4. DEFINITION OF HEALTH
“A state of complete
(Physical, Mental & Social)
well-being”
(World Health Organization)
5. The 10 Health Indicators
1- Physical Activity.
2- Overweight and Obesity.
3- Tobacco Use.
4- Substance Abuse.
5- Responsible Sexual Behavior.
6- Mental Health.
7- Violence and Injury.
8- Environmental Quality.
9- Immunization.
10- Access to Health Care.
6. MENTAL HEALTH
The successful performance of
Mental Functions.
Resulting in Productive activities
& Fulfilling relationships.
The ability to adapt to change &
cope with stressors.
The successful adaptation to
stressors are evidenced by
7. MENTAL ILLNESS
A Clinically Syndrome, marked by
Distress, Disability, Suffering or
Loss of freedom.
Maladaptive Responses to
stressors evidenced by thoughts,
feelings & behaviors, interfere with
the individual’s physical, social or
8. Mental Health/ Mental Illness
Concept Must Be Clear
Mental Health Mental Illness
Continuum - Not Static
(Introversion → Avoidant Personality → Social Phobia
→ Schizophrenia)
9. MENTAL HEALTH
Maslow identified:
A “Hierarchy of Needs”:
Self-actualization as fulfillment of
one’s highest potential
11. Aspects of Mental Health
Emotional Intelligence:
Emotions are skills for living.
Have emotional self control.
Recognize emotions in others.
Handle relationships.
Resiliency:
Emerge and grow from negative life events.
Spirituality:
That part of us that deals with relationships, values and
addresses questions of purpose and meaning in life.
12. Common & Serious
Mental Health Problems
Common Problems:
– Depressive Disorders.
– Anxiety Disorders.
Severe & Enduring Problems:
– Schizophrenia.
– Bipolar disorder.
– Major depression.
– Dementia.
13. Problems of Mental Disorders
Lifespan vs. Health span.
Physical Burden.
Poly-Pharmacy.
Psychosocial Burden.
Biological Basis of Psychiatric Disorders.
14. Lifespan vs. Health span
Lifespan: Length of life increased.
Health span: Length of healthy life before
Disability.
Factors affecting lifespan and health span:
1. Exercise: Improves mood and
cognition.
2. Sleep pattern.
3. Eating pattern.
4. Social networks: Protective against
15. Physical Burden
Comorbid Physical Diseases:
NS, IS, CVS, RS, US & GIT.
Disability: Physical & Mental.
Side Effects: Psychotropic Drugs.
17. Physical Comorbidity
Schizophrenia:
Obesity, Hypertension & Smoking.
Hepatitis C & HIV.
Drug related Movement Disorders.
Cancer Colon.
Rheumatoid Arthritis.
Bipolar Disorder
As for schizophrenia. +
Drug Related Thyroid Diseases.
Drug Related Renal Diseases (Lithium).
Causes of Death among Mental Patients:
Cardio-Respiratory Disease & Infectious disease.
19. Psychosocial Burden
Social Isolation.
Physical & Cognitive Dysfunctions.
Loss of Social & Occupational Status.
Loss of Friends.
Lack of Adequate Health Care.
Financial Insecurity.
Death Preoccupation.
Dependency on Their Families.
21. CAUSES OF MENTAL
ILLNESS
The concept of multiple
factors in the causation of
psychogenic disorders has
become generally accepted.
The factors are considered
to involve the individual, the
family & the community.
22. Biological Basis of Psychiatric Disorders
Nerves Environment
Hormones Brain
Action
Endocrine Glands Immune System
Physiology
& Behavior
23. The Biological Basis of
Psychiatric Disorders
Brain Mind
Biopsychosocial
Model
Psychoneuro-
Medically
Immunology
Unexplained
Physical Symptoms
Body
24. Diathesis-Stress Model
Diathesis Stress
“Predisposing Causes” “Precipitating Causes”
(Hereditary Predisposition) (Situational Factors)
Bio-Psycho-Social
Approach
Disorder “Maintaining Causes”
• Emphasizes Interaction of Physical Conditions
Biological and Social Factors
Recovery
26. Quality of Life
Well-being: Physical, Psychological, Social & Spiritual.
Physical Psychological
Functional Ability Anxiety
Strength/Fatigue Depression
Sleep & Rest Enjoyment/Leisure
Nausea Pain Distress
Appetite Happiness
Constipation Fear
Pain Quality of Cognition/Attention
Social Life
Spiritual
Financial Burden
Hope
Caregiver Burden
Suffering
Roles & Relationships
Meaning of Pain
Affection
Religiosity
Sexual Function
Transcendence
Appearance
27. How Does The Public View
The Mentally Ill?
They are fearful.
There is a big stigma.
The mentally ill are labeled.
Care is rationed.
People oppose care by using laws.
