2. Nursing as a profession began to emerge in the late nineteenth century, and by the twentieth century it had evolved in to a specialty with unique roles and functions.

3. The role of psychiatric nursing began to emerge in the early 1950s. In 1947 was published an article in the AJN that reemphasized the shortage of psychiatric nurses and outlined the difference between psychiatric and general duty nurses.

4. ROLE EMERGENCE ROLE EMERGENCE …. An article by Bennet and Eaton in the American Journal of Psychiatry in 1951 identified the following 3 problems affecting psychiatric nurses: The scarcity of qualified psychiatric nurses. The under use of their abilities The fact that “very little real psychiatric nursing is carried out. In 1952 Peplau published a book, Interpersonal relationship in nursing, in which she described the skills, activities and role of psychiatric nurses.

5. Stranger The role assumed by both nurse and patient when they first meet. Resource person Provides health information to a patient who has assumed consumer role. Teacher Helps the patient to grow and learn from experience with the health care system Leader Helps the patient to participate in a democratically implemented nursing process. Surrogate Assumes roles that have been assigned by the patient, based on significant past relationship, as in the psychoanalytical phenomenon of transference. Counselor Helps the patient integrate the facts and feelings associated with an episode of illness.

6. ROLE EMERGENCE ROLE EMERGENCE …. Two significant developments in psychiatry in the 1950s also affected nursing’s role for years to come. The first was Jone’s publication of the therapeutic community. A new treatment method in psychiatry in 1953. Therapeutic communities became the preferred environmental for psychiatric patients. The second significant development in psychiatry in the early 1950s was the use of psychotropic drugs. With these drugs more patients became treatable and fewer environmental constraints such as locked doors and strait jackets were required.

7. EVOLVING FUNCTIONS: In 1958 the following functions of psychiatric nurses were described (Hays, 1975) Dealing with patient’s problems of attitude, mood and interpretation of reality. Exploring, disturbing and conflicting thoughts and feelings. Using the patient’s positive feelings toward the therapist to bring about psycho physiological homeostasis. Counseling patients in emergencies, including panic and fear. Strengthening the well part of patients.

8. EVOLVING FUNCTIONS…. In the 1960s the focus of psychiatric nursing began to shift to primary prevention and implementation of care and consultation in the community. Representative of these changes was the shift in the name of the field from psychiatric nursing to psychiatric and mental health nursing. This focus was stimulated by the community mental health centers Act of 1963.

10. Poverty affects all the cultural groups and also other groups including the elderly, the disabled, the psychiatrically impaired and single – parent families. Families living in poverty are undergone tremendous financial and emotional stress that can often trigger or exacerbate mental problems.

11. GEOGRAPHIC LOCATION AND ACCESS TO MENTAL HEALTH CARE Most mental health services are located in urban areas because the majority of the people live near cities. All age groups in rural areas have limited access to health care. The lack of resources is particularly problematic for children and the elderly who have specialised needs. Study showed t hat t he rural areas had a higher prevalence of alcohol and drug abuse or dependence.

12. CHANGING FAMILY STRUCTURE : Traditionally families have been a source of guidance security love and understanding. The family has undergone some radical changes in the past half a century. Its structure has changes, its functions have been altered and its nature has been affected. In almost all the modern families there is a lack of trust between the husband and wife, also between the parent and children.

13. Women’s role has hanged drastically in the family structure over the past 25 years. Working women still bear the bulk of responsibility for child care and household duties and often feel guilty and stressed from trying to do everything be a good parent and be successful at a demanding job.

14. MOBILITY AND RELOCATION: Families commonly relocate geographically in search of better employment opportunities or for life style changes. Such relocations are stressful to families who must leave familiar environments and readjust to new environments and life style.

15. In the past one – parent families were usually the result of the death of a spouse. Now, one – parent families are mostly the result of divorce. Of all children in one parent homes, 88% live with their mother.

16. STEP FAMILIES: In a step family, problems in relations between step parents and children may generate tension and the difficulties can be especially great in the marriage of single parents when the c children of both parents live with them as siblings.

17. ENVIRONMENTAL INFLUENCES : Non genetic and non – biological factors also play important mediating roles in the transmission of risk and resilience to psychiatric diagnosis (Silverman 1989). Most notably, these include parenting behavior, martial or partner relationship and family functioning. Such parenting styles may influence the development of maladaptive coping styles and interpersonal skills associated with depression and anxiety in children.

18. HEALTH CARE The delivery of a populations health care varies with the culture. The more developed nations of the world have complex systems for providing health care for their citizens. MENTAL; HEALTH CARE IN CANADA: By the late 1960s “comprehensive government administered health insurance plans were established in all provinces of Canada.” Today a “single payer arrangement” is used in the Canadean health care system, which is based on five guiding principles. 1.Universality 2.Portability 3.Accessibility 4.Comprehensiveness. 5.Public administration

19. MENTAL HEALTH CARE IN GREAT BRITAIN: All British citizens are provided health care through a government managed national health care system. T he secretary for social services is responsible for setting fees for private e physicians, budgets for hospitals and salaries for hospital physicians. MENTAL HEALTH CARE IN U.S.: Health care in U.S. is based on the private insurance model. By the late 1970s many employers provided insurance, w which included coverage for mental health care, for t heir employees.

20. DEVELOPMENT OF PSYCHIATRIC NURISNG IN INDIA 1.Health committee’s report in 1946 recommended preparation of nursing personnel in psychiatric nursing  In 1956 a one year post certificate course in psychiatric nursing started at NIMHN’S Bangalore 2.Based on recommendations of the Mudaliar’s committee (1964)  INC included psychiatric nursing as a compulsory course in B.Sc Nursing 3.In 1975 started MSc Nursing in Psychiatric nursing at RAK in New Delhi

21. COMMUNITY SUPPORT SYSTEM MODEL

22. For mentally ill people to function well within their communities, a wide range of support services is necessary A typical programme may co-ordinate such services as health care, housing, food, income support, rehabilitation advocacy and crisis response.