Anda di halaman 1dari 112

Social Work in Mental Hospital Setting

SWR 432

Shabab Ahmad
Assistant Professor
Central University of H.P
Social Work in Mental Hospital Setting

It is called Psychiatric Social Work

It is the specialized branch of Social Work, which

has developed in connection with mental
hygiene and psychiatry. The essential purpose of
psychiatric SW is to serve the people with MI, EI,
or suffering with MD.
It has come into existence as a result of the
realization that pt. with mental or emotionally
ill could be helped more effectively through
understanding by dealing with the social and
environmental factor that are related to their

PSW= Psychiatry + Social Work

Psychiatry : It is the branch of medicine concerned
with the study and Rx of Mentally Ill, Emotionally
disturbed and abnormal person or either
suffering with any kind of mental disorder.

SW: Professional services based on the scientific

knowledge and skills in human relation which
assist the individual alone or in group to obtain
the social & personal satisfaction and
PSW: The practice of social work in relation to
the psychiatry, the term is known as PSW.

Ashdown & Brown (1953): PSW as a social

work undertaken by direct and responsible
R/ship with Psychiatry.

French (1940): Continued contribution of social

work knowledge & experience to the practice
of psychiatry.
PS Worker:
Psychiatric Social Worker: is a professional and
an imp member of psychiatric team. He utilize
social work principle and techniques for the
purpose of diagnosis, care, Rx and for
Rehabilitation of the Pt.
Psychiatric Institutions

• Mental Hospital
• Mental Health Institution
• Psychiatric Nursing Home
• C.G.C
• Psychiatric Clinic
Role and Function
• Aim as to reform the patient to community
• Better adjustment ( Socio-Psycho) of Pt.
• Making detailed history of Pt.
• Total Responsibility of psychological Rx
• Using Psychotherapies, Counseling Techniques, and conducting
Case work etc.
Four Fold Operation:
 Within the Patient
 Within the Family
 With the Prospective Employer
 With community People
Role of PSW
 Promotion of MH
 Intake  Awareness Camp
 Reception- Accepting  Conducting Workshop
 Diagnosis  Making Case Record
 Treatment  Case Identification
 Pre- convalescent  Providing referral Services
 Pre-Parol Services  Providing Recreational
 Follow- Up : after care Therapies
 Program Administration
 Counselling – Adm & Disch  Training for Health
Values : PSW
 Worth & dignity of the Individual
 Respect for the Pt.
 Acceptance
 Non-Judgemental Attitude
 Value for Individual’s capacity for change
 Value related to client self determination
 Social justice & social change
 Equal opportunities
 Non Discrimination
Psychiatric Social Work
Model & Approaches
• Psycho-Social Model • Functional Model
• Problem Solving Model
• Behavior Modification
• Family Therapeutic Model
• Task Centered Model
• Crisis Intervention Model
• System Model
Unit -1 Topic 3
History of Psychiatric & Medical Social Work
Development in USA: M&PSW
Phase -1: Including the time of 1st World war

1905: The 1st Social Worker appointed in General Hospital in Neurological

Clinic of Massachusetts General Hospital , USA.

1913: Boston Psychiatric Hospital established and was running –Social

Service Department, Under the headship of Dr. Ernest and Marry C.
Jarrett . In that time The term PSW was used for used first time in the
book: Kingdom of Evil, by Jarrett.

1917: Marry Richmond written a book Social Diagnosis, she laid

emphasized on the personality of Client , His R/ship to others and
behaviour of Client.

1920: Dr. William Healy established the Child Guidance Clinic (CGC) for the
Juvenile delinquents in USA.

1922: American Association of Psychiatry Social Worker came into

Phase –II, During 2nd World War
During the 2nd world war American Association was intensively
involved in working with Military Personnel's and their families.

After 2nd World war- Gradually Social Worker began to be employed

by many more psychiatric hospital & clinic and they became part
of psychiatric team

