C HA PT E R 1
History of Mental
Health Nursing
Learning Objectives Key Terms
1. Identify the major trailblazers to mental health nursing. • American Nurses
2. Know the basic tenets or theories of the contributors to Association (ANA)
mental health nursing. • Asylum
3. Define three types of treatment facilities. • Deinstitutionalization
4. Identify three breakthroughs that advanced mental health • Free-standing treatment
nursing. centers
5. Identify the major laws and provisions of each that influenced • National Association
mental health nursing. for Practical Nurse
Education and Service
(NAPNES)
• National Federation of
Licensed Practical
Nurses (NFLPN)
• National League for
Nursing (NLN)
• Nurse Practice Act
• Psychotropic
• Standards of care
■ The Trailblazers were the nurses who took the risks? Who were
the ones who spoke out on behalf of the
For centuries, nurses have been many things patient and the profession? In times when
to many people. People have nurses to thank nursing was considered only “women’s work,”
for cooking, cleaning, and ministering to and when women were not politically active,
those who fought battles. the major trailblazers were female.
Long before people knew what aerobic or
anaerobic microorganisms were, nurses knew Florence Nightingale
when to open or close the windows. Nurses Florence Nightingale (1820–1910) (Fig. 1-1).
helped women give birth to their young and has been called the founder of nursing. Her
nursed the babies when mothers were unable story and her contributions are numerous
to or when mothers died during or shortly enough to fill many volumes. She was born
after giving birth. The first flight attendants of wealth and was highly educated. When she
were nurses. For centuries, nurses have gone was very young, she realized she wanted to be
about the business of caring for people, but a nurse, which did not please her parents.
they have not always done that quietly. Who Conditions in hospitals were poor, and her
3
,4 UNIT 1 | Foundations for Mental Health Nursing
The tidal wave of deeper souls
Into our inmost being rolls,
And lifts us unawares
Out of all meaner cares.
Honour to those whose words or deeds
Thus help us in our daily needs,
And by their overflow
Raise us from what is low!
Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp,
The wounded from the battle-plain,
In dreary hospitals of pain,
Figure 1-1 Florence Nightingale at work
during the Crimean War. The cheerless corridors,
The cold and stony floors.
Lo! in that house of misery
parents wanted her to pursue a life as wife, A lady with a lamp I see
mother, and society woman. Pass through the glimmering gloom,
Florence worked hard to educate herself And flit from room to room.
in the art and science of nursing. Her And slow, as in a dream of bliss,
mission to help the British soldiers in the The speechless sufferer turns to kiss
Crimean War earned her respect around the Her shadow, as it falls
world as a nurse and administrator. This was Upon the darkening walls.
no easy task because many of the soldiers at As if a door in heaven should be
the Barrack Hospital at Scutari resented her Opened and then closed suddenly,
intelligence and did what they could to The vision came and went,
undermine her work. The light shone and was spent.
The relationship between sanitary con- On England’s annals, through the long
ditions and healing became known and Hereafter of her speech and song,
accepted due to her observations and dili- That light its rays shall cast
gence. Within 6 months of her arrival in From portals of the past.
Scutari, the mortality rate dropped from A Lady with a Lamp shall stand
42.7% to 2.2% (Donahue, 1985, p. 244). In the great history of the land,
She insisted on proper lighting, diet, clean- A noble type of good,
liness, and recreation. She understood that Heroic womanhood.
the mind and body work together and Nor even shall be wanting here
that cleanliness, the predecessor to today’s The palm, the lily, and the spear,
sterile techniques, is a major barrier to infec- The symbols that of yore
tion and promotes healing. She carefully Saint Filomena bore.
observed and documented changes in the She was a crusader for the improvement of
conditions of the soldiers, which led to care and conditions in the military and civil-
her adulation as “The Lady with the ian hospitals in Britain. Among her books are
Lamp” (from the poem “Santa Filomena” Notes on Hospitals (1859), which deals with
by H. W. Longfellow). the relationship of sanitary techniques to
Santa Filomena medical facilities; Notes on Nursing (1859),
by Henry Wadsworth Longfellow which was the most respected nursing text-
Whene’er a noble deed is wrought, book of the day; and Notes on Matters Affect-
Whene’er is spoken a noble thought, ing the Health, Efficiency and Hospital
Our hearts, in glad surprise, Administration of the British Army (1857)
To higher levels rise. (Donahue, 1985, p. 248).
