Defining mental wellbeing

Being mentally healthy involves

●being in a generally positive state of mental wellbeing,

●having the ability to cope with and manage life’s challenges,

●working productively,

●striving to fulfil one’s goals and potential,

●and having a sense of connection to others and the community in general.

Mental health is a desirable quality in its own right and is more than the absence of mental ill-health.
Mental health is a positive concept related to the social and emotional wellbeing of people and communities. The concept relates to the enjoyment of life, ability to cope with stress and sadness, the fulfilment of goals and potential, and a sense of connection to others (Hunter Institute of Mental Health, 2015).

Characteristics of mental wellbeing

Mentally healthy people demonstrate high levels of:

●functioning

●resilience to life’s stressors

●social and emotional wellbeing

●

Go back to the previous slides, and see if you can identify these themes in the definitions of mental health.

Functioning

Refers to how well an individual independently performs or operates in their environment, in terms of:

●interpersonal relationships e.g. ability to interact with and get along with other people

●school and work/occupational settings e.g. productive and achieving goals

●leisure/recreational activities e.g. participation in extracurricular activities at school, hobbies/interests/structured or unstructured activities in ‘free’ time outside school/work

●daily living skills e.g. participation in self-care and independent living activities such as personal hygiene, dressing, eating, remembering to take any prescribed medications, fulfilling household responsibilities, ability to access private and public transportation and travel/commute safely

●cognitive skills e.g. learning and applying knowledge, understanding and communicating, logical and clear thinking, planning and decision-making

●emotions e.g. self-regulation of a range of emotions, dealing with positive and negative emotions, keeping daily worries, hassles and other stressors under control

Social wellbeing

Is based on the ability to have satisfying relationships and interactions with others (APS, 2015).

A person with a high level of social wellbeing is likely to be willing and able to:

●develop and maintain healthy relationships with family and friends

●socially interact with others in appropriate ways

●respect and understand other individuals

●respect the cultural identities of others

●competently resolve conflicts with others

●effectively manage unhealthy relationships

●spend time with loved ones

●feel self-confident alone or with others (AIHW, 2012; NIHCE, 2009).

Emotional wellbeing

Is based on the ability to control emotions and express them appropriately and comfortably (APS, 2015).

A person with a high level of emotional wellbeing is likely to be willing and able to:

●develop awareness and understanding of their own emotions

●regulate their emotions and exercise control when appropriate

●express a range of emotions in a suitable manner

●identify emotions in others and empathise

●have a positive attitude about emotions, their experience and expression

●consider thoughts and behaviour as well as feelings when making personal choices and decisions

●accept mistakes or setbacks and learn from them

●make decisions with a minimum of worry, stress or anxiety

●manage their stress reactions using appropriate coping skills

●live and work independently while realising the importance of seeking and appreciating the support and assistance of others

●take on challenges, take risks and recognise conflict as being potentially healthy

●take responsibility for their actions (AIHW, 2012; University of California, 2014).

Resilience

The Study Design defines resilience as the ability to cope with and manage change and uncertainty.

It is the ability to cope with and adapt well to life stressors and restore positive functioning.

It means ‘bouncing back’ from adversity or difficult experiences that are stressors — such as family and relationship problems, school or workplace stressors, rejections, failures, threats or even tragedy—and restoring positive functioning.

Adaption through resilience may involve either adjusting to or overcoming the stressor (APA, 2016).

Several characteristics that resilient people demonstrate:

●a strong belief in their abilities to accomplish tasks and succeed (self-efficacy);

●high self-esteem;

●approaching adversity and stress with a sense of optimism, opportunity and hope;

●being adaptable and flexible;

●being organised;

●having problem-solving skills;

●and having the ability to make realistic plans and carry them out.

Social and emotional wellbeing (SEWB) for Aboriginal and Torres Strait Islander people

Social and emotional wellbeing (SEWB) can be understood in a more specific sense as it relates to Aboriginal and Torres Strait Islander people as multidimensional  and holistic framework for wellbeing. See p.482 of the textbook for a description of each.

●

●body

●mind and emotions

●family and kinship

●community

●culture

●Country

spirituality and ancestors

Mental wellbeing as a continuum

If we see mental health as a continuum, this implies:

•Two opposite ends, in this case, optimum mental health and mental disorder

•A person be anywhere between the two ends, representing that mental health can be experienced to different degrees

•A person can move up and down the scale over time, irrespective of whether they have a diagnosed mental illness

Mental health problems

Adversely affects the way a person thinks, feels and/or behaves, but typically to a lesser extent and of a shorter duration than a mental disorder.

e.g. relationship, school, work or health-related stress; trouble making friends; lack of motivation to complete specific tasks

(None of these things on their own would be considered a disorder.)

Mental disorder

A mental health state that involves a combination of thoughts, feelings and/or behaviours which are usually associated with:

●significant personal distress

●significant impaired functioning

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorder) contains strict diagnostic criteria for every recognised mental disorder. If you don’t fit the criteria, you don’t have  mental disorder.

