Psychiatric Nursing ▪ Mastery of the environment

▪ Education
Health (WHO) ▪ Employment
▪ State of complete physical, mental and social ▪ Income and Social Protection
wellness and not merely the absence of disease or
infirmity ▪ Food security
▪ Emphasis on health as a positive state of well Mental illness
being
▪ Disorders that affect mood, behavior, and
Mental health thinking
▪ A dynamic and ever-changing state ▪ Cause significant distress, impaired functioning
or both
▪ Influenced by many factors ▪ Individuals experience dissatisfaction with self,
▪ Individual relationships and ineffective coping
▪ Interpersonal Factors contributing to
mental illness
▪ Socio-cultural
Individual/personal factors ▪ Individual
▪ Biologic make-up ▪ Biologic make-up
▪ Intolerable or unrealistic worries or
▪ Autonomy and independence – toddlerhood fears
▪ Inability to distinguish reality from
▪ Self-esteem fantasy
▪ Intolerance of life’s uncertainties
▪ Capacity for growth
▪ A sense of disharmony in life
▪ Vitality ▪ Loss of meaning in one’s life
▪ Ability to find meaning in life ▪ Interpersonal
▪ Emotional resilience or hardiness ▪ Ineffective communication
▪ Excessive dependency on or withdrawal
▪ Sense of belonging from relationships
▪ Reality orientation – living in fantasy ▪ No sense of belonging
▪ Inadequate social support
▪ Coping or Stress management abilities ▪ Loss of emotional control

Interpersonal/relationship
▪ Socio-cultural
▪ Lack of resources
• Effective communication
• Ability to help others ▪ Violence
• Intimacy – young adults ▪ Homelessness
• Balance of separateness and connectedness
▪ Poverty
Social Determinants ▪ An unwarranted negative view of the
world
▪ Non-medical factors ▪ Discrimination such as stigma, racism,
▪ Sense of community classism, ageism, and sexism
▪ Access to adequate resources
▪ Intolerance of violence
▪ Support of diversity among people
 2005 while rates rose from 0.12 to 1.09 per
100,000 in females (Redaniel, Dalida and
Gunnell, 2011).
▪ Intentional self-harm is the 9th leading cause
of death among the 20-24 years old (DOH,
2003).
▪ A study conducted among government
employees in Metro Manila revealed that 32%
out of 327 respondents have experienced a
mental health problem in their lifetime (DOH
2006).
▪ Based on Global Epidemiology on Kaplan and
Sadock’s Synopsis of Psychiatry, 2015 and
Kaufman’s Clinical Neurology for Psychiatrists,
Mental health statistics (DOH) 7th edition, 2013
▪ 2004 WHO study, up to 60% of people attending ▪ Schizophrenia ---1% …..1 Million
primary care clinics daily in the country are
estimated to have one or more MNS disorders. ▪ Bipolar ---1% …. 1 Million
▪ 2000 Census of Population and Housing showed
▪ Major Depressive Disorder ---17%
that mental illness and mental retardation
rank 3rd and 4th respectively among the types …. 17 M
of disabilities in the country (88/100,000 ▪ Dementia --- 5% (of older than
▪ Data from the Philippine General Hospital in 65) …..
2014 show that epilepsy accounts for 33.44%
▪ Epilepsy ---0.06% …. 600,000
of adult and 66.20% of pediatric neurologic
out-patient visits per year. Mental health is everyone’s
▪ Drug use prevalence among Filipinos aged 10 to business
69 years old is at 2.3%, or an estimated 1.8 Roles of the health sector
million users according to the DDB 2015
▪ Provide care
Nationwide Survey on the Nature and Extent of
Drug Abuse in the Philippines ▪ Equitable and rights-based services,
▪ 2011 WHO Global School-Based Health Survey irrespective of age, gender, socio-
economic status, race, ethnicity,
has shown that in the Philippines, 16% of disability or sexual orientation
students between 13-15 years old have ever ▪ Most useful when they are delivered at
seriously considered attempting suicide while community levels, by practitioners
13% have actually attempted suicide one or best suited to provide effective care
within the constraints of available
more times during the past year. human and financial resources
▪ The incidence of suicide in males increased from ▪ Promote and prevent
0.23 to 3.59 per 100,000 between 1984 and
 ▪ Advocate for and provide promotion ▪ (e) Provided by mental health professionals
and prevention programmes, in and workers in a manner that ensures
collaboration with other sectors accountability.
