MENTAL HEALTH NURSING Unit – I.pptx Introduction

MENTAL HEALTH NURSING – I
PLACEMENT :V SEMESTER
UNIT - I
Presented by:
Mr. P. Vethadhas, M.Sc. (N), DCMHN,
Assistant Professor,

Learning Objectives
 Describe the historical development.
 Discuss the current trends in mental health nursing.
 Describe the prevalence and incidence of mental health problems and disorders.

Perspectives of Mental Health and Mental Health Nursing, evolution of mental health
services, treatments and nursing practices
Health
Health is a state of complete physical, mental and social well-being, and not merely the absence of disease.
Hence, mental health is an integral and essential component of health. It is the foundation for individual
well-being and the effective functioning in a community.
Mental health
Mental health is also related to promotion of mental well-being, prevention of mental disorders and
treatment, rehabilitation of people affected by mental disorders.
It is a state of balance between the individual and the surrounding world, a state of harmony between
oneself and others, a co-existence between the realities of the self and that of other people and the
environment.

Definitions
Karl Menninger (1947) defines mental health as, “An adjustment of human beings to
the world and to each other with a maximum of effectiveness and happiness.”
The American Psychiatric Association (APA 1980) defines mental health as,
“Simultaneous success at working, loving and creating with the capacity for mature and
flexible resolution of conflicts between instincts, conscience, important other people
and reality.”

The ability to accept self
The capacity to feel right towards
others The ability to fulfil life's tasks
Components of Mental Health

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

INDICATORS OFMENTALHEALTH
A positive attitude
towards self
Environmental mastery Integration
Autonomy
Perception of reality
Growth, development and
the ability for self
actualization
IOMH

Seven signs of mental health
1. Happiness
2. Control over behavior
3. Appraisal of reality
4. Effectiveness in work
5. Healthy self-concept
6. Satisfying relationships
7. Effective coping strategies

Characteristics of a Mentally Healthy Person
He has an ability to make adjustments.
He has a sense of personal worth, feels worthwhile 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.
He has a sense of responsibility.

He can give and accept love.
He lives in a world of reality rather than fantasy.
He shows emotional maturity in his behavior, and develops a capacity to tolerate
frustration and disappointments in his daily life.
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.

MENTALILLNESS
Mental illness is maladjustment in living. It produces a disharmony in the
person’s ability to meet human needs comfortably or effectively and function within
a culture. A mentally ill person loses his ability to respond according to the
expectations he has for himself and the demands that society has for him.
In general an individual may be considered to be mentally ill if:
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.

Definitions
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).

Changes in one's thinking, memory, perception, feeling and judgment resulting in
changes in talk and behavior which appear to be deviant from previous personality or
from the norms of community.
These changes in behavior cause distress and suffering to the individual or others or
both.
Changes and the consequent distress cause disturbance in day-to-day activities, work
and relationship with important others (social and vocational dysfunction).

Evolution Of Mental Health ServicesAnd Treatment
Historically, mental illness was viewed as a demonic possession, the influence
of ancestral spirits, the result of violating a taboo or neglecting a cultural ritual and
spiritual condemnation. As a result, the mentally ill were often starved, beaten, burnt,
amputated and tortured in order to make the body an unsuitable place for the demon.
Gradually, man began the quest for scientific knowledge and truth, which can be
traced as follows:

Pythagoras (580–510 BC) developed the concept that the brain is the seat of
intellectual activity.
Hippocrates (460–370 BC) described mental illness as hysteria, mania and
depression.
Plato (427–347 BC) identified the relationship between mind and body.
Asciepiades, who is referred to as the Father of Psychiatry, made use of simple
hygienic measures, diet, bath, massage in place of mechanical restraints.

The Greeks were the first to study mental illness scientifically and separate the
study of mind from religion. Aristotle, a Greek philosopher, emphasized on the
release of repressed emotions for the effective treatment of mental illness. He
suggested catharsis and music therapy for patients with melancholia.

