CHAPTER TWO NTRODUCTION TO MENTAL HEALTH AND MENTAL ILLNESS

MENTAL HEALTH  Mental health and mental illness are difficult to define precisely because it is a dynamic and ever changing state  People who can carry out their roles in society and whose behaviour is appropriate and adaptive are viewed as healthy.  Conversely those who fail to fulfill roles and carry out responsibilities or whose behavior is inappropriate are viewed as ill.  The culture of any society strongly influences its values and beliefs, and this in turn affects how that society defines health and illness.  What one society may view as acceptable and appropriate, another society may see as maladaptive or inappropriate.

 The World Health Organization (WHO) defines health as: “A state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity”  People in a state of emotional, physical, and social well-being fulfils life responsibilities, functions effectively in daily life, and is satisfied with their interpersonal relationships and themselves.  No single, universal definition of mental health exists.  Generally a person’s behavior can provide indicators to his or her mental health.

 Because each person can have a different view or interpretation of behavior (depending on his or her values and beliefs), the determination of mental health may be difficult.  Mental Health can also be defined as: “A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behaviour and coping, positive self-concept, and emotional stability”

Components of Mental Health 1. Autonomy and independence  The person who is autonomous and independent can work interdependently or cooperatively with others without losing his or her autonomy 2. Maximization of one’s potential  The person is oriented toward growth and self-actualization 3. Tolerance of life’s uncertainties  The person can face the challenges of day-to-day living with hope and a positive outlook despite not knowing what lies ahead 4. Self-esteem  The person has a realistic awareness of his or her abilities and limitations

5. Mastery of the environment  The person can deal with and influence the environment in a capable, competent, and creative manner 6. Reality orientation  The person can distinguish the real world from a dream, fact from fantasy, and act accordingly 7. Stress management  The person can tolerate life stresses, appropriately handle anxiety or grief, and experience failure without devastation. He or she uses support from family and friends to cope with crises, knowing that the stress will not last forever

Factors Influencing Mental Health There are three categories of factors influencing Mental Health Individual Factors 1. Person’s biologic makeup 2. Sense of harmony in life 3. Vitality 4. Ability to find meaning in life 5. Emotional resilience or hardiness 6. Spirituality 7. Positive identity

Interpersonal Factors 1. Effective communication 2. Ability to help others 3. Intimacy 4. A balance of separateness and connection Social/Cultural Factors 1. A sense of community 2. Access to adequate resources 3. Intolerance of violence 4. Support of diversity among people

MENTAL ILLNESS  The American Psychiatric Association defines mental disorder as: “A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom”

General Criteria to Diagnose Mental Disorders 1. Dissatisfaction with one’s characteristics, abilities, and accomplishments 2. Ineffective or non-satisfying relationships 3. Dissatisfaction with one’s place in the world 4. Ineffective coping with life events 5. Lack of personal growth

Factors Contributing to Mental Illness  Also can be viewed within individual, interpersonal, and social/cultural categories Individual factors 1. Biologic makeup 2. Anxiety 3. Worries and fears 4. A sense of disharmony in life 5. A loss of meaning in one’s life

Interpersonal factors 1. Ineffective communication 2. Excessive dependency or withdrawal from relationships 3. Loss of emotional control Social and cultural factors 1. Lack of resources 2. Violence 3. Poverty and Homelessness 4. Discrimination such as racism, classism, ageism, and sexism

Diagnosing Mental Illness  There are two systems that are in use internationally to diagnose Mental Illness (Disorders): DSM-V and ICD-10 Diagnostic and Statistical Manual of Mental Disorders (DSM-V)  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is taxonomy of Mental Disorders published by the American Psychiatric Association (APA) on May, 18th 2013 as an update to the previous DSM-IV-TR published in 2000.

 In most respects DSM-V is not greatly changed from DSM-IV- TR.  In the United States the DSM serves as a universal authority for psychiatric diagnosis.  Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.  The development of the new edition began with a conference in 1999, and proceeded with the formation of a Task Force in 2007, which developed and field-tested a variety of new classifications.

 It describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research  All mental health clinicians who diagnose psychiatric disorders use the DSM-V

 ICD-10 (International Statistical Classification of Diseases and Related Health Problems (ICD).  ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a Medical Classification list by the World Health Organization (WHO).  It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.  The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses.

 The codes can be expanded to over 16,000 codes by using optional sub-classifications.  The WHO provides detailed information about ICD online, and makes available a set of materials online, such as: a) An ICD-10 online browser b) ICD-10 Training c) ICD-10 online training d) ICD-10 online training support e) Study guide materials for download 

 It comprises 22 chapters, ranging from infectious diseases to external causes of morbidity and mortality  Chapter 5 addresses Mental and Behavioral Disorders  There are 10 disorder grouping in ICD classification, plus an “unspecified diagnostic category”  Each discrete disorder within each category is coded  Each disorder is defined in short description, and-where appropriate- advised about exclusion criteria