Mental Health - a Public Health Challenge

Transcription

1 Mental Health - a Public Health Challenge

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6 What is a mental health? Absence of mental illness Positive mental health Mental well-being

7 Public mental health Promotion of mental health Prevention of mental illness Prevention of disability due to mental illness

8 Subjective well-being Feeling good Life satisfaction Happiness

9 Psychological well-being Autonomy Self acceptance Personal growth Purpose in life Environmental mastery Positive relations with others

10 Emotional and social well-being Absence of behaviour problems Absence of emotional problems Doing what they are told Self esteem Good relationships with peers

11 What is a mental illness? It is when someone lacks the ability to manage day to day events and/or control their behavior so that basic physical and emotional needs are threatened or unmet.

12 What is mental illness like? Mental illness is a physical condition just like asthma or arthritis. But still society believes that a person who is mentally ill needs to show more willpower - to be able to pull themselves out it.

13 These disorders can affect persons of any age, race, sex, religion, or income. Mental illnesses are not the result of a personal weakness, lack of character, or poor upbringing.

14 ..It is also like telling a person who has an amputated leg to run across the room. But a person who has mental health issue has a broken brain.

15 Myths of Mental Illness Mental illness is caused by bad parenting. Fact: Most diagnosed individuals come from supportive homes. The mentally ill are violent and dangerous. Fact: Most are victims of violence. People with a mental disorder are not smart. Fact: Numerous studies have shown that many have average or above average intelligence.

16 8 Prevalence of mental disorders (%) Cyprus Denmark Greece Hungary Israel Lithuania Netherlands Slovakia Spain United Kingdom EU members before May 2004 EU members since May 2004 European Region Last available

17 8 Prevalence of mental disorders (%) Cyprus Denmark Greece Hungary Israel Lithuania Netherlands Slovakia Spain United Kingdom EU members before May 2004 EU members since May

18 Life Years Lost due to Disability Lopez et al for the World Bank OUP 2006 Unipolar depression Hearing Loss Osteoarthritis Chr. Obstr. Pul Disease Dementias Hearing Loss Alcohol Use Disorders Cerebrovascular Disease Diabetes

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26 Primary prevention of mental disorders Promoting mental health Specific diseases Organic brain syndrome Crisis or situational reaction Schizophrenia Senility Personality disorders

27 Secondary prevention of mental disorders Screening in large population groups Crisis intervention Education of public to recognize mental health in the early stages

28 Tertiary prevention of mental disorders Psychiatric rehabilitation Reality orientation Outpatient rehabilitation natural-death/suicide/all

29 Suicide What is suicide? Prevalence rates Mental disorder and suicide Other risk factors Understanding suicide Suicide prevention Treating people who are suicidal

30 Prevalence rates internationally highest suicide rates are in eastern and northern European countries Hungary rate of 45/100,000 Denmark rate of 32/100,000 low rates in mediterranean countries: Greece rate of 3/100,000 Spain rate of 4/100,000

31 30 SDR, suicide and self-inflicted injury, all ages, per Cyprus Denmark Greece Hungary Israel Lithuania Netherlands Slovakia Spain United Kingdom EU members before May 2004 EU members since May 2004 European Region 5 0 Last available

32 50 SDR, suicide and self-inflicted injury, all ages, per Cyprus Denmark Greece Hungary Israel Lithuania Netherlands Slovakia Spain United Kingdom EU members before May 2004 EU members since May

33 MYTH OR FACT? 1. Myth: People who threaten suicide don t go through with it Fact: Most people who commit suicide have made direct or indirect statements about their suicidal intentions 2. Myth: Suicide happens suddenly and without warning Fact: Most suicidal acts represent a carefully thought out strategy for coping with their problems 33

34 MYTH OR FACT? 3. Myth: People who attempt suicide have gotten it out of their system Fact: Any individual with one or more prior suicide attempts is at much greater risk than those who have never attempted suicide 4. Myth: Suicidal people are intent on dying Fact: Most suicidal people have mixed feelings about killing themselves; they are doubtful about living, not intent on dying. MOST WANT TO BE SAVED! 34

