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• Psychiatric Mental Health Nursing is a field of nursing that requires a specific set of knowledge, skills and abilities

Evolution of Psychiatric Care and Mental Health in the Philippines

• The evolution of psychiatric care in the Philippines is best viewed in relation to historical events such as the Pre-Spanish period, the Spanish periods, the American regime, the Japanese occupation, and American liberation

The Pre-Spanish Era

• Before the Spanish era, there wasn't much accurate information about mental illness or how it was handled
• It was thought many maladies, psychiatric or not, were caused by natural and supernatural events

The Spanish Era

• From 1521 to 1898, about four centuries of Spanish control were characterized by attributing mental illness and aberrant behaviour to religious and supernatural causes
• People with mental illness were believed to have offended or displeased gods; having angered witches or mangkukulam who would retaliate by casting curses, and/or having devilmen or manggagaway who would make them mentally ill by praying to the dark powers
• Those with mental illness were brought to churches for purification and exorcism
• Alternatively, they were brought to folk healers or herbolarios who put them through physical and psychological pain to drive away their mental illness
• The first official institutional care for the mentally ill began around the turn of the 19th century with the establishment of Hospicio de San Jose
• Hospicio de San Jose was the first Roman Catholic social welfare institution in the Philippines established in 1782, it also served as a foster care facility for orphans, the abandoned, those with special needs, and the elderly

The American Regime

• Mental impairments were recognized as medical illnesses during the American regime, from 1898 to 1946
• An advocacy for a more compassionate approach to the mentally ill grew
• In November 1904, the Insane Department of San Lazaro Hospital, the country's first hospital unit dedicated to the mentally ill, was established under the newly formed Bureau of Health
• December 18, 1928, the Insular Psychopathic Hospital, the first hospital dedicated to the treatment of patients with mental and nervous disorders, was formally inaugurated and opened
• The land it was constructed on was a 64-hectare estate and funded through substantial government funding
• Beginning in 1910, American physicians Almond T. Gough and Samuel Tretze taught psychiatry to medical students rotating at the Insane Department of San Lazaro Hospital and the Insular Psychopathic Hospital

The American Regime Treatment

• Common modes of treatment for the mentally ill involved empirical somatic therapies
• Fever therapy was used for patients experiencing a manic episode and involved fever induction through protein injections or the bite of malaria-infected mosquitoes
• Metrazol shock, which involved chemical shock induction through camphor oil injection, and insulin shock, which induced hypoglycemic coma, were also used
• Fever therapy was used for general paretics or brain syphilis, which was thought to be functional at the time
• Tryparsamide or neo-salversamized serum, which gave intravenous mercury preparations, was administered
• Psychotherapeutic techniques weren't generally used then but adjunctive therapeutic approaches, such as occupational and recreational activity, were already being explored

The Japanese Occupation

• Progress in psychiatry halted in the Philippines with the start of World War II in December 1941
• Many families of mentally ill patients took them home despite the National Psychopathic Hospital's continued operation
• Due to the Japanese Imperial Army’s need for patient rooms to store their goods, the remaining inpatients were housed in cramped quarters and given minimal food and medicine
• Electroconvulsive treatment using outdated Japanese equipment became the primary therapeutic modality, and local medicinal herbs were used

The Era of Liberation

• The discipline of psychiatry gained awareness and recognition as a result of the widespread emotional impacts of the war casualties
• Existing psychiatric facilities were extensively expanded and rehabilitated shortly after the end of World War II, and workforce training followed
• In July 1946, the National Psychopathic Hospital was renamed National Mental Hospital (NMH)

Mental Health and Illness

• The World Health Organization (WHO) describes health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"
• Mental health is a condition of well-being that enables individuals to realize their potential, cope with normal stresses, work productively and contribute to their communities
• Mental illness refers to all psychiatric disorders with definable diagnoses and manifest as significant dysfunctions which are related to developmental, biological, or psychological disturbances in mental functioning
• According to the US Department Health and Human Services in 2014:
• One in five American adults experienced a mental health issue
• Major depression was experienced by one in ten young people
• Serious mental illnesses, such as schizophrenia, bipolar disorder, or major depression, were experienced by one in twenty-five Americans
• Suicide was the 10th leading cause of death in the United States

Mental Attributes

• Attributes, such as rational thinking, coping effectively, communication effectively, meaningful relationships, learning and being productive, positive self-concept, self-care, happiness and joy, spiritual satisfaction, being developmentally on task, self-awareness and self-control are key to mental wellbeing

Risk and Protective Factors

• Individual attributes and behaviors
• Mental health and well being
• Social and economic circumstances
• Environmental factors

Perceptions of Mental Health and Mental Illness

• Mental refers to the brain, responsible for higher level thought processes
• Physical refers to the workings of the brain, synaptic connections, functioning areas, spinal innervations and connections
• Psychiatric disorders are "all in the head" but most damaging is the belief that these disorders are under personal control and indistinguishable from a choice to engage in bad behavior
• There's a stigma that people with mental illness are subjected to, they are flawed which results in social shunning, disgrace, and shame

Psychiatric - Mental Health Nursing

• Psychiatric-mental health nursing is a nursing specialty that focuses on promoting mental health through assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the lifespan
• Psychiatric-mental health nurses help people in crisis, those who are experiencing life problems, and those who have long-term mental illness

Basic Level and Advanced Practice Psychiatric-Mental Health Nursing Interventions

• Basic level interventions include:
• Coordination of care
• Health teaching and health maintenance
• Milieu therapy
• Pharmacological, biological, and integrative therapies
• Advanced level interventions include all the basic interventions, plus:
• Medication prescription and treatment
• Psychotherapy
• Consultation

DSM-5

• The Diagnostic and Statistical Manual (DSM) is published by the American Psychiatric Association (APA)
• The latest edition was published in 2013, describes criteria for 157 illnesses.
• The development of the DSM-5 was influenced by clinical field trials conducted by psychiatrists, psychiatric-mental health advanced practice registered nurses, psychologists, licensed clinical social workers, licensed counselors, and licensed marriage and family therapists

List of Disorders Categories in the DSM-5

• Neurodevelopmental Disorders
• Schizophrenia Spectrum Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Anxiety Disorders
• Obsessive-Compulsive Disorders
• Trauma and Stressor-Related
• Dissociative Disorders
• Somatic Symptom Disorders
• Feeding and Eating Disorders
• Elimination Disorders
• Sleep-Wake Disorders
• Sexual Dysfunctions
• Gender Dysphoria
• Disruptive, Impulse Control, and Conduct Disorders
• Substance-Related and Addictive Disorders
• Neurocognitive Disorders
• Personality Disorders
• Paraphilic Disorders
• Other Disorders

DSM-5

• The DSM classifies disorders, not people
• Terms such as "a schizophrenic" or "an alcoholic" should be avoided in favour of "an individual with schizophrenia" or "my patient has major depression" so as to not classify people