UNIT IX ppt.pptx

UNIT IX
Community Mental Health
Presented By:
Sapana Dahal
M.Sc. Nursing 2nd Year
6/4/2023 2

Objective
At the end of the session, participants will be
able to explain about mental health and existing
mental health care issues.
6/4/2023 3

Contents
• Mental Health
Definition
Characteristics of mentally healthy person
• Mentally Unhealthy Person
Definition
Legal Rights of Mentally Ill Person
• Community Mental Health
6/4/2023 4

Contents…
• Community Mental Health Nursing
Definition
Purpose
• Mental Health Care
Introduction
Components
• Mental Health in developed countries versus
developing countries
6/4/2023 5

Contents…
• Mental Health care in developed Versus
• Mental Health Care in Asia Pacific Region
• Improving mental health in developing
countries
• Related Articles
• References
6/4/2023 6

Introduction
Health is defined as the state of complete physical,
mental and social well- being and not merely the
absence of disease or infirmity. –World Health
Organization (WHO)
Mental health is a state of well-being in which an
individual realizes his or her own abilities, can cope
with the normal stress of life, can work productively
and is able to make a contribution to his or her
community. –World Health Organization (WHO)
6/4/2023 7

Introduction Contd…
Mental health is a state of mind characterized by
emotional well-being, good behavioral
adjustment, relative freedom from anxiety and
disabling symptoms, and a capacity to establish
constructive relationships and cope with the
ordinary demands and stresses of life.
- American Psychological Association
6/4/2023 8

World Mental Health Day is celebrated on 10th
October each year. The theme of 2022's World
Mental Health Day, set by the World Federation
for Mental Health, was 'Make mental health and
wellbeing for all a global priority'.
6/4/2023 9

Attributes of Mental Health
Source :Foundations of Psychiatric-
Mental Health Nursing
6/4/2023 10

According to mental health act 2006 “Mentally
Unhealthy Person” specifies a person suffering
from mental disorder and receiving treatment
from a Mental Health Worker and also implies to
a person admitted in a mental health institution.
6/4/2023 11

Rights of Mentally Ill Person
According to Mental Health (Treatment and
Protection) Act, 2006
• Every mentally ill person reserves the lawful
rights to be treated as a general citizen.
• Every mentally ill person shall be safeguarded
against psychiatric abuse and reserves the right
to access to all law services.
6/4/2023 12

Rights of Mentally Ill Person Contd…
• All mentally ill persons must be provided with
proper protection by his/her family or the
guardian appointed or designated by the local
District Administration Office.
• No person is authorized to make any kind of
discrimination towards a mentally ill person.
6/4/2023 13

• No adverse effect on the physical or mental health
of a mentally ill person shall be exercised by
means of use of force, coercion and beating or
others.
• A mentally ill person shall not be used for
research except under the following conditions:
(a) that such research proves beneficial for the
treatment or cure of the patient,
(b) that the patient gives consent, in the case of his
ability to do so, or his/her guardian does so
6/4/2023 14

• A mentally ill person shall not be made to
work without providing him/her salary or
wages or against his/her will.
• The confidentiality of a mentally ill person
being treated or admitted for the same in the
Center or a rehabilitation center and that of
betterment or cure after receiving treatment
shall not be breached.
6/4/2023 15

BUT, Providing details under the following
conditions shall not be treated as breach of
confidentiality:
(a) upon consent of the related person,
(b) upon demand for details of the mental health
of a person from the court.
(c) if a mental health doctor believes and proves
that maintenance of confidentiality proves a danger
to the health of the patient him/herself or the general
public.
6/4/2023 16

The American Psychological Association
defines community mental health as activities
that promote mental health that are performed in
the community instead of institutional settings.
6/4/2023 17

Community mental health is the application of
specialised knowledge to population and
communities to prevent mental illness, promote
and maintain mental health, to rehabilitate the
population at risk that continue to have residual
effects of mental illness. -Sreevani
6/4/2023 18

Community mental health nursing is the
application of knowledge of psychiatric nursing
in promoting and maintaining mental health of
community people, to help in early diagnosis and
care and to rehabilitate the clients after mental
illness. -Bimala Kapoor
6/4/2023 19

Purposes of Community Mental
Health Nursing
• Provide prevention activities to population for
the purpose of promoting mental health.
• Provide prompt interventions.
• Help individuals develop a sense of self worth
and independence.
• Anticipate emotional problems.
• Identify and change social and psychological
factors that influence human interactions.
6/4/2023 20

Purposes of Community Mental
Health Nursing Contd…
• Develop innovative approach to primary
preventive activities.
• Provide mental health education and how to
assess the mental health.
6/4/2023 21

Mental health care are the
services provided to the
treatment of mental illnesses
and the improvement of
mental health in people with
mental disorders or
problems.
6/4/2023 22

• It includes analysis and diagnosis of a person's mental
condition and treatment, care and rehabilitation for a
mental illness or suspected mental illness.
• Access to mental health care can be assessed by the
supply of professionals and the availability of
psychiatric beds in different settings such as general
hospitals, mental health hospitals and community
facilities.
6/4/2023 23

Components
• Community Mental Health Programs
Partial Hospitalization Programs
Psychosocial Rehabilitation and Skills Training
Programs
Programs for Assertive Community Treatment
Clubhouse Model
• Case Management
6/4/2023 24

