Introduction

The mental health care system in Australia has remained a dynamic one up to the present time and more especially during the early stages of colonization. This history focuses on the life experiences of Martha Entwistle, a convict nurse who served at Castle Hill Asylum (Raeburn et al., 2018). Her case is a perfect example of a cruel world and lack of food supply so typical for the 19th-century mental health treatment. It is important to examine these historical accounts to understand how far mental health care has come in the present.

This paper intends to compare the mental health situation during the time of Martha Entwistle and the present period. The discussion will cover issues like the acute and community mental health services alterations, engaging families and other communities, and developing processes of security and care. In addition, the paper shall describe the evolution of ethical concerns, the emergence of health promotion models, and assessment and planning to demonstrate the progress and future challenges in present day mental health practice.

Acute and Community Mental Health Settings

As for mental health care in Australia, it can be noted that during the early 19th century, it was not developed and provided with poor treatment and a rather simple approach. Martha Entwistle, a patient at the Castle Hill Asylum, the first mental health facility in the country, had her movements limited severely during her stay at the facility. The asylum, originally built as a convict outstation, was grossly inadequate and perennially under resourced (Raeburn et al., 2018).

The care that was offered was basic, sometimes bordering on abuse, due to the lack of clear differentiation between those who needed emergent treatment and those who could be managed through outpatient services. Entwistle, like many other caregivers of her time, was not professionally trained, which made it even more challenging to provide proper care. Inhumane and barbaric treatments were administered to the patients in what was more like a prison than a hospital. 

Fast forward to the present, the face of mental health has undergone a complete revolution. Contemporary acute care settings are purpose-built to meet the urgent, and sometimes complex, requirements of clients, with individualized units and interprofessional teams focused on client-centered care (Vaggers & Anderson, 2021).

The concept of community care services has also grown over the years to provide a mechanism where those with mental disorders could be taken back to the community and provided with care within their social context. This is a major deviation from the institutionalization model and is more focused on patient centered care and respect to their dignity. Modern mental health care is integrated, involving psychological, social and medical treatment that is personalized, unlike the traditional approach that was generalized. 

In comparison to the historical practices, there has been a significant improvement in infrastructure, patient’s treatment, and resources management. Where once patients were confined in poorly constructed structures and given simple and sometimes cruel treatments, they are now treated in clean and well-equipped structures that promote healing.

The shift from a punitive and imprisoning approach to one that focuses on treatment and recovery is a much-needed change, given that mental illness is now better understood as a health issue rather than a criminal justice matter. Another major change has been observed in the area of resource allocation where considerable funds are now being committed to ensure that both the acute and the community care systems are well equipped to address the multifaceted needs of the people (Vaggers & Anderson, 2021). 

Relevance of Family and Extended Communities

During the time of Martha Entwistle, families and other extended communities had no role in mental health care. Such patients as those taken to institutions such as Castle Hill Asylum were cut off from their families who, socially rejected and economically struggling, could not afford to cater for their needs any further.

Within these asylums, the emphasis was placed on seclusion and restraint, while the concept of family relationships was not given any attention in the treatment process (Raeburn et al., 2023). Therefore, patients were provided with severe loneliness, they had no social contacts that could have a positive impact on their mood. Lacking familial support only compounded these circumstances further making the already difficult situations even worse, thereby, increasing the chances of further isolation and hampering any possible recovery. 

The current approaches to the delivery of mental health services have shifted to embrace the role of families and communities. Modern families are not only welcomed but expected to be involved in the care process. They are not mere visitors to the patient’s life but active participants in the planning and implementation of treatment measures.

This change is based on the fact that mental health involves social and emotional support systems in an individual. It involves a joint effort between the families and the healthcare providers to develop an individualized comprehensive care plan that addresses both the medical, psychological, and social aspects of the patient. Furthermore, communities have assumed the role of providing needed support structures and networks that provide resources, social contacts, and opportunities for reintegration into society. 

It is important to understand the extent of change that has been brought about by this evolution in terms of patient outcomes. Close-knit family and community support has been associated with higher levels of compliance to treatment regimens, lower rates of relapse, and better overall outcomes (Pitanupong & Sammathit, 2023). Social connections make patients feel as if they belong and have something to do in society, and this is essential for mental health. In addition, the active participation of families guarantees that the patients receive persistent care after the formal therapy is over, which contributes to their stability and well-being in the long run.

