KRISTIAN KARL B.

KIW-IS

1. Research on the history or evolution of mental health- psychiatric nursing (10 points)

History reveals that mental illness has been around since the beginning of time. However, it was not until the late 18th
century when the view of mental illness became that of a disease requiring treatment and humane care. Overall, the
views of mental health and mental illness closely reflect the sociocultural climate of the time.

The Earliest Years

Mental illness is a complex experience, with different values and meanings worldwide. Although some cultures
considered mental illness in a negative light, attributing it to possession by spirits or demons, other cultures considered
mental illness somewhat differently, even as an exceptional state; one that would prepare that person to become a
healer as, for example, in shamanism. However classified or viewed, the complexity of mental illness has prompted
treatment, from ridding the person of spirits or demons to enabling the person to explore the possibility that he or she is
a potential healer. For the former, magical therapies such as charms, spells, sacrifices, and exorcisms were used. For the
latter, various initiation rituals were used.

In the West, however, the prevailing view of mental illness involved possession. A person who exhibited an odd or
different kind of behavior without identifiable physical injury or illness was seen as possessed, specifically by an evil
spirit or demon, and the patient’s behavior was the result of this state of possession. In response, treatments such as
magical therapies were commonplace. Physical treatments such as bleeding, blistering, and surgically cutting into the
skull to release the spirit also were done. If the patient was not disruptive, he or she could remain in the community.
However, if the patient’s behavior was violent or severe, the patient often was ostracized and driven from the
community.

During the Middle Ages and the Renaissance period, the view of mental illness as demonic possession continued. Witch
hunts and exorcisms were common. In addition, the strong religious influences at that time led to the belief that mental
illness was a punishment for wrongdoings. Persons with mental illness were inhumanely treated, being placed in
dungeons or jails and beaten.

The 18th and 19th Centuries

The early to middle 18th century laid the groundwork for future developments in the latter half of this century and the
next, especially in the United States. Society was beginning to recognize the need for humane treatment, which led to a
gradual reshaping of the view of mental illness. Treatment, rather than punishment, exorcisms, and magical therapies,
was becoming the focus. During this time, public and private asylums, buildings specially constructed to house persons
with mental illness, were developed. Individuals with mental illness were removed from their homes and placed in these
institutions.

This need for treatment prompted the development of institutions where care could be provided. For example, in 1751,
Benjamin Franklin established Pennsylvania Hospital in Philadelphia. This was the first institution in the United States to
provide treatment and care for individuals with mental illness. As the late 18th century approached, medicine began to
view psychiatry as a separate branch. At that time, mental illness embraced only such medical interventions as
bloodletting, immobilization, and specialized devices such as the tranquilizer chair both in the United States and abroad.
These practices continued until the very late 18th and early 19th centuries. Through the work of Dr. Benjamin Rush in
the United States, the focus of treatment began to shift to supportive, sympathetic care in an environment that was
quiet, clean, and pleasant. Although humane, this care was primarily custodial in nature. Moreover, individual states
were required to undertake financial responsibility for the care of people with mental illnesses, the first example of
government-supported mental health care.

A key player in the evolution of mental health and mental illness care during the 19th century was Dorothea Dix. A
retired schoolteacher, Dix was asked to teach a Sunday school class for young women who were incarcerated. During
her classes, she witnessed the deplorable conditions at the facility. In addition, she observed the inhumane treatment of
the women with mental illness. As a result, she began a crusade to improve the conditions. She worked tirelessly for
care reform, advocating for the needs of the mentally ill through the establishment of state hospitals throughout the
United States. Unfortunately, these state institutions became overcrowded, providing only minimal custodial care.
Although she was a nurse, her impact on the evolution of mental health and mental illness may be overlooked because
her work was primarily humanitarian.

Dorothea Dix was instrumental in advocating for the mentally ill. She is credited with the development of state mental
hospitals in the United States.