The mentally ill are losers when it
comes to the budget for care.
28. What are The Costs
of Mental Illness?
Police costs.
Public health costs.
Safety costs.
Court costs.
Business costs.
Social costs.
Jail costs.
30. L1:Community (30%).
F1 : Illness behavior.
L2:Mental morbidity in primary care (25%).
F2: Ability to detect.
L3:Mental morbidity by doctors (10%).
F3: Referral.
L4:Morbidity in mental health services
(2.5%).
F4: Admission.
L5: Psychiatric inpatients (0.5%).
31. The Provider- Caregiver
Relationship
– Expectations.
– Establish & Maintain Boundaries.
– Building on Strengths.
– Sharing One’s Own Family Life.
– Reciprocal & Positive Feelings.
32. Talking with Caregivers
Be Positive.
Be Flexible.
Be a Good Observer.
Work as Partner.
Listen Actively.
Begin Where The Caregiver Is.
Ask Leading Questions.
Make Comments Thoughtfully.
Answer Personal Questions.
37. PSYCHIATRY STRATEGIES
Integration of mental health with
primary health care through
the national mental health program.
Provision of tertiary care institutions for
treatment of mental disorders.
Eradication stigmatization of mentally ill
patients.
Protecting patient rights through regulatory
institutions like the central mental health
authority.
38.
39. Numbers of People
Affected Globally
450 million people with mental disorders:
– 150 million with Depression.
– 90 million with Alcohol or Drug Use Disorder.
– 40 million with Epilepsy.
– 25 million with Schizophrenia.
– 10 million Attempt Suicide every year.
– 1 million Commit Suicide every year.
40. Did You Know?
4 of the 10 leading causes of disability are
mental disorders:
- MD, Schizophrenia, Dementia & OCD.
6% of the population suffers from Severe &
Persistent Mental Illness:
- Dementia, Schizophrenia, BAD & MD.
13 % of the population has a diagnosis of:
- Dysthymia, Panic Disorder, Phobia & Antisocial
Personality Disorder.
41. Psychiatry by Numbers
25% of the population has a mental
disorder.
15% of patients in population have
depressive illnesses.
90% of the 10 most common
complaints in psychiatric setting
have no organic basis.
50% of mental health care can be
delivered by Non-Psychiatrists.
42. Relationship Between
Psychiatry & Medicine
A- Medical Conditions that have
psychiatric symptoms.
B- Psychosomatic Disorders.
C- Medically Unexplained
Physical Symptoms.
D- Mental Disorders that may
have physical symptoms.
43. A- Medical Conditions That Have
Psychiatric Symptomatology
1- Neurological Diseases:
Brain tumors, Epilepsy, MS, Parkinsonism,...
2- Endocrine Syndromes:
Thyroid, Suprarenal, Ovaries, Pancreas,…
3- Infectious Diseases & Autoimmune Syndromes.
4- System Failures:
Renal, Hepatic, Cardiac, Respiratory,...
5- Chronic Disability:
Blindness, Deafness, Muteness, Loss of limb,...
6- Blood Diseases:
Anemia, Leukemia, Hemolytic diseases,...
44. B- Psychosomatic Disorders
The physical condition must show either
demonstrable organic pathology or a
known patho-physiologic process.
They can influence not only the cause of
the illness but can also worsen the
symptoms & affect the course of the
disorder.
Examples: Angina, Hypertension,
Bronchial asthma, Rheumatoid arthritis,
Duodenal ulcers, IBS, Eczema, Psoriasis
& Urticaria.
45. C- Medically Unexplained
Physical Symptoms
Sometimes psychological factors can cause ill
health without actually causing a disease.
As a result of unhappiness, anxiety or stress due
to personal problems, physical symptoms may
develop.
A- Somatoform disorders.
B- Factitious disorders.
C- Malingering.
49. CAREGIVERS BURDEN
Physical Burden.
Financial Burden.
Time Burden.
Role Burden.
Emotional Burden.
Others.
50. Caregiving Burden
Signs of Caregiver Burnout
1- Physical Burden:
Weight Change: Gain or Loss.
Unexplained Somatic Complaints:
(Chronic headaches, backaches or
others).
Caregiver’s Syndrome:
(Fatigue from physical strain & sleep lack ).
Osteoporosis and Arthritis.
51. Caregiving Burden
Signs of Caregiver Burnout
3- Time Burden:
Caregiving is time-consuming.
Less time for other tasks.
Activities can be stressful.
4- Role Burden:
Feelings of being pulled in different
directions.
Family responsibilities.
Pressure and tension.
52. Caregiving Burden
Signs of Caregiver Burnout
5- Emotional Burden:
Common feelings: Being overwhelmed, Anger,
Frustration, Guilt, Exhaustion, Loneliness and
Social withdrawal.
