Unit 1: Historical Overview of Mental Health

Pre-moral period dates

Ancient-Renaissance
800 BC-1700 AD

View of Mental Health During Ancient Period (800 B.C.-1 AD)

- mental illness was caused by gods, beyond control of mortals
- Hippocrates disagreed with this theory, said people with mental health illness had "caught the illness"
- i.e. epilepsy called humors
- Rome: neglected and mistreated mentally ill b/c were s

View of Mental Health during Medieval period (1000-1300 AD)

- early medieval: thought mental health disease caused by demons, healing done by witch doctors
- church recognized the body (soma) and the soul (psyche) as an arena for battle
- Tx: were incarcerated by chains and dungeons and confined from community.
-

View of Mental Health during Renaissance (1300-1600)

- 13th century miracle cure in Gheel, Belgium
- sent to seek cure from patron saint of mentally ill (Saint Dymphna)

Moral (Humanistic) period dates

Colonial-Institutionalizaiton
1700s-1900s

View of Mental Health during Moral Humanistic period: 1700s

- scientific investigation of mental health began
- Phillipe Pinel, French Medical director of a prison, decided to opt for more humane treatment and had chains removed, classified symptoms, and involved them in activities
- Benjamin Rush (physician at PA

View of Mental Health during the Moral Humanistic Period 1800s

- period of Institutionalization: forced confinement of individuals for long periods of time in large facilities
- Dorothea Dix influenced the building of large state institutions (state hospitals) for mentally ill

View of Mental Health during Moral Humanistic Period 1900s

- Freud believed mental illness was psychological in origin: due to disturbed personality development and faulty parenting
- Freud introduced psychoanalysis: therapy that focused on repairing the trauma of the original psychological injury
- established c

mental health from 1917-1930s

Somatic therapies (ECT, insulin shock, lobotomies) expanded role of psychiatric nurse

Mental health from 1935-Depression Era

- Social Security Act created
- Federal Aid provided to blind, children, and elderly
- shifted care of ill people from state to federal government

Mental Health from 1940s-WWII

1.7 million Americans excused from military service due to mental illness or related reasons

National Mental Health Act

- Established the NIMH
NIMH purpose
- explore causes and tx. for mental disorders
- provide federal funds for training professionals in mental health field

Mental Health Study Act

- Created Joint Commission on Mental Illness and Health
- recommended shift of patient populations from state hospital systems to community health system
- bringing mentally ill back into community instead of institutionalization for tx, support, and reha

Thorazine and Mental Health

- first psychotropic drug discovered
- became possible to control symptoms of mental illness
- patients responsive to communication led to fewer restraints (were calmer)

Who was Linda Richards?

- 1st American Psychiatric Nurse
- Assessed physical and emotional needs of patient
- improved nursing care in U.S. state mental hospitals

Who was Harriet Bailey?

Created first psychiatric nursing textbook

Who was Hildegarde Peplau?

- Expanded role of psychiatric nurse by outlining scope of practice
- Wrote "Interpersonal Relations in Nursing" that gave first systematic theoretical framework for psychiatric nursing

McLean Aslyum, MA

- 1st school for psychiatric nurses created by Linda Richards
- trained nurses how to provide physical care to patients with mental disorders with medical illness

What does Modern Psychiatric Nursing look like today?

- uses evidence based practice and nursing expertise
- is a problem solving approach using best practices
- integrates patient preferences and values

Community Mental Health Act

- enacted by President Kennedy
- made mental health care a right for everyone
- Opened the doors of state institutions, which resulted in deinstitutionalization - mass exodus into the community

Medicare and Medicaid

- created increased access to care
- provided federal subsidy to health care

Developmental Disabilities Act

- focused on rights and treatment of people with developmental disabilities
- provided a foundation for people with mental disorders

Presidents commission on Mental Health

- supported community mental health centers
- provided insurance for mentally ill and protection of human rights

Mental Health Systems Act

- signed by President Carter
- established federal government role in services for children, elderly, minorities, and chronically mentally ill
- provided comprehensive mental health care for all

Mental Health Systems Act Repealed

- repealed by Reagan
- cut funding for psych and social services
- idea was fewer services = fewer economic constraints

What happened in 1985 that was important for mental health services

NIMH/NIH established the NINR

Decade of the Brain 1990s

- Brain imaging techniques to map the brain: CT, MRI, Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT)
- Neurobiological theories of mental illness: more than 100 different transmitters; dopamine, serotonin, norepinep

How do psychotropic drugs work?

manipulate the processes of neurotransmitter production and absorption to reestablish normal neurochemical balance

Omnibus Budget Reconciliation Act (OBRA)

- nursing home reform initiative
- particularly affected use of restraints and psychotropic drugs

Americans with Disabilities Act (ADA)

- promoted job opportunities
- prohibited discrimination for the disabled including mental illness

Patient Self-determination Act (PSDA)

- Required to inquire about advanced directives
- Required to let them know about their right to refuse medical care

Mental Health Parity Act

Prohibited lifetime or annual limitations on mental health coverage for certain insured employees

What is Healthy People 2020?

