"A major league baseball team is a collection of 25 youngish men who have made the major leagues and discovered that in spite of it, life remains distressingly short of ideal."Roger Kahn
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Introduction: Mental health has become a major international public health concern and the World Health Organization has placed high profile focus on the importance of mental health. Mental health is recognized by the World Health Organization and April 7, 2001 was first devoted for its observance.
It is estimated that 450 million people worldwide are affected by mental, neurological or behavioral illnesses at any given time. Mental illnesses are common to all countries and cause immense suffering. People with these disorders are often subjected to social isolation, poor quality of life and increasing mortality. These disorders are the cause of staggering economic and social costs. Mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Untreated, they bring about unhealthy behavior, non-compliance and prescribed medical regimens, diminished immune functioning, poor prognosis and eventual loss of valuable human potential.
Definition of Mental Health: Mental health is defined as a state of successful performance of mental function, resulting in fruitful activities, gratifying relationships with other people, and also includes the ability to adapt to change and to cope with diversity. Mental health is crucial to personal well-being, family and interpersonal relationships and contribution to community or society.
Mental disorders are health conditions that are characterized by alterations in thinking, mood, personality, or behavior, which are associated with distress and/or impaired functioning. Mental illness is a term that is applied collectively to all diagnosable mental disorders.
Types of Mental Health Illnesses: The difference types of mental illnesses are enumerated in the International Classification of Mental and Behavioral Disorders published by the World Health Organization. • Organic mental disorders e.g. Alzheimer's disease and delirium. • Mental and behavioral disorders due to psychoactive substances use e.g. alcohol, street drugs and medications. • Schizophrenia, schizotypal and delusional disorders e.g. paranoid schizophrenia and psychotic disorders. • Mood (affective) disorders e.g. depression and manic depression. • Neurotic, stress-related and somatoform disorders e.g. anxiety disorders and obsessive-compulsive disorders. • Behavioral syndromes associated with physiological disturbances and physical factors e.g. eating disorders and non-organic sleep disorders. • Disorders of adult personality and behavior e.g. paranoid personality disorder and transsexualism. • Mental retardation e.g. learning disabilities. • Disorders of psychological development e.g. specific reading disorders such as dyslexia and childhood autism. • Behavioral and emotional disorders with onset usually occurring in childhood and adolescent e.g. attention deficit (hyperactivity) disorder and conduct disorders. • Unspecified mental disorders.
Burden of Disability: Mental disorders generate an immense public health burden of disability. Mental disorders vary in severity and their impact on people's lives. Mental disorders such as schizophrenia, major depression and manic-depressive or bipolar illness and obsessive compulsive disorder and panic disorder can be enormously disabling. This burden of disability often is profoundly under recognized in most parts of the world. In the United States, mental illness is on par with heart disease and cancer. Mental disorders occur across the lifespan, affecting persons of all racial and ethnic groups, both genders and all educational and socioeconomic groups.
Mental disorders are not only the cause of limitations of various life activities but also can be a secondary problem among people with other disabilities. Depression and anxiety, for example, are seen more frequently among people with disabilities than those without disabilities.
Socioeconomic Burden of Mental Illness: In the United States approximately 40 million people aged 18 to 74 years of the population, had a diagnosis of mental disorder alone of a co-occurring mental and addictive disorder in the past year. At least one in five children and adolescents age 9 and 17 years has a diagnosable mental disorder in a given year.
It is estimated 25 percent of people over 65 years (8.6 million) experience specific mental disorders, such as depression, anxiety, substance abuse and dementia that are not part of normal aging. Alzheimer's disease strikes 8 to 15 percent of people over age 65 years, with the number of cases in the population doubling every 5 years of age after age 60 years. Alzheimer's disease is thought to be responsible for 60 to 70 percent of all cases of dementia and is one of the leading causes of nursing home placement.
The direct costs of diagnosing and treating mental disorders in the United States totaled approximately $ 69 billion in 1996. Lost productivity and premature death accounted for an additional $74.9 billion. The total cost of mental health disorders in England has been estimated at ?32 billion. More than a third of this cost is attributed to lost employment and productivity related to schizophrenia, depression, stress and anxiety.
Etiology of Mental Illness: The etiology of mental illness may be as a consequence of complex neurochemical, anatomical and physiological changes in the brain. Social factors have also been implicated in the pathogenesis of mental illness. Some of the main causes of mental illness are given below: • Hereditary. • Environmental contaminants e.g. lead, copper and mercury. • Other disease such as kidney impairment may lead to Alzheimer's disease. • Poor nutrition. • Poor sanitation. • Homelessness. • Microbiologically unsafe food. • HIV infection. • Poor physical health. • Psychological stress. • Posttraumatic stress. • Brain injury. • Metabolic disorders e.g. hypothyroidism.
