MENTAL HEALTH

Refers to the successful adaptation to stressors from internal and external environment evidenced by thoughts, feelings and behaviors that are age appropriate and congruent with local with local and cultural norms

MENTAL ILLNESS

Is the maladaptive response to stressors from internal and external environment

PSYCHIATRY

Refers to the branch of medicine that deals with diagnosis, treatment and prevention of diseases of the mind

OR

A branch of medicine that deals with diseases of the brain/mind

CONCEPTS/BELIEFS OF MENTAL HEALTH AND MENTAL ILLNESS

There are many concepts of mental health and illness. Many people and societies have their own perspective of mental illness and health

Medical concept

One is considered to be mentally healthy if he/she is described to be free from pain, gross pathology and disability of th

Illegal concept

Here; mental illness is described as inability to differentiate between right and wrong as well as the ability to conform behaviors to law codes

Process concept

Here, mental illness is considered in a person with inability to effectively integrate, physical and social system as life events are met at progressive stages of growth and development

GENERAL STATISTICAL OF MENTAL ILLNESS

• 15% of the general population experience mental illness/disorder
• General health system provides most of the care but not the specialized mental health services
• Depression is the most common psychiatric/mental illness in the community
• Depression and schizophrenia cause people to seek medical services frequently due to their grave or disturbing symptoms

CLASSIFICATION OF MENTAL ILLNESS

The purpose of classifying is to identify groups of people/patients who share similar clinical features in order to have a suitable diagnosis mgt can be planned and likely outcome/prognosis is predictable

They are classified into three;

1.Psychosis verses Neurosis

Psychosis is a severe form of mental disorder that is characterized by loss of

touch with the reality (delusion and abnormal sensory experiences, disorganized speech and behavior eg Schizophrenia

Neurosis is a form of mental disorder in which a patient does not lose touch with the reality ie he/she is able to recognize his/ her mental state eg phobias, stress disorders, anxiety disorders, panic attacks, conversion disorders(hysteria), post- traumatic stress disorder(PTSD, Obsessive compulsive disorder

2.Organic verses functional mental disorder

• Organic disorders are those disorders that result from an easily identifiable cause like infections or injury on the brain eg HIV induced psychosis organic mania, alcohol /substance induced mental illness
• Functional mental disorders are those mental illnesses that don’t result from easily identifiable cause or they may be due to abnormal reduction of biochemical substances
• Eg serotonin when reduced one gets depression meanwhile excess dopamine leads to mania

3.ICDS verses DSM

They tend to specify by breaking down some of the syndrome of diseases which enable health workers to diagnose and manage

GENERAL PRINCIPLES USED TO MANAGE THE MENTALLY ILL

• Accept mental patient as he/she is
• Be non-judgmental
• Don’t aim at punishing mentally ill patients
• Sincerely be interested in the patient
• Recognize and reflect on the feelings that may be expressed by the patient
• Talking to a mental patient should be for a purpose
• Listen to patients by trying to give time for a patient to express him/herslf
• Let patients express his strong feelings
• Use self-understanding as a Try to understand a patient by the following;
• Respect one’s own feelings, attitudes, and responses
• Self-understanding helps a person to be assertive
• Accept a patient’s own strengths and limitations/weakness
• Be consistent in your attitude and the ward routines to give a patient security
• Constantly reassure patients in a professional manner
• Patients’ behavior is changed through emotional responses or experiences but not by rational interpretation
• Don’t try to reason a mental patient eg those with delusion
• Don’t try to create unnecessary increase in patients’ anxiety
• Objective observation of patients to understand their behavior
• Develop and maintain a realistic nurse – patient relationship till discharge
• Avoid physical and verbal force as much as possible because this may harm the patient the pt the more or this may create an environment of fear or insecurity making the pt to run away from the hospital
• Nursing care is centered on the pt and not the control of symptoms ie look at the pt as an individual
• All explanations of routine and other procedures are given according to the pt’s level of understanding. Many procedures are modified but basic principles remain the same eg pts’ safety, comfort, privacy, economy etc. Mental pts also require other procedures just like any other pts

AETIOLOGY/CUASES OF MENTAL ILLNESS

Etiology is the study of causes of illnesses or disorders. There are many factors responsible for the causation of mental illness. There is no single factor that contributes to mental illness.

