COMMUNITY MENTAL HEALTH

NURSING, COMMUNITY MENTAL

HEALTH AGENCIES &
NATIONAL MENTAL HEALTH
PROGRAMME
COMMUNITY MENTAL HEALTH
NURSING
 DEFINITION
• The application of knowledge of psychiatric
Nursing in preventing, promoting and
maintaining mental health of the people to
help in early diagnosis and care and to
rehabilitate the clients after mental illness.
-BIMLA KAPOOR, 2002
• The process of involving raising the level of
mental health among people in a community
and reducing the number of cases suffering
with mental illness
- K. LALITHA,2007
 COMMUNITY MENTAL HEALTH NURSING
1. Focus is on mental health of families
2. Promotion &maintenance of mental
health
3. Primary socialization groups as
small system in interaction
4. Interaction and roles of individual in
small group setting in the development
of behavior
5. community, family & group
interrelationship as key influence on
mental health
6. social, psychological, culture &
situation are determinants of mental
health
7. Conceptual framework focuses on
development & maintenance of mental
health of small group
MENTAL HEALTH NURSING
1. Focus is on mental health of individual
2. Clinical management of mental illness
3. Individual as independent entities
4. Individual behavioral manifestation of
uniqueness of individual patient
5. Childhood experience causes
unresolved inner conflicts that are
expressed in behavior
6. Mental health is intrapsychic ones
7. Emphasizes on pathophysiologies of
individual patient
 PRINCIPLES OF COMMUNITY
MENTAL HEALTH NURSING
• Distinguished by unique conceptual framework, clinical
process & intervention strategy
• Social setting & situation contexts are considered in the
promotion of mental health & prevention of mental illness
• Holistic approach that relates the concepts of wholeness to
life experience
• Makes possible mix of humanistic & caring relationship &
scientific approach
• Primary concerns are target population, social &
community networks
• Focuses on interrelationships formed in group context as
people interact in daily living activities
 GOALS OF CMHN PRACTICE

• Promote and maintain mental health through

prevention counseling and intervention
• Promotes social, personal and cognitive growth for
positive mental health behavior
• Helps to recognize tensions, coping and
communication patterns
• Teach families and members to monitor mental
health and that of their communities
• Take self care
 GOALS OF CMHN PRACTICE

• Maintain & increase the potential of primary groups

• Help families to recognize that behavior has social, cultural
& situational aspects & the influences that have on group
functioning & member behavior
 FUNCTIONS
• Develops, organizes, implements, reviews and maintains
Quality Improvement Program functions and activities for
the Country mental health program.
• Identifies and assesses quality and related risk issues, and
collaborates with appropriate staff to prepare corrective
action plans in response to these issues.
• Prepares, implements and reviews annual Quality
Improvement Plan; prepares quality improvement
statistical indicators, narrative reports and collateral
materials.
• Participates in state and regional quality improvement
meetings.
• Reviews patient data and clinical documentation to
ensure compliance with county and state
regulations relating to medical necessity and case
documentation.
• Reviews records of patients who are under treatment
for emotional or mental illness to ensure
• proper utilization of treatment resources.
• Consults with treatment staff regarding patient
diagnosis, medical justification, length of treatment
and case documentation.
 HEALTH ILLNESS

MENTAL HEALTH, ABILITY TO COPE

MENTAL HEALTH DISRUPTION,
WITH ACTIVITIES OF DAILY LIVING IN
IMPAIRED ABILITY TO ADAPT
AN ADAPTIVE FASHION

PRIMARY SECONDARY TERTIARY

PREVENTION PREVENTION PREVENTION

SPECIFIC
PROTECTION EARLY DIAGNOSIS
HEALTH
OF & PROMPT REHABILITATION
MAINTENANCE VULNERABLE TREATMENT
POPULATION
MODELS FOR COMMUNITY MENTAL
HEALTH NURSING
 CLIENT CENTERED MODEL

• Community mental health nursing

incorporates community nursing and public
health nursing.
• Community nursing, as presently practice is
client centered in its approach
• Case management - the interventional
approach
CASE MANAGEMENT MODEL

• Case manager takes responsibility for co-

coordinating all services
• Different models of case management including
those that involve paraprofessionals and peer
assistance are being tried
• For e.g.: clients who have a dual diagnosis such
as substance abuse problem & a psychiatric
disorder, would require services from multiple
providers
 CAPITATION AND MANAGED
CARE MODELS
• The goal is to provide effective care at the lowest
possible cost and include prospective payment
systems
• Capitations is a funding mechanism in which all
defined services for a specified period of time are
provided for an agreed- on single payment
• Managed care programs are prepaid health plans in
which an identified intermediary is given authority
to manage care programs including mental health
services in their benefit package.
 PUBLIC HEALTH MODEL