▪ Can build awareness and understanding ▪ Section 15. Mental Heath Services at the
of mental health, end stigma and
discrimination, and lessen the need for Community Level. - Responsive primary mental
treatment and recovery services health services shall be developed and
integrated as part of the basic health services
▪ Work in partnership at the appropriate level of care, particularly at
the city, municipal, and barangay level. The
▪ can partner with all stakeholders – in standards of metal health services shall be
government, civil society, the private determined by the DOH in consultation with
sector and especially among people stakeholders based on current evidences.
with lived experience – to ensure
▪ Every local government unit (LGU) and
multisectoral, inclusive and people- academic institution shall create their own
centered support for people with program in accordance with the general
mental health conditions. guidelines set by the Philippine Council for
Mental Health, created under this Act, in
coordination with other stakeholders. LGUs and
▪ Support related initiatives. academic institutions shall coordinate with all
concerned government agencies and the private
▪ Advocate for and help address the sector for the implementation of the program.
structural risks and protective
factors influencing mental health – ▪ Section 16. Community-based Mental Heath
the conditions in which people are born Care Facilities. - The national government
and live through the DOH shall fund the establishment
and assist in the operation of community-
▪ Can promote and contribute to a
based mental health care facilities in the
whole-of-government and all-of- provinces, cities and cluster of municipalities in
society approach to mental health. the entire country based on the needs of the
population, to provide appropriate mental health
Republic act 11036 care services, and enhance the rights-based
▪ An Act Establishing a National Mental Health approach to mental health care.
Policy for the Purpose of Enhancing the Delivery ▪ Each community-based mental health care
of Integrated Mental Health Services, Promoting
and Protecting the Rights of Persons Utilizing facility shall in addition to adequate room,
Psychosocial Health Services, Appropriating office or clinic, have a complement of mental
Funds Therefor and Other Purposes health professionals, allied professionals,
support staff, trained barangay health workers
▪ Mental Health Act (BHWs) volunteer, family members of patients
or service users, basic equipment and supplies
Mental health services and adequate stock of medicines appropriate at
that level.
▪ Section 14. Quality of Mental Health
Services. - Mental health services provided ▪ Section 17. Reportorial Requirements. - LGUs
pursuant to this Act shall be: through their health offices shall make a
quarterly report to the Philippine Conucil for
▪ (a) Based on medical and scientific research Mental Health through the DOH. The report shall
findings; include, among others, the following data:
number of patients/service users attended to
▪ (b) Responsive to the clinical, gender, cultural and or served, the respective kinds of mental
and ethnic and other special needs of the illness or disability, duration and result of the
individuals being served; treatment, and patients/users' age, gender,
▪ (c) Most appropriate and least restrictive educational attainment and employment without
setting: disclosing the identities of such
patients/service user for confidentiality.
▪ (d) Age appropriate; and
▪ Section 18. Psychiatric, Psychosocial, and
Neurologic Services in Regional, Provincial, and
 Tertiary Hospitals. - All regional, provincial, emergencies or when the service user has
and tertiary hospitals, including private impairment or temporary loss of decision-
hospitals rendering service to paying patients, making capacity;
shall provide the following psychiatric,
psychosocial, and neurologic services; ▪ (e) Maintain a register containing information
on all medical treatments and procedures
▪ (a) Short-term, in-patient, hospital care in a administered to service users; and
small psychiatric or neurologic ward for
service users exhibiting acute psychiatric or ▪ (f) Ensure that legal representatives are
neurologic symptoms; designated or appointed only after the
requirements of this Act and the procedures
▪ (b) Partial hospital care for those exhibiting established for the purpose have been observed,
psychiatric symptoms or experiencing which procedures should respect the autonomy
difficulties vis-à-vis their personal and family and preferences of the patient as far as
circumstances; possible.
