History of Mental Health Treatment

• Pythagoras theorized the brain is the center of intellectual activity (BC).

• Greeks, Romans, and Arabs thought emotional disorders stemmed from organic brain dysfunction

• Hippocrates (460–375 BC) proposed mental illness was due to an imbalance of four body fluids: blood, plasma/phlegm, black bile, and yellow bile.

• Aristotle (382 – 322 BC) associated the mind with the heart.

• Galen (130 – 200 AD) linked emotional/mental disorders to the brain, prioritizing the satisfaction of patients’ physiological needs in treatment.

• During the Middle Ages to 1773, the mentally ill were excluded from society and often labeled as witches or lunatics, leading to torture, starvation, and execution.

• 1403: Bethlem Royal Hospital (England), the first mental hospital, was established, later known as "Bedlam."

• 1752: Pennsylvania Hospital opened the first "lunatics ward" in an attempt to treat the mentally ill and hired attendants for socialization.

Emergence of Psychiatric-Mental Health Nursing (1773 – 1881)

• 1798: Phillippe Pinel classified clients by observable behaviors
• 1812: Dr. Benjamin Rush, considered the "father of American psychiatry," believed mental illness was a disease and published the first U.S. psychiatric textbook.
• 1843-1880: Dorothea Lynde Dix helped found 32 mental hospitals across the U.S. and improved conditions for patients.
• 1873: Linda Richards, the First American Psychiatric Nurse, advocated for the same level of care for the mentally ill as for the physically ill.

Development of the Psychiatric Nurse's Work Role (1882 – 1914)

• 1882: Edward Cowles established the first training school for psychiatric nurses at McLean Asylum in Massachusetts.
• 1890: Trained nurses were employed in state mental hospitals.
• 1908: Clifford Beers founded the Connecticut Society for Mental Hygiene, after speaking of his abusive experiences in a mental institution in his book, ”A Mind That Found Itself”
• 1909: National Society for Mental Hygiene was established.
• 1913: Johns Hopkins was the first school to include a psychiatric nursing course in its curriculum, emphasizing assessment of both physical and emotional needs.

Development of Undergraduate Psychiatric Nursing Education (1915–1935)

• The National League for Nursing Education added psychiatric nursing to curriculum guides.
• 1920: Harriet Bailey authored the first psychiatric nursing textbook, Nursing Mental Disease.
• 1935: Introduction of somatic therapies, including insulin shock therapy.

Development of Graduate Psychiatric Nursing Education (1936–1945)

• 1936: Introduction of psychosurgery.
• 1937: Introduction of electroconvulsive therapy and standardization of clinical experiences.
• 1943: Three university-sponsored graduate programs existed.
• 1944: The American Psychiatric Association commissioned Laura Fitzsimmons to evaluate psychiatric nursing education programs.

Development of Consultation and Research in Psychiatric Nursing Practice (1946–1956)

• 1946: The Mental Health Act funded graduate nursing programs for psychiatric clinical nurses.
• 1950: The National League of Nursing required psychiatric nursing experience for accreditation; psychotropic medications were introduced.
• 1950s: Deinstitutionalization of psychiatric care began.
• 1952: Hildegard Peplau published Interpersonal Relations (IPR) in Nursing.
• 1953: Maxwell Jones published The Therapeutic Community.
• 1954: Major tranquilizers were developed; Hildegard Peplau established the first psychiatric nursing graduate program at Rutgers University.
• 1956: The National League of Nursing Education formed a committee to revise guidelines for advanced psychiatric nursing courses.

Events Influencing Psychiatric/Mental Health Nursing

• 1960: A shift in psychiatric nursing care focused on primary prevention.
• 1963: The Community Mental Health Centers Act expanded PMH-CNS practice in community settings
• 1963: First psychiatric-mental health nursing research journals were published
• 1965: PMH-RN practice expanded due to Medicare & Medicaid.
• 1970: Psychiatric nurses became leaders in specialized nursing practice.
• 1973: The ANA published its first Standards of Psychiatric Nursing Practice and began certifying PMH-RNs.
• 1980: Scientific growth in psychobiology