In 1950: The introduction of ECT, insulin therapy & chemotherapy

accelerated the trend towards the community mental health
Development of PSW in UK.
In 1877: The history of SW with the mentally ill can be traced to the
Second half of the 19th Cent. When “After Care Association “
established for female and convalescent , which was known as
After Care Association for Mentally Ill.
In 1913: Mental deficiency Act 1913 was passed by UK Govt. A
central Association for Mental Welfare was established for
implementation of this act.
In 1925: British Magistrate St. Leo Strachey impressed by CGC in USA,
She adapt the CGC concept in UK.
In 1929: The London Child Guidance Clinic was established under the
dept. of Social Service of London.
In 1930: Mental treatment Act 1930, passed by UK Govt. and became
the Land mark of mental health policies in Britain
After 2nd world war:
The National Health Services was introduced to
provide the comprehensive health services in all
In 1946: The passing of the National Health
Services Act 1946shifted the major responsibility
to community Health Care to local authority
In 1953: WHO generate the model of Mental
Services in which a verity of services – inpatients,
out pt, day care center were recommended as a
part of community Mental Health which promote
the M& PSW in the field of Health.
Development of Psychiatric Social Work in India
In 1936: History of M&PSW started with the establishment of Sir
Dorabji Tata Gradate School of Social Sciences in Bombay. Now
know as TISS.
1937: It started a CGC clinic at Nagpada MH. Under the directorship
of Dr. K.R. Masani from J.J. Hospital Bombay where a Social
Worker appointed in field of Health for Child development.
1938: A full time social worker employed in this CGC clinic from TISS.
It was the 1st time when 1st social worker job appoint as a full
1939: The medical & psychiatric Social work training started in India.
1946: Bhore-Committee derived the Term Medical & Psychiatric
Social Work . This committee recommended the Social services
dept. in hospital and made the plan for training of M&PSW
Job Era in the Field of M&PSW:
1948: Gouri Ran Benerjee, Research Scholar, has completed her
training in M&PSW from School of SS& Administration Chicago.
1949: Yarvada mental Hospital Pune, Malati Ranade appointed as a
Psychiatric Social Worker, After completion her training in
M&PSW. She was the 1st social worker in adult psychiatry
1950: JJ Hospital Bombay: A social Worker Appointed into
Psychiatric department .
1952: The combined course & Medical Introduced. Dr. Banerjee,
who did the pioneering work in PSW
Till 1955: The Credits for the growth of PSW goes to the TISS in the
state of MH.
1955: Positions of SW created in west Bengal related to Health
Services West Bangal was introduced as a part of medical Social
Services . Social Welfare officer in the state were posted in Govt.
hospital and administratively responsible to the Deputy Director ,
Social Welfare Dept.
1955: Delhi School of Social Work established and started providing
the training in the field of Social Work.
1956-57: It phase created the position of Social Worker in the field of
1958: DSSW, established the CGC and appointed a full time Social
1960: AIIMS created the post for Social Worker ( Medical)
1961: Dr. Sharda Menon, at Madras Mental Hospital started –
Industrial Therapy unit, sheltered workshop, counselling,
consultation to college & institute and created the position for SW
in the field of Health
1961: Social Worker positions were created in Mental Hospital
Bangalore. In 1971 change its name as NIMHANS. This hospital
introduced a diploma course in PSW to enable SW to work in field
of Mental Health.
1962: The Nur-Manzil Psychiatric Clinic opened in Lucknow ?, and
appointed the SW.
1962: Safdarjung Hospital generate the post of social worker in psy.
1962: Dr. Ram Manohar Lohia Hospital, New Delhi appointed the
Social Worker for health purpose
1964: Shahadra Mental Hospital established by Delhi Govt. which is
known as IHBAS, Dilshad Garden. Delhi. Appointed the SW in PSW
1966: Regular positions of M& PSW were created by UPSC, SSC.
Professional Institution for M&PSW

TISS- 1936 ( Later 1945)

DSSW- 1955
Baroda School of Social Work 1958
Bhopal School of Social Sciences 1960
Dept . of SW, Kashi Vidya Peeth, Banaras
Mental Hospital :
Delhi, Indore, Madras, Gwalior, Amritsar, Agra,
Karnataka, Ranchi. Manipur etc.
Unit-1 Topic-2

Role of Psychiatric Social Worker

Specific Role & Functions:
 Interviewing the Patients/ relatives for Social History
 Home Visit
 Outline the Rx
 Diagnosis
 Maintaining Pts care & improvement
 Work with Family / social Envt
 Work with pts/ case work/ Counselling/ Group work
 Referral / Link with Comty
 Follow-up
 Rehabn
 Training
 Financial Assistance
 Research Comty Education
 Total Mgt
Other Functions:
1. To study the situation and compliment the
examination by the psychiatrist
2. Administer the Social Rx
3. Participate in training Program
4. To impart the mental health education
5. To participate in the determination and formation of
agency policies with a view to socializing the agency
setup to meet the needs of clients
6. To promote research
7. Therapeutic Rx measures
Unit -1, Topic – 4

Psychiatric Social Work into Different Setting

Psychiatric Social Work into different Settings

In School Setting In Community Setting

Psychiatric Social

In Correctional
In Health Institution In Industrial Setting
PSW in School Setting: In school setting the PSW acts as a
Consultant, Counsellor, and as a PSW. He share his / her
knowledge with pupils, teachers, parents and with other
supportive body & discipline.
PSW provide the link b/w the school and social agencies and act as a
broker for the services provided for pupils and their families &
PSW: Involvement Public