This is different from the traditional medical model where the onus was on the health care provider to take care of the mentally ill individual, but now the family and other members of the community are involved in the recovery process.

Practice Changes for Safe and Supportive Care

The practices used for the delivery of care at Castle Hill Asylum where Martha Entwistle worked were barbaric and cruel. Originally built as a convict outstation, the facility was grossly under-equipped and understaffed. Treatment was mainly focused on managing symptoms and no consideration was given to the recovery process.

The treatments were primitive and often brutal, more concerned with controlling the patient’s actions than with helping him to heal. Physical treatments such as bloodletting and other forms of invasive treatments were also practiced, which was a clear indication of the primitive knowledge about mental health (Raeburn et al., 2018). It depicted that the environment was depressing, and the patient had little support; they were placed in poorly maintained conditions, and the main focus was their containment rather than treatment. 

The practice of mental health care in the present generation has been revolutionized (Alowais et al., 2023). The shift from such crude and severe approaches to the contemporary, patient-oriented approaches is marked by the adoption of evidence-based practices and the creation of protocols. Contemporary mental health centers are centers of healing and the programs that they provide are unique to the patient. The care is offered by a team of people including psychiatrists, psychologists, nurses and social workers who take time to understand the patient and design a comprehensive treatment plan that addresses all facets of the patient’s life. Such practices are rooted in modern research data, which implies that the interventions used are efficient and sensitive. 

While the practices of the early mental health care were often unhygienic and sometimes even fatal, the present day mental health care has several standard protocols that safeguard the patients. Such standards include the physical properties of the environment and the procedures for addressing emergencies and mitigating risks. On the care of the patient, it has been transformative, shifting from the patient’s care in the environment that respects, values, and fosters healing (Sharp et al., 2021).

The patient is no longer an object that needs to be manipulated but a person who has certain rights and requires that they be protected and their needs met in a safe environment. This evolution shows a stark difference from the colonial era and a clear indication of the progress made in the development of humane and effective care settings.

Approaches in Ethical Considerations and Contemporary Legal Issues

In Martha Entwistle’s time, the ethical issues involved in mental health care were full of dilemmas that would be considered utterly reprehensible in the present day (Raeburn et al., 2023). Such convict nurses as Entwistle were compelled to provide care without any form of training, which raised deep ethical questions. These were people who were themselves confined in prison and were expected to attend to patients in conditions that were more of punishment than care.

These nurses lacked proper training and were not equipped to deliver proper or even empathetic care; they were reduced to performing therapeutic measures that were more akin to detention. Moreover, the environment in which they operated did not have a very positive attitude towards mental illness; rather, it considered it a criminal matter. This confusion of punishment with care is a perfect example of the ethical issues of the time, when the dignity and rights of patients were violated. 

According to Comer (2022), the unethical practices that occurred in the past have significantly influenced the formation of the modern ethical principles and legislation in mental health. Admitting the crudities and injustices of the earlier practices, modern mental health care is regulated by strict ethical standards that pay much attention to the patient’s rights, including their right to dignity, self-determination, and the right to be informed.

The caregivers of today are well-educated individuals who work under policies that uphold the values of dignity, integrity, and research. The transition from the punitive model to the medical model of treatment and patients’ rights is indicative of a shift in culture, where mental health is recognized as a vital component of a person’s well-being that requires a comprehensive ethical approach. 

The rights of patients have been enhanced in many ways, which is a far cry from the legal situation in the past. During the earlier period, the patients had no privileges at all; their care was administered as per the convenience of the institution and not by considering their best interest. In the contemporary society, strong legal systems guarantee that patients enjoy their legal rights and liberties such as right to consent to treatment, right to privacy and right to be treated humanely (Comer, 2022). These legal measures are meant to protect people from the previous mistreatments, ensuring that people receive proper care that acknowledges their worth at every phase. These legal and ethical standards signal a more profound commitment to human rights and ethical responsibility, in contrast to colonial barbarity.

Health Promotion and Mental Illness

During the period of Martha Entwistle, the concept of health promotion was not very developed, and it mainly involved the moral treatment approach. Based on the idea that orderly occupations and rigid schedules could cure the mentally ill, this philosophy focused on work and ethical behavior. As most asylums of the nineteenth century, the patients of Castle Hill Asylum were exposed to these regimens because it was believed that work and discipline would cure insanity (Raeburn et al., 2023).

