MENTAL HEALTH NURSING

VIJAYAM'S

Psychiatrist
A medical practitioner specializing in the dlagnosis and trcatment of
mental illness.
A system of psychological theory and therapy that alms to treat mental
Psychoanalysis
disorders by investigating the interaction of conscious and unconsclous
elements in the mind and bringing repressed fears and conflicts Into
the conscious mind by techniques such as dream interpretation and
free association.
A form of psychotherapy in which patients act out events from ther
Psychodrama
past
Segregation The action or state of setting someone or something apart from other
people or things or being set apart.
:A sudden attack of illness, especially a stroke or an epileptic
fit.
Seizures
Suicide :It is an act of intentionally causing one's own death.
Therapy
INTRODUCTION *Sakel (1933): Insulin Coma

In
(1930s): Cardiazol
or Metrazol
Historically mental illness was viewed as a Meduna
demonic possession, the influence of ancestral
spirits, the result of violating a taboo or neglecting
h. Convulsive Therapy
Friedman and Wilcox (1942): Unilateral
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*
a cultural ritual and spiritual condemnation. As Electroconvulsive Therapy
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a result the mentally ill were often starved,

beaten, burnt, amputated and tortured in order I1. Psychological Therapies:
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to make the body an unsuitable place for the *Sigmund Freud: Psychoanalysis and Free
demon. Gradually man began the quest for association
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scientific knowledge and truth.

Carl C. Rogers: Client-Oriented
Psychotherapy
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*Frederich Pearls: Gestalt Therapy

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CONTRIBUTORS TO
*Eric Berne: TransactionalAnalysis
PSYCHIATRY
* Viktor E. Frankl: Existential Logotherapy
Contributors to the development of Albert Ellis: Rational Emotive Therapy
psychiatric treatment:
William Glasser: Reality Therapy
1. Organic Therapies: * Arthur Janov: Primal Therapy
W.Oliver (1785): Camphor induced
convulsions in Melancholia
*J.L.Moreno: Psychodrama

*Wagner von Jauregg (1917): Malarial *Aaron Beck: Cognitive Therapy (in
depression)
treatment in General Paresis of Insane
T.F. Main and Maxwell Jones:
*Klaesi (1922): Prolonged Narcosis
Therapy Therapeutic Communities

2.2
 Unit-2:: History of Psychiatry VIJAYAM'S

John Watson: Behaviourism

*Ivan Pavlov: Classical Conditioning
Joseph Wolpe: Systematic Desensitization
B.F. Skinner: Operant Conditioning

Some other Contributors to the Development Drug Treatment:

of
Hippocrates: Herbal remedies for mental illness
Fisher (1903): Used Rauwolfia extract in Major Psychosis
Bemthsen (1883): Synthesized Chlorpro-mazine
Charpentier (1950): Describid properties ofchlorpromazine
Delay, Deniker and Harl: Use of Chlorpromazine to treat certain psychotic symptoms and
(1952) coined term Neuroleptic
Cade (1949): Lithum
Zeller (1952): Described Iproniazid (aMAO inhibitor) as an antidepressant
butyrophenones
Janssen et al (1958): Synthesized large number of

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Kuhn (1958): Described properties of imipramine
Cohen (1960s): Deseribed properties of chlordiazepoxide
Hald et al (1948): Disulfiram (antabuse)
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2.1A. HISTORY OF PSYCHIATRIC NURSING- INDIA

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es

"History is a cyclic poem written by time upon the memories of man". -Percy Bysshe shelley.
In India:
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*Madness was considered as a sin.

Family treated them by branding, dipping in cold water, securing them with chains, leaving in
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the temples.
Shamans, priest and magicians were treating personals.
1912 Indian Lunacy Act came into force.
1918 Britishers built mental hospital at Ranchi for Europeans
1925 Indian mental hospital exclusively for Indians.
*1950 according to Bhore committee's recommendation, four more mental hospitals were
started.
*Indian government sent four nurses to complete diploma in psychiatry nursing to UK from
1948 to 1950.

