PSYCHIATRY SEMINAR

MRS.MONICA BETTY
MSC(N) 1ST YEAR
The standards of Psychiatric Nursing
The expected level of performance of all registered
psychiatric nurses.

Components:
•Assessment
•Diagnosis
•Outcome identification
•Planning
•Implementation
•Evaluation
Assessment
Role of Psychiatric mental health nurse:
 Collect data in a systematic and ongoing process
 Involve the patient, family, other health care providers
and environment in holistic data collection
 Prioritize data collection activities based on the
patient’s immediate condition or anticipated needs of
the patient or situation.
Diagnosis
The psychiatric mental health registered nurse
analyzes the assessment data in determining diagnosis
or problems including level of risk.
Role of Psychiatric mental health nurse:
 Derives the diagnosis or problems from the
assessment data.
 Identifies the actual or potential risks to patients
health and safety.
 Develops diagnosis or problem statement that
confirm or congruent with available and accepted
classification systems.
Cont.
 Validates the diagnosis or problems with the patient,
significant others and other health care clinicians.
 Documents diagnosis or problems in a manner that
facilitates the determination of the expected
outcomes and plans.
Outcome identification

 Identify expected outcomes for a plan individualized

to the patient or to the situation.
Role of Psychiatric mental health nurse:
 Derives culturally appropriate expected outcomes
from the diagnosis.
 Involves the patient, family and other health care
providers in formulating the expected outcomes
when possible.
 Consider associated risk, benefits, costs, current
scientific evidence and clinical expertise when
formulating expected outcomes.
 Documents expected outcomes as measurable goals.
 Includes a time estimate for attainment of expected
outcomes.
 Modifies expected outcomes leased on changes in the
status of the patient or evaluation of the situation.
Planning
Develop a plan that prescribes strategies and
alternatives to attain expected outcomes.
Role of Psychiatric mental health nurse:
 Develops the plan in collaboration with the patient,
family and other health care providers.
 Prioritizes elements of the plan based on the patient’s
level of risk for potential harm to self or others.
 Assists patients in securing treatment or services in
the least restrictive environment.
 Provides for continuity within the plan.
 Utilizes the plan to provide direction to other
members of the health care team.
 Documents the plan using standardized language or
recognized terminology.
 Develops plans to reflect the use of available research
evidence.
 Modifies the plan based on ongoing assessment of the
patient’s response and other outcome indicators.
Implementation
Implement the identified plan.
Role of Psychiatric mental health nurse:
 Implements the plan in safe and timely manner.
 Documents implementation and any modifications
including changes or omissions of the identified plan.
 Utilizes evidence based interventions and treatments
specific to the diagnosis or problem.
 Utilizes community resources and systems to
implement the plan.
 Collaborates with nursing colleagues and others to
implement the plan.
 Manages the psychiatric emergencies by determining
the level of risk and initiating and coordinating
effective emergency care.
A. Coordination of care
Role of Psychiatric mental health nurse:
 Coordinates implementation of the plan.
 Documents the coordination of care.

B. Health teaching and

health promotion
Role of Psychiatric mental health nurse:
•Uses health promotion and health teaching
methods appropriate to the situation, patient’s
developmental level, needs, readiness, ability to
learn, language and culture.
 Provides health teaching related to the patient’s need
and situation that may include mental health
problems and psychiatric disorders, treatment
regimen, coping skills, relapse prevention, self care
activities , resources, conflict management, problem
solving skills, stress management, relaxation
techniques and crisis management.
 Integrates current knowledge and research regarding
psychotherapeutic education strategies and content.
 Seeks opportunities for feedback and evaluation of
the effectiveness of strategies utilized.
C. Milieu Therapy
Maintaining safe and therapeutic environment in
collaboration with the patient, family and other health
care providers.
Role of Psychiatric mental health nurse:
 Orient the patient and family to the care
environment.
 Orient the patient to the rights and responsibilities
particular to the treatment or care environment.
 Ensure that the patient is treated in the least
restrictive environment necessary to maintain the
safety of the patient and others.
D. Pharmacological, biological and
complementary interventions

