Definition of mental health Describe the problem statement List the characteristics of a mentally healthy person List the warning Signals of Poor Mental Health Classify mental illness Enumerate the causes of mental ill-health Discuss the consequences of poor mental health Explain about the Mental Health Services Epidemiology of Alcoholism and Drug Dependence Describe the Symptoms of drug addiction Prevention, treatment, and rehabilitation for drug dependence When is World Mental Health Day

1. Mental Health
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine
28.07.2020

2. Learning Objectives
• Definition of mental health
• Describe the problem statement
• List the characteristics of a mentally healthy person
• List the warning Signals of Poor Mental Health
• Classify mental illness
• Enumerate the causes of mental ill health

3. Learning Objectives
• Discuss the consequences of poor mental health
• Explain about the Mental Health Services
• Epidemiology of Alcoholism and Drug Dependence
• Describe the Symptoms of drug addiction
• Prevention, treatment and rehabilitation for drug dependence
• When is World Mental Health Day

4. Definition of mental health

5. Definition of Health
Health is defined as a “state of complete physical, mental and
social well-being and not merely the absence of disease or
infirmity”
Positive Mental
Health
Negative Mental
Health
Individual's personality Emotional attitudes
which enable him to live harmoniously with his fellow-men

6. What is mental health?
Emotional Psychological Social

7. Definition of Mental Health
An individual realizes his or her own abilities
Can cope with the normal stress of life
Can work productively
Able to make a contribution to his or her community

8. Problem statement

9. Global Burden
• The tentative global estimates of the major mental disorders are
• Depression – 300 million
• Bipolar affective disorders – 60 million
• Schizophrenia & other psychosis – 23 million
• Dementia – 50 million

10. Global Burden
• Mental, neurological and substance use disorders :13% GBD
• Depression : 4.3% GBD – largest single causes of disability
worldwide (11% of all years lived with disability globally)
• Economic consequences : cumulative global impact of mental
disorders in terms of lost economic output will amount to US$
16.3 trillion between 2011 and 2030.

11. Indian Burden
• NMHS 2015 was carried out in 12 states
• 150 million – 13 years and above : suffer
• More in urban areas
• Neurosis and stress – twice in women
• Young adolescent – 7.3%
• Alcohol use disorder in men – 4.6%

12. Indian Burden
• Illicit substance abuse – 0.6%
• Less than 2% severe mental illness
• 0.9% are at risk of suicide
• The prevalence in the surveyed population was 10.6 %
• Lifetime prevalence is 13.7%
• Economic impact: Rs. 1000 – 2500/- per month

13. Prevalence of
Mental
Disorders
WHO Fact sheet for
India

14. Characteristics of a mentally
healthy person

15. Characteristics of a mentally healthy
person
• Mental Health is not mere absence of mental illness. A mentally
healthy person has 3 main characteristics:
1. He feels comfortable about himself, secure and adequate. He
accepts his shortcomings. He has self-respect.
2. The mentally healthy person feels right towards others, love
them. He has friendships that are satisfying and lasting, like
and trust others. He takes responsibility for his neighbours
and his fellow-men.

16. Characteristics of a mentally healthy
person
3. The mentally healthy person is able to meet the demands of life.
4. He does something about the problems as they arise.
5. He is able to think for himself and to take his own decisions.
6. He sets reasonable goals for himself.
7. He shoulders his daily responsibilities.
8. He is not bowled over by his own emotions of fear, anger, love or
guilt.

17. Warning Signals of Poor
Mental Health

18. Warning Signals of Poor Mental Health
1. Are you always worrying ?
2. Are you unable to concentrate because of unrecognized
reasons?
3. Are you continually unhappy without justified cause?
4. Do you louse your temper easily and often?
5. Are you troubled by regular insomnia?

19. Warning Signals of Poor Mental Health
6. Do you have wide fluctuations in your moods from depression
to elation, back to depression, which incapacitate you?
7. Do you continually dislike to be with people?
8. Are you upset if the routine of your life is disturbed?
9. Do your children consistently get on your nerves?
10.Are you “browned off” and constantly bitter?

20. Warning Signals of Poor Mental Health
11.Are you afraid without real cause?
12.Are you always right and the other person always wrong
13.Do you have numerous aches and pains for which no doctor
can find a physical cause?

21. Types of Mental Illness

22. Types of Mental Illness
• ICD-10 classifies the mental and behavioral disorders as
1. Organic, including symptomatic, mental disorders
2. Mental and behavioural disorders due to psychoactive
substance use
3. Schizophrenia, schizotypal and delusional disorders
4. Mood (affective) disorders

23. Types of Mental Illness
5. Neurotic, stress related and somatoform disorders
6. Behavioural syndromes associated with physiological
disturbances and physical factors
7. Disorders of adult personality and behaviour
8. Mental retardation
9. Disorders of psychological development

24. Types of Mental Illness
10.Behavioural and emotional disorders with onset usually
occurring in childhood and adolescence - e .g. conduct
disorders.
11.Unspecified mental disorder.

