Definition – mental health,componenetes ,indicaters,charecterstics of Mentally healthy person and illness . Characteristics of a mentally health person Evolution of mental health services and treatment DEVELOPMENT OF MODERN PSYCHIATRIC NURSING PREVALENCE & INCIDENCE OF MENTAL HEALTH DISORDERS CURRENT ISSUES AND TRENDS IN NURSING NATIONAL MENTAL HEALTH PROGRAMME MENTAL HEALTH TEAM OR MULTIDISCIPLINARY TEAM

1. Unit : 01
Objective
At the end of the Unit students need to understand about following point
• Definition – mental health,componenetes ,indicaters,charecterstics of
Mentally healthy person and illness .
• Characteristics of a mentally health person
• Evolution of mental health services and treatment
• DEVELOPMENT OF MODERN PSYCHIATRIC NURSING
• PREVALENCE & INCIDENCE OF MENTAL HEALTH DISORDERS
• CURRENT ISSUES AND TRENDS IN NURSING
• NATIONAL MENTAL HEALTH PROGRAMME
• MENTAL HEALTH TEAM OR MULTIDISCIPLINARY TEAM
• Educational Programs For The Psychiatric Nurse
• Scope of mental health nursing
• FUNCTIONS OF PSYCHIATRIC NURSE IN VARIOUS SETTINGS
• FACTORS AFFECTING THE LEVEL OF NURSING PRACTICE
• CONCEPTS OF NORMAL AND ABNORMAL BEHAVIOR
Mr. JAYESH PATIDAR 1

2. Perspective of mental health& Mental
health Nursing
• Mental Health :- An adjustment of human
being to the world & to each other with a
maximum of effectiveness & happiness- Karl
Menninger (1947)
According APA – Simultaneous success at
working ,loving & creating with the capacity
for mature & flexible resolution of conflict
between instincts,conscience,important
other people & Reality
Jayesh patidar
2

3. Components of mental health
• The ability to accept self
• The capacity to feel right towards others
• The ability to fulfill life's task
Criteria for mental health-
-Adequate contact with reality
-Control of thoughts and Imagination
- Efficiency in work and play
- Social acceptance
- Health emotional life
3

4. Indicators of mental health
• A positive attitude towards self
• Growth ,devt.& the ability for self
actualization
• Integration
• Autonomy
• Perception of reality
• Environmental mastery
4

5. Characteristics of a mentally health
person
• He has an ability to make an adjustments
• Sense of personal worth ,feels worthwhile and
important
• Solve his problems largely by his own efforts
& make his own decision
• Sense of personal security &Feel secure in
group ,Show understanding of other people
problems and motives
• Sense of responsibility
5

6. • Can give and accept love
• Lives in world of reality rather than fantasy
• Shows emotional maturity in his behavior &
develop capacity to tolerate frustration &
Disappointment in his daily life.
• Developed philosophy of life that gives
meaning and purpose to his daily activities.
• Varity of interest &Generally lives a well
balanced life of work ,rest and recreation.
6

7. Mental illness
• Maladjustment in living
• Mental & behavioral disorder are understood
as clinically significant conditions
characterized by alteration in thinking ,mood
or behavior associated with personal distress
and or Impaired functioning – WHO,2001
7

8. Characteristics of mental illness
• Changes in ones thinking, memory ,perception,
feeling & Judgment resulting in changes in talk
and behavior which appeared 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 causes
disturbances in day to day activities ,work &
relationship (Social & Vocational dysfunction )
8

9. Evolution of mental health services
and treatment
• Pythagoras (580-510 BC) – Brain is the seat of
intellectual activity
• Hippocrates (460-370 BC)-Mental illness as
hysteria, mania & Depression
• Plato (420-347 BC)- Identify relation between
mind and body
• Asciepiades-father of psychiatry –Made use of
simple hygiene ,measures,diet,,bath,massage
in place of Mechanical restraints
9

10. • Greek 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 emotion for effective
treatment.He suggested catharsis and music therapy
for patients with melancholia .
• Middle age – mentally ill were not considered as
outcasts. but as people to be helped .one of the great
figure during this time was St. Augustine ,believed that
although God acted directly in human affairs, people
were responsible for their own action.
10

11. • Renaissance in Europe(1300-1600AD )Saddest
chapter – Demons were the cause of
hallucinations, delusions and sexual activity &
Treatment was torture & even death.
11

12. Some Important Milestone
• 1773- first mental hospital in the US
(Williamsburg,virginia)
• 1793-Phillip Pinel removed chain
• 1812 – First American textbook in psychiatry
written by Benjamin Rush ,(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 experiennce(Founded
American mental health association)
12

