1. Evolution of Mental Health Services & Mental Health Nursing Dr Joanna Bennett

2. 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

3. Evolution of mental health services
Hippocrates ( 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

4. 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

5. 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

6. Hospitals for mentally ill
Egypt and Middle East AD
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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Asylums: Caribbean
Post emancipation 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Mental Health Nursing in Jamaica
months Post Basic psychiatric nursing course -
1997 Psychiatric and mental health nurse practitioner course - to UWI as MScN 2002
Dr Joanna Bennett

24. 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

25. 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

26. 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