, CHAPTER 1 | History of Mental Health Nursing 5
The first formal nurses’ training pro- or “psychiatric hospitals” to care for the men-
gram, the Nightingale School for Nurses, tally ill. There is a monument to her that sym-
opened in 1860. The goals of the school bolized her efforts on the Women’s Heritage
were to train nurses to work in hospitals, Trail in Boston.
to work with the poor, and to teach. This
meant that students cared for people in Linda Richards
their homes, an idea that is still gaining While Dorothea Dix was working for politi-
in popularity and professional opportunity cal help in mental health, a nurse named
for nurses. Florence Nightingale died at Linda Richards (1841–1930) (Fig. 1-3) was
the age of 90. pushing to upgrade nursing education. She
was the first American-trained nurse, and in
Dorothea Dix 1882 she opened the Boston City Hospital
Dorothea Dix (1802–1887) (Fig. 1-2) was a Training School for Nurses to teach the
schoolteacher, not a nurse. She believed that specialty of caring for the mentally ill. By
people did not need to live in suffering and 1890, more than 30 asylums in the United
that society at large had a responsibility to aid States had developed schools for nurses.
those less fortunate. Her primary focus was Linda Richards was among the first nurses
the care of prisoners and the mentally ill. She to teach and work seriously with planning
lobbied in the United States and Canada for and developing nursing care for patients. In
the improvement of standards of care for the cooperation with the American Nurses
mentally ill and even suggested that the gov- Association (ANA) and the National League
ernments take an active role in providing help for Nursing (NLN), she was instrumental in
with finances, food, shelter, and other areas developing textbooks specifically for nurses
of need. She learned that many criminals were that had stated objectives for outcomes of
also mentally ill, a theory that is borne out nursing education and patient care.
in studies today. Because of the efforts of
Dorothea Dix, 32 states developed asylums
Linda Richards
America's First Trained Nurse
Born in Potsdam, 1841
Figure 1-2 Dorothea Dix. Figure 1-3 Linda Richards.
, 6 UNIT 1 | Foundations for Mental Health Nursing
Harriet Bailey
The first textbook focusing on psychiatric
nursing was written in 1920 by Harriet Bailey.
It included guidelines for nurses who provided
care for those with a mental illness. Bailey un-
derstood that nurses caring for these patients
needed proper training. After she published
her book, the NLN began requiring all stu-
dent nurses have a clinical rotation in a psy-
chiatric setting (Videback, 2013).
Effie Jane Taylor
Effie Jane Taylor (Fig. 1-4) initiated the first psy-
chiatric program of study for nurses, in 1913.
She is also well known for her development and
implementation of patient-centered care, put-
ting emphasis on the emotional and intellec- Figure 1-5 Mary Mahoney.
tual life of the patient. Effie Taylor received a
diploma in nursing from Johns Hopkins School
of Nursing, later to become a nursing professor Americans in the field of nursing. An award
in psychiatry (American Association for the in her name is presented at the annual ANA
History of Nursing, Inc., 2007). convention to a person who has worked to
Mary Mahoney promote equal opportunity for minorities in
nursing. During her career, it was necessary to
Mary Mahoney (1845–1926) (Fig. 1-5) is open separate schools of nursing for African
considered to be America’s first African- American students because they were banned
American professional nurse. Her contribu- from the schools for white students. Two of
tions were primarily in home care and in the these separate schools were Spelman Seminary
promotion of the acceptance of African (currently known as Spelman College) in
Georgia and Tuskegee Institute in Alabama.
Hildegard Peplau
Dr. Hildegard Peplau (1909–1999) (Fig. 1-6)
was a nurse ahead of her time. She believed
that nursing is multifaceted and that the
nurse must educate and promote wellness as
well as deliver care to the ill. In her book,
Interpersonal Relations in Nursing (1952),
Dr. Peplau brought together some interper-
sonal theories from psychiatry and melded
them with theories of nursing and communi-
cation. She believed that nurses work in
society—not merely in a hospital or clinic—
and that they need to use every opportunity
to educate the public and follow role models
in physical and mental health. Peplau saw the
nurse as:
Figure 1-4 Effie Jane Taylor. (From Yale Univer- 1. Resource person. Provides information.
sity, Harvey Cushing/John Hay Whitney Medical 2. Counselor. Helps patients to explore their
Library.) thoughts and feelings.
