Mental Hygiene and Mental Health, Unit-7, Psychology, According to INC syllabus

1. UNIT-7
MENTAL HYGIENE AND
MENTAL HEALTH
PREPARED BY-
DR. RAHUL SHARMA
HOD OF MENTAL HEALTH NURSING
PH.D. COORDINATOR
ASSOCIATE PROFESSOR
SEEDLING SCHOOL OF NURSING,
JAIPUR NATIONAL UNIVERSITY, JAIPUR

2. Mental Hygiene
 Mental Hygiene is the science, which studies laws and means of curing
and preventing mental disease, personality disorder and other
abnormalities for balancing adjustment and healthy development of
personality.
 Definition- Mental Hygiene consist of measures to reduce the incidence of
mental illness through prevention and early treatment and to promote
mental health. (Singh and Tiwari- 1971)

3. MENTAL HEALTH
 Mental Health is a state of balance between the individual and the
surrounding world, a state of harmony between one self and others, a
coexistence between the realities of the self and other people and the
environment.
 Definition- An adjustment of human beings to the world and to each other
with a maximum of effectiveness and happiness. (Karl Menninger- 1947)
 Simultaneous success at working, loving and creating with the capacity for
mature and flexible resolution of conflicts between instincts, conscience,
important other people reality. (APA- 1980)

4. CONCEPT OF MENTAL HYGIENE
1. Prevention –
 Identifying the causes leading to maladjustment, whether personal or
social and taking suitable precautions to eliminate the same.
 Suggesting ways and means for achieving emotional and social
adjustment.
 Suggesting methods for resolving inner conflicts and frustration for
getting rid of anxiety, tension and emotional disturbances.

5. 2. Preservation-
 Develop the inner potential of an individual.
 Attention emotional maturity and stability.
 Achieve personal and social security and adequacy.
 Promote healthy human relationships and group interaction.
3. Curative measures-
 An individual can enjoy good mental health to the extent one is cured as early as possible of mental illness
and disease he is suffering from.
 Adequate equip with the knowledge regarding types of mental illness and disorder.
 Suggest various therapies for treatment and curing mental illness and disorders.
 Suggest methods for rehabilitation and readjustment of mentally ill persons.
4. Balanced Development of the Personality-
 Holds the key for an individual adjustment with one own self and the environment.
 Lack of balanced development in all aspects of personality results in maladjustment and happiness.
 Over all personality development is a prerequisite for an individual to be emotionally stable and well
balanced.

6. 5. Leading Happy and Contented Life-
o The ability of an individual to lead a full and a happy life is directly proportional to the mental health
enjoyed by him.
o Avoid unnecessary anxiety, conflicts and frustration.
CONCEPTS OF MENTAL HEALTH- JAHODA (1958)
1. A Positive Attitude Towards Self-
 It include an objective view of self, including knowledge and acceptance of strengths and limitations.
 The individual feels a strong sense of personal identity and security within the environment.
2. Growth, Development and the ability for self Actualization- It is indicator with individual successfully achieve the
task associated with each level of development.
3. Integration-
 It include the ability to adaptively respond to the environment and the development of a philosophy of life.
 It help the individual to maintain anxiety at a manageable level in response to stressful situation.
4. Autonomy- individual ability to perform, in an independent self directed manner, the individual makes choice
and accepts responsibility for outcomes.
5. Perception of Reality- It include perception of the environment without distortion, as well as the capacity for
empathy and social sensitivity.
6. Environmental Mastery- it is suggest that the individual has achieved a satisfactory role within the group, society
and environment. He is able to love and accept the love of others.

7. CHARACTERISTICS OF A MENTALLY HEALTHY PERSON
o He has an ability to make adjustment.
o He has a sense of a personal worth, feels worthwhile and important.
o He solves his problem largely by his own effort and makes his own decision.
o He has a sense of personal security and feels secure in a group, shows understanding of other
people problems and motives.
o He has a sense of responsibility.
o He can give and accept love.
o He lives in a world of reality rather than fantasy.
o He shows emotional maturity in his behavior and develop a capacity to tolerate frustration and
disappointment in his daily life.
o He has a variety of interest and generally lives a well balanced life of work, rest and recreation.