Psychiatric Services in Belize

• 1848: General Charles Saint Fancourt recommended a permanent residence for the mentally ill, resulting in the Fancourt Dispensary.
• 1857: Expansion of the asylum led to the purchase of new quarters for lunatics and paupers and was later converted into a jail.
• 1912: A new asylum was built on the coast in Belize City, known locally as the "crazy house."
• 1964: The asylum was renamed 'Seaview Hospital' and included the post of Psychiatrist.
• 1965: Dr. Neville Mason Brown was the first Psychiatrist in the colony and focused on care over custody via encouraging family visits and community outpatient services.
• 1965-1970: Dr. Neville Mason Brown, the only Psychiatrist in Belize at the time, also started Mental Health Awareness Week, removed iron bars from hospital windows, initiated the use of psychotropic medication and psychotherapy.
• 1971-1978: Dr. Habbibulah Chaudry (from the UK) served as Superintendent of Psychiatric Services, continued Dr. Mason-Brown's work, promoted legal changes, and instituted formal training for mental health workers.
• 1974: Community Psychiatry was implemented in Belize City, including outpatient clinics and social welfare services.
• 1976: Services expanded to all districts with monthly visits from a social worker and nurse practitioner.
• 1979: Seaview was renamed Rockview after relocation outside of Belize City.
• 1978-1992: Visiting consultants and psychiatrists operated psychiatric services.
• 1991-1993: The Psychiatric Nurse Practitioners Program was instituted at the Bliss School of Nursing.
• 1992: Dr. Belito Arana, the first Belizean Psychiatrist, headed the mental health department.
• 1994: Dr. Claudina Cayetano joined the Mental Health Services.
• 2003: Training of 12 Psychiatric Nurse Practitioners took place at the University of Belize.
• 2008: Dr. Emilio Molina joined the Mental Health Services and Rock-View Hospital relocated to Belmopan.
• 2011: Dr. Rodriguez joined the Mental Health team in Orange Walk, leaving in 2016.
• 2016: Dr. Aleman joined the Mental Health team in Orange Walk, leaving in 2018.
• 2017: Dr. Alejandro Matus became a Government Psychiatrist in Belize City.
• 2017-19: Dra. Zandra Herrera joined the Mental Health Services and left in December 2019.
• 2018: Training of 16 PNP (August 2018 – February 2020-UB)
• 2018: Dra Yudenia Marin Psychiatrist, in San Ignacio, left December 2021
• 2018: Dra Mojena (Psychiatrist) in Corozal & Orange Walk, left August 2021
• 2020: (November) – Dra Yoandra Guerra, Psychiatrist – Belmopan
• 2021: (September) – Dra. Idalmis Leon Rodriguez – Belmopan
• 2021: (September) – Dra. Liliana Miguel Casas– SRH
• 2023: Dr. Tailin Daudinot Dominguez - NRH
• 2023: Dr. Alejandro Estevez Fernandez – SICH

Role Emergence – Hildegard Peplau

• Stranger: Initial role for both nurse and patient upon meeting.
• Resource person: Provides health information.
• Teacher: Facilitates patient growth and learning.
• Leader: Involves the patient in a democratic nursing process.
• Surrogate: Nurse assumes roles based on the patient's past relationships (transference).
• Counselor: Helps the patient integrate illness-related facts and feelings.

Evolving Functions

• Addressing problems related to patients’ attitude, mood, and interpretation of reality.
• Exploring disturbing thoughts and feelings.
• Using positive feelings to achieve psychophysiological homeostasis.
• Counseling patients during emergencies, including panic.
• Reinforcing the patient’s strengths.

Elements of the Psychiatric-Mental Health Nursing Role

• Nurse-patient partnership.
• Clinical competence: Maintaining up-to-date knowledge and skills.
• Consumer-family advocacy: Advocating for patient and family needs.
• Fiscal responsibility: Balancing quality care with resource efficiency.
• Inter-professional collaboration: Working with other healthcare professionals.
• Social accountability: Addressing social factors affecting mental health.
• Legal-ethical parameters: Adhering to legal and ethical principles.

Elements of the Psychiatric-Mental Health Nursing Role

• Competent Caring
• Direct care: Delivering hands-on care, diagnosing, and treating mental health conditions while addressing physical and emotional needs.
• Communication: Engaging in therapeutic interactions, active listening, and information sharing.
• Management: Organizing and coordinating patient care.

Four Factors Influencing Nurses’ Role

• Laws: Legal frameworks define practice scope and standards.
• Qualifications: Education, certifications, and experience influence care provided.
• Practice setting: Work environment shapes responsibilities.
• Personal Initiative: Motivation and commitment affect contributions.

Meeting the Challenges of the Next Decade

• Outcome evaluation: Psychiatric nurses must measure and evaluate the impact of their care on patients, familties, and communities by conducting studies of their prractices
• Leadership skills: development improves patient care and advocacy.
• Political action: Engagement in legislative processes brings systemic changes.