Programs
• Community mental health programs, such as
day-treatment programs, are outpatient
programs that are staffed by inter- disciplinary
teams.
• It include at least one of the basic treatment
components of group therapy.
6/4/2023 25

Programs Contd…
• Research shows that the combination of these
treatment programs and medication therapy is
more effective for preventing relapse than the
use of medication alone.
6/4/2023 26

Models of Community Psychiatric
Programming
Partial Hospitalization Programs
• They offer short-term care that is similar to
that provided in an inpatient setting, except
the patient is able to return home each day.
• It is the most intensive treatment of the
therapeutic models.
6/4/2023 27

Programming Contd…
• Partial hospitalization programs provide less
than 24 hours of daily care and also meet the
needs of individuals who are living in the
community and who require a higher level of
care.
6/4/2023 28

A study conducted by Yanos et al, 2009
supported the implementation of evidence- based
approaches that were designed to enhance
recovery and the need for more flexible
treatment options, such as patient- centered care
instead of prescribed treatment programs.
(Yanos et al, 2009)
6/4/2023 29

Psychosocial Rehabilitation and Skills
Training Programs
• Community-based psychosocial
rehabilitation has been provided for
persons with severe mental illness for
more than 40 years.
• The primary criterion for rehabilitation
training is that the patient has a deficit in
skill performance or lacks the skills that
are necessary for living, learning, or
working.
6/4/2023 30

• These programs are designed for patients who
have the potential for growth and who are
capable of developing the skills necessary to
make personal choices and to manage their
illness.
6/4/2023 31

• The mental health workers assist patients with
normalizing their relationships with
themselves and others to help them to
successfully integrate into the community.
• Patients receive training and education in
managing the problems of daily living.
6/4/2023 32

Programs for Assertive Community Treatment
• Programs for Assertive Community Treatment
(PACT) also known as Assertive Community
Treatment (ACT) help people with severe and
persistent mental illness to stay out of the
hospital.
6/4/2023 33

Assertive Community Treatment is an
evidenced-based practice that offers treatment,
rehabilitation, and community integration
services to individuals diagnosed with serious
mental illness (SMI). ACT uses a person-
centered, recovery-based approach to care.
6/4/2023 34

ACT services include:
• assertive outreach
• mental health treatment
• vocational support
• integrated dual disorder treatment
• family education
• wellness skills
• community linkages
• peer support
6/4/2023 35

• The primary goal of these programs is to assist
patients with the development of community
living skills.
• A team of mental health practitioners is available
24 hours a day and 7 days a week and each
professional is responsible for a caseload of up to
100 patients.
6/4/2023 36

Clubhouse Model
The clubhouse model, which
was developed during the late
1940s, is a credentialed
international program that
provides a place where persons
with severe and persistent
mental illness can go to rebuild
their lives.
6/4/2023 37

Membership in a club is open to anyone with a
serious mental illness, is voluntary, and never
expires.
Clubhouse participants are called "members" (as
opposed to "patients" or "clients") and
restorative activities focus on their strengths and
abilities, not their illness.
6/4/2023 38

Clubhouses are community-based, and strive to
help members join and remain part of society,
with educational, prevocational, health, and
mental health support.
Members and staff work together to run
structured day programs that follow the workday
of the community where a given club is located.
6/4/2023 39

Programs are based on assumption that people
have individual strengths that can be built on and
that meaningful relationships and work are the
essential; members have the right to choose staff
to work with and the kind of work they do
6/4/2023 40

Components Contd…
Case Management
Case management is a system that coordinates
care and reduces fragmented treatment for
patients with severe and persistent mental illness.
Psychiatric nurses often direct the case
management multidisciplinary team that includes
nurses, physicians, and social workers.
6/4/2023 41

Case Management Contd…
The team members work together to manage
cases, develop a plan of care for a specific
patient population, and make appropriate
referrals.
The focus of case management is to support
individuals and their families by combining and
coordinating care or multiple services.
6/4/2023 42

Goals for case management :
• Identification and outreach
• Assessment
• Improving patient activities of daily living
• Service plan Monitoring
6/4/2023 43

The work of the case manager includes
monitoring the patient's symptoms, adherence to
medication, and ability to function on a day-to-
day basis.
Case managers assess all aspects of a person's
life to determine the patient's needs and his or
her ability to meet those needs.
6/4/2023 44

Nurse case managers generally have caseloads
that range from 10 to 25 patients, but they may
manage up to 70 individuals.
Case managers who are responsible for fewer
patients are likely to see more effective
outcomes from their interventions
6/4/2023 45

Mental Health in developed
countries vs developing countries
• The richer countries have higher rates of mental
health issues compared to poorer countries.
• For example, about one-quarter of U.S. adults report
having a mental health diagnosis such as anxiety or
depression or experiencing emotional distress.The
United States has some of the worst mental health-
related outcomes, including the highest suicide rate
and second-highest drug-related death rate.
6/4/2023 46

Contd..
• Australia which is identified as high-income country, had
the highest lifetime prevalence rates of anxiety.
• 1 in 5 (21%) people who had experienced a mental
disorder in their lifetime had symptoms in the 12 months
before the survey interview.
• For these people, anxiety disorders were the most
prevalent type of disorder (17%), followed by affective
disorders (8%) and substance use disorders (3%).
-2021 NSMHWB (ABS 2022a)
6/4/2023 47

