Unit 1. INTRODUCTION
(Unit 1. Introduction)
(CONCEPT OF MENTAL HEALTH)
(Concept of Mental Health)
Mental health is defined as a healthy mind but it cannot be defined without physical, social or spiritual health, mental health is a part of general health.
A person understands his own abilities, can cope with the normal stresses of life, can work productively and effectively, and can contribute to his community and maintain body, mind and the environment in which he is.
A person faces different problems and a person finds a way out of those problems. Mental health helps him to come out of these problems and fight the situation.
Emotional maturity affects a person’s mental health.
Mental health is a state of balance between the person and the surrounding world, harmony with other people and his environment.
A person’s ability to accept himself, to feel appropriate towards others and to complete life’s tasks are components of mental health.
A well adjusted and mature person is mentally healthy. The health or sickness of the body affects the mind and also affects the emotions and the mind also affects the body. Thus body-mind relationship is also taken in the concept of mental health.
CONCEPT OF MENTAL ILLNESS)
(Concept of Mental Illness)
Mental illness is a disorder of thought, mood, perception, orientation, or memory that impairs judgment, behavior, ability to recognize reality, or the ability to meet the normal demands of life. The mental condition is also associated with drug abuse and alcohol.
The term mental illness actually encompasses a number of mental disorders, and affects other parts of the body. Their severity can also vary.
Mental illness is seen when physical, mental, social well-being is disturbed. In mental illness a person shows symptoms like depression, anxiety, mood changes without any reason.
When a person expresses his mental pressure through restlessness, feelings, thoughts, it is called mental illness.
~Not satisfied with own adaptation.
~ Not happy with own characteristics, skills.
~Interpersonal Relationship (IPR) may not be effective or satisfying.
~Can’t keep up with the happenings in life.
~Difficulty or unable to make adjustments.
~Lack of own personal growth is seen.
~Can’t communicate well with others.
Discuss On Misconceptions About Mental Illness
(discusses misconceptions about mental illness)*
•Mental illness is uncommon
In fact many mental health conditions like Anxiety, Depression etc are actually called Common Mental Disorders. Rather it is quite normal.
•Mental illness is caused by supernatural forces and is the result of a curse or possession by an evil spirit.
Many people do not consider mental illness as an illness, but believe that the patient or family has been possessed by a spirit or curse due to past sins or past birth misdeeds. This belief is more prevalent among rural and illiterate people than urban and educated people.
•Mental illness is shameful.
There is a feeling that mental illness is shameful. Due to this attitude, there are many people who do not seek professional help. As a result, when they finally seek professional help, it is too late. Help should be sought without any shame or hesitation.
•People with mental illness exhibit strange behavior.
Patients in mental hospitals and clinics are often treated as eccentrics who spend their time exhibiting useless odd behaviors such as arm wringing.
•Mentally ill people are dangers.
Most people with mental illness are not violent. In cases where violence occurs, the incident usually results from the same causes as in the general population, such as feeling threatened or due to excessive use of alcohol and/or drugs. Even in these cases, they can be brought under control as effective medication/counseling is available.
•Patients discharged from mental hospitals are often viewed with suspicion
Some public opinion studies show that discharged patients are not allowed to live. Many people do not accept people with mental illness to have a normal relationship or even after recovery, to employ them or accept them as neighbors.
•Mental illness is contagious.
Mental illness is neither contagious nor contagious and does not spread from one person to another. The fear that it is contagious is a major misconception that leads people to view it with suspicion.
Marriage can cure mental illness
It is wrong to believe that a person with mental illness will get better after marriage. A patient who has recovered can marry and lead a normal life like any other person.
•People themselves are responsible for mental illness
Mental illness can happen to anyone, be it a person living in poverty or a rich person. It can also be genetic or inherited. No one chooses to live in mental illness. And people are not responsible for mental illness themselves.
People with mental illness can do low level jobs but are not suitable for really important or responsible posts.
People with mental illness, like everyone else, have the ability to function at any level based on their own abilities, experiences and motivation.
*Only Weak People Suffer from Mental Illness.
This disorder is mainly caused due to chemical imbalance in brain. Mental illness is not only weak or weak people, it can happen to anyone.
•Old Person (old people) only suffer from mental illness like depression.
In reality, the lowest incidence of severe mental disorder is seen in old people. It is wrong that only old people get depression.
•Electroconvulsive therapy (ECT) is an inappropriate method of treatment.
ECT is less painful and effective for the treatment of schizophrenia and major depression. ECT is not an inappropriate method of treatment.
