Assignment of- Community medicine
Submitted by – Prabhjot Kaur Saini
Submitted to – Dr. Arushi
Emphasis on community aspects of mental health, Role of
Physiotherapist in mental health problems such as mental retardation
INTRODUCTION
o According to the National Alliance on Mental Health, approximately 51.5 million adults in the U.S. (about
1 in 5 adults) experienced mental illness
o Community mental health centers are critical to meeting the demand for mental health treatment across
the country.
o Filling the gaps when individuals are unable to obtain treatment from private providers, community
mental health centers operate on the front line in helping individuals contend with challenges to their
mental health.
o DEFINITIONS
o • Community mental health is the application of specialized knowledge to population and communities to
promote and maintain mental health, and to rehabilitate population at risk that continue to have residual
effects of mental illness. --By Sreevani
DEVELOPMENT OF COMMUNITY MENTAL HEALTH IN INDIA
o 1912- Indian Lunacy Act came to force
o 1954- All India Institute of Mental Health (NIMHANS) was established
o 1955- the Joint Commission on Mental illness and Health was formed to study the problem of mental
health delivery
o 1963- Community Mental Health Centers (CMHC) act was passed
o 1974- Community mental health programme started at Sakkalwara of Bengaluru, an aipur Rani block of
Ambala
o 1975- Community Psychiatry unit was initiated at NIMHANS
o 1982- National Mental Health Programme was started.
o 1987- Indian Lunacy Act was replaced by Indian Mental Health Act
o 1975- Community Mental Health Construction Act was further expanded and included seven additional
points
o Follow up care
o Transitional services
o Services for children and adolescent
o Services for the elderly
o Screening services
o Alcohol abuse services
o Drug abuse services
o 1980- Community Mental Health Systems Act was passed
o 1980- DMHP was launched at Bellary district of Karnataka
o 1902 in National Mental Health Prognam (NMP) was launched in Maharashtra, for the first
COMPONENTS OF COMMUNITY
MENTAL HEALTH CARE
o Mental health promotion
o Stigma removal
o Psychosocial support
o Rehabilitatory services
o Prevention of harm from alcohol and substance use
o Treatment of the ill, using primary health care system
PRINCIPLES OF COMMUNITY
MENTAL HEALTH
o It is distinguished by unique conceptual framework, clinical process and intervention strategy
o It must consider social setting and conditions where family members experience and it should be based
on the potential and capabilities for the promotion of mental health and prevention of mental disorders
o It uses holistic approach
o It provides special kind of mental health services as the social and professional role of Physio
converges to have better outcome of services
o It should have primary concern for targeted population, and social and community networks
o It should have focuses on interrelationship formed in group context as they interact in daily living
activities
ISSUES IN CMHS
o Limited manpower
o Uneven distribution of resources
o Low priority in national budget for mental health
o Lack of awareness in the community
o Poor access to care
o Poverty
o Poor availability of medications
o Traditional healing techniques.
NATIONAL AGENCIES
S.NO.AGENCIES AREA OF WORK
The Eclat Society for the Welfare of Mental Retarded MR
2. Association of social health in India Drug Deaddiction counselling centers
3. Association of National Brotherhood for Social Welfare Drug deaddiction, MR
4. Parents association for the welfare of mentally MR
handicapped
Youth and masses Drug abuse
6 Servants of the people society MR
7. Society for social services Day care centrer for aged
8 Asha kiran Mentally ill
16 Abhilasha special education center Mentally ill, speech disorder
C Nav Jyothi center Mentally ill
1 National institute for mentally handicapped Mentally ill
12 Model school for mentally deficient children MR
Norwegian
Psychomotor
Physiotherapy
o Clinical Assessment : "Trial Treatment"
o Introduction to NPMP
o Patient History (medical and social)
o Examination in:
o Standing
o Sitting
o Lying supine/prone
o Standing
o Sharing experiences of assessment
o Clinical reasoning & Goal agreement:
patient as part of the process
Basic Body
Awareness Therapy
Movement Awareness: sensitivity to movement changes, movement
coordination & performance in relation to environment
• Movement Quality: movement in relation
to space, time and energy
1. Physical Health Approach:This aspect emphasizes improving
physical function and managing conditions like chronic pain, fatigue,
and mobility impairments. Physical therapists use exercise,
movement-based therapies, and rehabilitation techniques to
enhance strength, flexibility, and endurance, which can positively
affect mental health.
2. Psychosocial Approach:Mental health physical therapists consider
the impact of social, emotional, and psychological factors on a
person’s physical and mental health. Techniques such as
motivational interviewing, patient education, and behavioral
activation are used to address these psychosocial factors. This
aspect is crucial for managing pain psychology, which explores how
thoughts, feelings, and social circumstances influence pain
perception.