Contd..
Over 80% of those suffering from mental
disorders reside in LMIC and around 73% of
suicides in the world occur in developing
countries.
Common circumstances that come with living in
LMIC, such as losing or not having access to
stable essential resources like income,
employment, housing, etc.
6/4/2023 48

Contd..
Economic insecurity makes living situations
extremely difficult.
This can induce stress and lead to depression
which is considered the most common mental
health disorder in developing countries.
6/4/2023 49

Mental Health care in developed Vs
• Mental healthcare is 50 times more accessible
in developed countries compared to
developing countries.
• High-income countries have on average nearly
20 times more beds available to treat mental
health patients than low-income countries.
6/4/2023 50

developing countries Contd…
The Mental Health Atlas report 2020 of the
World Health Organization (WHO) showed that
mental health treatment in wealthy countries
averaged 62.2 mental health workers for every
100,000 people.
6/4/2023 51

developing countries Contd…
• Many of the low and middle income countries
lack adequate mental health resources.
• Mental health problems are often not
considered health issues that require medical
attention in some low- and middle-income
countries.
• Around 75% of people with mental disorders
in developing countries never receive any
treatment.
6/4/2023 52

Mental Health Care in Developed Vs
Developing Countries Contd…
• On average, countries spend only 1.7% of their
health budgets on mental health (Ridley et al,
2020).
• For many high-income countries, the health
budget allocated to mental health is over 3%,
while for developing countries it is less than
0.5%.
6/4/2023 53

• The investment in mental health also offers
opportunities for return on investment for
individuals, families, and communities as
individuals can return to meaningful work.
• Some of the strategies established by high-
income countries:
paying general practitioners to deliver mental
health services and hire mental health staff
6/4/2023 54

usage of tele-health platforms to assess and
treat mild- to-moderate symptoms virtually
 deploying community health workers to
screen people and help them navigate the
health system processes
creating and strengthening the non-profit
organizations to address mental health
symptoms and diagnosis.
6/4/2023 55

Mental Health Care in Asia Pacific
Region
In many parts of the Asia-Pacific region,
appropriate care may not be available and access
to mental health care may be limited for people
with mental health problems .
Although most of these countries have national
mental health policies, implementation at ground
level remains a huge challenge
6/4/2023 56

Region Contd…
Many countries in the region lack mental health
legislation that can safeguard the rights of people
with mental illnesses, and governments have
allocated low budgets for mental health services.
6/4/2023 57

Region Contd…
Developed OECD countries in the region such as
New Zealand, Australia, Japan, and the Republic
of Korea, report the highest number of
psychiatrists which is average of 15.3 per
100 000 population, whereas in middle and low
income Asia-Pacific countries there is fewer than
one psychiatrist on average per
100 000 population.
6/4/2023 58

Region Contd…
Mental health nurses play an important and
increasing role in the delivery of mental health
services in hospital, primary care or other settings,
but in many Asia-Pacific countries and territories,
their number is still very low.
Australia has the highest rate with over 90 mental
health nurses per 100 000 population, followed by
Japan and New Zealand with more than 75 nurses
per 100 000 population.
6/4/2023 59

Region Contd…
There are fewer than five mental health nurses –
on average – per 100 000 population in middle
and low income Asia-Pacific countries, and less
than one nurse per 100 000 population in
Bangladesh, India, Nepal, Myanmar, and
Cambodia, suggesting again the need for an
appropriate supply of mental health care
workforce to guarantee access.
6/4/2023 60

Region Contd…
• There are eight and 15 mental health beds per
10,000 population on average in lower-middle
and low income, and upper middle income Asia-
Pacific countries respectively, with Bangladesh
and Nepal reporting less than three psychiatric
bed .
• The large majority of beds in middle and low
income countries are available in mental health
hospitals.
6/4/2023 61

Improving Mental Health in
Developing Countries
• Co-ordination of national governments to work
with international organizations.
• World Health Organization Quality Rights
Toolkit which provides practical guidance on:
Human rights and quality standards that should
be respected, protected and fulfilled in both
inpatient and outpatient mental health and
social care facilities
6/4/2023 62

Preparing for and conducting a comprehensive
assessment of facilities
Reporting findings and making appropriate
recommendations on the basis of the
assessment.
6/4/2023 63

• Better information, awareness and education
about mental health and illness.
• Enhanced legal, social and financial protection
for persons, families or communities adversely
affected by mental disorders.
6/4/2023 64

Articles
A study conducted in Japan in 2018 to know
the public perceptions towards mental illness
showed that Over 80% of Japanese participants
believed that depressive disorder or
schizophrenia could be cured via treatment.
However, Japanese people still had relatively
strong vigilance and denial of competency
toward schizophrenia. (Kasahara-Kiritani
M,2018)
6/4/2023 65

Articles Contd…
A systematic integrative review was done on
Challenges and barriers in mental healthcare
systems and their impact on the family which showed
that mental health requires a real change away from
today's biomedical and pharmacological model to one
that can guarantee the recovery, care and well-being of
everybody involved. It has shown the importance of
integrating mental health at primary healthcare level
and fighting to reduce the stigma of mental health in all
areas.
6/4/2023 66

