A Brief History of Mental Health Care Mental Health In Early Civilizations to Renaissance Historical records indicate that many

early civilizations viewed mental illness with disgust. Instead of caring for the mentally ill, those with mental illness were often cast away and shunned. In the early years, it was believed that the mentally ill were possessed, evil, and possibly even witches. Many were afraid of the mentally ill and as a result, mentally ill persons were often sent to live out their lives in institutions. Mental Health In The 18th & 19th Centuries During the 18th and 19th centuries, the mentally ill were usually sent to live in asylums. Asylums in this time period were staffed by untrained personnel who often had no professional experience in working with the mentally ill. Mentally ill that were living in these asylums were often referred to as inmates and many were kept after treatment to continue to work in the asylums. Standards of care for the mentally ill did not exist, as a result, the mentally ill were often neglected and mis-treated. Asylums became overcrowded and the mentally ill were often ill treated and restrained to make control of their behaviors easier and manageable. The the treatment of the mentally ill in the 1800's did not go unnoticed and many began to call for reform. Private citizen Dorothea Dix was one of the first advocates for the mentally ill asking for humane and safe treatment for those will mental illness. In the late 1800's, schools of nursing were created to allow for trained personnel to care for the mentally ill. At this time, those committed to asylums were called patients instead of inmates and their care givers were called nurses. In the middle 1800's, the term psychiatry came about to define mental health care and treatment. Psychiatry was deemed a medical specialty with the help of The Journal of Mental Science. Mental Health In The 20th Century The year 1907 brought about standards of care for nurses when working with the mentally ill. The year 1913 marked the beginning of the Johns Hopkins Hospital School training for psychiatric nurses. Doctors were now in control of the care over mental health and mental health nurses instead of untrained personnel.

The 1930's produced changes in the treatment and care of the mentally ill. New treatments being explored used insulin and electroshock therapy as a treatments process for mental health. 1946 marked the passing of the National Mental health Act which established Mental Health treatment Institutions across the USA. Federal funds for mental health care, mental health research, and mental health education were becoming available across the nation. The 1940's & 1950's brought about the development of tranquilizers for use in the mental health field. During this time Psychiatric journals were being published that included new information regarding mental health practices and care guidelines for the mentally ill. The 1990's marked an expanse in the use of pharmacological interventions in the use of treating mental illness. Mental Health In The 21st Century Today, insurance issues and the need to contain costs has been said to lead to under treatment and under diagnosis. On the other hand, many people who are mentally ill are able to lead near normal lives with treatment and medication. With more than 5.7 million Americans being diagnosed with diseases like bipolar disease alone, the future of mental health will continue to drastically change over the years. to come. Source: Varcarolis, E (2005). Foundations of psychiatric mental health nursing. W.B. Saunders.

Nursing Theories Callista Roys Adaptation Theory Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms. Focuses on the ability of Individuals., families, groups, communities, or societies to adapt to change. The degree of internal or external environmental change and the persons ability to cope with that change is likely to determine the persons health status. Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation. Martha Rogers Concept of Science of Unitary Human Beings, and Principles of Homeodynamics Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development. The goal of nurses is to participate in the process of change.. Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen the wholeness of the Individual and redirect human and environmental patterns or organization to achieve maximum health. 5 basic assumptions: The human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts. 2. The individual and the environment are continuously exchanging matter and energy with each other 3. The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum 4. Patterns identify human being and reflect their innovative wholeness 5. The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion Hildegard Peplaus Interpersonal Relations Theory Defined Nursing: An interpersonal process of therapeutic interactions between an Individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help. Nursing is a maturing force and an educative instrument Identified 4 phases of the Nurse Patient relationship: Orientation individual/family has a felt need and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase. Identification where the patient begins to have feelings of belongingness and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance. 1.

Exploitation the nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services. Resolution where patients needs have already been met by the collaborative efforts between the patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.

Dorothea Orems Self-Care Theory Defined Nursing: The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness. Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being. Has a strong health promotion and maintenance focus. Identified 3 related concepts: Self-care activities an Individual performs independently throughout life to promote and maintain personal well-being. Self-care deficit results when self-care agency (Individuals ability) is not adequate to meet the known selfcare needs. Nursing System nursing interventions needed when Individual is unable to perform the necessary self-care activities: Wholly compensatory nurse provides entire self-care for the client. Example: care of a new born, care of client recovering from surgery in a post-anesthesia care unit Partial compensatory nurse and client perform care, client can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently. Example: Nurse can assist post operative client to ambulate, Nurse can bring a meal tray for client who can feed himself Supportive-educative nurses actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement.

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.

HISTORY AND EVOLUTION OF THE SPECIALTY Psychiatric Mental Health Nursing as a specialty has its roots in 19th century reform movements to reorganize mental asylums into hospitalized settings and develop care and treatment for the mentally ill. (Church, 1982). The first organized efforts to develop psychiatric nursing started at McLean Asylum in Massachusetts in 1882. Early nursing leaders such as Harriet Bailey, Euphemia Jane Taylor and Lillian Wald supported the Mental Hygiene Movement and advocated for the acceptance of the emerging specialty of psychiatric nursing into the larger community of general nursing. The first nurse organized training program for psychiatric nursing within a general nursing education program was established at Phipps Clinic at Johns Hopkins Hospital in 1913. This served as prototype for other nursing education programs. (Buckwalter & Church, 1979).Under nursing leadership, psychiatric mental health nursing evolved from the narrow focus of medical models and mind-body dichotomy towards a biopsychosocial approach to mental illness including the concept of mind as expressed in behavior and adaptation to experience (Church, 1982). As early as 1914, Adelaide Nutting, a well-known nursing educator at Teachers College at Columbia, addressing a conference at the new Psychopathic Hospital in Boston emphasized the role that nursing could play, not only in promoting recovery from mental illness, but in prevention of mental illness through the educative aspects of nursing care (Nutting, 1926). Psychiatric mental health nursing leaders played a critical role in identifying and developing relevant, specialized bodies of knowledge and securing the didactic and clinical experiences necessary for students to develop to achieve competence as menta lhealth nurses. They were successful in promoting the integration of mental health concepts into general nursing educational programs facilitating a national public awareness of the inter-relationship of mental and physical health in achieving patient outcomes. Through their efforts, psychiatric mental health nursing practice moved far beyond the walls of state hospital institutions in meeting the mental health needs of the broader community (Church, 1982). This position and visibility became extremely important when the next wave of reform occurred in the 1940s with the passage of the Mental Health Act.