Maxwell Jones concept of Therapeutic Community (1953) in USA also highly in Indian
psychiatric nursing.
'1956 one year diploma in psychiatry nursingwas started in NIMHANS at Bangalore.

2nI 2.3
VIJAYAM'S MENTAL HEALTIH HURSIHG

Development of Psychiatric Nursing in India:

In
h.
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Fig. 2.1 Psychiatric Nurse care in olden period

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Committees recommendations - one year post certificate course in psychíatric nursing was
started in l956 at the NIMHANS.
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In 1965-INC included psychiatrie nursing as a compulsory course in B.Sc nursing.

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In 1965-1966, psychiatric nursingcomponent was added in the GNM.

1967 TNAI (Trained Nurses Association ofIndia) formed a separate commitee for psychiatric
nursing to improve the perception to psychiatric nursing as well as toself guidelines.
In 1975, M.Se nursing was started in Rajkumari Amrit Kaur College ofNursing, New Delhi.
By the year of 1990there were four colleges of nursing - offering psychiatric nursing as an
elective subject in their M.Sc Nursing.
- Bombay - Chandigarh
- Ludhiana - Vellore

In 1976, RajkumarAmrit Kaur college of Nursing, New Delhi, started a specialized course
in psychiatric nursíng at the masters level of Nursing Education,

By 1983, diploma in psychiatric nursing was started at the Institution ofPsychiatry, Kanke,
Ranchi.

2.4
 VIJAYAM'S
Unit-2:: History of Psychiatry

*1978, CMC Vellore, Ludhiana, Thosc with mental disorders were

NIMHANS Bangalore (1988) started vicwcd as being cither divine or
speciality courses demonic; individuals seen as divine
were worshipped and adored, those
In 1987, the Indian Lunancy Act of 1912
scem as demonic were ostracized,
was reviscd further cxpanding the roles punished and sometimes burned at the
of psychiatry nurses. stake.
*In 1989, most of the schools of nursing h. Greek and Roman 800 BC to I AD:
startcd implementing the revised three
*The first progress in understanding
years general nursing and midwifcry mental disorders came with the Greek
courses. physician Hippocrates.
* A psychiatric nurse expert has involved Hippocrates (460-375 BC) described
in the 'action group' formulated in 1990 a variety of personalities or
at New Delhi to implement by the temperaments and proposed that
National Mental Health Programme in mental illness was a disturbance of

In
1991 was declared in the year of mental four body fluids or humors. These four
health nursing by the International Council
of Nurses (ICN). This theme was
h.
substances or humors corresponded
with happiness, calmness, anger and
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endorsed by the TNAI and nurses were sadness. Imbalances of four humors
urged to publish articles in India. were believed to cause mental
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Psychiatric nurses of Indian formed the disorders so treatment was aimed at

Indian Society of Psychiatric Nurses' in restoring balance through blood letting,
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1991 at NIMHANS. starving and purging.

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2005, The national consortium for Aristotle (382-322 BC) related mental
InPh.D. in nursing by INC affiliated with to physical disorders.
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the Rajiv Gandhi University of Health *Although there were no institutions for
Sciences sponsored by WHO calls for the mentally ill, many were cared for
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nurses to register for Ph.D. with great kindness by physicíans

temples dedicated to Greek and
Roman gods.
c. Christian Times (1-1000 AD):
2.1B. INTERNATIONAL LEVEL
*All diseases were again blamed on
demons and the mentally ill were
I. PRE-MORAL TREATMENT ERA
viewed as possessed.
a. Ancient times to 800 BC:
*Priests performed exorcisms to rid
People of ancient times believed that evil spirits.
any sickness indicated displeasurecor * When that failed, they used more

the gods and in fact was punishment severe and brutal measures such as
for sins and wrongdoings incarceration in dungeons, flogging and
straving.

RSRELSRE 2.5 e
VIJAYAM'S MENTAL HEALTH NURSING

d. Renaissance (1300-1600 AD): Assistance, the least restrictive

approach provided food and money
People with mental illness were
and often enabled the family to
distinguished from criminals in
England. maintain its integrity as a unit.

