Concepts of mental health

CONCEPTS OF
MENTAL HEALTH
PIYUSH PARASHAR

INTRODUCTION
• Health is an ability to make adjustment whereas illness represents a
failure of adjustment.
• Health is an absence of disease or there may not be obvious
symptoms of any kind and yet a person may not be functioning at
his/her optimum level, that means, not enjoying full health.

HEALTH
• It is described by success and by constructive compromise (
readjustment).
• Illness is represented by the terms psychoneurosis, psychoses,
psychosomatic disorders and character and behavior disorders.

MISCONCEPTION OF
MENTAL ILLNESS

• Mental Illness is multifactorial in nature.
• Most of the time mental illness is characterized by superstitions,
ignorance and fear.
• Some of the popular misconceptions about mental illness are as
follows:

Misconception that Abnormal Behavior is
Bizarre.
• Bizarre behavior shown by mentally ill patients is like
 Laughing without any reason
 Crying
 Getting violent
 Being abusive
 Tearing of clothes
 Sexual assault.

Misconception that abnormal behavior is
Bizarre
• It is a misconception that every mother who is mentally ill/ sick may kill her
baby or patients will stand naked in front of everyone.
• For example: a young girl who is not doing her studies well may leave the
school. A boy who is drug addict demands money from parents. Children
threatening parents that they will commit suicide are not indications of
mental illness. It is a misconception.
• Most of the patients suffer from mental disorder because of their
maladaptive behavior. So all those patients who are admitted to the
hospital or attend the Out Patient Department due to mental disorder
necessarily do not have a bizarre or dangerous behavior such as hysteria,
anxiety neurosis.
• Therefore, it is a misconception.

Misconception that Normal Person will Never
be Abnormal
• It is very difficult to say that all the time a person is healthy.
• There is a very thin edge or line between normalcy or abnormalcy. Normalcy in
place ‘A’ may be abnormal in place ‘B’ according to the socio- cultural setting.
• For example: a girl holding the hand of a boy and walking on the road side is
very normal in a Western setting. But in our country it is not considered
normal.
• Normal and abnormal behavior are subject to the society’s values.
• Unfortunately, abnormal people are stigmatized and obstracised by the society
for lack of knowledge as the society had earlier done by isolating tuberculosis
patients and leprosy patients till they were educated.

Misconception that Patients Admitted to Mental
Hospital are More Dangerous than those Admitted
to General Hospital
• Another misconception is that the mentally ill remain dangerous to
society even when they come out of the hospital.
• It is thought that they are emotionally unstable.
• Hence, any time they may become violent or kill someone. It is a
misconception that a patients admitted to mental hospitals are more
dangerous than those admitted to a general hospital, though being
treated by psychiatrists because, like other organic diseases, most
of the mentally ill patients respond to treatment and are able to
carry on with their responsibilities.
• Only patients with brain damage will never recover completely.

Misconception that Mental Health is not
related to Physical Health
• It is also a misconception that mental health is not related to
physical health.
• People who suffer from mental illness have its effect on physical
health and vice- versa.
• A person suffering from physical illness may become anxious, tense
or depressed. For example: high anxiety may lead to peptic ulcer or
myocardial infarction in a person.
• Similarly, a person suffering from a multiple fracture may have
severe depression for the reason that he is the only earning
member of the family.

Misconception that Prevalence of Mental
Illness is Low in India
• It is a misconception that prevalence of mental illness is low in our
country. Surveys of mental morbidity and epidemiological studies till
1975 have reported that about 1% of the population are suffering
from severe mental disorders and about 5 to 10% have less severe
mental disorders.
• Thus, mental disorders form very important public health problem.

Misconception that Mental Illness once
Acquired is Life Long
• People have ideas that mental illness, once it occurs, remains for
life time.
• Most of the mental illnesses can be controlled through proper
psychotherapy, drugs, behavior therapy or family therapy.
• So it is wrong to believe that mental illness, once acquired is life
long except in a small percentage of patients who become chronic.

Misconception that no Treatment is Available
for Mental Illness
• It is also very wrong belief that no effective treatment is available for
mental illness.
• Mental illness are curable or can be controlled with drugs and other
measures like physical methods, psychotherapy, behavior
modification techniques and family therapy.