13. • 1912- Eugene Bleuler- Coined the term
Schizophrenia
• 1912 Indian Lunacy act was passed
• 1927- Insulin shock treatment was used for
schizophrenia
• 1938- ECT Was used for psychoses.
• 1946 –Bhore committee Recommendations
five mental hospital were at Amritsar
(1947),Hyderabad (1953),Srinagar
(1958),Jamnagar (1960)&Delhi (1966).All india
institue of mental health was set up at
Bengaluru.(NIMHANS)
13

14. • 1949-Lithium was used mania
• 1952- Chlorpromazine (Revolution of
psychopharmacology)
• 1963-Community mental health centre act was
passed
• 1978-Alma-ata declaration of Health for all BY
2000 A.D. posed a major challenge to Indian
mental health professionals.
• 1981-Community psychiatric centre was set up to
experiment with primary mental health approach
at Chandigarh & Sakalwara,Bengaluru.
14

15. • 1982-The centre council of Health ,India
highest health policy making body accepted
the National Mental health policy & brought
out the National Mental health program .
• 1987- Indian mental health act was
passed.Govt India passed two acts, Mental
health act 1987 & Person with disability act
1995 to protect the rights of persons with
mental illness.
15

16. • 1990- Govt india formed an action group at
delhi to pool the opinions of mental health
experts about the national mental health
program.NIMHANS Took leadership in
orienting health programs of our country
(Approaches)
• Integration of mental heath care with general
health care
• School mental programs
• Promotion of child mental health through
Involvement of anganwadi(ICDS program)
16

17. • Crisis Intervention for suicide prevention
• Halfway home for mentally ill individuals for
social skill training ,vocational training
• Education and involment of general public
• Media material for public
• Training for non professionals
1997 – National human rights commission
prepared a plan of action for improving
condition in mental hospital in the country &
enhancing awareness of rights.
17

18. • 2001-Current situation analysis (CSA) was done to
evolve a comprehensive plan of action to
energize the NMHP.
• Advanced centre for Ayurveda in mental health
and neuroscience initiated research area like
epilepsy ,M.R.,Schizophrenia
• Advanced centre for yoga therapy and research at
NIMHANS Started.
• National human rights commission of India is
mandated under section 12 of the protection of
human Rights act 1993 to visit govt run mental
hospital to study living conditions of inmates &
make recommendations thereon.
18

19. • In 1997 project quality assurence in M.H.I to
analyze condition generally prevalling 37 Govt
run Mental hospital & Departments
Finding – M.H .still being managed &
administered custodial care .characters sized
by prison -like stucture with high walls,watch
towers,fenced wards & locked cells.MH like
detention centre where person with mental
illness kept caged in order to protect sociey
from danger their existence poses.
19

20. • 2001 –On Augst 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.Folloiwng tregedy ,national
human right commision of india advised all chief
minister to submitt a certificate stating no person with
mental illness are kept chained ineither govt or private
.
• After this district wise survey of all registered &
unregistered body purporting to offer mental health
care & license to be granted on standards are
maintained .
• Govt implemented Distric mental health progrm which
Incorporate the WHO community mental health care
model.It focus on treatment availability at primary
level,awareness ,,renovation,construction of Hospital.
20

21. • 2002-National survey of mental health
Resources carried out by the Direcctorate
General of health services ,Ministry of Health
& Family well fare .
• 2007- Under 11 five year plan ,centre of
excellence in the field of mental health were
established to upgrade & strengthen identified
existing mental health hospitals for
addressing acute manpower gap & provision
of state of the art mental health care facilities
in the long run. During this period 11 mental
health institute were funded for developing as
centre of excellence in mental health.
21

22. • 2008- WHO Mental health Gap action
program was launched which aims at scaling
up services for mental ,neurological &
substance use disorders for countries with low
&middle income.
• 2013- WHO Launched Mental health action
plan 2013-2020.Which identified imp.role of
mental health in achieving health for all
people.It stresses prevention of mental illness
& aims to achieve equality through universal
health coverage.
22

23. • 2013- Under 12th five plan govt of India integrated different
componenent of national mental program with national rural health
mission,namely school health,reproductive child health,&adolesent
friendly clinics to reach out to the community in effective manner.
• 2013- Mental health care Bill was introduced in Rajya sabha 0n 19
augst 2013.The bill abolished mental heath act 1987.
• 2013- under central sector ,ministry of social justice &
Empowerment launched Deendayal Disabled Rehabilitation Scheme
& provided financial assistance to NGOs.for providing with
disabilities & mental retardation including special school,half way
homes,etc.National trust for wellfare of person with autism
,cerebral palsy,MR,&multiple disabilities various scheme for
Rehabilitation such individual.
• 2014- April 2011,govt of india constituted a policy group to
recommended a mental health policy for the country.After due
deliberations and Intense discussion group has recommended
policy.Suggested policy has been duly considered by MOHAFW&
Govt of India.National mental health policy is in accodance with
intent of world health assembly resolution.This policy incorporates
an integrated ,participatery rights & evidence based approach.
23

