Planning equipments and supplies for nursing care: Unit and Hospital

INTRODUCTION:
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of
serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals
may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize
in the temporary or permanent care of residents who, as a result of a psychological disorder, require
routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted
on a voluntary basis, but people who psychiatrists believe may pose a significant danger to
themselves or others, may be subject to involuntary commitment.

HISTORY:
Modern psychiatric hospitals evolved from, and eventually replaced the older lunatic asylums. The
development of the modern psychiatric hospital is also the story of the rise of organized,
institutional psychiatry. While there were earlier institutions that housed the "insane" the arrival
of institutionalization as a solution to the problem of madness was very much an event of the
nineteenth century. To illustrate this with one regional example, in England at the beginning of the
nineteenth century there were, perhaps, a few thousand "lunatics" housed in a variety of disparate
institutions but by 1900 that figure had grown to about 100,000. That this growth coincided with the
growth of alienism, later known as psychiatry, as a medical specialism is not coincidental. In the late
19th and early 20th centuries, terms such as "madness," "lunacy" or "insanity" -- all of which
assumed a unitary psychosis -- were split into numerous "mental diseases," of which dementia,
praecox, and schizophrenia were the most common in psychiatric institutions.
The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment
and restraint. With successive waves of reform, and the introduction of effective evidence-based
treatments, modern psychiatric hospitals provide a primary emphasis on treatment, and attempt
where possible to help patients control their own lives in the outside world, with the use of a
combination of psychiatric drugs and psychotherapy. These treatments can be involuntary.
Involuntary treatments are among the many psychiatric practices which are questioned by the AntiPsychiatric movement. Involuntary treatment is emphatically opposed by the mental patient
liberation movement, but this movement does not have any issue with any psychiatric treatment that
is consensual, provided that both parties are free to withdraw consent at any time.

TYPES:
-

Crisis stabilization

The crisis stabilization unit is in effect an emergency room for psychiatry, frequently dealing with
suicidal, violent, or otherwise critical individuals.
-

Open units

Open units are psychiatric units that are not as secure as crisis stabilization units. They are not used
for acutely suicidal persons; the focus in these units is to make life as normal as possible for patients
while continuing treatment to the point where they can be discharged. However, patients are usually
still not allowed to hold their own medications in their rooms, because of the risk of an impulsive
overdose. While some open units are physically unlocked, other open units still use locked entrances
and exits depending on the type of patients admitted.
-

Medium-term

Another type of psychiatric hospital is medium term, which provides care lasting several weeks.
Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of
these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is
effective.
-

Juvenile wards

Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children and/or
adolescents with mental illness. However, there are a number of institutions specializing only in the
treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders,
anxiety, depression or other mental illness.
-

Long-term care facilities

In the UK long-term care facilities are now being replaced with smaller secure units (some within the
hospitals listed above). Modern buildings, modern security and being locally sited to help with
reintegration into society once medication has stabilized the condition are often features of such
units. An example of this is the Three Bridges Unit, in the grounds of Hanwell Asylum in West
London and the John Munroe Hospital in Staffordshire. However these modern units have the goal of
treatment and rehabilitation back into society within a short time-frame (two or three years) and not
all forensic patients' treatment can meet this criterion, so the large hospitals mentioned above often
retain this role. These hospitals provide stabilization and rehabilitation for those who are having
difficulties such as depression, eating disorders, mental disorders, and so on.

Halfway houses

One type of institution for the mentally ill is a community-based halfway house. These facilities
provide assisted living for patients with mental illnesses for an extended period of time, and often aid
in the transition to self-sufficiency. These institutions are considered to be one of the most important
parts of a mental health system by many psychiatrists, although some localities lack sufficient
funding.
-

Political imprisonment

In some countries the mental institution may be used for the incarceration of political prisoners, as a
form of punishment. A notable historical example was the use of punitive psychiatry in the Soviet
Union and China.
-

Secure units

In the UK, criminal courts or the Home Secretary can refer people to what are known as psychiatric
secure units, even though for many decades now, the term "criminally insane" is no longer legally or
medically recognized. They are hospitals mostly run by the National Health Service, which
undertake psychiatric assessments and can also provide treatment and accommodation in a safe,
hospital environment where its patients can be prevented from harming themselves or others. They
also run under clearly defined Home Office rules. These secure hospital facilities are divided into
three main categories and are referred to as High, Medium and Low Secure. Although it is a phrase
often used by newspapers, there is no such classification as "Maximum Secure". Low Secure units
are often referred to as "Local Secure" as patients are referred there frequently by local criminal
courts for psychiatric assessment before sentencing. Some units have been opened in recent years
with the specific purpose of providing Therapeutically Enhanced Treatment and so form a
subcategory to the three main ones.