CHARACTERISTICS OF MENTALLY HEALTHY PERSON
(Characteristics of a Mentally Healthy Person)
•>They know their strength and weakness very well.
•> He has sufficient capacity to adjust to changed circumstances and conditions.
•> It has the ability to accept oneself, others and nature.
•> He is emotionally mature and stable as he can express his emotions in a desirable manner and exercise proper control over them.
•> Able to build close relationships with others.
•> He is socially adjustable as he has sufficient ability to get along well with himself and others.
•> Have their own personal identity.
•> He is able to think independently and take the right decision at the right time.
•> He always lives in the world of reality rather than imagination and fantasy.
•> They have a positive self-concept and relate well to people and their environment.
•> Able to solve their problems with their own efforts as much as possible.
•>Able to appreciate and enjoy life.
•>Thought and action are independent and depend on individual standards of behavior and values.
•> He has enough courage and power of endurance to face failures in his life.
•> They never worry about their failures and mistakes.
•> Capable of facing reality. They respect themselves.
•>They develop achievable goals in their lives. They are happy with themselves and their lives.
•> Open and friendly, and have no difficulty meeting new people.
•>They are capable of successfully working on the job and supporting themselves.
•> Able to get enough sleep. Maintains a healthy daily routine. Shows emotional maturity.
•> They feel very safe and secure in their respective group and environment.
•> He has loyalty to the group he belongs to.
•> They try to complete their work as nicely as possible.
•>Capable of coping with stress and depression in a healthy way.
•> Capable to communicate well with people. Capable to feel good for people.
•> Capable of expressing their feelings and emotions.
•> Fulfills his responsibilities fully.
•> They are confident and do not show undue fear and anxiety for any newly assigned achievement
GENERAL PRINCIPLES OF MENTAL HEALTH NURSING OR PSYCHIATRIC NURSING
General Principles of Mental Health Nursing or Psychiatric Nursing
These are the principles that apply to the care of anyone with a behavior disorder. Everyone has certain basic needs that must be met regardless of the illness. The principles are general and apply to the mentally ill as well as the physically ill.
Principles are created based on the concept. Each Principle creates a guideline for the emotional care of the patient. The following principles are used in mental health nursing practice.
(The patient is accepted exactly as he is)
Acceptance means being non-judgmental. Acceptance shows the possibility of being loved and cared for. Acceptance does not mean complete permission but setting positive behavior to respect him as an individual client.
It is the nurse’s responsibility to accept patients as they are. Even if the patient behaves inappropriately, the treatment should be done properly.
~Acceptance may be conveyed as follows;
•Being non-judgmental and non-punitive.
The patient’s behavior is not judged as right or wrong, good or bad. The patient is not punished for his inappropriate behavior. All methods of punishment, direct (chaining, putting him in a separate room) and indirect (ignoring his presence or drawing attention) should be avoided.
Even when the patient has behaved against the expectations of the nurses, the patient should not be rejected. Direct and Indirect Punishment should also not be given to the patient.
•Showing honesty and interest with the patient.
To have a sincere interest in another person means to consider the person’s interest. Nurses should have an interest in caring for the client, which can be shown as follows.
~ To study the behavior pattern of the patient.
~Allowing him to make his own choices and decisions as far as possible.
~Identifying client’s likes and dislikes.
~Being honest with him.
~Spending time with the client.
~Avoid sensitive topics and issues
•Listening to the client properly.
•Encourage the client to express his feelings and emotions.
•Talking to the client for a specific purpose.
The communication of the nurse with the patient should be related to their needs. The communication of the nurses should be directed towards achieving the goals set by both the client and the nurse. It is more effective to present the reality in the conversation with the patient. The needs and interests of the patient should also be known. .
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(Self-understanding as therapeutic tools)
A Psychiatric Nurse has a realistic self-concept and should be able to identify feelings, attitudes and responses. Through their ability to be aware and accept their own power and limitations, they should help others see their power and limitations. Self-Understanding Aggressive in life situations And helps to be steadfast without guilt.
3 Consistency is used to contribute to patient’s security
(Consistency is used to contribute to patient safety)
This means that there should be consistency in staff attitudes, in the daily routine of the ward and in defining the limitations placed on the patient. Which contributes to the security of the patient. The safety and security of clients is the main objective of providing mental health nursing care. Will help the client to increase emotional maturity.
(Reassure the client in an acceptable manner.)
Reassurance should be given in an acceptable manner
Reassurance builds patient confidence.