▪ (c) Out-patient in close collaboration with ▪ Section 20. Drug Screening Services. -
existing mental health programs at primary Pursuant to its duty to provide mental health
health care centers in the same area; service and consistent with the policy of
treating drug dependency as a mental health
▪ (d) Home care services for services users with issue, each local health care facility must be
special needs as a result of, among others, capable of conducting drug screening.
long-term hospitalization, non-compliances ▪ Section 21. Suicide Prevention. - Mental
with or inadequacy of treatment, and absence health services shall also include mechanisms
of immediate family; for suicide intervention, prevention, and
▪ (e) Coordination with drug rehabilitation response strategies, with particular attention
center vis-a-vis the care, treatment, and to the concerns of the youth. Twenty-four
rehabilitation of persons suffering from seven (24/7) hotlines, to provide assistance
addiction and other substance-induced mental to individuals with mental health conditions,
health conditions; and especially individuals at risk of committing
suicide, shall be set up, and existing hotlines
▪ (f) A referral system involving other public shall be strengthened.
and private health and social welfare service
providers, for the purpose of expanding access ▪ Section 22. Public Awareness. - The DOH and
to programs aimed at preventing mental illness the LGUs shall initiate and sustain a heightened
and managing the condition of persons at risk nationwide multimedia campaign to raise the
of developing mental, neurologic, and level of public awareness on the protection and
psychosocial problems. promotion of mental health and rights
including, but not limited to, mental health and
▪ Section 19. Duties and Responsibilities of nutrition, stress handling, guidance and
Mental Health Facilities. - Mental health counseling, and other elements of mental
health.
facilities shall:
CHAPTER V
▪ (a) Establish policies, guidelines, and protocols
for minimizing the use of restrictive care and EDUCATION, PROMOTION OF MENTAL
involuntary treatment; HEALTH
IN EDUCATIONAL INSTITUTIONS AND
▪ (b) Inform service user of their rights under IN THE WORKPLACE
this Act and all other pertinent laws and
regulations; ▪ Section 23. Integration of Mental Health into
▪ (c) Provide every service user, whether the Educational System. - The State shall
admitted for voluntary treatment, with ensure the integration of mental health into the
complete information regarding the plan of educational system, as follows:
treatment to be implemented; ▪ (a) Age-appropriate content pertaining to
▪ (d) Ensure that informed consent is obtained mental health shall be integrated into the
from service users prior to the implementation curriculum at all educational levels; and
of any medical procedure or plan of treatment
or care, except during psychiatric or neurologic
 ▪ (b) Psychiatry and neurology shall be required • All diseases blamed on demons
subjects in all medical and allied health
courses, including post-graduate courses in • Mentally ill – viewed as “possessed
health. • Priests performed exorcism to rid sufferers of
evil spirits
▪ Section 24. Mental Health Promotion in
Educational Institutions. - Educational • Use of incarcerations in dungeons, flogging and
Institutions, such as schools, colleges, starving
universities, and technical schools, shall
develop policies and programs for students, Renaissance
educators, and other employees designed to:
raise awareness on mental health issues, • People with mental illness were distinguished
identified and provide support and services for from criminals
individuals at risk, and facility access,
including referral mechanisms of individual with • Harmless – allowed to wander the countryside
metal health conditions to treatment and or live in rural communities
psychosocial support.
