mental health nursing mental health nursing psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. these include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm. nurses in this area receive specific training in psychological therapies, building a therapeutic alliance, dealing with challenging behaviour, and the administration of psychiatric medication. in most countries, after the 1990s, a psychiatric nurse would have to attain a bachelor's degree in nursing to become a registered nurse (rn), and specialise in mental health. degrees vary in different countries, and are governed by country-specific regulations. in the united states one can become a rn, and a psychiatric nurse, by completing either a diploma program, an associates (asn) degree, or a bachelors (bsn) degree. up until the 1990s 5 gcses/o levels were sufficient and no degree or other nursing qualifications were required. mental health nurses can work in a variety of services, including: child and adolescent mental health services (camhs), acute medical units (amus), psychiatric intensive care units (picus), and community mental health services (cmhs). history civilian public service -93, harrisburg, pennsylvania, psychiatric nursing class (8389167373) the history of psychiatry and psychiatric nursing, although disjointed, can be traced back to ancient philosophical thinkers. marcus tullius cicero, in particular, was the first known person to create a questionnaire for the mentally ill using biographical information to determine the best course of psychological treatment and care. some of the first known psychiatric care centers were constructed in the middle east during the 8th century. the medieval muslim physicians and their attendants relied on clinical observations for diagnosis and treatment. in 13th century medieval europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses to care for them and treatment was rarely provided. these facilities functioned more as a housing unit for the insane. throughout the high point of christianity in europe, hospitals for the mentally ill believed in using religious intervention. the insane were partnered with "soul friends" to help them reconnect with society. their primary concern was befriending the melancholy and disturbed, forming intimate spiritual relationships. today, these soul friends are seen as the first modern psychiatric nurses. in the colonial era of the united states, some settlers adapted community health nursing practices. individuals with mental defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community attendants. wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to care for them. in other communities, the mentally ill were sold at auctions as slave labor. others were forced to leave town. as the population in the colonies expanded, informal care for the community failed and small institutions were established. in 1752 the first "lunatics ward" was opened at the pennsylvania hospital which attempted to treat the mentally ill. attendants used the most modern treatments of the time: purging, bleeding, blistering, and shock techniques. overall, the attendants caring for the patients believed in treating the institutionalized with respect. they believed if the patients were treated as reasonable people, then they would act as such; if they gave them confidence, then patients would rarely abuse it. the 1790s saw the beginnings of moral treatment being introduced for people with mental distress. the concept of a safe asylum, proposed by philippe pinel and william tuke, offered protection and care at institutions for patients who had been previously abused or enslaved. in the united states, dorothea dix was instrumental in opening 32 state asylums to provide quality care for the ill. dix also was in charge of the union army nurses during the american civil war, caring for both union and confederate soldiers. although it was a promising movement, attendants and nurses were often accused of abusing or neglecting the residents and isolating them from their families. the formal recognition of psychiatry as a modern and legitimate profession occurred in 1808. in europe, one of the major advocates for mental health nursing to help psychiatrists was dr. william ellis. he proposed giving the "keepers of the insane" better pay and training so more respectable, intelligent people would be attracted to the profession. in his 1836 publication of treatise on insanity, he openly stated that an established nursing practice calmed depressed patients and gave hope to the hopeless. however, psychiatric nursing was not formalized in the united states until 1882 when linda richards opened boston city college. this was the first school specifically designed to train nurses in psychiatric care. the discrepancy between the founding of psychiatry and the recognition of trained nurses in the field is largely attributed to the attitudes in the 19th century which opposed training women to work in the medical field. in 1913 johns hopkins university was the first college of nursing in the united states to offer psychiatric nursing as part of its general curriculum. the first psychiatric nursing textbook, nursing mental diseases by harriet bailey, was not published until 1920. it was not until 1950 when the national league for nursing required all nursing schools to include a clinical experience in psychiatry to receive national accreditation. the first psychiatric nurses faced difficult working conditions. overcrowding, under-staffing and poor resources required the continuance of custodial care. they were pressured by an increasing patient population that rose dramatically by the end of the 19th century. as a result, labor organizations formed to fight for better pay and fewer hours. additionally, large asylums were founded to hold the large number of mentally ill, including the famous kings park psychiatric center in long island, new york. at its peak in the 1950s, the center housed more than 33,000 patients and required its own power plant. nurses were often called "attendants" to imply a more humanitarian approach to care. during this time, attendants primarily kept the facilities clean and maintained order among the patients. they also carried out orders from the physicians. in 1963, president john f. kennedy accelerated the trend towards deinstitutionalization with the community mental health act. in 1964, the civil rights act was passed, which made it illegal for an organization to discriminate if federally funded. despite this ruling, certain