Mental Health Treatment and mhGAP Overview

Affective

Develop compassionate attitude in the care of patients with mental illness.

Alzheimer's disease

A primary degenerative cerebral disease of unknown etiology in the majority of cases with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years.

Autism spectrum disorders

An umbrella term that covers conditions such as autism, childhood disintegration disorder and Asperger's syndrome.

Autonomy

The perceived ability to control, cope with and make personal decisions about how one lives on a daily basis, according to one's own rules and preferences.

Behavioural activation

Psychological treatment that focuses on improving mood by engaging again in activities that are task-oriented and used to be enjoyable, in spite of current low mood. It may be used as a stand-alone treatment, and it is also a component of cognitive behavioural therapy.

Cognitive behavioural therapy (CBT)

Psychological treatment that combines cognitive components (aimed at thinking differently, for example through identifying and challenging unrealistic negative thoughts) and behavioural components (aimed at doing things differently, for example by helping the person to do more rewarding activities).

Confusion, confusional state

A state of impaired consciousness associated with acute or chronic cerebral organic disease. Clinically it is characterized by disorientation, slowness of mental processes with scanty association of ideas, apathy, lack of initiative, fatigue, and poor attention.

Contingency management therapy

A structured method of rewarding certain desired behaviours, such as attending treatment and avoiding harmful substance use. Rewards for desired behaviours are reduced over time as the natural rewards become established.

Convulsion, convulsive movement

Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena.

Delirium

Transient fluctuating mental state characterized by disturbed attention and awareness that develops over a short period of time and tends to fluctuate during the course of a day.

Delusion

Fixed belief that is contrary to available evidence. It cannot be changed by rational argument and is not accepted by other members of the person's culture or subculture.

Detoxification

The process by which an individual is withdrawn from the effects of a psychoactive substance. The withdrawal process is carried out in a safe and effective manner, such that withdrawal symptoms are minimized.

Disability

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner, or within the range, considered to be normal for a human being.

Disinhibited behaviour, disinhibition

Lack of restraint manifested in disregard for social conventions, impulsivity and poor risk assessment. It can affect motor, emotional, cognitive and perceptual aspects of a person's functioning.

Disorganized / disordered thinking

Disorganized behaviour

Behaviour including posture, gait, and other activity that is unpredictable or not goal-directed (e.g., shouting at strangers on the street).

Distractibility

Difficulty concentrating and focusing on tasks

attention is easily diverted by extraneous stimuli.

Family therapy

Counselling that entails multiple (usually more than six) planned sessions over a period of months, delivered to individual families or groups of families, including the person living with mental illness, if feasible.

Focal deficits

Neurological signs that are observable bodily phenomena or responses suggestive of the localization of a relatively circumscribed lesion of the nervous system.

Hallucination

False perception of reality: seeing, hearing, feeling, smelling or tasting things that are not real.

Hyperarousal

Intense and prolonged autonomic discharge accompanied by a state of frozen watchfulness and alertness to environmental stimuli, often seen in post-traumatic stress disorders.

Interpersonal therapy (IPT)

Psychological treatment that focuses on the link between depressive symptoms and interpersonal problems, especially those involving grief, disputes, life changes and social isolation.

Motivational enhancement therapy

A structured therapy (lasting 4 or less sessions) to help people with substance use disorders, using motivational interviewing techniques.

Occupational therapy

Therapy designed to help individuals improve their independence in daily living activities through rehabilitation, exercises, and the use of assistive devices.

Oppositional behavior

Markedly defiant, disobedient, provocative, or spiteful behavior often accompanied by severe temper outbursts or in headstrong, argumentative, and defiant behavior.

Parent Skills Training

A family of treatment programs that aims to change parenting behaviors and strengthen confidence in adoption of effective parenting strategies.

Problem-solving counselling

Psychological treatment that involves the systematic use of problem identification and problem-solving techniques over several sessions.

Psychoeducation

The process of teaching people with MNS disorders and their carers/family members about the nature of the illness, including its likely causes, progression, consequences, prognosis, treatment, and alternatives.

Racing thoughts

Rapid thought pattern with tangential movement from one idea to the next often associated with mania or other mental illnesses.

Relapse

A return to drinking or other drug use after a period of abstinence, often accompanied by reinstatement of dependence symptoms.

Relaxation training

Involves training in techniques such as breathing exercises to elicit the relaxation response.

Respite care

Provision of temporary health-care facilities to a person normally cared for at home.

Seizure

Episode of brain malfunction due to disturbances of cortical function resulting in sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena.

Self-harm

Intentional self-inflicted poisoning or injury to oneself, which may or may not have a fatal intent or outcome.

Social network

A construct of analytical sociology referring to the characteristics of the social linkages among people as a means of understanding their behaviour, rather than focusing on the attributes of individuals.

Social withdrawal

Inability of a person to engage in age appropriate activities or interactions with his or her peers or family members.

Status epilepticus

Defined as 5 min or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures

it can be convulsive or non-convulsive.

Stigma

A distinguishing mark establishing a demarcation between the stigmatized person and others attributing negative characteristics to this person. The stigma attached to mental illness often leads to social exclusion and discrimination and creates an additional burden for the affected individual.

Suicidal thoughts / ideation

Thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans.

Wandering

People living with dementia feel the urge to walk about and, in some cases, leave their homes. They can often experience problems with orientation, which may cause them to become lost.

Mental Health Treatment Gap

This is a public health concern that is compounded by the fact that many individuals with Mental, Neurological and Substance-related (MNS) conditions remain untreated despite the existence of effective treatment.

