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MENTAL HEALTH AND MENTAL HEALTH SERVICES. WARNING SIGNALS OF POOR MENTAL HEALTH. WILLIAM C. MENNINGER drew up the following questions to aid in taking one’s own mental health pulse: (if the answer is definitely ‘yes’ for any one question it indicates poor mental health)
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WARNING SIGNALS OF POOR MENTAL HEALTH WILLIAM C. MENNINGER drew up the following questions to aid in taking one’s own mental health pulse: (if the answer is definitely ‘yes’ for any one question it indicates poor mental health) a) Are you always worrying? b) Are you unable to concentrate because of unrecognised reasons? c) Are you continually unhappy without justified causes?
d) Do you loose your temper easily and often? e) Do you have wide fluctuations in your mood from depression to elation, back to depression, which incapacitate you? f) Do you continually dislike to be with people? g) Are you upset if the routine of your life is disturbed? h) Do your children consistently ‘get on your nerves’? i) Are you ‘browned off’ and constantly bitter? [ j) Are you afraid without real cause?
k) Are you always right and the other person is always wrong? l) Do you have numerous aches and pains for which no doctor can find a physical cause?
Consider the following list of activities and decide if you would consider a person doing such a thing to be mentally ill. a) Going for a walk in a Thunderstorm. b) Checking the door is locked three times before leaving the house. c) Having five baths every day. d) Betting Rs. 5,00,000/- on a horse.
e) Having hair dyed pink with green stripes. f) Getting pregnant without being married. g) Being scared of spiders. h) Getting anxious before an examination. i) Writing an extra statement because 13 is an unlucky number. j) Living in isolation without interacting with people.
Mental illness is a complex area, difficult to define, and definitions of normal and abnormal behaviour vary over time, from society to society, and in different contexts.
ABNORMALITY There is a difficulty in distinguishing normal from abnormal behavior. The following are the definitions: • Deviation from the average • Deviation from the ideal • Abnormality as a sense of subjective discomfort • Abnormality as the inability to function effectively • Legal definitions of abnormality
GRADATIONS OF ABNORMAL AND NORMAL BEHAVIOUR: DRAWING THE LINE ON ABNORMALITY It is better to view abnormal and normal behavior as marking two ends of a continuum rather than as absolute state. As such behavior should be evaluated in terms of gradations, ranging from completely normal functioning to extreme abnormal behavior. Obviously, behavior typically falls somewhere between the two extremes.
MODELS OF ABNORMALITY: From Superstition to Science For much of the past, abnormal behavior was linked to superstition and witchcraft. People displaying abnormal behavior were accused of being possessed by the devil or some sort of demonic god. This typically involved whipping, immersion in hot water, starvation, or other forms of torture in which the cure was often worse than affliction.
Contemporary approaches take a more enlightened view, and six major perspectives on abnormal behavior predominate. They are: the Medical Model the Psychoanalytic Model the Behavioral Model the Cognitive Model the Humanistic Model the Socio-cultural Model
MODELS OF PSYCHOLOGICAL DISORDERS Medical model – Suggests that physiological causes are at the root of abnormal behavior ( for ex. a brain tumor or chemical imbalance in the brain or disease) Psychoanalytic Model – Abnormal behavior stems from childhood conflicts over opposing wishes regarding sex and aggression. Behavioral Model – Abnormal behavior is a learned response – Its emphasis is on here and now. Both Medical and Psychoanalytic Models look at abnormal behavior as symptoms of some underlying problem.
Cognitive Model – The model suggests that people’s thoughts and beliefs are central to abnormal behavior. ( the primary goal of treatment using the cognitive model is to explicitly teach new and more adaptive ways of thinking) Humanistic Model – It suggests that individuals can, by and large, set their own limits of what is acceptable behavior. It focuses on the relationship of the individual to society, considering the ways in which people view themselves in relation to others and see their place in the society.
Socio-cultural Model – The model suggests that people’s behavior – both normal and abnormal – is shaped by family, society and cultural influences. • Social phenomena such as homelessness have been associated with psychological disorders – People from lower classes may be less likely than those from higher classes to seek help until their symptoms become relatively severe and warrant a more serious diagnosis
ABNORMAL BEHAVIOUR ‘Abnormal’ literally means ‘away from the normal’. It implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the body. The concepts of ‘normal’ and ‘abnormal’ are meaningful only with reference to a given culture. Normal behavior conforms to social expectations where abnormal behavior does not.