Reassurance is given to increase the confidence of the client. While providing reassurance to the client, nurses must understand and analyze the condition. False reassurance should not be given.
*5. Change the patients behavior through emotional experience and not by rational interpretation.
(Changing patient behavior through emotional experience, not through rational interpretation.)
The focus of psychiatry is mainly on the feeling of the patient and not on the intellectual aspects. Therefore, there are certain principles or techniques through which the expectation of changes in the patient’s behavior can be maintained, such as role play, social drama, which provides corrective emotional experiences.
(Unnecessary increase in patient anxiety should be avoided)
Mentally ill patients are already in some anxiety due to various reasons.
Some Approaches That Increase Patient Anxiety
~Shows the nurse’s own anxiety.
~Showing patient’s weakness and defects.
~Patient often faces failure.
~Putting demands on the patient that he apparently cannot meet.
~Contradiction of the patient’s psychotic ideas.
~sharp comment passing.
(Making objective observation of patient to understand behavior.)
Objective is the ability to understand and evaluate the client’s feeling and should not mix their feelings, opinion or judgment. For that, nurses should improve their observation skills.
maintain a genuine nurse-patient relationship)
Realistic or professional relationship focuses on the personal and emotional needs of the patient and not on the needs of the nurse. To maintain a realistic nurse-patient relationship, the nurse must have a realistic self-concept and be capable of understanding the meaning of the patient’s feelings and behaviors.
9.Avoid Physical And Verbal Force as much as possible.
Any type of force on a person will cause psychological trauma. The nurse should keep the following points in mind while forcing the client.
~Proceed quickly, accurately and effectively with adequate help.
~Don’t show anger while restraining.
~Tell the patient the reason for applying the restraints
And say that when he gets control over it he will be allowed to go and meet others.
~ Be present to fulfill the patient’s needs. Never let the patient feel that he is being punished.
~Never remind him of the incident again after he is in control.
10.Nursing Care Is Centers On The Patient As A Person And Not On Control Of Symptoms
Nurses should understand the meaning behind his behavior and symptoms are reflections of problems. Two patients presenting with similar symptoms may have different needs .eg. One may have a headache due to lack of sleep and another may have hypoglycemia
Analysis and study of symptoms is necessary to reveal their meaning and significance to the patient.
12.Many Procedures Are Modified But Basic Remains Unaltered. (Many procedures have been modified but the basics remain the same.)
Many methods in the psychiatric nursing field are tailored to the individual needs of the patient but the underlying nursing scientific principles remain the same. The basic principles remain the same such as safety, security, comfort, privacy, material and time money and economy maintaining therapeutic effectiveness etc.
DEFINITION OF TERMS USED IN PSYCHIATRY
DEFINE PSYCHIATRY
Psychiatry is a branch of medicine that focuses on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders, administered by medically qualified individuals.
An individual’s mental health is influenced by a combination of factors that are specific to the individual as well as related to interactions with society, community and family.
DEFINE PSYCHIATRIC NURSING
It is an important area of nursing practice, which uses the theory of human behavior because it is a science. which is concerned with the prevention, care and cure of mental disorders and their consequences and applies itself as an art or expression to nursing practice.
Psychiatric nursing is called mental health nursing in which apart from providing care to a person with a mental disorder, it helps them to recover and improve their quality of life.
DEFINE PSYCHIATRIST
Psychiatrists are physicians who specialize in the diagnosis and treatment of mental health disorders. Psychiatrists provide treatments such as medication management, psychotherapy, and alternative therapies that help people manage mental illness.
REVIEW OF DEFENSE MECHANISM
A defense mechanism is a technique or mechanism used by a person to control stress or reduce anxiety or resolve conflict. This provides an initial defense for the personality.
Mental mechanisms are psychological strategies implemented to cope with reality and maintain self-image. Mental mechanisms are also called defense mechanisms.
•Positive Defense Mechanism
•Negative Defense Mechanism
(1).Compensation
Ex. A person is physically handicapped. She cannot come forward in sports so to remove this deficiency she develops her pleasing personality or uses other skills to advance in her studies and divert her attention elsewhere from this deficiency, the blind person advances in music.
(2).Substitution
In this, a person sets a goal beyond his capacity but fails to succeed by setting a smaller goal.
Ex. A person cannot become an IAS officer instead they become an IPS officer.
(3).Sublimation
In this, the person redirects the things/habits that are not accepted by the society and turns them into the form accepted by the society. Choose a healthy path that also satisfies his affairs/habits.