25. Major Mental Illness
• The major illnesses are called psychoses. Here, the person is
"insane" and out of touch with reality.
Schizophrenia
• Split personality in
which the patient
lives in a dream
world of his own
Manic Depressive
Psychosis
• The symptoms vary
from heights of
excitement to
depths of
depression
Paranoia
• Undue and
extreme suspicion
and a progressive
tendency to regard
the whole world in
a framework of
delusions

26. Minor Mental Illness
Neurosis or Psychoneurosis
• In this the patient is unable to react normally to life situations.
He is not considered "insane" by his associates, but
nevertheless exhibits certain peculiar symptoms such as
morbid fears, compulsions and obsessions
Personality and Character Disorders
• This group of disorders are the legacy of unfortunate
childhood experiences and perceptions.

27. Causes of Mental Illness

28. Causes of Mental Ill-health
A. Organic Conditions: Mental illnesses may have their origin
in organic conditions such as cerebral arteriosclerosis,
neoplasms, metabolic diseases, neurological diseases,
endocrine diseases and chronic diseases such as
tuberculosis, leprosy, epilepsy, etc.
B. Heredity: Heredity may be an important factor in some cases
Eg. the child of two schizophrenic parents is 40 times more
likely to develop schizophrenia than is the child of healthy
parents.

29. Causes of Mental Ill-health
C. Social Pathological Causes: To produce any disease, there
must be a combination of genetic and environmental factors.
• The social and environmental factors associated with mental ill-health
comprise: worries, anxieties, emotional stress, tension, frustration,
unhappy marriages, broken homes, poverty, industrialization, urbanization,
changing family structure, population mobility, economic insecurity, cruelty,
rejection, neglect and the like.
• The social environment not only determines the individual's attitudes but
also provides the "framework" within which mental health is formulated.

30. Environmental Factors
Carbon disulfide, mercury, manganese,
tin, lead compounds
Toxic substances
Barbiturates, alcohol, griseofulvinPsychotropic drugs
Deficiency of thiamine, pyridoxineNutritional factors
Deficiency of iodineMinerals

31. Environmental Factors
Eg. Measles, rubella – adverse effects
on the child’s brain development
Infective agents
Road and occupational accidentsTraumatic factors
• Nervous system is most sensitive to
radiation during the period of neural
development
Radiation

32. The infant and young child should experience a warm, intimate and continuous relationship with his mother and
father. It is in this relationship where underlies the development of mental health. It follows that broken homes are
likely to produce behaviour disorders in children and this has been confirmed by several studies.
The programmes and practices of the school may satisfy or frustrate the emotional needs of the child. Children
who have emotional problems may need child guidance clinic or psychiatric services. From the standpoint of the
child's mental health and his effectiveness in learning, proper teacher-pupil relationship and climate of the class
room are very important.
The causes of mental illness in the aged are organic conditions of the brain, economic insecurity, lack of a home, poor status and insecurity.
The basic needs of the adolescents are: (a) the need to be needed by others, (b) the need for increasing
independence, (c) the need to achieve adequate adjustment to the opposite sex and (d) the need to rethink the
cherished beliefs of one's elders. The failure to recognize and understand these basic needs may prevent sound
mental development.
Crucial points in our lifecycle
Prenatal period: Pregnancy is a stressful period for some women. They need help
not only for their physical but also emotional needs.
First 5 years of life: The roots of mental health are in early childhood.
School child: Everything that happens in the school affects the mental health of
the child.
Adolescence: The transition from adolescence to manhood is often a stormy one
and fraught with dangers to mental health, manifested in the form of mental ill-
health among the young, and juvenile delinquents in particular.
Old age: The mental health problems of the aged have received considerable
attention in recent times in the developed countries.

33. Needs of man / woman remain the same
The need for
affection
The need for
belonging
The need for
independence
The need for
achievement
The need for
recognition or
approval
The need for
a sense of
personal
worth
The need for
self-
actualization
These needs only differ in degree and qualitative importance
at various ages.

34. Mental disorders with other diseases
• Cancer, cardiovascular disease and HIV infection/AIDS
• Require common services and resource mobilization efforts
• Risk factors : low SES, alcohol use and stress are common to
both mental disorders and other NCDs
• Substantial concurrence of mental disorders and substance use
disorders.