GUIDELINES TO BE FOLLOWED FOR LICENSE TO OPEN OR RUN

PSYCHIATRIC HOSPITAL/NURSING HOME:
No person shall establish or Maintain Psychiatric Hospital /Psychiatric Nursing Home unless he
holds valid license under this act. The following guidelines are to be followed to procure a license in
Karnataka State.

1. According to Mental Health Act, chapter 1, section 2(G) , the deputy commissioner of districts are
nominated as the authority to issue license (government circular no.HFW222 PTD 2001 dated
08/10/2001).
2. The application is to be submitted to the concern authority.
Form 1- Application for maintaining a psychiatric hospital/ psychiatric nursing home.
Form 2- Application for the establishment of psychiatric hospital/psychiatric nursing home.
3. License fee as under should be paid.
50 bedded Hospital/Nursing Home-Rs.1000/51-100 bedded Hospital/Nursing Home-Rs.2000/More than 100 bedded Hospital/Nursing Home Rs. 5000/4. After receipt of application the licensing authority will make enquire deemed fit to ascertain the
suitability. For this vide Govt. Order no. HFW21IME2006, dated 08/01/2007, District wise
inspecting officers have been Nominated. Inspections to be carried out through them.
a) The Government of India gazette notification dated 31/05/2007 has prescribed the following for
every 100 bedded mental health/nursing home.
I. A full time qualified Psychiatrist.
II. One Mental Health Professional Assistant (Clinical Psychologist or Psychiatric Social Worker)
III. Staff Nurses in the ratio of 1:10
IV. Attenders in the ratio of 1:5
V. Medical Officers having recognized MBBS Degree: Patient of 1:50.
5. If licensing authority is satisfied that the psychiatric hospital / nursing home is with the minimum
facilities prescribed, license can be sanctioned in the prescribed form, if it is not satisfactory can be
rejected with a suitable order .
6. Also the Authority which declines the license can give full opportunity for the applicant to tell
his /her grievances and give the reasons for each and every aspect for denial of license.

RECOMMENDATIONS FOR INPATIENT MENTAL HEALTH UNITS:

The information contained in this Design Guide is intended to be applied to locked inpatient mental
health facilities, with the goals of promoting safe and recovery-oriented environments.
DESIGN RECOMMENDATIONS:
- Flexibility
The design of a mental health facility needs to respond to changing workloads, care objectives, and
technologies, such as wireless technologies for staff.
Spaces should be universally designed to accommodate a range of related functions.
Standardization of unit layouts should be developed to reduce care team orientation to different
units and to streamline maintenance of each unit.
Group spaces in particular need to be designed and grouped to accommodate a range of functions
and to accommodate change if possible.
-

Efficiency

Support spaces, such as storage and utility rooms, should be designed to be shared where possible
to reduce the overall need for space.
Minimize unnecessary travel distances for nursing staff to use support space and to reach patient
rooms in an inpatient setting. Place most frequently used support areas closest to the central nursing
area.
-

Patient Needs

Patient and resident dignity, respect for individuality, and privacy should be maintained without
compromising the operational realities of close observation, safety, and security. Patient and resident
vulnerability to stress from noise, lack of privacy, poor or inadequate lighting, ventilation and other
causes, and the subsequent harmful effect on well being, are well-known and documented
A key architectural objective should be to reduce emphasis on the institutional aspects of care and to
surround the patient with furniture, furnishings, and fixtures that are appropriate from a safety
standpoint but are more residential in appearance. Proper planning and design should appeal to the
spirit and sensibilities of both patients and care providers. A spirit of community should be
encouraged. Mental health facilities should be environments of healing that allow the building itself

to be part of the therapeutic setting and process. The technical requirements to operate the building
should be unobtrusive and integrated in a manner to support this concept.

