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Mental Health NursingMental Health Nursing Historical Foundations Historical Foundations

At the completion of this session students will:At the completion of this session students will: Be able to discern the different ways in which mental Be able to discern the different ways in which mental

illness has been constructed in the pastillness has been constructed in the past Appreciate the different ways that have been used to Appreciate the different ways that have been used to

treat mental disorders in the pasttreat mental disorders in the pastCritique the theory that treatment has improved over Critique the theory that treatment has improved over

timetimeBe aware of some of the key historical, social and Be aware of some of the key historical, social and

political developments of mental health services in New political developments of mental health services in New ZealandZealand

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Timeline...........Timeline...........

Ancient CivilisationAncient Civilisation: Ancient Romans, Greeks and Arabs : Ancient Romans, Greeks and Arabs treated people with mental health problems humanelytreated people with mental health problems humanely

Middle ages (AD 500-1450Middle ages (AD 500-1450: The age of : The age of Witchcraft, superstition and mysticism. Witchcraft, superstition and mysticism. People were locked away with no professionals People were locked away with no professionals to take care of them. to take care of them.

1403 1403 The first Mental hospital, Bethlehem Royal Hospital, The first Mental hospital, Bethlehem Royal Hospital, opened in the UK opened in the UK

The Renaissance (14The Renaissance (14thth-17-17thth centuries) centuries):

Mental illness thought to be reversible Mental illness thought to be reversible

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Timeline...........Timeline........... Eighteenth CenturyEighteenth Century: Move towards : Move towards humane kindness and the emergence of humane kindness and the emergence of Psychiatric Mental Health NursingPsychiatric Mental Health Nursing

William Battie (1703-1776)William Battie (1703-1776)

1757 - Benjamin Franklin introduced a form 1757 - Benjamin Franklin introduced a form of Electroconvulsive therapy of Electroconvulsive therapy

19 – 2019 – 20thth century century: Definition of madness : Definition of madness shifts from ‘spirit possession theory’ shifts from ‘spirit possession theory’

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Timeline...........Timeline...........1845 Lunacy Act1845 Lunacy Act

Asylums were established in New Zealand as part of the Asylums were established in New Zealand as part of the process of colonisation process of colonisation

1846 The first premises were provided for the care of 1846 The first premises were provided for the care of ‘lunatics’ in New Zealand‘lunatics’ in New Zealand

Six provincial asylums were built on the British model Six provincial asylums were built on the British model between 1854 and 1872between 1854 and 1872

Staffed by Staffed by ‘attendants who were more akin to warders ‘attendants who were more akin to warders than nurses’than nurses’ (O’Brien, 2001) (O’Brien, 2001)

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Timeline...........Timeline...........

Punishment was replaced by the development of Punishment was replaced by the development of care care

1818 – First medical Journal published: ‘The 1818 – First medical Journal published: ‘The Journal of Psychological Doctors’ (Germany)Journal of Psychological Doctors’ (Germany)

1855 – Training for doctors developed 1855 – Training for doctors developed ‘Certificate in psychological medicine’ ‘Certificate in psychological medicine’

1870 Education Act - education was provided 1870 Education Act - education was provided for all attendants of asylumfor all attendants of asylum

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Timeline...........Timeline...........Nursing rises in status but the status of the asylum Nursing rises in status but the status of the asylum worker in New Zealand shared the stigmatised status of worker in New Zealand shared the stigmatised status of those they were looking afterthose they were looking after

1882 First nursing school (USA) for mental health 1882 First nursing school (USA) for mental health nursing based on Nightingales teaching nursing based on Nightingales teaching

1885 Handbook for the instruction of attendants of the 1885 Handbook for the instruction of attendants of the insane was publishedinsane was published

1902 15,000 had been sold and mental health nursing 1902 15,000 had been sold and mental health nursing became a written instead of oral traditionbecame a written instead of oral tradition

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Timeline...........Timeline...........1890: A Training Scheme was developed for 1890: A Training Scheme was developed for nurses nurses

1892: 15 Asylums were participating in the 1892: 15 Asylums were participating in the training schemetraining scheme

New Zealand now followed UK in developmentsNew Zealand now followed UK in developments

1907 First training programme for psychiatric 1907 First training programme for psychiatric nurses and registration commenced in Auckland nurses and registration commenced in Auckland

1923 ‘The handbook for mental Nurses’ was 1923 ‘The handbook for mental Nurses’ was published published

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Timeline...........Timeline...........