24. • World mental health day observed on 10 th oct
every year.
• Indian Psychiatric association- Profeshional body
.Berkeley Hill of Ranchi Founded the Indian
Association for mental hugiene in 1929.In 1935 indian
division of the royal medicio psychological association
was formed with effort of Banarasi Das.In1946 ,indian
Psychiatric society was inaugereated.
• Aims – promotion of metnal health & education,promote
and advance subject pf psychiatry ,formulation&advise
on the standards of education & traing in
psychiatry,research.Indian journal of Psychiatry
publishing.
24

25. • Indain Society of Psychiatric Nurses – started 1991 at
NIMHANS,Bengaluru under guidance of Dr.K Reddemma.ISPN
Publishing on journal Indian journal of Psychiatric nurses.1st
conference child psychiatric nursing in2002.
• Current issues,future perspects & challenges-
India – Lack of clearly enunciated definition of the role of
psychiatric nurses.Great emphasis should be given encourage
M.sc.Nursing in Psychiatric nursing .
• Need to offer more colleges in diploma in Psychiatric Nursing.
• Psy nurse :pt ratio as per INC is 1:5 in Non teaching and 1:3 in
Teaching hospital.
• NMHP 1982 Recommended formation of Distric mental health
team in order to decentralize mental health care at Distric
level with 2 qualified psychiatric nurse and one psychiatrist.
25

26. • Analysis of 10 epidemiological studies shows prevalence rates
as follow-
• National prevalence rates for all mental disorder was
665.4/1000 population: with rural and urban rates of 64.4 and
66.4/1000
• Most widely prevalence disorder were observed to be
depression and anxity.Urban morbidity rate was observed to
be 2 per 1000,higher than rural morbidity rate.(Madhav MS
2001)
• National prevalence rates for specific disorders
• Schizophrenia – 2.3/1000
• Affective disorder – 31.2/1000
• Anxiety neurosis – 18.5/1000
• Hysteria – 4.1/1000
• Mental retardation – 4.2/1000
26

27. Prevalence &Incidence of mental
health problems and disorder
• Bhore committee – mental urban pt require institutional
treatment would be 2 per 1000 in the country .
All mental disorder – 73/1000 population, Rural 70.5 & urban73
• Schizophrenia 2.5/1000
• Affective disorder (Depression) 34/1000
• Anxiety neurosis – 16.5/1000
• Hysteria 3.3/1000
• Mental retardation 5.3/1000
• According health information of india 2005 mental morbidity
rate is not less than 18-20/1000 and types of illness and their
prevalence are very much the same as in other part of the
world . 27

28. • According to community based epidemiological studies under
WHO Mental health GAP Action program in India ,the
estimated life time prevalence of mental disorder range from
12.2 to 48.6 %
• MOHAFW suggests 6-7 %of India populations suffer from
mental disorder with about 1 % suffering from severe mental
disorder. while there in 10,000 people experience an episode
of acute psychosis every year., about 25 % homeless.
• Schizphrenia and bi – polar disorder are prevalent in about
200 cases per 10,000 people.burdon of these disorder is likely
to increase to 15 % by 2020(Ghanshyam B,Nagarathiam
S.India is failing the mentally ill as abuse continue.
28

29. • Common psychiatric illness encountered in a clinic of a General
hospital are neurotic Disorder (anxity neurosis,OCD,reactive
depression)
• Psychosomatic disorder –(HTN,DM,Peptic ulcer,tension headache)
• Functional psychosis – (Schizophrenia,mania,depression& organic
psychosis)
• Child guidance clinic – (MR,Conduct disorder,Hyperkineic
syndrome,enuresis )
• Geriatric clinic – Depression,dementia,delusional disoreder
• Psychosexual – Dhat syndrome,Premature ejacualation,erectile
impotence )
• Prevalence 58.2per thousand which means that there are 5.7 crore
people suffering from some sort of psychiatric disturbances .out of
this 4 lakh have organic psychosis,26 lakh schizophrenia,1.2 crore
affective psychosis:thus there are about 1.5 crore people suffering
from severemental disorders.,Besides 12000 pt in Govt hospital.
29

30. • Mental Health act – Indian lunacy act ,Act4 of 1912,replaced the
indian lunactic asylums act,act 36 of 1858.It was enacted to govern
reception,detention and care of lunatics and their property and to
consolidiate and amend the law relating lunacy.
• Act was divided 4 parts & 8 chapters consisting 100 sections.The
enactment of indian Lunancy act of 1912 was folowed by opening of many
new asylums.an improvement in general conditions of asylums & increase
in awareness regarding situation of asylums.
• In 1946 Bhore committee submitted its recommendations .Indian
psychiatric society ,established in jan1947,was quick to react to
recommendations of committee .In Jan1949 an ad hoc drafting committee
appointed which consisted of 3 distinguished psychiatrist.they prepared a
draft bill called as the Indian mental Health act which was redrafted &
finalize in 1950 and forwarded to govt of India .After 37 years mental
health act 1987 passed was finally passed by Lok sabha ON 19 March
1987.Later govt of India issued orders that the act came into force effect
from april1,1993 in all states and union Territories of India. It is an act to
consolidate &amend law relating to the treatment & care of mentally ill
persons ,to make better provision with respect to their property & affairs
& for matters connected those with or incidental there to .the act divided
in 10 chapter consisting 98 sections .
30