KEY DESIGN CONCEPTS FOR DESIGNING INPATIENT MENTAL

HEALTH UNITS INCLUDE:
Create a non-institutional, home-like environment through careful attention to external and
internal architectural features and interior design elements.
Layout should incorporate an open and bright design.
Unit configuration should be based on a pod-like design and should be absent of long
corridors in order to promote social engagement and interaction with staff and provide for a
more domestic and less institutional feel.
Layout should be free of blind corners. Portions of the unit, such as the office suite, should be
designed to be closed off after hours to reduce the amount of area within the unit required to
be supervised by staff.
Provide ample visual and physical access to nature, which promotes healing. Provide
attractive, secure outdoor spaces directly off the unit. In addition to ample courtyard space for
patient activities, consideration should be given to incorporating healing gardens. Indoor
patient activity areas should have access to natural light and views, as well as appropriate
acoustic control.
Incorporate wall color, trim, accent colors, and securely-anchored artwork in common areas
and patient rooms.
Minimize the potential for furnishings, fixtures, and equipment within the unit to be used as
a weapon or anchor point for hanging.
Develop multiple patient room clusters within the unit to allow for separation of different
patient sub-groups. Mental Health Facilities Design Guide December 2010
3-4 Office of Construction & Facilities Management
The nursing station should blend in both in scope and design with the therapeutic
environment. The nursing station should have direct visibility of all patient wings and activity
areas. The station itself should be designed to allow for informal interaction with patients
without compromising the confidentiality of patient records.
Include an identifiable reception area for greeting patients and their families in a lobby area
just outside the unit. In addition to functional benefits, a reception area sends a welcoming
message to users.
Sufficient signage should be placed to direct patients and families to this area.
For additional information and elaboration on principles identified above and throughout this
Guide with respect to designing therapeutic, home-like, and safe inpatient mental health
units.

RISK REDUCTION:

The following facility detailing, planning, and design concepts should be integrated into the project
to reduce the following risks in mental health facilities:
- Elopements:
1. Allowing one way in and out of congregate areas, as allowed by code.
2. Courtyards instead of fenced outdoor areas.
3. Electronic door controls for emergency egress as allowed by code.
4. Simple circulation with no blind spots.
5. Casual observation (visibility from staff offices and work areas that are not directly responsible for
observing patients)
- Patient Behavioral Incidents:
1. Visibility
2. Specify products for the facility that cannot be used as a weapon or used in a suicide attempt.
3. Design appropriate abuse resistance in areas where patients are left alone for periods of time.
4. Integrate technology to assist in observing and maintaining security in areas not readily visible to
staff.
5. Equipment, carts, and other supplies should be adequately stored in locked rooms. Alcoves should
not be used for storing or parking of equipment, carts and assistive devices in corridors and other
unsecured areas.
- Reducing Patient/Staff Injuries:
1. Appropriate accommodations for disabled and bariatric patients.
2. Eliminate balconies, openings, etc. that would allow a patient to jump froman elevated platform.
3. Patient rooms and other areas where patient is alone have enough abuse resistance to allow time
for an appropriate response team to arrive before a patient harms themselves or is able to exit the
space.
- Reducing Patient and Staff Stress:

1. Natural light in staff/patient areas.

2. Noise control.
3. Open layout, with no unnecessary barriers between staff and patient.
4. Space for both patients and staff is designed so neither feels trapped or vulnerable; overcrowding
is avoided.
5. Attractive views of the exterior.
6. Use of natural materials, a soothing color palette and residential character in the interior design of
the facility.
7. Familiar and healing environments.
8. Patient and staff areas that allow for relaxation and controlling ones social environment (e.g.,
quiet rooms, staff lounges, secure outdoor space).

SPECIFIC REQUIREMENTS FOR PSYCHIATRIC UNIT:

-

Security:

The design shall provide the level of security appropriate described in the functional program for the
specific type of service or program provided as well as the age level, acuity, and risk of the patients
served (e.g., geriatric, acute psychiatric, or forensic for adult, child, and adolescent care).
-

Perimeter security:

If it is provided, Perimeter security shall addresses elopement prevention, prevention of contraband

smuggling, visitor access control, and exit ingress and egress processes and procedures and meet the
following requirements: .
(1) A perimeter security system shall be provided that will contain patients within the nursing unit or
treatment areas outside the unit until clinical staff and/or hospital security can escort them to an
adjacent compartment or an exit stair.
(2) The perimeter security system shall be designed to prevent limit contraband smuggling and shall
include provisions for monitoring and controlling visitor access and egress.
(3) Openings in the perimeter security system (e.g., windows, doors, gates) shall be controlled by
locks (manual, electric, or magnetic) when required by the functional program.

