Social Change and Mental Health

1
Social Change and Mental Health

• Chapter 1

2
Social Change and Mental Health Treatment

• Depends on communitys views and fears
• See Table 1.1
• Periods of social stability
• Less fear, more tolerance for diverse behavior
• Easier and safer for people with mental illness
• Periods of rapid change
• Anxiety and fear towards mental illness
• Often treated inhumanely

3
Moral Treatment

• Definition
• Moral, compassionate and pleasant environment
• 18th century
• Philippe Pinel removed chains at Bicetre
  (France)
• William Tuke established The York Retreat
  (England)
• 19th century
• Quaker Friends Asylum Kind towards patients
• Care of the mentally ill became a public
  responsibility in the United States and Canada
  (Horace Manns plea)

4
Dorothea Dix1802-1887

• Was responsible for mental health care system
  reform in the U.S., Canada and Great Britain
• Introduced the idea of state hospitals
• Twenty states established or enlarged state
  hospitals.
• Appointed as Superintendent of Women Nurses
  during Civil War

5
Early Institutional Life Its Reality

• Major concern was management of a large number of
  people who were forced to live together.
• Women could be institutionalized at whim of
  husband or father.
• Men and women were often abused.
• It eventually evolved into self-contained
  communities.

6
Clifford Beers(1876-1943)

• Wrote of his abusive experience in several mental
  hospitals - A Mind That Found Itself
• Founded the National Committee for Mental Hygiene
• Led committees efforts in the development of
  child guidance clinics, prison clinics and
  industrial mental health approaches.

7
Psychiatric Nursing ThoughtEarly Views

• Traced to Florence Nightingales holistic view of
  patients
• Need for specialized psychiatric-mental health
  nursing recognized during Moral Treatment Era
• First training school for PMHN was The Boston
  City Hospital Training School for Nurses (1882)
  at McClean Hospital.
• First training school organized by nurses for
  psychiatric training was Johns Hopkins Phipps
  Clinic
• Nursing Mental Disease by Harriet Bailey in 1920
  First psychiatric nursing text

8
Modern Thinking Evolution of Scientific Thought

• Psychosocial vs. biologic theory
• Psychiatric pluralism (Adolf Meyer)
• Freud and psychoanalytic theory
• Integration of biological theories in
  psychosocial treatment

9
Government Involvement in Mental Health Care

• National Mental Health Act - 1946
• National Mental Health Advisory Council, which
  established the National Institute of Mental
  Health (NIMH)
• Provided grants to states for construction of
  clinics
• Hill-Burton Act - 1946
• Federal support for hospital construction
• Community Mental Health Centers Construction Act
  - 1963
• Funded community mental health centers
• Led to deinstitutionalization

10
Continued Evolution of Psychiatric-Mental Health
Nursing

• Development of masters degree programs in
  psychiatric nursing
• Interpersonal Relations in Nursing published in
  1952.
• Mainstreaming of psychiatric nursing into nursing
  education

11
Late 20th Century

• Community Mental Health Movement
• 1961 Action for Mental Health
• 1963 Mental Retardation and CMHC Construction Act
• Deinstitutionalization
• Decrease in inpatient population
• Sanctioning of Holistic Nursing Care
• Two psychiatric nursing journals by 1963
• First development of common standards Statement
  on Psychiatric Nursing Practice

12
Contemporary Issues

• Changing demographics
• Age of managed care
• National mental health objectives
• Mental Health A Report of the Surgeon General
• Report of the Surgeon Generals Conference on
  Childrens Mental Health A National Action
  Agenda
• Healthy People 2010 National Health Promotion
  and Disease Prevention Objectives