A Concise Textbook of Psychiatric Mental Health Nursing Visanth VS, Mallesha S
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Mental Health
According to WHO, Health is a complete state of physical, mental and social well-being, not merely an absence of disease or infirmity.
Mental health is a state of emotional, psychological and social well-being which is expressed in terms of self-esteem and confidence. It affects the way we think, experience and express and it is essential for making choices, maintaining social relationships and handling stressors.
Mental health is influenced by individual factors, including biologic makeup, autonomy, and independence, self-esteem, capacity for growth and ability to find meaning in life, sense of belonging, reality orientation, and coping or stress management abilities.
The interpersonal factors, such as effective communication, helping others, intimacy, and maintaining a balance of separateness and connectedness and the social/cultural factors are including sense of community, access to resources, intolerance of violence, and support of diversity among people also affect mental health.
Criteria for Good Mental Health
  • Adequate contact with reality
  • Efficiency in work and play
  • Positive self-concept
  • Control of thoughts and imagination
  • Social acceptance
  • A healthy emotional life.
Mental Illness
Mental illness is a condition of behavioral or thinking pattern that results either suffering or an impaired ability to function in normal life. This may be persistent, relapsing and remitting, or occur as a single episode.
Deviant behavior does not necessarily indicate a mental disorder.
Mental Health and Mental Illness Continuum
A primary difference between mental health and mental illness is that everybody has some quantity of mental health all of the time, as in case of physical health, while it is possible that a person can be without a mental illness.
It is possible for a person to have a poor mental health with no mental illness. Despite poor mental health not defined as a disease or an illness, a person with poor mental health often suffer with emotional distress and psychosocial impairment associated with it.
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Diagram 1.1: Mental health—mental illness continuum
Evolution of Mental Health Services, Treatments and Nursing Practices
History of Development of Mental Health Care: Worldwide
It was William Sweetser who referred the term ‘mental hygiene’ in the mid-19th century, which can be seen as the precursor to modern approaches to focus on promoting positive mental health. Isaac Ray, one of the founders of the American Psychiatric Association (APA), described mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.
Views of madness in the middle ages in Europe used to be a combination of the divine, demoniac and transcendental. Theories of the four humors (black bile, yellow bile, phlegm, and blood) were used, sometimes separately and sometimes together with theories of evil spirits to describe mental illness.
Arnaldus de Villa Nova (1235–1313) connected ‘evil spirit’ and Galen-adapted ‘four humours’ theories and put forward trephining as a solution to let demons and excess humors escape. Other physical treatment modalities in common use included purges, bloodletting and whipping. Mental illness was often seen as a moral issue, either as a punishment for offense or an assessment of faith and character.
Christian theology recommended various therapies, including fasting and prayer for people disunited from God and exorcism of people possessed by the devil. In this way, although mental disorder was commonly believed to be due to sin, other more prosaic causes were also searched, including diet and alcohol, overwork, and grief.
16th to 18th Centuries
Some psychologically disturbed people may have been sufferer of the occultist-hunts that spread in tides in early modern era. However, those pronounced lunatics were progressively admitted to local correction houses and jails or sometimes to the private madhouses.
Restraints and forceful confinement were used for those people who were judged to be dangerously ill or potentially hostile to themselves, others or equity. The evolution of this group of madhouses has been linked to new plutocrat social relations, which resulted in families no longer being able to or ready to take care of disturbed relatives.
Madness was frequently portrayed in literary works, like the plays of Shakespeare.
By the end of the 17th century, mental illness was progressively viewed as an organic or physical anomaly, no longer involving the spirit or moral responsibility. The insane were typically viewed as aloof wild animals. Harsh treatment methods and restraining in chains was seen as curative, meant to suppress the animal instincts.
There was occasionally a focus on the environment of asylums, from diet to exercise patterns to number of visitors. Owners of the asylums sometimes advertised of their facilities. Treatment modalities used in few public mad houses was also cruel, often secondary to jails. The most vicious and notorious was Bedlam where at a time people could pay to watch the inmates as a form of entertainment.4
Treatments focused on humoral theory then gradually gave away to analogy and phrasings from mechanics and other evolving physical sciences. Multiple new schemes were introduced for the classification of mental illnesses, motivated by evolving systems for the biological classification of organisms and medical classification of diseases.