(4) Use of security cameras or alternate and other security measures consistent with the functional
program requirements shall be permitted.
- Toilet room doors:
(a) Where indicated by the patient safety risk assessment, toilet room doors shall be equipped with
keyed locks that allow staff to control access to the toilet room.
(b) If a swinging door is used, The door to the toilet room shall swing outward or be double acting.
(c) Each entry door into a patient toilet room required to provide space for health care providers to
transfer patients to the toilet using portable mechanical lifting equipment.
(5) Where a toilet room is required:
(a) Thresholds shall be designed to facilitate use and to prevent tipping of wheelchairs and other
portable wheeled equipment by patients and staff.
(b) Grab bars shall be designed to facilitate use (i.e., be graspable) but not be loop able.
(6) Where indicated by the psychiatric patient injury and suicide prevention risk assessment, use of
alcohol-based hand rubs shall be prohibited in patient toilet rooms.
- Patient bathing facilities:
(1) A bathtub or shower shall be provided for each six beds not otherwise served by bathing facilities
within the patient rooms.
(2) Bathing facilities shall be designed and located for patient convenience and privacy.
- Patient storage:
(1) Each patient shall have within his or her room a separate wardrobe, locker, or closet for storing
personal effects.
(2) Shelves for folded garments shall be used instead of arrangements for hanging garments.
(3) Adequate storage shall be available for a daily change of clothes for seven days.
- Outdoor Areas:

When outdoor areas are required by the functional program, they shall meet the following
requirements:
- Fences and walls serving a locked unit shall be designed to:
(1) Hinder climbing.
(2) Be installed with tamper-resistant hardware.
(3) Have a minimum height of 10 feet (3.04 meters) above the outdoor area elevation.
(4) Be anchored to withstand the body force of a 350-pound (158.9-kg) person.
If provided, gates or doors in the fence or wall shall:
(1) Swing out of the outdoor area.
(2) Have the hinge installed on the outside of the outdoor area.
(3) Be provided with a locking mechanism that has been coordinated with life safety exiting
requirements.
Trees and bushes shall not be placed adjacent to the fence or wall.
Plants selected for use shall not be toxic to patients if consumed.
Lights shall not be accessible to patients. Poles supporting lights shall not be capable of being
climbed.
If provided, security cameras shall not be accessible to patients and cameras shall view the
entire outdoor area.
If provided, furniture shall be secured to the ground. Furniture shall not be placed in locations
where it can be used to climb the fence or wall.
Elevated courtyards or outdoor areas located above the ground floor level shall not contain
-

skylights or unprotected walkways or ledges.

Comfort/quiet room:

If required by the functional program, a comfort/quiet room shall be provided for patients who
require less stimulation, but do not require a seclusion room.
a) In acute psychiatric hospitals, the number of seclusion treatment rooms shall be permitted to
be decreased with the use of comfort/quiet rooms; however, at least one seclusion treatment
room shall be provided.
b) In long-term psychiatric facilities, provision of comfort/quiet rooms shall be permitted in lieu
of seclusion treatment rooms based on the functional program.

c) A minimum of 80 square feet per patient/resident shall be provided in a comfort/quiet room.

- Nourishment area:
Food service within the unit may be one or a combination of the following:
(1) A nourishment station
(2) A kitchenette designed for patient use with staff control of heating and cooking devices
(3) A kitchen service within the unit that includes a hand-washing station, storage space, refrigerator,
and facilities for meal preparation.
Environmental services room. Location of this room either in or immediately accessible to the
nursing unit shall be permitted unless otherwise dictated by the functional program. For
requirements.
- Consultation room(s):
(1) Separate consultation room(s), with a minimum floor area of 100 square feet (9.29 square meters)
each, shall be provided at a room-to-bed ratio of one consultation room for each 12 psychiatric beds
or fewer.
(2) The room(s) shall be designed for acoustical and visual privacy and constructed to achieve a level
of voice privacy of 50 STC (which in terms of vocal privacy means that some loud or raised speech
is heard only by straining, but is not intelligible).
(3) The visitor room may serve as a consultation room.

