INTRODUCTION

OF
MENTAL HEALTH NURSING

KAJAL MORE
MSC(N)
 MENTAL HEALTH
It is a state of balance between the
individual & the surrounding world, a state
of harmony between oneself & others, co-
existence between the realities of the self &
that of other people.
 DEFINITIONS
Karl Menninger (1947) defines mental
health as
“An adjustment of human beings to the
world & to each other with a maximum of
effectiveness & happiness.”
The American Psychiatric Association
(APA 1980) defines mental health as
“ Simultaneous success at working, loving
and creating with the capacity of mature &
flexible resolution of conflicts between
instincts, conscience, important other
people & reality.”
COMPONENTS OF MENTAL
HEALTH
THE
THE
CAPACITY TO
ABILITY TO
FEEL RIGHT
ACCEPT
TOWARDS
SELF
OTHERS

THE ABILITY
TO FULFIL
LIFE’ S TASKS
 THE ABILITY TO ACCEPT SELF
A mentally healthy individual feels
comfortable about himself. He feels
reasonably secure & adequately accepts his
shortcomings. In other words, he has self-
respect.
THE CAPACITY TO FEEL RIGHT
TOWARDS OTHERS
An individual who enjoys good mental
health is able to be sincerely interested in
other’ s welfare. He has friendship that is
satisfying & lasting. He is able to feel a
part of group without being submerged by
it. He takes responsibility for his neighbors
& his fellow members.
 THE ABILITY TO FULFIL LIFE’ S
TASKS
A mentally healthy person is able to think
for himself, set reasonable goals & take his
own decision. He does something about the
problems as they arise. He shoulders his
daily responsibilities, and is not bowled
over by his own emotions of fear, anger,
love or guilt.
 CRITERIA FOR MENTAL
HEALTH
Adequate contact with reality.
Control of thoughts & imagination
Efficiency in work & play.
Social acceptance.
Positive self-concept.
A healthy emotional life.
 INDICATORS OF MENTAL
HEALTH
A POSITIVE GROWTH,DEVELOPMENT
ATTITUDE & THE ABILITY FOR SELF-
TOWARDS ACTUALIZATION
SELF

INTEGRATION
 INDICATORS OF MENTAL
HEALTH

AUTONOMY PERCEPTION OF REALITY

ENVIRONMENTAL
MASTERY
 A POSITIVE ATTITUDE
TOWARDS SELF
This includes an objective view of self,
including knowledge & acceptance of
strengths & limitations.
The individual feel a strong sense of personal
identity & security within the environment.
 GROWTH,DEVELOPMENT &
THE ABILITY OF R SELF
ACTUALIZATION
This indicator correlates with whether the
individual successfully achieves the task
associated with each level of development.
 INTEGRATION

Integration includes the ability to adaptively

respond to the environment & of which help
the individual maintain anxiety at a
manageable level in response to stressful
situations.
 AUTONOMY

It refers to the individual’ s ability to perform

in an independent self-directed manner, the
individual makes choices & accepts
responsibility for the wants & needs of
others.
 PERCEPTION OF REALITY

This includes perception of the environment

without distortion, as well as the capacity for
empathy & social sensitivity – a respect &
concern for the wants & needs of others.
ENVIRONMENTAL MASTERY

This indicator suggests that the individual

has achieved a satisfactory role within the
group, society or environment. He is able to
love & accept the love of others.
 CHARACTERISTICS OF A
MENTALLY HEALTHY PERSON
• He has an ability to make adjustments.
• He has a sense of personal worth, feels
worthwhile & important.
• He solves his problems largely by his own
effort & make his own decisions.
 CHARACTERISTICS OF A
MENTALLY HEALTHY PERSON
• He has a sense of personal security & feels
secure in a group, shows understanding of
other people’ s problems & motives.
• He has a sense of responsibility.
• He can give & accept love.
 CHARACTERISTICS OF A
MENTALLY HEALTHY PERSON
• He lives in a world of reality rather than
fantasy.
• He shows emotional maturity in his
behavior, and develops a capacity to tolerate
frustration & disappointments in his daily
life.
 CHARACTERISTICS OF A
MENTALLY HEALTHY PERSON
• He has developed a philosophy of life that
gives meaning & purpose to his daily
activities.
• He has a variety of interests & generally
lives a well-balanced life of work,rest &
recreation.
 MENTAL ILLNESS

• Mental illness is maladjustment in living. It

produces a disharmony in the person’ s
ability to meet human needs comfortably or
effectively & function within a culture.
 MENTAL ILLNESS

• In general, an individual may be considered

to be mentally ill if:-
1. The person’s behavior is causing distress
& suffering to self & others.
2. The person’ s behavior is causing
disturbance in his day to day activities,
job & IPR.
 DEFINITION

