Mental and Behavioral Health PDF

MENTAL AND BEHAVIORAL HEALTH CHAPTER 21  INTRODUCTION - Mental health includes the emotional, psychological and social well-being of individuals - It affects how people think, feel, and act as they cope with life - Helps determine how people handle stress, relate t...

MENTAL AND BEHAVIORAL HEALTH CHAPTER 21  INTRODUCTION - Mental health includes the emotional, psychological and social well-being of individuals - It affects how people think, feel, and act as they cope with life - Helps determine how people handle stress, relate to others, and make choices - Mental health is important in all stages of life, from childhood and adolescence through adulthood - It is also defined as state of well being in which every individual realizes his/her own potential, is able to cope with the normal stresses of life, works productively and fruitfully, and contributes to his/her community. - It is the fundamental element of the resilience, health assets, capabilities and positive adaptation that enable people to both to cope with adversity and to reach potential and humanity (Friedli, WHO Europe, 2009)  Mental and Behavioural HEALTH - Depression, anxiety, schizophrenia and substance abuse are the prominent among mental health disorders. - Affecting more than 450 million people worldwide and associated with substantial morbidity and mortality Mental Health Disorder - Broad term that refers to a set of emotions, cognitions and behaviours that cause distress to individuals or others - Abnormal from the perspective of society or culture - Result in harm to self and others or in functional impairment in or more domains(work, school and home) - Can affect your thoughts, mood or behaviour - Can impact the way you perceive the world around you - Can cause distress. May affect how you cope at work, how you function in relationships and your ability to manage everyday tasks - Result in harm to self or others or functional impairment in or more domains (work, school and home) - The most prevalent of the emotional disorders and most costly to individuals and society are DEPRESSION and ANXIETY  ] Behavioural Disorders - Involve substance use or participation in non-drug related risky behaviours like gambling or overeating also known as behavioural addictions that they appear compulsive (out of control of the individual) and pose serious threats to the participants health and well being - Represent extreme cases of typical behaviours ( alcohol dependence, overeating to point of obesity Misuse of a substance is often indicative of a risk for more pathological use Pathological use maybe characterized by continued substance use despite serious consequences (HIV infection, incarceration) Tolerance need to take more of a substance to experience its customary effects and withdrawal Substance use, both licit (alcohol, tobacco ) and illicit (cocaine, heroin) varies along a continuum.  CONTINUUM OF SUBSTANCE USE No Use>>Experimentation (trying a substance one or more times >> Misuse (Occasional use that has not resulted in serious consequences)>>Abuse (continued use in spite of problems or use in dangerous situations) >>>>Dependence (characterized by tolerance, characteristic withdrawal symptoms and functional impairment) Abuse and Dependence = Pathological use SUICIDE - A purposeful act directed toward ending one’s life - Intended to refer to successful completion of the act SUICIDE ATTEMPT - Intended to refer to any act of self harm including para-suicidal behaviour such as cutting regardless of the intent of the behaviour or the outcome SUICIDAL IDEATION - Refers to thoughts about killing or harming oneself EPIDEMIOLOGY: Mental Health Disorders - Affect large segment of the U.S. population - Research suggests that about 1 in 5 adults age 18 or older meet criteria for mental health disorder  - in the Philippines, the prevalence of mental disorders ranged between 11.3% and 11.6% with an average annual increase of 2.0%, increasing from 7.0 to 12.5 million Filipinos diagnosed with a mental disorder between 1990 and 2019. - Anxiety and depression are the two of the most prevalent mental health disorders What is the program of the Philippines for mental health? - Republic Act 11036 otherwise known as the Mental Health Act has been promulgated to enhance and integrate mental health service delivery to Universal Health Care through promotion and protection of the rights of persons using psychosocial health services and increasing investments in mental health.  