BASIC CONCEPTS & PRINCIPLES

OF MENTAL HEALTH NURSING IN

PROVISION OF CARE

Facilitator: Ms. Ummy Msenga

Date: October/ 2024
 Objectives:

By the end of this session, students are expected to be able to:

 Define the following terms Mental health, mental
disorders/mental illness
 Explain the evolution of mental health services internationally
 Explain historical background of mental health services in
Tanzania
 Explain principles of mental health in the provision of mental
health care
 Activity: Brain storming
Define mental health, mental illness
and mental disorder??
 Definitions
• Mental health is a successful adaptation to stressors from
the internal or external environment, evidenced by
thoughts, feelings, and behaviors that are age-appropriate
and congruent with local and cultural norms.
• Mental illness is maladaptive responses to stressors from
the internal or external environment, evidenced by
thoughts, feelings, and behaviors that are incongruent
with the local and cultural norms and interfere with the
individual’s social, occupational, and/or physical
functioning.
• Mental disorder is a clinically significant behavioural or
psychological syndrome or pattern associated with present
distress or disability.
 Historical Background of Mental Health
Internationally
• History of the science in psychiatry and the procedures
utilized in the treatment and care of mentally ill patients
makes interesting reading.
• It is impossible to say when exactly psychiatry began as it
is apparent and possibly before.
• The fate of the psychiatric patient remained on the
inhumane and primitive methods full of dangers.
• This was because the mentally ill patient was considered to
be problem and disgrace to the family , Therefore, the
patient was put into asylums far away from their homes in
the interest of the public and the family
 Historical Background of Mental Health
Internationally
• The historical development of psychiatry falls under the
following periods:
• Demonological period
• Humanitarian period
• Political period
• Scientific period
 Historical Background of Mental Health
Internationally
Demonological Period (1)
• In this period, the psychiatric patient was considered to be
possessed by the evil spirit, the demons and other super-
natural powers that attribute to their abnormal behaviors.
• To the primitive man the whole society of that time, all
illness in the patient was caused by the demons including
other forces acting outside the human body
• The decision whether the patient is possessed good or bad
spirit depended upon the symptoms presented by the
patient
 Historical Background of Mental Health
Internationally
• Demonological Period (2)
• If the behavior of the patient or speech appeared to have
religions or cool significance, then it was considered that
the patient is having good spirits and was somehow treated
with considerable kindness and respect, for it was thought
that they had supernatural powers.
• However, those who expressed aggression, noise,
destructiveness, and all sorts of abnormal conducts were
said to have bad spirits. They were treated harshly, beaten
and staved
 Historical Background of Mental Health
Internationally
• Demonological Period (3)
• Methods of Treatment During Demonological Period
• Exorcism: Casting out the evil spirit from the patient by
saying long prayers, spells , offerings and doing rituals,
use of herbs, purgatives made from sheep and wines.
• Charms: The use or application of the magic. The
effectiveness of such methods rested upon the faith of
the people, patient , and the mental condition he is
suffering.
• Neurotics could get some relief and psychotics did not get
much relief
 Historical Background of Mental Health
Internationally
• Demonological Period (4)
• Torture: Punishment in the most cruel and crude way, to
make the body of the patient unpleasant place for the evil
spirit to stay, so is driven out of the body of the patient.
The torture was blistering , plunging in cold water of
ponds, lakes , and rivers, starving by not giving food and
water, and beating up the patient and locking them up in
dark, wet and poorly ventilated rooms.
• Others were bounded together (particularly those who
were not responding with treatment) and transferred to
forest — left there for the mercy of the wild animals to
finish them
 Historical Background of Mental Health
Internationally
Humanitarian Period
• This period was also called Roman period. It was practiced
early 860 B.C, when Greek priests advocated kindness for
mentally ill patients and suggested for both physical and
recreational activities.
• The Greek healers interest turned towards observation and
experimentation on the care of psychiatric patients.
• The early scientific experiments movement is well - observed
in the writings of contributors to our present knowledge of the
working of the human mind
 Historical Background of Mental Health
Internationally
Imhotep
• An Egyptian physician of 400 B.C treated the mentally ill
patient as those of any other physical conditions.
• He was considered as “ master bringer of peace” in the life
of those suffered from psychiatric disorders.
• The ancient Egyptians used some form of neurosurgery in
treating mentally ill patients; they opened the skull of the
patient in attempt to relieve the shut in evil spirit in the brain.
• Evidence was from old skulls picked from the pyramids;
they made holes on the skulls and let the fluid out (bore hole
operation
 Historical Background of Mental Health
Internationally
Hippocrates (1)
• The Greek physician and philosopher of 460 -357 B.C, has
been called the “ father of medicine”
• He totally disagreed with the ideas of believing that god and
evil spirits had influence towards the cause of mental illnesses.
• He believed and emphasized that the brain is central organs of
intellectual activities and that mental illnesses was due to brain
pathology.
• He initiated the phrenitis (inflammation of the brain)
• His method of treatment was far more from the previous ones
 Historical Background of Mental Health
Internationally