Articles Contd…
It has also shown how important it is for the
person with mental illness and their family
members to participate in the treatment process
and in developing policies to help strengthen the
mental healthcare system by improving the
adaptation, continuity, suitability and efficiency
of the care, providing higher quality resources
and instilling more positive attitudes in service
providers. (Carbonell A, 2020)
6/4/2023 67

References
• Park K. Textbook of Preventive and Social Medicine: Mental
Health. 25th Edition. Jabalpur: Bhanot Publishers; 2019. page:892
– 895.
• Stanhope M, Lancaster J. Public Health Nursing.8th Edition. The
United States of America: Elsevier Publishers ; 2014.page: 791-
792.
• Townsend M , Morgan Karyn.Psychiatric Mental Health
Nursing.9th Edition.New Delhi: Jaypee Brothers Medical
Publishers;2020.
• Nepal WHO Special Initiative for Mental Health Situational
Assessment .World Health Organization. Retrieved on 2023/4/24.
Available from https://cdn.who.int/media/docs/default-
source/mental-health/special-initiative/who-special-initiative-
country-report---nepal---2022.pdf?
6/4/2023 68

References Contd…
• Gilbert BJ, Patel V, Farmer PE, Lu C. Assessing
development assistance for mental health in developing
countries: 2007–2013. PLoS medicine. 2015 Jun
2;12(6):e1001834.
• Gurung D, Poudyal A, Wang YL, Neupane M, Bhattarai K,
Wahid SS, Aryal S, Heim E, Gronholm P, Thornicroft G,
Kohrt B. Stigma against mental health disorders in Nepal
conceptualised with a ‘what matters most’framework: A
scoping review. Epidemiology and Psychiatric Sciences.
2022;31:e11.
• Rai Y, Gurung D, Gautam K. Insight and challenges: mental
health services in Nepal. BJPsych international. 2021
May;18(2).
6/4/2023 69

References Contd…
• Carbonell A, Navarro‐Pérez JJ, Mestre MV.
systems and their impact on the family: A
systematic integrative review. Health & social
care in the community. 2020 Sep;28(5):1366-79.
• Kasahara-Kiritani M, Matoba T, Kikuzawa S,
Sakano J, Sugiyama K, Yamaki C, Mochizuki M,
Yamazaki Y. Public perceptions toward mental
illness in Japan. Asian journal of psychiatry. 2018
Jun 1;35:55-60.
6/4/2023 70

Unit IX
Development of Personality
Prepared By:
Sapana Dahal
Community Health Nursing
Batch 2022

Objectives
At the end of the session, participants will be
able to explain about Development of
Personality.
6/4/2023 73

Contents
• Introduction
• Types of Personality
• Factors affecting Personality
• Importance of Personality Development
• Approaches to Understanding Personality
• References
6/4/2023 74

Mental Health Care System in Nepal
• Several strengths and
challenges to consider in
mental health care system.
• Gradually increasing
multi-sector involvement.
6/4/2023 75

Contd…
Governance
• Coordinated and delivered by the Department of
Health Services (DoHS), under leadership of the
Ministry of Health and Population (MoHP).
• Responsibility of the NCD and Mental Health
Section of the Epidemiology and Disease
Control Division (EDCD).
6/4/2023 76

Contd…
• Curative Service Division of DoHS governs
the secondary and tertiary care mental health
interventions.
• Management Division of DoHS manages the
Health Information System and drug supply.
• National Health Training Center oversees the
identification of training needs, development
and accreditation of training curricula, and
organization of trainings.
6/4/2023 77

Contd…
Human Resources
• An estimated 144* psychiatrists plus 3 child
psychiatrists. Of these, 110 are in private
practice.
• Estimated 75 psychiatric nurses and 30
psychologists in private practice.
*190 as per PAN
6/4/2023 78

Contd…
Healthcare Facilities for Mental Health
• One specialist public-sector psychiatry hospital
• Four private sector psychiatry hospitals.
• Hospital-based mental health care is mainly
delivered from 19 medical colleges and several of
the 364 private general hospitals and 27
government hospitals.
6/4/2023 79

Contd…
Healthcare Facilities for Mental Health
• Two public-sector facilities for
alcohol/substance use rehabilitation
• Three outpatient facilities for children and
adolescents.
6/4/2023 80

Contd…
Primary Care Integration
• Has adapted the mhGAP tools to fit its context,
in the form of the Community Mental Health
Care Package 2017.
• The National Mental Health Strategy and
Action Plan 2020 .
6/4/2023 81

Contd…
Psychotropic Medications
• Psychotropic medications, including
antipsychotics, antidepressants, anxiolytics, mood
stabilizers, and anti-epileptics.
• Prescribed by registered medical doctors.
• Depression, psychosis, alcohol use disorder and
epilepsy included in the DoHS's Basic Health
Service Package 2075 (2018).
6/4/2023 82

Contd…
Psychosocial services
• Limited availability of psychological services
in Nepal outside of a few tertiary care hospitals
and private hospitals and clinics.
• Basic psychological interventions delivered
through NGO programs in selected districts
and population groups.
6/4/2023 83

