10 Mental Health

Mental Health
& Mental Illness

What is
Mental
Health??
Mental health refers to the maintenance

of
successful mental activity.
What is
Mental
Health??
Mental health refers to the maintenance

of
successful mental activity.
This includes maintaining productive daily activities
and maintaining fulfilling relationships with others.
It also includes maintaining the abilities

to adapt to change and to cope with
Teaching and Learning Aims
• There is ignorance,
superstition, stigma and
fear around Mental
Illness
• Aetiology, pathogenesis
diagnosis and treatment
are imperfect.
• There is a different
paradigm and a less
rigorous epidemiology 4
Often sad,sometimes
mad,occasionally bad
• The medical model is
• insufficient
• Diagnosis is largely
• clinical and
experiential
5
More of an art than a science
• Treatment is
pragmatic
• Prevention is about the
politics of health
• “populations,people
pressures, poverty”
6
Mental Health is a worldwide
problem
7
Some Statistic
 One in four people in the world will be affected by mental or

neurological disorders at some point in their lives;
 Around 450 million people currently suffer from such conditions;
 mental disorders among the leading causes of ill-health and
disability worldwide.
 WHO expect to rank Mental Illness as second by 2020, behind
ischaemic heart disease but ahead of all other diseases;
 nearly 2/3 (two-thirds) of people with a known mental disorder
never seek help from a health professional;
 Currently, more than 40% of countries have no mental health
policy;
 over 30% have no mental health programme;
 Around 25% of countries have no mental health legislation.
General Mental
Disorders
 Autism spectrum disorders

 Dementia
 Depression
 Epilepsy
 Headache disorders
 Mental disorders
 Mental health and older adults
 Mental health in emergencies
 Mental health: strengthening our response
 Schizophrenia
 Suicide
M
It is definitely NOT
easy being a teenager!
Sometimes it’s tough to

avoid feeling stressed, and
pressure can build up in
many areas of life (socially, in
school, at home, and while
making big
life decisions)
Mental illness can occur when the brain
(or part of the brain) is not working well
or is working in the wrong way.
When the brain is not working properly,
one or more of its 6 functions will be
disrupted
Behavior
Thinking
Perception Physical
Emotion Signaling
Symptoms can
include
Thinking difficulties
or problems Extreme emotional Sleep problems
focusing attention highs and lows
When these symptoms
significantly disrupt a person’s life,
we say that the person has a
mental disorder
or a mental
So, what are the
CAUSES
of mental
illness??
Well, the causes of mental illness are
COMPLICATED!!
+ →
Genetics Environment Brain Disorder
What do we know about
the
causes of mental
illness?

The symptoms of mental
illness are a result of
abnormal brain
functioning.
Mental illness is a
brain disorder.
Mental illness is rarely if

ever caused by stress
alone
the

causes of mental
illness? It is not the consequence of poor
parenting or bad behavior.
It is not the result of personal

weakness or deficits in personality.
It is not the manifestation of

malevolent spiritual intent.
Only in exceptional cases is it caused

by nutritional factors.
It is not caused by poverty.

Many mental illnesses begin
during childhood
and persist into
adolescence.
Some of these include:

• Attention Deficit Hyperactivity
Disorder (ADHD)
• Autism Spectrum Disorders
(ASD)
• Generalized Anxiety Disorder
(GAD
BUT… some illnesses begin
during adolescence.
The illnesses that most

often begin during
adolescence include:
●
Major Depression (MD)
●
Schizophrenia
●
Bipolar Disorder (BD)
●
Panic disorder
●
Social Anxiety Disorder
●
Eating Disorders
●
Obsessive Compulsive Disorder
●
Addictions
people with mental illnesses?
• Most people with mental disorders live
productive and positive lives while receiving
treatments for their mental illness.
• Some people have severe and persistent

mental disorders which respond poorly to
current treatments (as in all other illnesses)
• Mental illness does not respect any

boundaries of race, class or geography.
• The majority of people have a friend,

acquaintance or family member who has or
has had a mental disorder.
Mental health
problems can be
treated!
If you feel VERY sad, stressed or worried, it might help
to talk to someone about how you are
feeling.
Triple integration
Health and
social care
Hospital
Physical
and out-of-
and mental
hospital
health care
care
Treatment and Care
Hospital Care
Community Care
25
Preventive Networks
Church,Family, Home, Friends,
Work
26
The Mental Health Act
Compulsory Psychiatric
Treatment
Criminal responsibility
Power of attorney
27
Toxic interactions: mental,
physical and social
Barnett, Mercer et al 2012

Poor mental health increases the
cost of physical health care
Annual per patient costs with and without depression
(excluding MH treatment costs)
Welch et al 2009
180%
160%
140%
% increase in annual per patient costs
(excluding costs of MH care)
120%
100%
Depression
Anxiety
80%
60%
40%
20%
0%
Heart Failure Stroke Heart disease Diabetes Hypertension Arthritis COPD Cancer Asthma
Melek & Norris 2008