The term ‘crazy’ and insane came to mean mental disorder in this period. The term ‘lunacy’, long used to denote to periodic disturbance, came to be used for insanity. ‘Madness’, the term previously used to denote crippled or foolish, evolved to mean loss of reasoning or self-control.
The term ‘Psychosis’ had varied usage denoting to a condition of the mind or soul. ‘Nervous’, meaning to wind or twist, meant muscle or vigorous, was used by physiologists to denote to the body's electrochemical signaling process which resulted in coining the term ‘nervous system’.
‘Obsession’, from a Latin word meaning to sit against, previously meant to beset or be owned by an evil spirit, evolved to mean a fixed unchangeable idea that could destroy the mind.
By the end of the 18th century, a moral movement started, that emphasized more humane, social and personalized approaches. Major figures included the Physician Vincenzo Chiarugi in Italy, the ex-patient superintendent Pussin and the psychologically inclined medic Philippe Pinel in revolutionary France; the Quakers in England, led by businessman William Tuke; and later, in the United States, campaigner Dorothea Dix.
19th Century
The 19th century, in the background of industrialization and population explosion, witnessed a huge expansion of the number and size of asylums in each Western country, a movement known as ‘the great confinement’ or the ‘era of asylum ‘.
The term ‘psychiatry’ was formulated as the medical specialization and became more academically entrenched.
20th Century
The 20th century exhibited the evolution of psychoanalysis, which came to the power later. Kraepelin's classification attained popularity, including the classification of mood disorders from what would later be termed schizophrenia.
Asylum administrators tried to improve the picture and medical status of their profession. The institutionalized were increasingly referred to as ‘patients’ and the asylums were renamed as hospitals. People started referring people as having a ‘mental illness’ started from this period in the early 20th century.
Lobotomies, Insulin shock therapy, Electroconvulsive therapy, and the ‘neuroleptic’ chlor-promazine came into use mid-century.
A movement against psychiatry came to the existence in the 1960s. Deinstitutionalization progressively occurred in the West, with many psychiatric hospitals being closed down in response to community mental health services.
Various types of psychiatric treatments and medications gradually came into use, like ‘psychic energizers’ and lithium salts. Benzodiazepines obtained widespread popularity in the 1970s for anxiety and depression.5
Cognitive behavioral therapy was formulated. During the 1990s, novel SSRI antidepressants were some of the most commonly prescribed drugs in the world.
The Diagnostic and Statistical Manual of Mental Disorder (DSM) and then International Statistical Classification of Diseases and Related Health Problems (ICD) accepted new classification, representing a return to a Kraepelin-like descriptive system. The official diagnoses exhibited a large expansion, even though homosexuality was then downgraded and left out in the face of human rights protests.
21st Century
From the year 2002, DSM-5 Research Agenda scientists were called up to contribute with their publication to the theoretical basis for the DSM-5, of which draft criteria are now accessible to the scientific community.
History of Development of Mental Health Care: India
Ancient Hindu and Punjabi manuscripts known as Ramayana and Mahabharata includes fictional characterizations of depression and anxiety states. Mental illnesses were commonly thought to reflect hypothetical metaphysical entities, celestial agents, black magic or witchcraft.
An ancient work known as the Charaka Samhita, part of the Hindu medicinal book ‘The Ayurveda’, considered ill health as resulting from an inequality among three types of bodily forces called Dosha.
Psychiatry in Precolonial India
During the domination of King Ashoka, many health care facilities were established for people with mental problems. According to Ashoka Samhita, these facilities or hospitals were built with independent enclosures for various curative practices including keeping the inmates and providing treatments available during those times.
A temple at Chengalpattu, Tamil Nadu, contains engravings on the walls belonging to the period of Chola. There are various ancient data regarding propagation of alienation of insane people in Shahdaula's Chauhas in Gujarat and Punjab. Even though there is no much evidence supporting the development of mental health care in the Moghul period, there are some references to some mental health institutions in the period of Mohammad Khilji (1436–1469). There are also some clues of the presence of a mental hospital at Dhar near Mandu, Madhya Pradesh, where Maulana Fazulur Hakim was the physician.
Psychiatry in Colonial India
Mental asylums existed in the British India was a very less obvious form of social control and were greatly influenced by British psychiatry. They were mainly for the British soldiers who were posted in India during that time. The function of such institutions was mainly custodial rather than curative.
