Mental Health
DSM 5 Categories of disorders
Definitions of mental illness, health, disorders & SDOH
Causes (SDOH and neurobiology)
Population effects
Suicide
Treatments (medications and new drugs)
WHO definition
Mental health = state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community
SDOH
Mental health is shaped by the social, economic, and physical environments, epigenetics, psychosocial and physiological stress
Stress in early childhood + cumulative exposure to stresses has physiological effects and is associated with SUDs
Abnormal behaviour = some combination of 7 criteria
- Rarity or very unusual
- Behaviour is socially unacceptable or violates social norms
- Perception or interpretation of reality is faulty
- The person is distressed / not in control of their behaviour
- Behaviour is inflexible, maladaptive, self-defeating or dangerous
- Observations fit a syndromal pattern or theory of disorder
- Disability and/or disadvantage is present
Some argue neurodiversity is normal (argue that neurological conditions are the result of normal variations in the genome)
Anti-psychiatry = belief that mental health disorders are a social construct created by doctors
Consequences of diagnosis
Positive:
• Descriptive value
• Prompts consideration of treatments
• Establishing evidence based care
• Considers the whole syndrome
• Predictive value
• Information retrieval
• Aids communication
• Public health planning and monitoring
• Source of concepts for scientific theory development and research
Negative:
• Diagnosis marks the formal status of “having a mental illness” being conferred
• Individuals react differently, and often, negatively to this diagnosis
• Stigma can follow from a diagnosis
• Method of diagnosis delivery impacts responses
• Individuals can be reduced to their diagnosis
• Individuals are not passive victims and develop their own coping strategies
DSM-5 definitions
Syndrome is characterised by = Clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour that is (assumed to) reflect a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
Disorder syndrome is usually associated with =
• Present distress (e.g. via a symptom), or
• Disability (e.g. work; social or other)
Mental illness definition Mental Health Act 2014 (Vic)
Step 1: medical condition that is characterised by a significant disturbance of thought, mood, perception or memory, subject to certain exceptions
Step 2 (definition by exclusion): certain beliefs, behaviours or attributes which alone or in combination cannot constitute a mental illness in the absence of other factors (such as sexuality, religious and political beliefs etc)
Clinical diagnosis is not enough to plan treatment - also need to understand the context, the change of the phenomenon over time, and have a structured interview to determine this
Some disorders are unique to certain cultures (abnormal to some cultures)
Eg Koro in South east Asia and eating disorders in Western cultures
COVID-19 impacted social determinants of mental health through short and long-
term changes in social engagement and employment & economic activity.
Social isolation and loneliness
Most commonly affect 15-25 years and 75+ years & COVID-19 has exacerbated the risks
Global megatrends
Rapid tech development: tech innovation, hyper-connectivity, changing work
Demography: shifts (aging pop), urbanisation, migration, health challenges
Environmental pressures: climate change, resource scarcity
Shifting power: multipolarity, economic inequality, conflict, crumbling social cohesion
Definitions
Social isolation = “an objective state of having minimal contact and interaction with others and a generally low level of involvement in community life” and it can be either voluntary or involuntary
Loneliness = a subjective, unwelcome feeling of lack or loss of companionship or emotional attachment with other people, and it is involuntary
Prevalence and duration = Hard to measure as people think it is shameful, most people experience it in life, mostly lasts less than a year
Causes of social isolation and loneliness
Age - Older people have experienced chronic and acute stresses and cumulative effects are predictors of isolation/loneliness
Poor environment for elderly - need good social environment as they have mobility restrictions and no longer drive
Living alone, not being in a relationship, breakdown of a relationship, single parents
Being disconnected from family or friends
Impacts on physiological, behavioural, psychological, and societal health - consequences for human health:
• Premature death
• Elevated systolic blood pressure
• Poorer quality and quantity of sleep
• Diminished immunity and protective
cell function
• Increased rates of cognitive decline
• Higher risk of cognitive progression towards Alzheimer’s disease
• Increased risk of ischemic heart disease and stroke
Benefits of social connectedness:
• Cessation of smoking
• Abstinence from problem drinking
• Adherence to medication
• Healthy eating
Effects on the community:
• lost productivity
• increased health care (mental & physical) costs
Strategies to improve social support and inclusion
• Introducing interventions as part of a wider strategic approach;
• Targeting specific groups of older people;
• Using existing community resources;
• Using volunteers to run programs;
• Using targeted and tailored approaches;
• Involving older people in the planning, delivery & evaluation of programs
Group interventions = include such things as peer teleconferencing, mutual support and discussion groups and participation in arts and
cultural activities.
