3. Introduction
• During the Middle Ages, the mentally ill were believed to be
possessed or in need of religion.
• Many cultures viewed mental illness as a form of religious
punishment or demonic possession.
4. Cont.
• These negative attitudes towards mental illness, lead to
stigmatization of mental illness, and ill-treatment of the
mentally ill individuals.
5. Institutionalization
• In the 1800’s, as medical psychology developed, psychiatric
institutions or asylums began to develop around the world.
6. Cont.
• The institutional inpatient care model, was considered the
most effective way to care for the mentally ill.
• Institutionalization was also welcomed by families and
communities struggling to care for mentally ill relatives.
7. Cont.
• However, with an increase in number of patients, the
asylums were overcrowded, with critical shortage of
resources.
• Care in these institutions was so degrading to both patients
and staff.
• Staff had to work long days with poor pay, and most
institutions were located in remote areas.
8. Cont.
• Patients were over medicated and ill treated as observed by
Szasz, an American psychiatrist.
• Therefore, public enquiries on management and treatment
of the mentally ill were instituted.
• Some of the findings from these enquiries helped shaping
public attitudes and led to deinstitutionalization.
9. Deinstitutionalisation
• In the mid- 1950s a push for deinstitutionalization and
outpatient treatment began in many countries
• This was facilitated by the development of antipsychotic
drugs and other therapeutic modalities. For example:
10. Cont.
• Cameron & Laing (1955) recognized nursing as therapeutic
and stated that patients transformed when nurses talked
with them
• Dr. Bickford noted that the way the nurse relates to the
patient can be therapeutic with little/no input from Doctors
11. Cont.
• Maxwell Jones, significant in the search for alternatives to
hospital care advocated for therapeutic milieu and
recommended nurses working in asylums to provide
outpatient care, to visit clients homes, and encouraged
community support.
12. Cont.
• Deinstitutionalisation in the United States was codified by
the Community Mental Health Centres Act of 1963.
• Strict standards were passed so that only individuals “who
posed an imminent danger to themselves or someone else”
could be committed to state psychiatric hospitals.
13. Cont.
• By the mid-1960s in the U.S., many severely mentally ill
people had been moved from psychiatric institutions to local
mental health homes.
• In place of institutionalized care, community-based mental
health care was developed such as community mental health
centres, supervised residential homes and community-based
psychiatric teams.
14. African perspective
• CMH has been in existence in Africa long before the advent
of Western medicine.
• Prayers, sacrifices and herbs were some of the treatments
used.
15. Cont.
• The first generation of African psychiatrists championed a
proper structured community mental health services.
• This was a result of evidence that outcomes of functional
psychosis were better in patients treated in Afro-Village
system where patients could access psychiatric services on a
community outreach basis.
16. Malawian perspective
• Like other African countries, in Malawi, community health
care has been in existence since time in memorial
• Mostly practiced through family systems and also heavy
reliance on spirituality, traditional healers
17. Cont.
• Up to now professional MH care is largely institutional.
• In district hospitals, mental health care is provided by
enrolled nurses , who run psychiatric and epilepsy clinics,
visit peripheral health centers and manage a few inpatients
18. Cont.
• In accordance with WHO (1978) mental health services need
to be integrated into PHC. However, in Malawi there is little
mental health services in PHC .
• Furthermore, CMH services are not well established.
19. Cont.
• Mental health services are faced with numerous challenges
such as:
• Lack of supervision
• Critical shortage of resources etc.
• There are very few studies on mental health.
• MH services are largely provided by general practitioners.
• All these challenges hinder the development of CMH
services.
20. Mental health movements.
Reform movement Era Setting Focus of reform
Moral Treatment 1800–1850 Asylum
Humane, restorative
treatment
Mental Hygiene 1890–1920
Mental hospital or
clinic
Prevention, scientific
orientation
Community Mental
Health
1955–1970
Community mental
health center
Deinstitutionalization,
social integration
Community
Support
1975–present Communities
Mental illness as a
social welfare problem
(e.g. treatment
housing, employment)