3. Psychotherapeutic Approach: In addition to traditional physical
rehabilitation, mental health physical therapy incorporates
techniques from psychology in physical therapy, such as cognitive-
behavioral strategies, mindfulness practices, and stress
management. These methods aim to help individuals build coping
skills, manage anxiety and depression, and adopt healthy habits for
both mental and physical well-being.
Deep breathing diaphragmatic breathing and box breathing where
you refocus your attention on your breathing. Box breathing is a
breathing exercise to assist patients with stress management and
can be implemented before, during, and/or after stressful
experiences. Box breathing uses four simple steps. Its title is
intended to help the patient visualize a box with four equal sides
as they perform the exercise. This exercise can be implemented
in a variety of circumstances and does not require a calm
environment to be effective
Step One: Breathe in through the nose for a count of 4.
Step Two: Hold breath for a count of 4.
Step Three: Breath out for a count of 4.
Step Four: Hold breath for a count of 4.
Repeat
Note: The length of the steps can be adjusted to
accommodate the individual (e.g., 2 seconds instead of 4
seconds for each step).
2. Guided Imagery: A relaxation exercise intended to assist
patients with visualizing a calming environment. Visualization of
tranquil settings assists patients with managing stress via
distraction from intrusive thoughts. Imagery employs all five
senses to create a deeper sense of relaxation. Guided imagery
can be practiced individually or with the support of a narrator.
Step One: Sit or lie down comfortably. Ideally, the space
will have minimal distractions.
Step Two: Visualize a relaxing environment by either
recalling one from memory or created one through
imagination (e.g., a day at the beach). Elicit elements of the
environment using each of the five senses using the
following prompts:
What do you see? (e.g., deep, blue color of the water)
What do you hear? (e.g., waves crashing along the shore)
What do you smell? (e.g., fruity aromas from sunscreen)
What do you taste? (e.g., salty sea air)
What do you feel? (e.g., warmth of the sun)
Step Three: Sustain the visualization as long as needed or
able, focusing on taking slow, deep breaths throughout the
exercise. Focus on the feelings of calm associated with
being in a relaxing environment.
3. Progressive Muscle Relaxation: Involves tensing and releasing
muscles, progressing throughout the body, with the focus on the
release of the muscle as the relaxation phase. Progressive muscle
relaxation can be practiced individually or with the support of a
narrator.
Step One: Sit or lie down comfortably. Ideally, the space
will have minimal distractions.
Step Two: Starting at the feet, curl the toes under and tense
the muscles in the foot. Hold for 5 seconds, then slowly
release for 10 seconds. During the release, focus attention
on the alleviation of tension and the experience of
relaxation.
Step Three: Tense the muscles in the lower legs. Hold for 5
seconds, then slowly release for 10 seconds. During the
release, focus attention on the alleviation of tension and the
experience of relaxation.
Step Four: Tense the muscles in the hips and buttocks. Hold
for 5 seconds, then slowly release for 10 seconds. During
the release, focus attention on the alleviation of tension and
the experience of relaxation.
Step Five: Tense the muscles in the stomach and chest.
Hold for 5 seconds, then slowly release for 10 seconds.
During the release, focus attention on the alleviation of
tension and the experience of relaxation.
Step Six: Tense the muscles in the shoulders. Hold for 5
seconds, then slowly release for 10 seconds. During the
release, focus attention on the alleviation of tension and the
experience of relaxation.
Step Seven: Tense the muscles in the face (e.g., squeezing
eyes shut). Hold for 5 seconds, then slowly release for 10
seconds. During the release, focus attention on the
alleviation of tension and the experience of relaxation.
Step Eight: Tense the muscles in the hand, creating a fist.
Hold for 5 seconds, then slowly release for 10 seconds.
During the release, focus attention on the alleviation of
tension and the experience of relaxation.
Challenges of Being a Physical Therapist in Mental
Health
The integration of mental health and physical therapy poses unique challenges for
practitioners. One significant challenge is navigating the scope of practice for
physical therapists. While PTs are well-trained in assessing physical health,
incorporating mental health interventions requires additional training and skills.
Mental health physical therapists must be mindful of their scope of practice and
adhere to the code of ethics for physical therapists, which emphasizes providing
competent care and seeking collaboration with mental health professionals when
necessary.
Additionally, balancing the physical and psychological aspects of care can be
demanding. Physical therapists may encounter patients with complex cases
involving trauma, chronic pain, or co-occurring mental health disorders, necessitating
a nuanced approach that goes beyond standard physical rehabilitation techniques.
Physical therapists are prepared for this challenge.
Reterences
o Bernstein, D. A. and Borkovec, T. D. 1973. Progressive relaxation training: A manual for the helping
professions.
o Bernstein, D. A. et al. 2000. New directions in progressive relaxation training: A guidebook for helping
professionals. Greenwood Publishing Group.