• ”Dangerous Lunatics” – thrown in prison,
▪ All public and private educational institutions chained and starved
shall be required to have a complement of
mental health professionals. • Mentally ill considered evil or possessed
▪ Section 25. Mental Health Promotion and Hospital of St. Mary of Bethlehem
Policies in the Workplace. - Employers shall • Officially declared a hospital for the insane,
develop appropriate policies and programs on the first of its kind in 1547
mental health issues, correct the stigma and
discrimination associated with mental
conditions, identify and provide support for • 1775 - Visitors were charged a fee for the
individuals with mental health conditions to privilege of viewing and ridiculing the inmates
treatment and psychosocial support. (McMillan, 1997)
Historical Perspectives of the
Treatment of Mental Illness
Ancient times
• Any sickness indicated displeasure of the gods
• Punishment for sins and wrongdoing
• People with Mental Illness – viewed as either Period of enlightenment (1790)
divine or demonic • Asylum - formulated by Philippe Pinel (France)
• Aristotle – attempted to relate mental and William Tuke (England)
disorders to physical disorders
• A safe refuge or haven offering
• Developed a theory that the amounts protection at institutions where people
of blood, water and yellow and black hade been whipped, beaten and starved
bile in the body controlled the because they were mentally ill
emotions
• Moral treatment of the mentally ill
• Correspond with happiness,
calmness, anger, and sadness • Dorothy Dix (1802-1887) – began a crusade to
• Imbalances can cause mental reform the treatment of mental illness after a
illness visit to Tuke’s institution in England
Treatment: aimed at restoring balance through blood • Instrumental in opening 32 state
letting, starving, and purging... hospitals in the US that offered
asylum to the suffering
Early Christian times
• Primitive beliefs and superstitions were strong
 • Advocated adequate shelter, nutritious Community mental health
food and warm clothing
• Less restrictive environments
• Short- lived – After 100 years,
attendants were accused of abusing • Deinstitutionalization – a deliberate shift from
residents of state hospitals institutional care to community facilities
• Philippe Pinel • Community Mental Health Centers
• Served smaller geographic catchment

• William Tuke • Less restrictive treatment located

closer to individual’s homes, families
and friends
• Provided emergency care, impatient
care, outpatient services, partial
Period of scientific study and treatment hospitalization, screening services, and
of mental disorders education
• Began with Sigmund Freud, Emil Kraepelin, and • Income for disabled persons
Eugen Bleuler (1857-1939) 21st Century
• Study of psychiatry and diagnosis and • Revolving Door Effect – People with severe and
treatment of mental illness persistent mental illness have shorter hospital
• Freud challenged society to view human beings stays, but they are admitted to hospitals more
objectively frequently
• Kraepelin began classifying mental disorders • Boarding – Patients are “boarded” or kept in
according to their symptoms the Emergency Department while waiting to see
if the crisis de-escalates i=or until an
• Bleuler coined the term schizophrenia inpatient bed can be located or becomes
Sigmund Freud (1856-1939) available
• Planned or self-admission – short hospital
stays and do not contribute to revolving door
Emil Kraepelin (1856-1926) phenomenon
• Homeless population
Eugen Bleuler (1857-1939) • Substance abuse
Healthy People 2030 Mental Health
Objectives
Development of Psychopharmacology
(1950) • Reduce the suicide rate
• First Psychotropic Drugs to be discovered: • Reduce suicide attempts by adolescents
• Chlorpromazine (Thorazine) – • Reduce suicidal thoughts in LGBT students
antipsychotic drug • Increase the proportion of children and
adolescents who get preventive mental health
• Lithium – anti-manic agent care in school
• Monoamine oxidase inhibitor – anti-depressant • Increase the proportion of children and
adolescents who get treatment
• Haloperidol (Haldol) – anti-psychotic
• Reduce the proportion of persons who experience
• Tricyclic anti-depressants major depressive episodes

• Benzodiazepine – anti-anxiety agents • Increase the proportion of adults with mental

health disorders who receive treatment
 • Increase the proportions of persons with co- • Client is assigned to a case manager who
occurring substance abuse and mental coordinates all types of care needed by the
disorders who receice treatment for both client
disorders
• Decreases fragmented care from a variety of
• Increase depression screening by primary care sources
providers
• Eliminates unneeded overlap of services
• Increase the number of homeless adults with
mental health problems who receive mental • Provides care in the least restrictive
health services environment
• Reduce anxiety and depression in family • Decreases cost for insurers
caregivers Psychiatric Care
• Reduce the proportion of adults with disabilities
who experience serious psychological distress • Costly because of long term nature of the
