Social Change and Mental Health

1. Social Change and Mental Health Chapter 1

2. Social Change and Mental Health Treatment • Depends on community’s views and fears • See Table 1.1 • Periods of social stability • Less fear, more tolerance for diverse behavior • Easier and safer for people with mental illness • Periods of rapid change • Anxiety and fear towards mental illness • Often treated inhumanely

3. Moral Treatment • Definition: • Moral, compassionate and pleasant environment • 18th century • Philippe Pinel: removed chains at Bicetre (France) • William Tuke: established The York Retreat (England) • 19th century • Quaker Friends Asylum: Kind towards patients • Care of the mentally ill became a public responsibility in the United States and Canada (Horace Mann’s plea)

4. Dorothea Dix1802-1887 • Was responsible for mental health care system reform in the U.S., Canada and Great Britain • Introduced the idea of state hospitals • Twenty states established or enlarged state hospitals. • Appointed as Superintendent of Women Nurses during Civil War

5. Early Institutional Life: Its Reality • Major concern was management of a large number of people who were forced to live together. • Women could be institutionalized at whim of husband or father. • Men and women were often abused. • It eventually evolved into self-contained communities.

6. Clifford Beers(1876-1943) • Wrote of his abusive experience in several mental hospitals - A Mind That Found Itself • Founded the National Committee for Mental Hygiene • Led committee’s efforts in the development of child guidance clinics, prison clinics and industrial mental health approaches.

7. Psychiatric Nursing Thought:Early Views • Traced to Florence Nightingale’s holistic view of patients • Need for specialized psychiatric-mental health nursing recognized during Moral Treatment Era • First training school for PMHN was The Boston City Hospital Training School for Nurses (1882) at McClean Hospital. • First training school organized by nurses for psychiatric training was Johns Hopkins’ Phipps Clinic • Nursing Mental Disease by Harriet Bailey in 1920: First psychiatric nursing text

8. Modern Thinking: Evolution of Scientific Thought • Psychosocial vs. biologic theory • Psychiatric pluralism (Adolf Meyer) • Freud and psychoanalytic theory • Integration of biological theories in psychosocial treatment

9. Government Involvement in Mental Health Care • National Mental Health Act - 1946 • National Mental Health Advisory Council, which established the National Institute of Mental Health (NIMH) • Provided grants to states for construction of clinics • Hill-Burton Act - 1946 • Federal support for hospital construction • Community Mental Health Centers Construction Act - 1963 • Funded community mental health centers • Led to deinstitutionalization

10. Continued Evolution of Psychiatric-Mental Health Nursing • Development of master’s degree programs in psychiatric nursing • Interpersonal Relations in Nursing published in 1952. • Mainstreaming of psychiatric nursing into nursing education

11. Late 20th Century • Community Mental Health Movement • 1961 Action for Mental Health • 1963 Mental Retardation and CMHC Construction Act • Deinstitutionalization • Decrease in inpatient population • Sanctioning of Holistic Nursing Care • Two psychiatric nursing journals by 1963 • First development of common standards: Statement on Psychiatric Nursing Practice

12. Contemporary Issues • Changing demographics • Age of managed care • National mental health objectives • Mental Health: A Report of the Surgeon General • Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda • Healthy People 2010: National Health Promotion and Disease Prevention Objectives