Misconception that Mentally ill should only be
Treated in Asylums
• People often think that the mentally sick patients should be put in
asylums and forgot about.
• It is not correct belief. Many times of mental sicknesses are cured
through treatment given in an out patient department.
• There are psychiatric units attached to general hospitals. Patients in
medical and surgical wards are attended by psychiatrists.
• Problems of school children are handled in clinics.
• Admission to an asylum or mental hospital does not necessarily
mean that the patients are incurable as they are cared for by an
experts team in the psychiatric ward of general hospital.

Misconception that Mental Illness is
Something to be Ashamed of
• People who suffer from mental illness don’t go for treatment
because of a social stigma that mental disorders are something to
be ashamed of.
• So, the family does not want anybody to know that one of its
members is suffering from mental illness.
• But if there is slight pain in abdomen or physical illness to a person,
family members do not hesitate to consult the doctor or neighbors
because, unlike mental illness, most physical illnesses are not
looked down upon in society.

FEARS OF
STUDENT NURSE
• NURSES who is going to work in a
psychiatric unit also has some
misconceptions about mentally ill patients.
• She has her own anxiety and fears.
• These fears and anxiety may or may not
discuss with anyone.
• Fears can be of bodily harm, becoming
mentally ill while nursing the patients, fear
of inadequacy and self control, fear of
rejection by the patient, fear of injuring a
client or patient emotionally, fear of
emotional involvement with the patient.

FEAR OF BODILY HARM
• Student nurses may fear to go for their clinical experience in a
psychiatric ward.
• It is because they must have heard that psychiatric patients are
violent and dangerous.
• They may have learnt this through audio visual media.
• But as a student- nurse in the psychiatric ward, she finds her fears
baseless.
• Fears are reduced by discussing with her nursing group or team
members so that she is able to understand the behavior of the
patients.

FEAR OF BECOMING MENTALLY ILL
• It is a common feeling in the people that doctors and nurses working with mentally
sick tend to become mentally ill themselves.
• If a nurse develops mental sickness while working with psychiatric patients, the
cause is not necessarily the contact with the psychiatric patient but could be her
problems of personality development.
• Listening to the experience of a mentally ill patient can be introjected by the nurse.
• The nurse starts identifying herself probably suffering from the same mental illness
as the patient.
• That is not exactly so. It is for lack of knowledge in psychiatric nursing that leads
the student to think so.
• The nurse who has this type of fear can talk to the senior nurse or psychiatrist so
that her anxiety of fear is reduced.

FEAR OF PERSONAL INADEQUACY
• Personal inadequacy means when the nurse does not feel confident
in caring for the patient due to inadequate knowledge and skill in
psychiatric nursing.
• This may cause her to avoid the patient. The patient also develops
an indifferent attitude towards the nurse.

• For example: A student- nurse who does not have much knowledge
of psychiatric nursing goes to the patient who is withdrawn and is
suffering from chronic schizophrenia.
• As she does not know how to deal with these patients, she avoids
contact with the patient , saying “ patient does not want to talk?”
• Whereas, had she known how to deal with a withdrawal patient, she
would not have been frightened of facing the patient.
• In other words, developing knowledge and skill in the subject would
help a student- nurse to overcome fear of inadequacy of caring the
mentally ill patient.

FEAR OF LOSS OF EMOTIONAL CONTROL
• Abnormal behavior such as shouting, losing temper in daily life
produces an emotional reaction in a normal individual who is
observing the situation.
• Hence, it is natural for a nurse to develop a fear of losing emotional
control while caring for a patient with mental illness.
• But gradually with her knowledge she learns that this behavior of
the patient is a part of symptomatology.
• She need not get emotionally disturbed over the behavior.
• For example: Patient who has broken a window pane, torn a sheet,
or has become naked.

FEAR OF
REJECTION BY
PATIENT
• When the nurse looks after the physical,
therapeutic and psychological needs of the
patient who has the abdominal surgery, the
patient feels this nurse is good in giving care
and shows respect for her knowledge.
• But the patient with mental illness may not
accept the nurse immediately due to his
symptoms of disease such as social
withdrawal, having persecutory delusions,
anxiety or trauma he experiences with the
female sex etc.
• But the nurse’s knowledge of psychiatric
nursing will help her to gain confidence in
caring for the patients with mental illness and
reduce the fear of rejection b the patient.

FEAR OF EMOTIONAL INVOLVEMENT
WITH PATIENT
• The nurse fears that when she works closely with patient she may
develop attachment to him.
• Whenever there is professional relationship there is some degree of
emotional attachment also. The nurse has to limit her relationship
according to the objectives.
• For example: If a patient wants the nurse to visit him duty hours she
can assure him that the other nurses working in the ward would
help him when she is off.
• Nurses who are not able to develop this emotional maturity need
guidance and help that means the nurse has to learn to differentiate
between professional and social relationship.

