Presentation Name CHP200: Community Health Program-l Mohamed M. B. Alnoor Presentation Name Company Name COPMI: Children Of Parents with a Mental Illness.

CONTENT MENTAL HEALTH MENTAL HEALTH Definitions Mental Health jhjkkjkljlkjljll MENTAL HEALTH MENTAL HEALTH CONTENT jhjkkjkljlkjljll Definitions Mental Health Mental Illness( MI ) Importance Myths of MI We are all vulnerable Etiology of MI jhjkkjkljlkjljll Classification and types of MI Distribution of MI Overview- Morbidity and Mortality Prevention of MI Management of MI Integration of MI into PHC Conclusion jhjkkjkljlkjljll

Definition Mental Health jhjkkjkljlkjljll MENTAL HEALTH Definition jhjkkjkljlkjljll Mental Health The World Health Organization defines mental health as "a state of well-being in which the individual: jhjkkjkljlkjljll realizes his/her own abilities can cope with the usual stresses of life can work productively and fruitfully is able to make a contribution to his/her community.” jhjkkjkljlkjljll

control their behavior jhjkkjkljlkjljll MENTAL HEALTH Definition jhjkkjkljlkjljll Mental Illness It is when someone lacks the ability to: manage day to day events and/or control their behavior so that basic physical and emotional needs are threatened or unmet. jhjkkjkljlkjljll jhjkkjkljlkjljll

Definition Mental Illness jhjkkjkljlkjljll MENTAL HEALTH Definition jhjkkjkljlkjljll Mental Illness A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. jhjkkjkljlkjljll jhjkkjkljlkjljll

Definition Mental Illness A clinically significant behavioral syndrome jhjkkjkljlkjljll MENTAL HEALTH Definition jhjkkjkljlkjljll Mental Illness A clinically significant behavioral syndrome psychological syndrome pattern that is associated with jhjkkjkljlkjljll present distress disability significant risk of suffering death Pain Disability An important loss of freedom. jhjkkjkljlkjljll

Definition are medical conditions that disrupt a person's: jhjkkjkljlkjljll MENTAL HEALTH Definition jhjkkjkljlkjljll are medical conditions that disrupt a person's: Mental Illnesses thinking feeling mood ability to relate to others jhjkkjkljlkjljll daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. jhjkkjkljlkjljll

Myths of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE Background jhjkkjkljlkjljll Myths of Mental Illness Mental illness is caused by bad parenting. Fact: Most diagnosed individuals come from supportive homes. jhjkkjkljlkjljll The mentally ill are violent and dangerous. Fact: Most are victims of violence. People with a mental disorder are not smart. Fact: Numerous studies have shown that many have average or above average intelligence. jhjkkjkljlkjljll

Facts of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE Background jhjkkjkljlkjljll Facts of Mental Illness There is ignorance, stigma, superstition, and fear around Mental Illness Etiology, pathogenesis diagnosis and treatment are imperfect. There are good reasons to integrate mental health into primary health care jhjkkjkljlkjljll jhjkkjkljlkjljll

Etiology of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH Etiology of Mental Illness jhjkkjkljlkjljll Multifactorial Etiology Stressors Disability Sociodemographic Physical Illness Psycho- pathology jhjkkjkljlkjljll Environmental Biological Utilization & Access to Health Care Other jhjkkjkljlkjljll

Etiology of Mental Illness MENTAL HEALTH Etiology of Mental Illness jhjkkjkljlkjljll Multifactorial Etiology BIOLOGOCAL FACTORS jhjkkjkljlkjljll Mental & behavioral disorders Biological Factors: Genetics appears to play a role in the development of mood disorders. The strongest evidence for the role of genetics comes from twin studies. Certain chemical imbalances in the brain have been linked to mood disorders. Psychological Factors: Cognitive distortions may lead to the development of mood disorders. Cognitive distortions: An illogical and maladaptive response to early negative life events that leads to feelings of incompetence and unworthiness that are reactivated whenever a new situation arises that resembles the original events. Social Factors: Difficulties in interpersonal relationships may lead to mood disorders. The link between depression and troubled relationships may explain why women are more likely to suffer from depression--women tend to be more relationship-oriented than men. PSYCHO- LOGICAL FACTORS SOCIAL FACTORS

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Always Included in Definition depression Schizophrenia Major Depression Bipolar Disorder schizophrenia Bi polar Personality jhjkkjkljlkjljll Sometimes Included An xiety Severe Anxiety Disorders Cognitive Disorders Some Personality Disorders

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Schizophrenia Criteria for Schizophrenia Delusions Hallucinations Disorganized Speech Disorganized Behavior jhjkkjkljlkjljll Negative Symptoms Flat Affect Lack of Motivation Social/Occupational Dysfunction