History of Mental
Health Nursing
Learning Objectives Key Terms
1. Identify the major trailblazers to mental health nursing. • American Nurses
2. Know the basic tenets or theories of the contributors to Association (ANA)
mental health nursing. • Asylum
3. Define three types of treatment facilities. • Deinstitutionalization
4. Identify three breakthroughs that advanced mental health • Free-standing treatment
nursing. centers
5. Identify the major laws and provisions of each that influenced • National Association
mental health nursing. for Practical Nurse
Education and Service
(NAPNES)
• National Federation of
Licensed Practical
Nurses (NFLPN)
• National League for
Nursing (NLN)
• Nurse Practice Act
• Psychotropic
• Standards of care
■ The Trailblazers were the nurses who took the risks? Who were
the ones who spoke out on behalf of the
For centuries, nurses have been many things patient and the profession? In times when
to many people. People have nurses to thank nursing was considered only “women’s work,”
for cooking, cleaning, and ministering to and when women were not politically active,
those who fought battles. the major trailblazers were female.
Long before people knew what aerobic or
anaerobic microorganisms were, nurses knew Florence Nightingale
when to open or close the windows. Nurses Florence Nightingale (1820–1910) (Fig. 1-1).
helped women give birth to their young and has been called the founder of nursing. Her
nursed the babies when mothers were unable story and her contributions are numerous
to or when mothers died during or shortly enough to fill many volumes. She was born
after giving birth. The first flight attendants of wealth and was highly educated. When she
were nurses. For centuries, nurses have gone was very young, she realized she wanted to be
about the business of caring for people, but a nurse, which did not please her parents.
they have not always done that quietly. Who Conditions in hospitals were poor, and her
3
,4 UNIT 1 | Foundations for Mental Health Nursing
The tidal wave of deeper souls
Into our inmost being rolls,
And lifts us unawares
Out of all meaner cares.
Honour to those whose words or deeds
Thus help us in our daily needs,
And by their overflow
Raise us from what is low!
Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp,
The wounded from the battle-plain,
In dreary hospitals of pain,
Figure 1-1 Florence Nightingale at work
during the Crimean War. The cheerless corridors,
The cold and stony floors.
Lo! in that house of misery
parents wanted her to pursue a life as wife, A lady with a lamp I see
mother, and society woman. Pass through the glimmering gloom,
Florence worked hard to educate herself And flit from room to room.
in the art and science of nursing. Her And slow, as in a dream of bliss,
mission to help the British soldiers in the The speechless sufferer turns to kiss
Crimean War earned her respect around the Her shadow, as it falls
world as a nurse and administrator. This was Upon the darkening walls.
no easy task because many of the soldiers at As if a door in heaven should be
the Barrack Hospital at Scutari resented her Opened and then closed suddenly,
intelligence and did what they could to The vision came and went,
undermine her work. The light shone and was spent.
The relationship between sanitary con- On England’s annals, through the long
ditions and healing became known and Hereafter of her speech and song,
accepted due to her observations and dili- That light its rays shall cast
gence. Within 6 months of her arrival in From portals of the past.
Scutari, the mortality rate dropped from A Lady with a Lamp shall stand
42.7% to 2.2% (Donahue, 1985, p. 244). In the great history of the land,
She insisted on proper lighting, diet, clean- A noble type of good,
liness, and recreation. She understood that Heroic womanhood.
the mind and body work together and Nor even shall be wanting here
that cleanliness, the predecessor to today’s The palm, the lily, and the spear,
sterile techniques, is a major barrier to infec- The symbols that of yore
tion and promotes healing. She carefully Saint Filomena bore.
observed and documented changes in the She was a crusader for the improvement of
conditions of the soldiers, which led to care and conditions in the military and civil-
her adulation as “The Lady with the ian hospitals in Britain. Among her books are
Lamp” (from the poem “Santa Filomena” Notes on Hospitals (1859), which deals with
by H. W. Longfellow). the relationship of sanitary techniques to
Santa Filomena medical facilities; Notes on Nursing (1859),
by Henry Wadsworth Longfellow which was the most respected nursing text-
Whene’er a noble deed is wrought, book of the day; and Notes on Matters Affect-
Whene’er is spoken a noble thought, ing the Health, Efficiency and Hospital
Our hearts, in glad surprise, Administration of the British Army (1857)
To higher levels rise. (Donahue, 1985, p. 248).