As a PSW within in a School setting is in direct contact
with students as well as Teacher and administration
team. PSW deal with the problem of child. He provide
the counselling, therapies psychiatric treatment, clinical
test etc. for resolving the child in school setting.
Here are different illness occur in child
1. MR 7. Absenteeism
2. Conduct disorder 8. Poor Performance
3. Tic Disorder 9. School Phobia
4. Speech
5. Habit Dis
6. Pervasive Development Dis
Psychiatric SW: in Health Institution
Psychiatric Hospital, Nursing home, Psychological clinic, health ward,
general Hospital.
 History Taking
 Interview taking
 Counselling
 Referral
 Record Making Case Work
 Restoration
 Clinical Role
 Non Clinical Role
PSW in Correctional Institutional Setting:
PSW play a very imp role in correctional institutional. In CI
SW/ PSW/ MSW provide the redirection & re-education to
child, Juvenile or to person who have committed the crime,
or involve in anti social behavior.
CI are – reformatory School, Special School, Probation Home,
Observation Home, Remand Home, Bal Sudhar Grah, etc.
Helping to enhance the capacity & Motivation
Allowing them for Ventilation of feeling freely
Giving the information
Help the offenders in decision making
Assisting modification of the environment
Organize development programme : Personality, Psycho-Social.
Providing Vocational Training
Role of SW/MSW/PSW: in Industrial Setting :
In industries , factories or in any business establishment, where
many worker / employees works, and they sometime suffer with
Job stress, work interest, conflict in job situation, in-adjustment
within organization and psychological problem among employees
which deal by professionals SW/MSW/PSW.
They deal with common Employee’s Problem:
Stress, Over work load, Absenteeism , Emotional Problem, Family
Problem, Accidents, Health Hazards, Improper Communication
SW can do- Case Work , Group Work, Research Work, Administrative
Work in Organisation.
Thank You
Unit -1, Topic – 1

Mental Health
Normal & Abnormal Behaviour
Normal Behaviour
Concept of Normal:

The word Normal came form Latin word

“Norma” which means a Carpenter’s square. A
Norma become a rule or standard pattern and
it was in this sense, introduced into English
• Definition:
Sjmon: The normal person is one, who
overcomes the severity of threat and

Features: Sociability, similarity in personality

traits, similarity in various need &
achievements, Adjustment with situation,
knowledge of right & wrong, decision making
power, removal of tendency of illegal acts/
social evils.
Criteria to measure:
• Ability to learn
• Ability to satisfy the need
• Integration & consistency of personality
• Adequate feeling of security
• Adequate spontaneity
• Realistic life goal
• Efficient content with reality
• Reasonable degree of self evaluation
Model to Measure the Normality of Behaviour

 Medical Model
 Statistical Model
 Utopian Model
 Subjective Model
 Social Model
 Process Model
 Continuum Model
• Medical Model: Normal personality or health behaviour is
conceptualized as absence of psychiatric diseases or
• Statistical Model: Statistical normal personality or MH fall with in
two standard deviation of normal distribution curve.
• Utopian Model: In mental health the focus in defining normality
is on “ optimal functioning”
• Subjective Model: In this normality is viewed as an absence of
diseases or disability or help –seeking behaviour.
• Social Model: A normal is expected to behavior a socially
permission behaviour.
• Process Model: It view normality as a dynamics & changing
process, rather than static as a concept.
• Continuum Model: It describe normal & abnormal disorder as
falling at the two ends of a continuum rather than being
disparate entities.
Abnormal Behavior:

Abnormal individual marked by limited

intelligence, emotional instability, personality
disorganization and character deficits.
Kiskar: Human Behavior & experience which
are strange, unusual or different in ordinary
sense are considered as abnormal behaviour.

Features: Mentally disturbed, Imbalance

Personality, Anti-Social Attitude, Emotionally
not stable, Lack of Control power. Weak
Defence Mechanism
Abnormal Behavior Include:
Maladaptive Behavior, Psychopathology, Mental
Illness, Mental Disease, Behavior Disorder,

Model to Measure the Abnormality of Behaviour

 Biological Model
 Psycho-Social Model
 Socio-Cultural Model
 Diathesis -Stress Model
Criteria used to define Normality & Abnormality
Descriptive Criteria: D.C is integrated the type of
behaviour considered normal & Abnormal
Explanatory Criteria: It explain why particular
behaviour is normal and it is concern with as an
assumption process.

Descriptive Criteria Explanatory Criteria

 Statistical Criteria Psychological Criteria
 Pathological Criteria Adjustment Criteria
Thank You
Classification of Mental & Behaviour Disorders:

Classification of Mental & Behaviour Disorder

According to ICD -10. (1992)

ICD-10= International Classification of Disorders

Vol-10, 1992
Classification of Mental Disorders ICD-10:
First modern attempt at classification was International list of causes of
Death (1893). WHO in 1948 took over the responsibility of updating it.