Ex. When a person is very angry, he transfers his anger by boxing.
(4).Rationalization.
This is a very common mechanism. Everyone uses this mechanism. It rationalizes when a person’s reputation is damaged or ego is hurt. When a young man who wants to marry a certain girl fails, it shows his fault that he is proud, unfaithful or has a bad past. This mechanism is found in two forms.
Ex:-
~ Sour grapes (Grapes are sour.):– If a young man does not find a beautiful woman, it shows that a beautiful woman is an additional liability.
A doctor without a vehicle says that he does not want to risk his life by driving.
~ Sweet lemons :- In this a person covers his failures by declaring his virtues. E.g. A poor man declares that he does not want to earn more money and reasons that money is the cause of evil.
5).Repression (suppression, inhibition)
This is a kind of defense mechanism. In which a person deliberately tries to forget some things or events. In which it is not really forgotten but it is pretended to be gone.
Ex. He pretends to be very sad when a student is caught for making a mistake in the exam hall. And later he makes a statement to his friends that he has forgotten the incident.)
(6).Undoing (Apologizing)
When a person makes a mistake or does not do a proper job, a person apologizes for his mistake, asks to be forgiven or punished, it is called undoing.
Ex. If a student is late in coming to the classroom, he apologizes to the teacher to avoid punishment.
(7).Identification
In this a person copies another person’s voice, idea, clothes, personality, gestures, appearance, and behavior and tries to look like the other person.
Ex. A person who copies Shahrukh Khan in his clothes, style and voice in order to look like Shahrukh Khan himself.
(8). Transference
In transference, one person’s image is unconsciously identified with another. One person’s image and qualities resemble that of another person.
Ex.A patient who loves his daughter finds a nurse of the same age and height as his daughter
So he transfers his positive feelings to the nurse as his daughter.
It is also possible that if he dislikes his daughter he transfers his negative feelings to the nurse by being rude, abusive or aggressive for no reason.
(9).Intellectualization
Similar to rationalization, this is another defense mechanism showing reason. Intellectualization is the intellectual behavior to get away from emotion and threatening condition through talking or dialogue intelligently and thinking.
Ex. A nurse or doctor cannot afford to have an emotional relationship with every patient. Hence they distance themselves from the situation with insensitive silent words. A nurse is seen using this mechanism with a very sick person whose death is certain. This mechanism is used to remove the professional crisis. But using this in relationships every time gives unhealthy emotional experiences.
(10).Introjection
In this a person copies the voice and ideas of another person. This defense mechanism is more common in children. And they imitate those who are older than them.
Ex. In school children try to look like their teacher.And try to speak like their teacher.
(1).Suppression
In this unwelcome ideas memories in the preconscious mind. Trying to consciously dismiss impulses, feelings, thoughts that are painful is called suppression. We push it in the subconscious mind and when we want to recall it, it is inaccessible.
Ex. If there is an argument or a quarrel with a friend before the exam, he has to answer it, but while writing the paper, he tries to write the paper calmly, forgetting the incident for a while and completing the paper. Or a patient suppresses his painful feelings by saying, “I don’t want to talk about it.”
(2).Displacement
Displacing or displacing one’s emotions onto another person or object, or expressing anger at one person onto another.
Ex. A 3rd year nursing student gets angry at the nurse in charge of a hospital ward so the student takes out her anger on her junior student.
(3).Projection
This is a frequently used defense mechanism. In this, rejected thoughts, waves, desires etc. are transferred to others. In this, a person blames his mistakes and others. When projection is used, problems arise in our relationships.
E.g. If the student has failed in the exam, he blames the examiner that he does not know how to check the paper properly.
(4).Regression
It is an immature way of responding to stress. Some people cannot face the challenges of life courageously. At such times, they reduce anxiety by behaving like people younger than their age. In this, the person is treated as his next developmental level instead of reality.
Some regressions are normal, like being overly emotional, tears in the eyes. Regressions with extreme forms and degrees result in psychosis.
Ex. After the birth of a new born baby in the family, less attention is given to the child and the child starts doing infantile behavior like bed wetting.
(5).Fixation
In this defense mechanism, although the person is of adult age, immature things remain in him and that matter gets fixed in his personality.
Ex. There is a habit of thumb sucking even in old age.
(6). Acting Out
Acting out is a defense mechanism when a person deals with emotional conflict or stress through actions rather than feelings.
Instead of saying, * Ex.* I’m angry with you,” he can throw a book at the other person. That is, he turns his feeling into an action.