During the middle ages, the mentally ill were not considered as outcasts, but as
people to be helped. One of the great figures during this time was St. Augustine, who
believed that although God acted directly in human affairs, people were responsible
for their own actions.

Renaissance in Europe (1300–1600 AD): This period represented the saddest
chapter in the history of psychiatry when it was believed that demons were the cause
of hallucinations, delusions and sexual activity, and the treatment was torture and
even death.

Some Important Milestones
1773 The first mental hospital in the US was built in Williamsburg, Virginia.
1793
Philippe Pinel removed the chains from mentally ill patients confined in Bicetre, a hospital outside Paris,
thus bringing about the first revolution in psychiatry.
1812
The first American textbook in psychiatry was written by Benjamin Rush, who is referred to as the Father
of American Psychiatry.
1908
Clifford Beers, an ex-patient of a mental hospital, wrote the book, ‘The Mind That Found Itself’ based on
his bitter experiences in the hospital. He founded the American Mental Health Association, which made a
major contribution towards the improvement of conditions in mental hospitals.
1912 Eugen Bleuler, a Swiss psychiatrist coined the term ‘schizophrenia’.
1912 The Indian Lunacy Act was passed.
1927 Insulin shock treatment was introduced for schizophrenia.

1936 Frontal lobotomy was advocated for the management of psychiatric disorders.
1938 Electroconvulsive therapy (ECT) was used for the treatment of psychoses.
1939
Development of psychoanalytical theory by Sigmund Freud led to new concepts in the treatment of mental
illness.
1946
The Bhore Committee presented the situation with regard to mental health services. Based on its
recommendations, five mental hospitals were set up at Amritsar (1947), Hyderabad (1953), Srinagar (1958),
Jamnagar (1960) and Delhi (1966). An All India Institute of Mental Health was also set up at Bengaluru
(currently known as National Institute of Mental Health and Neurosciences or NIMHANS).
1949 Lithium was first used for the treatment of mania.
1952
Chlorpromazine was introduced which brought about a revolution in psychopharmacology and changed the
whole picture of mental health care.

1963 The ‘Community Mental Health Centers’Act was passed.
1970s
Slow and steady reduction of beds in custodial institutions, growth in General Hospital Psychiatric Units and
out-patient services was seen.
1978
The Alma-Ata declaration of “Health for All by 2000 AD” posed a major challenge to Indian mental health
professionals. In order to achieve mental health for all (as a part of the achievement of Health for All by
2000 AD), in 1980 the Government of India called for experts in the field for assessing the mental health
needs of the people and recommended steps for providing mental health care.
1981
Community psychiatric centers were set up to experiment with primary mental health care approach at
Raipur Rani, Chandigarh and Sakalwara, Bengaluru.
1982
The focus shifted to community based care, which became the basis for the National Mental Health
Program.
1982
The Central Council of Health, India's highest health policy making body accepted the National Mental

1987
The Indian Mental Health Act was passed. The Government of India passed two acts, Mental Health Act
1987, and Person with Disability Act 1995 to protect the rights of persons with mental illness,
mainstreaming of these people into the society. As per the Mental Health Act, 1987, there is a provision for
constitution of Central Mental Health Authority (CMHA) at central level and State Mental Health
Authority (SMHA) at state level. These statutory bodies are delegated with the task of development,
regulation and coordination of mental health services in the state.
1990
The Government of India formed an Action Group at Delhi to pool the opinions of mental health experts
about the National Mental Health Program (NMHP). National Institute of Mental Health and
Neurosciences (NIMHANS), Bengaluru, took the leadership in orienting health care professionals about
the mental health programs of 5our country. A number of innovative approaches for the treatment and
rehabilitation of mental illness initiated, and the most important ones are:

1990 Integration of mental health care with general health care.
School mental health programs.
Promotion of child mental health through the involvement of anganwadis [Integrated Child Development
Services (ICDS) program].
Crisis intervention for suicide prevention.
Halfway homes for mentally ill individuals for social skills training, vocational training.
Education and involvement of the general public through the activities of non-governmental organizations.
Media materials for public education.
Training for non-professionals to work with mentally ill individuals.
1997
National Human Rights Commission prepared a Plan of Action for improving the conditions in mental
hospitals in the country and enhancing awareness of the rights of those with mental disability.