• Mental & behavior disorders are understood

as clinically significant conditions
characterized by alterations in thinking,
mood (emotions) or behavior associated
with personal distress or impaired
functioning.(WHO)
 CHARACTERISTICS OF
MENTALLY ILLNESS
• Changes in one’s thinking, memory,
perception, feeling & judgement resulting in
changes in talk & behavior which appear to
be deviant from previous personality or
from the norms of community.
 Misconceptions related to mental illness
• 1. Mental Illness is Rare
• Reality: Mental health disorders are common. Around 1 in 5
individuals will experience a mental health issue at some point in their
lives.
• 2. Mental Illness Equals Dangerous Behavior
• Reality: Most people with mental health conditions are not violent. In
fact, they are more often victims of violence than perpetrators.
• 3. Mental Illness is a Character Flaw
• Reality: Mental health conditions arise from complex interactions
between biological, psychological, and environmental factors, not from
personal weakness.
• 4. All Mental Health Issues are the Same
• Reality: Mental illnesses vary significantly in terms of symptoms,
causes, and treatment approaches. Each disorder requires a unique
understanding and treatment plan.
• 5. You Can "Just Get Over It"
• Reality: Mental illnesses often require professional
treatment and support. Recovery is a process that
involves therapy, medication, or other interventions.
• 6. Children Don’t Experience Mental Illness
• Reality: Mental health issues can affect individuals of all
ages, including children. Early recognition and
intervention are critical.
• 7. Mental Health Problems are a Result of Poor
Parenting
• Reality: While family dynamics can influence mental
health, disorders often stem from a combination of
genetic, biological, and environmental factors, not solely
parenting.
• 8. Medication is the Only Treatment
• Reality: While medications can be effective, many mental
health issues benefit from a combination of therapies,
including counseling, lifestyle changes, and support
groups.
• 9. Individuals with Mental Illness Can't Work or
Function Normally
• Reality: Many people with mental health conditions lead
productive lives and can successfully manage their
symptoms with appropriate treatment and support.
• 10. Stigma Doesn’t Affect Recovery
• Reality: Stigma can deter individuals from seeking help
and can negatively impact their recovery process.
Educating healthcare providers and the public is essential
for improving outcomes.
PRINCIPLES OF MENTAL
HEALTH NURSING
1. ACCEPT THE PATIENT EXACTLY AS
HE IS.
• Acceptance conveys the feelings of being loved and care:
it provides the patient with an experience, which is
emotionally neutral, where he finds unlearning of his sick
behavior is less threatening before he can relearn the art
of living with himself with others.
• Acceptance does not mean complete permissiveness, but
setting of positive behavior to convey to him the respect
as an individual human being acceptance is expressed in
the following ways:
2) USE SELF UNDERSTANDING AS A
THERAPEUTIC TOOL
• Self understanding leads to understanding to others.
• Patient’s behavior can produce lot of anxiety or fear in the
nurse, and she ought to understand why she is anxious or
frightened.
• We can understand ourselves better by
• Exchanging personnel experience freely with our
colleagues
• Discussing our personal reaction with an experienced
• Participating in group conference regarding our patient
care.
• Introspective on why we feel or the way we do.
3) USE CONSISTENT BEHAVIOUR TO
INCREASE PATIENT’S EMOTIONAL
SECURITY.
• Patient to be consistently and continuously exposed to an
atmosphere of quiet acceptance.
• Permissiveness to be limited e.g. with homicidal, suicidal,
hyperactive and suspicious patients.
• Patient is allowed to feel as he does but limitations are put
on his behavior.
• Attempt to win patient’s liking is most disastrous for the
patient.
4) GIVE REAASSURANCE RENCE TO
PATIENTS IN ACCEPTABLE MANNER
• Reassurance is building patient’s confidence or restoring
his confidence. While giving reassurance , we must avoid
saying to the patient ‘you will get well, “nothing to worry”
5) Change patient’s behavior through emotional
experience and not by rational interpretation.

• Major focus in psychiatry is on feeling aspect and not on

intellectual aspect. Telling and advising the patient is not
effective in changing behavior.
• Role play and emotional drama and transactional analysis
are few ways of creating emotional experience in a
patient.
6) AVOID UNECESSARY INCREASE IN
PATIENT’S ANXIETY
• Anxiety is a feeling of fear for an unknown object or event.
• It is a threat to biological integrity of a person.