(7).Reaction Formation
In this Unacceptable real feeling is repressed and acceptable opposite feeling is expressed.
Ex. A woman actually dislikes her mother-in-law but also treats her mother-in-law well in front of other people.
(8).Conversion
In this, the person converts his strong emotional conflict into physical symptoms. For which there is no apparent reason. This mechanism operates entirely on an unconscious level.
Ex.Someone hears the news of his close friend’s death and loses balance on both his legs and becomes unconscious.
(9) Dissociation
In this defense mechanism, a person copes with emotional stress by changing his usual awareness of self. The person withdraws from the real world and behaves immaturely. He does not know what is going on around him.
Ex.A person may engage in bulimic eating in a subconscious attempt to escape their feelings of shame and self-loathing.
(10).Denial
This is a common and oldest of all defense mechanisms. In this, the person rejects the events that he does not like or painful things and refuses to face the reality. Generally, people use denial for death, serious illness, painful and fearful things.
Ex. When the son is addicted to alcohol, when his mother complains about her son from the neighbors, the mother pretends to be very busy with work and does not pay any attention to the complaints of the neighbors.
Teamwork is essential for the success of any group. Teamwork means the joint, co-ordinated and dedicated effort of each member of the team for the achievement of the team’s interest, goal or objective.
Members of several branches participate in the promotion of a therapeutic environment known as the Mental Health Team. It consists of many members. Which are as follows.
Psychiatrist
They are medical doctors who provide diagnosis, treatment and prevention of mental and emotional disorders. Conduct therapy sessions and are mental health team leaders. Prescribe medication and therapy and provide counseling. Psychiatrist is medication management. , provides treatments such as psychotherapy and alternative therapies that help a person manage mental illness.
General Physician
General physicians are often the first point of contact for people with mental disorders, offering support and advice to mentally ill patients. They have more specific psychological treatment experience and training. A general physician will properly guide and help the patient.
Mental Health Nurse
Assesses and understands the client’s nursing needs. Holistic nursing provides care. Provides and monitors medication. Maintains patient records and reports. Nurses carry out counseling and psychotherapy with patients.
Educates and provides treatment to client and family members.
Clinical Psychologist
A clinical psychologist is a professional who treats patients with mental health disorders. They mainly work with people with mental problems like Anxiety, Depression, Addiction, Stress.
Works in both hospitals and community health teams. Assists in assessment of patients’ mental health needs and plans psychological therapies with individuals and groups.
Psychiatric Social Worker
Master’s degree or Ph.d in social work.Works in social services rather than health services.Uses adaptive capacity of individuals with community resources and environment.Provides counseling and advice to referred patients and conducts group therapy sessions. is
Occupational Therapist
Responsible for recreational, vocational, and activity programs. Assists patients in improving skills that help them obtain or maintain employment, and cope with daily life.
They work in hospitals or in the community.
Provides various types of theapy in individual or group.
•Educational Therapist (Educational Therapist).
Determines Effective Instruction; Methods, assessment of individual capacity and selection of special programs for disadvantaged children etc.
Organizes continuing education program for hospital students with emotional and behavioral problems. Provides health education to children and parents.
•Musical Therapist
Musical therapists use music to promote a person’s mental health. Through music, focus on self-expression. Promotes improvements in memory, attention, and concentration, and provides an opportunity for a person to feel proud of their accomplishments. Through music. It tries to improve a person’s mental health.
•Psychodrama Therapist.
They encourage people to express their feelings and emotional conflicts by doing drama and role play activities. A psychodrama therapist is also an important member of the mental health team.
Diversional play therapist
They observe the child or client during play. Observing the child’s behavior while playing, the type of toys and his reaction to them etc.
Recreational Therapist
Recreational activities encourage the client to redirect their attention away from personal thoughts, feelings and emotions to prevent them from paying too much attention. They provide entertainment to the client to prevent their mental health from being impaired.
Speech Therapist
Speech therapists provide assessment, diagnosis, and treatment of speech, language, and communication disorders. Speech therapists also provide training to other health care personnel.
Dietician
A dietitian helps the client to balance the diet. Acts as a resource person for the psychiatric mental health team and as a nutritional counselor for clients suffering from nutritional disorders such as anorexia nervosa, bulimia nervosa and pica. Helps the client to improve his eating pattern.
Clergymen Or Chap lain
They are religious persons who encourage the client to go to the hospital.
Identifies the spiritual needs of the mentally ill client.
Provides support to individuals and provides spiritual rest as needed.
They can act as a counselor when needed. Discusses religious matters with the client.