Categories of Mental Health Disorders 1. Mood (Depressive or Bipolar Disorders - Pervasive and persistent feelings of sadness or loss of enjoyment or pleasure - Poor self concept, decrease attention/concentration 2. Anxiety Disorders (phobia, panic) - Adaptive emotional responses (ex. fear, anxiety) triggered persistently and inappropriately  - Characterized by physical symptoms (heart palpitations, sweating) - Cognitive avoidance (distraction techniques ) - Distortions and behavioural avoidance 3. Trauma Disorders (post traumatic stress disorder ) - Anxiety disorder resulting from exposure to traumatic event. Ex. Rape, war/combat, natural disaster, terrorism)  - Individual perceives self or other person to be at risk of incurring serious injury or dying - Individual re- experiences event through vivid dreams or memories, with dissociation and emotional numbing 4. Personality Disorders - someone’s traits cause distress and make it hard for them to function in everyday life - People with personality disorders have their own patterns of unhelpful thoughts and behaviour - People with personality disorders may find it hard to work and form positive relationship with others 5. Psychotic disorders ( Schizophrenia) 6. Eating disorders 7. Substance abuse disorders  SYMPTOMS OF MENTAL ILLNESS 1. Eating disorder – extreme dieting may be a sign 2. Hearing voices could be a sign of psychosis 3. An on going feeling of hopelessness after childbirth could be a sign of post natal depression 4. People with depression can have a lasting sadness or low mood 5. People with anxiety often have excessive worry or fears. Sometimes feelings of anxiety happen without any apparent reason * Therefore drastic changes in person’s thoughts, moods or behaviour can be a sign they have mental illness  Some signs of mental illness to look out for - Unusual or illogical thoughts - Unreasonable anger or irritability - Poor concentration and memory, not being able to follow a conversation - Hearing voices that no one else can hear - Increased or decreased sleep - Increased or low appetite or preoccupation with control over food, calories or excessive exercise - Lack of motivation - Withdrawing from people - Drug use - Feelings that life is not worth living or suicidal thoughts - Becoming obsessed with a topic like death or religion - Not looking after personal hygiene or other responsibilities - Not doing as well as usual at school or work  CAUSES OF MENTAL ILLNESS 1. Genetic Factors - Having a close family member wit mental illness can increase the chance that you might get a mental illness. However, just because one family member has a mental illness doesn’t mean tat others will. 2. Drug and Alcohol Abuse - Illicit drug used can trigger a manic episode (bipolar disorder) or an episode of psychosis. Drugs such as cocaine, marijuana and amphetamines can cause paranoia 3. Other biological factors - Some medical conditions or hormonal changes can cause mental health problems 4. Early life environment - Negative childhood experiences can increase the risk of some mental illnesses. Example of negative childhood experiences are abuse and neglect 5. Trauma and stress - In adulthood, traumatic life events or on going stress can increase the risk of mental illness. Issues such as social isolation, domestic violence, relationship breakdown, financial or work problems can impact on mental health. Traumatic experiences such as living in a war zone can increase the risk of post traumatic stress disorder (PTSD) 6. Personality factors - Some traits such as perfectionism or low self - esteem can increase the risk of depression  Can mental illness be prevented? Good mental health can be boosted by positive things in life such as: 1. Having support from family, friends and the community 2. Having a strong sense of identity and culture 3. Having a healthy body, by eating a healthy diet and exercising 4. Reducing stress if possible 5. Being optimistic 6. Developing adaptive ways of coping with life’s problems 7. Getting support * Mental illness can attract stigma and discrimination. These are two of the biggest problems for people with mental health issues. Why is mental health important for students? - Stronger mental health for students means they can learn better and be more likely to realize the full potential of their abilities. - Ultimately students with positive mental health can build relationships more effectively, make decisions and work together Students with positive mental health - Students who receive the support they need from their families, schools and other social circles tend to be eager and excited to participate in social events and extracurricular activities - They may have a greater interest in their studies, retain information more effectively, and progress steadily toward graduation as they grow socially, emotionally and academically.  Among Other Behavioural Addictions 1. Pathological gambling – 1-2% of the pop. 2. Sexual behaviour – 5% 3. Problematic internet use – 6% 4. Eating or food addictions – 3% with women affected more than men  There is a high degree of co-morbidity among mental health disorders and mental health and behavioural disorders. SUICIDE: - Accounted for more than 32,000 deaths in the U.S. in 2006. - Suicide itself is not a mental disorder, but one of the most important causes of suicide is mental illness most often DEPRESSION.  - Symptoms such as very low mood, negative thinking, severe anxiety and psychosis can lea to suicidal thoughts Other Risk Factors for Suicide 1. Substance abuse 2. Chronic health issues, pain or physical disability 3. Feelings of isolation or helplessness 4. Loss 5. Negative life events (abuse, significant loss, financial crisis)  SUICIDE WARNING SIGNS: 1. Expression of hopelessness or helplessness 2. An overwhelming sense of shame or guilt 3. A dramatic change in personality or appearance, or irrational or bizarre behaviour 4. Changed eating or sleeping habits 5. A drop in school or work performance 6. A lack of interest in things previously important and the future 7. writing, speaking or joking about suicide, death or dying or intention 8. Giving away possessions and putting affairs in order 9. Suddenly seeming at peace 10. Increasing alcohol and drug use 11. Withdrawing from friends, family or society  Mental Health Disorders In addition to economic impacts, mental health disorders are associated with the following: Educational and occupational impairment Difficult social RELATIONSHIPS Stress and mental health problems in family members caring for an affected person Poor quality of life Development of, and impaired recovery from medical conditions Substance abuse/ dependence Death by suicide or other causes BEHAVIOURAL DISORDERS - Substance use disorders cause significant morbidity and mortality worldwide - Alcohol, tobacco, illicit substances and prescription medications are all responsible for a substantial number of avoidable deaths because of their deleterious health effects Behavioural Disorders (cont.) - Specifically, excessive use of both licit and illicit substances is associated with cardiovascular disease and many different types of cancer - By impairing attention, concentration and judgement, alcohol consumption is believed to be a causal factor in risky sexual practices, increasing the risk of unwanted pregnancies and sexually transmitted infections (STI), aggressive behaviour, and fatal motor vehicle crashes. - Smoking during pregnancy is associated with premature birth as well as low birth weight, which increase the risk for attention deficit hyper-activity disorder (ADHD), conduct problems and poor school achievement - Non prescription use of medications account for a substantial number of emergency department admissions and overdoses - Illicit substance use significantly increases the risk of contracting infectious diseases (HIV, Hepatitis B) through injection/intravenous use or risky sexual practices with infected partners. - Drug use during pregnancy is associated with withdrawal symptoms among infants after birth and an increase risk of offspring development substance use disorders SUICIDE - Following a successful suicide, bereavement of family and friends can be lengthy and complicated. - In addition to grief, surviving family members and friends feel guilty, confused, depressed and anxious and may even experienced suicidal thoughts or make suicide attempts themselves.  RISK AND PROTECTIVE FACTORS A. Biologic Risk Factors - Genetics have been found to account for 30% to 40% of an individual’s risk for anxiety and depression and 50% to 60% of risk for substance dependence - Genetics is more influential in the progression to pathological use Other Biologic associated with dysphoric mood ( either anxiety or depression) include the following: Hormonal changes (ex. Mood disorder with post partum onset Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), associated with a rapid onset of tics, Tourette’s syndrome and obsessive-compulsive disorder in children Disturbances of the circadian rhythm Endophenotypes - Represent inherited traits that are risk factors for disorder - Present and detectable before the disorder is expressed. Inherited Temperaments or Traits Indicative of Risk: Anxiety and Depression Traits: - Tendency toward introversion, shyness and caution in novel situation - Tendency to be fussy, agitated and irritable - Tendency toward negative, depressed, irritable or angry mood Alcohol Dependence Traits: Facial flushing, decreased sensitivity to effects of alcohol Alcohol and Drug Dependence Traits: Behavioural dis-inhibition, sensation seeking, impulsivity, impaired functioning( complex cognitive processes such as planning and judgement) psychiatric disorders  Suicide Traits: Impulsivity POTENTIAL ASSOCIATIONS BETWEEN PSYCHIATRIC AND SUBSTANCE USE DISORDERS 1. Pathological substance use causes anxiety, depression and other mental health disorders by increasing stress or impacting sensitive neural systems 2. Anxiety, depression and other mental health disorders caused pathological substance use because substances help to regulate negative moods 3. Psychiatric and substance use disorders share genetic risk factors (difficult temperament, negative affectivity) and other risks ( ex. Maladaptive responses to stress, lack of adequate coping mechanisms) 4. Psychiatric and substance use disorders reciprocally influence one another B. Psychological Risk Factors - Individuals thoughts, beliefs, expectancies and self perceptions are shaped through an interaction of inherited temperaments, sensitive neural systems, hormones and early learning experiences and thereby influence the development of mental health and behavioural disorders - Both depression and anxiety are associated with maladaptive thought patterns, although the content of the maladaptive thoughts associated with anxiety and depression differs - Beliefs about the effects of a substance known as outcome expectancies influence the age of onset and level of substance use. - Positive expectancies (beliefs that drinking will produce positive outcomes) are associated with increase used. - Suicidal risk increases when suicidal thoughts are combined with an increased acceptance of suicide as a viable option and feelings of hopelessness. C. SOCIAL RISK FACTORS - Among individuals exposure to anxious parents or to a substance using peers increases the