NORMAL AND ABNORMAL I) Psychiatric signs and symptoms are patterns of disturbed human behavior. Such patterns are also labeled with such terms ‘maladaptive’, ‘disordered’, ‘deviant’, ‘inappropriate’ and ‘abnormal’. II) Although grossly deviant behavior patterns are readily recognized as abnormal, the distinction between ‘normal’ and ‘abnormal’ can be difficult. III) A rough definition is ‘Behavior is abnormal if it causes trouble either for the patient or for others’. Behavior may cause trouble because of its intensity, its frequency, its lack of appropriateness to a given situation.
MENTAL DISORDERS The term ‘mental’ springs from a dualistic interpretation of human behavior The dualistic interpretation holds that the human organism consists of two separate components: The body or soma The mind or psyche These two components have impact upon one another – they are viewed as essentially separate. MENTAL DISORDERS ARE SIMPLY DISTURBANCES OF BEHAVIOUR
POPULAR MISCONCEPTIONS Mental Disorders have been generally characterized by superstition, ignorance and fear. Although successive advances in the scientific understanding of abnormal behavior have dispelled many false ideas, there remain a number of popular misconceptions. They are The belief that abnormal behavior is always bizarre. The idea that ‘normal’ and ‘abnormal’ are sharply differentiated. The view of mental disorders as a hereditary stigma. The view of genius as ‘akin to insanity’ The view of mentally ill persons as incurable and dangerous. The belief that mental disorder is a disgrace. An exaggerated fear of one’s own susceptibility to mental disorder.
General reaction of public to mentally ill persons The following emotional reactions which directly or indirectly determine our approach to mentally ill are Fear and suspicion…..that the mentally ill person may be harmful. Disgust and Dislike….because the mentally ill person is not clean Anger and Rejection…..because the mentally ill person annoys others. Sympathy and Pity Amusement and laughter Distrust Indifference
CAUSES OF MENTAL ILLNESSES Mental illnesses are caused by variety of factors viz. Changes in the structure and functioning of the brain. Heredity factors. Childhood experiences. Home/family atmosphere Other factors viz. Bad peer-group influence, unemployment, poverty, insecurity, exposure to stressful situations etc.
PSYCHIATRY Psychiatry is that branch of medicine devoted to the study, treatment and prevention of human behavior disturbances. Most of the specialties within the field of medicine deal primarily with disturbances in the structure and functioning of individual organs or organ systems. Psychiatry is concerned primarily with the functioning of the human organism as a unit – this refers to behavior
Human behavior is a function not only of biological but also of psychological and social variables – Hence, mental health professional must be familiar with both the biological and social sciences. For the clinical management of problem-behavior, a number of mental health professions have evolved
EXTENT OF MENTAL HEALTH PROBLEM • Severe mental illness – 1% to 2% (point prevalence) • Neurosis and psycho-somatic disorders (point prevalence) – 2% to 3% • Mental retardation – 0.5 % to 1% of all (point prevalence) children • Psychiatric disorders in – 1% to 2% of all children children
EXISTING MENTAL HEALTH SERVICES : INSUFFICIENT • Govt. Mental Hospitals – 45 (beds: approx. 25000) • Private nursing homes/clinics • General hospital • The no. of beds are insufficient • At least 50% of the beds (in Mental Hospitals) are occupied by long – stay patients. Not more than 10% of these requiring urgent mental health care are receiving the needed help.
MAN-POWER AVIALABLE- INADEQUATE • Psychiatrists – approx. 2500-3000 • Psy.Social Workers – approx 600-700 • Clinical Psychologists- approx 700-800 • Psychiatric Nurses – approx 600-700
15% to 20% of all help-seekers in general health services, in both developed and developing countries, do so for emotional and psycho-social problems.
Presently only 10% (approximately) of those who require mental health care are getting the services- most of these services are confined to urban areas. • There is a need to develop and evaluate alternate approaches to mental health care delivery system which is feasible and relevant to the Indian situation.
