Unit 1A- Introduction to Mental Health

1. Unit 1A-Introduction to Mental Health M. Mullings-Barrett, MSc Nursing, Mental Health/Psychiatric Nurse Practitioner, Regional Mental Health Officer M. Mullings-Barrett, NCU 2011

2. Objectives • At the end of the session students will be able to: • Discuss the concept of mental health/illness and related terms • Explain the history of psychiatry as a foundation for current psychiatric nursing practice • Outline the scope of the mental health services in Jamaica • Analyse the immediate and long term effect of the community mental health care from a national and international perspective M. Mullings-Barrett, NCU 2011

3. Concept of mental health/illness and related terms M. Mullings-Barrett, NCU 2011

4. Health • HEALTH: According to the World Health Organization, health “…is a state of complete physical, mental and social well being and not merely the absence of disease and infirmity…” • Mental health is the “…capacity for each of us to think, feel and act in ways that enhance our ability to enjoy life and deal with challenges we face.” M. Mullings-Barrett, NCU 2011

5. MENTAL HEALTH • Mental health is: • How you think, feel and act in order to deal with the situations which life presents. • How you look at yourself, your life and the people in your life. • How you handle stress, evaluate your options and make choices. M. Mullings-Barrett, NCU 2011

6. MENTAL HEALTH Mental health is a state of well being in which the individual realizes his or her own abilities, is able to cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. M. Mullings-Barrett, NCU 2011

7. MENTAL ILLNESS Mental illness therefore speaks to the individual who is no longer experiencing wellness be it cognitively, spiritually, emotionally or psychologically. M. Mullings-Barrett, NCU 2011

8. MENTAL DISORDERS Mental Disorders define a realm of biological, cognitive and behavioural dysfunction, which impair the person’s psychological, social, occupational wellbeing. American Psychiatric Association, 2000 M. Mullings-Barrett, NCU 2011

9. PSYCHIATRY • The branch of medicine that deals with the diagnosis, treatment and prevention of mental and emotional disorders M. Mullings-Barrett, NCU 2011

10. National historical perspective on mental health M. Mullings-Barrett, NCU 2011

11. Ancient times • The sickness was believed to be displeasure of the gods and punishment for sins and wrongdoings • Depending on the symptoms displayed the disorder in some cultures were viewed as divine or demonic • Individuals seen as divine were worshipped, those as demonic were ostracized, punished in various ways - from being sent out of cities, to being starved, beaten, and even put to death. M. Mullings-Barrett, NCU 2011

12. Ancient times • Aristotle (382 – 322BC), developed a theory to relate mental disorders to physical disorders and developed the four “humors” – blood, water and yellow and black bile in the body, that controlled emotions. • These corresponded with happiness, calmness, anger and sadness; imbalances of these four “humors’ were believed to cause mental disorders • Treatment was therefore aimed at restoring balance through blood letting, starving and purging M. Mullings-Barrett, NCU 2011

13. Ancient times • “Trephining” was performed by some prehistoric people – a hole was placed in the skull to relieve the symptoms of mental illness e.g. headaches, demons and probably mental derangement. • In Egypt persons with mental disorders were kept in sanitariums. M. Mullings-Barrett, NCU 2011

14. Ancient times • In Greece, Hippocrates (460-375 BC) became aware of the state of ‘melancholia and epilepsy”. • Treatment was in special temples with fresh air, pure water and sunshine. There was “symphony and sweet harmony of voices” in the environment • In addition, theatricals, riding, walking, and listening to the sound of waterfalls were used as to divert their attention from the melancholic feelings. • Some patients were chained, flogged and starved. M. Mullings-Barrett, NCU 2011

15. Ancient times • The practices of the Greeks followed into the Roman civilization and mental Illness was treated by bleeding, purging and the use of sulfur baths. • In the early Christian times (1 – 1000 AD) primitive beliefs and superstition continued which linked mental illness with being possessed by devils, hence priests were responsible for their treatment. • Exorcism was also practiced • If this did not work, more severe and brutal measures such as incarceration in dungeons, flogging and starving were used M. Mullings-Barrett, NCU 2011