 Uses the knowledge of pharmacological, biological and

complementary interventions and applies clinical skills
to restore the patient’s health and prevent further
disability.
Role of the nurse
 Apply current research findings to guide nursing
actions related to pharmacology, other biological
therapies and complementary therapies.
 Include health teaching for medication management
•Educate on information about potential adverse effects, ways
to cope with transitional side effects and other treatment
options.
E. Prescriptive authority and
treatment
Role of the nurse
 Conduct a thorough assessment of past medical trials,
side effects, efficacy and patient preference.
 Prescribe or recommend psychotropic and related
medications based on clinical indicators.
 Educate and assist the patient in selecting the
appropriate use of complementary and alternative
therapies.
F. Psychotherapy
Role of the nurse:
 Use knowledge of theories and adaptations to select
therapeutic methods based on the patient’s needs.
G. Consultation
The nurse provides consultation to influence the identified
plan, enhance the abilities of other clinicians to provide
services for patients and effect change.
Evaluation
Role of the nurse
 Evaluates progress toward attaining expected outcomes
 Involve the patient, family or significant others and
clinicians in the evaluation process.
 Documents results of the evaluation.
 Uses ongoing assessment data to revise the diagnosis,
outcome, the plan and the implementation as needed.
Standards of professional
performance
 Quality of practice
 Education
 Professional practice evaluation
 Collegiality
 Collaboration
 Ethics
 Research
 Resource utilization
 Leadership
Challenges and scope of
psychiatric nursing
Challenges of psychiatric nursing
 Knowledge development, Dissemination and application
The challenges of a psychiatric mental health nurses is to
stay abreast of the advances in total health care in order
to provide safe, competent care to individuals with mental
disorders.
 • Overcoming stigma
1. Nurses can play important role in dispelling myths of
mental illnesses.
2. To reduce the burden of mental illness and improve
access to care.
3. Nurses can educate all of their patients about the
etiology, symptoms and treatment of mental illnesses.
• Health care delivery system challenges
Providing nursing care within integrated community based
services where culturally competent, high quality nursing
care is needed to meet the emerging mental health care
needs of the patient.

• Impact of technology
Nurses are challenged to continue to develop their
technical and computer skills and to use this technology in
improving care.
Scope of psychiatric nursing
 Promote mental health nursing through the assessment,
diagnosis and treatment of human responses to mental
health problems and psychiatric disorders
 Provide mental health care to patients seeking mental
health services in a wide range of delivery setting
 Work in child guidance clinics, school health programmes,
sheltered workshops, halfway homes and in foster homes
for destitute and mentally retarded.
 Works as a counselor in adolescent clinics, AIDS clinics
and as psychiatric nurse consultant in general hospital.
• Team leader for crisis intervention.
• Nurse educator, counsellor and clinic specialist, consultant
and conducts research.
Mental health laws and acts
 History
 Mental health act was drafted by parliament in 1987
 It came into effect in all the states and union territories
of India in April 1993
 It replaces The Indian Lunacy Act 1912
 Which had earlier replaced The Indian Lunatic Asylum
Act of 1858
Definition of the Act:
“An Act to consolidate and amend the law relating to
the treatment and care of mentally ill persons, to make
better provisions with respect to their property and affairs
and for matters connected there with or incidental thereto:

Salient features of the Act:

Mental health act is divided into 10 chapters
•Chapter I: Deals with preliminaries of the act
•Chapter II: Deals with establishment of mental health
authorities at central and state levels
•Chapter III: Deals with establishment and maintenance of
psychiatric hospitals and nursing homes
•Chapter IV: Deals with the procedures of admission and
detention of mentally ill in psychiatric hospitals
•Chapter V: Deals with the inspection, discharge, leave of
absence and removal of mentally ill persons
•Chapter VI: Deals with the judicial inquisition regarding
alleged mentally ill persons possessing property and its
management
•Chapter VII: Deals with the maintenance of mentally ill
persons in a psychiatric hospitals or psychiatric nursing homes
•Chapter VII: Deals with protection of human rights of
mentally ill persons
•Chapter IX: Deals with the penalities and procedures for
infringement of guidelines of the act.
•Chapter X: Deals with miscellaneous matters not covered in
other chapters of the act.
Objectives of the act
 To establish central and state authorities for licensing and
supervising the psychiatric hospitals
 To establish such psychiatric hospitals and nursing homes
 To provide a check on working of these hospitals
 To regulate admission into psychiatric hospitals and
psychiatric nursing homes
 To protect society from the presence of mentally ill
persons
 To provide facilities for establishing guardianship of
mentally ill persons who are incapable of managing their
own affairs
Admission
 Admission on voluntary basis
 Any person who considers himself to be mentally ill and
wishes to be admitted to a psychiatric hospital may apply
to the medical officer in-charge
 If he is a minor, the guardian can make this application on
his behalf
 The medical officer should make inquiry within 24hrs and
should admit the patient if he opines that treatment is
required.
Admission under special circumstances
•Any mentally ill patient who is unwilling for admission on a
voluntary basis may be admitted and kept as an inpatient in
the psychiatric hospital/nursing home
•An application should be made out on his/her behalf by a
relative or a friend of the mentally ill person, provided the
medical officer deems fit