Development of mental asylums started during the early colonial period and was more apparent till the first Indian independence revolution was started. The first mental hospital in India was at Bombay which was established in the year of 1745 and was able to accommodate around 30 inmates. In 1795, the first mental hospital which was run by the government was established in Bihar and was aimed at providing custodial services to mentally ill soldiers.6
During this period, patients with mania were treated with opium and leeches were used on the mentally ill patients to suck their blood out. Hot baths were also given as a way of treatment. Music was used as a method to calm down the patients. In the community settings, mentally ill patients were taken care by the local communities and the treatment were given by the traditional doctors of Ayurveda and Unani.
After 1914, a new trend of gradual expansion of mental asylums where observed rather than building new projects. One of the important developments in this period is the establishment of India's first psychiatric rehabilitation projects by the Central Institute of Psychiatry. They initiated an occupational therapy for the mentally ill in the year 1922.
Another important change occurred during this period is the increasing awareness about the mental hygiene which paved its way to preventive psychiatry in India. Electroconvulsive Therapy (ECT) in 1943 and Psychosurgery (1947) treatment were started in India.
It was in the year 1946, when the Bhore Committee (Health survey and planning committee) was appointed and surveyed the mental hospitals. They reported many medical and professional inadequacies that were prevalent in the mental health institutions. It also suggested more intensive training for professionals of psychiatry and a separate child psychiatry units in hospitals.
Psychiatry in Independent India
A new era of betterment of mental hospitals started after the independence of India in 1947. The government of India focused primarily upon the formation of General hospital psychiatric units (GHPUs) rather than building more psychiatric hospitals.
Some new mental institutions, mainly at Delhi, Jaipur, Kottayam and Bengal were added. During Mid-1950s a rapid development in the spread to GHPUs in India was witnessed. In 1957, Dutta Ray started a mental health out-patient service at Irwin Hospital in New Delhi.
By the 1960s, traditional institutions like Central institutions of psychiatry (CIP) offered a variety of specialized services, like child and adult clinics. Old age, epileptic and neuro psychiatric services were started to fulfill the range of all-inclusive Out-patient Department (OPDs).
Another main innovation in the 1960s was the idea of a day-time hospital. Gradually, alternative accommodations were searched for patients who had recovered from the mental illness, yet could not return to their own families.
With respect to the recommendation of the Bhore committee, AIIMH (All India Institute of Mental Health) was started in 1954, which formed the National Institute of Mental Health and Neurosciences (NIMHANS) in 1974 at Bangalore.
A training program for Primary Health Care was started in 1978–79. In 1978–1984 Indian Council of Medical Research financed and administered a multicenter collective project on ‘severe mental morbidity’ in Bangalore and Patiala.
Many training programs for psychiatrists, psychologists, social workers, nurses and primary vare doctors were carried out at Sakalwara, Karnataka unit during 1981–82. Fighting social stigma and improving the social network of patients were considered as main elements of a useful rehabilitation program.7
Evolution (History) of Psychiatric Nursing Practices
  • Fourth century AD, during the period of Emperor Ashoka, hospitals started with 15 beds for mentally ill with two male and two female nurses. In 1964–65 Psychiatric nursing was included in curriculum.
  • For the first time in India, 11 British nurses along with one matron were brought from the UK to work in the mental hospital at Ranchi in the 1930s.
  • Short training courses of three to six months were conducted in Ranchi in 1921, which were recognized by the Royal Medical Psychological Association.
  • During 1948–50 four nurses were sent to the UK by Goverment of India for mental health nursing diploma.
  • From 1943, the Chennai Government organized a three months’ psychiatric nursing course (subsequently stopped in 1964), for male nursing students at the Mental Hospital, Chennai (in lieu of midwifery).
  • During 1954 Nur Manzil Medical Health centre, Lucknow gave psychiatric nursing orientation course of 4–6 weeks duration.
  • Goverment of India decided to start training psychiatric nurses during 1953–54 and started the first organized course at All India Institute of Mental Health (presently NIMHANS).
  • In 1964–1965, the Indian Nursing Council (INC) made it a requirement to integrate psychiatric nursing in the nursing diploma and degree courses.
  • In 1967, a separate Psychiatric Nursing Committee was formed in the Trained Nurses Association of India.
  • Diploma in Psychiatric Nursing is conducted in three institutions in India.
  • Master of Psychiatric Nursing (MPN) program is conducted in many institutions.
  • Doctoral program in psychiatric nursing (PhD) at NIMHANS, Bangalore.