The 6th revision of the International Cl. of disease, injuries & causes of
death (1948) included psychiatric disorders for the first time.
ICD 8 (1972) glossary
ICD 9 (1978) glossary
ICD 10 (1992) International Statistical classification of diseases & related
health problems
Dissatisfied with ICD 6.
The American Psychiatric Association published the DSM Diagnostic and
Statistical Manual Disorder-IV.
Evolution of DSM: DSM 1: 1952
DSM II: 1968
DSM III: (1980); DSM IIIR 1987
DSM IV: (1994); DSM IVTR 2000
ICD 10 : Composition Of Chapters
Chapter number an designation Range of codes
I Certain infectious and parasitic diseases A00-B99
II Neoplasms C00-D48
III Disease of the blood and blood forming organs
and certain disorders involving the immune D50-D89
IV Endocrine, nutritional and metabolic diseases E00-E90
V Mental and behavioural disorders F00-F99
VI Diseases of the nervous system G00-G99
VII Diseases of the eye and adnexa H00-H59
VIII Diseases of the ear and mastoid process H60-H95
IX Diseases of the circulatory system I00-I99
X Diseases of the respiratory system J00-J99
ICD 10 : Composition Of Chapters

Chapter number an designation Range of codes

XI Diseases of the digestive system
XII Disease of the skin and subcutaneous K00-K93
tissue L00-L99
XIII Diseases of the musculo-skeletal
system and connective tissue
XIV Disease of the genito-urinary system M00-M99
XV Pregnancy, childbirth and the
puerperium N00-N99
XVI Certain conditions originating in the O00-O99
perinatal period
XVII Congenital malformations, P00-P95
deformations, and chromosomal
abnormalities Q00-Q99
ICD 10 : Composition Of Chapters
Chapter number an Range of codes
designation R00-R99

XVIII Symptoms, signs and abnormal

clinical and laboratory findings, not
elsewhere classified
XIX Injury, poisoning and certain other
consequences of external causes
XX External causes of morbidity and V01-Y98
XXI Factors influencing health status and Z00-Z98
contact with health services

Persons with potential health hazards related to socio

economic circumstances (Z55-Z65)
• Z55 Problems related to education and literacy
• Z55.3 Under achievement in school
• Z56 Problems related to employment and unemployment
• Z56.2 Threat of job loss
• Z60 Problems related to social environment
• Z60.3 Acculturation difficulty
• Z65 Problems related to other psychological circumstances
• Z65.4 Victim of crime and terrorism (Includes victim of
1. Foo- F09- Organic , Including symptomatic Mental Disorder
2. F10-F19- M & B disorder due to use of psychoactive substance
3. F20-F29- Schizophrenia, Schizotypal, & Delusional disorders
4. F30-F39- Mood ( affective ) Disorders
5. F40- F49- Neurotic stress –related and somato-form disorders
6. F50- F69- Behaviour syndrome associated with psychological

7. F60-F69- Disorder of Adult personality & behaviour

8. F70-F79- Mental Retardation
9. F80- F89- Disorder of Psychological development
10. F90-F98- behaviour & Emotional disorder with onset usually
accruing in childhood & adolescence
11. F99- Unspecified Mental Disorders
1. Psychiatric Interview & Principle
2. Psychiatric Examination
3. Psycho-Social Diagnosis & Mgt
4. Family Assessment
Topic -1

Psychiatric Interview
Psychiatric Interview:

Interview: Interview means the exchange the information b/w

two people. It is done in order to asses, evaluate, help and to
collect the information from a person / client.

Psychiatric Interviewing is not only to collect or exchange the

information but also to help the person/client in the therapeutic

Interview is the major part in the psychiatry without information

the diagnosis can not be done or formulate .
Purpose: of Psychiatric Interview
• Understanding the client in the context of environment
• Diagnosis of illness
• To prepare a line of management for treatment(Rx).

1. Sense of Reassurance
2. Sense of Acceptance
3. Confidentiality
4. Sense of Relief
5. Rapport Building
6. Case Record
Objective of Psychiatric Interview:
 To describe the patient condition, family development and
emotional factors affecting his behaviour .
 To find out the pre –disposing factors
 Making diagnosis
 To identify the psychological emergencies
 To prepare plan for Treatment and interventions.

Techniques: Observation, Listening, Reflecting, information

providing, Clarifying, Pin pointing, sharing, focusing, summarization
Recording etc.
Process of Psychiatric Interview:
• Opening Interview
• Rapport Building
• Listening power in Psychiatric Interviewing
• Control of interview / and termination.