31. DEVELOPMENT OF MODERN PSYCHIATRIC
NURSING
Psychiatric nursing in general arose from the need
for hospitals to provide socially acceptable levels of care.
Some Important Milestones:
1840: Florence nightingale made an attempt to meet the
needs of psychiatric patients with proper Hygiene, better
food, light and ventilation and use of drugs.
31

32. 1872: First training school for nurses, based on the
Nightingale system was established by the New
England Hospital.
1882: First school to prepare nurses to care for the
mentally ill was opened at McLean Hospital in Waverly.
1913: Johns Hopkins became the first school of
nursing to include a fully developed course for
psychiatric nursing in the curriculum. 32

33. 1943: Psychiatric nursing course was started for
male nurses.
1956: One year post-certificate course in
psychiatric nursing was started at NIMHANS,
Bengaluru.
1960: The name ‘psychiatric nursing’ was changed
to ‘psychiatric and mental health nursing’.
33

34. 1963: Journal of psychiatric nursing and mental
health service was published.
1965: The Indian Nursing Council included
psychiatric nursing as a compulsory course in the
B.Sc Nursing program.
1967: The Trained Nurses Association of India
(TNAI), formed a separate committee for psychiatric
nursing.
34

35. 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 M.Sc Nursing at the Rajkumari Amrit Kaur College of
Nursing, New Delhi.
1986: The Indian Nursing Council made psychiatric nursing
a component of General Nursing and Midwifery
course.American Psychiatric association established.
35

36. • 1990- Integration of neuroscience into holistic
biopsychosocial practice of Psy.Nsg occurred.
• Advances in understanding interrelationship
of brain,behavior,emotion and cognition
offered many new opportunities for
psy.nurses.International council of nurses
declared 1990 as the year of mental health
nursing
• 1991- Indian society of psychiatric nurses
formed at NIMHNS ,Bengaluru
• 1994- above mention changes led to revision
of standards of psy & mental health nursing
36

37. • 1995- Journal of American Psychiatric Nurses
Association established
• 2000-Scope & standards of psy. Mental health
clinical nursing was published by American nurses
association.
• 2003- American nurses association began
certifying mental health practioshner.
• 2010- ISPN published journal –Indian journal of
Psychiatric Nurses.
• Nurse role pt.advocacy,fiscal
responsibility,profeshional collberation,Legal and
ethical obligation.
37

38. CURRENT ISSUES AND TRENDS IN
NURSING
A psychiatric nurse faces various
challenges because of changes in patient care
approach. Some of these changes that affect her
role are as follows:
38

39. Trends in health care
Economic Changes
Changes in illness orientation
Changes in care delivery
Information Technology
Consumer empowerment
39

40. Deinstitutionalization
Physicians shortage and gaps in service
Demographic Changes
Social Changes
Mental Health Care Changes
40

41. TRENDS IN HEALTH CARE
Increased mental health problems
Provision for quality and comprehensive services
Multi-disciplinary team approach
Providing continuity of care
Care is provided in alternative settings
41

42. ECONOMIC CHANGES
Industrialization
Urbanization
Raised standard of living
42

43. CHANGES IN ILLNESS ORIENTATION
Shift from illness to orientation
(modification of style), specific to holistic, quantity
of care to quality of care.
43

44. CHANGES IN CARE DELIVERY
Care delivery is shifted from institutional
services to community services, genetic services to
counseling services, nurse patient relationship to
nurse patient partnership.
44

45. CONSUMER EMPOWERMENT
Increased consumer awareness
Awareness of the community in early detection and
treatment of mental illness as well as proper
utilization of available psychiatric hospitals
Patient are health care consumers demanding quality
health care services at affordable cost with less
restrictive and more humane rates
45

46. DEINSTITUTIONALIZATION
Bringing mental health patients out of the
hospital and shifting care to community
46

47. PHYSICIANS SHORTAGE AND GAPS IN
SERVICE
Physician shortage can provide the opportunity
for new roles for example, nurse practitioner. In
respect to gaps in services, nurses always meet the
needs of people for whom services are not available,
for example, home visiting nurse.
47

48. DEMOGRAPHIC CHANGES
Type of family (increased number of nuclear
families)
Increasing number of the elderly group.
48

49. SOCIAL CHANGES
 The need for maintaining intergroup and intragroup
loyalties
 Peer pressure.
49

50. MENTAL HEALTH CARE CHANGES
Increased public awareness regarding mental health
Need to maintain mental stability
Increased mental health problems
50
Mr. jayesh patidar