• In this model the client is the community

rather than the individual. It involves three
prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
 Primary prevention
• Refers to activities directed at reducing the
incidence of mental disorder within a
population
• Aggregates ( population groups) at risk of
developing the identified mental disorder
and environmental factors that may
contribute to that risk are targeted.
• E.g.: teaching classes on stress management
on factory workers
 Secondary prevention
• Refers to activities directing at reducing the
prevalence of mental disorder by shortening the
duration of sufficient number of established
cases.
• Achieved by encouraging early referrals,
decreasing barriers to early diagnosis and
providing effective treatment
• E.g.: rape crisis centers, operating shelters for
abused women, screening clients with chronic
disease
 Tertiary prevention
• Activities that are aimed at reducing the
residual defects that are associated with
mental disorders.
• E.g.: teaching social skills to clients enrolled
in partial hospitalization programs
 INTERVENTIONS PERFORMED BY
CMHN
• Case management services (i.e. linking client
to benefits and entitlements)
• Full psychosocial assessment
• Group, individual and family treatment (
education, counseling, psychotherapy)
• Monitoring of consumers in residential and
acute care settings for safety and response to
treatment and medications
• Pharmacotherapy (e.g. prescribing and
monitoring medication)
• Physical assessments
• Psycho education services
• Risk assessment and mental status examination
• Treatment planning
• Treatment of individuals with co-occuring
disorders
ROLE OF NURSE
 Liaison role
• Bridges the gap between
 clients
and family members
Family and health care professionals
Community welfare agencies and families
 Consultant role
• Advices family and other community
resources about the level of support and care
required for a specific group
 Practitioner or clinician role
• Renders direct nursing care to the clients
within the community
• Assists the client to develop coping abilities
• Identifies client with behavioral deviations
• Assist for therapeutic care
• Follow up care and continuity of services
• Conducts student enrichment programmes
with the help of teacher
• Arranges vocational training for chronically
mentally ill clients
• Trains Anganwadi workers and teachers
• Educates parents about the importance of
good child rearing practices
• Training of primary care workers in provision
of basic mental health care
 Counselor role
• Counsels the family members and help them in
meeting clients need at home
• Motivates the community to provide support to the
families
• Mobilizes the community agencies and its resources
for welfare of mentally ill
 Nurse educator role
• Organizes community awareness compaigns
• Teaching the community on the
manifestations of illness, importance of early
diagnosis
• Organizes short term courses to improve
knowledge and skills of health care
professionals
• Conducts counseling session
 Coordinator role
• Coordinate with all team members
• Follows therapeutic team members, advices
and implements necessary care related
activities informs to the team members
whatever observations made
 Therapeutic role
• Plans and assists psychotherapeutic activities
for improvement in the clients condition
• Encourages family members to utilize
outdoor services in OPDs
 Domiciliary care
• Assess health status, coping strategies,
psychological functioning of individual,
supportive system
• Plans and implements necessary care
• Treats minor complaints
• Conducts counseling session
 Researcher role
• Plans and conducts research activities
• Conducts mini project
• Publishes articles
• Conducts public opinion survey, mobilizes the
concerned authorities to improve the
services within the community
 Social skill training
• Teaching relaxation exercises
• Training to develop effective interaction and
communication abilities.
• E.g.: deaddiction centers for recovering
addicts, coping skills, adjustment skills
 Other services
• Assertive training
• Conducts group meeting
• Provides bereavement counseling
• Provides crisis intervention services
 BREAK
• WIFE : Dr. my husband thinks he is a satellite dish
• DOCTOR: Don’t worry. I can cure him.
• WIFE : I don’t want him cured. I want you to adjust him to
get the movie channel.
COMMUNITY MENTAL HEALTH
AGENCIES
 NON GOVERNMENTAL
ORGANIZATION