Internal and external factors

The biopsychosocial model (BPS) is a way of describing and explaining how biological, psychological and social factors combine and interact to influence a person’s mental health (and disorder).

Biological and psychological factors are both internal.

Social factors are external.

Biological

Physiological, anatomical and genetic factors, such as:

●neurotransmitters

●hormones

●brain structures

●age

family history

Psychological

Factors relating to a person’s unique behaviours and mental processes, such as:

●perceptions

●personality

●thoughts and thinking styles

●emotions

●coping strategies

Social

Factors that are external to the person, such as

●family and friends

●societal expectations

●support services

●early experiences

●physical environment

Cumulative risk

Refers to the increased risk of developing a mental disorder that occurs as a result of exposure to multiple biological, psychological and/or social risk factors simultaneously.

●Sometimes a risk factor may in itself not be particularly influential, but has a significant effect within the context of other influences (sometimes, 1+1=3)

●An individual risk factor may also provide the breaking or tipping point, resulting in onset of mental health disorder

●Generally, the more risk factors to which we are exposed the greater our vulnerability to a mental health disorder

●Protective factors also factor into the ‘equation’ when considering cumulative risk; more protective factors = more resilience to mental disorder

Stress

is a state of physiological and psychological arousal produced by internal or external stressors that are perceived by the individual as challenging or exceeding their ability or resources to cope.

Anxiety

A state of physiological and psychological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or something unpleasant is about to happen. It is normal to experience anxiety in certain situations.

Severe anxiety

Generally accompanied by intense physiological sensations and responses, such as shortness of breath, sweating, trembling, nausea, stomach cramps, dizziness, feelings of suffocating, feelings of losing control and/or feelings of impending doom.

Specific phobia

A mental disorder characterised by excessive, marked, irrational fear or anxiety about a specific object or situation (the phobic stimulus), often leading to avoidance behaviour. The first symptoms of a specific phobia usually arise in childhood or early adolescence. It is estimated that as many as 10% of Australians may have some type of phobia (APA, 2013; Beyond Blue, 2015).

Exposure (or even thinking about) the phobic stimulus causes anxiety and/or panic attack. Anticipatory anxiety is the gradual rise in anxiety level as a person thinks about, or ‘anticipates’, being exposed to a phobic stimulus in the future. Most people have experienced a mild form of anticipatory anxiety when they have an ‘attack of nerves’ before making a presentation to an audience. For those with a phobia, their anxiety may rise to a level where they are incapacitated by it.

Differences between the three- stress, anxiety, and specific phobia

●Stress is a normal physiological reaction to the perception of threat, anxiety may or may not be a symptom of a mental disorder (depending on intensity and frequency).

●Stress (and phobia) is linked to an identifiable stimulus (the stressor), whereas anxiety is not necessarily linked to a specific stimulus - it is a more general feeling of apprehension / discomfort. People often don’t know why they are feeling anxious.

●Stress can be good (eustress) or bad (distress), whereas anxiety is always unpleasant to experience.

●Neither stress nor anxiety are, on their own, mental disorders. Specific phobia is a diagnosable mental disorder.

DSM-5 diagnostic criteria

●Marked fear or anxiety about a specific object or situation

●The phobic object or situation almost always provokes immediate fear or anxiety

●The phobic object or situation is avoided or endured with intense fear or anxiety

●The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context

●The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

●The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

●The disturbance is not better explained by symptoms of another disorder

Types of specific phobia

Common types of specific phobia include:

●animal e.g. spiders, snakes, dogs, insects, birds, fish, mice

●situational e.g. aeroplanes, elevators, enclosed spaces, tunnels

●natural environment e.g. heights, storms, darkness, thunder, lightning, being near water

●blood–injection–injury e.g. seeing blood, having blood taken, having an injection, getting a cut, any invasive medical procedure

●other phobias e.g. choking, vomiting, loud noises, costumed characters, falling down, becoming ill, dying

Panic attack

In specific phobia, exposure to the phobic stimulus may cause a panic attack.

A panic attack is period of sudden onset of intense fear or terror, often associated with feelings of impending doom.

During the attack, there are physiological or psychological changes such as

●shortness of breath or smothering sensations

●a racing or pounding heart

●sweating

●trembling

●tightness in the chest

●feeling dizzy, unsteady, lightheaded or faint

●nausea

●feelings of going crazy, losing control or even dying.

An attack may be a result of a trigger or seems to occur ‘out of the blue’. A panic attack can occur when in a calm state or an anxious state.

Symptoms of panic attacks

Panic attack is defined in the DSM as four or more of the following symptoms that develop suddenly and reach a peak within 10 minutes:

●palpitations, pounding heart or accelerated heart rate

●sweating

●trembling or shaking

●sensations of shortness of breath or smothering

●feeling of choking

●chest pain or discomfort

●nausea or abdominal distress

●feeling dizzy, unsteady, lightheaded or faint

●de-realisation (feelings of unreality) or

●depersonalisation (being detached from oneself)

●fear of losing control or going crazy

●fear of dying

●paresthesias (numbness or tingling sensations)

●chills or hot flushes