mental health - a public health challenge -...
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Mental Health
- a Public Health Challenge
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What is a mental health?
� Absence of mental illness
� Positive mental health
� Mental well-being
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Public mental health
� Promotion of mental health
� Prevention of mental illness
� Prevention of disability due to
mental illness
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Subjective well-being
� Feeling good
� Life satisfaction
� Happiness
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Psychological well-being
� Autonomy
� Self acceptance
� Personal growth
� Purpose in life
� Environmental mastery
� Positive relations with others
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Emotional and social well-being
� Absence of behaviour problems
� Absence of emotional problems
� Doing what they are told
� Self esteem
� Good relationships with peers
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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.
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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.
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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.
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+..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”.
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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.
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CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004European Region
Last available
Prevalence of mental disorders (%)
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CyprusDenmarkGreeceHungaryIsraelLithuaniaNetherlandsSlovakiaSpainUnited KingdomEU members before May 2004 EU members since May 2004
Prevalence of mental disorders (%)
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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
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Primary prevention of mental
disorders
� Promoting mental health
� Specific diseases
– Organic brain syndrome
– Crisis or situational reaction
– Schizophrenia
– Senility
– Personality disorders
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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
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Tertiary prevention of mental
disorders
� Psychiatric rehabilitation
� Reality orientation
� Outpatient rehabilitation
� http://www.biography.com/people/groups/un
natural-death/suicide/all
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Suicide
• What is suicide?
• Prevalence rates
• Mental disorder and suicide
• Other risk factors
• Understanding suicide
• Suicide prevention
• Treating people who are suicidal
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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
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SDR, suicide and self-inflicted injury, all ages, per 100 000
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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
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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
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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!
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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.
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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
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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
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� http://www.youtube.com/watch?v=1PGKdk2
Wmd8
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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
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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
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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
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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
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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
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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
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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)
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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
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Suicide prevention
• crisis intervention
• use of telephone (distress lines)
• 24-hour service
• use of trained volunteers
• emotional support
• connection to other services
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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.
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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)
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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
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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