2001 Current situation analysis (CSA) was done to evolve a comprehensive plan of action to energize the NMHP.
Advanced Center for Ayurveda in Mental Health and Neurosciences at the National Institute of Mental
Health and Neurosciences (NIMHANS), initiated research studies in areas like epilepsy, mental
retardation, schizophrenia, etc.
The advanced center for yoga therapy and research at NIMHANS started intervening in psychiatric
disorders through yogic approach: a few nurses are involved in teaching basic yogic exercises to the
mentally ill patients.
The National Human Rights Commission of India is mandated under section 12 of the protection of
Human Rights Act 1993 to visit Government run mental hospitals to study the living conditions of inmates
and make recommendations thereon.

In 1997 project, quality assurance in Mental Health Institutions was initiated to analyze the conditions
generally prevailing in 37 Government run mental hospitals and departments. The findings of this study confirm that
mental hospitals in India are still being managed and administered on a custodial mode of care. Characters sized by
prison-like structure with high walls, watch towers, fenced wards and locked cells. Mental hospitals are like
detention centers where persons with mental illness are kept caged in order to protect society from the danger their
existence poses.

2001
On Aug 6th, 27 more mentally ill people died as they were tied to their beds when fire engulfed
the thatched roof of the Moideen Badusha Mental Home at Erwadi, Tamil Nadu State. Following this
tragedy, the National Human Rights Commission of India (NHRC) advised all the chief ministers to submit
a certificate stating no person with mental illness are kept chained in either Government or private
institutions. The incident of Erwadi has opened up the eyes of the Government which in turn took lots of
affirmative actions to improve mental health sector in the country, like district wise survey of all registered
and unregistered bodies purporting to offer mental health care and license to be granted on standards are
maintained. Government has implemented the District Mental Health Program which incorporates the
WHO community mental health care model. It focuses on treatment availability at primary level,
community awareness and renovation and construction of hospital 6for mental health in the State. It also
covers training components for human resource development in the field of mental health.

2002
National Survey of Mental Health Resources carried out by the Directorate General of Health Services,
Ministry of Health and Family Welfare.
2007
Under the Eleventh five year plan, Centers of Excellence in the field of mental health were established to
upgrade and strengthen identified existing mental health hospitals for addressing acute manpower gap and
provision of state of the art mental health care facilities in the long run. During this period, 11 mental
health institutes were funded for developing as Centers of Excellence in Mental Health.
2008
WHO Mental Health Gap Action Program was launched which aims at scaling up services for mental,
neurological and substance use disorders for countries especially with low and middle income.
2013
World Health Organization launched the Mental Health Action Plan 2013-2020 on 7 October, 2013. The
action plan identifies the important role of mental health in achieving health for all people. It stresses
prevention of mental illness and aims to achieve equity through universal health coverage.

2013
Under the Twelfth five year plan the Government of India integrated different components of National
Mental Health Program with the components of National Rural Health Mission, namely school health,
reproductive child health and adolescent friendly clinics to reach out to the community in a more effective
manner.
2013
The Mental Health Care Bill was introduced in the Rajya Sabha on 19 August, 2013. The Bill abolishes the
Mental health Act, 1987.
2013
Under central sector, the Ministry of Social Justice and Empowerment launched Deendayal Disabled
Rehabilitation Scheme (DDRS) and provided financial assistance to Non-Governmental Organizations
(NGOs), for providing various services to persons with disabilities and mental retardation including special
schools, half way homes, etc. The National Trust for the Welfare of Persons with autism, cerebral palsy,
mental retardation and multiple disabilities implements various other schemes for the rehabilitation of such
individuals.