*Those considered harmless were Banishment occured in some

allowed to wander the countryside or communities which led to wandering
live in niral communities but the more bands of lunatics.
"dangerous lunatics" were thrown in Confinement was the most
prison, chained and starved. restrictive method of coping with the
In 1547, the hospital of St.Mary of mentally ill who were chained.
Bethlehem was officially declared a
hospital for the insane, the first of its
II. END OF 18TH CENTURY
kind.
Period of Enlightenment and creation of
*During the same period in the colonies,

In
mental institutions
the mentally ill were considered evil
or possessed and were punished. The moderm era of psychiatric care began
Which hunts were conducted and
offenders were burned at the stake.
h.
with the involvement of two men, philippe
Pinel in France and William Tuke in
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England.
e. Colonial period (1700 1790 AD):
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* The need for special institutions for In 1792, Philippe Pinel was placed in
individuals with psychiatric disorders charge of La Bicetre, a hospital for
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referred to as "lunatics" was identified mentally ill persons in Paris. He began

in the early 1770s. more humane treatment of patients with
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mental illness by removing their chains

*In 1773, the Eastern Lunatic Hospital and advocating compassionate treatment.
was built in Williamsburg, Virginia.
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In 1783, Benjamin Rush inaugurated At about the same time in England,

William Tuke raised funds for a retreat
the first course of study in mental
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illness. Often called the "father of for members who had mental disorders.
American Psychiatry", Rush wrote The York Retreat was opened in 1796;
the first Amercian textbook on restriants were abandoned and
psychiatry and encouraged more sympathetic care in quiet, pleasant
humane treatment of persons with surroundings with some form of industrial
mental illness. Occupation such as weaving or farming
Rosenblatt has written of the ABCs was provided.
ofthe community response during this The concept of the asylum developed
time (premoral treatment era). from the humane efforts of Pinel and
A assistance Tuke. The term asylum can mean
B-banishment protection, social support or sanctuary
C-confinement from the stresses of life.

2.6 E
 Psychiatry VIJAYAM'S
Unit-2:: History of

However, the period of Enlightement was AdolfMeyer suggested the term "mental
short Within 100 years of the
lived. hygiene" to denote mental health.
establishment of the first asylum, the
Period of Scientific Study:
reformers were being charged with
misuse and abuse of their charges. *The shift in focus from sanctuary to
treatment is linked to Sigmund Freud.
Within relatively brief period, the
a
meaning of asylum changed; it evolved Sigmund Freud developed a personality
from a place of refuge to place of theory based on unconscious motivations
torment. for behavior or drives.
Using a new technique, psychoanalysis,
he delved into the patient's feelings and
EARLY 20TH CENTURY
III. THE 19TH AND emotions regarding past experiences,
As hospitals were established by the particularly early childhood and
middle of the 19th century to provide long adolescent memories, to explain the basis

In
term custodial care for mentally ill of aberrant behavior.
persons, humane treatment became more
Emil Kraepelin made tremendous
prevalent.

Dorothea Lynde Dix, a militant crusader

h.
contributions to the classification ofmental
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disorders.
for the humane treatment ofpatients with
*Engene Bleuler coined the term
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mental illness, was responsible for much

Schizophrenia and added a note of
for the reform of the mental health care
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optimism to its treatment.

system in the 19th century.
Increased Government Involvement in
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She was instrumental in developing the

Mental Health Care:
concept of asylum; she playeda direct
*In 1946, National Mental Health Act was
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role in opening 32 state hospitals.

passed which supported research,
The mental health movement was training and thé establishment of clinics
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strongly influenced by the 1908 publication

and treatment centers.
ofa book written by Clifford Beers titled
A MIND THAT FOUND ITSELF. This This act created a six member National
book depicted his 3 year experience in 3 Mental Health Advisory Council that
different hospitals. In all ofthese facilities, established the National Institute of
he was beaten, choked, imprisoned for Mental Health (NIMH) which was
long periods in dark, padded cells and responsible for overseeing and coordinat-
confined many days in straightjacket.At ing research and training.
the end of this book, he recommended
Period of Psychotropic drugs:
that a national society be established for
the purpose of reforming care and *A great leap in the treatment of mental
treatment, disseminating information and lness began in about 1950 with the
encouraging and conducting research. development of psychotropic drugs or
drugs used to treat mental illness.

