History of Psychiatry; Psychiatric Nursing
History of psychiatric mental health
The history of psychiatric mental health has come a long way or it would be better said that the study of psychiatric mental health has come a long way. Skulls recovered and dated back to 5000 BC have large holes drilled into the sides of their head to release the demon spirits that possessed them.
Psychiatric mental health history
Hippocrates later would try to rationalize the existence of mental health, he refused to believe that they were possessed by the demons or that God was responsible. Hippocratic medicine as it was coined by his peers revolved around the theory of ‘humours’, no not humors as in funny. “Humours” as in basic juices or fluids health or illness was a result of these juices included blood, choler (yellow bile), phlegm, and melancholy.
Before the asylum, from the beginning of time to as early the 1800’s another “treatment” was to lock up the mentally ill and to treat them basically like animals. They were chained up in basements to keep them safe from themselves and others. Most of the time the family members had done this because there family member hadn’t always been like this and they still love them deeply.
Hippocrates in the Flesh
First Asylum in U.S.
The First "Asylum" for the Insane!
The first asylum was introduced in the 1730 in the U.S. but it was hardly close to the civilized facilities that we run today. This asylum as it was called was the typical dungeon looking castle on the hill the one you find in the horror movies, perhaps the one the created the stigma behind the psychiatric mental health. Unfortunately, the stigma is part of the history and the history is part of the stigma that we as nurses and other healthcare professionals are trying to escape.
The first hospital for the mentally ill was established in Williamsburg, VA, and brought us one step closer to the ever evolving area of psychiatric mental health. Another key area were the crusades of the famous Dorothea Dix where she was responsible for the organization of 32 mental hospitals, and transfer of those with mental illness from asylums and jails.
The work of Clifford Beers and Adolf Meyer.
Clifford Beers (1876–1943) was hospitalized in several mental hospitals after a nervous breakdown and he describes his accounts of this in his autobiography A Mind That Found Itself (1913). Basically he founded the principles of “mental hygiene movement” which included emphasizing early intervention, prevention, and the promotion of mental health. These ideas were later crafted into the basic ideas of mental hygiene which were founded by the psychoanalysis of Adolf Meyer (1866–1950). He believed that the treatment of early forms of maladjustment could prevent more serious problems later on. His ideas also contained suggestions for preventive measures.
President Truman signed the National Mental Health Act
On July 3, President Truman signed the National Mental Health Act, which for the first time in history funding for psychiatric education and research was available. This lead to the establishment of the National Institute of Mental Health (NIMH) in 1949, also in 1949 lithium was discovered and greatly reduced the symptoms of bipolar disorder although the FDA wouldn’t approve the drug until 1970.
John F. Kennedy
Three years after the discovery of lithium in 1949, the first psychotropic drug was discovered. Chlorpromazine (Thorazine) alleviated symptoms of hallucinations, delusions, and agitation and thought disorders. This discovery greatly improved the condition of consumers with psychosis and delusion paving the way for the beginning of psychotropic drug discovery.
Congress back the funding of twelve million dollars for research in the clinical and basic aspects of drugs that would help to treat individuals with a mental illness and so the Psychopharmacology Service Center was birthed. The number of mentally ill in mental hospitals declined due to the response of the disease processes to the newly discovered psychotropic drugs.
With a growing need to continue to help those discharge from the institutions and to maintain that they continue to respond well to the new treatments the Health Amendments Act authorized the support of community services for the mentally ill, such as halfway houses, daycare, and aftercare.
In 1961the Action for Mental Health was proposed to Congress. This proposal assessed mental health conditions and resources throughout the United States “to arrive at a national program that would approach mental illness and treat each person with a mental illness as a unique individual.
This opened the door in 1963 when President Kennedy proposed and signed legislation that started the community mental health center movement. These facilities today are the backbone of psychiatric nursing care because this is the system used when deinstitutionalizing somebody and integrating them back into the community. This legislation was also used to substitute comprehensive community care for institutional care.
The Community Mental Health Center Act Amendments of 1965 were passed and included changes that would allow funds to be granted to facilities that served clients with alcohol and substance abuse construction and staffing grants to centers were extended and facilities that served those with alcohol and substance abuse disorders.
Grants were also handed out to support and provide facilities’ that reached out to poverty areas to establish mental health services in those areas. Further grants were used to facilitate further establishment of psychiatric mental health children services.
Over that flew over the cuckoo's nest
President Jimmy Carter
Electroconvulsive therapy (ECT) which has place in mental health today was struck with a fiery dart from Hollywood in the movie “One that Flew Over the Cuckoo’s nest” in 1975. In the movie it depicted ECT as a form of punishment rather than a means to reach a therapeutic outcome in the mental wellness of patients. The account of ECT had nothing to do with what actually occur during ECT, but it did not matter, during that generation people believed ECT must be stopped.
This would be overcome however and in 1987 the APA published a report that stated ECT was not just for desperate cases anymore but as an effective treatment for bipolar disorder. ECT has widespread use and apart from the stigma that still covers it, it still has a therapeutic outcome. Today informed consent must be signed before an ECT can be done to a patient and the post-ECT recovery is much like what would occur during general anesthesia recovery.
During the President Jimmy Carter’s term in 1980 he proposed the Mental Health Systems Act which updated the federal community mental health center program by strengthening the bonds between the federal, state, and local governments to ensure that they were all on the same page. This Act was the final result of many recommendations made by Jimmy Carter’s Mental Health Commission.
Grant programs were authorized for the CMHCs to assist in expanding services to meet an array of populations that were needed to be reached with mental health needs such as lower income households. These grants also included expanded development of services for the severely mentally ill as well as severely emotionally disturbed, and grants that was intended for expanding education on mental wellness and to get patient input and participation of mentally ill patients.
The role of the nurse in psychiatric nursing is to establish a client-nurse relationship that is both therapeutic and goal oriented. Nurses have the task to assess clients to see if they are progressing as they should with their current treatments. Cultural influences as far as the history of Psychiatric mental health is due to early dealings with the mental health patients. Many stigmas about how the mentally ill are treated and what they are capable of have been erroneously molded by society and consequently has become a part of the history of psychiatric mental health that we are trying to escape.
As the history of psychiatric mental health has told us, the world has come a long way in treating the mental illness once they have been identified. Now the goal of mental health is to catch somebody before they begin to exhibit symptoms of a mental illness through screenings. Psychiatric mental health is something used throughout our nursing careers whether or not we are working with a mentally ill patient or not. It is in our everyday lives as a nurse that we use psychiatric mental health that has evolved so well throughout history.