2014
In April 2011, the Government of India Constituted a policy group to recommend a mental health policy
for the country. After due deliberations and intense discussions, the group has submitted recommended
policy. The suggested Mental Health Policy has been duly considered by the Minister of Health and
Family Welfare, Government of India. This National Mental Health Policy 2014 is in accordance with the
intent of World Health Assembly resolution. This policy incorporates an integrated, participatory rights
and evidence based approach.
World Mental Health Day is observed on 10th October every year, with the overall objective of raising
awareness of mental health issues around the world and mobilizing efforts in support of mental health.

Indian PsychiatricAssociation
Indian Psychiatric Association is a professional body of psychiatry in India; it is the largest
association of Indian psychiatrists. Berkeley Hill of Ranchi founded the Indian Association for
Mental Hygiene in 1929. In 1935, the Indian division of the Royal Medico Psychological Association
was formed with the efforts of Banarasi Das. In 1946, the Indian Psychiatric Society was
inaugurated.
The main aims of this association are promotion of mental health and mental health education,
promote and advance the subject of psychiatry, formulation and advise on the standards of education
and training in psychiatry, promote research in the field of psychiatry, deal with matters relating to
mental health concerning the country and promote ethics in practice of psychiatry in India. Indian
Psychiatric Society is publishing its own journal, Indian Journal of Psychiatry.

Development of Modern Psychiatric Nursing
Psychiatric nursing in general arose from the need for hospitals to provide
socially acceptable levels of care for patients.

1840s
Florence nightingale made an attempt to meet the needs of psychiatric patients with proper hygiene, better
food, light and ventilation and use of drugs to chemically restrain violent and aggressive patients.
1872
First training school for nurses, based on the Nightingale system was established by the New England
Hospital for Women and Children, USA. Linda Richards, the first nurse to graduate from the one-year
course, developed 12 training schools in the USA.
1882
First school to prepare nurses to care for the mentally ill was opened at McLean Hospital in Waverly. A
two-year program was started but few psychological skills were addressed and much importance was given
to custodial care such as personal hygiene, medication, nutrition, etc.

1913
Johns Hopkins became the first school of nursing to include a fully developed course for psychiatric nursing
in the curriculum.
The important factor in the development of psychiatric nursing was the emergence of various somatic
therapies like, insulin shock therapy (1927), psychosurgery (1936), and ECT (1938). These therapies
required the medical surgical skills of the nurses and increased the demand for improved psychological
treatment for patients who did not respond well. As the nurses collaborated with the doctors in carrying out
these therapies, they struggled to define their role as psychiatric nurses.
Major growth in psychiatric nursing occurred after World War II because of the emergence of services
related to psychiatric problems. The content of psychiatric nursing became an integral part of general
nursing curriculum.
1921 Short training courses of 3 to 6 months were conducted in Ranchi.

1943
Psychiatric nursing course was started for male nurses.
The Chennai Government organized a three-month psychiatric nursing course for male nursing students.
1946
Health Survey Committee's report recommended preparation of nursing personnel in psychiatric nursing
also. Commencement of training in existing institutions like mental hospitals of Bengaluru and Ranchi.
1948 - 50 Four nurses were sent to UK by the Government of India, for training in ‘mental nurses’ diploma.
1952
Dr Hildegard Peplau defined the therapeutic roles that nurses might play in the mental health setting. She
described the skills and roles of the psychiatric nurse in her book ‘Interpersonal Relations in Nursing’. It
was the first systematic theoretical framework developed for psychiatric nursing.
1953 Maxwell Jones introduced therapeutic community.
1953 - 54 The urgent need for nurses trained in psychiatric care was felt by the Government of India.

1954
Nur Manzil Mental Health Centre, Lucknow, started psychiatric nursing orientation courses of 4–6 weeks
duration.
1956
One year post-certificate course in psychiatric nursing was started at NIMHANS, Bengaluru.
1958
All the wards at the Agra Mental Hospital were ordered to be kept open and all ward locks were removed
from the charge of the ward attendant. Nurses took an active role in patient care and handled their newer
responsibilities with great consciousness and devotion. It was observed that nursing staff have better
opportunities to judge the behavior of the patient and there are more interpersonal contacts between patients
and staff.
1960
The focus began to shift to primary prevention and implementing care and consultation in the community.
The name ‘psychiatric nursing’ was changed to ‘psychiatric and mental health nursing,’ and a second change
was made in the 1970s when it was known as ‘pychosocial nursing’ .