2.7
 MENTAL HEALTH NURSING
VIJAYAM'S

*Chlorpromazine, an antipsychotic drug -Inpatient services.

and lithium, an antimanic agent, were the -Outpatient services
first drugs to be developed. Partial hospitalization services
Over the following 10 years, monoamine Twenty - four hour emergency
oxidase inhibitor antidepressants; services.
haloperidol, an antipsychotic; tricyclic Consultation and educational services
antidepressants; and antianxicty agents for community agencies and
called benzodiazepines, were introduced. profession personnel.
Decade of the Brain:
*Forthe first time, drugs reduced agitation, *The 1990s were declared the Decade of
psychotic thinking and depression.
the Brain by congress.
Hospitals stays were shortened and may *During this decade, a steep increase in
people were well enough to go home. brain research occured that coincided
with an increased interest in biologic

In
explanations for mental disorders.
IV. LATE 20 CENTURY

Community Health Movement and *It

h. crystallized the fact that some behaviors
are caused by biologic irregularities and
Deinstitutionalization
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not willful contariness or worse.
*The movement towardtreating those with
It also enabled individuals to move
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mental illness in less restrictive

beyond blaming toward a focus on what
environments gainedmomentum in 1963
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could be done.
with the enactment of Community Mental
Health Centers Act. Evolution of Psychiatric Nursing Practice:
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Deinstitutionalization, a deliberate shift Psychiatric nursing is a specialized area of

from institutional care in state hospitals nursing practice that uses the theories of human
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to community facilities began. behavior as its scientific framework and requires

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the purposeful use to selfas its art of expression.

Thus deinstitutionalization accomplished
full emergence of psychiatric nursing requires
the release of individuals from long-term
a review of the social changes that occurred
stays in state institutions, the decrease in
before 1773. According to Peplau, the historical
admissions to hospitals, and the development of psychiatric nursing began in
development of community-based
1773. She identified five eras or phases in the
services as an alternative to hospital care.
establishment of psychiatric nursing, both as an
The goal of Community Mental Health aspect of all nursing and as a specialty in nursing
Centers Act was to expand community Early Views:
mental health services and diminish
society's sole reliance on mentalhospitals *The roots of contemporary psychiatric-
mental health nursing thought can be
*Each community mental health center
traced back to Florence Nightingale's
(CMHC) was mandated to have five
basic services:
seminal work, Notes on Nursing,
originally published in 1839.

2.8
 History of Psychiatry VIJAYAM'S
Unit-2:
The holistic view of the patient, with the to provide therapeutic nursing care.
body and soul seen as inseparable and
*By the end ofthe 19th century, there was
the patient viewed as a member ofa family
growing appreciation of the therapeutic
and community was central to role of the psychiatric nurse.
Nightingale's view of nursing. Even
though she did not address care ofpatients * Duties included assisting the physician,
in asylums, Nightingale was sensitive to administering sedative drugs, and
human emotion and recommended providing hydrotherapeutic measures
interactions that would be classified as (e.g., hot and cold douches, continuous
therapeutic communication today. baths and wet-sheet packs).

Phase The Emergence of Psychiatric Mental

I: Phase ll: Development of Undergraduate
Health Nursing (1773 - 1881)
Psychiatric -Mental Health Nursing Education
(1915-1935).
*The nurse's role was to overseeoperation
the care
*In 1915, Linda Richards, the first
given and to ensure the smooth
psychiatric nurse in the United States

In
of the ward.
often referred to as "the first American
*Housekeeping duties, dietary Psychiatric nurse" suggested that mentally
management and laundry care were
considered nursing responsibilities.
h.
ill patients receive the same quality care
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as physically ill patients.