Conference room:- A conference and treatment planning room shall be provided for use by

the psychiatric unit. This room may be combined with the charting room.
Space for group therapy:- This may be combined with the quiet space. (Social spaces) when
the unit accommodates no more than 12 patients and when at least 225 square feet (20.90
square meters) of enclosed private space is available for group therapy activities. Patient
laundry facilities. Patient laundry facilities with an automatic washer and dryer shall be

provided.
Patient storage facilities:- A staff-controlled secured storage area shall be provided for
patients effects that are determined to be potentially harmful (e.g., razors, nail files, cigarette
lighters). Child psychiatric unit patient areas shall be separate and distinct from any adult
psychiatric unit patient areas Capacity. Maximum room capacity shall be four children.

Space requirements:- Patient room areas (with beds or cribs) shall meet the following space
requirements:

- For single-bed rooms, a minimum of 100 square feet (9.29 square meters).
- For multiple-bed rooms, a minimum of 80 square feet (7.43 square meters) per bed and 60
square feet (5.57 square meters) per crib

Patient toilet room:- Each patient shall have access to a toilet room, including access via a

corridor where permitted by the functional program.

1) The combined area for social activities shall have 35 square feet (3.25 square meters) per
patient.
2) The total area for social activities and dining space shall have a minimum of 50 square feet
(4.65 square meters) per patient.
3) If a separate dining space is provided, it shall have a minimum of 15 square feet (1.39 square
meters) per patient.

ECT AREA:
If ECT is included in the functional program, the requirements in this section shall be followed, with
the exception noted in below:Where a psychiatric unit is part of a general hospital, all of the requirements shall be permitted to be
accommodated in an operating room in a surgical suite that meets the requirement.

Guidelines for issuing licence to Psychiatric Institutions:

A. Manner and conditions of maintaining Psychiatric institutions - (Rule 20 of State Mental
Health Rules 1990):a. such Psychiatric Institutions should be located only in the area approved by the local authority;
b. such Psychiatric Institutions should be located in the building constructed with the approval of
the local authority;
c. the building, where such Psychiatric Institution is situated, should have sufficient ventilation and
should be free from any pollution which may be detrimental to the patients admitted in such
hospital or nursing home;
d. such Psychiatric Institutions should have enough beds to accommodate thepatients;
e. The nurses and other staff employed in such Psychiatric Institutions should be duly qualified and
competent to handle the work assigned to them;
f. The supervising officer in charge of such Psychiatric Institutions should be a person duly
qualified, having a post-graduate qualification in Psychiatry recognized by the Medical Council
of India.

B.

Minimum facilities required for treatment of in patients (Rule 22 of State Mental Health

Rules 1990) (section 10 of the Act)

The minimum facilities required for every Psychiatric Institutions for treatment of patients shall be as
follows:
1. Staff requirements.a. Psychiatrists: (i) A psychiatric hospital/psychiatric

Nursing

Home,

Forensic

Psychiatric

units

and

Child/Adolescent Psychiatry Clinic &Guidance Units should have at least a full time psychiatrist
for every 100 patients and parts there of;
(ii) De-Addiction centers should have the service of a Consultant Psychiatrist visiting the hospital,
and examining the in patients every day, conducting OP at least two hours twice in a week and
will be available on call to attend on emergencies.
(iii)
General Hospital Psychiatry units/beds should have the service of a Consultant Psychiatrist
conducting OPs on the days on which Psychiatric patients are admitted and visiting Psychiatric
inpatients in the hospital every alternate day and will be available on call to attend on
emergencies.
(iv)A Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units should have a
Psychiatrist who will be attending these centers for at least one half day session in a week and
will be available on call to attend on emergencies
(v) Long term Psychiatric Care Homes should have at least one qualified Psychiatrist visiting the
institution at least once fortnightly and review all the patients and will be available on call to
attend on emergencies.
b. Medical Officers having recognized M.B.B.S Degree.A psychiatric hospital/psychiatric Nursing Home, De-addiction center,

Forensic Psychiatric units

and Child/Adolescent Psychiatry Clinic &Guidance Units should have Medical Officers having
recognized M.B.B.S Degree in the doctor Patient ratio of 1:50 and round the clock service of one
Medical Officer should be available in the facility.
c. Clinical Psychologist or Psychiatric Social Worker: (i) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, Forensic Psychiatric Units
and Child/Adolescent Psychiatry Clinic &Guidance Units should have at least one full time
Clinical Psychologist or Psychiatric Social Worker for every 100 patients and parts there of
(ii) In Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units, service of at
least one Clinical Psychologist or one Psychiatric Social Worker during the hours of operation of
(iii)

the institution.
Long term care homes should have the services of one Clinical Psychologist or One
Psychiatric Social Worker and they should attend half-day duty in every week.