One-on-one interventions = include direct provision of support services eg counselling, provision of activities such as a foster grandparent scheme, and home visiting.
Internet and technology-based interventions = include online U3A programs and new work on the use of avatars with older people.
Companion animals = provide health benefits that mitigate the impacts of social isolation and loneliness
Governemnt interventions = ACEL, Friends for Good, Friendship alliance, Men's sheds, Community visitors scheme etc
Prevalence of mental disorders in Aus
1 in 5 (21.4%) people experience a mental disorder in any 12-month period
Comorbidity is common
Higher rates in Aboriginal and Torres Strait Islander peoples
Highest in 16-24 year olds and females
ADHD is the most common childhood/adolescent mental disorder
47.1% of people with a common mental disorder get help in a 12-month period & usually go to a GP
Burden of disease
Global burden of disease = quantifies prevalence and relative harm a disorder causes
Disease burden measured in DALYs, YLLs, and YLDs
Total spending on mental health services was $11 billion in 2019-2020
Growing bruden due to population growth and ageing + failure to prevent, manage, and treat mental disorders
Policy of mental health care
Considerable reform in mental healthcare over the last 50 years (shift from institutional care to community rehab and use of services provided by NGOs)
Policies influenced: coordination of care, social inclusion, recovery approach, understanding mental health, prevention through early intervention
National Mental Health Strategy started in 1992 and includes National mental health policy (2008), National mental health plan (2009), Mental health statement of rights and responsibilities (2012)
Fifth National Mental Health and Suicide Prevention Plan - Priority areas: effective suicide prevention, improving indigenous mental health, reducing stigma and discrimination, etc
Interventions for mental health problems
Spectrum of interventions: universal, selective, indicated
Universal - eg improve knowledge and awareness of mental health problems, how to prevent them and how to seek help (mental health literacy)
Primary care eg ATAPs and Better Access, clinical services eg bed based services, community support sector services eg group support services
Mental health literacy = knowledge and beliefs about mental disorders which aid their recognition, management or prevention
Components: knowledge of causes and risk factors, about how to prevent mental disorders, beliefs and self help strategies, treatment options, first aid skills
Beyond blue started in 2000 and supported by the federal government - focused on raising awareness of depression and reducing the associated stigma (now other conditions)
Stepped care models = delivery of evidence-based services that increase, or decrease, in intensity, according to need
Start with an evidence-based treatment of low intensity
Involve systematic monitoring of progress
Involve those who do not respond stepping up to a higher intensity treatment
May involve adding treatments of different modalities
Benefits
Low intensity - less time from a professional and patient, lower cost, lower therapist expertise
Self-help treatments (books or online) most often used as the first step
Good evidence of effectiveness for self-help treatments for depression and anxiety
Make more efficient use of workforce and technology
Clinical guidelines (e.g. UK NICE guidelines) have endorsed stepped care
Benefits for anxiety and
depressive conditions over usual care
Need for prevention (better than cure)
Prevalence of mental disorders has not decreased - due to drivers or masking by changes in risk factors or increased awareness or reporting of symptoms
K10 psychological distress scale = measures psychological distress
Total score can go above criteria for major depressive disorder
Paired with interviews
More Australians meet high and very high K10 scores every 3 years
Mental illness is not distributed evenly in the population - largest increases in K10 were in femages aged 55-64 - at risk of homelessness, isolated, marital issues, poor super
Rates are increasing now after a dip
click to edit
Funding for mental health is increasing but K10 rates are not changing
Possible drivers of mental illness
Wealth + Income inequality
Current social and health policies
Gaps in the delivery of gold-standard mental health care Ie poor treatment quality
Higher psychological distress in unequal societies which leads to high rates of depression, anxiety, suicide, psychotic disorders
Prevalence of mental illness is HIGHER in more unequal rich countries
Inequality is measured by the GINI index (small changes in GINI index can make a large impact)
More psychiatrist services offered in affluent areas of VIC + more consultations, GP treatment plans created etc
Inequality has worsened
Telehealth worsened the situation
Inverse care law = % of the population with high K10 is inversely related to the use of mental health services in the area
Over-medicalisaiton
Clinical iatrogenesis = problems result from medical care
Social iatrogenesis = problems result from health policies created by industrial organisations
Cultural iatrogenesis = problems arise from cultural beliefs that restrict the autonomy of people
Drop off in self help efforts (which may outway benefits of medicalisation)
Trend - high self help at low severity mental health issues and low self help at high severity (due to reliance of medication and professional advice)
Need to ask patients what their strengths are and their self help strategies and work with those - do not just prescribe medications
Use of recovery focused interventions (CHIME framework)
Mixed effects
CHIME = connectedness, hope, identity, meaning, empowerment