Phase ll: Development of the work Role of 1920, Harriet Bailey wrote the first
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*In
Nurse in Psychiatric Mental Health Facilities textbook of psychiatric nursing, Nursing
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(1882- 1914) Mental Disease.

*Dr. Edward Cowles, director of McLean *The very same year Harry Stack Sullivan
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Asylum in Massachusetts firmly believed also felt that nurses have a very important
that patients in mental hospitals should role to play in milieu therapy.
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receive nursing care.

*Several advancements occured as the
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* Cowles assisted Linda Richards, National Committee on Mental Hygiene

considered the first psychiatric nurse in and the American Nurses Association
United States, to open training school for promoted study ofmentally ill persons by
psychiatric - mental health nurses that publishingjournal articles.
were based on Florence Nightingale's
principles and training practices. Phase IV: Development of Graduate
Psychiatric - Mental Health Nursing Education
The Boston City Hospital Training school (1936-1945)
for nurses was established in 1882 at
McLean Hospital. *Interest in undergraduate psychiatric
nursing education and supplementary
*In 1890, trained nurses were employed
postgraduate courses paved the way for
on nursing skills of state mental hospitals. in this
graduate education as it evolved
These nurses were trained of menial
era.
tasks and were able to develop their skills

2.9
 MENTAL HEALTH NURSING
VIJAYAM'S
In 1952, "Peplau's Classic Book",
*By 1937, clinical expericnces in
standardizcd. Interpersonal Relation in Nursing
psychiatric hospitals were
League for Provided a framework for practicing
The same year National
psychiatric nursing.
Nursing (then called National League for
Nursing Education) recommended that In 1954, First graduate program in
psychiatric nursing be made part of the Psychiatric nursing was established at
curriculum of gencral nursing programs. Rutgers University by Hildegard E.
By 1939, approximatcly halfofall nursing Peplau.
schools provided psychiatric nursing Both Peplau and Mellow substantially
courses for students but participation in contributed to the practice of psychiatric
such courses did not become a nursing.
requirement for nursing licensure until1
In 1956, National League of Nursing
1955.
Education formed a committee to review
The National League of Nursing and revise a proposed guide for the

In
Education developed curriculum development of an advanced clinical
guidelines for instruction education. The
guidelines included 60 to 80 hours of h. course in psychiatric nursing.
Developments since 1956:
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theoretical instruction along with 12 to 16
weeks of clinical experience. *The community mental health act
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*By the end of this fourth era, the climate promoted the specialization ofpsychiatric
nursing services as the provision of care
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of nursing profession was more favorable

for consideing the pressing problems of was shifted back to the community.
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psychiatric nursing in institutions and Nurse practitioners or clinical specialists

agencies of all kinds. could provide direct care to the psychiatric
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Phase V: Development of consulation and clients in a variety of settings.

Research in Psychiatric Mental Health Nursing
-
*The first doctoral programme in
Practice (1946 - 1956)
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psychiatric nursing was started in Boston

* This era began with the passage of the in 1960.
Mental Health Act of 1946. In 1963, two nursingjournals focused on
This act set up funding ofgraduate nursing psychiatric nursing: the journal of
programs to prepare psychiatric clinical psychiatric nursing (now the journal of
nurse specialists. Psychosocial Nursing and Mental Health
Services) and Perspectives in Psychiatry
*In 1951, Mellow wrote of the work she
did with schizophrenic patients. She called care.
these activities "nursing therapy". It In 1967, the Division of Psychiatric and
described her approach of focusing on Mental health Nursing Practice of
client's psychosocial needs and strengths. American Nurses Association Published
the Statement of Psychiatric Nursing
Practice.

