Mental health

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Mental health describes a level of psychological well-being, or an absence of a mental disorder.[1][2] From the perspective of 'positive psychology' or 'holism', mental health may include an individual's ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience.[1] Mental health can also be defined as an expression of emotions, and as signifying a successful adaptation to a range of demands.

The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".[3] It was previously stated that there was no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined.[4] There are different types of mental health problems, some of which are common, such as depression and anxiety disorders, and some not so common, such as schizophrenia and bipolar disorder.[5]

Most recently, the field of global mental health has emerged, which has been defined as 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.[6]

Contents

History

In the mid-19th century, William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health.[7] Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.[7]

An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions into which they were put.[8] This was known as the "mental hygiene movement".[8] Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing.[8] Dix's efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed.[8]

At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America.[7][9]

The mental hygiene movement, also known as the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life.[10]

Significance

Evidence from the World Health Organization suggests that nearly half the world's population are affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life.[11] An individual's emotional health can also impact physical health and poor mental health can lead to problems such as substance abuse.[12]

Maintaining good mental health is crucial to living a long and healthy life. Good mental health can enhance one’s life, while poor mental health can prevent someone from living an enriching life. According to Richards, Campania, & Muse-Burke (2010) “There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health” (2010). It was also concluded in their research that people who lack emotional expression are inclined to anti-social behaviors. These behaviors are a direct reflection of their mental health. Self-destructive acts may take place to suppress emotions. Some of these acts include drug and alcohol abuse, physical fights or vandalism.[13]

Perspectives

Mental well-being

Mental health can be seen as an unstable continuum, where an individual's mental health may have many different possible values.[14] Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges.[citation needed] Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness of otherwise healthy people. Positive psychology is increasingly prominent in mental health.

A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.[15][16]

An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning. The population of the USA in its' majority is considered to be mostly uneducated on the subjects of mental health .[17] Another model is psychological well-being.

Prevention

Mental health can also be defined as an absence of a mental disorder. Focus is increasing on preventing mental disorders. Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.[18][19]

Cultural and religious considerations

Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate.[20] Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment.

Research has shown that there is stigma attached to mental illness.[21] In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma.[22]

Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association.[23]

Emotional mental health issues around the world

Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative, which was created in 1998 by the World Health Organization (WHO).[24]Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease.These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, “even economically advantaged societies have competing priorities and budgetary constraints”.

The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. “A first step is documentation of services being used and the extent and nature of unmet needs for treatment. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care.”

Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near constant pressures to cut insurance and entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, U.S.A), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the Peoples Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower middle-income (China, Columbia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income.

The coordinated surveys on emotional mental health disorders, their severity, and treatments were implemented in the aforementioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. Their research showed that “the number of respondents using any 12-month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries’ percentages of gross domestic product spent on health care”. “High levels of unmet need worldwide are not surprising, since WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually <1%) of already diminished health budgets on mental health care, and they rely heavily on out-of-pocket spending by citizens who are ill equipped for it”.

Emotional mental health in the United States

According to the World Health Organization in 2004, depression is the leading cause of disability in the United States of America for individuals ages 15 to 44.[25] Absence from work in the U.S. due to depression is estimated to be in excess of $31 billion dollars per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis.[26] Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention).[27] In 2004, suicide was the 11th leading cause of death in the United States of America (Centers for Disease Control and Prevention), third among individuals ages 15–24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high.[citation needed]

There are many factors that influence mental health including:

Mental health resourcesOn average, the higher the number of psychiatrists, psychologists, and social workers per capita in a state, the lower the suicide rate.
Barriers to treatmentThe lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status.
Mental health treatment utilizationThe lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status. When mental health treatment is utilized more, while holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita in the state, and the lower the suicide rate.
Socioeconomic characteristicsThe more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status.
Mental health policyThe more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services.

The Spirit Level: Why More Equal Societies Almost Always Do Better argues about 50% of the reason why Americans have the highest rates of mental illness including depression, anxiety and addiction is due to America having the highest income inequality in the world.[28]

Emotional mental illnesses should be a particular concern in the United States of America since the U.S.A has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries.[29] While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on the average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care.[30]

Mental health policies in the United States

The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the “mental hygiene” movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.[31]

In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: “I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience. . . .”[32] Many asylums were built in that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In those asylums, traditional treatments were well implemented: drugs were not used as a cure for a disease, but a way to reset equilibrium in a person’s body, along with other essential elements such as healthy diets, fresh air, middle class culture, and the visits by their neighboring residents. In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.[33]

In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.[34] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists – including Beer himself – which marked the beginning of the “mental hygiene” movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues.[35] However, prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the Depression.[31]

In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days.[36] However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power.[36] Besides, the community helping system was not fully established to support the patients’ housing, vocational opportunities, income supports, and other benefits.[31] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.

After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.[37] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were suffering from a “chronic mental illness.” People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge.[36] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.[37]

The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programs, which increase the likelihood of prevention programs being included in future US mental health policies.[38][39] The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.[40]

Emotional mental health improvement

Being mentally and emotionally healthy does not preclude the experiences of life which we cannot control. As humans we are going to face emotions and events that are a part of life. According to Smith and Segal, “People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook in which they also remain focused, flexible, and creative in bad times as well as good”[41] (2011). In order to improve your emotional mental health, the root of the issue has to be resolved. “Prevention emphasizes the avoidance of risk factors; promotion aims to enhance an individual’s ability to achieve a positive sense of self-esteem, mastery, well-being, and social inclusion”[42] (Power, 2010). It is very important to improve your emotional mental health by surrounding yourself with positive relationships. We as humans, feed off companionships and interaction with other people. Another way to improve your emotional mental health is participating in activities that can allow you to relax and take time for yourself. Yoga is a great example of an activity that calms your entire body and nerves. According to a study on well-being by Richards, Campania and Muse-Burke, “mindfulness is considered to be a purposeful state, it may be that those who practice it believe in its importance and value being mindful, so that valuing of self-care activities may influence the intentional component of mindfulness”[43] (2010).

Therapies

Activity therapies

Activity therapies, also called expressive therapies promote healing through active engagement. These therapies include music therapy, art therapy, dance therapy, drama therapy, writing therapy, and play therapy.

Alternative therapies

Alternative therapy is a branch of alternative medicine, which includes a large number of therapies imported from other cultures. It also includes a number of new medicines that have not yet passed through the process of scientific review. Alternative therapies include traditional medicine, prayer, yoga, traditional Chinese medicine, Ayurvedic medicine, homeopathy, hypnotherapy, and more.

Meditation

Increased awareness of mental processes can influence emotional behavior and mental health. A 2011 study incorporating three types of meditative practice (concentration meditation, mindfulness meditation and compassion toward others) revealed that meditation provides an enhanced ability to recognize emotions in others and their own emotional patterns, so they could better resolve difficult problems in their relationships.[44]

Biofeedback

Biofeedback is a process of gaining control of physical processes and brainwaves. It can be used to decrease anxiety, increase well-being, increase relaxation, and other methods of mind-over-body control.

Group therapy

Group therapy involves any type of therapy that takes place in a setting involving multiple people. It can include psychodynamic groups, activity groups for expressive therapy, support groups (including the Twelve-step program), problem-solving and psychoeducation groups.

Pastoral counselling

Pastoral counseling is the merging of psychological and religious therapies and carried out by religious leaders or others trained in linking the two.

Psychotherapy

Psychotherapy is the general term for scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as gestalt therapy, psychoanalysis, cognitive behavioral therapy and dialectical behavioral therapy.

See also

Related concepts

Related disciplines and specialties

References

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