Psychiatric patients have already some amount of anxiety

so psychiatric nurses should not further increase their
anxiety by:
• Contradicting his psychotic ideas.
• Demanding the patient to complete set task.
• Making him to face repeated failure.
• Using big sentences, professional terms while talking with
him.
• Care less conversation with patient
7) DEMONSTRATE OBJECTIVE OBSERVATION TO
UNDERSTAND AND INTERPRET THE MEANING OF
PATIENT’S BEHAVIOUR
• We need to observe the patient when he says or does.
• Analysis of the observation should be done to draw thaw
the motivation or purpose behind his talk or action.
• While working with patient learn his basic problems guess
what he will do. Keep asking yourself what is the goal of
patient and why he behaves like this.
• Be objective.
• Objectivity is not coldness but it is indifference and
absence of feelings and ability not to let your own
judgment confused with emotional warmth.
8) MAINTAIN REALISTIC NURSE
PATIENT RELATIONSHIP
• Realistic and professional relationship focuses on the
personal and emotional needs of patient.
• It is therapeutically oriented and planned
• It is always based on patient’s needs
• Nurse differentiate between patient’s demands and actual
needs
• It is for purpose or bringing adaptive ness, integration and
maturity in relations.
9) AVOID PHYSICAL AND VERBAL
FORCE AS MUCH AS POSSIBLE
• Any kind of force results in psychological trauma in patient
• Restraining the violent patient is an e.g. of physical restrain.
If all needs to be use the following points to be kept in mind:
•Carry out procedure quickly , firmly and effectively
•Do not show anger while tying
•Tell him the reason and tell that he will be allowed to mix with
others when he get the control on him.
•Attend his needs as usual never show him that he is being
punished
•After he becomes controlled never remind him again about the
incidence.
10) NURSING CARE IS CENTERES ON THE
PATIENT AS A PERSON AND NOT ON CONTROL
OF SYMTOMS
• Every is caused, understand the meaning behind the
behavior.
• Two patients showing the same symptoms may have
different needs .e.g. one may have headache due to
sleeplessness and other may have due to hypoglycemia
• Analysis and study of symptoms is necessary to reveal
their meaning and their significant to patient
11) EXPLAIN ROUTINE PROCEDURE AT
PATIENT’S UNDERSTANDING LEVEL
• Every patient has right to know what is being done and
why it is being done on him
• Every procedure should be explained at his
understanding level to reduce his anxiety
• Character of explanation depends on: patient’s attention,
level of anxiety, and level of ability to decide.
12) MANY PROCEDURES ARE
MODIFIED BUT BASIC REMAINS
UNULTERED
The nursing principles remain same such as:
• Safety
• Comfort
• Individuality and privacy
• Maintain therapeutic effectiveness , workmanship during
procedure
• Economy of time, energy and material
⚫ A psychiatrist
⚫ A psychiatric nurse
⚫ A clinical psychologist
⚫ A psychiatric social worker
⚫ An occupational therapist or an activity therapist
⚫ A pharmacist and a dietician
⚫ A counsellor
 NATIONAL MENTAL HEALTH PROGRAM

• The GOI launched the National Mental

Health Program(NMHP) in 1982,keeping in
view the heavy burden of mental illness in
the community,& the absolute inadequacy
of mental health care infrastructure in the
country to deal with it.
 AIMS

1. Prevention & treatment of mental

neurological disorders & their associated
disabilities.
2. Use of mental health technology to
improve general health services.
3. Application of mental health principles
in total national development to improve
quality of life.
 OBJECTIVES

1. To ensure availability & accessibility of

minimum mental health care for all in the
foreseeable future, particularly to the
most vulnerable & underprivileged
sections of the population.
2. To encourage application of mental
health knowledge in general health care
& social development.
 OBJECTIVES

3. To promote community participation in the

mental health services development & to
stimulate efforts towards self-help in the
community.
 STRATEGIES

1. Integration of mental health with primary

health care through the NMHP.
2. Provision of tertiary care institutions for
treatment of mental disorders,
3. Eradicating stigmatization of mentally ill
patients & protecting their rights through
regulatory institutions like the central & state
mental health authority.
 APPROACHES
1. Integration of mental health care services
with existing health services.
2. Utilization of the existing infrastructure of
health services & also deliver the minimum
mental health care services.
3. Provision of appropriate task-oriented
training to the existing health staff.
4. Linkage of mental health services with the
existing community development program.
 TREATMENT:-MULTIPLE LEVELS

c. Diagnosis & management of gradmal

epilepsy, especially in children.
d. Liaison with local school teachers &
parents regarding MR & behavioral problems
in children.
e. Counselling problems related to alcohol &
drug abuse.
 TREATMENT:-MULTIPLE LEVELS

B. MO of PHC aided by HS, to be trained

for:-
a. Supervision of MPW’s performance.
b. Elementary diagnosis
c. Treatment of functional psychosis.
d. Treatment of uncomplicated cases of
psychiatric disorder associated with
physical diseases.
 TREATMENT:-MULTIPLE LEVELS

e. Management of uncomplicated
psychological diseases.
f. Epidemiological surveillance of mental
morbidity.
C. District hospital: It was recognized that
there should be at least one psychiatrist
attached at every district hospital as an
integral part of district health services.
 TREATMENT:-MULTIPLE LEVELS

The district hospital should have 30-50

psychiatric beds. The psychiatrist in a district
hospital was envisaged to devote only a part
of his time to clinical care & a greater part in
training & supervision of non-specialist
health workers.
 TREATMENT:-MULTIPLE LEVELS

D. Mental hospitals & teaching psychiatric units:

Major activities of these higher centers of
psychiatric care include:
a. Help in care of ‘difficult’ cases.
b. Teaching.
c. Specialized facilities like occupational therapy
units, psychotherapy,counseling & behavioral
therapy.
 REHABILITATION

The components of this sub-group includes

treatment of epileptics & psychotics at the
community level & development of
rehabilitation centers at both the district level
& higher referral centers.
 PREVENTION

The prevention components is to community-

based, with initial focus on prevention &
control of alcohol- related problems. Later
on, problems like addictions,juvenille
delinquency & acute adjustment problems
like suicidal attempts are to be addressed.