WHO estimated that globally over 450 million people suffer from mental disorders. Currently mental and behavioral disorders account for about 12 percent of the global burden of diseases. This is likely to increase 15 percent by 2020.
World Health Organization Global Study
The World Health Organization is currently undertaking a global survey of 26 countries in all regions of the world, based on ICD and DSM criteria.
The first published figures on the 14 country surveys completed to date indicate that, of those disorders assessed, anxiety disorders are the most common in all countries. (Prevalence rate 2.4 to 18.2%) and mood disorders next most common (12-month prevalence of 0.8 to 9.6%), while substance disorders (0.1–6.4%) and impulse-control disorders (0.0–6.8%) were consistently less prevalent.
In 2000 a review of epidemiological studies estimated that the prevalence of mental disorders in India was 70 per 1000 in rural and 73 per 1000 in the urban population. In 1999, a study stated that the prevalence of mental disorders in child and adolescent population was 9.4 percent. Similarly, another study from Bangalore in 2005 documented the burden of mental disorders to be 12.5 percent. The study also showed that there were no significant differences among prevalence rates of mental disorders in urban middle class, slum and rural areas with annual incidence of 18 per 1000 population.
The prevalence of mental disorders among 0-3 yr old children was 13.8 percent, most commonly due to breath holding spells, pica, behavior disorder, expressive language disorder and mental retardation.
The prevalence rate in the 4–16 year old children was 12.0 percent mainly due to enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder. Compared with the general population, industrial workers were more predisposed to mental disorders.
In 2002, the prevalence rate of mental disorders in the Indian industrial population was estimated to be 14 to 37 percent.
Prevalence of Suicide
  • National crime record International Journal of Scientific and Research Publications, Volume 3, Issue 2, February 2013, India reported, 27.7 percent increase in recorded number of suicides between 1995 and 2005 with suicide rate of 10.5 per million.
  • A study conducted in rural areas of south India, in 2010 reported 37% of those who died by suicide had a mental disorder. The two most common reasons were alcohol dependence (16%) and adjustment disorders (15%).11
Mental disorders diagnosed and treated in the six states is given in Table: 1.1 and 1.2
Table 1.1   Prevalence of ‘psychosis’ in 6 states
Need (% diagnosed)
Covered (% Treated)
Uttar Pradesh
West Bengal
The treated cases were in the urban areas (61.7% vs 47.5%); higher, The rate of treatment was lower in the rural population.
Table 1.2   Prevalence of ‘depression ’ in 6 states
Need (% diagnosed)
Covered (% treated)
Uttar Pradesh
West Bengal
Though the prevalence rates of depression are higher than psychoses, the rates treated are far lower, pointing to the limited awareness in the community. The rate of treatment was lower in the rural population.
Uneven Distribution
In relation to above box 1.6, diagram represents need and availability of mental health services in which need exceeds the services.12
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Fig. 1.1: Uneven distribution of mental health need and services
The Mental Health Act, which was drafted by the parliament in 1987, was executed into effect in all the states and union territories of India in 1993. This act replaces the Indian Lunacy Act of 1912, which had earlier replaced the Indian Lunatic Asylum Act of 1858. After the independence, The Indian Psychiatric Society was established in the year 1947 and the Mental Health Act was passed in the year 1987.
The main purpose of Mental Health Act 1987 was to consolidate and amend law relating to treatment and care of mentally ill persons and for better provision with respect to property and affairs of mentally ill persons. According to this act some previously used terms were replaced such as nursing home or asylum to a psychiatric hospital, lunatic to mentally ill person and a criminal lunatic to a mentally ill prisoner.
(Refer chapter 14 for detail explanation of Mental Health Act.)
National Mental Health Policy
The National Mental Health Policy outlines the prioritized agenda for extending within a pragmatic time-frame basic mental health care facilities to all sections of the population across the country by the year 2020. The tactical vehicle for implementing the said policy will be the refocused National Mental Health Programme, initially formulated in 1982, with five key areas:
  1. The District Mental Health Programme (DMHP), redesigned around a Nodal Institution which in most instances will be the Zonal Medical College.13
  2. Strengthening the Medical Colleges with a view to develop psychiatric manpower (HRD), improve psychiatric treatment facilities at the secondary level and to promote the development of general hospital psychiatry in order to reduce and eventually to eliminate a large extent the need for big mental hospitals with a huge proportion of long-stay patients.