Cognitive disturbances: Lack of concentration
and finding it difficult to complete complex tasks.
Sleep disorders: Sleeplessness / stressful dream.
Anxiety: about facing another day and what the
future holds.
Depression: feeling sad and hopeless.
Adjustment disorders.
55. Conclusions
Mental disorders among patients & their
caregivers are frequent, associated with
increased medical & functional morbidity.
Attention to physical, psychological & spiritual
concerns are necessary.
Use of medication, psychotherapy or
counseling in an integrated manner results in
best outcomes.
The good physician will treat the disease but
the great physician will treat the patient.
Mental health means enhancing physical
treatment & promoting mental health.
56. Nursing Is Of
Paramount
Importance
Among Mental
Patients
Only when lower order needs have been met can we be concerned with the higher order needs. When you reach self-actualization you may exhibit the following characteristics: keen sense of reality, objective judgment, see problems in terms of challenges and solutions not just complaints and excuses, independent, socially compassionate, accepting others as they are, spontaneous and natural, creative, inventive and original. Story of Ethan and his mom- Ethan having trouble with constipation & pediatrician is not helpful. Ethan is uncomfortable & unhappy. Stresses mom out. Mom needs help but doesn’t know where to get it. If HV helps her what would happen? mom will have energy to devote to Ethan and his intervention Ethan will be more receptive because he will feel better & be healthier Mom will see professional as invested. Will trust more. Will listen more. Mom will feel better about herself because she got Ethan the help he needs. She was effective.
*Parents need to know that we care before they care what we know. Boundaries What you can do & aren’t prepared to handle If problem is beyond your expertise-REFER Professional distance is the boundary we, as the professionals, set with each family To be successful at HV we need good boundaries When we do not have appropriate professional boundaries we lose our objectivity Without objectivity we can’t use proper judgment and fully serve the families Don’t expect families to set the boundaries Building on strengths Recognize/acknowledge parent as expert on the child Sharing one’s own family life Appropriate if related to family’s life Communicates understanding & support Validates the parent’s experience/feelings Trust the power of the process of developing the relationship Relationship is dynamic, varies in nature & effect Development occurs through relationship Relationships are patterns of interaction over time All relationships involves mutuality Each person influences the other at the moment and in important ways over time Shared Delight Korfmacher Article 1190 EHS mothers from 17 sites around the US How moms rated HR correlated with how their involvement was viewed by professionals Parent-report measures tend to be positively biased…rated very highly even when qualitative reports suggest much more variability in the relationship HR should not be static, should change over time as the child matures and needs change and families and prof get to know each other more This study showed relationships went down from first (6 months) to second eval (15 months) and leveled off at third (26 months)
Communication=process by which families and professionals exchange messages that influence, facilitate and define the purposes of EI Help parents strive for realistic optimism Don’t assume you know more about the child than the parent Start with something where parents can be successful Use “door openers” which invite them to say more about the incident or their feelings. Such as “I see” “oh” “tell me more” “No kidding Speak in plain, everyday language Generalizations about parents of children with disabilities will influence your actions, so don’t label Brady Article Identifying and describing types and patterns of talk during interactions b/w 15 families of ycwd and EI prof Video-taped and then analyzed with computerized coding system What amt & type of talk are used by prof & families? Prof talked 50% of the total visit time-23% direct to families, 27% to child Families talked 44% of the time-1/2 to child, ½ to professional Considerable variability-Prof 33-70% & Family 25%-63% Professionals give info (direct) and praise (indirect) most often Families initiates (direct) and responds (indirect) most often Lots of variability here also Is there a rel. b/w amt & types of professional talk and the amt & types of family talk? Positive correlation b/w total indirect prof and total family talk (& family initiates) The more prof praised, encourages, and accepted families’ ideas the more involved families were in the ix Younger prof less likely to give info and more likely to direct families What sequential patterns of talk are most common? Older prof give info more (gave it in a f-c way) but prof give info and then tend to give more info indicating lack of ix by family. When major focus is prof giving info that wasn’t requested by families power and control in the relationship are likely not being shared. Following a family member’s expression of feelings prof tended to react to content and not to expression of feelings…tendency to rush in , offer solutions, and try to “fix” the problem Key tenet of family-centered tx is to listen actively, acknowledge, and address families concerns and needs Need to reflect feelings (a microskill in active listening) allows families to identify and clarify their concerns and accept their feelings as valid
Empathy seeing things from the other person’s perspective Respect belief in the worth of all human beings and acting on those beliefs Perseverance & resilience commitment and conviction that enable professionals to continue in the face of obstacles, set backs, and lack of progress Passion need to have a strong drive to know more regardless of current knowledge or skill. Lifelong learner! Don’t be afraid to say “I don’t know” but then find out! Don’t be guided by “traditional” expectations…won’t know until we try or let’s try another way