Mental Health Gap Action Program (mhGAP)

First launched in 2008, to scale up care for MNS disorders.

mhGAP program focus

The program asserts that, with proper care, psychosocial assistance and medication, tens of millions of people could be treated for depression, psychoses and epilepsy, prevented from suicide and begin to lead normal lives - even where resources are scarce.

Non-specialized health-care providers

General physicians, family physicians, Nurses

First points of contact and outpatient care

First level referral centers

Community/barangay health workers.

Reasons for integrating mental health into non-specialized health care

1. The burden of mental disorders is great. 2. Mental and physical health problems are interwoven. 3. The treatment gap for mental disorders is enormous. 4. Enhance access to mental health care. 5. Promote respect of human rights. 6. It is affordable and cost-effective. 7. Generates good health outcomes.

mhGAP Intervention Guide

This presents the integrated management of priority MNS conditions using algorithms for clinical decision-making that are aimed to aid health-care providers to assess, manage and follow-up individuals with priority MNS conditions.

mhGAP version 1.0

The first version was developed in 2010 as a simple technical tool to allow for integrated management of priority MNS conditions using protocols for clinical decision-making.

mhGAP version 2.0

Launched in 2016 with updates incorporating new evidence-based guidance, enhanced usability, and new sections to expand its use by both health care providers as well as program managers.

Effective Communication Skills

Use Effective Communication Skills.

Respect and Dignity

Promote Respect and Dignity.

Essentials of Mental Health Clinical Practice

Includes assessing physical health, conducting a MNS assessment, and managing MNS conditions.

MNS Assessment

Conduct a MNS Assessment.

Treatment Planning

Part of managing MNS conditions.

Psychosocial Interventions

Includes psychoeducation, reducing stress and strengthening social supports, promoting functioning in daily activities, and psychological treatment.

Pharmacological Interventions

Part of managing MNS conditions.

Referral to specialist/hospital

Referral to specialist/hospital if needed.

Follow-up

Involves ongoing assessment and management of the patient.

Involving Carers

Involves family or caregivers in the management process.

Links with other sectors

Collaboration with other sectors to provide comprehensive care.

Special Populations

Consider the needs of Special Populations.

mhGAP Master Chart

Contains the overview of priority conditions and the emergency presentations of each MNS condition.

Emergency Presentation

Must be assessed as the presence of any of the given presentations require immediate management and care.

Seven Priority Conditions

Includes Depression, Psychoses, Epilepsy, Child & Adolescent Mental and Behavioral Disorders, Dementia, Disorders due to Substance Use, and Self-Harm/Suicide.

Depression

Primarily characterized by persistent depressed mood with markedly diminished interest in, or pleasure from, activities.

Common Presentation of Depression

Multiple persistent physical symptoms with no clear cause, low energy, fatigue, sleep problems, persistent sadness or depressed mood, anxiety, and loss of interest or pleasure in activities.

Assessment of Depression

Consider physical conditions such as anemia, malnutrition, and hypothyroidism as this can resemble some manifestations of depression.

Management of Depression

Includes psychoeducation, reducing stress, strengthening social supports, promoting functioning in daily activities, and referrals.

Brief psychological treatments

Interventions delivered by trained individuals under supervision.

Group interpersonal therapy

A type of brief psychological treatment involving group dynamics.

Multi-component behavioral treatment

A brief psychological treatment that combines various behavioral strategies.

Cognitive behavioral therapy

A form of brief psychological treatment focusing on changing negative thought patterns.

Psychopharmacologic management

The use of medications to manage psychological conditions.

Time for response to antidepressants

Four to six weeks.

Duration of antidepressant treatment

Should continue for 9-12 months.

Tapering medication

Should be done slowly if ceasing medication.

Antidepressant prescription criteria

Do not prescribe if there is no depression.

Normal grief reaction

Symptoms that do not last two weeks and/or do not involve impaired functioning.

Pregnancy and antidepressants

Do not prescribe if the person is pregnant or breastfeeding.

First-line treatment for children

Offer psychosocial intervention first

do not prescribe if younger than 12.

Adolescents and antidepressants

Do not prescribe to adolescents aged 12-18 as first-line treatment.

Avoiding tricyclic antidepressants (TCAs)

Avoid among the elderly, people with cardiovascular disease, and people with dementia.

Risk factors for overdose

Avoid TCAs in people with ideas, plans, or previous acts of self-harm or suicide.

Follow Up for clients

Observe if the client shows improvement, remains the same, or deteriorates.

Monitoring clients on antidepressants

Look for symptoms of mania, inadequate response, or no response.

Psychoses

Includes psychosis and bipolar disorder

causes stigma, discrimination, and human rights violations.

Characteristics of psychosis

Disturbed perception, thinking, behaviors, and emotions.

Bipolar disorder

Characterized by significant mood and activity disturbances with manic and depressive episodes.

Common presentation of psychosis

Marked behavioral changes, neglecting responsibilities, agitated behavior, fixed false beliefs, hallucinations, and lack of awareness of mental health problems.

Assessment for psychosis

Establish communication, evaluate for medical conditions, and assess for other relevant MNS conditions.

Promoting functioning in ADLs

Helps a person cope with and manage their symptoms.

Follow Up for psychosis

Focus on re-assessment of symptoms and assessment of medication side effects.

Seizures

Brief disturbances in the electrical functions of the brain.

Causes of epilepsy

There are potentially many different causes of epilepsy but it is not always easy to identify one.