Hippocrates (2)
• He believed in the environment and that it matters so much in
patients’ management so he removed the patient from their
home environment and parents to change the environment.
• He also believed that hysteria is observed in females only and
defined it as the wandering of the uterus to different parts of the
body in search for pinning a child.
• For that belief , he recommended marriage as the best treatment
for hysterics.
• He also suggested that court to improve the rights of psychiatric
patients.
 Historical Background of Mental Health
Internationally
Galen
• A Roman physician, who study the anatomy and physiology of
the nervous system and ruled out that presence of symptoms,
did not necessarily indicate that the organ or body part which
seemed to be the origin was the affected part
• He developed a theory of rational soul, divided it into external
part consists of five senses and the internal part consists of
such functions or imaginations, judgments, perception, and
movement.
• Galen also believed that the brain is the centre or the source of
mental conditions; his concept was as that of Hippocrates.
 Historical Background of Mental Health
Internationally
Plato
• He put up the ideology of studying individual peoples
mind.
• Commencing with himself through the assistance of his
relatives to give him his own life history and later he
continued to study his family members and educators in
order to explain the theory of human behavior.
• Plato also concluded that psychiatric conditions were
centered on the brain functions; if one was not at peace
mentally, they were more likely to show psychiatric
symptoms
 Historical Background of Mental Health
Internationally
Political Period (1)
• The first recognition of the mentally ill patient was in the
14-17th century. During the leadership of Edward II in the
England when parliament approved the bill
• Edward II passed the bill to protect psychiatric patients
and their properties including all rights
• During this period, hospital was better as compared to
prison and workshops where patients continued to be
detained. More hospitals continued to be built away from
the cities and towns because people still had stigma on
mental patients’ behaviors
 Historical Background of Mental Health
Internationally
Political Period (2)
• Houses for the insane were dark, damp, and less ventilated.
Treatment at that time included charming, beating, hard
working in farms, and key and lock behind the iron bars in
well built cells (small rooms)
• Political period contributed very much to the present practice
of psychiatry as one can observe some of the management
tasks on the use
 Historical Background of Mental Health
Internationally
Scientific Period
• During the 19th century, treatment including the care of psychiatric
patient in the hospital improved very much.
• More modern treatment and investigations were done in a more
scientific method.
• Doctors and nurses developed more interest in the patient care and
treatment.
• Training of staff was done in order to provide the best treatment and
care.
• Treatment includes the following:
• Electroconvulsive therapy, insulin therapy and, narcotics
• Occupational and recreational therapy, psychotherapy, flowchart
method (counseling), neurosurgery, auto molecular therapy
(vitamins) and drugs (antidepressants/tranquilizers)
 Historical Background of Mental Health
Internationally
Contributors in scientific period (1)
• Phillip Pinel(1745-1826)
• He was working in the hospital Bicentre in France.
• He advocated human treatment to psychiatric patients,
removed chains, and improved treatment and recreational
facilities
• Also improved sanitation and housing; his practice and
ideologies of care was adopted by: Chiarugi in Italy
(1959 ), Daniel Tuke in England (1827 -1895), Dorothea
Dixin USA (1802-1887), and Frekin in German
 Historical Background of Mental Health
Internationally
Contributors in scientific period (2)
• Ferrick
• In 1835, he strengthened the report of abolishing the cages
in which patients were exposed like animals and people
watched for fun.
• He introduced legislation for the mentally ill patients to be
admitted through legal procedures and now was separated
from criminals.
• Jean Charcort (1825-1893)
• He focused the interest of physician on hysteria. He
believed that hysteria is a hereditary condition but this
theory has been disrupted out of field of psychiatry.
 Historical Background of Mental Health
Internationally
Contributors in scientific period (3)
• Emil Kraepelin (1856-1926)
• He was considered“ father of descriptive psychiatry.” He
carried psychiatry from the view of relying on symptoms to a
more comprehensive reliable descriptive system.
• He set up the first research unit (institute) with a laboratory of
serology, chemistry, Pathology, and experimental psychology.
• He gave a proper classification of mental illness and he
believed that Mental disorders were definite disease
• He emphasized on the importance of total clinical picture with
proper diagnosis, cause, course, symptomatology, and prognosis of
the condition in general.
• He also stressed on clinical observation and research for the
physical origins of mental conditions
 Historical Background of Mental Health
Internationally
Contributors in scientific period (4)
• Eugen Bleuler(1857 –1937)
• He worked on the mental condition mainly on
schizophrenia. He ruled out that not all schizophrenia
(dementia praecox) ended in personality deterioration nor
was the onset only on puberty.
• He also formulated the word schizophrenia because he
considered it to be disorganization of personality. (schizen-
split and phren-mind)
• He took the interest to study or describe some of the
symptoms; e.g. autistic thinking, ambivalence, and schizoid
personality
 Historical Background of Mental Health
Internationally
Contributors in scientific period (5)
• Pierre Janet (1859-1947)
• He formulated that many sexual disturbances are result
and not the cause of nervous disorders.
• He differed from Freud about the aetiology of anxiety. He
believed the inadequacies can lead to anxiety.