Modern Treatments for Mental Illness: Treatments for mental illness take many different forms, including medication, psychotherapy, complementary therapies and self help strategies. It is worth bearing in mind that what works for one person may not work for another. Some treatments work best in combination and even the same person may prefer different treatments at different points in his or her life. • Physical therapies include maintaining the general physical health of the patient, providing psychiatric medication, such as anti-depressants, or administering electroconvulsive therapy. • Psychological treatments or talking treatments may take many different forms, including counseling and psychotherapy. Psychological therapies usually depend on the person with a mental health problem talking to somebody else, often a trained professional. • Alternative and complementary therapies offer alternatives, which replace orthodox Western medicine. The term complementary therapy is generally used to indicate therapies which differ from orthodox Western medicine and which may be used to complement, support or sometimes to replace it. Examples include aromatherapy, meditation and yoga. • Self help strategies serve to alleviate mental health problems, ranging from individual strategies for adapting to day-to-day difficulties and symptoms through to self-help group and support strategies. Examples of self help strategies include: self-management of manic depression, hearing voices strategies, self-harm strategies and self-help groups for depression. • Social support is not a treatment as such but it can have a beneficial effect at least equivalent to that of other forms of interventions. Social support involves providing practical help around the social dimensions of a patient's mental health problems. For example by ensuring that the patient is properly housed and receives an adequate weekly income.
Recommendations on Ways to Reduce, Eliminate or Prevent Metal Illness: • Develop effective mental health policies and legislation. • Improve mental health by ensuring timely access to appropriate, quality mental health services. • Develop service delivery mechanisms for early recognition of symptoms and interventions. • Develop fundamental structural changes that require creative and flexible responses from service providers, administrators, researchers and policymakers alike. • Develop more social and behavioral research programs to explore the concept of resilience to identify strengths that may promote health and healing. • Implement strategies for translating new knowledge into critical applications. • Use community support programs and facilities for severe and persistent disorders. • Develop educational and outreach programs to reduce negative consequences of mental illness. • Develop rehabilitation programs. • Develop new drug treatments based on the best available science. • Develop alternative methods of treatment. • Develop family support groups. • Develop global action programs that focus on forging strategic partnerships to enhance countries capacity to combat and reduce the burden of mental disorders and promote mental health. • Adopt health lifestyles such as: (i) Develop emotionally, creatively, intellectually and spiritually. (ii) Initiate, develop and sustain mutually satisfying personal relationships. (iii) Face problems, resolve them and learn from them. (iv) Be confident and assertive. (v) Be aware of others and empathize with them. (vi) Use and enjoy solitude. (vii) Play and have fun. (viii) Laugh, both at themselves and at the world.
Future Research and Mental Illness: Research on the brain and behavior in mental illness and mental health is moving at a rapid pace. An increasing strong consumer's movement in the mental health field is adding urgency to the tasks of translating new knowledge into clinical practices and refining service delivery systems to use new and emerging information optimally for patient/consumer needs. The elimination of stigma associated with mental disorders will in turn encourage more individuals to seek needed mental health care.
Progress in fundamental science with an emphasis on translating new knowledge such as the use of neurogenesis and stem cell research into clinical applications can strengthen opportunities for future clinical and service system innovations. Research-based treatments afford an unprecedented opportunity to achieve a major reduction in the burden of mental illness. With enhancements of clinical service and service systems, recovery is an achievable objective of mental health clinical intervention.
References: ? Lebowitz, B.D., Pearson, J.L., & Cohen, G.G. (1980). Clinical Geriatric Psychopharmacology. Baltimore, MD: Williams & Wilkins. ? Murray, C.J.L., & Lopez, A.D. (1996). The Global Burden of Diseases. Cambridge. MA: Harvard University Press. ? Pattron, D.D. (2004). Recent Research in Public Health. New York: Scientific Publishers. ? Ritchie, K., & Kildea, D. (1995). Is senile dementia age-related or ageing related evidence from meta analysis of dementia prevalence in the oldest old. Lancet 34, 931-934. ? Robins, L.N., Locke, B.Z., & Regier, D.A. (1991). An overview of Psychiatric Disorders in America. New York: Free Press. ? Brain Work: The Neuroscience Newsletter. (2004). New York: The Dana Foundation. ? http://www.mentalhealth.org.uk ? http://www.who.int
About the Author
Dr Pattron is a Public Health Scientist in the Ministry of Health, Trinidad
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