35. Consequences of poor
mental health

36. Consequences of poor mental health
• Lead individuals and families into poverty.
• Homelessness and inappropriate incarceration – exacerbate
their marginalization and vulnerability.
• Stigmatization and discrimination
• Persons with mental disorders often have their human rights
violated

37. Consequences of poor mental health
• Denied economic, social and cultural rights, with restriction on
the right to work and education, as well as reproductive rights
and the right to the highest attainable standard of health.
• Subject to unhygienic and inhuman living conditions, physical
and sexual abuse, neglect, and harmful and degrading
treatment practices in health facilities.

38. Consequences of poor mental health
• Denied civil and political rights: right to marry and found a
family, personal liberty, the right to vote and to participate
effectively and fully in public life, and the right to exercise their
legal capacity on other issue affecting them, including their
treatment and care.
• Live in vulnerable situations and may be excluded and
marginalized from society, which constitutes a significant
impediment to the achievement of national and international
development goals.

39. Mental Health Services

40. Mental Health Services
(1) Early diagnosis and treatment
(2) Rehabilitation
(3) Group and individual psychotherapy
(4) Mental health education
(5) Use of modern psychoactive drugs
(6) After-care services

41. Comprehensive Mental Health
Programme
• The National Mental Health Programme was launched during
1982
• Comprehensive mental health program includes all community
facilities pertinent in any way to prevention, treatment and
rehabilitation.
• Nine essential elements of Comprehensive mental health
program

42. Comprehensive Mental Health
Programme
In-patient &
Outpatient services
Partial
hospitalization
Emergency
Services
Diagnostic
services
Pre-care and
aftercare services
Education services
Training
Research and
evaluation

43. Alcoholism and Drug
Dependence

44. Drug and Drug abuse
• Drug is defined as "any substance that, when taken into the
living organism, may modify one or more of its functions"
• Drug abuse is defined as self- administration of a drug for non-
medical reasons, in quantities and frequencies which may
impair an individual's ability to function effectively, and which
may result in social, physical, or emotional harm.

45. Drug Dependence
• A state, psychic and sometimes also physical, resulting from the
interaction between a living organism and a drug
• Characterized by behavioural and other responses that always
• Include a compulsion to take the drug on a continuous or
periodic basis in order to experience its psychic effects
• Sometimes to avoid the discomfort of its absence.
• A person may be dependent upon more than one drug

46. Agent Factors
• Alcohol
• Opioids (Heroin)
• Cannabinoids (Marijuana)
• Sedatives or hypnotics
(Barbiturates)
• Cocaine
• Stimulants including caffeine
• Hallucinogens (LSD)
• Tobacco
• Volatile solvents
• Drugs used in combination

47. Alcohol
• Alcohol is a drug and may be classified as a sedative,
tranquillizer, hypnotic or anaesthetic.
• Intoxication is socially acceptable
• Produces psychic dependence & physical dependence
• Harmful use of alcohol : 3 million deaths worldwide (2016)
• Prevalence of alcohol dependence : India in 2016 was 4.9%

48. Alcohol : Mortality & morbidity
• Liver cirrhosis, RTAs & Cancers
• Suicides, domestic violence, crime, poverty, and STDs
• Psychosis
• Gastritis and Pancreatitis
• Cardiomyopathy and Peripheral neuropathy

49. Tobacco
• Prevalence of tobacco use in India is 28.6 % (2016-17)
• Smoke tobacco and/or use smokeless tobacco; khaini, gutkha
etc.

50. Tobacco : Passive smoking
• Second-hand tobacco smoke is the combination of smoke
emitted from the burning end of a cigarette or other tobacco
products and smoke exhaled by the smoker.
• Lung cancer in non-smoking Japanese wives married to men
who smoked.
• Heart disease and stroke.

51. Tobacco : Host factors
• Pleasure, desire to experiment
• Desire to escape
• Increasingly, people are unwilling to accept even minor
discomforts and are looking to drugs for solutions.

52. Symptoms of drug addiction

53. Symptoms of drug addiction
Loss of interest
in sports and
daily routine
Loss of
appetite and
body weight
Unsteady gait,
clumsy
movements,
tremors
Reddening and
puffiness of
eyes, unclear
vision
Slurring of
speech
Fresh, numerous injection
marks on body and blood
stains on clothes
Nausea,
vomiting and
body pain

54. Symptoms of drug addiction
Drowsiness or
sleeplessness,
lethargy and
passivity
Acute anxiety,
depression,
profuse sweating
Changing mood,
temper, tantrums
Depersonalization
and emotional
detachment
Impaired memory
and concentration
Presence of
needles, syringes
and strange
packets at home

55. Environmental factors
Unemployment
Living away from home
Migration to cities
Relaxed parental control
Alienation from family
Early exposure to drugs

56. Environmental factors
Leaving school early
Broken homes
One parent families
Large urban environments
Areas where drugs are sold , traded, or produced

57. Environmental factors
Certain occupations (tourism, drug production or sale)
Areas with high rates of crime or vice
Areas where there are drug using gangs
Areas where delinquency is common

58. Prevention
• Legal approach: Important approach in the prevention of drug
abuse
• The antismoking measures suggested are
a. Prohibition of the sale of tobacco products to minors
b. Prohibition of smoking in public
c. Insisting on the placing of mandatory health warning on
cigarette packets.