National Health Care Agenda focusing on promoting health and prevention disease

Healthy people 2020 focuses on reducing

- suicide rates in children and adolescents
- mental disorders among adults
- adverse effects from stress

Healthy people 2020 focuses on Increasing

- community support for people with mental disorders
- treatment for people with depressive disorders
- access to care for people with personal and emotional problems

Mental Health: A Report of the Surgeon General (1999)

addresses treatment, costs, ethics/values, privacy, and future visions for mental health

Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda (2000)

conference held to get recommendations for a national action agenda on children's mental health

President's New Freedom Commission on Mental Health

order to conduct comprehensive study on the mental health service delivery system and make recommendations based on findings

Pre-moral period dates

Ancient-Renaissance
800 BC-1700 AD

View of Mental Health During Ancient Period (800 B.C.-1 AD)

- mental illness was caused by gods, beyond control of mortals
- Hippocrates disagreed with this theory, said people with mental health illness had "caught the illness"
- i.e. epilepsy called humors
- Rome: neglected and mistreated mentally ill b/c were s

View of Mental Health during Medieval period (1000-1300 AD)

- early medieval: thought mental health disease caused by demons, healing done by witch doctors
- church recognized the body (soma) and the soul (psyche) as an arena for battle
- Tx: were incarcerated by chains and dungeons and confined from community.
-

View of Mental Health during Renaissance (1300-1600)

- 13th century miracle cure in Gheel, Belgium
- sent to seek cure from patron saint of mentally ill (Saint Dymphna)

Moral (Humanistic) period dates

Colonial-Institutionalizaiton
1700s-1900s

View of Mental Health during Moral Humanistic period: 1700s

- scientific investigation of mental health began
- Phillipe Pinel, French Medical director of a prison, decided to opt for more humane treatment and had chains removed, classified symptoms, and involved them in activities
- Benjamin Rush (physician at PA

View of Mental Health during the Moral Humanistic Period 1800s

- period of Institutionalization: forced confinement of individuals for long periods of time in large facilities
- Dorothea Dix influenced the building of large state institutions (state hospitals) for mentally ill

View of Mental Health during Moral Humanistic Period 1900s

- Freud believed mental illness was psychological in origin: due to disturbed personality development and faulty parenting
- Freud introduced psychoanalysis: therapy that focused on repairing the trauma of the original psychological injury
- established c

mental health from 1917-1930s

Somatic therapies (ECT, insulin shock, lobotomies) expanded role of psychiatric nurse

Mental health from 1935-Depression Era

- Social Security Act created
- Federal Aid provided to blind, children, and elderly
- shifted care of ill people from state to federal government

Mental Health from 1940s-WWII

1.7 million Americans excused from military service due to mental illness or related reasons

National Mental Health Act

- Established the NIMH
NIMH purpose
- explore causes and tx. for mental disorders
- provide federal funds for training professionals in mental health field

Mental Health Study Act

- Created Joint Commission on Mental Illness and Health
- recommended shift of patient populations from state hospital systems to community health system
- bringing mentally ill back into community instead of institutionalization for tx, support, and reha

Thorazine and Mental Health

- first psychotropic drug discovered
- became possible to control symptoms of mental illness
- patients responsive to communication led to fewer restraints (were calmer)

Who was Linda Richards?

- 1st American Psychiatric Nurse
- Assessed physical and emotional needs of patient
- improved nursing care in U.S. state mental hospitals

Who was Harriet Bailey?

Created first psychiatric nursing textbook

Who was Hildegarde Peplau?

- Expanded role of psychiatric nurse by outlining scope of practice
- Wrote "Interpersonal Relations in Nursing" that gave first systematic theoretical framework for psychiatric nursing

McLean Aslyum, MA

- 1st school for psychiatric nurses created by Linda Richards
- trained nurses how to provide physical care to patients with mental disorders with medical illness

What does Modern Psychiatric Nursing look like today?

- uses evidence based practice and nursing expertise
- is a problem solving approach using best practices
- integrates patient preferences and values

Community Mental Health Act

- enacted by President Kennedy
- made mental health care a right for everyone
- Opened the doors of state institutions, which resulted in deinstitutionalization - mass exodus into the community

Medicare and Medicaid

- created increased access to care
- provided federal subsidy to health care

Developmental Disabilities Act

- focused on rights and treatment of people with developmental disabilities
- provided a foundation for people with mental disorders

Presidents commission on Mental Health

- supported community mental health centers
- provided insurance for mentally ill and protection of human rights

Mental Health Systems Act

- signed by President Carter
- established federal government role in services for children, elderly, minorities, and chronically mentally ill
- provided comprehensive mental health care for all

Mental Health Systems Act Repealed

- repealed by Reagan
- cut funding for psych and social services
- idea was fewer services = fewer economic constraints

What happened in 1985 that was important for mental health services

NIMH/NIH established the NINR

Decade of the Brain 1990s

- Brain imaging techniques to map the brain: CT, MRI, Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT)
- Neurobiological theories of mental illness: more than 100 different transmitters; dopamine, serotonin, norepinep

How do psychotropic drugs work?

manipulate the processes of neurotransmitter production and absorption to reestablish normal neurochemical balance

Omnibus Budget Reconciliation Act (OBRA)

- nursing home reform initiative
- particularly affected use of restraints and psychotropic drugs

Americans with Disabilities Act (ADA)

- promoted job opportunities
- prohibited discrimination for the disabled including mental illness

Patient Self-determination Act (PSDA)

- Required to inquire about advanced directives
- Required to let them know about their right to refuse medical care

Mental Health Parity Act

Prohibited lifetime or annual limitations on mental health coverage for certain insured employees

What is Healthy People 2020?

National Health Care Agenda focusing on promoting health and prevention disease

Healthy people 2020 focuses on reducing

- suicide rates in children and adolescents
- mental disorders among adults
- adverse effects from stress

Healthy people 2020 focuses on Increasing

- community support for people with mental disorders
- treatment for people with depressive disorders
- access to care for people with personal and emotional problems

Mental Health: A Report of the Surgeon General (1999)

addresses treatment, costs, ethics/values, privacy, and future visions for mental health

Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda (2000)

conference held to get recommendations for a national action agenda on children's mental health

President's New Freedom Commission on Mental Health

order to conduct comprehensive study on the mental health service delivery system and make recommendations based on findings