• He grouped obsessive compulsive neurosis and phobia.
• He also stated the theory of psychic tension, which
personality function occurred when different elements
dissociated away or split off from the stream of
consciousness
 Historical Background of Mental Health
Internationally
Contributors in scientific period (6)
• The contribution of the following scientists established
school in psychiatry:
• Sigmund Freud (1856-1909) established
psychoanalytic school.
• Carl Jung (1875 -1961) established the analytical
school of psychology.
• Alfred Adler (1870 -1937) established school of
individual psychology.
• Adler also established school of existential analysis
 Historical Background of mental health in
Tanzania
• Tanzania , like any other countries all over the world, mental
health has been a long-standing history in a mankind and
people from our ancestors.
• All these people have different feelings toward its causes and
the management.
• Early in history , most Tanzanians had similar beliefs relating
to demons and evil spirits being responsible for mental
disorders.
• How to get rid of these demons, the mentally disturbed person
had to be taken to a traditional healer who will perform the
healing
 Historical Background of mental health in
Tanzania
• Traditional healers took interest in treating patient suffering.
There were considerable social danger and more exploiters in
the society. Cases of neuroses benefited more as compared to
psychoses
• Some people believed that mentally ill patient s in the mental
hospital are badly treated and confined in the cell, once you get
into mental hospital you will never get out, and they regarded
mental hospital as something between a person and a
concentration camp, something which is not true.
 Historical Background of mental health in
Tanzania
• Up to now , there is still a stigma and discrimination among
people towards the mentally ill persons and mental hospital.
When visiting the psychiatric hospital to see their patients ,
they feel oversensitive and not at easy.
• There are also stigma and discrimination of mentally ill by
some health care providers – not all people are happy to work
in psychiatric hospital
• There are also stigma among patients themselves
 Historical Background of mental health in
Tanzania
• Lutindi was the first hospital to care for psychiatric patients
in Tanzania, followed by Irente at Lushoto and later Mirembe
psychiatric hospital which was established/built in 1927.
• Since then, various psychiatric units and rehabilitation
villages were established at least in each region level to make
sure psychiatric services runs smoothly.
• Community psychiatry was introduced by Dr. Rugeiyamu in
1973 at Mirembe hospital with an objective caring patients on
their own environment, so that families, relatives, friends ,
and community provides adequate support to the psychiatric
patients and thus reducing stigma and discrimination also
facilitating healing process.
 Historical Background of mental health in
Tanzania
• Mirembe psychiatric school was opened in 1973 to train nurses
for six months on psychiatric nursing with an award of certificate
in psychiatric nursing.
• The aim of the program was to increase knowledge, skill ,and
attitudes of staffs who will provide care to psychiatric patients
in respective to various health facilities.(Community,
dispensary, health center, district, and regional levels).
• The school is supported directly by the Ministry of Health.
• Later 1983 – 1996, the program changed from certificate to
diploma in psychiatric nursing. The program was for 18
months. In 1996, the program changed to 2 years.
• In 1994, the advanced diploma in mental health program was
established by the ministry of health for two years of studies
 Historical Background of mental health in
Tanzania
• All effort was made in order to increase more competent staff for
care of mentally ill patients and improving mental health services
in different health facilities
• The current curriculums of nursing have made effort for mental
health to be among subjects to be taught in all schools of nursing
(NTA 4 -6).
• Community psychiatry is practiced nearly all over the country at
the community, district and regional levels. The mental health
coordinator coordinates the mental health services in their
respective areas.
• Within the dispensary, health centers, district and regional
hospitals there are clinics/ward/ units where mentally ill are
attended or referred to special treatment and care center
 Specialized Facilities Rendering Mental Health
Services
Specialized Mental Health Services
• Functionally, mental health services are operated in six
specialized facilities such as: psychiatric crisis services,
psychological testing and referral services, research and
education services which are decentralized unit without
patients' clinics, centralized hospital, and a day hospital
program.
• In Tanzania, there are various health facilities that
rendering mental health services:
• Psychiatric hospitals – Mirembe National Hospital for Mental
health services and Isanga Institute for Forensic Psychiatry
 Specialized Facilities Rendering Mental Health
Services
• Other health facilities
• Psychiatric units – Include all Regional and some district
hospitals; for example, Morogoro psychiatric unit,
Mawenzi hospital, Kitete-Tabora hospital, Muhimbili
psychiatric unit and Mbeya. They treat and care for the
patient at the possible near homes to reduce the burden of
Mirembe hospital
• Health centers
• Dispensaries
• Non-governmental organizations e .g. MEHATA, religious
hospitals, health centers etc…
Existing Social Support Systems for Psychiatric
Patients
• Social support system available in the community for the
mentally ill patients include:
• Religious groups
• Family members
• Relatives
• Community social groups with specific activities
• Non- governmental organizations e.g. Basic Needs
• Social welfare/social work
• Primary healthcare committee
• Village government
• Social clubs
 Principles of mental health in the provision of
mental health care

