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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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

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 Dr Joanna Bennett

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” Dr Joanna Bennett

Asylums - Caribbean 1862 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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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

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

Mental Health Nursing First public nursing courses developed in 19thC (Britain 1891) Since that time the status of psychiatric nursing has risen and fallen Dr Joanna Bennett

Mental Health Nursing in Jamaica Stewart, H.C. (1982) The history of Psychiatric nursing in Jamaica (unpublished) 1948 first graduate of Certificate (RMN) Dr Joanna Bennett

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 Dr Joanna Bennett

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 Dr Joanna Bennett

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) Dr Joanna Bennett

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 Dr Joanna Bennett

Debate continues – general view: 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 Dr Joanna Bennett