  3. Streamlining and modernization of Mental Hospitals to transform them from the present mainly custodial mode to tertiary care centers of excellence with a dynamic social orientation for providing leadership to research and development (R and D) in the field of community mental health.
  4. Strengthening of Central and State Mental Health Authorities in order that they may effectively fulfill their role of monitoring ongoing Mental Health Programmes, determining priorities at the ventral/state level and promoting intersectoral collaboration and linkages with other national programmes.
  5. Research and training aimed at building up an extensive database of epidemiological information relating to mental disorders and their course/outcome, therapeutic needs of the community, development of better and more cost-effective intervention models, promotion of intersectoral research and providing the necessary inputs/conceptual framework for health and policy planning.
Prioritized Goals
Subject to availability of resources the following time-frame is visualized for attainment in a phased manner for above mentioned policies:
10th Five Year Plan (2002–2007)
  • District Mental Health Programme (DMHP) will be extended to one district attached to each of the 100-Medical College in Country, thereby covering 100-Districts by the end of the plan period including the 27-districts where DMHP is already in place, thus making a total of 100- districts across the Country.
  • Strengthening of Medical Colleges with allocation of ₹ 50.00 lakhs each to 100-Medical Colleges preferably located in backward areas for upgrading the departments of psychiatry with the aim of instituting post graduate training courses leading to MD (Psychiatry).
  • Streamlining and modernization of Mental Hospitals with the aim of reduction in chronicity through intensive therapeutic intervention using non-conventional antipsychotic medications, promoting care of chronically mentally ill patients in the community using outreach maintenance.
  • Strengthening of Central and State Mental Health Authorities by facilitating the establishment of permanent secretariats and related machinery and networking of the state authorities with that at the national level to ensure effective coordination in all areas of activity.
  • Research and training by sponsoring relevant community based research projects and building up an extensive database which will form the basis for development of intervention models and policy planning.14
11th Five year Plan (2007–2012)
The district mental health programme will be extended to other 100-districts while consolidating the same in the 100-districts covered at the end of the 10th plan. Psychiatry Department of the remaining Medical Colleges will be upgraded and the infrastructure created during the previous plan will be reinforced. Qualitative as well as quantitative improvements will be introduced in the areas of research, training and International Electrotechnical Commission (IEC), with more focused attention on epidemiological catchments area surveys on a larger scale.
12th Five Year Plan (2012–2019)
The district mental health programme will be extended to the remaining 161-districts and the gains made in the previous plans will be consolidated, upgradation of the remaining 39-Medical College Psychiatry Departments will be undertaken and 20-Mental Hospitals will be taken up for disinvestments/reconstruction.
Non-viable mental hospitals will be closed down or merged with general hospitals to create general hospital psychiatry units (GHPUs). Central and State Mental Health Authorities will be further reinforced and technologically more sophisticated long-term research projects will be initiated in selected institutions while continuing support to community based research. IEC activities will be augmented to cover all sections of the population across the whole country.
National Health Policy
The Ministry of Health and Family Welfare, Government of India, evolved a National Health Policy in 1983 and 2002.
  • The policy lays stress on preventive, promotive, public health and rehabilitation aspects of health care.
  • The policy stresses the need of establishing comprehensive primary health care services to reach the population in the remote area of the country.
  • A greater awareness of health problems and means to solve them.
  • Supply of safe drinking water and basic sanitation.
  • Reduction of existing imbalance in health services by concentrating on the rural health infrastructure.15
  • Establishment of dynamic health management information system to support health planning.
  • Provision of legislative support to health protection and promotion.
  • Research into alternative methods of healthcare delivery and low cost health technologies.
  • Greater coordination of different systems of medicine.
  • To achieve an acceptable standard of good health amongst the general population of the country.
  • To increase access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions.
  • To ensuring a more equitable access to health services across the social and geographical expanse of the country.
  • To increase the aggregate public health investment through a substantially increased contribution by the Central Government.
  • To strengthen the capacity of the public health administration at the State level to render effective service delivery.
  • To enhance the contribution of the private sector in providing health services for the population group which can afford to pay for services.
  • To rationalize use of drugs within the allopathic system.
  • To increase access to tried and tested systems of traditional medicine.
The Government of India launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it.
NMHP has three Components
  1. Treatment of Mentally ill.
  2. Rehabilitation.
  3. Prevention and promotion of positive mental health.
  • 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.
  • To encourage application of mental health knowledge in general health care.
  • To promote community participation in the mental health services development.