, CHAPTER 1 | History of Mental Health Nursing 5
The first formal nurses’ training pro- or “psychiatric hospitals” to care for the men-
gram, the Nightingale School for Nurses, tally ill. There is a monument to her that sym-
opened in 1860. The goals of the school bolized her efforts on the Women’s Heritage
were to train nurses to work in hospitals, Trail in Boston.
to work with the poor, and to teach. This
meant that students cared for people in Linda Richards
their homes, an idea that is still gaining While Dorothea Dix was working for politi-
in popularity and professional opportunity cal help in mental health, a nurse named
for nurses. Florence Nightingale died at Linda Richards (1841–1930) (Fig. 1-3) was
the age of 90. pushing to upgrade nursing education. She
was the first American-trained nurse, and in
Dorothea Dix 1882 she opened the Boston City Hospital
Dorothea Dix (1802–1887) (Fig. 1-2) was a Training School for Nurses to teach the
schoolteacher, not a nurse. She believed that specialty of caring for the mentally ill. By
people did not need to live in suffering and 1890, more than 30 asylums in the United
that society at large had a responsibility to aid States had developed schools for nurses.
those less fortunate. Her primary focus was Linda Richards was among the first nurses
the care of prisoners and the mentally ill. She to teach and work seriously with planning
lobbied in the United States and Canada for and developing nursing care for patients. In
the improvement of standards of care for the cooperation with the American Nurses
mentally ill and even suggested that the gov- Association (ANA) and the National League
ernments take an active role in providing help for Nursing (NLN), she was instrumental in
with finances, food, shelter, and other areas developing textbooks specifically for nurses
of need. She learned that many criminals were that had stated objectives for outcomes of
also mentally ill, a theory that is borne out nursing education and patient care.
in studies today. Because of the efforts of
Dorothea Dix, 32 states developed asylums
Linda Richards
America's First Trained Nurse
Born in Potsdam, 1841
Figure 1-2 Dorothea Dix. Figure 1-3 Linda Richards.
, 6 UNIT 1 | Foundations for Mental Health Nursing
Harriet Bailey
The first textbook focusing on psychiatric
nursing was written in 1920 by Harriet Bailey.
It included guidelines for nurses who provided
care for those with a mental illness. Bailey un-
derstood that nurses caring for these patients
needed proper training. After she published
her book, the NLN began requiring all stu-
dent nurses have a clinical rotation in a psy-
chiatric setting (Videback, 2013).
Effie Jane Taylor
Effie Jane Taylor (Fig. 1-4) initiated the first psy-
chiatric program of study for nurses, in 1913.
She is also well known for her development and
implementation of patient-centered care, put-
ting emphasis on the emotional and intellec- Figure 1-5 Mary Mahoney.
tual life of the patient. Effie Taylor received a
diploma in nursing from Johns Hopkins School
of Nursing, later to become a nursing professor Americans in the field of nursing. An award
in psychiatry (American Association for the in her name is presented at the annual ANA
History of Nursing, Inc., 2007). convention to a person who has worked to
Mary Mahoney promote equal opportunity for minorities in
nursing. During her career, it was necessary to
Mary Mahoney (1845–1926) (Fig. 1-5) is open separate schools of nursing for African
considered to be America’s first African- American students because they were banned
American professional nurse. Her contribu- from the schools for white students. Two of
tions were primarily in home care and in the these separate schools were Spelman Seminary
promotion of the acceptance of African (currently known as Spelman College) in
Georgia and Tuskegee Institute in Alabama.
Hildegard Peplau
Dr. Hildegard Peplau (1909–1999) (Fig. 1-6)
was a nurse ahead of her time. She believed
that nursing is multifaceted and that the
nurse must educate and promote wellness as
well as deliver care to the ill. In her book,
Interpersonal Relations in Nursing (1952),
Dr. Peplau brought together some interper-
sonal theories from psychiatry and melded
them with theories of nursing and communi-
cation. She believed that nurses work in
society—not merely in a hospital or clinic—
and that they need to use every opportunity
to educate the public and follow role models
in physical and mental health. Peplau saw the
nurse as:
Figure 1-4 Effie Jane Taylor. (From Yale Univer- 1. Resource person. Provides information.
sity, Harvey Cushing/John Hay Whitney Medical 2. Counselor. Helps patients to explore their
Library.) thoughts and feelings.