d. Staff Nurse.(i) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, Forensic Psychiatric Units
and Child/Adolescent Psychiatry Clinic &Guidance Units should have one staff nurse for every
10 beds and round the clock service of at least one staff nurse should be made available in each
ward.
(ii) Psychiatric Rehabilitation Homes/Centers or other Partial hospitalization units should have one
Staff Nurse for every 15 beds and service of at least one staff nurse should be made available
round the clock.
(iii)
Long term Psychiatric Care Homes should have one staff nurse for every 15 beds.
e. Attenders.(i) ANMs, Nursing Assistants, Hospital Attendant Gr I & II will be treated as Attenders for licensing
purpose.
(ii) Psychiatric Hospital/Psychiatric Nursing Home, De-Addiction Centre, ForensicPsychiatric Units,
and

Child/Adolescent

Psychiatry

Clinic&

Guidance

Unit,

Psychiatric

Rehabilitation

Homes/Centers or other Partial hospitalization units should have one Attender for every 10
patients/beds
(iii)
Long term care homes should have one Attender for every 15 beds.
(iv)In the case of institutions where patients are admitted only with bystanders, the minimum
number of attenders shall not be insisted
(v) Service of a watcher should be provided round the clock at the entrance of the Psychiatric
institution
f. Further staff requirements.Further staff requirements for the different types of the institutions shall be Provided as per
guideline issued by the State Mental Health Authority, in this regard from time to time.
2. Physical features.a) The plinth area of the building, housing a Psychiatric Hospital/Psychiatric Nursing Home or
other Mental Health Care centers, shall ordinarily occupy only half of the land area of the plot in
which it is located. In situations where there is genuinedifficulty to provide this much of open
land area, 10% to 30% of the total carpet area prescribed for patients shall be provided as
additional living area, depending on the quantum in shortage of open land area.
b) The open land area or the additional living area shall be easily accessible to the in patients.
c) There should be proper drainage system and facility for waste disposal.
d) Each patient should be provided with an area of 60 sq. feet as dormitory and further 30 Sq. feet
as living room cum dining room area
e) There should be one bath room and one toilet each for every eight male patients and for every six
female patients.
f) The floor area for dormitory, living room and dining room mentioned above are exclusively for
the use of the patients. Additional floor area for the use of the staff has to be provided separately,
to meet standard requirements.

g) There should be adequate ventilation and supply of safe drinking water and the patients should
have access to drinking water round the clock.
h) There should be proper compound wall to ensure the protection of the patients.
i) Cots, beds, pillows and adequate number of bed sheets and pillow covers should beprovided to
all inmates in the Psychiatric institutions and separate dining rooms should be available for male
and female inmates.
j) A register should be maintained with watcher and, the name, purpose and time of visit of all the
visitors should be entered in the register for psychiatric hospital and nursing home. In the case of
GH with Psychiatry ward/beds this register should be kept by the ward staff.
k) There should be separate dining room for male and female inmates.
l) A written booklet showing the details of, facilities and privileges available in the institution is to
be maintained.
m) The details of the staff working in the institution and facilities available have to be displayed in a
notice board in a prominent place in the institution.
(3) Support / facilities:(i) The minimum support /facilities for Psychiatric Hospitals/Psychiatric Nursing Homes specialized
Psychiatric Hospitals/Specialized Psychiatric Nursing Home like De- addiction centers, Forensic
Psychiatric Units and Child/Adolescent Psychiatric Centre should be as under:
(a) Provision for emergency care for outpatients and for handling medical emergencies for
outpatients and inpatients.
(b) A well-equipped modified electro convulsive therapy unit (optional);
(c) Psycho diagnostic facilities
(d) Provision for recreational/rehabilitation activities; and
(e) Facilities for regular out patient care.
(ii) Rehabilitation Centre or other Partial Hospitalization Units and long term Care Homes should
have provision for Recreation and Rehabilitation activities.
(4)Provision for treating out patients (section 14 of Mental Health Act)
a) Psychiatric Hospitals/Psychiatric Nursing Homes should have outpatient section open at least for
three hours per day for six days in a week.
b) Specialized Psychiatric Centers like De-addiction centers; Child/Adolescent Psychiatric Centers
should have an outpatient section working for at least two hour twice in a week.
c) General Hospital Psychiatry units, should have Out Patient services on every alternate days
(Minimum 3 days in a week) for at least three hours
d) Rehabilitation Centers or other partial hospitalization units should have two hour outpatient
section once in a week.