(Refer chapter 15 for detail explanation of mental health programme)17
A Multidisciplinary/Interdisciplinary Approach
Team work is important in any setting so as in a mental health setting. In mental health care setting, different professionals act hand in hand to help the patient with an overall objective of patient wellness.
For the promotion of a therapeutic environment, members of various discipline coordinate their activity. Four health care professionals constitute the core mental health disciplines: Psychiatric nursing, psychiatry, clinical psychology and psychiatric social work.
Teamwork is a coordinated and dedicated effort of each and every member of the team toward achievement of a vested interest, target or goal of the team as an entity. It becomes more significant in a mental health setting where the contribution of all the members is extremely vital for a comprehensive care of the mentally ill client.
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Fig. 1.2: Mental health team members
The psychiatrist is a doctor with a postgraduation in psychiatry with 2 to 3 years of residential training. He is responsible for diagnosis, treatment and prevention of mental disorders, prescribe medicines and somatic therapies and function as a leader of the mental health team.
Psychiatric Nurse Clinical Specialist
The psychiatric nurse clinical specialist should have a master degree in nursing, preferably with postgraduate research work.
She/he participates actively in primary, secondary and tertiary prevention of mental disorder and provides individual, group and the family psychotherapy in a hospital and community setting. She/he also takes the responsibility of teaching, administration and research, etc. in a mental health setting. She/he takes up the role of a leader and can practice independently.18
Registered Nurse in a Psychiatric Unit
The registered nurse undergoes a General Nursing and Midwifery program or BSc Nursing/PB BSc Nursing program with added qualification such as diploma in psychiatric nursing, and should have registration with state nursing council.
She/he is skilled in caring for the mentally ill, gives holistic care by assessing the patient's mental, social, physical, psychological and spiritual needs and applies psychiatric nursing process.
Clinical Psychologist
The clinical psychologist holds a Doctoral degree in clinical psychology and is registered with clinical psychologist's association. He/she conducts psychological tests, interprets and evaluates the finding of these tests and implements a program of behavior modification.
Psychiatric Social Worker
The psychiatric social worker is a graduate in social work and postgraduate in psychiatric social work. He/She assesses the individual, the family and community support system, helps in discharge planning, counseling for job placement and is aware of the state laws and legal rights of the patient and protects these rights.
Psychiatric Para-professionals
  • Psychiatric nursing aids
  • ECT technicians
  • Auxiliary personnel
  • Occupational therapist
  • Recreational therapist
  • Diversion play therapist
  • Creative art therapist
  • Clergyman.
The scope of mental health nursing is not restricted within the confines of the bed-side nursing care. A mental health nurse needs to be skilled and clinically competent, sensitive to the social environment, the advocacy of the needs of the patient's and their families as well as beware of the legal and ethical dilemmas.
Philosophical Beliefs in Nursing Practice [Nature of Mental Health Nursing]
  • Individual has intrinsic worth and dignity and respect.
  • Each person foundation as a holistic being, who acts, interacts with and reacts to the environment as a universal person.
  • All behavior of the individual is meaningful. It arises out from personal needs and goals and can be understood only by the person's internal frame of reference and within the context in which it occurs.
  • Behavior consists of perceptions, thought, feelings, and actions.
  • Individual vary in their coping capacities, which depend on genetic, environmental influence, nature and degree of stress, and available resources. All individual have the potential for both health and illness.19
  • The goal of nursing care is to promote wellness, maximize functioning, and enhance self-actualization of clients.
  • An interpersonal relationship will produce change and growth within the individual.
  • The psychiatric nurse adopts knowledge from the psychosocial and biophysical sciences and theories of the personality and the human behavior.
Scope of Mental Health Nursing
The areas concerned for the psychiatric mental health nurse include a wide range of actual or potential mental health problem.
A mental health nurse needs to be skilled and clinically competent, sensitive to the social environment, the advocacy needs of the clients and their families as well as be aware of the legal and ethical dilemma.
Components of Scope of Mental Health Nursing
There are six components involved in the Nurse patient partnership or the Nurse patient relationship:
  1. Clinical competence.
  2. Patient family advocacy.
  3. Fiscal responsibility.
  4. Interdisciplinary collaboration.
  5. Social accountability.
  6. Legal ethical parameters.
Apart from the six components there are other different areas that include the following:
  • Current issues and trends in care involving in health care, economic issues, changes in illness orientation, changes in care delivery system, information technology, consumer empowerment, deinstitutionalization, physician shortage and gaps in service, demographic changes, and changes in patient needs.
