Evolution of Mental Health Services

& Mental Health Nursing

Dr Joanna Bennett

Evolution of mental health services

• Egyptian writings (1500BC) - 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 >>15th & 16th

– 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 700-1200AD• Spain 15th 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 18th C

18thC – 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 – 18th C

• Pinel’s example was 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 19th C

• Methods of caring for the mentally ill was more humane

• 1839 restraints were forbidden

• 1883 Kraepelin - 1st 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 1920s -Shock therapy – insulin (coma), ECT

3 1950s - 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– 1st mental hospital in Spanish Town for

Europeans & upper classes

Mental health services: Caribbean

• Asylums in the Caribbean introduced later than Europe (1790s)

• 1819 Restraints (head and leg locks & chains), bleeding, purging and immersion in water tanks continued in Caribbean– “Mid 18thC – most mentally-ill Blacks either

died from suicide (eating dirt or hanging) or incarcerated in dungeons of plantations or infirmaries”

Asylums - Caribbean1862 asylum which became Bellvue in1930s– viewed as more humane than been locked

away with criminals and paupers (general pattern pre-asylums)

– Trinidad & Tobago 1858– Grenada 1879– Antigua 1871

Legislation (British) up to mid-20th 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 20thC– first Black Caribbean psychiatrists trained in

UK, US Canada

• 1950s – 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 19thC (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 MScN 2002

Models/Approaches to mental health nursing

• 1950s into the early 1980s 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 1990s was on the therapeutic relationship/interpersonal relations as the primary role of the mental health nurse

• 21st C– growing emphasis on evidence-based practice

– challenge mental health practitioners’ belief in the primacy of the 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