Chapter 1: What is Mental Health?

defining mental health

• “A state of well-being in which every individual realizes [their] own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to [their] community.”

• NOTE:

  • no single definition of mental health is widely accepted

    • cultural differences

    • competing professional theories

mental health includes the ability to

• Understand oneself and one’s life

• Relate to other people and respond to one’s environment

• Experience pleasure and enjoyment

• Handle stress and withstand discomfort

• Evaluate challenges and problems

• Pursue goals and interests

• Explore choices and make decisions

• Mental illnesses are conditions in which people’s thinking, mood and behaviours negatively impact their day-to-day functioning.

key message(s) of mental health

• People who are at higher risk include First Nations, Metis and Inuit people; women; people with low income and millennials (Ipsos, 2017). This shows how important the social determinants of health are.

• Trauma, especially in childhood, causes health differences. Trauma tends to affect the most vulnerable people and populations (Kimberg, 2016). Addressing trauma is key to decreasing suffering and achieving better health outcomes for vulnerable people.

historical treatment of mental illness in canada

• At time of Confederation, presumed that mental illnesses were caused by physical disease or damage to the brain

• No clear understanding of cause of mental illness

• Established residential asylums

canadian prevalence

• in any given year, one in five canadians experience a mental health problem

  • 20%

• by the time canadians reach age 40, one in two have experienced a mental health problem

  • 50%

what does The International Classification of Diseases (ICD), WHO do?

• Addresses all types of illness

• Used internationally

• Canada’s official classification system

• Updated in 2018, in its 11th version

• Move from “categorical” system of diagnosis to “dimensional” system

what does The Diagnostic and Statistical Manual of Mental Disorders (DSM), American Psychiatric Association do?

• Addresses psychiatric disorders but no other illnesses

• Strictly in North America

• Latest version, DSM-5, much less cautious about labelling individuals as “mentally ill”; many more individuals may now receive psychiatric diagnoses

what are concerns about diagnostic classification?

• Psychiatric diagnosis can cause an individual problems

• Discrimination due to widespread fear and misunderstanding

• Criticisms of diagnosis

  • Problems with reliability and validity

  • Effects of labelling

  • Cultural relativity

  • Political and economic misuses of diagnoses

what are problems with reliability and validity?

• Reliability

  • Consistency of results when a measurement is

    repeated

  • E.g. , Will someone receive the same diagnosis across different tests?

• Validity

  • Whether a measure really captures what it purports to measure

  • E.g. , May show symptoms due to another problem

• Diagnoses criticized as being vague, arbitrary, and unscientific (Cooper, 2014)

• Few diagnoses are linked to specific causes/mechanisms of action

why diagnose?

• Assumption that diagnosis will provide the means of understanding and addressing mental disorders to designate the correct treatment to fit the condition

• Assume that benefits outweigh potential risks

mood disorders

• Among most commonly occurring mental illnesses in Canada and globally (McRae et al., 2016)

• Depressive disorders

  • among the most common mental disorders; characterized by one or more depressive episodes lasting at least two weeks (WHO, 2018)

• Bipolar disorder

  • involves both substantial elevations of mood as well as depressed or low mood (WHO, 2018).

    • Mania can involve euphoria, intense or agitated mood, hyperactivity and high energy, and diminished perceived need for sleep or food.

    • Hypomania is less intense form of elevated mood; typically lasts for a shorter period of time

anxiety of fear-related disorders

• Tend to start early in life and often persist for many years

• Generalized anxiety disorder

  • defined by extended period of anxiety and worry accompanied by multiple symptoms, e.g., muscle tension, fatigue, poor concentration, insomnia, irritability

• Specific phobias involve

  • excessive fears in relation to certain objects or situations

• Panic disorder

  • diagnosed when individual has experienced multiple panic attacks

• Social anxiety disorder

  • involves significant fear of particular social situations due to concerns about being judged by others

obsessive-compulsive and related disorders

• Experiences often accompanied by repetitive or ritualistic behaviours intended to ease distress

• Obsessive-compulsive disorder

  • person experiences obsessions that are inappropriate or irrational and lead to significant anxiety or distress.

  • To ease this distress, person will often engage in compulsions, e.g., handwashing, counting

• Hoarding disorder

  • associated with excessive accumulation of and/or challenges in letting go of possessions, irrespective of their actual work

• Hypochondriasis

  • involves preoccupation with possibility of having a serious or life-threatening illness

schizophrenia and other primary psychotic disorders

• Usually emerge in adolescence or early adulthood (Miettunen et al., 2019)

• Schizophrenia

  • affects the way brain processes and interprets information and leads people to experience psychosis:

    • Delusions

    • Hallucinations

    • Impaired cognition

    • Changes in behavior (i.e., bizarre or unpredictable)

disorders specifically associated with stress

• Include disorders directly resulting from exposure to or ongoing experiences of stressful or traumatic events

• Post-traumatic stress disorder (PTSD):

  • develops in response to profoundly threatening or horrifying incidents

    • flashbacks

    • disturbing dreams

    • persistent frightening thoughts and memories

    • anger

    • irritability in response to terrifying experience

feeding or eating disorders

• Involve serious disturbance in feeding or eating behaviour

• Feeding disorders

  • characterized by behaviours such as eating non-edible materials;

  • do not relate to concerns over body weight, size, or shape

• Eating disorders

  • involve atypical eating behaviours and preservation on food, profound worry centring on body weight and shape

    • Most common: binge eating disorder and bulimia nervosa

treatment and recovery

• Most mental health problems can be treated so that people can recover and maintain day-to-day functioning.

• Treatment comes in many forms including:

  • individual and group therapy

  • counselling

  • psychosocial intervention

  • medication