  • Educational programs for the psychiatric nurse from Diploma to Doctorate and also various short-term training program.
  • Standards nursing practice is a beginning step toward of quality of nursing care and standards are provided in all the health team members therefore they improve the quality of care in mentally ill patients.
  • Development of code of ethics to take up independent roles in all therapy and protect the rights and act as patient advocate.
  • Legal aspects in Psychiatric Nursing.
  • Promotion of research in Mental Health Nursing aids in the innovative findings in the both theories and research.
  • Cost effective nursing care to identify the cost involved in the training of the nurse and the quality care output.
  • Focus of care on certain target groups like elderly, children, women, mentally retarded and chronic mentally ill.
  • Role of nurse in contemporary mental health care that involve both the extended role and the other areas of working.20
Role in Contemporary Mental Health Care
  • Community mental health nurse.
  • Psychiatric home care nurse.
  • Forensic psychiatric nurse.
  • Psychiatric consultation liaison nurse.
  • Case manager.
  • Gero psychiatric nurse.
  • Parish nurse.
  • Tele health/Tele nurse.
  • Psychiatric Nurse Educator.
  • Nurse Manager.
Role of Nurse in Various Settings
Role in Mental Hospital
  • Patient care.
  • Education and supervision.
  • Ward management.
  • Interpersonal Process Recording (IPR) and communication.
  • Role in other therapies like,
    • Chemotherapy
    • Family therapy
    • ECT and Physical therapy.
Role of Nurse in Community Mental Health
  • Consultative role
  • Clinical role
  • Therapeutic role
  • Researcher
  • Trainer
  • Administrator
  • Domiciliary care.
Factor Affecting the Level of Nursing Practice
  • Increased consumer.
  • Awareness of community in early detection and treatment of mental illness.
  • Availability of multidisciplinary team approach.
  • Reorganization of physical structure of the hospital.
  • Change in method of treatment.
  • Increased priority on rehabilitation of the patient.
  • Expansion of psychiatric services within general hospital.
  • Emphasis of mental health services in national health policy.21
Concepts of Normal and Abnormal Behavior
Concept of Normal Behavior
People having average amount of intelligence, personality, stability, and social adaptability are considered as normal.
Do You Know?
Word normal derived from latin word norma means rule. To follow rule or pattern or standards.
Concept of Abnormal Behavior
Abnormality refers to maladjustment to one's society and culture which surrounds him. It is the deviating from the normal in an unfavorable and pathological way. In other words, it deals with the unusual behavior of man. The unusual or maladapted behavior of many persons which do not fit into our common forms of behavior is known as abnormal behavior.
A close analysis of various types of abnormal behavior indicates that abnormal behavior circumscribes a wide range of maladaptive reactions like psychoneuroses, psychoses, delinquents, sexually deviants, and drug addicts, etc. The abnormal deviants who are about 10 percent of the general population are classified into four main categories:
  1. Psychoneurotic
  2. Psychotic
  3. Mentally defective
  4. Antisocial.22
Thus, abnormality and normality can only be defined in terms of conformity to the will and welfare of the group and in the capacity for self-management.
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Defining the concepts of normal and abnormal behavior is found to be difficult. Several models have been put forward in order to explain the concept of normal and abnormal behavior.
Medical Model
Medical model describes mental illness as a result of organic pathology. According to this model, abnormality is characterized by the disturbances in thought, emotions and behavior.
Statistical Model
Statistically normal mental health falls within two Standard Deviations (SDs) of the normal distribution curve. Therefore mental illness falls outside two Standard Deviations of the normal distribution curve.
Utopian Model
Utopian model regards normal mental health as an individual's ability to blend various mental faculties so that he can function at optimum level.
Process Model
Normal behavior is the result of interacting system. This model focuses the need for developmental changes in the attainment of mature adult functioning.23
Social Model
Normality is defined in context with social norms prescribed by the culture. When there is a deviation from the social norms, it is considered as an abnormal behavior.
Behavioral Model
Behavior that is adaptive and socially acceptable is considered as normal. Abnormal behavior is a set of faulty behaviors acquired through learning.
There is no clear demarcation between Normality and Abnormality because no individual is static and their behavior or nature varies and the continuum also will be deviated but it is depicted on the basis of the general derivation systematically processing.