16. Ancient times • In the renaissance (1300 – 1600), a distinction was made between the mentally ill and criminals; those considered harmless were allowed to wander the countryside or live in rural communities but the more dangerous ones were thrown into prison, chained and starved. • In 1547, the Hospital of St. Mary of Bethlehem, became an official hospital for the insane, the first of its kind • By 1775, visitors of the institution were charged a fee to view the inmates who were looked upon as animals and were ridiculed • In the colonies and US during this same period the mentally ill were considered evil or possessed and were punished – witch hunts were conducted and offenders were burnt at stake M. Mullings-Barrett, NCU 2011

17. Pre modern Era – development of asylums • In the 1790s, Philippe Pinel of France and William Tukes of England developed the concept of asylums a safe refuge or haven offering protection at institutions • This initiated a more moral treatment for the mentally ill • In the USA, Dorothea Dix (1802 – 1887) started a reformation of the treatment of the mentally ill after visiting Tukes institution in England • She was instrumental in opening 32 state hospitals that offered asylum to the suffering; “ she believed that society was obligated to those who were mentally ill and promoted adequate shelter, nutritious food and warm clothing M. Mullings-Barrett, NCU 2011

18. Pre modern Era – development of asylums • Problems started to develop in the asylums as attendant were accused of abusing residents • It was also viewed as isolating patients from families and home. Thus the term insane asylum took on a negative connotation M. Mullings-Barrett, NCU 2011

19. Pre-modern era - The period of scientific study • In 1883 Emil Kraeplin a German Psychiatrist published a book in which he classified behaviours based on symptoms observed. He named one illness “Dementia Praecox” • Eugene Bleular named it “Schizophrenia” in 1911 • Clifford Beers, in 1907, in his book “A Mind That Found Itself”, emphasized the importance of prevention and early recognition of mental illness • The concept of Mental Hygiene was developed M. Mullings-Barrett, NCU 2011

20. Pre-modern era - The period of scientific study • Sigmund Freud (1856-1939) revolutionized the concepts of the mind with his psychoanalytic theories • Psychotherapy was developed M. Mullings-Barrett, NCU 2011

21. Pre-modern Era – development of psychopharmacology • The development of psychotropic drugs in the 1950’s was a great step in the treatment of the mentally ill. The first drugs to be developed were Chlorpromazine (an antipsychotic) and lithium (an antimanic agent) • Over the next 10 years - drugs such as monoamine oxidase inhibitor antidepressants, haloperidol (antipsychotic), tricyclic antidepressants and anti-anxiety agent – benzodiazepines were introduced • Persons could now be treated for shorter periods as in-patients; agitated and aggressive behaviours controlled and a reduction in stay in hospitals. M. Mullings-Barrett, NCU 2011

22. Other treatments used prior to psychotropic agents • Insulin shock therapy • Electroconvulsive therapy (1938) for Depression. • Surgery – Prefrontal Lobotomy: to reduce agitation and aggression M. Mullings-Barrett, NCU 2011

23. The Jamaican story • Similar situations existed in Jamaica (1850- 70s) as was taking place across the rest of the world • Persons who were mentally ill were beaten, stoned, starved, tied with ropes. • In fact it became an offence to be mentally ill and they were often charged with “lunacy” and locked –up • As with the development of lunatics asylum across the world – the Kingston Public Hospital also had an asylum • Treatment in the asylum was also very poor as residents were also abused and some underwent a condition called “tanking” M. Mullings-Barrett, NCU 2011

24. The Jamaican story • It was as a result of one patient – Ann Pratt who wrote about the state of affairs at that institution • A special commission was sent from England to investigate the situation- This led to recommendations for the establishment of a special psychiatric hospital • Other discoveries were also made by psychologists that started the influence that changed the treatment of the mentally ill M. Mullings-Barrett, NCU 2011