Rule of Psychiatric Interview:

1. Make - no promise
2. Do not take the side of client
3. Don’t force the client into the first session
4. Be- Non judgmental
5. Generate the interest for communication in Client
Psychiatric Interview : is divided into Two Part

Socio Demographic Profile

1.History Taking process

2. Mental Status Examination (MSE)

1. History Taking Process:
A. Identification of Data: Name, age , sex, etc.
- informants
- Reliability: Contact, Consistency, Continuity, Closeness, Collaborative

B. Present Chief Compliant:

C. History of Past Illness: if any

D. Family Details with Family Tree
-Family medical & psychiatric details, if any
- Family Relationship: cordial or disturb, not smooth
- Attitude of Family members: ignorant, caring,
- Present Living Condition: Housing condition
E. – Personal History:
- Birth & Development History
- Education History
- Occupational History
- Marital History
- Pre-Morbid Personality/ Temperament
F. -- Habit: Eating & Sleeping Pattern or any
Part -2
Mental Status Examination
A. Appearance
- Attitude: cooperative or not, Guarded, Hostile, Attentive,
- Behaviour & Psychomotor Activity (PMA):
Excitement /Stupor- Akinesis/ Restless/
- General Description: Looks, Grooming, Dressing
- Sign of Anxiety: Yes /No
- Eye Contact: Yes/ No
B. Speech : Present/ Mute/ Rapid/ Slow/ stuttering / Echolalia/
Echopraxia / muttering/ stammering
Tone: Normal, warm, Soft , Aggressive
Pitch: High or Low
C. Mood & Affect : Euthymic/ Euphoric/ Flat/ Anxious/
Elation/Exaltation /Ecstasy [mania], Anxious, Restless –Anxiety
Sad, irritable, angry in depression. S-O

D. Thought Disturbance:
-Stream of Thought: Flight/ slow/ circum-stantiality /
- Possession of Thought: OCD/ against desire
- Content of Thought: Delusion, Phobic,
- From of Thought: Derailment/ Omission/ fusion/

Mood: Pervasive feeling tone which is sustained ( verbatim)

Affect: outward expression of immediate experience of
- Productivity: Good/Bad / Poor
- Continuity:
- Language Impairment : incoherence/ clang association/

Type of Delusion: Persecution, Reference, Guilt, Nihilistic,

Poverty, Grandiose, Love, infidelity, Somatic, Hopelessness,
Helplessness, worthlessness, Suicidal Ideation etc.

 Delusion of Control- some one is controlling the thoughts
 Thought Insertion- some body inserting the Thoughts
 Thought Broadcasting- Telecasting of Thoughts
 Thought Withdrawal- Elimination of Thoughts
E: Hallucination :
Auditory: [ elementary, 1st person, 3nd person H]
Tactile: Tactile or insect are moving in body, or on body.
Pseudo Hallucination:
Extracompine H: a hallucination which is outside the
limits of the sensory field
Reflex H: a stimulus in one sensory field produces a
hallucination in another.
Functional H: a stimulus causes the hallucination, but it is
experienced as well as the hallucination.
Hypnogogic H: when the subject is falling asleep, during
Hypnopompic H: when the subject is waking up
F.: Sensorium:
Alertness: yes /No
Orientation: Intact or Not Intact
Memory: Recent, Remote, Recent Past
Fund of Knowledge: any information
Abstract Thinking: similarities / difference
Judgment : Personal/ social/ test
Insight: Present / Absent
1. Complete denial of illness
2. Slight awareness of being sick and need help,
but dyeing at same time
3. Awareness of being sick, due to something
unknown reasons
4. Intellectual Insight: fail to resolve the problem
5. True Emotional Insight

Diagnosis: Bipolar Disorder

Psychosocial Diagnosis and Management
1. Psycho-Social Approach: Gorden Hamilton &
Florence Hollis in 1940

Emphasis on:
- Alleviating Client distress
- Decrease the malfunctioning
- Enhance the client satisfaction
- Person in the situation
Intra-inter personal conflict
Dealing the faulty Attitude perception
Dealing with faulty communication
2. Function Approach: Jessie Thaft & Robinson in
3. Problem Solving Approach: by Perlman in 1957
4. Task Centered Approach: (Rapid Action): by
Laura & William J. Raid in 1950, at Chicago
5. System Approach by L. Von Bertalanffy
Family Assessment Points:

 Family Tree
 Family Present Condition
 Family Occupation
 Boundaries and Subsystem
 Role Structure and Functioning
 Leadership & Decision Making
 Communication & Cohesiveness
 Adaptive Pattern
 Expressed Emotion
 Social Support
 Family Burden
Thank You
Unit- 4
• Personality Disorder
• Psychoactive Substance use Disorders
• Schizophrenia
• Mood Affective Disorders
• Neurotic Stress Related and Somatoform
• Post Traumatic Stress Disorder
• Field of Psychiatry: Child Psychiatry, Geriatric,
Forensic and Community Psychiatry
• Psychological Treatment Methods: Group Therapy,
Family Therapy, Counselling, Behaviour Therapy,
Rehabilitation, Psychotherapy, Cognitive Behavioural
Therapy and Therapeutic Community
• Biological Therapy: Electro - Convulsive Therapy,
Chemotherapy and Psychosurgery
• Transactional Analysis and Existential Approach
• Legal and Ethical Issues in Psychiatry: Indian Lunacy
Act-1912, Mental Health Act-1987 and NDPSA-1985,
PWD Act 1995, RCI Act 1992 and National Trust Act.
Unit-5 Topic

