Dr. Sushmita Ganguli

Overview:

The state of one’s psychological, emotional and social well-being is defined as mental health. It affects how we think, feel and act. It also helps determine how we handle stress, relate to others and make healthy choices. Every year, 10^th October is observed as World Mental Health Day. The objective of celebrating this day is to educate people about mental health issues and make all efforts in support of mental health. We need to understand that being both physically and mentally fit is the key to success in all aspects of life. People should be educated about the importance of mental health which would help in breaking the stereotypes around mental health which our today’s society has created. Many people still do not take the treatment for their mental illness due to the fear of being stigmatized. People should be made aware of the consequences mental illness can cause and must give utmost importance to keep the mind healthy like the way we keep our physical body healthy. Access to healthcare and social services capable of providing treatment and social support is the key.

Mental illness does not discriminate; it can affect anyone regardless of your age, gender, geography, income, social status, race/ethnicity, religion, sexual orientation, background or other aspects of cultural identity. While mental illness can occur at any age, three-fourth of all the mental illness begin by the age of 24. Mental illnesses take many forms. Some are mild and only interfere in limited ways with daily life, such as certain phobias. Other mental health conditions are so severe that the person may need a care at the hospital. They can occur in a short period of time or can be episodic and can be ongoing and long lasting as well.

There is no single cause for mental illness. Through research it is now getting clear that it is a combination of various biological, environmental and psychological factors.

There are more than 200 types of mental disorders and few of them are listed below:

• Mood disorders 
• Eating disorders 
• Anxiety disorders 
• Post traumatic disorder 
• Schizophrenia
• Depression
• Child Behaviour disorders
• Phobias
• Personality Disorders

Importance of Mental Health:

Mental health is important in every stage of life, from childhood to adolescence through adulthood. Proper mental health results in proper functioning of the mind, which in turn, results in been productive in activities. People usually forget that mind is an important part of our body and many tend to ignore the fitness of their mind. Both physical and mental health go hand in hand and are equally important for the optimum performance and quality of life. Mental Illness refers collectively to all diagnosable mental disorders- health conditions involving significant changes in thinking, emotion and/or behaviour, distress and/or problems functioning in social, work and family activities. Although the terms are used interchangeably, poor mental health and mental illness are not the same. A person can experience poor mental health and not be diagnosed with mental illness. Likewise, a person diagnosed with mental illness can experience periods of physical, mental and social wellbeing.

Benefits of good mental health:

• A stronger ability to cope with life’s stressors 

When mental and emotional states are at peak levels, the challenges of life are easier to overcome.

• Positive self- image 

Mental health greatly corelates with personal feelings about oneself. Mental wellness plays a part in self- esteem and confidence building.

• Healthier relationships 

If mental health is in good standing, you might be more capable of providing quality time, affection, support to family, friends

• Better Productivity

Dealing with depression or other mental disorders can impact your productivity levels. If you feel mentally strong, it’s more likely that you will work more efficiently.

• Higher Quality of Life 

When mental well-being thrives, your quality of life improves. This can give room for greater participation in community building. 

Understanding Mental health and Mental disorders: 

Risk factors for Mental disorders

Researchers have elucidated some risk factors that predispose children and adults to mental disorders. It has also helped to change the concept of a risk factor from a fixed, specific circumstance or life stressor to a broader, more general phenomenon that may be modifiable or malleable and related to a developmental phase. Some of these factors are listed below:

Biological factors:

• Genetics (Heredity):

Mental illness occurs from the interaction of multiple genes and other adverse life experiences like trauma, abuse can influence or trigger a person who has inherited susceptibility to it.

• Infections:

Certain infections have been linked to brain damage and mental illness. For example, a condition known as paediatric autoimmune neuropsychiatric disorder (PANDAS) associated with Streptococcus bacteria has been linked to the development of obsessive- compulsive disorder and other mental illnesses in children.

• Brain defects or injury:

Defects in or certain areas of the brain have also been linked to mental illnesses.

• Prenatal damage:

Some evidence suggests that a disruption of early foetal brain development or trauma that occurs at time of birth, for example, loss of oxygen to brain may be a factor in the development of mental illness like autism spectrum disorder.

• Substance abuse:

Long term substance abuse has been linked to anxiety, paranoia and depression. 

• Other factors:

Poor nutrition and exposure to lead may play a role in development of mental illness.

Psychological factors:

• Severe psychological trauma suffered as a child such as physical, emotional or sexual abuse 
• An important early loss, such as loss of parent 
• Neglect 
• Poor ability to relate to others 

Environmental Factors:

Certain stressors can trigger mental illness like –

• Death or divorce 
• A dysfunctional family life
• Feelings of low self-esteem, anxiety, loneliness
• Changing jobs or school
• Social or cultural expectations 
• Substance abuse by the person or person’s parents 

Warning Signs and Symptoms:

It is especially important to pay attention to sudden changes in thoughts and behaviours. Also keep in mind the onset of several of symptoms below and not just one indicates that a problem should be assessed.

