INNOVATIVE MODELS OF CARE IN PSYCHIATRIC NURSING PRACTICE IN

INDIA AND ABROAD

By:- Firoz Qureshi Dept. Psychiatric Nursing

1. INTRODUCTION

Innovation in psychiatric nursing practice started in the United States in the early 1960s with federal legislation authorising funds to build community mental health centres and to staff them

The major aim was to provide mental health nursing care in the community and reduce census in psychiatric hospitals.

In India, integration of mental health care with primary health care was considered as a primary method from the time of move towards the goal of “Health for All by the year 2000 AD (1978).

2. TRADITIONAL APPROACHES

2.1 Mental Hospital

Nurses to guard the patients, attend to the basic needs, assist in chemo and physical therapy, behaviour therapy, psychosocial therapy and organise activity therapies.

2.2 General Hospital Psychiatric Units (GHPU)

The first GHPU was established in 1933 at Calcutta with most of the units starting incollaboration with neurology and named as “Neuropsychiatric clinics”. Nurses provided bothgeneral and psychiatric nursing care.

2.3 Community care programmes

Mental Health care services were provided by public health nurses (PHN) and by multipurpose health workers (MPHW) working in community utilizing the available care & appropriate resources.

3. INNOVATIVE APPROACHES

Institutional neurosis is an outcome of long incarceration of individual in an institution. Stigma arising out of admission in mental hospitals leads to social isolation and rehospitalisation. To manage the social and vocational inadequacies besides clinical disability, innovative approaches are required.

3.1 Participation of the family in the treatment at Hospital

Dr. Vidyasagar, the then Superintendent of Amritsar Mental Hospital in 1950s, started taking the family into the hospital campus and they lived with patient in separate tents

3.2 Home Care programme

The first experiment was reported from Chandigarh. A nurse was trained in making assessment of the patient, interview the relatives, counsel them regarding the illness and caring for the ill member of the family and dispensing the drugs.

3.3 Foster Care

Patients were allowed to stay with families where psychiatrists would check periodically. Group of psychiatric patients live with their families, were given subsidiary of Rs. 5/- per family member

3.4 Partial Hospitalization

• Although facility is there but not fully explored.

It was started in Madras in 1962 and the patientswould either come to the hospital during day time for various therapeutic procedures and go back to their homes in the night or during the day they go for work and return to hospital at night.

3.4.1 Day and a night hospital:

It provides occupational and recreational outlets. The creative talents of the patients are brought out by use of pottery, carpentry and cooking. Counselling & guidance are also given to clients attending the day care.

3.4.2 Day centre

Voluntary agencies run these centres and itis for caring the chronic mentally ill as an aftercare service.

3.4.3 Half way homes/ Hostels in the community

It give semi-sheltered life. Residents of these homes are drawn for various wards. Family visits them periodically. Nurses monitor their medical compliance and financial management

3.4.4 Quarter way homes/Ward-Hostels

The group of patients 6-8 at a time, stay for a period of one month with almost no hospital supervision during the period. It is to facilitate their discharge into the community subsequently.

3.4.5 In association with camps in rehabilitation homes run by agencies

Patient after receiving treatment & having onlyresidual defects are placed in voluntaryorganisations for shelter less to bring them into the mainstream of the society.

3.4.6 Placement of chronic mentally ill

Adopt individual patients and visit them frequently

3.4.7 Friends of NIMHANS

Some of the parents of chronic schizophrenics have formed a registered association to offer after care facility in the community for extended stay of chronic mentally ill, in small groups.

3.4.8 Association for sheltering mentally ill:

3.4.9 Therapeutic community: is a democratic system in

hospital

3.5 Community Leaders

Community leaders were oriented to health andmental health to use them as facilitators of mentalhealth care activities.

4 sessions for 6 batches, 30 leaders from 10 villages to share mental health knowledge to other villagers, to identify needy patients and refer to the centre, to discuss with family members and to maintain continued contact with mental health agencies for consultation.

3.5 Community Leaders (cont…)

3.6 Parents and relatives of patients

Parents and relatives of patients were assistedto form “Self-Help Group” in the care andmanagement of their wards.

3.7 Traditional Healers

All the persons suffering from psychosis & epilepsy, detected during a survey carried out in villages aroundthe rural mental health centre attached to NIMHANS,had consulted traditional healers, while, only few had, in addition, gone to any modern healing centres.

3.8 Training of lay volunteers

Training of lay volunteers who belong to the samesocio-economic class and the same community asthe patient and hence knew the problem in livingwhich the patient had

3.9 Integrated Child Development Services (ICDS)

Nurses visited Anganwadi centres and trained Anganwadi workers for developing mental healthcare services for children in rural, urban slums and tribal areas.

3.10 Student volunteers

Students of the National Service Schemes ofcolleges were used for providing recreational therapy to psychiatric patients.

4. CONCLUSION

While surveying the pattern of innovative approaches in psychiatric nursing practice, it wasfound that nurses play an important role in the general hospital psychiatric unit, in the mental hospitals and in community

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