Contd…
Health Information System
• Integrated in two different formats depending
on the type of the health facility.
• The information from the hospitals and
Primary Health Care Centers are recorded
based on the diagnoses made by the medical
doctors.
6/4/2023 84

Contd…
• Basic Health Centers, health workers will have
to choose from a set of 15 pre-coded diagnosis
options which includes most of the priority
MNS conditions.
6/4/2023 85

Contd…
• Mental health care has been included in the list
of basic health services in Sub-Section 4 (e) of
Section 3 of the Public Health Services Act,
2075.
6/4/2023 86

Contd…
Political Support
• Gradually increased its political commitment
to mental health services in recent years.
• Mental health care has been included in the list
of basic health services in Sub-Section 4 (e) of
Section 3 of the Public Health Services Act,
2075.
6/4/2023 87

Contd…
Political Support
• National Health Policy, 2019, section 6.17.5,
has a strategy to expand mental health services
integrated into overall health systems.
• Estimated USD$1.5m annual budget for
mental health interventions.
6/4/2023 88

Contd…
Mental Health Policy and Mental Health Plan
2020
• Mental health is mentioned in section 6.17.5 in
the National Health Policy.
• The National Mental Health Strategy and
Action Plan (2020).
National Mental Health Care Program adopted
in 2022.
6/4/2023 89

Contd…
2020
Developed and disseminated comprehensive
guide to strengthen primary care mental health
services.
New district mental health care program
developed and launched.
6/4/2023 90

Contd…
2020
Operationalized the Suicide Prevention
National Resource Centre and national
helpline
6/4/2023 91

Contd…
Legislation
• The Act Relating to Rights of Persons with
Disabilities, 2074 (2017) provides for every
citizen’s right to health, rehabilitation, social
security, and recreation.
6/4/2023 92

Contd…
Legislation
Section 35 and 36 of the Act ensure additional
service facilities for people with mental or
psychosocial disabilities in line with UN
Convention to the rights of Persons with
Disabilities.
6/4/2023 93

Contd…
Strengthening Mental Health Systems
• Strengthening the administrative structure at
Ministry of Health and Population –
Epidemiology and Disease Control Division –
and Provincial Health Directorates.
• Preparing for a sustainable transition of mental
health programmes.
6/4/2023 94

Contd…
Strengthening Mental Health Systems
• Creating a mental health toolkit for
municipalities.
• Expanding suicide prevention and registries.
• Improving supports for persons living with
epilepsy by identifying care gaps.
• Developing a dementia care plan.
6/4/2023 95

Contd…
Community Based
Traditional healers
Faith healers and traditional healing systems are
engraved in all forms of cultural and religious
practice in Nepal from Hinduism, Buddhism, to
Indigenous cultures.
6/4/2023 96

Contd…
Traditional healers
Three main types of traditional healers in Nepal:
dhami jhankri,lama and mata.
Many community members seek services from
traditional healers due to economical and access
barriers to modern medicine and perceived fear
of “injection” and “saline” treatment
6/4/2023 97

Contd…
Community Based
Stigma In both rural and urban communities
• Stigma towards mental illness
• Discrimination against persons with mental
illnesses.
• Causes dropout in the treatment of mental
health problems.
6/4/2023 98

References
• Park K. Textbook of Preventive and Social Medicine: Mental
Health. 25th Edition. Jabalpur: Bhanot Publishers; 2019.
page:892 – 895.
• Stanhope M, Lancaster J. Public Health Nursing.8th Edition.
The United States of America: Elsevier Publishers ;
2014.page: 791-792.
• Townsend M , Morgan Karyn.Psychiatric Mental Health
Nursing.9th Edition.New Delhi: Jaypee Brothers Medical
Publishers;2020.
• Nepal WHO Special Initiative for Mental Health Situational
Assessment .World Health Organization. Retrieved on
2023/4/24. Available from
https://cdn.who.int/media/docs/default-source/mental-
health/special-initiative/who-special-initiative-country-report--
6/4/2023 99

References
• Gilbert BJ, Patel V, Farmer PE, Lu C. Assessing
development assistance for mental health in developing
countries: 2007–2013. PLoS medicine. 2015 Jun
2;12(6):e1001834.
• Gurung D, Poudyal A, Wang YL, Neupane M, Bhattarai K,
Wahid SS, Aryal S, Heim E, Gronholm P, Thornicroft G,
Kohrt B. Stigma against mental health disorders in Nepal
conceptualised with a ‘what matters most’framework: A
scoping review. Epidemiology and Psychiatric Sciences.
2022;31:e11.
• Rai Y, Gurung D, Gautam K. Insight and challenges: mental
health services in Nepal. BJPsych international. 2021
May;18(2).
6/4/2023 100

References
• Carbonell A, Navarro‐Pérez JJ, Mestre MV.
systems and their impact on the family: A
systematic integrative review. Health & social
care in the community. 2020 Sep;28(5):1366-79.
• Kasahara-Kiritani M, Matoba T, Kikuzawa S,
Sakano J, Sugiyama K, Yamaki C, Mochizuki M,
Yamazaki Y. Public perceptions toward mental
illness in Japan. Asian journal of psychiatry. 2018
Jun 1;35:55-60.
6/4/2023 101

