Mental Health

- a Public Health Challenge

What is a mental health?

� Absence of mental illness

� Positive mental health

� Mental well-being

Public mental health

� Promotion of mental health

� Prevention of mental illness

� Prevention of disability due to

mental illness

Subjective well-being

� Feeling good

� Life satisfaction

� Happiness

Psychological well-being

� Autonomy

� Self acceptance

� Personal growth

� Purpose in life

� Environmental mastery

� Positive relations with others

Emotional and social well-being

� Absence of behaviour problems

� Absence of emotional problems

� Doing what they are told

� Self esteem

� Good relationships with peers

What is a mental illness?

It is when someone lacks the ability to

manage day to day events and/or

control their behavior so that basic

physical and emotional needs are

threatened or unmet.

What is mental illness like?

Mental illness is a

physical condition just

like asthma or arthritis.

But still society believes

that a person who is

mentally ill needs to

show more willpower -

to be able to pull

themselves out it.

Mental illnesses are not the result of a personal weakness, lack of character, or poor

upbringing.

These disorders can affect persons of any

age, race, sex, religion, or income.

+..It is also like telling a person who has an amputated leg to run across the room.

But a person who has mental health issue

has a “broken brain”.

Myths of Mental Illness

� Mental illness is caused by bad parenting.

Fact: Most diagnosed individuals come from supportive homes.

� The mentally ill are violent and dangerous.

Fact: Most are victims of violence.

� People with a mental disorder are not smart.

Fact: Numerous studies have shown that many have average or above average intelligence.

0

1

2

3

4

5

6

7

8

CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004European Region

Last available

Prevalence of mental disorders (%)

0

1

2

3

4

5

6

7

8

1970 1980 1990 2000 2010 2020

CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004

Prevalence of mental disorders (%)

Life Years Lost due to Disability

Lopez et al for the World Bank OUP 2006

Unipolar depression Dementias Hearing Loss

Hearing Loss Alcohol Use Disorders

Osteoarthritis Cerebrovascular Disease

Chr. Obstr. Pul Disease Diabetes

Primary prevention of mental

disorders

� Promoting mental health

� Specific diseases

– Organic brain syndrome

– Crisis or situational reaction

– Schizophrenia

– Senility

– Personality disorders

Secondary prevention of

mental disorders

� Screening in large population groups

http://www.mentalhealthscreening.org/

� Crisis intervention

� Education of public to recognize mental

health in the early stages

Tertiary prevention of mental

disorders

� Psychiatric rehabilitation

� Reality orientation

� Outpatient rehabilitation

� http://www.biography.com/people/groups/un

natural-death/suicide/all

Suicide

• What is suicide?

• Prevalence rates

• Mental disorder and suicide

• Other risk factors

• Understanding suicide

• Suicide prevention

• Treating people who are suicidal

Prevalence rates

internationally highest suicide rates are in

eastern and northern European countries

Hungary – rate of 45/100,000

Denmark – rate of 32/100,000

low rates in mediterranean countries:

Greece – rate of 3/100,000

Spain – rate of 4/100,000

0

5

10

15

20

25

30

CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004European Region

Last available

SDR, suicide and self-inflicted injury, all ages, per 100 000

0

10

20

30

40

50

1970 1980 1990 2000 2010 2020

CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004

SDR, suicide and self-inflicted injury, all ages, per 100 000

MYTH OR FACT?

1. Myth: People who threaten suicide don’t go through with it

Fact: Most people who commit suicide have made direct or indirect statements about their suicidal intentions

2. Myth: Suicide happens suddenly and without warning

Fact: Most suicidal acts represent a carefully thought out strategy for coping with their problems

33

MYTH OR FACT?

3. Myth: People who attempt suicide have gotten it out of their system

Fact: Any individual with one or more prior suicide attempts is at much greater risk than those who have never attempted suicide

4. Myth: Suicidal people are intent on dying

Fact: Most suicidal people have mixed feelings about killing themselves; they are doubtful about living, not intent on dying. MOST WANT TO BE SAVED!

34

MYTH OR FACT?

5. Myth: Asking people about suicidal thoughts or actions will cause them to kill themselves

Fact: You cannot make someone suicidal when you show an interest in their welfare by discussing the possibilities of suicide� Concerned, non-judgmental questions encouraging the

person to discuss his/her ideas may help relieve the psychological pressure

6. Myth: All suicidal individuals are mentally ill

Fact: A suicidal person is extremely unhappy but not necessarily mentally ill; a “normal” person can be suicidal.