Admission under reception order

•On application: only the relative not other than husband,
wife, guardian or a friend can make out an application for the
admission of mentally ill patient.
•An application should be made out to the magistrate in
writing supported by 2 medical certificates, one of them
issued by a gazetted medical officer.
•Thee patient may now be admitted after the magistrate
obtains consent from the medical officer in charge of the
mental hospital.

On production before the magistrate:

•Mentally ill patients exhibiting violent behaviour, creating
obscene scenes and dangerous to the society can be
detained by the police officer and produced in the court
within 24hrs, supported by two medical certificates,
subsequent to which the magistrate issues a reception order.
Admission in emergencies
•The medical officer in charge may order the admission of a
mentally ill patients if thinks he is dangerous to himself or
others
•The patient should be produced before the magistrate with
24 hours (max. of 72hrs) or the magistrate himself may visit
the psychiatric hospital/ nursing home and pass reception
order on examination

Temporary treatment order

•It is an order issued by the magistrate where the risk is
perceived to the patient’s life or to that of others
•If the medical officer in-charge feels it necessary, he can apply
to the magistrate
•Alternatively, the relatives can get the magistrate to issue
an order for treatment
•A Single medical certificate is required which is valid for 6
months.

Admission of mentally ill persons

•A mentally ill prisoner may be admitted into a mental
hospital on he orders of the presiding officer or a court

Miscellaneous admission
•A mentally ill patient can be admitted either on
humanitarian grounds or for observation purpose
•Social workers can obtain an order from the magistrate
pending report from medical officer
Discharge
 Discharge of a patient admitted on voluntary basis
 Medical officer in charge of psychiatric hospital/nursing
home on recommendation from two medical
practitioners preferably a psychiatrist, can issue directions
for discharge of the patient
 Discharge of a patient admitted under special
circumstances
 A relative or a friend may make an application to the
medical officer for care and custody of the patient.
•The relatives are required to furnish a bond with or
without sureties along with an undertaking that the
mentally ill person shall be prevented from causing injury
to self or others

Discharge of a patient admitted on reception order

•An applicant who feels that the patient has recovered
from illness may make an application for discharge to the
magistrate
•A certificate should accompany such an application from
medical officer in charge of psychiatric hospital/ nursing
homes
•If the magistrate deems fit he may issue an order for
discharge.
Discharge of a patient admitted by police
•Patient may be discharged after the family members agree
in writing to take proper care and the medical officer in
charge opines that he is fit to be discharged

Discharge of mentally ill prisoner

•The hospital authorities have to report every 6 months
about the person’s state of mind, including if the person is fit
to stand the trial, to the authority which had ordered
detention
•The person is then handed over to the prison officer for
further legal action
Leave of absence
•On application by a relative or others to the medical
officer in charge and a bond duly signed stating that the
patient will be taken proper care of and prevented from
injuring self or others, a leave of absence may be granted
for a period of a maximum of 60 days.