The 20th Century

The 20th century ushered in a new era of ideas regarding mental health and illness. Scientific thought was coming to the
forefront. In the beginning of the 1900s, two schools of thought about mental illness were prevalent in the United States
and Europe. One school viewed mental illness as a result of environmental and social deprivation that could be treated
by measures such as kindness, lack of restraints, and mental hygiene. The other viewed mental illness as a result of a
biological cause treatable with physical measures such as bloodletting and devices. This gap in thinking—deprivation on
one end of the spectrum and biological causes on the other end—led to the development of several different theories
attempting to explain the cause of mental illness.

One such theory was the psychoanalytic theory developed by Sigmund Freud. His theory focused on a person’s
unconscious motivations for behaviors, which then influenced a person’s personality development. Freud, a
neuropathologist, examined a person’s feelings and emotions about his or her past childhood and adolescent
experiences as a means for explaining the person’s behavior. According to Freud, an individual develops through a series
of five stages: oral, anal, phallic/oedipal, latency, and genital. He considered the first three of these five stages (oral,
anal, and phallic) to be the most important. If the person experiences a disruption in any of these stages, experiences
difficulty in moving from one stage to the next, remains in one stage, or goes back to a previous stage, then that
individual will develop a mental illness. Freud’s views became the mainstay of mental health and mental illness care for
several decades.

The development of PSYCHOPHARMACOLOGY, the use of drugs to treat mental illness and its symptoms, also changed
treatment for mental illness. The intent was control of symptoms through the use of drugs to allow individuals to be
discharged from institutions and return to the community where they could function and live productive lives.
Subsequently, the numbers of persons requiring hospitalization dramatically decreased. Moreover, psychopharmacology
provided a lead into the future for deinstitutionalization and for addressing the underlying biological basis for mental
illness.

Research into the proposed causes or factors associated with mental illness exploded during the 1990s, which was
dubbed “the decade of the brain.” Interest in neurotransmitters and their role in influencing mental illnesses was
explored. New medications were developed based on proposed theories of how medications may regulate
neurotransmitter reuptake. Along with the burgeoning pharmaceutical industry and the embracing of the biological
model of illness by physicians, this era led to a major shift away from more humane, less-invasive forms of therapy, such
as counseling, as the main psychiatric treatment to one involving medical-somatic options as first-line intervention
(Whitaker, 2011).

2. What are the impact of mental health care delivery system in the Philippines specially in the community? (10
points)

National information on mental health services in the Philippines indicates that there are substantial gaps and
inconsistencies in the delivery of mental healthcare. The recently enacted Mental Health Act legislation provides a
platform for the delivery of comprehensive and integrated mental health services. However, there remain many
challenges in the provision of accessible and affordable mental healthcare.
The Philippines has recently passed its first Mental Health Act (Republic Act no. 11036). The Act seeks to establish access
to comprehensive and integrated mental health services, while protecting the rights of people with mental disorders
and their family members (Lally et al, 2019). However, mental health remains poorly resourced: only 3–5% of the total
health budget is spent on mental health, and 70% of this is spent on hospital care (WHO & Department of Health, 2006).

Accordingly, the majority of mental healthcare is provided in hospital settings and there are underdeveloped community
mental health services. The National Center for Mental Health was previously estimated to account for 67% of the
available psychiatric beds nationally (Conde, 2004). More recent data indicate that there are 1.08 mental health beds in
general hospitals and 4.95 beds in psychiatric hospitals per 100 000 of the population (WHO, 2014). There are 46 out-
patient facilities (0.05/100 000 population) and 4 community residential facilities (0.02/100 000) (WHO, 2014). There are
only two tertiary care psychiatric hospitals: the National Center for Mental Health in Mandaluyong City, Metro Manila
(4200 beds) and the Mariveles Mental Hospital in Bataan, Luzon (500 beds). There are 12 smaller satellite hospitals
affiliated with the National Center for Mental Health which are located throughout the country. Overcrowding, poorly
functioning units, chronic staff shortages and funding constraints are ongoing problems, particularly in peripheral
facilities. There are no dedicated forensic hospitals, although forensic beds are located at the National Center for Mental
Health.