35 MYTH OR FACT? 5. Myth: Asking people about suicidal thoughts or actions will cause them to kill themselves Fact: You cannot make someone suicidal when you show an interest in their welfare by discussing the possibilities of suicide Concerned, non-judgmental questions encouraging the person to discuss his/her ideas may help relieve the psychological pressure 6. Myth: All suicidal individuals are mentally ill Fact: A suicidal person is extremely unhappy but not necessarily mentally ill; a normal person can be suicidal. 35

36 What is suicide? difficult to determine suicide taboo topic a mortal sin used to be illegal in Canada difficult to know person s intention large number of equivocal suicides reporting practices and judgments differ widely making it difficult to get accurate information

37 Key components act of deliberate self-injury degree of selfdestructiveness appeal to other people suicidal gesture, cry for help (Farberow & Schneidman, 1961) intention varies from clear intention to unconscious wish to reckless/impulsive behaviour to suicidal ideation, with many people being ambivalent about suicide

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39 Attempters and Completers Characteristic Attempters Completers Sex More often female More often male Age Younger Older Means Low lethality High lethality Setting Diagnoses High chance of rescue Dysthymia, Borderline Personality Low chance of rescue Mood disorder, Schizophrenia, Substance Abuse

40 Mental disorder and suicide Retrospective studies suggest that up to 90% of those who complete suicide had a mental disorder at the time of their death Several mental disorders have high rates of suicide: - mood disorder - schizophrenia - substance abuse/alcoholism

41 Mental disorder and suicide Iowa 500 study followed people who had been hospitalized for depression and schizophrenia with a control group of people without a mental disorder Suicide as a % of all deaths was 10% for depression group, 10% for schizophrenia group, and 0% for control group

42 Other risk factors Age in general, older men have higher rates of completed suicide (although the increase in suicide in young men has narrowed this gap); younger people higher rates of suicide attempts Marital status high rates of suicide attempts for single people; high rates of completed suicide for people who are widowed, separated, or divorced; risk also diminishes if person has children Race high among Caucasians and aboriginal people

43 Other risk factors Physical illness Life stress especially loss experiences Loneliness, isolation Previous attempts Suicide plan Family history Suicide sometimes occurs after improvement in mental health

44 Understanding suicide Biological suicide is related to mental disorders, serotonin level, genetic link Psychological Freud, anger turned inward; Cognitive-behavioural modelling and social learning; Existential-humanistic hopelessness and despair, lack of meaning Sociocultural suicide is related to social norms and culture

45 Emile Durkheim states that we must understand the relationship between individual and society. Egoistic suicide: suicide of isolated individual. Altruistic: overinvolvement with society. Suicide undertaken on behalf of the group. Anomic: when society fails to regulate its members (adolescent rejected by peer group, farmer ruined by economic structure) Fatalistic: excessive regulation (e.g., prisoners, slaves)

46 Suicide prevention No formal recognition of the problem in Canada; no official government or professional organization; suicide the deserted field England Anti-suicide prevention bureau, 1906; New York, Save a life league England Samaritans, 1953 Los Angeles Suicide Prevention Center (Farberow & Shneidman, 1961), 1960, AAS, Center for Suicide Studies in Washington DC

47 Suicide prevention crisis intervention use of telephone (distress lines) 24-hour service use of trained volunteers emotional support connection to other services

48 Suicide prevention Warning Signs Signs are often not verbal. Giving away beloved objects. Changes in eating or sleeping habits. Displaying a sense of calmness after a period of agitation.

49 Suicide education programs provides information to students in high school, builds awareness little research showing the effectiveness of suicide prevention, crisis intervention, distress lines, or suicide education programs in reducing suicide rates many suicidal people do not come into contact with these services suicide education and awareness can actually increase suicidal ideation (Shaffer et al., 1988)

50 Effective suicide prevention General approaches to primary prevention and health promotion building competence, coping, and problem-solving skills Reduction of access to lethal means CO gas in UK, firearms

51 Treating suicidal individuals Need to assess suicidal risk and ensure adequate supervision of attempter Deal with life crisis swiftly Therapy focused on building protective factors and reducing risk factors, through a variety of different approaches Encourage open talk about suicidal ideation