51. Educational Programs For The Psychiatric
Nurse
• Diploma in Psychiatric Nursing (The first program
was offered in 1956 at NIMHANS, Bangalore).
• M.Sc in Psychiatric Nursing (The first program
was offered in 1976 at Rajkumari Amrit Kauri
College of Nursing, New Delhi).
51

52. • M. Phil. In Psychiatric Nursing (1990,
M. G. University, Kottayam).
• Doctorate in Psychiatric Nursing (offered at
MAHE, Manipal; RAK College of Nursing, New
Delhi; NIMHANS, Bangalore).
• Short-term training programs for both the
degree and diploma holders in nursing 52

53. Standards of Mental Health Nursing
These standards are a means for improving the
quality care for mentally ill people. They were
enunciated by the American Nurses Association
(ANA) in 1973.
53

54. Development of Code of Ethics
This is very important for a psychiatric nurse
as she takes up independent roles in psychotherapy,
behaviour therapy, cognitive therapy, individual
therapy, group therapy, maintains patient’s
confidentiality, protects his rights and acts as
patient’s advocate.
54

55. Legal Aspects in Psychiatric Nursing
The practice of psychiatric nursing is
influenced by law, particularly in its concern for the
rights of patients and the quality of care they receive.
The client’s right to refuse a particular treatment,
protection from confinement, intentional torts,
informed consent, confidentiality and record keeping
are a few legal issues in which the nurse has to
participate and gain quality knowledge. 55

56. Promotion of Research in Mental Health
Nursing
The nurse contributes to nursing and the
mental health field through innovations in theory
and practice and participation in research.
56

57. Cost-effective Nursing Care
Studies need to be conducted to find out the
viability in terms of cost involved in training a nurse
and the quality of output in terms of nursing care
rendered by her.
57

58. Focus of Care
A psychiatric nurse has to focus care on certain
target groups like the elderly, children, women,
youth, mentally retarded and chronic mentally ill.
58

59. NATIONAL MENTAL HEALTH PROGRAMME
INTRODUCTION:
•Psychiatric symptoms are common in general
population in both sides of the globe.
•These symptoms - worry, tiredness, and sleepless
nights affect more than half of the adults at some time.
•While as many as one person in seven experiences
some form of diagnosable neurotic disorder.
59

60. BURDEN OF DISEASE:
•During the last two decades, many epidemiological
studies have been conducted in India, which show 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.
• Most of these patients live in rural areas remote from
any modern mental health facilities.
60

61. •A large number of adult patients (10.4 - 53%) 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 asked detailed mental health history).
•Due to the under- diagnosis of these patients,
unnecessary investigations and treatments are offered
which heavily cost to the health providers.
61

62. National Mental Health Programme:
The Government of India has launched the
National Mental Health Programme (NMHP) in
1982, keeping in view the heavy burden of mental
illness in the community, & the absolute
inadequacy of mental health care infrastructure
in the country to deal with it.
62

63. AIMS OF NMHP:
1. Prevention & treatment of mental &
neurological disorders & associated disabilities.
2. Use of mental health technology to improve
general health services.
3. Application of mental health principles in total
national development to improve quality of life.
63

64. OBJECTIVES OF NMHP:
1. To ensure availability and accessibility of minimum
mental health care for all in the foreseeable future,
particularly to the most vulnerable and underprivileged
sections of population.
2. To encourage application of mental health knowledge
in general health care and in social development.
3. To promote community participation in the mental
health services development and to stimulate efforts towards
self-help in the community. 64

65. STRATEGIES OF NMHP:
1. Integration mental health with primary health care
through the NMHP;
2. Provision of tertiary care institutions for treatment of
mental disorders;
3. Eradicating stigmatization of mentally ill patients
and protecting their rights through regulatory
institutions like the Central Mental Health Authority,
and State Mental health Authority. 65

66. APPROACHES OF NMHP:
Integration of mental health care services with the
existing general health services.
Utilization of the existing infrastructure of health services
and also deliver the minimum mental health care services.
Provision of appropriate task oriented training to the
existing health staff.
Linkage of mental health services with ht existing
community development programme.
66

67. COMPONENTS OF NMHP:
I.
TREATMENT
III.
PREVENTION
COMPONENTS
OF
NMHP
II.
REHABILITATION
67

68. I. Treatment: Multiple levels
A.
• Village and Sub-centre level
B.
• MO of Primary Health Centre
C.
• District Hospital
D.
• Mental Hospitals and teaching psychiatric
units
68

69. A. Village and Sub-centre level:
Multipurpose workers (MPW) and Health
Supervisors (HS), under the supervision of Medical
Officer (MO) to be trained for:
•Management of Psychiatric emergencies
•Administration and supervision of maintenance
treatment for chronic psychiatric disorders.
69