The causes are classified into three;

1.PRE DISPOSING FABTORS

These are sometimes called intrinsic factors. They are factors that operate or people are born with them and they determine the vulnerability to mental illness. They include the following;

• Heredity: This is genetic endowment or factors that run in the family because of the presence of that illness.
• Environment in the uterus: This includes factors such as maternal infections, use of drugs, severe anemia and malnutrition as well as stress before delivery
• Bio chemical factors: Abnormal neural transmitters in the brain are considered to be the causes of some psychological disorders eg; depression and Serotonin and dopamine are the neuro- transmitters that cause the two conditions that cause the psychological disorders mentioned earlier.
• Personality: Some specific personality types are more prone to developing certain mental illnesses eg people who are anti social i.e schizoid personality end up with schizophrenia and those with hysterionic end up developing hysteria

2.PRECIPITATING FACTORS

These are factors that occur shortly before the onset of a disorder and they appear to have induced or sparked off the condition. They include the following;

a) Psychological and social factors;

These are factors that might be caused by the parents/care takers and affect the child at a later age. They are;

• Faulty upbringing
• Maternal deprivation ( lack of maternal love, affection, emotional warm and security)
• Over protection; not allowing the child to experience or face
• Anxious parents; are parents that expect a lot from the children within a short period of time they are punished heavily when slight mistakes are done, no reward when they do good
• Child hood insecurities due to death or separation of parents

b) Psychological stresses

• Psychological stresses at work or at home eg domestic violence
• Financial problems like poverty
• Loss of a job
• Disappointment
• Loss of status or position in the society
• Failure to achieve goals in life

c) Marriage and partnership

• Failure to marry
• Infertility
• Divorce/ separation
• Unwanted sex/gender of the children
• Domestic violence and misunderstanding in the home

1. Social factors
   • Poverty/ unemployment
   • Insecurity/ disaster g war in the north, famine, landslides, fire out break
   • Very big family g failure to feed the family

e) Physical stresses

• Physiological changes like puberty
• Infections such as malaria, meningitis, HIV
• Drugs eg alcohol, marijuana, cocaine
• Tumour of the brain
• Changes in the brain function g changes in the blood glucose level
• Metabolic deficiencies vitamin deficiencies
• Trauma to the brain eg in RTAs
• Degenerative conditions such as dementia
• Poisons or intoxication
• Vascular factors such as severe haemorrhage
• Chronic illnesses g diabetes, TB and HT

3. PERPETUATING FACTORS (MAINTAINING FACTORS)

These factors prolong the cause of the disorder after it has been provoked or the agrovate the disease already existing.

They include;

• Lack of support from the family or
• Use of alcohol or substance when already sick
• Difficult personally for example aggressive, isolated, timid etc
• Family problem g domestic violence
• When a patient is institutionalized or depend on others

PROMOTION OF MENTAL HEALTH AND PREVENTION OF MENTAL ILLNESS

• For this reason the government has come up with the following objective to be
• Increased awareness on mental health condition
• Develop and disseminate policy and guidelines on mental health
• Train health workers in the provision of mental health condition
• Ensure availability of general and psychiatric drugs and essential supplies
• Provide adequate Information Education Communication (IEC) materials on mental health
• Provide appropriate infrastructure and health facilities/services
• Formulate legislation on substance abuse
• Address the issues of all kinds of violence including child abuse and domestic violence

Levels of prevention Primary

• Primary prevention is the effort directed towards reducing the incidence of mental disorders in the community by strengthening individual, family and group copying

THE ROLE OF A NURSE IN PRIMARY PREVENTION

The tool delivering health services at primary level is health education on

1) Behaviour

• Encourage health seeking behaviour in individual, families and communities g people s mind of their behaviour e.g brashing.

2) Infections

• Reduce infections that are likely to damage the brain g malaria, HIV, meningitis.

