UNIT: 15
COMMUNITY MENTAL HEALTH NURSING
1. Development of Community Mental Health
Services:
2. National Mental Health Programme
3. Institutionalization Versus Deinstitutionalization
4. Model of Preventive Psychiatry: Levels of
Prevention
5. Mental Health Services available at the primary,
secondary, tertiary levels including
rehabilitation and Role of nurse
6. Mental Health Agencies: Government and
voluntary, National and International
7. Mental health nursing issues for special
populations: Children, Adolescence, Women,
Elderly, Victims of violence and abuse,
Handicapped, HIV/AIDS etc.
Definition
Community mental psychiatric nursing is the application of specialized
knowledge to population,communities to promote and maintain mental
health, to rehabilitate population at risk that continue to have residual
effects of mental health.
Development
1980- Community Mental Health Systems Act was passed
1982- National Mental Health Program (NMHP) was launched in Maharashtra, for the
first time in India
Community mental health care includes
Mental health promotion
Stigma removal
Psychosocial support
Rehabilitatory services
Prevention of harm from alcohol and substance use
Treatment of the ill, using primary health care system
Objectives
To promote and maintain mental health of family through preventive and
promotive interventions
To enhance the potentials of community people to use their strength to provide
essential competence for positive mental health
To educate the family members regarding identification of various stressors and
coping mechanisms to deal with problems
To help the family members to recognize that the social, cultural and situational
aspects have an influence on behavior and how it can affect the individual person’s
behavior in the family
To teach the community people to monitor their mental health and that of
community.
National mental health programme
National Mental Health Programme Govt of India integrated mental health with
other health services at rural level. It is being implemented since 1982 and
Maharashtra was the first state to implement NMHP.
Objectives
Basic mental health care to all the needy especially the poor from rural, slum and
tribal areas
Application of mental health knowledge in general health care and in social
development
Promotion of community participation in mental health service development and
increase of efforts towards self help in the community.
Prevention and treatment of mental and neurological disorders and their
associated disabilities
Use of mental health technology to improve general health services Application of
mental health principles in total national development to improve quality of life.
Components of community
mental health programme
NMHP has 3 components:
Treatment of Mentally ill
Rehabilitation
Prevention and promotion of positive mental health.
2.REHABILITATION
1. Establishment of rehabilitation centres at both district and referral centres.
2. Treatment maintenance of person with epilepsy and psychosis in the
community.
EXAMPLE:
3. PREVENTION
PREVENTION WOULD BE COMMUNITY BASED AND FOCUS TOWARDS
1.Preventing and controlling alcohol abuse
2. Juvenile delinquency
3. Acute adjustment and suicide prevention.
Strategies
Institutionalization Vs Deinstitutionalization
Institutionalization is the process of committing a person to a facility where their freedom to leave will be
restrained, usually mental hospital
Deinstitutionalization is a long term trend wherein fewer people reside as patients in mental hospitals and
fewer mental health treatments are delivered in public hospitals.
Essential components of a sound deinstitutionalization process
Prevention of inappropriate mental hospital admissions through the provision of community facilities
1. Discharge to the community of long term institutional patients who have received adequate preparation
2. Establishment and maintenance of community support systems of non institutionalized patients
1) Positive effects of deinstitutionalization
Integration of family and social system in care of patients.
2) Provision of better care to mentally ill, in their home communities.
3) Helps in returning sense of worth, ability and independence to those who had been dependent on others
for their care
Negative effects of deinstitutionalization
Failure of implementation effectivelyRevolving door syndromeEmergency department use by acutely
disturbed individuals has increased Due to increased number of patients , general hospital psychiatric units
are overwhelmedPatients who do not receive adequate care commit homicidesState prisons are occupied by
severely mentally ill patients.