70. •Diagnosis and management of grandmal epilepsy,
especially in children.
•Liaison with local school teachers and parents
regarding mental retardation and behavioral problems
in children.
•Counseling problems related to alcohol and drug
abuse.
70

71. B. MO of Primary Health Centre (PHC) aided by HS, to
be trained for:
•Supervision of MPW’s performance.
•Elementary diagnosis.
•Treatment of functional psychosis.
•Treatment of uncomplicated cases of psychiatric disorders
associated with physical diseases.
•Management of uncomplicated psychosocial problems.
•Epidemiological surveillance of mental morbidity.
71

72. C. District Hospital:
It was recognized that there should be at least one
psychiatrist attached to every district hospital as an
integral part of the district hospital services.
The hospital should have 30-50 psychiatric beds.
The psychiatrist in a district hospital was envisaged to
devote only a part of his time to clinical care and a
greater part in training and supervision of non-specialist
health workers. 72

73. D. Mental Hospitals and teaching psychiatric units:
Major activities of these higher centers of
psychiatric care include:
•Help in care of ‘difficult’ cases.
•Teaching.
•Specialized facilities like, occupational therapy units,
psychotherapy, counseling and behavioral therapy.
73

74. II. Rehabilitation:
The components of this sub-program
include treatment of epileptics and psychotics at the
community level and development of rehabilitation
centers at both the district level and higher referral
centers.
74

75. III. Prevention:
The prevention component is to be
community based, with initial focus on prevention
and control of alcohol-related problems. Later on,
problems like addictions, juvenile delinquency and
acute adjustment problems like suicidal attempts are
to be addressed.
75

76. MENTAL HEALTH TEAM OR
MULTIDISCIPLINARY TEAM:
Multidisciplinary approach refers to
collaboration between members of different
disciplines who provide specific services to the
patient. The multidisciplinary team includes:
76

77. MENTAL
HEALTH
TEAM
1.
PSYCHIATRIST
2.
PSYCHIATRIC
NURSE
3. CLINICAL
PSYCHOLOGIST
4. PSYCHIATRIC
SOCIAL
WORKER
5.
OCCUPATIONAL
THERAPIST OR
ACTIVITY
THERAPIST
6.
PHARMACIST
AND
DIETICIAN
7. COUNSELOR
77

78. 1. PSYCHIATRIST:
A psychiatrist is a medical doctor with a
special training in psychiatry. He is accountable for
the medical diagnosis and treatment of patient. Other
important functions are:
•Admitting the patient into acute care setting.
•Prescribing and monitoring psychopharmacologic
agents.
78

79. •Administering ECT.
•Conducting individual and family therapy.
•Participating in interdisciplinary team meetings.
•Owing to their legal power to prescribe and to write
orders, psychiatrists often function as leaders of the
team.
79

80. 2. PSYCHIATRIC NURSE:
A psychiatric nurse is a registered nurse with
specialized training in the care and treatment of
psychiatric patients; she may have a Diploma, M.Sc,
M.Phil or PhD in psychiatric nursing. She is
accountable for the bio-psychosocial nursing care of
patients and their milieu. Other functions include:
80

81. •Administering and monitoring medications.
•Assisting in numerous psychiatric and physical
treatments.
•Participate in interdisciplinary team meetings.
•Teach patients and families.
•Take responsibility for patient’s records.
•Act as patient’s advocate.
•Interact with patient’s significant others. 81

82. 3. CLINICAL PSYCHOLOGIST:
A clinical psychologist should have a Masters
Degree in Psychology or Ph.D degree in clinical
psychology with a specialized training in mental
health settings. He is accountable for psychological
assessments, testings, and treatments. He offers
direct services such as individual, family or marital
therapies.
82

83. 4. PSYCHIATRIC SOCIAL WORKER:
A psychiatric social worker have a Masters
Degree in Social Work or Ph.D degree with a
specialized training in mental health settings. He is
accountable for family case work and community
placement of patients. He conducts group therapy
sessions. He emphasizes intervention with the
patient in social environment in which he will live.
83

84. 5. OCCUPATIONAL THERAPIST OR
AN ACTIVITY THERAPIST:
An occupational therapist or an activity
therapist is accountable for recreational,
occupational and activity programs. He assists the
patients to gain skills that help them cope more
effectively to gain or retain employment, to use
leisure time.
84

85. 6. PHARMACIST AND DIETICIAN
85

86. 7. COUNSELOR:
A counselor provides basic supportive
counseling and assists in psycho educational and
recreational activities.
86

87. SCOPE OF MENTAL HEALTH NURSING
The areas of concern for the psychiatric mental
health nurse include a wide range of actual or
potential mental health problems, such as emotional
stress or crisis, self concept changes, development
issues, physical symptoms that occur with
psychological changes, and symptom management
of patient with mental disorders.
87