35

What is suicide?

• difficult to determine suicide

• taboo topic – a mortal sin

• used to be illegal in Canada

• difficult to know person’s intention

• large number of equivocal suicides

• reporting practices and judgments differ

widely making it difficult to get accurate

information

Key components

• act of deliberate self-injury – degree of self-

destructiveness

• appeal to other people – suicidal gesture,

“cry for help” (Farberow & Schneidman, 1961)

• intention – varies from clear intention to

unconscious wish to reckless/impulsive

behaviour to suicidal ideation, with many

people being ambivalent about suicide

� http://www.youtube.com/watch?v=1PGKdk2

Wmd8

Attempters and Completers

Characteristic Attempters Completers

Sex More often female More often male

Age Younger Older

Means Low lethality High lethality

Setting High chance of

rescue

Low chance of

rescue

Diagnoses Dysthymia,

Borderline

Personality

Mood disorder,

Schizophrenia,

Substance Abuse

Mental disorder and suicide

• Retrospective studies suggest that up to

90% of those who complete suicide had a

mental disorder at the time of their death

• Several mental disorders have high rates

of suicide:

- mood disorder

- schizophrenia

- substance abuse/alcoholism

Mental disorder and suicide

•Iowa 500 study followed people who had

been hospitalized for depression and

schizophrenia with a control group of

people without a mental disorder

• Suicide as a % of all deaths was 10% for

depression group, 10% for schizophrenia

group, and 0% for control group

Other risk factors

• Age – in general, older men have higher rates of

completed suicide (although the increase in

suicide in young men has narrowed this gap);

younger people higher rates of suicide attempts

• Marital status – high rates of suicide attempts

for single people; high rates of completed

suicide for people who are widowed, separated,

or divorced; risk also diminishes if person has

children

• Race – high among Caucasians and aboriginal

people

Other risk factors

• Physical illness

• Life stress – especially loss experiences

• Loneliness, isolation

• Previous attempts

• Suicide plan

• Family history

Suicide sometimes occurs after improvement in

mental health

Understanding suicide

•Biological – suicide is related to mental disorders,

serotonin level, genetic link

• Psychological – Freud, anger turned inward;

Cognitive-behavioural – modelling and social

learning; Existential-humanistic – hopelessness and

despair, lack of meaning

• Sociocultural – suicide is related to social norms

and culture

Emile Durkheim states that we must understand

the relationship between individual and society.

– Egoistic suicide: suicide of isolated individual.

– Altruistic: overinvolvement with society.

Suicide undertaken on behalf of the group.

– Anomic: when society fails to regulate its

members (adolescent rejected by peer group,

farmer ruined by economic structure)

– Fatalistic: excessive regulation (e.g.,

prisoners, slaves)

Suicide prevention

• No formal recognition of the problem in

Canada; no official government or professional

organization; “suicide – the deserted field”

• England – Anti-suicide prevention bureau, 1906;

New York, Save a life league

• England – Samaritans, 1953

• Los Angeles Suicide Prevention Center

(Farberow & Shneidman, 1961), 1960, AAS,

Center for Suicide Studies in Washington DC

Suicide prevention

• crisis intervention

• use of telephone (distress lines)

• 24-hour service

• use of trained volunteers

• emotional support

• connection to other services

Suicide prevention

� Warning Signs

– Signs are often not verbal.

– Giving away beloved objects.

– Changes in eating or sleeping habits.

– Displaying a sense of calmness after a

period of agitation.

Suicide education programs

• provides information to students in high

school, builds awareness

• little research showing the effectiveness of

suicide prevention, crisis intervention, distress

lines, or suicide education programs in reducing

suicide rates

• many suicidal people do not come into contact

with these services

• suicide education and awareness can actually

increase suicidal ideation (Shaffer et al., 1988)

Effective suicide prevention

• General approaches to primary prevention and

health promotion – building competence, coping,

and problem-solving skills

• Reduction of access to lethal means – CO gas

in UK, firearms

Treating suicidal individuals

• Need to assess suicidal risk and ensure

adequate supervision of attempter

• Deal with life crisis swiftly

• Therapy focused on building protective

factors and reducing risk factors, through

a variety of different approaches

• Encourage open talk about suicidal

ideation