25. Modern Era – development of community mental health services • In the 1950’s & 1960’s developed countries such as the United States of America and England began to focus on providing mental health services at the community level. • This was due to the enactment of the Community Mental Health Centers Construction Act which has as its focus – deinstitutionalization ( a deliberate shift from institutional care in state hospitals to community facilities) M. Mullings-Barrett, NCU 2011

26. Modern Era – development of community mental health services • The aim was to : • Reduce institutional care & stigma of the mentally ill • Treat the mentally ill in facilities closer to their homes • Reduce costly in-patient care and maintain patients at an optimal level of functioning in their own homes. M. Mullings-Barrett, NCU 2011

27. Modern Era – development of community mental health services – (Jamaica) • In Jamaica, Bellevue Hospital was the sole facility for the care of the Mentally Ill until 1966. • In 1958 the World Health Organization (WHO) Psychiatric Consultant – Dr. Roberts recommended to the Government of Jamaica that Psychiatric facilities be established island wide • This led to inception of the community mental health services (CMHS) in 1966 M. Mullings-Barrett, NCU 2011

28. Modern Era – development of community mental health services – (Jamaica) • First, Social Workers from the BVH were sent to communities to treat patients, however they did not have all the required skills to do the work. • In 1966, six nurses received special training in psychiatric nursing and deployed from BVH to some health and hospitals across the island, to provide the follow up treatment of patients who were discharged from BVH. M. Mullings-Barrett, NCU 2011

29. Modern Era – development of community mental health services – (Jamaica) • The Post Basic Psychiatric Nursing Course was introduced later to train these specialist nurses. It initially started with a 4 months training which was increased to 6 months in 1999. • After the introduction of the specialist Nurse (Mental Health Officer’s), the population of Bellevue Hospital started to decreased from 3000 in the 1960’s to 1500 to the present figures of under 1000. • The introduction of the mental health nurse practitioner programme(late 1990s) led to the training of advanced practice nurse who specialized in psychiatric and could provide a holistic care for patients M. Mullings-Barrett, NCU 2011

30. Modern Era – development of community mental health services – (Jamaica) • A policy decision from the Ministry of Health and Environmental Control in 1972, directed that patients be treated in local hospitals and clinics. • UHWI opened an in patient unit and later the Cornwall Regional Hospital. • With the incept of decentralization, patients are treated on the medical wards of community hospitals M. Mullings-Barrett, NCU 2011

31. CMHS – interdisciplinary team • The staffing of the CMHS has gradually increased over the years. Presently it includes: • Psychiatrists • Mental Health Officers (MHOs) • Mental Health/Psychiatric Nurse Practitioners (MH/PNPs) • Psychiatric Nursing Aides • Psychologists • Social Workers M. Mullings-Barrett, NCU 2011

32. CMHS • In general the CMHS involves all the mental health services offered at the community level, aimed at • promotion of good mental health through education of individuals, families & communities • prevention of mental illness • early detection and screening for mental disorders • prompt treatment of mental disorders • rehabilitation of the mentally ill M. Mullings-Barrett, NCU 2011

33. Scope of service • Levels of care • Primary – clinics • Secondary – all hospitals in the different parishes • Tertiary - specialist hospitals/units: Rehabilitation facilities • Bellevue Hospital • Ward 21 – University Hospital of the West Indies • Ward 10 – Cornwall Regional Hospital • Detoxification Unit - UHWI • Non –governmental organisations – Mensana, Wasp, City Spirit, etc • Supervised living facilities M. Mullings-Barrett, NCU 2011

34. Reference • American Psychiatric Association (2000) Diagnostic and statistical manual of mental health disorders. Text Revision. (4th Ed.) New York: Author • Videbeck, S. L. (2008). Psychiatric mental health nursing. (4th Ed.). Iowa: Wolters Kluwer, Lippincott Williams& Wilkins M. Mullings-Barrett, NCU 2011