88. To understand the problem and select an appropriate
intervention, integration of knowledge from the
biological, psychological and social domain necessary.
Today the scope of mental health nursing is not restricted
within the confines of the bedside nursing care.
A mental health nurse needs to be skilled and clinically
competent, sensitive to the social environment, the
advocacy needs of the patients and their families as well
as be aware of the legal and ethical dilemmas.
88

89. ROLE OF A PSYCHIATRIC NURSE
Primary mental health nursing
Collaborative psychiatric nursing practice
Clinical Nurse Specialist (CNS)
Nurse psychotherapist
Psychiatric nurse educator
Psychosocial rehabilitation nursing
Child psychiatric nursing
Gerontological and geriatric nursing
Deaddiction nursing
Neuropsychiatric nursing
Community mental health nursing
89

90. Primary Mental Health Nursing
Psychiatric nurses are moving into the domain of
primary care and working with other nurses and
physicians to diagnose and treat psychiatric illness in
patients with somatic complaints. Cardiovascular,
gynecological, respiratory, gastrointestinal and family
practice settings are appropriate for assessing patients
for anxiety, depression and substance abuse disorders.
90

91. Collaborative Psychiatric Nursing Practice
Patients who are having difficulty being
stabilized on their medications or who have co-
morbid medical illnesses are seen in a psychiatric
nursing clinic where nurses and physicians
collaborate to provide high quality patient care.
91

92. Clinical Nurse Specialist (CNS)
The Clinical Nurse Specialist provides
consultative services to nursing personnel. She
attends clinical teaching programs, demonstrates
therapies, conducts in-service education programs,
initiates and participates in curriculum
revision/changes and nursing research.
92

93. Nurse Psychotherapist
The psychiatric nurse can take up
psychotherapy roles as in individual therapy, group
therapy, counseling etc.
93

94. Psychiatric Nurse Educator
The main function of psychiatric nurse
educator is planning and changing the curriculum
according to the needs of the society and learner.
The number of nurses in the field of teaching
psychiatric nursing needs to be enhanced. This is a
big challenge for nursing curriculum planners.
94

95. Psychosocial Rehabilitation Nursing
It is concerned with helping people with
chronic mental illness to lead more independent and
satisfactory lives in the community.
95

96. Child Psychiatric Nursing
In child psychiatric nursing the nurse
identifies the emotional and behavioral problems of
the children and provides comprehensive care.
96

97. Gerontological and geriatric nursing
Gerontological nursing provides emotional
support to those people who have retired from services,
who have no financial sources and helps them in
understanding the situation and developing new coping
mechanisms. Geriatric nursing is expanding the
psychiatric nursing practice to aged people who have
been affected by emotional and behavioral disorders
such as dementia, chronic schizophrenia, delirium etc.
97

98. Deaddiction Nursing
A psychiatric nurse in these units, identifies
psychosocial problems and maintaining factors in
addicts. She also provides various therapies to the
addicts and their family members.
98

99. Neuropsychiatric Nursing
Psychiatric nursing practice is extended to
patients who are suffering from neuro-psychiatric
disorders such as dementia, epilepsy, brain tumour,
head injury with behavioural problems, HIV
infection with behavioural problems etc.
99

100. Community Mental Health Nursing
It is the application of knowledge of
psychiatric nursing in preventing mental illness,
promoting and maintaining mental health of the
people. It includes early diagnosis, appropriate
referrals, care and rehabilitation of mentally ill
people.
100

101. FUNCTIONS OF PSYCHIATRIC NURSE
IN VARIOUS SETTINGS
1. Inpatient Psychiatric ward
2. Psychiatric outpatient department
3. ECT training centre
4. Psychotherapy unit
5. Day care centers or Day hospitals
6. Family therapy units
101

102. 7. Child psychiatric ward
8. Home settings
9. Community mental health centers
10. Hospice care centers
11. Emergency departments
12. Medical inpatient wards
13. Industrial medical centers
14. Hospitals for criminal insane, jails and prisons102

103. INPATIENT PSYCHIATRIC WARD:
•Provide safe environment
•Perform psychosocial, high risk and physical assessment
•Promotion of self care activities
•Medication management
•Observing and documenting the patient’s behavior
•Help in decision making and assuming the responsibility of
life
103

104. •Providing feed back
•Participation in various therapies
•Psycho education
•Counseling
•Social skills and stress management techniques
•Discharge, referral and follow up care
•Supervision of subordinates
•Cleanliness
104

105. PSYCHIATRIC OUTPATIENT
DEPARTMENT:
•Clinical assessment
•Psychometric assessment
•Psychotherapy
•Counseling
•Conducting group therapy
•Psycho education
105

106. ECT TRAINING CENTRE:
•Teaching
•Preparation for ECT
•Providing care
•Assist with post treatment
•Providing reassurance
•Psycho education regarding ECT
106

107. PSYCHOTHERAPY UNIT;
•Establishing therapeutic nurse patient relationship
•Assisting the patient
•Providing opportunities to practice new skills
•Reinforcing appropriate behavior
•Emotional support
107