THE PREDOMINANT CHARACTERISTICS OF COMMUNITY PSYCHIATRY ARE: *Responsibility to a population for mental health care delivery *Treatment close to the patient in community based centers *Provision of comprehensive services. *Multidisciplinary/ team approach *Emphasis on prevention as well as treatment *Avoidance of unnecessary hospitalization
COMMUNITY MENTAL HEALTH • The concept of community psychiatry has its antecedents in Clifford Beers’(1908) mental hygiene movement. • The period between 1955 to 1980 was an era of de-institutionalization in USA and other western countries. This provided an impetus to the development of community psychiatry
COMMUNITY MENTAL HEALTH • In 1975 the WHO strongly recommended the delivery of mental health services through primary health care system as a policy of the developing countries. • Attempts were made in India to develop models of psychiatric services in the PHC setting at PGI, Chandigarh in 1975 (Raipur Rani Block of Ambala Dist.) and NIMHANS in 1976 (sakalwara)
REHABILITATION • Combined and coordinated use of medical, social, psychological, educational and vocational measures for training and retraining the individuals to the highest possible level of functional ability • Rehabilitation should start as early as possible.
HALF-WAY HOME • This facility provides aftercare following institutionalization, seeking to ease the individual’s adjustment to the community. • Patient has freedom/family contacts with the patient can be improved. • To prepare the family and patient to accept each other and prepare the patient to go back to the family.
DAY-CARE CENTRES • A community based hospital care where the patients are treated during the day; return to their homes at nights • It is a good measure of rehabilitation
NIGHT-CARE CENTRE • The individual might receive treatment during all or part of the night while carrying on his usual occupation in the day time.
SHELTERED WORKSHOP • A protective environment for people with disabilities
DOMICILIARY SERVICE • Services are provided in patient’s home • No stigma • Family involvement in the treatment is possible • No dislocation of client from the natural environment
ETHICAL ISSUES AND PRINCIPLES Every mental health professional must have a clear social responsibility. He/she must maintain high standards of professional competence and ensure continuing-education. Benevolence and patient interest precede self-interest.
He/she must maintain high moral standard. Patient welfare is of paramount concern to a mental health professional. It includes not treating cases which are not in his/her domain, terminating treatment when can not help the patient, and treating with the best of the ability. Confidentiality of the patient records must be meticulously maintained. Treatment should be given with patient’s consent; consent should be entirely voluntary for research purpose. Hospitalization should be patient’s welfare.
Treatment should be humane and never punitive/treatment should never be refused. No gifts and gratification should be accepted from patients under treatment. Any sexual advance towards any patient is unethical. In case of doubt and/or unconventional treatment procedures, a second opinion must be obtained. It is unethical to force a contract on a patient during treatment.
THE MENTAL HEALTH ACT 1987 • Mentally ill person is defined as a person who is in need of treatment by reason of any mental disorder other than mental retardation.
The Act uses the term ‘mentally ill person’ instead of ‘lunatic’ • The term ‘mentally ill prisoner’ is used instead of ‘criminal lunatic’ • The term ‘psychiatric hospital’ is used instead of ‘mental hospital’. • The Act defined the terms: - ‘psychiatric nursing home’ - ‘psychiatrist’.
Establishment of Mental Health Authorities at the Central and State Levels
It lays down the guidelines for establishment and maintenance of psychiatric hospitals and nursing homes. • There is a provision for a Licensing Authority who will process applications for licenses.
ADMISSION • Admission can be made in a psychiatric hospital/nursing home in the following manner • Voluntary admission - by the client’s request, if he is a major - by the guardian, if a minor
ADMISSION CONTD… 2) Admission under special grounds • this is an involuntary hospitalization if the client cannot express his willingness for admission. • A relative can make an application for admission, if the hospital is satisfied that the admission will be in the interest of the mentally ill person • The duration of admission cannot exceed 90 days.
ADMISSION CONTD… 3) Reception order on petition 4) Reception order without petition
The Act deals with the inspection, discharge, leave of absence and the removal of mentally ill person. • The Act also deals with Judicial inquisition regarding alleged mentally ill person possessing property, custody of the person and management of his property.
(If the court feels that the alleged mentally ill person is incapable of looking after both himself and his property, an order can be issued for the appointment of a guardian. • If it is felt that the person is only incapable of looking after his property but can look after himself, a manager can be appointed.)
There is a provision for an inspecting officer who will inspect the psychiatric hospitals and nursing homes to prevent any irregularities.
The Act also deals with the procedures of admission and detention in psychiatric hospitals or nursing homes.