59. Prevention – Legal approach
• The minimum age at which minors may legally have access to
alcoholic beverages, has been raised in some countries.
• Mandatory jail sentences for drunken driving

60. Prevention – Educational approach
• Common approaches have included educational programmes
for school children and public information campaigns on
electronic media.
• The message should also provide specific advice, rather than
general, and as far as possible the information should be new to
the audience and should be capable of provoking action
• Cinema theatre advertisements

61. Prevention – Community approach
• There should be a strong emphasis on action at the community
level to prevent drug abuse.
• Initiating preventive interventions in the community
• A popular approach to the prevention of drug abuse is provision
of teen centres (athletics, sports, music, artistic activities)
• NGOs play a crucial role in the development of such activities

62. Treatment
• Long term treatment is not only a medical problem, but needs
the cooperation of psychologists and sociologists.
• There is a high relapse rate with all treatment methods

63. Medical Care
• Identification of drug addicts and their motivation for
detoxication
• Detoxication (requires hospitalization)
• Post-detoxication counselling and
• Follow-up : based on clinic and home visits)
• Rehabilitation

64. Rehabilitation
• Long and difficult process
• Relapses are very frequent
• Community should avoid discrimination.
• Facilities for Vocational Training

65. Rehabilitation
• Combined and coordinated use of medical, social, educational and
vocational measures for training and retraining the individual to the highest
possible level of functional ability
• Medical – Minimizing mental & physical disabilities, restoration of function
• Vocational – Education, restoration of capacity to earn a livelihood
• Social – Restoration of family and social relationships
• Psychological – Restoration of personal dignity and confidence

66. World Mental Health Day
• The world mental health day was first proclaimed by the World
Federation for Mental Health (WFMH) in 1992.
• It is co- sponsored by WHO
• It requests Members States "to promote mental health and
healthy behaviour using the commemoration of the World
Mental Health Day 10th October".

67. World Mental Health Day
Year Theme
2020 Mental Health For All Greater Investment – Greater
Access for Everyone, Everywhere
2019 Mental Health Promotion And Suicide Prevention
2018 Young People And Mental Health In A Changing World
2017 Mental Health In The Workplace
2016 Psychological First Aid
2015 Dignity In Mental Heath

68. Mental health impact from COVID-19
• The analysis suggests that, in the longer term, SARS and
MERS survivors may be at risk for mental illnesses such as
depression, anxiety, fatigue, and post-traumatic stress disorder
(PTSD) in the months and years following discharge from
hospital.

69. Barriers
• Progress in mental health service delivery has been slow in
most low- and middle-income countries.
• Barriers include
Existing public-health
priorities and its
influence on funding
Challenges to delivery
of mental health care in
primary-care settings
Low numbers of those
trained in mental health
care
Lack of mental health
perspective in public-
health leadership.

70. Ability to recognize psychological distress
Knowledge and beliefs about causes
Knowledge and beliefs about self-help
Knowledge and beliefs about professional-help
Attitudes that facilitate recognition and help seeking
Knowledge of how to seek mental health information
Components
of mental
health
literacy

71. Salutogenesis
• Derivation of Greek + Latin
• Latin: Salus = health
• Greek: genesis = source
• In combination = Sources of health

72. Disease
surveillance
Pathogenesis -
the focus on
disease
aetiology
Focus on
disease
prevention
Salutogenesis,
the focus on
health

73. Sense of Coherence (SOC)
The heart of Salutogenesis
A pervasive, long-lasting and dynamic feeling of confidence that
one’s internal and external environments are predictable and that
there is a high probability that things will work out as well as can
be expected” (Antonovsky, 1979)
SOC has strong positive correlations to perceived health, mental
health, and quality of life.

74. Mental
Health First
Aid
Managing
Mental
Wellbeing
Train the
trainer
My
Resilience
Coaching
Mental
Wellbeing
Mental
Health
Awareness
Mental
Wellbeing

75. Summary
• Mental disorders are universal
• Prevalence is 10.6 %
• Prevention includes
1) Primordial – Improving the social environment and promotion
of social , emotional and physical well being of all people.
2) Primary – Screening in schools & universities Counselling
services

76. Summary
3) Secondary: Consists of early diagnosis of mental illness and
treatment
4) Tertiary: Rehabilitation services

77. SRQ – 20 :
Screening tool
developed by
WHO for
Primary
Healthcare
setting
Thank you…