e) Outpatient section in all these centers should be manned by a Psychiatrist and the presence of a
Clinical Psychologist/Psychiatric Social Worker and (Psychiatric) Nurse are to be ensured as far
as possible.
f) All admissions should be made through the Outpatient section as far as possible When
admissions are made out-side of the outpatient section, the psychiatrist inCharge shall record on
the patients case record, the reasons for resorting to such a procedure

(5) Further Amenities.Further amenities for the patients shall be provided as per guide lines issued in this regard by the
State Mental Health Authority from time to time.

C. Maintenance of records (Rule-24 of State Mental Health Rules 1990) :- Every institution shall
maintain the records of the treatment of patient in Form VI of State
Mental Health Rules 1990.

D. Other provisions:
(i)
General Hospital with Psychiatry Units/beds.:- All the provisions in this Guidelines
applicable for Psychiatric Hospitals/Psychiatric Nursing Homes except that for the service of
full time Psychiatrists will be applicable for General Hospital with Psychiatry units/beds
(ii)

also.
Minimum number of Staff Nurses and Attenders required:- For
Hospital/Psychiatric Nursing Home, De-Addiction Centre,
Child/Adolescent Psychiatry Clinic &

Psychiatric

Forensic Psychiatric Units,

Guidance unit and Psychiatric Rehabilitation

Centersminimum number of Staff Nurses and Attenders required will be 3 each irrespective
(iii)

of the number of beds in the institution.

In the absence of qualified Clinical Psychologists service of trained Psychologists will be
considered for issuing license to private psychiatric institutions. This is a temporary
arrangement which will be continued till the shortage of qualified Clinical Psychologists is

(iv)

over.
In the absence of qualified Psychiatric Social Workers service of trained Medical Social
workerswill be considered for issuing license to private psychiatric institutions. This is a
temporary arrangement which will be continued till the shortage of qualified Psychiatric
Social Workers is over.

THE STANDARDS OF PSYCHIATRIC NURSING PRACTICE:

The Standards of Psychiatric Nursing Practice describes, in broad terms, the expected level of
performance of all Registered Psychiatric Nurses. There are four (4) Standards of Psychiatric
Nursing Practice. A standard may be defined as a benchmark of achievement that is based on a
desired level of excellence. The standards provide a guide to the knowledge, skills, values, judgment,
and attitudes that are needed to practice safely. They reflect a desired and achievable level of
performance against which actual performance can be compared. Their main purpose is to promote,
guide, and direct professional psychiatric nursing practice.
Under each standard of practice there are a number of indicators that help determine how to meet the
standard of practice. An indicator is a statement that helps illustrate how the standards can be met.
The indicators are representative but not comprehensive for each standard.
STANDARD 1: THERAPEUTIC INTERPERSONAL RELATIONSHIPS:Registered Psychiatric Nurses establish professional, interpersonal, and therapeutic
relationships with individual, groups, families, and communities.
Indicators:
A Registered Psychiatric Nurse:

Acts as role model for positive professional, interpersonal, and therapeutic relationships.

Uses professional judgment and practices with personal integrity to initiate, maintain, and
terminate professional, interpersonal, and therapeutic relationships.

Consistently applies processes of self-awareness within professional practice.

Collaborates and advocates with individuals, families, groups, and communities.

Creates therapeutic environments in diverse practice settings.

Creates partnerships in professional, interpersonal, and therapeutic relationships.

Recognizes and addresses power imbalances in professional, interpersonal, and therapeutic

relationships.

STANDARD 2: APPLICATION AND INTEGRATION OF THEORY-BASED KNOWLEDGE

Registered Psychiatric Nurses apply and integrate theory-based knowledge relevant to
professional practice derived from psychiatric nursing education and continued life-long
learning.
Indicators:
A Registered Psychiatric Nurse:

Uses theory-based knowledge in psychiatric nursing practice.