• Confused thinking 
• Prolonged depression (sadness or irritability)
• Feelings of extreme highs and lows
• Excessive fears, anxieties, worries
• Social withdrawal
• Dramatic changes in eating or sleeping habits
• Strong feelings of anger
• Strange thoughts (Delusions)
• Hallucinations 
• Suicidal thoughts 
• Inability to cope with daily routine and activities
• Excessive complaints of physical ailments 

Taking action, Getting Help:

It’s important to recognize when you need to get help. Talk therapy and/ or medicines can treat mental disorders. If you don’t know where to get treatment, start by contacting your primary care provider.[9]

Learning to manage stress can help limit potential triggers. Relaxation techniques like meditation, yoga, deep breathing exercises can help soothing anxieties. Physical exercises can help improve self-image and release chemicals in brain that trigger positive feelings. 

Talk with familiar people who are supportive like family members, friends or local support groups. Recognize that stigma can pose a significant barrier to seeking help. 

Each individual’s situation must be assessed carefully and treatment should be individualised. Comprehensive treatment to prevent early symptoms progressing into serious illness can include ongoing individual and family counselling, vocational and educational support, participation in a multi-family problem-solving group and medication when appropriate. Family members are valued partners and should be involved whenever possible. 

Just as with other medical illnesses, early intervention can make a crucial difference in preventing what could become a serious illness. 

Time and again, several research and behavioural studies have shown promising results in treating and managing mental disorders.

A study conducted by National university of Ireland, Galway, Ireland is exploring the feasibility, effectiveness and acceptability of a novel psycho-social intervention for early psychosis based on a combined cognitive remediation training and cognitive behavioural therapy approach focused on social recovery.[3] An ongoing study by The Royal Ottawa Mental Health Center is aimed to show the impact of Online Yoga on Psychosis. [4]. Similarly, a study by NYU Langone Health proposes to adapt an evidence- based peer parent navigator intervention (PPN), called Parent Connectors which will be used to enhance the delivery of Coordinated Speciality Care. Studies have also shown that eating behaviours are influenced by emotional states.[5] Similarly, a study by University Ghent has shown the effectiveness and cost effectiveness of health promotion intervention like walking, targeting physical activity and eating habits in people with mental disorders. [2]

Issues:

Nearly 9 out of 10 people with mental disorders across the world say that stigma and discrimination have a negative effect over their lives.[1] These two aspects also make their mental health problems worse and difficult to recover. The main reason behind this is the stereotyped views imposed by the society coupled with media reports portraying people with mental disorders to be dangerous and evil.

The relationship between inequalities related to socioeconomic status and protected characteristics and poor health is two-way; experiencing disadvantage and adversity increases the risk of mental health problems and experiencing mental health problems increases the risk of experiencing disadvantage. 

An increase in mental health awareness is welcomed because it helps in removing stigma around mental health and encourages those suffering from these issues in silence to speak up and seek help. But it should not stop at this. Plans must be made and steps should be taken for immediate redressal. 

Local authorities should promote emotional wellbeing and build resilience from birth through universal and targeted programmes. A multisectoral and comprehensive approach needs to be introduced to address mental health promotion, prevention, treatment, discrimination, exclusion, care and recovery.

Mental health situation in India demands active policy interventions and resource allocation by the government. Measures should be taken to sensitize the community. People with mental disorders should have same access to mental health measures as it is for physical ailments. One model adopted by India is ASHA (accredited social health activist) by the ministry of health and family welfare where community health workers educate, sensitize and guide women and children to an expert in their locality. National and State Mental Health Programs along with National Rural health Mission is on its way to delivering mental health as a part of integrated primary care at the cutting edge of public healthcare system.[1]

WHO’s Mental Health Action plan 2013-2020 recognizes the essential role of mental health in achieving health for all. The Mental Health Gap Action Program (mhGAP) launched by WHO in 2008 uses evidence based technical guidance, tools and training packages to expand services in countries, especially in resource- poor settings.

Conclusion:

Progressive government policies based on evidence- based approaches, an engaged media, a vibrant educational system, a responsive industry, aggressive utilisation of newer technologies and creative crowd sourcing might together help dispel the blight of mental illness. The community at large has a great role to play in respecting the rights and needs of people with mental disabilities. In working to reduce the prevalence and distress caused by mental health problems, we need to start at the earliest point possible. We should strongly advocate for approaches and interventions that reduce the risk factors underpinning the inequalities and the application of these proportionately across the social gradient to achieve these ambitions. While early steps have been taken by the government, the problem needs to be dealt on war footing. We need a constant stream of funds for educating and creating awareness about mental health and chronic disorders around it. Campaigns should be undertaken to encourage people to talk about their mental well-being and reach out to their therapist if required. 

Timely intervention, awareness about the issue, availability of professional help and appropriate policies is the only way to improve the situation. It is thus imperative to believe and propagate that people with mental illness deserve to live their lives with dignity and confidence. It requires a collaborative public-private-social partnership to change things considerably. 

References:

[1]. Srivastava K, Chatterjee K, Bhat PS. Mental health awareness: The Indian scenario. Industrial psychiatry journal. 2016 Jul;25(2):131. 

[2]. ClinicalTrials.gov Identifier: NCT01336946

[3]. ClinicalTrials.gov Identifier: NCT04273685

[4]. ClinicalTrials.gov Identifier: NCT05046912

[5]. ClinicalTrials.gov Identifier: NCT04018521

[6]. Gamm L, Stone S, Pittman S. Mental health and mental disorders—A rural challenge: A literature review. Rural healthy people. 2010;2(1):97-114.

[7]. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A. No health without mental health. The lancet. 2007 Sep 8;370(9590):859-77.[8]. Jorm AF. Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry. 2000 Nov;177(5):396-401.