or delay preventive care because of cost disorders
• Increase proportion of women screened for Psychiatric Nursing Practice – History
postpartum depression
• Linda Richards (1873)
Consequences of Non-Treatment
• First graduate nurse in the United
• Deterioration of personal relationships States
• Worsening of untreated disorder • First American psychiatric nurse
• Physical health problems
• Homelessness • Believed that the mentally sick should
be at least as well cared for as the
• Psychiatric boarding physically sick
• Arrest
• Incarceration • First Training of nurses to work with persons
• Victimization with mental illness – McLean Hospital in
• Suicidality Belmont Massachusetts (1882)
• Familial violence • Custodial care focused on nutirion,
• Danger to Others
hygiene, and activity
Community Support Service Programs
• Nurses adopted medical-surgical principles to
• Meet the needs of persons with mental illness the care of clients with psychiatric disorders
outside the wall of the institution and treated them with tolerance and kindness
• Focus: • Somatic Treatments
•
Rehabilitation • Insulin shock therapy (1935)
•
Vocational support
•
Education • Psychosurgery (1936)
•
Socialization
•
Management of symptoms • Electroconvulsive therapy (1937)
• Medications
Managed Care • Nursing Mental Disease by Harriet Bailey (1920)
• Designed to purposely control the balance – first psychiatric nursing textbook
between the quality of care provided and the
cost of that care • John Hopkins (1913) – fisrt school of nursing
• People receive care based on need rather than to include a course in psychiatric nursing in its
request curriculum

Case Management • National League of Nurses (1950)- started

accrediting nursing programs and required
• Management of care on a case-to-case basis schools to include an experience in psychiatric
nursing
 • Two Early Nursing Theorists that Shaped • Incorporate the phases of the nursing process,
Psychiatric Nursing Practice including specific types of interventions for
nurses in psychiatric settings
• Hildegard Peplau
Psychiatric-Mental Health Nursing
• June Mellow Phenomena of Concern
Hildegard Peplau • Promotion of optimal mental and physical
• Published Interpersonal relations in Nursing health and well being and prevention of mental
(1952) illness
• Impaired ability to function related to
• Interpersonal techniques: Crux of Psychiatric psychiatric, emotional, and physiological
Nursing (1962) distress
• Described the therapeutic nurse-client • Alterations in thinking, perceiving, and
communicating because of psychiatric disorders
relationship with its phases and tasks or mental health problems
• Wrote intensively about anxiety • Behaviors and mental states that indicate
potential danger to self or others
• Emotional stress related to illness, pain,
disability, and loss
• Symptom management, side effects, or
toxicities assocaiated with self-administered
drugs, psycho-pharmacologic interventions, and
other treatment modalities
June Mellow • The barriers to treatment efficacy and
• Nursing Therapy (1968) recovery posed by alcohol and substance abuse
and dependence
• Described her approach of focusing on client’s • Self-concept and body image changes,
psychosocial needs and strengths developmental issues, life process changes and
• Contended that the nurse as a therapist is end-of-life issues
particularly suited to working with those with • Physical symptoms that occur akong with
severe mental illness in the context of daily altered psychological status
activities, focusing on the here and now to
meet each person’s psychosocial needs • Psychological symptoms that occur along with
altered physiologic status
• Interpersonal, psychological, sociocultural,
spiritual, or environmental circumstances or
events that have an effect on the mental and
emotional well-being of the individual and
fanily or community
• Elements off recovery, including the ability to
ANA Standards of Care maintain housing, employment, and social
support, that help individuals reengage in
• Authoritative statements that describe the seeking meaningful lives
responsibilities for which nurses are
accountable • Societal factors such as violence, poverty, and
substance abuse
American Psychiatric Nurses
Association (APNA) Areas of Practice- Basic Level Functions
• Outline areas of practice and phenomena of • Counseling
concern for the psychiatric mental health nurse
• Interventions and communication
techniques
 • Problem solving
• Crisis intervention
• Stress Management
• Behavior modification
• Milieu Therapy
• Maintain therapeutic environment
• Teach skills
• Encourage communication between
clients and others
• Promote growth through role modeling
• Self-care Activities
• Encourage independence
• Increase self-esteem
• Improve function and health
• Psychobiologic Interventions
• Administer medications
• Teach
• Observe
• Health teaching
• Case Management
• Health promotion and maintenance
Areas of Practice- Advanced Level
Functions
• Psychotherapy
• Prescriptive authority for drugs
• Consultation and liaison
• Evaluation
• Program development and management
• Clinical supervision