SELE 2.10
 Unit-2:: History of Psychiatry VIJAYAM'S

In 1973, the division of psychiatric and Social Changes:

mental health practice of American The nced for maintaining intergroup and
Nurses Association developed standards intragroup loyalties
ofcare which it reviscd in 1982, 1994 and Peer pressure
2000.
In 1982, thec American Nurses Association At Economic Changes:
defined the CMH nurse's role in the *Industrialization
continuum of care as "the nurse

.
Urbanization
participates with other members of the
community in assessing, planning, Raised standard ofliving
implementing and evaluating mental
Technological Changes:
health services and community services
that include the promotion of the *Mass media
continuum of primary, secondary and Electronic systems
tertiary prevention of mental illness.

In
*During the 20th century, psychiatric Information Technology
nursing been to evolve as a clinical
specialty. Nurses were previously h.
Increased awareness in the public
regarding mental health
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involved as managers and coordinators
activities as they provided therapeutic
Need to maintain mental stability
of
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care based on the medical model. Increased mental health problems

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By advanced study and clinical practice

Theabove changes set the current trends in
experienced in a masters's program inmental health care. Some of these are:
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psychiatric nursing, clinicalspecialists anaEducational Programmes for the PsychiatricC

nurse practitioners gained expert Nurses.
knowledge in the care and prevention of
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psychiatric disorders. Diploma in psychiatric nursing (the first

programme was offered in 1956 at
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NIMHANS, Bangalore)

M.Sc., in psychiatric nursing (the first

2.2RENDS IN PSYCHIATRIC programme was offered in 1976 at
NURSINIG Rajkumari Amrit Kaur college of Nursing,
New Delhi)
A psychiatric nurse faces various challenges
because of changes in patient care approach. M.Philin Psychiatric Nursing (1990,
Some of these changes that affect her role are M.GUniversity, Kottayam)
as follows: A. Doctorate in Psychiatric Nursing (offered
Demographic Changes: at MAHE, Manipal, RAK college of
*Type of family (increased number of Nursing, Delhi, NIMHANS, Bangalore)
nuclear families) Short-term training programmes for both the
*Increasing number of the elderly group degree and diploma holders in nursing.

2.11
 MENTAL HEALTH NURSING
VIEAYAMS

In
Fig. h.
2.2 Trends of Psychiatry Nurse
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Trends in the Role of Psychiatric Nurse: clinical teaching programmes, demonstrates
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iPrimary Mental Health Nursing: therapies, conducts in-service education

programmes, initiates and participates in
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Psychiatric nurses are moving into the

domain of primary care and working with curriculum revision/changes and nursing
research.
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other nurses and physicians to diagnose and

treat psychiatric illness/ in patients with iyNurse Psychotherapy: The psychiatric
somatic complaints. Cardiovascular,
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nurse can take up psychotherapy roles as in

eynecological, respiratory, gastrointestinal individual therapy, group therapy, counselling
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and family practice settings are appropriate etc.

for assessing patients for anxiety, depression
and substance abuse disorders. Psychiatric Nurse Educator: The main
function of psychiatric nurse educator 1s
ACollahorative Psychiatric Nursing planning and changing the curriculum
Practice: Patients who are having difficulty according to the needs of the society and
being stabilized on their medications or who learner. The Indian Nursing Council included
have co-morbid medical illnesses are seen
psychiatric nursing as compulsory for the
in psychiatric nursing clinic where nurses
qualifying examination in B.Sc. Nursing
and physicians collaborate to provide high
programme in 1965, and from 1986 it
quality patient care.
became a component in General Nursing and
pt Clinical Nurse Specialist (CNS): The Midwifery course as well. The number of
clinical nurse specialist provides consultative nurses in the field of teaching psychiatric
services to nursing personnel. She attends nursing needs to be enhanced. This is a big
challenge for nursing curriculum planners.