Introduction
• Personality derived from the Greek word
“persona” meaning “mask/character”.
• “The aggregate of the physical and mental
qualities of the individual's as these interact
and function in characteristic fashion with his
environment’’. -
(Taylor)
6/4/2023 103

Personality is also described as the unique
pattern of traits which characterises the
individual.
According to (DSM-IV-TR) (American
Psychiatric Association (APA), 2000)
,personality traits is defined as
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"enduring patterns of perceiving, relating to, and
thinking about the environment and oneself that
are exhibited in a wide range of social and
personal contexts.’’
6/4/2023 105

Types of Personality
According to Friedman and Rosenman
Type A personality
Type B personality
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Factors Influencing the Development
of Personality
• Heredity
• Environment and
• Self
6/4/2023 109

of Personality Contd…
Heredity
• Physical characteristics
• Mental characteristics
• Genetic characteristics
Environment
6/4/2023 110

of Personality Contd…
Self
Self means 'I' concept means what ideas I have
about me.
Components of self
• Knower
• Striver
• Doer
6/4/2023 111

Importance of Personality
Development.
• Grooms an individual and helps him make a
mark of his/her own
• Reduces stress and conflicts
• Helps to develop a positive attitude in life
• Helps an individual to inculcate positive
qualities
• Helps to develop an impressive personality and
makes you stand apart from the rest
6/4/2023 112

Approaches to Understanding
Personality
a) The Trait Approach
b) The Psychoanalytic Approach
6/4/2023 113

Personality Contd…
a) The Trait Approach
Given by Sheldon ,Carl Jung and Kretschmer.
6/4/2023 114

The Trait Approach
SHELDON’S CLASSIFICATION
6/4/2023 115
PHYSIQUE TEMPERAMENT MOST LIKELY
PSYCHOPATHOLOGY
Endomorphic
Soft and round
people
-Comfort loving
-Pleasure seeking
-Sentimental and
socializing people
-They can have severe
mood changes.
- Extreme elation of
mood.
-Depression.

The Trait Approach Contd…
PSYCHOPATHOLOGY
Mesomorphic
Muscular built
strong and atheletic
type.
-Very active, full of
energy
-Less religious.
-Aggressive &noisy
-achievement
oriented people.
Severe types of
mood alteration
(changes).
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6/4/2023 117
PSYCHOPATHOLOGY
Ectomorphic
These people
have thin body
built, slender
and very
delicate and
fragile.
Sensitive and delicate
intellectual, more
religious people.
-They withdraw.
They are susceptible
to schizophrenia,
anxiety neurosis,
peptic ulcer.

KRETSCHMER’S CLASSIFICATION
6/4/2023 118
PHYSIQUE TEMPERAMENT MOST LIKELY PSY
CHOPATHOLOGY
Pyknic
Fat and round and
graceful people.
Happy, very social,
make friends very
easily
Mood alteration
Extreme elation of
mood. -Depression.
Can develop Manic-
Depressive Psychosis.

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PSY
CHOPATHOLOG
Y
Athletic
Muscular built and
strong skeleton,
hands and feet large.
Very active,
aggressive and
success oriented
Mood changes and
develop
schizophrenia.

6/4/2023 120
PSY
CHOPATHOLOG
Y
Asthenic
Thin body built
individuals are tall,
the skin is dry.
A social lacking
emotions, dry &
unsympathetic look
Schezoid and
schizophrenia

JUNG'S CLASSIFICATION
6/4/2023 121
PHYSIQUE TEMPERAMENT MOST LIKELY PSY
CHOPATHOLOGY
Introvert
Thin built
individuals.
Withdrawn.
-Occupied in
themselves, manage
stressful situation
alone.
Schizophrenia

JUNG'S CLASSIFICATION
6/4/2023 122
PSY
CHOPATHOLOG
Y
Extrovert
Fat, muscular
Sociable people -
Social, like to have
company most of
the time
Mood alteration
Manic-depressive
Psychosis.

Personality Contd…
b) The Psychoanalytic Approach
Given by Sigmund Freud
• Levels of Consciousness (Topographical
model of mind)
• Subsystems of Personality ( Structural Theory
of mind)
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The Psychoanalytic Approach
Contd…
Levels of Consciousness (Topographical model
of mind)
• The Conscious
• The Preconscious
• The Unconscious
6/4/2023 124

Levels of Consciousness
(Topographical model of mind)…
The Conscious
The part of the mind in which perceptions
coming from the outside world or within the
body or mind are brought into awareness.
6/4/2023 125

The Preconscious
The preconscious system is composed of those
mental events, processes, and contents that can
be brought into conscious awareness by focusing
attention
6/4/2023 126

The Unconscious
Mental contents and processes are kept from
conscious awareness through the force of
censorship or repression, and it is closely related
to instinctual drives.
The contents of the unconscious can become
conscious only by passing through the
preconscious.
6/4/2023 127

Freud compared the human mind with
an ICEBERG
6/4/2023 128
Source :Textbook of Psychiatric Nursing:

The Psychoanalytic Approach
Subsystems of Personality ( Structural Theory of
mind)/Dynamics of Personality
• Id
• Ego
• Superego.
6/4/2023 129

Subsystems of Personality ( Structural
Theory of mind)/Dynamics of
Personality
ID(Pleasure Principle)
• Original source of personality which is present
in a newborn
• Completely selfish, concerned with immediate
gratification of instinctual needs, the biological
drives, like hunger , sex
• Eros and Thanatos
6/4/2023 130

