aggravating and relieving factors, if any.

73. History of present illness
 When the patient was well the last time should be noted.
 The time of onset should be established.
 The symptoms of the illness from the earliest time at which a
change was noticed until the present time should be
narrated chronologically, in a coherent manner.
 The presenting chief complaints should be expanded.
 In particular, any disturbances in body functions like sleep,
appetite and sexual functioning should be inquired.

74. Life chart
 Graphical representation of the previous episodes with
year and duration, precipitating factors, treatment
duration and place, symptoms presented in each
episodes, drug compliance in between the episodes and
complete asymptomatic periods etc.
Past psychiatric history
 Explanation of the previous episodes from the first
episode till the episode prior to the present episode.
 Other history regarding alcohol or drug abuse or
dependence.

76. Past medical and surgical history
 History of any serious medical, neurological or surgical
illness, surgical procedure, accident and hospitalization
is obtained.
 Past history of head injury, convulsions,
unconsciousness, diabetes mellitus, hypertension,
coronary artery disease etc.
Treatment history
 Details of the treatment given in the present episode
and the previous episodes should be asked along with
the response to treatment.

77. Family history
 Family structure: - Drawing of a family tree (pedigree
chart) helps in recording all the relevant information in
very little space and is easily readable. It should be
noted whether the family is nuclear or extended nuclear
family. If consanguineous relationship is present it
should be recorded. Age and cause of death should be
asked. Three generations including patient should be
included in the genogram.

78. Family history: - of similar or other psychiatric illnesses,
major medical illnesses, alcohol or drug dependence and
suicide or suicide attempts should be recorded.
Current social situation: - home circumstances, per capita
income, socio economic status, leader of the family and
current attitude of the family members towards the patient’s
illness should be noted. The communication patterns in the
family, range of affectivity, cultural and religious values and
social support system should be inquired about, when
relevant.

79. Personal history
 Perinatal history: - Any febrile illness, medications, drugs
and/or alcohol use, trauma to abdomen and any physical or
psychiatric illness during pregnancy (particularly in the first
three months of gestation) should be asked. Other relevant
questions are: whether a wanted or wanted child, date of
birth, whether normal or abnormal delivery, any
instrumentation, where born (hospital/home), any perinatal
complication (cyanosis, convulsions, jaundice), birth cry
(immediate or delayed), birth defects, any prematurety.

80. Childhood history
 Patient was brought up by mother or someone else
 Breast feeding
 Weaning
 Maternal deprivation
 Age and ease of toilet training
 Occurrence of neurotic traits such as Stuttering / stammering / tics /
enuresis / encopresis / night terrors / thumb sucking / nail biting /
head banging / body rocking / morbid fears or phobias /
somnambulism / temper tantrums.

81.  Educational history
 Age of beginning and finishing formal education,
academic achievements and relationships with peers
and teachers should be asked.
 Any school phobia, non-attendance, truancy, any
learning difficulties, and reasons for termination of
studies (if occurs prematurely) should be noted.

82. Play history
 What games were played at what age with whom and where.
 Relationships with peers, particularly the opposite sex should
be recorded.
 Leadership roles / aggressive behaviors should be recorded.
Menstrual and obstetric history
 Regularity and duration of menses, the length of each cycle,
any abnormalities, he last menstrual period, the number of
children born, termination of pregnancy if any should be asked.

83. Occupational history
 The age starting work
 Jobs held in chronological order
 Reasons for changes
 Job satisfactions
 Ambitions
 Relationships with authorities, peers and subordinates
 Present income and whether the job is appropriate to the
educational and family background should be asked.

84. Sexual and marital history
 Sexual information, how acquired and what kind,
 Masturbation
 Adolescent sexual activity
 Premarital and extramarital sexual relationships
 Sexual practices (normal/abnormal)
 Any gender identity disorder
 Duration of marriage
 Marriage arranged with or without consent of parents or by
self choice
 Number of marriages/ divorces/separations
 Role in marriage, interpersonal and sexual relations
 Contraceptive measures used
 Sexual satisfactions
 Mode and frequency of sexual intercourse
 Psychosexual dysfunctions if any

85. Premorbid personality (PMP)
 Interpersonal relationship:- Interpersonal relationship
with family members, friends, work-mates and superiors,
introverted / extroverted, ease of making and keeping the
social relations
 Use of leisure time:- hobbies; interests; intellectual
activities; energetic and sedentary
 Predominant mood: - optimistic / pessimistic; stable / prone
to anxiety; cheerful / despondent; reaction to stressful life
events.

86.  Attitude to self: - self – confidence level; self-criticism;
selfish/thoughtful of others/ self appraisal of abilities,
achievements and failures.
 Attitude to work and responsibility: - decision making;
acceptance of responsibility; flexibility; perseverance;
foresight.
 Religious beliefs and moral attitudes: - religious beliefs;
tolerance to other’s beliefs and standards; altruism.
 Fantasy life:- sexual and non sexual fantasies; daydreaming
– frequency and content; recurrent or favorite daydreams;
dreams
 Habits :- food habits; alcohol, tobacco, drug use; sleep habits.

87. B. PHYSICAL EXAMINATION
A detailed general physical examination and systemic
examination is a must in every patient. Physical disease
which is etiologically important, accidentally co-existent
or secondarily caused by the psychiatric condition, is
often present.