1 Mental Health and Illness An Epidemiological Perspective

2 Mental Health-Everybody’s Business Peter Sims Professor of Public Health medicine University of Papua New Guinea

3 Teaching and Learning Aims There is ignorance, superstition, stigma and fear around Mental Illness Aetiology, pathogenesis diagnosis and treatment are imperfect. There is a different paradigm and a less rigorous epidemiology

4 Often sad,sometimes mad,occasionally bad The medical model is insufficient Diagnosis is largely clinical and experiential

5 More of an art than a science Treatment is pragmatic Prevention is about the politics of health “populations,people pressures, poverty”

6 Mental Health is a worldwide problem

7 Mental illness is common 6 in 10 women and 4 in 10 men in Western Europe and North America will have a significant mental illness during their lifetime Mental illness can affect any one of us Mental illness occurs in all societies and cultures

8 We are all vulnerable

9 A Holistic Approach BODY MINDSPIRIT Arrow of Time CULTURE

10 Intelligence IQ IQ = 100 I.Q. = the Mental Age x 100 the Chronological age

11 Personality Each human being is unique We all have different personalities My personality reflects genetic inheritance and Environment

12 Behaviour SUPER-EGO EGO ID The Parent The Adult The Child

13 The Subconscious Mind The Conscious The Subconscious

14 A Classification Affective Disorders Anxiety,depression,mania,obsessional disorders Schizophrenia Simple,Hebephrenic,Catatonic,paranoid Organic states Delirium,dementia Personality Disorder Abnormal personality,Psychopathy Substance abuse problems Drugs, alcohol Learning disorders Subnormality

15 The Classification of Mental Illness : The Neuroses Depression, Anxiety, Mania, Obsessions and compulsions (usually the patient retains insight and orientation; they experience deep distress and may commit suicide) The Psychoses Schizophrenia, puerperal psychosis (the patient is disorientated, deluded, and lacking in insight) The Dementias Progressive deterioration with loss of recent memory and deterioration of a normal personality, They may be primary or more commonly secondary to another condition e.g. alcohol, stroke

16 Clinical Diagnosis

17 The Classification of Mental Illness Drug Problems Addictive drugs, (Heroin, Cocaine, Amphetamines,) alcohol and drug related illness-psychosis, delirium and dementia Personality Disorders A personality and behaviour that is damaging to the individual and/or to society and which is not tolerated by the dominant culture Mental subnormality/learning disorders: Problems around intelligence and ability to learn on the basis of teaching and experience

18 Aetiology Inheritance-Genetics/Intra- uterine environment Schizophrenia,Huntington’s Infections- HIV,Syphilis,CJD Drug Abuse Alcohol,Heroin etc Trauma/head injuryBiochemistry/metabolic Porphyria,Diabetes Vascular-CVA Neurological diseases MS,Brain tumour Upbringing Mothering,education, parenting Nutrition/PCM

19 Treatment and Care Hospital Care Community Care

20 Preventive Networks Church,Family, Home, Friends, Work

21 The Mental Health Act Compulsory Psychiatric Treatment Criminal responsibility Power of attorney

22 Mental Handicap/learning disability The mind of a young child in the body of an adult

23 Canst thou not minister to a mind diseased, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff’d bosom of that perilous stuff Which weighs upon the heart? Macbeth