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Major Depression Criteria for Major Depression Depressed Mood Diminished Interest Weight Loss or Gain Sleep Disturbance Restlessness or Being Slowed Down Fatigue & Loss of Energy Thoughts of Death jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Major Depression Criteria for Major Depression Feelings of Worthlessness or Excessive Guilt Difficulty Thinking & Concentrating Symptoms Occur Almost Every Day Significant Distress & Impairment jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Bipolar Disorder Criteria for Bipolar Disorder Manic Episodes Elevated mood Grandiosity Decreased need for sleep Talkativeness Racing thoughts jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Bipolar Disorder Criteria for Bipolar Disorder Marked Impairment Occupation Social relationships jhjkkjkljlkjljll May Alternate with Depressive Episodes

DISTRIBUTION IMPORTANCE Mental Health is a worldwide problem jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll jhjkkjkljlkjljll Mental Health is a worldwide problem jhjkkjkljlkjljll

DISTRIBUTION These disorders can affect persons of any jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll These disorders can affect persons of any age, race, sex, religion, or income. Mental illnesses are not the result of: jhjkkjkljlkjljll personal weakness. lack of character. poor upbringing. We are all vulnerable jhjkkjkljlkjljll

DISTRIBUTION IMPORTANCE We are all vulnerable MENTAL HEALTH jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll jhjkkjkljlkjljll We are all vulnerable jhjkkjkljlkjljll

DISTRIBUTION Overview- Morbidity and Mortality IMPORTANCE jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality Mental illness usually strike individuals in the prime of their lives during adolescence and young adulthood. jhjkkjkljlkjljll Established Monitoring and Treatment Guidelines to Lower Risk Are in Serious Mental Illness (SMI )Populations Underutilized Underutilized jhjkkjkljlkjljll

DISTRIBUTION Overview- Morbidity and Mortality IMPORTANCE jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality The Majority of People Who Need Mental Health Treatment Don’t Receive It 50% homeless have SMI that is untreated > 50% of SMI do not seek treatment, the barrier: Stigma and discrimination. Only 30% adults and 50% children with a diagnosable mental disorder receive treatment in any one year jhjkkjkljlkjljll jhjkkjkljlkjljll

DISTRIBUTION Overview- Morbidity and Mortality jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality Increased Morbidity and Mortality Largely Due to Preventable Medical Conditions jhjkkjkljlkjljll Metabolic Disorders, Cardiovascular Disease, Diabetes Mellitus High Prevalence of Modifiable Risk Factors (Obesity, Smoking) Epidemics within Epidemics (e.g., Diabetes, Obesity) jhjkkjkljlkjljll

DISTRIBUTION Overview- Morbidity and Mortality IMPORTANCE jhjkkjkljlkjljll MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality Increased risk of death from medical causes in schizophrenia: (10 -15 - 25 yrs) shorter lifespan. about 60% of premature deaths in persons with schizophrenia are due to “natural causes” - Cardiovascular disease - Diabetes - Respiratory diseases - Infectious diseases jhjkkjkljlkjljll “natural causes” jhjkkjkljlkjljll

DISTRIBUTION KSA Estimates Overview- Morbidity and Mortality MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality KSA Estimates Riyadh: 30 – 40 % of PHC patients with mental disorders (mostly undiagnosed) Al-Khobar: 22 % of health clinics patients had mental health disorders (8 % diagnosed) Central province: 18 % of adults with minor disorders, with rates higher among: - Young: 15-29 years (23 %) - Divorced and widowed (40 %) Suicidal rates: 1.1 per 100,000 mostly among men; aged: 30-39 years & immigrants jhjkkjkljlkjljll

DISTRIBUTION KSA Mental Healthcare Facilities MENTAL HEALTH Beds jhjkkjkljlkjljll MENTAL HEALTH DISTRIBUTION jhjkkjkljlkjljll Beds Number Facility 30-120 each 14 MoH Psychiatric Hospitals 570 1 Al-Taif Hospital 165 total Military, National Guards and University Hospitals 146 total Private Hospitals 280 each 3 Hospitals for Ʀ of Drug Dependence 20-30 each 61 Departments / Clinics in General Hospitals jhjkkjkljlkjljll KSA Mental Healthcare Facilities jhjkkjkljlkjljll

DISTRIBUTION USA Estimates Overview- Morbidity and Mortality MENTAL HEALTH IMPORTANCE DISTRIBUTION jhjkkjkljlkjljll Overview- Morbidity and Mortality ( >18 yrs)  USA Estimates 26.2%: Mental illness 10.5%:Serious Psychological Distress 6 % : SMI jhjkkjkljlkjljll This can result from life events such as: losing a job, coping with disability of self or a family member divorce, death of a loved one, life-threatening illness, natural disasters such as (hurricanes, wildfires.)