3) Maternal child health

• Ensure timely and effective obstetrical assistance to guard against effects on the mother and new born.
• Immunize against killer diseases g measles, tetanus
• Proper feeding during pregnancy and there
• Diagnose and treat metabolic disorders as early as possible
• Provide proper antenatal and postnatal care to mother and
• Individuals and couples should use family planning methods to control birth and avoid sexually transmitted infections and diseases.
• Mothers should avoid using strong drugs during pregnancy because it may affect the fetus.
• Encourage psychological support to the mother during and after
• Mothers should avoid effects of radiations when

4) Nutrition

• People should have a well- balanced diet early diagnosis and treatment of nutritional

5) Drugs

• People should learn to solve problems through other means accepted by the society other than use of drugs.
• Control toxic drugs dispensed by traditional leaders and
• In case of use of drugs try to give early attention to drug related
• Encourage people to avoid alcohol

• Limit doses of drugs that are addictive in nature g narcotics.

6)  Chronic illness

• Strengthen social support for the frustrated, aged/ disadvantaged and try to help them to retain their usefulness.
• Improve on medical care when need arises for such people.

7)  Upbringing

• Ensure proper upbringing of children by showing love affection, warmth and protection.
• Encourage parent to foster proper bonding.
• Appropriate disciplinary measures should be taken that doesn’t endanger the child’s
  life.
• Teach adaptive techniques to be used at the time of stress.
• School leaders should develop health atitudes towards children by encouraging self
• inquiry discovery, reliance and ability to copy with situation independently.
• If in schools identify problems of scholarstic materials and emotional disturbances try to
  give timely intervation.
• Help the teachers to identify and recongise children with psychological, physical/learning problems e.g mentally retarted abilities.
• Reduce those confirmed in instituations such as boarding schools, day care centres,orphanages.

8)  Hormonal disorders

• Try to correct early if possible

9)  Family Relationships

• Ensure harmonious relationships among parents and family
• Families should learn to work together towards achievement or improvement of social conditions at home.

10)  Counseling

• Encourage genetic counseling to couples who may wish to marry but there is history of mental illness in families.
• Counsel couple or married people who have problems
• Counsel individuals independently in stressful events
• Encourage people to share problems with friends and

• Health Services or Facilities
  • Extend mental health facilities or services near to the community g child Guidance clinic, adolescence.

• Target groups
  • Focus on target groups g women at menopause, elderly refuges and the homeless or new comers in an area, victims of disaster. Give attention to such people.

SECONDARY LEVEL OF MENTAL ILLNESS PREVENTION

This refers to decreasing the duration of mental illness /disorders. It involves early detection/identification and effective treatment of the condition with the goal of reducing the prevalence in the community

THE ROLE OF A NURSE IN THE SECONDARY PREVENTION OF MENTAL ILLNESS

• Recognize psychiatric symptoms early and treat them promptly
• Case findings through screening and periodic examination in the population at risk
• Regular monitoring of clients already identified and are already on Rx
• Consultation of other health workers when providing care to the identified cases/clients
• Timely and appropriate referral of patients/clients when one cannot manage
• Early and effective Rx of the family members
• Provision of counseling to patients/ care takers, and family members
• Adequate follow up of patients/ clients through home visiting
• Carrying out community out reaches to health educate the community members not to stigmatize the mentally

TERTIARY LEVEL OF MENTAL ILLNESS PREVENTION

Tertiary level of mental illness prevention aims at reducing the occurrence of residual effect or disability due to the illness or disorder

This involves rehabilitation after defect or disability has occurred

THE ROLE OF A NURSE IN TERTIARY PREVENTION OF MENTAL ILLNESS

• Identify agents in the community that provide such services eg rehabilitation centers like the serenity center on Entebbe road associations, fellowships etc
• Foster a realistic attitude towards the mentally ill
• Teach behavioral therapy eg eating, toileting, and dressing behavior to the mentally sick
• Encouraging the patients to continue with medications either to control the s&s of the disease or to treat it
• Emphasize follow up of patients in the community
• Prevention of institutionalization among the psychiatric patients