108. DAY CARE CENTERS OR DAY HOSPITALS:
•Clinical assessment
•Observing and documenting patient behavior
•Medication management
•Teaching social skills
•Counseling
•Psycho education
•Occupational and recreational therapy 108

109. FAMILY THERAPY UNITS:
•Assessing the individual and family needs
•Facilitation of a family
•Promote adaptive family functioning
•Psycho education
109

110. CHILD PSYCHIATRIC WARD:
•Assessing biological and psychological need of the child
•Determine the child’s strengths and limitations
•Monitor the child’s developmental levels
•Provide a safe therapeutic environment
•Teaching self care skills
•Genetic counseling
•Psycho education
•Medication management
•Emotional support
•Participate in various therapies 110

111. HOME SETTINGS:
•Assessment of symptoms
•Teaching
•Stress management
•Medication management
•Case manager
•Appropriate referrals to community agency
•Venipuncture for lab analysis
•Supportive counseling and psychotherapy
•Promotion of mental health and prevention of mental
illness 111

112. COMMUNITY MENTAL HEALTH CENTERS:
•Identification of patient
•Refer the patient to hospitals
•Home visit
•Follow up care
•Conducting public awareness programme
•Training of paraprofessionals
•Management of resources planning and co-ordination
112

113. HOSPICE CARE CENTERS:
• Helping cancer or terminally ill individuals
•Providing supportive psychotherapy
•Provide support groups for families of terminally ill
113

114. EMERGENCY DEPARTMENTS:
•Crisis intervention during natural disasters
•Obstetric nursing centers
•Helping the mother in labor
•Providing support to bereaved parents
114

115. MEDICAL INPATIENT WARDS:
• Psychosocial intervention for chronic illnesses
with major psychological effects
115

116. INDUSTRIAL MEDICAL CENTERS:
•Implementing and participating in industrial
substance abuse programs for employees
•Providing crisis intervention
•Stress management
116

117. HOSPITALS FOR CRIMINAL INSANE,
JAILS AND PRISONS:
• Medication management
•Promote coping skills
•Diagnose and treat psychiatric disorders
•Psychotherapy
•Assessment for potential for violence
•Review of police reports
117

118. FACTORS AFFECTING THE LEVEL OF
NURSING PRACTICE
The level at which psychiatric nurses practice
is determined by various factors such as:
•Nurse Practice Acts (Laws)
•Professional Practice Standards
•Educational qualifications and experience
•Health care organization philosophy
•Self motivation and personal initiatives 118

119. Nurse Practice Acts (Laws):
Nurse practice acts regulate entry into
the profession and define the legal limits of nursing
practice that must be adhered to by all nurses.
Nurses must be familiar with the nurse practice act
of their state and limit their practice.
119

120. Professional Practice Standards:
Professional Practice Standards define nursing
practice and performance; first developed by the
ANA in 1973 and recently revised in 2000.
120

121. Educational qualifications and experience
Nurses’ qualifications include education,
work experiences and certification status which
determine the level of practice.
121

122. Health care organization philosophy
A Health care organization philosophy of
mental health and mental illness and its approach
towards treatment help to share the expectations of
both the nurses and patient.
122

123. CONCEPTS OF NORMALAND ABNORMAL
BEHAVIOR
Psychiatry as evident from the above is concerned
with abnormal behavior in its broadest sense, but defining
the concepts of normal and abnormal behavior as such has
been found to be difficult. These concepts are much under
the influence of socio-cultural factors.
Several models have been put forward in order to
explain the concept of normal and abnormal behavior. Some
of these are: 123

124. MEDICAL MODEL
STATISTICAL
MODEL
SOCIO-
CULTURAL
MODEL
BEHAVIOR
MODEL
MODELS
124

125. MEDICAL MODEL:
•Medical model considers organic pathology as the
definite cause for mental disorder.
• According to this model abnormal people are the
ones who have disturbances in thought, perception
and psychomotor activities.
•The normal are the ones who are free from these
disturbances.
125

126. STATISTICAL MODEL:
•It involves the analysis of responses on a test or a
questionnaire or observations of some particular
behavioral variables.
•The degree of deviation from the standard norms arrived
at a statistically, characterizes the degree of abnormality.
•Statistically normal mental health falls within two
standard deviations (SDs) of the normal distribution
curve.
126

127. SOCIO-CULTURAL MODEL:
The beliefs, norms, taboos and values of a society
have to be accepted and adopted by individuals.
•Breaking any of these would be considered as abnormal.
•Normalcy is defined in context with social norms
prescribed by the culture.
•Thus cultural background has to be taken into account
when distinguishing between normal and abnormal
behavior.
127

128. BEHAVIOR MODEL:
•Behavior that is adaptive, is normal, maladaptive is
abnormal.
•Abnormal behavior is a set of faulty behaviors
acquired through learning.
128