Personality
Ego(Reality Principle):
• Spans all three topographical dimensions of
conscious, preconscious, and unconscious.
• It substitutes the reality principle for the
pleasure principle
6/4/2023 131

Personality
Superego(Morality Principle)
• The superego establishes and maintains an
individual's moral conscience based on a
complex system of ideals and values
internalized by parents.
6/4/2023 132

Personality
The ego-ideal
Prescribes what a person should do according to
internalized standards and values.
6/4/2023 133

6/4/2023 Source : PSYCH-MENTAL HEALTH HUB

DIRECTIONS OF PERSONALITY
DEVELOPMENT
• It goes through a continuous phase of
development
• Direction of development of personality is
mainly from dependent to independent
6/4/2023 136

Psychosocial Theory/Model of
Personality
• Father of psychosocial development: Erik
Hamburger Erikson
• “Psycho” relates to mind, Brain and
personality.
• “Social” which means the external
relationship.
6/4/2023 137

Psychosocial Theory/Model of
Personality
• It is a basis for broad or complex discussion
and analysis of personality and behavior and
also facilitating personal development and
behavior self and others.
• Erikson stated that personality develops in a
predetermined order through eight stages of
psychosocial development, from infancy to
adulthood.
6/4/2023 138

Trust Versus Mistrust
• Infant Stage: Birth to one
year
• Goal: to develop trust
without completely
eliminating the capacity
for mistrust
• Developing trust is the
first task of the ego, and it
is never complete
6/4/2023 140

Trust Versus Mistrust Contd…
• Trust - Firm belief in reliability, truth, ability,
or strength of someone or something.
• Mistrust - State of being suspicious; lack of
trust
• Too much trust: Sensory Maladjustment -
Overly trusting
• Too much mistrust : Withdrawal -
Characterized by depression, paranoia &
psychosis
6/4/2023 141

Autonomy Versus Shame and Doubt
• Toddler:1-3 years
• Goal: to achieve autonomy
while minimizing shame
and doubt.
• Autonomy– Independence
6/4/2023 142

Contd…
• Shame - A painful feeling of humiliation or
distress caused by the consciousness of wrong
or foolish behavior.
• Doubt - Feeling of uncertainty or lack of
conviction
Shame develops with the child's self-
consciousness
6/4/2023 143

Contd…
Left over doubt may become paranoia.
Too much autonomy :Impulsiveness- Sort of
shameless willfulness that leads in later
childhood and even adulthood, to jump into
things without proper consideration of your
abilities.
6/4/2023 144

Contd…
Too much Shame and doubt :Compulsiveness
- A person feels as if their entire being rides on
everything they do, and so everything, must be
done perfectly
6/4/2023 145

Initiative Versus Guilt
Pre-schooler: Ages 3 to 5
years
Goal: to learn initiative
without too much guilt.
Initiative - a positive response
to the world's challenges,
taking on responsibilities,
learning new skills, feeling
purposeful.
6/4/2023 146

Initiative Versus Guilt Contd…
• This stage is a time for play, not for formal
education.
• Satisfaction develops when a child get success
in activities, which motivate the child to take
further initiative
6/4/2023 147

Initiative Versus Guilt Contd…
• When a sense of guilt and self doubt arises, a
child feels that his imagination and initiative are
unacceptable.
• Too much initiative :Ruthlessness
• Too much guilt can make the child slow to
interact with other and may inhibit their
creativity
6/4/2023 148

Industry Versus Inferiority
• 6-12 years old
• Develop sense of self-worth or sense of
accomplishment
• Same sex peers, parents and other adults
become more important.
• Feelings of inferiority develop when a child is
unable to achieve success or is criticized by
others for poor performance
6/4/2023 149

Industry Versus Inferiority Contd…
• Too much industry: Narrow Virtuosity
• Too much inferiority: Inertia
6/4/2023 150

Identity Versus Role Confusion
• 13-19 years
• Goal: to achieve ego identity and avoid role
confusion
• Ego Identity - knowing who you are and how
you fit in to the rest of the society.
• Too much identity :Fanaticism
• Too much role confusion: Repudiation
6/4/2023 151

Intimacy Versus Isolation
• Young Adulthood:19-40 years
• Intimacy - ability to be close to others, as a
lover, a friend, and as a particular participant
in society.
• Too much intimacy : Promiscuity
• Too much isolation: Exclusion
6/4/2023 152

Generativity Versus Stagnation
Middle Adulthood - 40 and 65
Goal: to cultivate the proper balance of
generativity and stagnation.
Generativity - an extension of love into the
future.
Stagnation - self absorption, caring for no one.
The stagnant person stops to be a reproductive
member of the society
6/4/2023 153

Generativity Versus Stagnation
Contd…
• Too much generativity :Overextension
• Too Much Stagnation: Rejectivity
6/4/2023 154

Ego Integrity Versus Despair
• Ego Integrity - Coming to terms with your life,
and thereby coming to terms with the end of
life.
• Despair - The complete loss or absence of
hope. Late adulthood/Maturity/Old age
• Begins around retirement, around 60
• Goal: to develop ego integrity with a minimal
amount of despair.
6/4/2023 155