• Non profit, welfare oriented organizations

• Recognized by government
• CHILD MENTAL HEALTH:
Sangath society (Goa)
The research society (Mumbai)
Samadhan (New Delhi)
 NGO CONT’D
• SUICIDE PREVENTION ACTIVITIES:
Sneha in Chennai
MPA – Bangalore
Saarthak – Delhi
Prerna- Mumbai
• WOMEN’S MENTAL HEALTH:
Bapu Trust-Pune
 NGO CONT’D
• SEVERE MENTAL DISORDER
AMEND- Bangalore
• DEMENTIA
ARDSI
• PHYSICAL DISABILITIES:
Ashagram- Madhya pradesh
INTERNATIONAL AGENCIES
 INTERNATIONAL SOCIETY FOR
MENTAL HEALTH ONLINE (ISMHO)
• Non profit organization , formed in 1997
• Aims to promote the understanding, use and
development of online communication,
information and technology for the
international mental health community
• ISMHO conducts all of its official business via
the internet
 NATIONAL ALLIANCES FOR THE
MENTALLY ILL (NAMI)
• Dedicated to the eradication of mentally ill
and to the improvement of the quality of life
of all those lives are affected by these
diseases.
• It is a non-profit, self help, support &
advocacy organizations for consumers with
severe mental illness.
VOLUNTARY ORGANIZATIONs
 ANJALI.C
• Non profit organization founded by ratnaboli
Roy in 2000
 BANYAN
• A half way home for people with mental
illness
• Focus is on destitute women with mental
illness, to identify and provide shelter, care
and psychiatric/ medical services to them
 NIMHANS
• National Institute of Mental Health and Neuro
Science, established in 1974, a deemed
university that awards its own degrees
• Focus is on mental health, neuro sciences and
allied subjects, to promote growth and
development in tune with global trends.
• To develop the center into an advanced center
for service, training and research
 PARIPURNATA
• Started in 1991.
• Their focus is on women with mental illness
belonging to low income groups, from jails,
mental hospitals
RICHMOND FELLOWSHIP SOCIETY
• Started in 1986.
• Focus is to offer skilled help to those
chronically mentally or emotionally disturbed
• To establish manpower development to work
in the area of psychosocial rehabilitation
VOLUNTARY ORGANIZATION
FOR MENTALLY CHALLENGED
 ASSOCIATION FOR WELFARE OF THE
MENTALLY DISABLED (AWMD)
• It is a networking and organizational support for
all India Institute of speech and hearing,
NIMHANS
• Focus is to help children with mental disabilities
and their parents
• Conducts one-day-a week home-based therapy
programme for children and parents, organizes
orientation and self help training programme,
helps train beneficiaries in income generating
activities, vocational groups learn new skills
 MANOVIKAS KENDRA
REHABILITATION AND RESEARCH
INSTITUTE FOR THE HANDICAPPED
• Focus is to provide services in areas of prevention,
education, training, rehabilitation and research in
the field of mental, physical and sensory disabilities
• Helps families cope with stress, tension and
depression associated with raising a child with
disabilities.
• Emphasis on development of cognitive, social
language, motor and self help group
 Ms. Chellamethu Trust and Research
Foundation
• To provide day and residential services to
people with mental disabilities and substance
abuser
• Conduct research in area of mental health
and dependency
• Provide professional services for substance
dependants and their families
NATIONAL INSTITUTE FOR MENTALLY
HANDICAPPED (NIMH)
• To rehabilitative the mentally challenged
persons
• Undertake research and development
programmes
• Training to personnel working in the field of
mental health
• Undertake consultancy and advisory services
for organizations working in related fields.
 Break
Pt : I always see spots before my eyes.
Dr: Didn’t the new glasses help?
Pt : Sure, now I see the spots much clearer
• Pt: Dr you must help me. I am under such a
lot of stress, I keep losing my temper with
people.
• Dr: tell me about your problem?
• Pt: I just did, didn’t I, you stupid fool.
NATIONAL MENTAL HEALTH
PROGRAMME
 OBJECTIVES
• To ensure availability and accessibility of
minimum mental health care for all
• To encourage application of mental health
knowledge in general health care and in
social development
• To promote community participation in the
mental health services development
 APPROACHES
• Diffusion of mental health skills to the
periphery of the health service system
• Appropriate appointment of tasks in mental
health care
• Equitable and balanced territorial
distribution of resources
• Integration of basic mental health care into
general health services
• Linkage to community development
 TARGETS OUTLINES IN NMHP
• Adoption of programme (NMHP) by all states
• Formation of National Mental Health
advisory body as focal point
• Co-ordination cell at DGHS
• Formulation of curriculum for health
personnel of different levels
• Organization of mental health training
programmes for primary health care
personnel at the state levels
 TARGETS CONT’D
• Provision of psychiatrists at district level
• Enhancing mental health training in
undergraduate medical education
• Formation of task force on psychotropic drugs
• Development of linkages with other
developmental programmes like Integrated
Child Development Services scheme (ICDS)
• Improvement of mental hospitals and
psychiatric teaching units
 AIMS
• Prevention and treatment of mental and
neurological and their associated disabilities
• Use of mental health technology to improve
general health services
• Application of mental health principles in
total national development to improve
quality of life
 STRATEGIES
• CENTER TO PERIPHERY STRATEGY:
Establishment and strengthening of
psychiatric units in all district hospitals, with
out patient clinics and mobile teams reaching
the population for mental health services
 STRATEGY CONT’D
• PERIPHERY TO CENTER STRATEGY:
Training of an increasing number of
different categories of health personnel in
basic mental health skills, with primary
emphasis towards the poor and the
underprivileged directly benefiting about 200
million people
 CURING IS COSTLY
PREVENTION PRINCIPLE