states such as mississippi and alabama fought these laws in court, promoting segregation within healthcare. moreover, since psychiatric drugs were becoming more available allowing patients to live on their own and the asylums were too expensive, institutions began shutting down. nursing care thus became more intimate and holistic. expanded roles were also developed in the 1960s allowing nurses to provide outpatient services such as counseling, psychotherapy, consultations, prescribing medications, along with the diagnosis and treatment of mental illnesses. the first developed standard of care was created by the psychiatric division of the american nurses association (ana) in 1973. this standard outlined the responsibilities and expected quality of care of nurses. in 1975, the government published a document called "better services for the mentally ill" which reviewed the current standards of psychiatric nursing worldwide and laid out better plans for the future of mental health nursing. global health care underwent huge expansions in the 1980s; this was due to the government's reaction from the fast increasing demand on health care services. the expansion was continued until the economic crisis of the 1970s. in 1982, the area health authorities was terminated. in 1983, better structure of hospitals was implemented. general managers were introduced to make decisions, thus creating a better system of operation. the year 1983 also saw a lot of staff cuts which were heavily felt by all the mental health nurses. however, a new training syllabus was introduced in 1982, which offered suitable knowledgeable nurses. the 2000s have seen major educational upgrades for nurses to specialize in mental health as well as various financial opportunities. interventions nursing interventions may be divided into the following categories: psychiatric medication psychiatric medication is a commonly used intervention and many psychiatric mental health nurses are involved in the administration of medicines, both in oral (e.g. tablet or liquid) form or by intramuscular injection. nurse practitioners can prescribe medication. nurses will monitor for side effects and response to these medical treatments by using assessments. nurses will also offer information on medication so that, where possible, the person in care can make an informed choice, using the best medical-based evidence available. electroconvulsive therapy psychiatric mental health nurses are also involved in the administration of the treatment of electroconvulsive therapy and assist with the preparation and recovery from the treatment, which involves anesthesia. this treatment is only used in a tiny proportion of cases and only after all other possible treatments have been exhausted. nurses may also be involved in gaining consent for this procedure. however, consent arrangements vary depending on the jurisdiction in which the treatment takes place. physical care along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good levels of personal hygiene, nutrition, sleep, etc., as well as tending to any concomitant physical ailments. in mental health patients, obesity is not rare because some medications can have a side effect of gaining weight which can cause the patient to have low confidence and lead to other health issues. to fix this problem, mental health nurses are urged to encourage patients to get more exercise to enhance their physical health, along with their mental health by improving the patients confidence and lowering stress levels, improving their mental health which has been a focus for mental health nurses because many patients do not get enough exercise. nurses may also need to help the patients with alcohol or drug abuse because mental health patients are at a higher risk for this behavior. mental health nurses need to be able to communicate to patients about this. the alcohol and drug abuse could cause the patient to also have a higher risk of sexually transmitted diseases because alcohol and drugs can lead to more sexual behavior. psychosocial interventions psychosocial interventions are increasingly delivered by nurses in mental health settings. these include psychotherapy interventions, such as cognitive behavioural therapy, family therapy, and less commonly other interventions, such as milieu therapy or psychodynamic approaches. these interventions can be applied to a broad range of problems including psychosis, depression, and anxiety. nurses will work with people over a period of time and use psychological methods to teach the person psychological techniques that they can then use to aid recovery and help manage any future crisis in their mental health. in practice, these interventions will be used often, in conjunction with psychiatric medications. psychosocial interventions are based on evidence-based practice, and therefore the techniques tend to follow set guidelines based upon what has been demonstrated to be effective by nursing research. there has been some criticism that evidence based practice is focused primarily on quantitative research and should reflect also a more qualitative research approach that seeks to understand the meaning of people's experience. spiritual interventions the basis of this approach is to look at mental illness or distress from the perspective of a spiritual crisis. spiritual interventions focus on developing a sense of meaning, purpose, and hope for the person in their current life experience. spiritual interventions involve listening to the person's story and facilitating the person to connect to god, a greater power or greater whole, perhaps by using meditation or prayer. this may be a religious or non-religious experience depending on the individual's own spirituality. spiritual interventions, along with psychosocial interventions, emphasize the importance of engagement, however, spiritual interventions focus more on caring and 'being with' the person during their time of crisis, rather than intervening and trying to 'fix' the problem. spiritual interventions tend to be based on qualitative research and share some similarities with the humanistic approach to psychotherapy. therapeutic relationship as with other areas of nursing practice, psychiatric mental health nursing works within nursing models, utilising nursing care plans, and seeks to care for the whole person. however, the emphasis of mental health nursing is on the development of a therapeutic alliance. in practice, this means that the nurse should seek to engage with the person in care in