Annual per patient costs with and without mental health problems
Beacon Health Strategies 2011

Significant financial impact across
the health system
› Between 12% and 18% of all expenditure on long-term
conditions is linked to poor mental health and wellbeing (Naylor
et al 2012)
› People with MH problems use significantly more unplanned

hospital care for physical health needs, including 3.6x higher rate
of potentially avoidable admissions for ambulatory care-sensitive
conditions (Dorning et al 2015)
› Medically-unexplained symptoms account for around 15-30% of

GP appointments and around 3% of total NHS expenditure
(Bermingham et al 2010)
Poorer outcomes for patients
3x higher death rate People with diabetes
from respiratory and co-morbid
disease among people depression have 37%
Patients with chronic Depression increases
with schizophrenia increased risk of all-
heart failure are eight mortality rates after
(Saha et al 2007) cause mortality over a
times more likely to die heart attack by 3.5 times
two-year period (Katon
within 30 months if they (Lesperance et al 2002)
et al 2004)
have depression (Junger
Co-morbid MH
et al 2005)
problems have a greater
effect on quality of life Twofold increase in
than any other form of mortality after heart
co-morbidity
Cardiovascular patients with (Mujica- bypass surgery over an
Moto 2014)
depression experience 50 per average follow-up
cent more acute exacerbations period of five years
per year (Whooley et al 2008) (Blumenthal et al 2003)
10 areas where integration is needed
Prevention / 1. Incorporating mental health into public health programmes
public health 2. Health promotion among people with severe mental illnesses
General 3. Improving management of ‘medically unexplained symptoms’

practice 4. Strengthening primary care for the physical health needs of people
with severe mental illnesses
Chronic 5. Supporting the mental health of people with long-term conditions

disease 6. Supporting the mental health and wellbeing of carers
management
Hospital care 7. Supporting mental health in acute hospitals
8. Addressing physical health in mental health inpatient facilities
Community / 9. Providing integrated support for perinatal mental health

social care 10. Supporting the mental health needs of people in residential homes
Swindon LIFT Psychology
› Supported self-management for the psychological aspects of
living with a long-term condition
› Service model
› ‘Least intervention first time’: Direct access to psycho-educational courses
without referral e.g. ‘Living well after stroke’
› One-to-one supported self-help and psychological interventions for those who
need them
› Delivered in GP surgeries, colleges, libraries
› Outcomes
› Significant reduction in waiting times
› Removal of stigma associated with mental health referral
› Reduced referrals into secondary mental health services?
3 dimensions of care for diabetes
› Focus
› Integrating medical, psychological and social support for diabetics with
persistent sub-optimal glycaemic control in south London, UK
› Interventions
› Diabetes management: medication support, diabetes education
› Mental health: psychological interventions, family work, drugs
› Social: debt management, housing support, occupational rehab
› Patient-led case meetings held regularly with MDT members
› Outcomes
› Significant, sustained improvement in diabetes control
› Reduction in complications and unscheduled care
› Approx. 35% return on investment per year
Integrated care: Key themes
› Going beyond co-location
› Redefining ‘core business’, rethinking role boundaries
› Performing an educational function alongside a clinical one
› Empowering people through self-management training and support
› Improving access to low-intensity interventions e.g. self-care, psychoeducation
› Strengthening connections with other public services e.g. housing, employment
› Harnessing wider community resources e.g. peer support, social prescribing
› Screening proactively among high-risk groups
› Developing shared electronic medical records
› Investment in workforce development – training all staff in basic mental health
skills
› Normalising mental health within routine care, reducing stigma
Getting the basics right
Good communication Not about turning

skills, careful use of everyone into ‘experts in
language everything’
Willingness to take
a ‘whole person’
perspective
A new frontier for integrated care
› A compelling case for integrating mental health support across all
levels of the health system
› Lots of promising examples of local innovation but need to adopt

a more systematic, strategic approach
› The broader implications for professional education and training

require further thought
› Need leadership from across the system

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Mental Health

& Mental Illness

Mental health refers to the maintenance

Mental health refers to the maintenance

It also includes maintaining the abilities

 One in four people in the world will be affected by mental or

 Autism spectrum disorders

Sometimes it’s tough to

Mental illness is rarely if

It is not the result of personal

It is not the manifestation of

Only in exceptional cases is it caused

It is not caused by poverty.

Some of these include:

The illnesses that most

• Some people have severe and persistent

• Mental illness does not respect any

• The majority of people have a friend,

Barnett, Mercer et al 2012

Melek & Norris 2008

Beacon Health Strategies 2011

› People with MH problems use significantly more unplanned

› Medically-unexplained symptoms account for around 15-30% of

General 3. Improving management of ‘medically unexplained symptoms’

Chronic 5. Supporting the mental health of people with long-term conditions

Community / 9. Providing integrated support for perinatal mental health

Good communication Not about turning

› Lots of promising examples of local innovation but need to adopt

› The broader implications for professional education and training

› Need leadership from across the system

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