1963
Journal of Psychiatric Nursing and Mental Health Services was published.
Mysore Government started a nine-month course in psychiatric nursing for male nursing students, in lieu
of midwifery.
1964
Mudaliar committee felt the need for preparing a large number of psychiatric nurses and recommended
inclusion of psychiatry in the nursing curriculum (as per International Council of Nursing).
1965
The Indian Nursing Council included psychiatric nursing as a compulsory course in the BSc Nursing
program.
1967
The Trained Nurses Association of India (TNAI), formed a separate committee for psychiatric nursing to
improve the perception of psychiatric nursing as well as to set guidelines for nursing teachers to conduct
theory classes and clinical training in psychiatric nursing.
1973
Standards of Psychiatric and Mental Health Nursing practice were enunciated to provide a means of
improving the quality of care.

1975
Psychiatric Nursing was offered as an elective subject in MSc Nursing at the Rajkumari Amrit Kaur
College of Nursing, New Delhi. Now various colleges offer psychiatric nursing as an elective subject in
MSc Nursing. Some of them include SNDT College of Nursing, Mumbai; NIMHANS, Bengaluru;
College of Nursing, Ludhiana; College of Nursing, CMC, Vellore; Father Müller's College of Nursing,
Mangalore; College of Nursing, Thiruvananthapuram; MAHE, Manipal; MV Shetty Institute of Health
Sciences, Mangalore, Sri Devaraj Urs College of Nursing, Kolar, etc.
1980
Scientific advances in the area of psychobiology, brain imaging techniques, knowledge about
neurotransmitters and neuronal receptors, molecular genetics related to psychiatry, etc. emerged. These
contributed to the shift from psychodynamic models to more balanced psychobiological models of
psychiatric care.
1986
The Indian Nursing Council (INC) made psychiatric nursing a component of General Nursing and
Midwifery course. American Psychiatric Nurses Association was established.

1990
During these years integration of neurosciences into holistic biopsychosocial practice of psychiatric
nursing occurred. Advances in understanding the inter-relationships of brain, behavior, emotions and
cognition offered many new opportunities for psychiatric nurses.
International Council of Nurses declared 1990 as the year of mental health nursing.
1991 Indian Society of Psychiatric Nurses formed at NIMHANS, Bengaluru.
1994 The above mentioned changes led to the revision of Standards of Psychiatric and Mental Health Nursing.
1995 Journal of American Psychiatric Nurses Association was established.
2000
The scope and standards of psychiatric mental health clinical nursing was published by American Nurses
Association.
2003 American Nurses Association began certifying psychiatric mental health practitioners.
2010 ISPN published journal titled Indian Journal of Psychiatric Nurses.

Over the years, the professional psychiatric nursing role has grown in
complexity. In contemporary psychiatric nursing practice, the role includes the
parameters of clinical competence, patient advocacy, fiscal responsibility,
professional collaboration, social accountability, legal and ethical obligations.

Indian Society of Psychiatric Nurses (ISPN)
Indian Society of Psychiatric Nurses (ISPN) was started in the 1991 at NIMHANS,
Bangalore, under the guidance of Dr. K. Reddemma, with the motive of enhancing the
advanced knowledge and skills in the field of psychiatric nursing,
to provide a platform for discussion and deliberation on evidence based practice,
to create awareness and translate the research findings to practice.
ISPN is publishing its own journal called the Indian Journal of Psychiatric Nurses.

Indian Society of Psychiatric Nurses (ISPN)
First national conference of ISPN was held at NIMHANS on the theme ‘Child
psychiatric nursing’ in 2002.
The first international conference of ISPN was held in 2005 on the theme ‘Adolescent
mental health issues’ at NIMHANS, Bangalore.
In 2005, ISPN became a member of Indian Confederation of Health Accreditation.