Following World War II pharmacological Following World War II pharmacological treatments emergedtreatments emerged

Antidepressant’s then Antipsychotic’sAntidepressant’s then Antipsychotic’s

So successful that many institutionalised So successful that many institutionalised clients were able to leave hospital for the clients were able to leave hospital for the first time in decadesfirst time in decades

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Timeline...........Timeline...........

1950 -1954 Hildegarde Peplau initiates, 1950 -1954 Hildegarde Peplau initiates, first speciality training and text book :first speciality training and text book :

‘ ‘Interpersonal relations in nursing’ Interpersonal relations in nursing’

Conceptualisation of mental healthConceptualisation of mental health nursing as a therapeutic relationship wasnursing as a therapeutic relationship was an international trend an international trend

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Timeline...........Timeline...........Nursing Theorists Render, Orlando and Barker Nursing Theorists Render, Orlando and Barker developed further on Peplau’s theorydeveloped further on Peplau’s theory

1970 Education from mental institutions to 1970 Education from mental institutions to polytechnics and universities polytechnics and universities

1995 development of postgraduates certificate 1995 development of postgraduates certificate /program of mental health nursing/program of mental health nursing

2000 Professionalism of speciality of mental health 2000 Professionalism of speciality of mental health nursing: postgraduate diploma's , mastersnursing: postgraduate diploma's , masters

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TimelineTimeline1980’s De-institutionalisation1980’s De-institutionalisation

1994 New Zealand Ministry of Health establish a set of 1994 New Zealand Ministry of Health establish a set of five strategic directions five strategic directions ‘Looking Forward: Strategic ‘Looking Forward: Strategic Directions for the Mental Health Services’.Directions for the Mental Health Services’. ( (www.moh.govt.nz) )

1996 Mason Report (Mason, Johnston & Crowe, 1996)1996 Mason Report (Mason, Johnston & Crowe, 1996)

1996 The Mental Health Commission established to 1996 The Mental Health Commission established to oversee implementation of the National Mental health oversee implementation of the National Mental health Strategy (Strategy (www.mhc.govt.nz))

1997 1997 ‘Moving Forward: The National Plan for More and ‘Moving Forward: The National Plan for More and Better Mental Health Services (MOH, 1997a)Better Mental Health Services (MOH, 1997a)

(Elder et al, 2005)(Elder et al, 2005) 1212

Timeline...........Timeline...........1998 Blueprint for Mental Health Services (1998 Blueprint for Mental Health Services (http://www.mhc.govt.nz/publications/1998/Blueprint1998.pdf))

Treaty of Waitangi (1840) is accorded a central place in Treaty of Waitangi (1840) is accorded a central place in policy development and service provision by both MHC policy development and service provision by both MHC and MOH bodiesand MOH bodies

1990’s Recovery principles developed and consumers 1990’s Recovery principles developed and consumers became involvedbecame involved

Mental Health Nursing has blossomed into a skilled Mental Health Nursing has blossomed into a skilled profession but there are still many challenges facing profession but there are still many challenges facing mental health nurses with ongoing policy developments mental health nurses with ongoing policy developments in the provision of services and the need to balance the in the provision of services and the need to balance the caring and controlling functions of mental health nursing caring and controlling functions of mental health nursing practice. practice.

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Challenge yourself with these Challenge yourself with these questionsquestions

1.1. What skills do you consider consumers would bring to What skills do you consider consumers would bring to mental health services?mental health services?

2.2. What may be some of the barriers to involving What may be some of the barriers to involving consumers in mental health services?consumers in mental health services?

3.3. How do you explain how mental health care appears to How do you explain how mental health care appears to have come full circle with regard to the humane have come full circle with regard to the humane approach used in Roman Times?approach used in Roman Times?

4.4. What do you see as the costs or benefits of a recovery What do you see as the costs or benefits of a recovery philosophy being established within mental health philosophy being established within mental health nursing ?nursing ?