 Principles refer to rules or laws that have proved to be

applicable in most, if not all situations.
 Mental health nursing is the process whereby the nurse assists
persons, individuals or in groups, in developing a more positive
self-concept, a more harmonious pattern of interpersonal
relationships, and a more productive role in society.
 Principles of psychiatric nursing provide general guidelines that
should be used in the nursing care of all mentally ill people
unless the assessment data indicate otherwise.
 Principles of mental health in the provision of
mental health care
 The Principles of mental health includes:
o The nurse must view the client as a holistic being with a
multiplicity of interrelated and interdependent needs. It directs
a nurse psychiatrist who must become skilled in understanding
the interrelatedness of all the client’s subsystems.
o The nurse can be most helpful to the client by focusing on his
strengths and assets, not on his weaknesses and liabilities.
 Each individual has potential for growth; the strengths clients
have should be built on to encourage the emotional growth of
the individual.
 Principles of mental health in the provision of
mental health care
o The nurse needs to accept the client as a human being who has
value and worth exactly as he/she is. Each individual is unique
and has inherent value, i.e. call the patient by name,
 Mr.…, convey acceptance to the patient.
o The nurse must view the client’s behavior as designated to meet
a need or to communicate a message. All behavior has meaning.
o The nurse needs to make effort to convey to the client her
understanding of this fact and her willingness to help the client
meet the need or communicate the message in a socially
acceptable way through which the client’s needs can be met.
 .

o The nurse has the potential for establishing a relationship with

most, if not all, clients.
 All human beings are sufficiently similar so that there is a
basis, no matter how small, for understanding and
communicating with one another.
o Nurse should interact with every client in a helpful way.
 The quality of interaction in which the nurse engages with the
client is a major determinants of the degree to which the client
will be able to alter his behavior in the direction of more
satisfying and satisfactory interpersonal relationships.
 An individual learns behavioral responses primarily in
interaction with significant people in his environment. In most
settings, the nurse has the opportunity of spending the greatest
amount of time with the client through therapeutic interaction
and helping him to effect behavioral change.
 Principles of mental health in the provision of
mental health care
o The nurse needs to view the client’s behavior as the best
possible adaptation he is capable of making at the time.
 All behavior is a learned response based on the individual’s
perceptions of past events and maladaptive behavior
represents an adaptation to previous unhealthy or unique
situations.
 If maladaptive behavior was learned, it can be unlearned, and
more adaptive behavior can be learned in response to healthier
and more usual situations.
 This belief is one of the bases of the nurse-client relationship
 Summary

• The history and development of psychiatry and management

falls under periods of demonological, humanitarian, political
and scientific period of which each period has a significant
benefit for the modern mental health practice.
• The great contributors to the development of modern
psychiatry include; Sigmund Freud (1856–1909) established
psychoanalytic school, Carl Jung (1875-1961) established the
school of analytical school of psychology, and Alfred Adler
(1870-1937) established school of individual psychology.
 Various health facilities offer mental health services in
Tanzania from lower to upper level. Such services include
identification, treatment, referral, and mental health
promotion.
 References

• Andrews, G., &Jenkins,R.(1999).Management of mental

disorders (UK ed.).Sydney:World Health Organization
Collaborating Centre for Mental Health and Substance Abuse
• Barry, P. D. (2002.) Mental health and mental illness (7th ed.).
Philadelphia : Lippincott.
• Lees, L. (1997). Text book of psychiatry. New York Oxford
University Press.
• Puri, B. K., Laking, P. J., & Treasaden, I. H. (2008). Textbook
of psychiatry (2nd ed.). London: Churchill Livingstone.
 References
• Rawlins, R. P., Williams, S. R., & Beck, C. K. (1993). Mental
health - psychiatric nursing: A holistic life - cycle approach (3
Rd ed.). St. Louis: Mosby.
• Stuart, G. W ., & Sundeen, S. J. (1995). Principles and practice
of psychiatric nursing (5th ed .). St. Louis: Mosby
• Taylor, M. C. (1994). Essentials of psychiatric nursing (15th ed.).
St. Louis: Mosby