8. WARNING SIGNS OF POOR MENTAL HEALTH
1. In younger children-
 changes in school performance
 poor grades despite strong efforts
 excessive worrying or anxiety
 Hyperactivity
 Persistent nightmares
 Persistent disobedience or aggressive behavior
 Frequent temper tantrums

9. 2. In older children and Adolescents-
• Abuse of drugs or alcohol
• Inability to cope with daily problems and activities
• Changes in sleeping or eating habits
• Excessive complaints of physical problems
• Defying authority, skipping schools, stealing or damaging property.
• Intense fear of gaining weight
• Long lasting negative mood, along with poor appetite and thoughts of death
• Frequent outburst of anger
3. In Adults-
 Confused thinking
 Long lasting sadness or irritability
 Extreme high and low moods
 Excessive fear, worrying or anxiety
 Social withdrawal
 Dramatic changes in eating or sleeping habits

10.  strong feeling of anger
 Delusions or hallucination
 Increasing inability to cope with daily problems and activities
 Thoughts of suicide
 Denial of obvious problem
 Many unexplained physical problems
 Abuse of drug or alcohol
PROMOTIVE AND PREVENTIVE MENTAL HEALTH STRATEGIES-
In 1960 psychiatrist Gerald Caplan described level of prevention specific to psychiatry.
1. Primary Prevention- It seeks to prevent the occurrence of mental disorder by
strengthening individual, family and group coping abilities.
Role of a Nurse in Primary prevention- Community mental health nurse are in a key
position to identify individual, family and group needs, conflicts and stressors. They play
a major role in identifying high risk groups and preventive the occurrence of mental
illness in them

11. A. Individual centered Intervention-
 Antenatal care to the mother and educating her regarding the adverse effect of irradiation, certain
drugs and prematurity.
 Ensuring timely and efficient obstetrical assistance to guard against the ill effect of anoxia and injury to
the new born at birth.
 Dietary corrections to those infants suffering from metabolic disorders.
 Correction of endocrine disorder.
 Training program for physically and mentally handicapped children like blind, deaf, mute and mentally
subnormal.
 Counseling the parents of physically and mentally handicapped children with particular reference to
the nature of defects.
 Fostering bonding behavior. Explaining importance of warm, accepting, intimate relationship and avoid
the prolonged separation of mother and child are essential.
B. Intervention Orientation to the child in the school-
 Teaching growth and development to parents and teachers.
 Identifying the problems of school performance and emotional disturbances among school children
and giving timely interaction.

12. C. Family centered Intervention to Ensure Harmonious Relationship-
 Consulting with parents about appropriate disciplinary measures.
 Promoting open health communication in families.
 Crisis counseling to the parents of physically and mentally handicapped children.
 Ensuring harmonious relationship among members of the family and teaching healthy adaptive
techniques at the time of stress producing event.
D. Intervention Orientation to keep families intact-
 Extending mental health education services at child guidance clinics about child rearing practice.
 Strengthening social support for the frustrated aged and helping them to retain their usefulness.
 Promoting educational services in the field of mental health and mental hygiene.
 Developing parent-teacher association.
 Home maker services- when there is absence of the mother from due to illness or other reasons for
prolonged periods, the public health nurse can arrange for the services.
 Providing marital counseling for those having marital problems.

13. E. Intervention for Families in Crisis- In developing crisis situation such as the child passing through
adolescence, birth of a new baby, retirement or menopause, death of wage earner inn the family,
desertion by the spouse etc. crisis intervention can be given at-
• Mental hygiene clinics
• Psychiatric first aid centers
• Walk in clinics
Mental Health Education-
 Conduct mass health education programs through film shows, flash cards and appropriate audio-
visual aids, regarding prevention of mental illness and promotion of mental health in the community.
 Educate health workers regarding prevention of mental illness so that they can function effectively in
all the areas of prevention.
F. Society centered prevention measures-
 Community development
 Collection and evaluation of epidemiological, biostatistical data.
 Cultural deprived families need better hygienic living condition, proper food, education, health
facilities and recreational facilities.