MODELS OF
NORMAL AND
ABNORMAL
BEHAVIOR
• To study about normal and abnormal
behavior, various approaches/ models has
been used.
• The combination of more than one models
have been useful in deciding the normal or
abnormal behavior.
• The most commonly used models are :

MEDICAL MODEL
• This model emphasized on organic view.
• Presence or absence of signs symptoms would qualify the person
as normal or abnormal.
• People having disturbance of thought, motor activities and affect are
considered as abnormal.
• Medical model helps in cause and effect relationship, thereby, it is
easy to diagnose and provide treatment.

SOCIO- CULTURAL MODEL
• In this model the emphasis is on those socio- cultural factors which
lead to maladaptive behaviors.
• Maladaptive behavior is presented more when the individual has to
make adjustment in other’s culture and community.
• When an individual is not able to adjust to the stress of rapid
economic and social change, she/he may show the signs and
symptoms of anxiety leading to maladaptive behavior.

STATISTICAL MODEL
• Statistical Model refers to the distribution of population on a normal
curve.
• If you take an example of IQ test, most people will cluster around a
central point say 68.26% and the rest will go to extremes that is
superior or inferior.
• Similarly majority of the population has behavior which lies towards
the middle of normal distribution graph.

PSYCHOANALYTICAL MODEL
• Sigmund Freud explained the normal and abnormal behavior
resulted from interaction of three key systems that is id, ego and
super ego.
• When these conflicts are unresolved, neuroses and other mental
disorder occur.

NURSING APPROACH TO
MENTALLY ILL PATIENT

INTRODUCTION
• Approach or method of care of a mentally sick person will depend
upon a nurse’s reaction to the disturbed behavior are:
 Bizarre
 Aggressive
 Hostile
 Suspicious
 Dependent
 Violent
 Harmful

NURSE’S REACTION TO DISTURBED BEHAVIOR
REACTION EXAMPLE
ANGER The nurse may be angry with the patient who refuses to take medicine from her.
REPULSIVE The nurse may be repulsed by the way the patient is eating food from floor.
SHOCKED The nurse may feel frightened by the excited patient due to fear of being assaulted.
SURPRISED Because the patient is aggressive and he is aware of nurse’s fear and he says that the
nurse is scared of him.
CONFUSED The nurse is not clear how to help the patient.
EMBARRASED AND
SURPRISED
A patient with delusion of grandiosity tells the nurse that he wants to sleep with her.
THREATENED The nurse may feel frightened by the excited patient due to fear of being assaulted.
SYMPATHY AND PITY The nurse feels that the patient is suffering so she says” poor man”.
NON- CARING
ATTITUDE
On account of the bizarre behavior of the patient, the nurse adopts a non- caring attitude
towards the patient. Socially psychiatric patients are considered as mad people and are
not taken care of by the society.

NURSING APPROACH TO MENTALLY ILL
PATIENT
• It is important for a psychiatric nurse to know her own behavior first
though this is difficult in the beginning.
• Nurse may not be able to identify strengths and weakness as
psychiatric nurse.
• Her/his strength may be that she/ he is good at developing rapport
with the patient. Weakness could be that she/he lacks good
knowledge of the psychiatric nursing subject. This, the nurse would
be able to acquire gradually.

• The basic approach or steps to the caring process are as follows:
 Assessment and identification of needs.
 Plan of action
 Implementation of plan
 Evaluation

PRINCIPLES OF
NURSING MENTALLY
SICK PATIENT

Accept the Patient as a Human Being
• Every human being has values and worth. He is different from
others because every individual is unique.
• Due to sickness, his behavior may be different. Family members
and society may not accept the patient ‘as he is’. This will give him
a feeling that he is still wanted.
• Calling the patient by name and recognizing his work in the ward
will make him feel worthy.
• The patient or client should be viewed as a HOLISTIC BEING. The
patient has inter- related needs.

FOCUS ON THE STRENGTHS OF THE
PATIENT
• Every individual has strengths and weaknesses. Reinforcement of
strengths helps him grow.
• If a depressed patient has leadership qualities. The nurse should/
could encourage him to participate in some of the activities.
• This act will give him a feeling of satisfaction and worthiness.
Gradually, he may improve in his daily activities also.
• So the strength and assets of the patient should be reinforced. If he
is an excited patient he may always like to lead the group.