Ego Integrity Versus Despair
Contd…
• Older people become depressed, spiteful,
paranoid, hypochondrial, or developing the
patterns of senility with or without physical
bases.
• Too much ego integrity: Presumption
• Too much despair: Hostility
6/4/2023 156

Erickson’s Psychosocial Theory
6/4/2023 157

Freud’s Psychoanalytical Theory
• Describes human development from the
perspectives of personality, thinking and
behavior.
• Psychoanalytical theory explains development
as primarily unconscious and influenced by
emotion.
6/4/2023 158

Freud’s Psychoanalytical Theory
Sigmud freud psychoanalytical model of
personality development states that individuals
go through five stages of psychosexual
development and that each stage is characterized
by sexual pleasure in parts of the body: the
mouth, anus and genitals
6/4/2023 159

Freud’s Phases of Psychosexual
Development
• Oral stage
• Anal stage
• Phallic stage
• Latency stage
• Genital stage
6/4/2023 160

Development
Oral stage : Birth to 18 Months
• Behavior is directed by the id
• Goal : Immediate gratification of needs
• Focus of energy : Mouth
• Major development :Weaning of off
breastfeeding
• Fixation: Smoking, Overeating
6/4/2023 161

Development Contd…
Anal stage: 18 months – 3years
Focus of energy: Anus
Major development :Toilet training
Fixation : orderliness, messiness
6/4/2023 162

Phallic stage: 3-6 years
Focus of energy: Genitals
Major development :Resolving
oedipus and electra complex
Fixation : Deviancy, sexual dysfunction
6/4/2023 163

Latency stage:6years-12years
Focus of energy: dormant sexual feeling
Major development :developing defense
mechanism
Fixation : none
6/4/2023 164

Genital stage:13 to 20 Years
Focus of energy: Genitals
Major development :Reaching
full sexual maturity
Fixation : sexually mature and mentally healthy
6/4/2023 165

Relevance of Psychoanalytic Theory
to Nursing Practice
Knowledge of the structure of the personality
can assist nurses who work in the mental health
setting.
Ability to recognize behaviors associated with
the id, the ego, and the superego assists in the
assessment of developmental level
6/4/2023 167

Relevance of Psychoanalytic Theory
to Nursing Practice Contd…
• Understanding the use of ego defense
mechanisms is important in making
determinations about maladaptive behaviors,
in planning care for clients to assist in creating
change or in helping clients accept themselves
as unique individuals.
6/4/2023 168

Interpersonal Theory
Harry Stack Sullivan (1953) believed that
individual behavior and personality
development are the direct result of
interpersonal relationships.
Sullivan's major concepts include the following:
6/4/2023 169

Contd…
Anxiety
Sullivan believed that anxiety is the "chief
disruptive force in interpersonal relations and the
main factor in the development of serious
difficulties in living."
It arises out of one's inability to satisfy needs or
to achieve interpersonal security.
6/4/2023 170

Contd…
Satisfaction of needs
Fulfillment of all requirements associated with
an individual's physiochemical environment.
Interpersonal security
When all needs have been met, one experiences
a sense of total well-being, which is termed as
interpersonal security.
6/4/2023 171

Contd…
• He believed individuals have an innate need
for interpersonal security.
Self-system
Collection of experiences, or security measures,
adopted by the individual to protect against
anxiety.
6/4/2023 172

Contd…
Three components of the self-system:
• Good me
• Bad me
• Not me
6/4/2023 173

Relevance of Interpersonal Theory to
Nursing Practice
Nurses develop major develop therapeutic
relationships with clients in an effort to
gratification of help them generalize this ability
to interact successfully with others.
6/4/2023 174

Relevance of Interpersonal Theory to
Nursing Practice Contd…
Knowledge about the behaviors associated with
all levels of anxiety and methods for alleviating
anxiety helps nurses to assist clients in achieving
interpersonal security and a sense of well-being.
6/4/2023 175

References
1. Townsend M. Psychiatric Mental Health Nursing:
Theoretical Models of Personality Development.7th
Edition. New Delhi: Jaypee Brothers Publishers;2012.
2. Kapoor B. Textbook of Psychiatric Nursing: Personality
Development and Subsystems of Personality. 3rd Edition.
Volume I. New Delhi; Kumar Publishing House; 2009.
3. Hales R, Yudofsky S,Talbott J. Textbook of Psychiatry:
Normal Child and Adolescent Development. 3rd Edition.
Volume I. New Delhi; Jaypee Brothers Publishers. 1997
4. Sadock B, Sadock V,Ruiz.P.Synopsis of Psychiatry:
Theories of Personality and Psychopathology.11th Edition.
LWW Publishers;2014.
6/4/2023 176

References Contd…
5.Ghimire S, Vyas J.Textbook of Postgraduate Psychiatry
:Stages of Psychosexual Development.3rd Edition. New
Delhi; Jaypee Brothers Publishers.2018.
6.Worret H. Fortinash K. Psychiatric Mental Health
Nursing :Community Mental Health Nursing.5th Edition.
Elsevier Publishers.2011.
7.Personality Type A and B Theory explained: Traits and
ExamplesAvailable from
https://www.toolshero.com/psychology/personality-type-
a-b/
6/4/2023 177

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