14. 2. Secondary prevention- Secondary prevention targets people who show early symptoms of mental
health disruption, but regain premorbid level of functioning through aggressive treatment.
Role of a Nurse in secondary prevention-
 Early diagnosis and case findings- This can be achieved by educating the public, community leaders,
industrialists, Mahila Mandals, balwadis etc. in how to recognize early symptoms of mental illness.
Case finding through screening and periodic examination of population at risk, monitoring of
patients etc. Thus, in clinics, schools, home, health care and the work place, community mental
health nurses detect early sign of increased level of anxiety, decreased ability to cope with stress
and failure to perceive self and provide direct services as appropriate.
 Early reference- The public should be educated to refer these cases to proper hospitals as soon as
they recognize early symptoms of mental illness.
 Screening programs- Simple questionnaires should be developed to identify the symptoms of
mental illness and early identify in community areas.
 Early and effective treatment for patient and providing counseling services to caregivers of mentally
ill patients.

15.  Training of health personnel- orientation courses should be provided to health
workers to detect cases in the course of their routine work.
 Consultation services- Nurses working in general hospitals may across various
conditions such as psychosis, anxiety, peptic ulcer, bronchial asthma etc. These basic
care providers need guidance and consultation to deal with such conditions in an
affective manner.
 Crisis intervention- If crisis is not tackled in time, it may lead to mental disorders or
even suicide.
3. Tertiary Prevention- Tertiary prevention targets those with mental illness and helps to
reduce the severity, discomfort and disability associated with their illness. Community
mental health nurses play a vital role in monitoring the progress of discharged patients
in halfway homes, houses etc.

16. Role of a Nurse in Tertiary Prevention-
 Family member should be involved actively in the treatment program.
 Occupational and recreational activities should be organized in the hospital.
 Community based programs can be launched by meeting the family members when
the need for discharge from the hospital. These program can be implemented
through day hospitals, night hospitals, after care clinics, half way homes, ex-patient
hostels, foster care homes etc.
 There should be constant communication between community health nurse and
mental health institution regarding the follow up of the discharge patient.
 Nurses need to be familiar with the agencies in the community that provide these
services. Collaborative relationship between mental health care providers and
community agencies are essential.
 An important intervention in the maintenance of patients as their own homes in the
community is the training in community living.
 Another aspect of community life that is more difficult to assess accurately and deal
with effectively, is the stigma attached to mental illness.

17. MENTAL HEALTH SERVICES-
Mental Health Agencies- Government at National Level-
There are 42 mental hospitals in the country with a bed availability of 20,893 in the
governments sector. In the private sector, there are 5,096 beds. These facilities have to
manage an estimated 1.02 crore people with severe mental illness and 5.12 crore
people with common metal disorders.
Mental Health Agencies- Voluntary
Voluntary organizations are a valuable community resource for mental health. It is play
an important role in developing suicide prevention and crisis support, formation of self
help of families, organizing community based housing facilities for short term and long
term care of persons with chronic illness, day care centers, sheltered employment
facilities, life skill programs for school drop out children and public mental health
education.
Non- Governmental Organizations-
It is recognized by government as non profit or welfare oriented organizations, which
play a key role as advocate, service providers, activist and researchers on a range of
issues pertaining to human and social development. Mental Health non-governmental
organizations are located throughout India. While many are formed in urban areas,
have begun to extend services in rural areas too.

18. Partial Hospitalization-
It is an innovative alternative to hospitalization. It is ideally suited to most of the
psychiatric syndromes, chronic psychotic disorder, neurotic conditions, personality
disorders, drug and alcohol dependence and mental retardation.
Day care centers, day hospitals and day treatment programs come under partial
hospitalization. Partial hospitalization has the advantage of lesser separation from
families, more involvement in the treatment program.
Quarter way Homes-
It is a place usually located within the hospital campus itself, but not having the regular
service of a hospital. There may not be routine nursing staff or routine rounds and most
of the activities of the place are taken care of by the patients themselves.
Halfway Homes-
It is a transitory residential center for mentally ill patients who no longer need the full
services of a hospital, but are not yet ready for a completely independent living. It
attempts to maintain a climate of health rather than of illness and to develop strength
individual capacity.