FOCUS ON THE STRENGTHS OF THE
PATIENT
• Here the nurse puts limits to his behavior . Every patient should be
assessed for his strength and weakness keeping in mind the
severity of the illness.
• The nurse may keep following points to help the patient to identify
his/her strengths
 Identify strengths of patient through discussion.
 Focus on strengths.
 Provide positive feedback to patient regarding his/her strengths.
 Encourage activities and behavior that reinforces those strengths
of the patient.

Must Develop Therapeutic Relationship with
Patient
• The nurse must have the ability to develop a therapeutic
relationship with most of her patients.
• The basic needs of life e.g. , respect and self esteem of human
beings are common.
• A psychiatric nurse with the knowledge of human behavior will be
able to develop therapeutic relationship with most of her patients.
• The helping relationship which a nurse is able to develop with the
patient will give a satisfying direction to the behavior of the patient.

BE NON- JUDGEMENTAL AND NON-
PUNITIVE
• Due to mental disorder, the patient performs certain acts which may
be repulsive to the nurse or other people.
• The patient may be doing this due to lack of insight and judgement .
So a nurse with the knowledge of psychodynamics of mental
disorders should not categorize the behavior of patient as good or
bad.
• Ignoring a patient who is asking a question is a type of indirect
punishment.
• Similarly scolding the patient in front of others or not letting the
patient to watch T.V. is a direct punishment.

NURSE NEEDS TO BE AN ACTIVE
LISTENER
• Active Listener is one or the important tools in helping the mentally
ill patient to develop confidence in a nurse.
• While responding to the patient nodding one’s head, using Hamm,
hoon, yes, carry on, go on, I am listening gives a feeling to the
patient that he/she is being heard.
• So along with active listening, the nurse has to make note of non-
verbal communication also.

NURSES MUST SHOW PROFESSIONAL
INTEREST
• Professional interest should be shown in the patient.
• A nurse must allow the patient to speak. Explanation should be
given for the demands of the patient which cannot be met.
• For example: Giving explanation to a hypomanic patient why he/she
cannot be discharged.
• Accept the patient with all his/ her symptoms and fears. A nurse
also should be aware of his/her own likes and dislikes.

TALK TO THE PATIENT WITH SPECIFIC
OBJECTIVE
• While talking to the patient with mental illness, a psychiatric nurse must
develop specific therapeutic goals.
• Talk may be initiated by the patient or the nurse.
• For example: the patient says, “ Sister, will you have some time to talk
to me today?”
• The patient leaves the sentence incomplete and look for nurse’s
response
• A psychiatric nurse must understand the need of the patient and tell
him/her the specific time when she would be able to come and talk.

NURSE MUST BE CONSISTENT IN
BEHAVIOR
• It is important for a nurse to develop consistency in her behavior
with mentally ill patient.
• This enables the patient to develop therapeutic relationship.
• For example: Patient with delusional disorder comes and asks the
morning shift nurse about the effect of red liquid medicine.
• The nurse replies that the liquid is for controlling his/ her cough.
evening nurse also replies that as he has cough, it has been
instructed to give this syrup to control the cough.

NURSE SHOULD USE SELF AWARENESS
AS THERAPEUTIC TOOL
• A psychiatric nurse needs a strong sense of self awareness or at
least the willingness to develop.
• The term ‘ sense of self’ refers to self awareness or self knowledge.
It is necessary because a nurse must be able to differentiate her
subjective beliefs from the facts.
• Self awareness includes recognition of the values, beliefs, conflicts,
interaction, style and attitudes.
• In case a nurse has the problem of disliking a patient who has
behavior changes due to alcoholism, there is need to discuss her
feelings with team members.

AVOID PHYSICAL AND VERBAL
RESTRAINS
• A patient with mental illness goes through lot of physical and verbal
restrains from family before coming to the hospital.
• Some of the patients expect and welcome restrains because of the guilt.
Restrains should be avoided as much as possible.
• For example: physical restrain could be tying the patient without giving
reason. Even tying is required. Patient needs to be explained the reason
for tying. Patient should not be neglected during tying and as he/she
progresses, restrains must be removed.
• For example: verbal restrain could be getting angry with the patient
when he/she has not taken medicine. “Open your mouth and take your
medicine immediately, don’t throw medicine out of your mouth”.

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