1. PURSUING WELLNESS PSYC 377 Week 1 1

2. CURRENT FACTS Mental Health Systems are in need of transition because: More than 450 million people suffer from mental disorders. Many more have mental problems. Mental health is an integral part of health; indeed, there is no health without mental health. Mental health is more than the absence of mental disorders. Mental health is determined by socio-economic, biological and environmental factors. Cost-effective inter-sectoral strategies and interventions exist to promote mental health. 2

3. W HAT IS M ENTAL H EALTH “Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.” 3

4. W HAT ARE THE DETERMINANTS OF M ENTAL H EALTH ? Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time: Persistent socio-economic pressures are recognized risks to mental health for individuals and communities. Mental Health is associated with indicators of poverty, including low levels of education. Rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence and physical ill-health and human rights violations. Psychological and personality factors that make people vulnerable to mental disorders. Biological causes of mental disorders including genetic factors and imbalances in chemicals in the brain. 4

5. W HAT ARE THE CURRENT STRATEGIES USED IN M ENTAL H EALTH ? Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles: Climate that respects and protects basic civil, political, socio- economic and cultural rights is fundamental to mental health promotion. Security and freedom is very important to maintain a high level of mental health. National mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. Mental health promotion should be part of policies and programmes in government and business sectors including education, labour, justice, transport, environment, housing, and welfare, as well as the health sector. 5

6. P ROMOTING M ENTAL H EALTH How can you promote mental health? Early childhood interventions (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged populations); Support to children (e.g. skills building programmes, child and youth development programmes); Socio-economic empowerment of women (e.g. improving access to education and microcredit schemes); Social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged); 6

7. P ROMOTING M ENTAL H EALTH Programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters); Mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools); Mental health interventions at work (e.g. stress prevention programmes); Housing policies (e.g. housing improvement); Violence prevention programmes (e.g. community policing initiatives); and Community development programmes (e.g. 'Communities That Care' initiatives, integrated rural development). 7

8. A CLOSER LOOK ON COUNTRY PROFILES ON MENTAL HEALTH – G ROUP W ORK Countries profiles in Mental Health published by WHO, 2011 (http://www.who.int/mental_health/evidence/atlas/profiles/en/) Cyprus Turkey Iran Nigeria Sweden US Russian Federation 8

9. A CLOSER LOOK ON COUNTRY PROFILES ON MENTAL HEALTH – G ROUP W ORK Questions: 1. What is the total expenditure of on health? 2. What is the suicide rate? 3. What is the contribution of neuropsychiatric disorders on global burden of disease? 4. Give the following information on mental health services available: i. Number of day treatment facilities ii. Number of mental hospitals iii. Number of admissions to mental hospitals 5. How much is spent on medicines for mental health disorders? 6. Is data available on: treatment, number of persons treated, admissions to hospitals...etc? 7. What are your conclusions on the country? 9

10. G ROUP W ORK – W HAT ARE THE ISSUES WITH MENTAL HEALTH SERVICES Five stakeholders: 1. Clients/Patients/Survivors and users of mental health services 2. Clients’ family members 3. Clinicians 4. Administrators 5. Policy makers 10

11. C LIENTS /P ATIENTS /S URVIVORS AND USERS OF MENTAL HEALTH SERVICES : Stigma: Cluster of negative attitudes and prejudicial beliefs Fearful of negative evaluation or criticism Immigrants are unwilling to reiceve help from mainstream services due to stigma Health-related quality of life: Medication and resulting weight gain and vitality Competence of service providers: Inadequate Insufficient No comprehension of traditional methods such as consultation with a traditional healer Cultural awareness : Somalian women and church activity Non-English speaking clients 11

12. C LIENTS ’ FAMILY MEMBERS Stigma: Difficulties accessing services such as respite Forced to give up custody to obtain mental health services Services not equipped to deal with their grief Culture of blaming them for problems Competence of service providers: Inadequate Insufficient No comprehension of traditional methods such as consultation with a traditional healer Even though the families play an important role in health care decisions of patients and their adherence/compliance to treatment, they are excluded from sessions 12

13. C LINICIANS Responsible for delivering, coordinating or monitoring services Increasing severity of symptoms Increasing complexity of clients’ health and mental health problems (hypertension coupled with depression and substance abuse) Medicine adherence – willingness to follow a medication plan: Side-effects (weight gain, sexual dysfunction, diabetes) Constipation, dry mouth, blurred vision, severe movement disorders Difficulties due to having to deal with treatment plans incorporating numerous health and mental health providers –a gency policy might not realize the importance of underlying health issues Co-morbidity: Substance abuse and mental health condition, Hypertension and depression Depression and cornoray artery disease 13

14. A DMINISTRATORS Structural and fiscal organization Human and economic costs associated with fragmented mental health system Human cost: Untreated mental illness would result in indivudals seeking more expensive medical care earlier than they would (individuals diagnosed with severe mental illness had higher rates of emergency room visists) Early treatments for symptoms might also increase lifetime costs of maintaining stability over time (people with schizopherenia recieveing early treatment live longer and require continuing living with economic dependency longer) 14

15. A DMINISTRATORS Economic cost: Cost containment- distribution of mental health services is restricted to a capitated budget (‘managed care’) and services that are most necessary are provided only Fragmented service systems and cost-containment practices restrict access to care for example children with depression tend to use emergency services more and children with ADHD use medical services twice the amount of other children 15

16. P OLICY MAKERS Mental health policy : ‘an organized set of values, principles, and objectives for improving mental health and reducing the burden of mental disorders in a population‘ (WHO, 2004) Mental health policy is shaped by historical, scientific developments and efforts of policy makers and politicians working on behalf of individuals, families and communities Policy makers do not have time to gather evidence and information Their position is difficult because they speak for their constituents but also for the government 16

17. H OW DO YOU BRING ABOUT MENTAL HEALTH REFORM Health promotion: Planned activities that are educational resulting in philosphical shift for example redefining focus of their work political resulting in policy reform using data from World Health Report, Health People and Insitute of Medince reports organizational accomodating integrated practice model for example attention to co-occuring illnesses (substance use and mental illness / HIV, shizophrenia and employment) 17