Preventive Networks Mosque, Family, Work, Home, Friends. MENTAL HEALTH jhjkkjkljlkjljll Preventive Networks Mosque, Family, Work, Home, Friends. jhjkkjkljlkjljll

Prevention of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH Prevention of Mental Illness jhjkkjkljlkjljll Protection of the very young (promotion of family life) Prevention of social stress and insecurity Protection of the aged who may suffer from jhjkkjkljlkjljll Cerebral degeneration Depression Psychopathic states jhjkkjkljlkjljll

Prevention of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH Prevention of Mental Illness jhjkkjkljlkjljll Prevention of brain damage Public education in mental health Premarital consultations and medical examination Provision of suitable institutions jhjkkjkljlkjljll jhjkkjkljlkjljll

Prevention of Mental Illness jhjkkjkljlkjljll MENTAL HEALTH Prevention of Mental Illness jhjkkjkljlkjljll Legislation as regards drug abuse, compulsory admission to hospitals jhjkkjkljlkjljll guardianship Rehabilitation jhjkkjkljlkjljll

management Early identification and treatment is of vital importance: MENTAL HEALTH management jhjkkjkljlkjljll Early identification and treatment is of vital importance: By ensuring access to: effective treatment recovery supports jhjkkjkljlkjljll - recovery is accelerated - further harm related to the course of illness is minimized. Even with serious mental illnesses today, treatment is highly effective: 70 - 90 % - significant reduction of symptoms - improved quality of life.

What is PHC ? Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll What is PHC ? Primary health care is about: Providing 'essential health care' Universal accessibility to individuals and families in the community Being based on the needs of the population. Being Decentralized Active participation of the community (WHO, 1978: Declaration of Alma-Ata)  jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: Why ? (I) Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: Why ? (I) Mental and physical health problems are interwoven (ensure that people are treated in a holistic manner) The morbidity burden is great (economic and social hardships that affect the whole society) Treatment gap is enormous (between the prevalence of mental disorders, on one hand, and the number of people receiving treatment and care) jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: Why ? (II) Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: Why ? (II) Is affordable and cost effective Generates good health outcomes, (particularly when linked to a network of services at secondary level and in the community) Promotes respect of human rights  jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: Why ? (III) Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: Why ? (III) MH in PHC is complementary to secondary and tertiary level mental health services   General hospital services: jhjkkjkljlkjljll Manage acute episodes of MI Do not provide for chronic disorders (revolving door syndrome) jhjkkjkljlkjljll

MH into PHC: How ? Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: How ? Putting in place strategies to Prevent MI Manage MI Adequate training of PHC workers to apply key psychosocial and behavioral science skills, jhjkkjkljlkjljll Interviewing Counseling Interpersonal skills Use of a holistic, comprehensive approach to Diagnose and Treat MI jhjkkjkljlkjljll

MH into PHC: How ? Integration of Mental Health into PHC jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: How ? Policy and plans: to incorporate MH into PHC. Advocacy is required to shift attitudes and behavior. PHC tasks must be limited and doable. Specialist mental health professionals and facilities must be available to support PHC. jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: KSA Attempt . jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: KSA Attempt . Primary care physicians provide basic mental health services through primary care Selected primary care physicians, who have received additional training, serve as referral sources for complex cases A community mental health clinic provides complementary services, such as psychosocial rehabilitation jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: KSA Results . jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: KSA Results . As a result of training and ongoing support by mental health specialists based at the Community Mental Health Clinic: Physicians’ knowledge and management of mental disorders have improved. Many people with mental disorders, who otherwise would have been undetected or hospitalized, are now treated within the community. jhjkkjkljlkjljll jhjkkjkljlkjljll

MH into PHC: Conclusion . jhjkkjkljlkjljll MENTAL HEALTH Integration of Mental Health into PHC jhjkkjkljlkjljll MH into PHC: Conclusion . Needed and cost effective Require certain skills and competencies to diagnose, treat and refer people with MI. Most successful when incorporated into health policy and legislation, and supported by senior leadership, adequate resources and governance. Must be coordinated with a network of services at different levels of care and complemented by broader health system development. jhjkkjkljlkjljll jhjkkjkljlkjljll

jhjkkjkljlkjljll MENTAL HEALTH jhjkkjkljlkjljll The Takeaway Academic performance is enhanced by physical and emotional health We can learn to recognize problems much earlier Depression, Anxiety and Stress are treatable Education, Psychotherapy and Medication are all effective Self Care--eat, sleep, exercise--is a cornerstone of health (for all of us!) jhjkkjkljlkjljll MH into PHC is needed and cost effective jhjkkjkljlkjljll