2.12
 Unit-2: History of Psychiatry
VIJAYAM's
viPsvchosocial Rehabilitation Nursing: It xtit. Oncalogy Nursing: Helps Terminally
is concerned with helping people with ill
patient, support to family members.
chronic mental illness to lead more
vtOccupational Nursing: Control industrial
independent and satisfactory lives in the accidents, manage stress control measures,
community.
prevent substance abuse.
yitChild Psychiatric Nursing: In child Emergency Room Nursing: Manage crisis
psychiatric nursing the nurse identifies the Intervention, disaster, anxiety andstress.
emotional and behavioural problems of the Mental
| Illness in the 21st Century:
children and provides comprehensive nursing
This has led to the te door
care.
effect.
tGerontological and Geriatric Nursing: Deinstitutionali tive and
V Gerontologicalnursingprovides emotional negative effects.
support to those people who have retired Severe and por i
illness
from services, who have understanding patients stayings
the situation and developing new coping
1od in hospital
byt admitting fre y.

In
mechanisms.
In General hoss.ta sychiatric units the
*
Geriatric nursing is expanding the
psychiatric nursing practice to aged people h.
number ofadmi .iigpatientsinereased but
discharging qu ckly.
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who have been affected by emotional and Homelessness is a major problem, so
behavioural disorders such as dementia, mentally ill pacients are found in parks,
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chronic schizophrenia, delirium etc. airport, bus tenninals, jails and other public
Deaddiction Nursing: A psychiatric nurse
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places.
in these units, identifies psychosocial Some occupiesHalfway house, rent cheap
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problems and maintaining factors inaddicts hotel for shulter.

She also provides various therapies to the Psychiatric problems worsend by
addicts and their family members.
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homel:ssness and lack of adequate

Neuropsychiatric Nursing: Psychiatric comr: inity resources.
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nursing practice is extended to patients who Eme: gency room visits for acutely
are suffering from neuro-psychiatric disturbed persons have increased in some
disorders such as dementia, epilepsy, brain cities. Homelessness is a major problem
tumor, head injury, HIV infection with
behavioural problems etc.
in the United States today.
An 1993, the Access to community care
iCommunity Mental Health Nursing: It is and effective services and support
the application of knowledge ofpsychiatric (ACCESS) was created and funded by
nursing in preventing mental illness, the federal government to help homeless
promoting and maintaining mental health of mentally in patients.
the people. It includes early diagnosis,
| Goals of (ACCESS):
appropriate referrals, care and rehabilitation Improve access to comprehensive
ofmentally ill people.
services.
xijostetric Nursing: Care regarding Reduce duplication and cost of services.
pregnancy, aborsion, during labour. Improve efficiency of services

2.13 S
VIJAYAM'S

2.3.MATIONAL MENTAL HEALTH

. MENTAL HEALTH NURSING

To promote community participation in

the mental health service development
and to stimulate efforts towards self-help
PROGRAMMEV in the community.

Aims of NMHP:
To create more awareness on mental health
among rural people and to give them better iPrevention and treatment of mental and
mental health care, this community-based mental neurological disorders and their
health programme was started in India in 1982. associated disabilities.
It formed one of the important milestones in of mental health technology to
ic Use
community psychiatry in India. improve general health services.
National mental health programme was Application of mental health principles in
started with the slogan of "REACHING THE i total national development to improve
UNREACHED". quality of life.
Two strategies, complementary to each

In
Nativual Menal Health Dar other, were planned for immediate action:
h.
iCentre Periph ery Strategy:
to
Establishment and strengthening of
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psychiatric units in all district hospitals,
with outpatient clinics and mobile teams
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reaching the population for mental health

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servicesS.

iiPeriphery to Centre Strategy: Training

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70th tober of an increasing number of different

categories of health personnel in basic
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Fig. 2.3 National Mental Health Day mental health skills, with primary emphasis
towards the poor and the underprivileged,
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directly benefiting about 200 million

Objectives of NMHP: people.

The integration of mental health services

with gerneral health services.
Approaches/steps to NMHP:
iDiffusion of mental health skills to the
Tominimum
ensure availability and accessibility of
mental health care for all in the
periphery of health service system.

foreseeable future, particularly to the

The appropriate appointment oftasks in
mental health care.
most vulnerable and underprivileged
sections of populations. ii The equitable and balanced territorial
distribution of resources.
j To encourage application of mental health
integration of basic mental health care
knowledge in general health careand in jThe
social development. into the general health services.