The concept of social determinants of mental health was hardly acknowledged, and there was minimal focus on early intervention. The emphasis was not on prevention or on the general mental health of the population, but on controlling symptoms once the individual was in the asylum. Consequently, these early attempts at health promotion were limited and to a great extent, unsuccessful due to the lack of knowledge and resources. 

Today, health promotion strategies have changed significantly to embrace the concept of mental health as not a simple matter. Contemporary models are integrated, focusing on early intervention and community-based prevention programs aimed at addressing the causes of mental disorders. Public awareness programs have become important today as they help in creating awareness on mental health issues, changing attitudes towards mental illness, and promoting timely treatment. Mental health interventions are policies that help foster mental health by encouraging physical activity, social interactions, and easy access to mental health services (Hale et al., 2021).

Also, mental health is no longer considered a separate entity and is aligned with other health-related initiatives, which recognize the connection between physical and mental health. This comprehensive approach guarantees that mental health aspects are incorporated into the promotion of public health, including proper nutrition, exercise, non-use of substances, and prevention of various diseases. 

In contrast to the previous approaches that were either scarce or frequently inadequate, modern interventions have effectively lowered the rates of mental health problems through eradicating root causes and improving quality of life (Morganstein & Ursano, 2020).

Significant progress has been made in the reduction of risk factors through early intervention programs, support from the community, and effective public health awareness campaigns, which has improved mental health status in individuals and the society. This is a significant shift from the practices of Entwistle’s time, and a clear demonstration of the success of a strategic, coordinated approach to mental health promotion.

Changes to Assessment and Planning Processes

During the first half of the nineteenth century, the assessment and planning of the mental health care were rudimentary especially in places such as Castle Hill Asylum (Raeburn et al., 2018). The techniques used were crude, and the observations made were based on mere impressions and broad judgments. It was common to see patients being grouped into broad categories of behavior and their individuality and medical conditions not being considered. Lack of staff training and medical knowledge of the time led to rather crude and unrefined assessments of the patients. If one could speak of care planning at all, it was much more oriented toward control and management than toward the patients’ requirements. It was general, with little attention paid to individual treatment plans, and the main objective was to prevent disruption. 

The current approaches to assessment and planning are different from the traditional ones and have brought a revolution in the mental health field. Currently, a team approach is employed where a psychiatrist, a psychologist, a social worker, and a nurse work together to develop a treatment plan for the patient. These plans are not only extensive but also individualized, meaning that they are developed to suit the patient’s requirements and conditions. Contemporary evaluations employ a range of tests and procedures that take into account psychological, social, and biological determinants of mental health (Kirkbride et al., 2024). Technology is indispensable here, with electronic health records helping to maintain continuity of care and keep all assessments current and easily shared among the care team. Sophisticated technologies such as predictive analytics build on the foundation of enhanced accuracy of diagnoses and individualized treatment plans, which in turn enables more effective interventions. 

Contemporary evaluation and planning result in improved diagnosis and more effective interventions (Kirkbride et al., 2024). Patient outcomes have changed for the better because of the approaches that are introduced in the care plans which are flexible, adaptable and evidence-based. The emphasis on the patient-oriented approach ensures that the clients receive the necessary care to recover and eliminate mental issues rather than being treated as objects of an organization. It also demonstrates the advancement of mental health care in terms of quality and effectiveness which is important in understanding the advancement since Castle Hill Asylum.

Conclusion

The paper point out how mentally ill patients in the early part of the nineteenth century were treated with cruelty and sometimes inhumanity as compared to present day humane and scientific treatments. While in the past, the aim was on the control of the disorder and the behavior of the patient that did not matter as a person, the modern models of treatment are person-centered, team, and technology-appropriate. These findings suggest that it is important for mental health practitioners to have knowledge of this historical experience in order to enhance the effectiveness of practice and the results that could be expected. It means that people have to acknowledge that it is possible to learn from the past and build better and more compassionate treatments for patients. Further research should focus on the effectiveness of using new technologies in the treatment of mental diseases and on the further elaboration of such patient-oriented approaches which, at the same time, would remain original and sensitive to patients’ needs. 
 

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