Psychological Treatment Methods:

• Group Therapy
• Family Therapy
• Counselling
• Behaviour Therapy
• Rehabilitation
• Psychotherapy
• Therapeutic Community
Psychotherapy :
- Psychotherapy is a kind of Treatment by psychological

- Treatment of an emotional nature in which a trained

person deliberately maintain a professional R/Ship
with the object :-
- of removing, modifying or retarding existing symptoms
- of mediating disturbed pattern of behaviour
- of promoting positive personality group and development.
Type : Psychotherapy
• Supportive: Restoration, controlling, Strengthening of
existing defenses.

• Re-educative: Readjustment, developing insight.

• Reconstructive: Alterations, Expansion of personality

growth with development of new adaptive
Group Therapy:
• It is first used by Joseph Pratt in 1905 for the TB patients
• G T or Group psychotherapy is less time consuming therapy
• Mainly one group constitute 8 or 10 people can be treated at one
• In this group patients is formed and treat them for their specific
purpose- Skill enhancement, Social skills Training, confidence
building, Education purpose
• It is the Time saving methods
• GT offers opportunity the patients to realize that many others
have and share problems which are very similar to their own
problem and that they are not alone in their suffering.
• Typically sessions are held once or twice in a week with each
session of 1-2 hours.
Behaviour Therapy:
• It is a type of Psychotherapy.
• It is based upon theories of learning and aim at changing
maladaptive behaviour and substituting it with adaptive behavior.
• The B T is based upon the operant conditioning model ( Skinner )
and Classical Conditioning ( Pavlov).
• The learning theories assume that all behaviour is learned
• The reward is must to change the behaviour
• BT is a short duration therapy, it is easy to train and it is cost
• Total duration 6-8 weeks
• Initially session are given daily but the later sessions are spaced
Techniques of Behaviour Therapy
1. Systematic Desensitization
[Relaxation and Hierarchy Construction in case of
2. Aversion
[for addicted people, unpleasant aversion is produced
by the electric stimulus, by drugs (Apo-morphine
and Disulfiram)]
3. Flooding: Direct exposure of the stimulus.
[ used in case of phobias]
4. Operant Conditioning: for Increasing behaviour
• Positive Reinforcement- rewards, material,
• Negative Reinforcement- punishment
• Modelling – induced a copy of Model behaviour
5. Operant Conditioning: for decreasing behaviour
• Timeout
• Punishment
• Satiation
Therapeutic Community:
In general TC are the residential setting which use the
hierarchical model and follow the treatment stages. The
main objective is the Rehabilitation.
By Craft: TC is a like a Milieu Therapy which aim at helping
process & Rehabilitation.

Maxwell Jones [UK - 1948] and T Main, started the TC

without any knowledge. T main started it during IInd
world war for people resettlement and Maxwell started
for the Psychosomatic Problem to know the reason for
the poor drug adherence
Aim of TC: “Home is the best institution” for the better
Basics Aspects:
Rehabilitation, Habilitation, Community as Change Agent,
Efficacy of self help.
Organization of TC:
Structure, Process, Staff, Client
Illness Covered in TC:
• Multiple Substance abuse
• Personality Disorders
• Mental Illness
Principle of TC:
1. Individual is responsible for change emphsised on the
self or self services
2. Open communication
3. Democratic Decision Making
4. Equalization
5. Personal Assets
6. Peer Pressure
7. Team Work
8. Client is Centered
Treatment Process:
Stage-1 Induction & Early Treatment
• Rule, Regulation, Process of TC
• Building Trust among staff & others
• Complete Assessment of the Problem
• Commitment for Change
Stage -2 Primary & Treatment
• Use of Structure
• Enhancement of Motivation & Confidence
• Helping to identify the client potential
• Focus on Minimizing the problem
• Development of Healthy Life style
Stage -3 : Re- Entry
• Restoration
• Family Counselling
• Making Community
• Cohesiveness
• Community Programme
- The combined and coordinated use of medical, social,
educational and vocational measures for training and
retraining the individual to the highest possible level of
functioning ability”.
- It includes all measures aimed at reducing the impact of
disabling and handicapping conditions and at enabling
the disabled and handicapped to achieve social
- Medical, Vocational, Social and Psychological and
Psychosocial Rehabilitation ( Psychiatric Rehabilitation)
Biological Therapy:

• Electro - Convulsive Therapy,

• Chemotherapy and
• Psychosurgery
Electro - Convulsive Therapy:
• It means the Electro-shock Treatment or Shock Therapy
• It is the electric Treatment in which current is pass through
electrode across the brain.
• Careletti and Bini, used the much safer form of convulsive
methods in 1938 for shock Treatment and further known as ECT.
• In 1974, APA’s Council on Research and Development
appointed a Task force to control the misuse and proper
utilization, and provided the certain guidelines for the safe and
effective use of these therapy.
• In 1990 APA Task force Report on ECT redefined the indications
gave the guidelines for consent.
Indication for ECT:
1. Major Severe Depression
[ suicidal risk, stupor, poor intake of food and fluids , psychotic
features, unsatisfactory response to drug therapy
2. Severe Catatonia ( functional)
3. Severe Psychosis

Side Effect: Headache, Body aches, Vomiting , Amnesia ( loss of

short term memory)

Mode of Treatment:
1. Direct- absence of muscular relaxation and general Anesthesia
2. 2. Modified – presence of Anesthesia
It means Therapy or treatment by drugs or chemical,
which use in the treatment of Psychiatric disorders. It
include the Psychoactive, Psychotropic drugs and
Classification of Psychotropic Drugs:
• Anti Psychotic
• Anti Depressants
• Mood Stabilizing Drugs
• Anti Anxiety
• Anti-Epileptic
• Alocohol and Drugs Dependence
• Miscellaneous Drugs
Characteristics of Chemotherapy:

1. It should cure the underlying pathology causing the

disorder or symptom under focus
2. It should benefit all the pts suffering from disorders
3. It should have no side effect
4. It should have rapid onset of action
5. No dependence is here
APA defined as – as a Surgical intervention, to severe
fibers connecting one part of brain with another , or to
remove, destroy or stimulate brain tissue, with the
intent of modifying, behaviour, thought or mood
disturbance, for which there is no underlying organic

Indication: Severe Depression, Severe OCD, Severe

Anxiety, Schizophrenia,
Side Effect: Seizures, Personality Change (Very Rare)
Transactional Analysis:
- Transactional Theory based on the Transactional Analysis,
commonly known as TA.
- It is an integrated approach to the theory of psychology and
psychotherapy and its has elements of psychoanalytic.
- T A. founded by Eric Berne in 1950, and it was the famous –
“Parent-Adult-Child” theory.
- It has wide application in SW, SCW, clinical, therapeutic Rx,
organizations, in education and personal development,
encompassing, communication, management, personal
r/ship & behaviour, whether you are in business, a parent, a
social worker or interested in personal development.
- In 1950, Eric Berne developed the theories of transactional
- He said that verbal communication, particularly in face to face, is
the center of the human R/ship, and psycho-analysis.
- The point of discussion was started from when two person
encounter each other, one of them will speak to other called as
Transactional Stimuli. The reaction from other side called
Transactional Response.
- T.A. become the method of examine the transaction, where in:
“I do something to you and you do something back”
- Berne also said that each person is made up of three Alter-Ego-
“Parent ----- Adult ------ Child”
TA- Three Ego States:
Berne devised the concept of ego states to help explain how we
are made up, and how we relate to others. Each of us is really
three people i.e. people are able to see in three different ways:
Parent: Language of Moral Values
(Behaviours, thoughts & feeling copied from parents or parents figure)
Adult: Language of logic & rationality
(Behaviours, thoughts & feeling that are direct response there & now)
Child: language of Emotions
( Behaviours, Thoughts, & feeling replayed from childhood)
Parent Ego State:

This is a set of feeling, thinking and behaviour that

we have copied from our parents and significant
others. As we grow up we take in ideas, beliefs,
feelings & behaviours from our parents and
Adult Ego:
It is about direct responses to the here & now. We
deal with things that are going on today in ways
that are not unhealthy influenced by our past.
• The Adult ego state is about being spontaneous
& aware with the capacity for intimacy
• When in our Adult we are able to see people as
they are, rather than what we project onto
them. We ask
Legal and Ethical Issues in Psychiatry:

• Indian Lunacy Act-1912,

• Mental Health Act-1987
• NDPSA-1985,
• PDA Act 1995,
• RCI Act 1992 and
• National Trust Act.-1999
Mental Health Act (MHA) 1987: Revised

• The Act was enacted by Parliament to replace the Indian Lunacy

act of 1912. Significant changes were incorporated in this act.
The term lunatic which was considered to be pejorative was
replaced by the term ‘Mentally Ill person’. The act provides for
the establishing authorities in mental health at the Central and
the State level to regulate and oversee the management and
treatment of mentally ill.