2.14
 VIJAYAM'S
Unit-2:: History of Psychiatry
NLinkage to community development. There will be community health workers who
belong to the community and who are attached
yi Mental health care which includes
treatment, rehabilitation and prevention to the PHCs and these health workers will
provided through all the health care identify the paticnts who suffer from common
delivery systems. psychiatric disorders and bring them to the PHCs
for treatment.
vii.Improved and specialized care made
available through mental hospitals and Services or Components of NMHP:
teaching psychiatric hospitals. Subprogramme: Multiple
J. Treatmentplanned:
viii. Mental health training: minimum levels were
essentials of mental health should be aNillage and Suh-centre Level:
taught to all health care workers at Multipurpose workers (MPW) and heath
undergraduate level and specialized supervisors (HS), under the supervision
trainíng at various levels. of the medical officer (MO), to be trained
w. The care of the mentally retarded and for:

In
treatment programme for drug Management of psychiatric
dependence.
Functioning: h. emergencies.
*Administration and supervision of
la
NMHP suggests that the involvement of maintenance treatment for chronic
mental hospitals, teaching hospitals, district and psychiatric disorders.
al

taluk hospitals, primary health centres, general

Diagnosis and management of
W

practitioners and private psychiatrists jointly to

grandmal seizures, especially in the
look after the mental health care of the
children.
es

community.
Counselling in problems related to
Mental hospitals are required for very chronic
alcohol and drug abuse.
ot

and disturbed patients who cannot be looked after

in the community, many of whom may have to Primary Health Centre (PHC): MO,
N

be certified and admitted into mental hospitals aided by HS, to be trained for:
as voluntary patients.
*Supervision ofthe MPW'S
The department of psychiatry in medical i4,performance.
colleges will take the responsibility of training
Elementary diagnosis.
the general practitioners and the medical officers
in the PHCs so that they will be able to look Treatment offunctional psychosis.
after the common psychiatric disorders in the
*Treatment of uncomplicated cases of
ommunity. They will function as referral and psychiatric disorders associated with
research centres.
physical illness.
The district and taluk hospitals will have
department of psychiatry and the psychiatrists *Management of uncomplicated
in these hospitals will supervise psychosocial problems.
the medical
officers in the PHCs as well
as the general *Epidemiological survelillance of
practitioners. mental morbidity.

2.15
 MENTAL. HEALTH HURSHIG
VIJAYAM'S

PHC Dertre
Techonjes

In
Fig. h.
2.4 Primary Health Centre
la
al

District Hospitul:
psychiatrist attached to every district
1

*It was recognízed that there should be at least

W

hospital as an integral part of the district health.services.

The district health hospitals should have 30-50
psychiatric beds.
es

units: The major activíities of these higher

Mental hospitals and teaching psychiatric
ot

include:
health centres of psychiatric care
in care of difficult cases.
N

Help
* Teaching
Specialized facilities like occupation therapy units, psychotherary, counselling and behaviour
therapy.
ARehabilitation Subprogramme: The componcnts of this subprogramme include maintenance
treatment of epileptics and psychotics at the community levels and development ofrehabilitation
centres at both the district level and the higher referral centres.

aPrevention Subprogramme: The prevention component is to be community based, with the

initial focus on the prevention and control ofalcohol-related problems like addictions,juvenile
delinquency and acute adjustment problems like suicidal attempts are to be addressed.

e2.16
Unit-2:: History of Psychiatry VIJAYAM'S

The National Mental Health Progranme has been revised in 2003. The
programme
objectives are as follons:
Rescarch devclopment programme in community mental health.

Health and policy planning.

Promotion ofreferral services.

Provision of psychotropic drugs
Home care support by provision ofsufficient man power.

Services/ Components of NMHP

In
Treatment
Sub-programme |
h.
Rehabilitation
Sub-programme
Prevention
Sub-programme|
la
al
W

Village and PHC District Mental Hospitals

Sub-centre level Hospital and teaching
psychiatric unit
es

Fig. 2.5
ot
N

2.17