Current Issues, Future Prospects and Challenges – India
There is a lack of clearly enunciated definitions of the roles of professional psychiatric
nurses.
Greater emphasis should be given to encourage a master's degree in psychiatric nursing,
so that nurses become pioneers in teaching non-professionals and play active roles in
specialized treatment modalities like behavior therapy, family therapy and individual and
group counseling.
To offer Diploma in psychiatric nursing courses in more colleges so that trained
psychiatric nurses will be available for psychiatric units in general and district hospitals.

To maintain the minimum standards of psychiatric nursing care in mental hospitals, the
recommended psychiatric nurse:patient ratio as per the INC is 1:5 in non-teaching and 1:3
in teaching hospitals. High priority needs to be given to increase psychiatric nursing
manpower at the diploma, masters and doctorate levels.
There is a crucial need to create proper jobs at par with other professionals, particularly
in the community. High priority must be given to fill vacant positions in educational
institutions. This will facilitate adequate manpower development in psychiatric nursing.
An integrated and co-ordinated role, both in service and training is essential in
maintaining the quality and standard of psychiatric nursing.

Unfortunately, most psychiatric centers do not have qualified psychiatric nurses, even
today. High priority should be given to place qualified psychiatric nurses in counseling
centers, community mental health and school mental health programs.
The National Mental Health Program for India (1982) recommended the formation of a
District Mental Health Team (DMHT) in order to decentralize mental health care at the
district level, with two qualified psychiatric nurses and one psychiatrist.

The role of the psychiatric nurse in the district mental health program is to provide care
to the inpatients. The qualified psychiatric nurses will actively participate in decentralized
training to professionals and non-professionals working at taluk and Primary Health
Centers (PHCs). They will also supervise the task of multipurpose workers in mental
health care delivery. They will assist psychiatrist in research activities in monitoring
mental health care at district and PHC levels. Nurse's active participation in mental health
education to the public will go a long way in creating public awareness in the care of
individuals with various mental disorders.

In the present scenario most of the nursing institutions and hospitals are working in
independent environment and rendering services not intandem with each other. While
hospital staff nurses are working only in hospitals, the teaching faculty is teaching only in
schools and colleges. As a result, the nurses who are working in the hospital are unable to
update their know-how as regards the new trends and practices, while teaching staff fail to
update their practical skills. Such a system breeds a wider gap between theory and practice
which is not healthy for the system as a whole. As the gap between education and practice
has widened, there are now significant differences between what is taught in the classroom
and what is practiced in the service setting.

Among the various mental health settings, National Institute of Mental Health and
Neurosciences (NIMHANS), Bangalore, and Dharwad Institute of Mental Health and
Neurosciences (DIMHANS), Dharwad, Karnataka are practicing the dual role (education
and practice) system, the HOD of Nursing department is given the responsibility of
managing both the service and the education components. This integration of the education
with service will raise the quality of patient care and also improve the quality of learning
experiences for nursing students under the close supervision of teachers who are also
practitioners.

In dual responsibility, the challenge is to combine theoretical knowledge with
significant technical training so as to assure a competent performance by a
professional nurse in the hospital setting. Clearly, a partnership between nurse
educators and hospital nursing personnel is essential to meet this challenge.
Dovetailing both the clinical and teaching services at the ground level will not only
augur well for the system but also bring about ground breaking changes in the times
to come.

PrevalenceAnd Incidence Of Mental Health ProblemsAnd
Disorders
The WHO declared the World Health Day theme for the year 2001 as “Mental
Health: Stop Exclusion—Dare to Care”, in order to focus global public health attention
on this relatively neglected problem. Information regarding the prevalence of mental
disorders in India needs to be generated to establish a database for mental health
planners to assess the status of mental health in the country. The Bhore Committee
concluded that mental patients requiring institutional treatment would be 2 per 1000 in
the country.