risk of developing an anxiety or substance use disorder - Parental depression significantly increases the risk of depression among offspring - Direct exposure to a threatening stimulus (trauma, social evaluation) will also lead to the development of specific phobias and traumatic stress disorders D. ENVIRONMENTAL RISK FACTORS - Stress and adverse early environments such as those characterized by child abuse and neglect, domestic violence, discrimination and poverty. - Social isolation - Inadequate transportation, housing, education, employment and nutrition - Poor parenting practices - Easy access to drugs and alcohol and exposure to drug using peers - Increased in the number of prescription written for opioid and stimulant medications as well as availability for purchase on line - Poverty  ENVIRONMENTAL RISK FACTORS SPECIFIC TO SUICIDE - Suicide among family or friends - Inaccessibility of mental health services - Serious physical illness E. CULTURE/DIVERSITY - Diversity in terms of gender, race, age, socioeconomic status and religious affiliation is a critical factor in determining both risk and resilience for mental health and behavioural disorders - Research suggests that anxiety and mood disorders are more prevalent among women - Substance use and suicide are more frequent among men - Men have an earlier onset of substance use and use more heavily than women. - Rates of cigarettes smoking are gender comparable - Women who do use substances may progress to pathological use more rapidly and have greater difficulty in quitting than men - Social injustice and discrimination are significant risk factors for mental health and behavioural disorders - Stigma and discrimination may explain why mental and behavioural disorders are more prevalent among sexual minorities (lesbian, gay, transgendered) - Age is also a risk factor. Individuals over age 50 are higher risk than their younger counterparts - Young adults are at greater risk for suicidal ideation and attempts. - Minority status has also been implicated as a risk factor for developing all mental health and behavioural disorders F. Protective Factors - Helps mitigate the risk of developing mental health and behavioural disorders - Cognitive, social, environmental and cultural factors that contribute to good mental and behavioural health outcomes, HOW a. Secure attachment during infancy which contributes to the development of a positive self image and adequate social skills b. Strong attachments to family, school and community among adolescents c. Social support and positive preventing practices d. Adequate coping skills for managing stress e. High self esteem f. Strong religious beliefs  PREVENTION AND HEALTH PROMOTION STRATEGIES The Institute of Medicine ( IOM) proposed a typology for prevention of mental health and behavioural problems This typology comprises 3 categories A. Universal Prevention – is similar to primary prevention; Efforts are targeted toward an entire population regardless of risk level B. Selective Prevention- a form of secondary prevention because they are directed toward those at greater risk for mental health and behavioural disorders  - The individuals possess risk factors such as anxious temperament or early childhood adversity C. Indicated Prevention - Here they are experiencing subclinical symptoms that do not meet the criteria for disorder such as anxious mood without functional impairment Selective Prevention and Indicated Prevention are collectively referred to as TARGETED PREVENTION 1. Theoretical Framework The Health Belief Model - Provides a framework for understanding how people perceive themselves to be at risk for developing problems and factors associated with decisions to enact disorder prevention and health promotion behaviour  4 COGNITIVE DIMENSIONS THAT IMPACT AN INDIVIDUAL’S WILLINGNESS TO MODIFY RISKY HEALTH BEHAVIOURS INCLUDED IN THIS MODEL 1. Perceived Susceptibility – is the extent to which individuals recognized that they are at risk for developing an undesirable health outcome 2. Perceived Severity – involves the extent to which associated consequences are perceived to be grave. 3. Perceived benefits of change 4. Perceived barriers to change 5. Perceived self-efficacy - Is the result of the recent modification of the health belief model - Is important in predicting the likelihood of behaviour change - Self efficacy refers to confidence or a belief in one’s competence to do what is needed to enact health enhancing behaviours  Public Policy Universal prevention efforts include policy changes that are directed toward an entire population and serve to reduce the incidence of mental health and behavioural disorders a. Improving nutrition and housing b. Improving access to education and health care c. Improving access to work and reducing poverty d. “Sin taxes”- increasing the cost f alcohol and cigarettes e. Raising the legal age to purchase and drink alcohol f. Reducing the availability of alcohol by regulating number and open hours of places selling alcohol g. Advertising bans h. Banning smoking in public places  i. Reducing the toxicity of gasoline and car exhausts j. Minimizing access to high places such as rooftops and bridges k. Enforcing gun control policies L. Controlling the availability of pesticides and prescription medications