Mental health care act, 2017

An act to provide for mental healthcare and service for
persons with mental illness and to protect, promote and
fulfill the rights of such persons during delivery of mental
healthcare and services and for matters connected there
with or incidental there to.
Human rights of mentally ill
 Right to communicate with people outside the hospital
through correspondence telephone and personal visits
 Right to keep personal effects
i. Patient may bring clothes and personal items, taking
into consideration, the hospital storage space
ii. The hospital staff should provide hospital safe for
valuables and should remove any dangerous items from
the patient.
 Right to education
 Right to privacy
•Right to enter into contractual relationships
i. If ruled incompetent, a person cannot vote, marry or
make contracts.
• Right to Habeas corpus
i. Its an important constitutional right for all patients. It
provides speedy release of any person who claims to be
detained illegally
• Right to treatment
• Right to refuse treatment
i. Voluntary patients have the right to refuse any
treatment and should not be forcibly medicated except
in situations when patient is violent to self and others
• Right to religious freedom
• Right to sue or be sued
•Right to be employed if possible
•Right to manage and dispose of property
•Right to make purchases
•Right to independent psychiatric evaluation
•Right to marry and divorce
•Right to legal representation
National mental health
programme
 The government of India felt the necessity of evolving a
plan of action aimed at development of the national
mental health programme
 National mental health programme was launched in 1982
in order to create awareness of mental illness and for
improving the magnitude of mental illness, improving the
availability of infra structure and trained manpower in
India.
Objectives
 To ensure the availability and accessibility of minimum
mental health care for all in future, particularly to the
most vulnerable and underprivileged sections of the
population
 To encourage the application of mental health knowledge
in general health care and in social development
 To promote community participation and stimulate
efforts towards self-help in the community.
Targets
 Adoption of the plan by each state of India
 Formation of national mental health advisory body as
focal point
 A national co ordination group will be formed comprising
representatives of all state senior health administrators
and professionals from psychiatry, education, social
welfare and related professions
 Formation of curriculum of health personnel of different
levels
 Provision of programming officers for mental health at
state levels
•Enhancing mental health training in under graduate medical
education
•Development of linkage with other programs like
integrated child development services scheme(ICDS)

Approaches
•Integration of mental health care services with the existing
health services
•Utilization of the existing infrastructure of health services
and also delivers the minimum mental health care services
•Provision of appropriate task-oriented training to the
existing health staff
•Linkage of mental health services with the existing
community development program
 Components
 Treatment : Multiple levels
i. Village and sub centre levels
 Multi purpose workers and health supervisors under the
supervision of the medical officer to be trained for
a) Management of psychiatric emergencies
b) Administration and supervision of maintenance,
treatment of chronic psychiatric disorders
c) Diagnosis and management of grandmal epilepsy in
children
d) Liaison with local school teacher and parents regarding
MR and behavioral problems in children
e) Counseling- alcohol and drug abuse
Primary health centre
Medical officer aided by health supervision to be trained for
• Elementary diagnosis
•Treatment of functional psychosis
•Treatment of uncomplicated cases of psychiatric disorders
associated with physical disease
•Management of uncomplicated psychosocial problems
•Epidemiological surveillance of mental morbidity

District hospital
•One psychiatrist for every district hospital as an part of
district health services
•The district hospital should have 30-50 psychiatry beds
Rehabilitation

 Includes maintenance treatment of epileptics and

psychotics at the community levels an development of
rehabilitation centers at both district level and higher
referral centers

Prevention
 Should be community based, with initial focus on
prevention and control of alcohol- related problems
 Problems like addiction, juvenile delinquency, acute
adjustment problems like suicidal attempts are to be
addressed
Tenth five year plan (2002-2007)
 DMHP was extended to 100 districts across the country
 Infrastructure support had to be provided for psychiatric
departments in the hospital and strengthening of medical
college hospitals
 Modernization of mental health hospitals to reduce
chronicity of mental disorders
 Sponsoring community based research
 Innovation, information , education, communication
strategies will be generated through multidisciplinary
collaboration
Eleventh five year plan (2007-2012)
 DMHP will be extended to another 200 districts
 Reinforcement of upgrading psychiatry departments with
adequate infrastructure facilities
 Construction of modern building with good infrastructure
 Provision of adequate man power for all psychiatric units
 Research training programmes have to be organized for
qualitative and quantitative improvement
Twelfth five year plan (2012-2017)
 DMHP will be extended to remaining 193 districts
 20 mental hospitals will be taken up for reconstruction
 Non-viable mental hospitals will be closed or merged
with general hospital
 Long term community based research projects will be
initiated
 IEC activities will be planned to cover all sections of
population