19. Self Help Groups-
Self help Groups are composed of people who are trying to cope with a specific problem or
life crisis and have improved the emotional health and well being of many people.
Suicide Prevention Centers-
There are many suicide prevention centers in India in the voluntary sector doing good work
and helping those in need.
 Helping Hands and medico-Pastoral Association in Bangalore.
 Sneha in Chennai.
 Sahara In Mumbai.
 Sanjivini and Sumaitri in New Delhi.
Other Mental Health Services-
 Community group homes
 Large homes for long term care
 Hostels
 Home care programs
 District rehabilitation centers

20.  Ego Defence Mechanisms :
Ego defence mechanisms are methods of attempting to protect self
cope with basic drives or emotionally painful thoughts, feelings or events. Ego defence
mechanisms also referred to as defence mechanisms, are considered as protective
barriers to manage instinct and affect in stressful situations (Freud, 1946)
 Purposes:
The purpose of Defence mechanisms is to reduce or eliminate
anxiety. They may be used to resolve a mental conflict, to reduce anxiety or fear, to
protect one’s self-esteem or to protect one’s sense of security. Depending upon their
use, they are therapeutic or pathological. They can be helpful when used in very small
doses and if overused, become ineffective and can lead to a breakdown of the
personality. Most defence mechanisms operate at the unconscious level of awareness
(Table 7.1).

23. Types of Defence Mechanisms
Defence mechanisms can be divided into adaptive and maladaptive
mechanisms (Table 7.2).

24. Implications
 Defence mechanisms enable a person to resolve conflicts. They are essential
to the maintenance of normal equilibrium.
 Difficulties only occur if the defence mechanisms are inadequate to deal with
anxiety or inappropriate to the situation in which they are used.
 Many mental mechanisms are a means of compromising with forbidden
desires, feeling of guilt, etc.
 When mental mechanisms are used moderately they are harmless and help to
face conflicts and frustrations easily and protect ego and also help to relieve
tensions and feel comfortable.
 Excessive and persistent use of these defence mechanisms is harmful. They do
not solve the problems, but only relieve the related anxiety. Too much
dependence makes us unable to face problems. For example, if a student is
unable to face the examination and withdraws from taking it, he may
experience greater difficulty in the next attempt. Hence, it is better to learn to
face the problems instead of resorting to these mechanisms.
 Many times more than one mechanism may operate in the process of adjusting
to the situation.

25. PERSONAL AND SOCIAL ADJUSTMENT
Many individuals have a desire to attain great wealth or to become extremely
or famous, but hardly a few of them attain these. Those of them, who take their
failures realistically, become satisfied with what they have attained and face the world
squarely. They can be called well-adjusted individuals. But those who are always
brooding over their failures or adopt abnormal means to satisfy their desire for
or wealth by becoming too arrogant or day dreamers, etc. are the persons who have
maladjusted personality.
Definitions:
 Adjustment means the modification to compensate for or meet special conditions.
(Webster—1951)
 Adjustment is the interaction between a person and his environment. How one
adjusts in a particular situation depends upon one’s personal characteristics as
the circumstances of the situation. In other words, both personal and
factors work side by side in adjustment. An individual is adjusted, if he is adjusted
himself and to his environment. (Arkoff—1968)

26. Areas of Adjustment:
Adjustment, although seeming to be a universal characteristic like quality, it may have different
and dimensions, such as:
 Health adjustment
 Emotional adjustment
 Social adjustment
 Home adjustment
 School or professional adjustment
Adjustment of a person is based on the harmony between his personal characteristics and the
of the environment of which he is a part. Personal and environmental factors work side by side in
bringing about this harmony.

27. Personal Adjustment:
Personal adjustment is a process of harmony between the individual and his environment. The
individual purposefully applies efforts and energy not only to accommodate perfectly within the
and the environment, but also to fulfil his needs and lead a happy social life. The adjustment is highly
selective and a specialized process. The adjustment of an individual is more dynamic and capable of
readjustment with new environment and there is remarkable mobility in the process of adjustment.
Characteristics of a Well-adjusted Person:
 Basic needs are satisfied
 Leads balanced life
 Respects self and others
 Has realistic goals
 Aware of one’s own strengths and weaknesses
 Flexible mind-set
 Ability to deal with adverse circumstances
 Realistic perception of the world
 Comfortable with the surrounding environment
 Absence of fault-finding attitude

28. Social Adjustment :
 As social beings we live in a society. We form opinions about others and others form opinions
us. Everybody wants acceptance and recognition from and within the society. We try to behave
according to the norms of the society, so that we can adjust with others.
 Social adjustment can be defined as a psychological process. It frequently involves coping with new
standards and values in the society. In the technical language of psychology, getting along with the
members of the society as best as one can is called social adjustment.