During the last two decades, many epidemiological studies have been
conducted in India, which shows that the prevalence of major psychiatric disorder is
about the same all over the world. The prevalence reported from these studies range
from the population of 18 to 207 per 1000 with the median 65.4 per 1000. Most of
these patients live in rural areas remote from any modern mental health facilities. A
large number of adult patients coming to the general OPD are diagnosed mentally ill.
However, these patients are usually missed because either medical officer or general
practitioner at the primary health care unit does not ask detailed mental health history.
PrevalenceAnd Incidence Of Mental Health ProblemsAnd
Disorders

Analysis of 15 epidemiological studies shows prevalence rates as shown in the below (Ganguli
HC, 2000).
Prevalence of mental disorders
All mental disorders—73/1000 population (with rural and urban rates of 70.5 and 73/1000,
respectively)
Schizophrenia—2.5/1000 population
Affective disorder (depression)—34/1000 population
Anxiety neurosis—16.5/1000 population
Hysteria—3.3/1000 population
Mental retardation—5.3/1000 population

Analysis of 10 epidemiological studies shows prevalence rates as follows:
National prevalence rates for all mental disorders was 65.4/1000 population; with rural
and urban rates of 64.4 and 66.4/1000, respectively. Thus, the urban rate is marginally higher
than the rural rate. The most widely prevalent disorders were observed to be depression and
anxiety. The urban morbidity rate was observed to be 2 per 1000, higher than the rural morbidity
rate. (Madhav MS 2001).

National prevalence rates forspecific disorders
 Schizophrenia—2.3/1000 population
 Affective disorder—31.2/1000 population
 Anxiety neurosis—18.5/1000 population
 Hysteria—4.1/1000 population
 Mental retardation—4.2/1000 population

 According to community based epidemiological studies under the WHO Mental Health GAP
Action Program, in India, the estimated life-time prevalence of mental disorders range from
12.2% to 48.6%.
 The Ministry of Health and Family Welfare suggests that 6–7% of India's population suffers
from mental disorders with about 1% suffering from severe mental disorders while three in 10,
000 people experience an episode of acute psychosis every year, about 25% of mentally ill
people are homeless.
 Mental Illnesses like schizophrenia and bi-polar disorder are prevalent in about 200 cases per
10,000 people. The burden of these disorders is likely to increase to 15% by 2020 (Ghanashyan
B, Nagarathinam S. The Lancet 2010, 376:9753).

 The common psychiatric illnesses encountered in a clinic of a General Hospital are Neurotic
disorders (for example, anxiety neurosis, obsessive-compulsive disorder and reactive
depression), psychosomatic disorders (for example, hypertension, diabetes mellitus, peptic ulcer,
tension headaches, etc.), functional psychosis (for example, schizophrenia, mania and depression
and organic psychosis).
 In a child guidance clinic, the common mental illnesses include mental retardation, conduct
disorder, hyperkinetic syndrome, enuresis, etc.
 In a geriatric clinic, the common disorders are depression, dementia, delusional disorders, etc.
 In a psychosexual clinic the common problems include Dhat syndrome, premature ejaculation,
erectile impotence and so on.

 The prevalence of psychiatric disorders is 58.2 per thousand which means that there are about
5.7 crore people suffering from some sort of psychiatric disturbance. Out of this 4 lakh people
have organic psychosis, 26 lakh people have schizophrenia and 1.2 crore people have affective
psychosis; thus, there are about 1.5 crore people suffering from severe 12mental disorders,
besides 12,000 patients in Government mental hospitals in the country (Reddy et al, 1996).
 Various community based surveys show the prevalence of mental disorders in India as 6- 7%
for common mental disorders and 1-2% for severe mental disorders. In India, the rate of
psychiatric disorders in children aged between 4 to 16 years is about 12%. Treatment gap for
severe mental disorders is approximately 50% and in case of Common Mental Disorders it is
over 90% (Ministry of Health and Family Welfare, Annual Report 2012-13, p.161).

Conclusion
Mental health disorders are a significant global issue that affects millions of people.
Understanding the prevalence and impact of these disorders is crucial for developing effective
prevention and treatment strategies. With appropriate treatment and support, individuals with
mental illness can lead fulfilling and productive lives.

MENTAL HEALTH NURSING Unit – I.pptx Introduction

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MENTAL HEALTH NURSING Unit – I.pptx Introduction