Synthesizes and applies recognized theories or frameworks to engage in innovative problem

solving.

Provides theoretical and/or evidence-based rationale for psychiatric nursing practice.

Applies theory to psychiatric nursing decisions and interventions.

Applies theory-based knowledge, skill, and judgment to assess, plan, implement, and evaluate the
practice of psychiatric nursing.

Applies critical thinking in the problem solving process.

Applies communication theory to ensure effective verbal and written communication.

Applies documentation principles to ensure effective written communication.

Remains current in knowledge relevant to the professional practice setting.

Engages in life-long learning.

STANDARD 3: PROFESSIONAL RESPONSIBILITY

Registered Psychiatric Nurses are accountable to the public for safe, competent, and ethical
psychiatric nursing practice.
Indicators:
A) Registered Psychiatric Nurse:

Practices in accordance with the Code of Ethics, Standards of Psychiatric Nursing Practice, and
relevant legislation.

Assumes responsibility and accountability for own practice.

Recognizes personal and professional limitations and consults and refers appropriately.

Creates and maintains professional boundaries.

Integrates cultural safety into psychiatric nursing practice.

Recognizes and reports unprofessional and/or unethical conduct.

Assumes responsibility and accountability for continuing competence.

STANDARD 4: PROFESSIONAL ETHICS:

Registered Psychiatric Nurses understand, promote, and uphold the ethical values of the
profession.
Indicators:
A) Registered Psychiatric Nurse:

Practices and conducts ones self in a manner that reflects positively on the profession.

Promotes and adheres to the professional Code of Ethics.

Uses ethical principles to guide psychiatric nursing practice.

Applies the elements of confidentiality and consent in psychiatric nursing practice.

Recognizes the power imbalance in the therapeutic relationship and mitigates the risks of
exploiting that power.

Supports the rights of clients to make informed decisions.

Maintains boundaries between professional and personal relationships.

ANA Standards for Psychiatric Nursing Practice:Standard I -Assessment The RN collects client data.
Standard II - Diagnosis The RN analyzes assessment data and determines a nursing diagnosis.
Standard III - Outcome Identification The RN identifies expected outcomes individualized to the
client.
Standard IV - Planning The RN develops a plan of care that is negotiated among the client, nurse,
family and health care team and prescribes evidence based interventions to attain expected outcomes.
Standard V-Implementation The RN implements the interventions identified in the plan of care.
Standard Va -Counseling The RN uses counseling interventions to assist clients in improving or
regaining their previous coping abilities, fostering mental health, and preventing mental illness and
disability.
Standard Vb - Milieu Therapy

The RN provides, structures and maintains a therapeutic

environment in collaboration with the client and other health care professionals.

Standard Vc - Promotion of Self-Care Activities The RN structures interventions around the

client's ADL's to foster self-care and mental and physical well-being.
Standard Vd -Psychobiological Interventions The RN uses knowledge of psychobiological
interventions and applies clinical skills to restore the client's health and prevent further disability.
Standard Ve - Health Teaching The RN, through health teaching, assists clients in achieving
satisfying, productive, and healthy patterns of living.
Standard Vf - Case Management The RN provides case management to coordinate comprehensive
health services and to ensure continuity of care.
Standard Vg - Health Promotion and Health Maintenance

The RN employs strategies and

interventions to promote and maintain health and prevent mental illness.

DOCUMENTATION:
The facility shall maintain a record for each person admitted to a psychiatric clinic. The record shall
include the following:
(1) Patient identifying information
(2) Referral source.
(3) Presenting problems.
(4) Appropriately signed consent forms.
(5) Medical, social, and developmental history.
(6) Diagnosis and evaluation.
(7) Treatment plan.
(8) Treatment progress notes for each contact.
(9) Medication orders.
(10) Discharge summary.
(11) Referrals to other agencies, when indicated.

(b) Records shall also be maintained as follows:

(1) Legible and permanent.
(2) Reviewed periodically as to quality by the facility or clinical director as appropriate.
(3) Maintained in a uniform manner so that information can be provided in a prompt, efficient,
accurate manner and so that data is accessible for administrative and professional purposes.
(4) Signed and dated by the staff member writing in the record.
(c) Confidentiality of mental health records.
(d) All case records shall be kept in locked and protected locations to which only authorized
personnel shall be permitted access.