Evolution of Mental Health Services Mental Health Nursing

Evolution of Mental Health Services & Mental Health Nursing Dr Joanna Bennett

Evolution of mental health services • Egyptian writings (1500 BC) - descriptions of mental disorders • Early beliefs that mental disturbances was due to spirit possession • Homer (Greek Civilisation) emotional disturbances produced by the rages of the Gods

Evolution of mental health services • Hippocrates (460 -377 B. C. ) – Earliest ‘scientific’ theories of mental illness – brain responsible for thoughts and feelings – Descriptions of ‘postpartum insanity’ & ‘manic depression’ – Suggested hereditary susceptibility

Evolution of mental health services • Dark Ages (from 200 A. D. ) – Mental disturbances were due to possession by the devil – Faith healing was main treatment – Lack of improvement indicated faith was weak

Evolution of mental health services • Dark Ages >>15 th & 16 th – Anyone showing signs of mental illness was branded a witch or Magician – Witchcraft was punishable by death, mainly burning or drowning

Hospitals for mentally ill • Egypt and Middle East 700 -1200 AD • Spain 15 th C • 1547 First mental hospital in London (Bedlam) – Treatment primitive and brutal – No distinction between criminals and mentally ill – Treatment by warders not doctors or nurses - consisted of punishment – No beds, toilets or adequate food – Little change until 18 th C

th 18 C – Asylums • 1791 Philippe Pinel chief of mental hospital near Paris – Reforms changed the spirit of care for the mentally ill – No more chaining of patients, punishment forbidden – Isolation for only short periods – Kindness is necessary in managing MI, personalities of nurses and doctor important factor

Mental health services – 18 th C • Pinel’s example was quickly followed in other parts of the world • Tuke – York Retreat 1796 – Encouragement & kindness the basis of care – Routine work – Abolition of fear – Treatments like blood-letting, purging were abandoned

Mental health services 19 th C • Methods of caring for the mentally ill was more humane • 1839 restraints were forbidden • 1883 Kraepelin - 1 st classification of MI • Freud(1856 – 1939) – psychoanalysis based on ideas about mental processes and development

Development of physical treatments 1 Bromides 1857 & barbiturates 1903 – sedation, but did not treat cause of MI 2 1920 s -Shock therapy – insulin (coma), ECT 3 1950 s - Tranquillising drugs – chlorpromazine 2&3 Facilitated the move to community care

Evolution of Mental health services: Caribbean (Hickling & Sorel 2005) • Records mainly available for Jamaica – Native Tainos treated mentally ill without restraints in open humane community systems – So effective the Spanish attributed it to sorcery – Incarceration for abnormal behaviour introduced by European colonisers – 1 st mental hospital in Spanish Town for Europeans & upper classes

Mental health services: Caribbean • Asylums in the Caribbean introduced later than Europe (1790 s) • 1819 Restraints (head and leg locks & chains), bleeding, purging and immersion in water tanks continued in Caribbean – “Mid 18 th. C – most mentally-ill Blacks either died from suicide (eating dirt or hanging) or incarcerated in dungeons of plantations or infirmaries”

Asylums - Caribbean 1862 asylum which became Bellvue in 1930 s – viewed as more humane than been locked away with criminals and paupers (general pattern preasylums) – Trinidad & Tobago 1858 – Grenada 1879 – Antigua 1871 Legislation (British) up to mid-20 th C was concerned with custody and compulsory detention

Asylums: Caribbean • Post emancipation - 1874 Lunatic asylum Law - those deemed insane could be arrested by the police, charged with lunacy and incarcerated • Bellvue became the repository for those showing behavioural disturbances

Asylums: Caribbean • Treatments followed more humane approach of Europe • Large acreage enabling freer movement & mechanical restraint was outlawed • Retention of some barbaric practices such as cold showers for treatment and the exercise of power & control

Mental health services: Caribbean • Early 20 th. C – first Black Caribbean psychiatrists trained in UK, US Canada • 1950 s – advent of antipsychotics – led to deinstitutionalisation process • 1965 – UWHI psychiatry dept and psychiatric unit – Community mental health clinics

Mental health services: Caribbean • 1974 Development of community mental health care – Pilot rehabilitation ward at Bellevue – Amendment of 1873 Mental hospital Act – authorize MHOs (CPN) to take those deemed mentally ill to clinic or hospital for evaluation and treatment – This removed the powers of arrest for lunacy by the police

Mental health services: Caribbean • Jamaica – Mental health care decentralised and integrated into primary care (in part) – Supported by private/independent and NGO sectors

Mental Health Nursing • Many centuries care of mentally ill in the hands of untrained person – Lack of scientific knowledge – ‘Care’ unsympathetic, cruel – punishment & restraint

Mental Health Nursing • First public nursing courses developed in 19 th. C (Britain 1891) • Since that time the status of psychiatric nursing has risen and fallen

Mental Health Nursing in Jamaica • Stewart, H. C. (1982) The history of Psychiatric nursing in Jamaica (unpublished) • 1948 first graduate of Certificate (RMN)

Mental Health Nursing in Jamaica • 1966 integration of psychiatric nursing into general nursing programme • 1968 phasing out of 3 -yr RMN • 1975 training of psychiatric aides to assist with patient care

Mental Health Nursing in Jamaica • 1982 6 -months Post Basic psychiatric nursing course • 1997 Psychiatric and mental health nurse practitioner course - to UWI as MSc. N 2002

Models/Approaches to mental health nursing • 1950 s into the early 1980 s that mental health nursing was a specialty in ascendancy. This was a period when many of the leading nurse theorists came from this specialty ( e. g. Peplau 1952, Orlando 1961, Travelbee 1971)

• Emphasis up to the 1990 s was on therapeutic relationship/interpersonal relations as the primary role of the mental health nurse • 21 st C – growing emphasis on evidence-based practice – challenge mental health practitioners’ belief in the primacy of therapeutic relationship

• the pendulum swung from an emphasis on personalized processes to a concern about demonstrable outcomes • Debate continues – general view: – Therapeutic relationship/engaging patient is crucial to delivering effective interventions – Biopsychosocial interventions leads to better outcomes for patients