• In 1987, the Mental Health Act was enacted and became law in
1990, and came into force in all states and Union Territories on
1st April, 1993.
• Mental Health Act have 10 Chapters and 98 Subsections
• CHAPTER I : Definitions ( sec: 1- 4)
• CHAPTER II : Mental Health Authorities (sec: 5- 14)
• CHAPTER IV : Admission and Detention in Psychiatric Hospital & Nursing
home (15-36 total)
Part -1: Admission on Voluntary Basis (sec 15-18)
Part-2: Admission under Special Circumstances (sec 19)
Part -3: Reception Order
Reception order on Application(sec 20-22)
Reception Order on production of mentally ill person before Magistrate
(sec 23-25)
Further provision regarding admission & detention of certain Mentally
ill (sec 26-29)
Miscellaneous provision (sec 30-36)
• CHAPTER V: Inspection, Discharge, Leave of Absence & Removal of
Mentally ill (37-49)
Part 1 : Inspection (visitors, mentally ill & ill prisoners) (sec 37-39)
Part 2 : Discharge (CMO, on application, relatives,) (sec 40-44)
Part 3 : Leave Procedure (45-46)
Part 4 : Removal (sec 47-49)
• CHAPTER VI : Judicial Inquisition about- Management of Property
( sec 50-77)
• CHAPTER VII : Maintenance cost for mentally ill in psychiatric
hospital (sec 78-80)
• CHAPTER VIII : Protection of Human Rights of Mentally ill persons
( sec 81)
• CHAPTER IX: Penalties & Procedure (maintenance of Psy. Hospital
Nursing home, etc) (sec 82-87)
• CHAPTER X : Miscellaneous ( pension, repeal, saving provision of
bonds etc) (sec 88-98)
The Person with Disability Act 1995:
• Full Name : as “The persons with disabilities (equal
opportunities, protection of rights and full participation) Act
• Applicable to State Government departments, Boards,
Corporations, Panchayats, other establishments of State
Government and other allied establishments
• The Act was passed with a view to undertake various
measures for the welfare of disabled people, such as
creation of barrier free environments, remove discrimination
in the employment, provision of services for early detection
and rehabilitation of the disabled. The Act also envisages
the establishment of homes for the severely disabled.
• A disabled person is one whose disability has been assessed
at 40% of any disability by the medical authority.
Persons with disability are entitled to exercise their civil,
political, social, economical and cultural rights on an
equal basis with others.
• Disability –” summarizes a great number of different
functional limitations occurring in any populations in
any country of the world. People may be disabled by
physical, intellectual or sensory impairment, medical
conditions or mental illness.
• Such impairment conditions or illness may be
permanent or transitory in nature”.
Statement of objects and reasons- PDA act 1995
• Prevention of Disabilities.
• Protection of rights.
• Provision of medical care.
• Education, training, employment & rehabilitation.
• Create barrier free environment.
• Remove any discrimination.
• Counteract abuse & exploitation.
• Integration of person with disability in to social
Impairment: Impairment is any loss or abnormally of
Psychosocially, physiology or anatomically structure or

Disability: it is nay restriction or lack of ability to perform

an activity in the manner or within the range considered
normal fro a human being.

Handicap: It is the disadvantage for a given individual,

resulting from an impairment or disability that time or
prevents the fulfillment of a role that is normal.
Persons with Disabilities (Equal opportunities, Protection of Rights & Full
Participation) act 1995: Chapters are as:-
Chapterisation :
• Preliminary
• Central co ordination committee
• State Co Ordination Committee
• Prevention & early detection of disabilities
• Education
• Employment
• Affirmative action
• Non discrimination
• Research & Manpower development
• Recognition of Institutions for persons with disabilities
• Institution for persons with severe disabilities.
• The Chief Commissioner and commissioners for persons with
• Social security
• Miscellaneous.
Type of Disability:

• Loco-motor disability
• Mental retardation and Mental illness
• Blindness and Low vision
• Hearing Disability
The National Trust Act- 1999
Full Name: The National Trust for Welfare of Persons with autism,
cerebral palsy, mental retardation and multiple disabilities Act,

• The National Trust is a statutory body under the ministry of social

justice and empowerment, Govt. of India set up under the
'National Trust future for the welfare of persons with autism,
Mental Retardation and multiple disabilities Act. (Act 44, 1999).

• The National Trust: An Organization
• (For the Welfare of persons with Autism, Cerebral Palsy, and
Mental Retardation & Multiple Disabilities)
• (Ministry of Social Justice & Empowerment, Govt. of India), 9th
Floor, Jeevan Prakash Building, K.G. Marg, New Delhi-110001.
• Email:, Website:, Phone:
011-43520861, Fax-23766898.
Objectives of National Trust:
• To enable and empower persons with disability to live
independently and as full as possible with in and as close to the
community to which they belong.
• To strengthen facilities to provide support to persons with
disability to live within their own families.
• To extend support to registered organizations to provide need
based services during the period of crisis in the family of persons
with disability.
• To deal with problems of persons with disability who do not have
family support.
• To promote measures for the care and protection of persons with
disability in the event of death of their parent or guardian.
• To evolve procedures for the appointment of guardians and
trustees for persons with disability requiring such protection.
• To facilitate the realization of equal opportunities, protection of
rights and full participation of person with disability.