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CHAPTER 1

INTRODUCTION TO MENTAL HEALTH

By: Mukhtar Beshir (Mental Health Specialist)
 CHAPTER OUTLINE
❑ INTRODUCTION:
• Mental Health and Mental Disorders?
• Public attitude towards mental illness
• Mental Health situation in Somaliland
• Perinatal Mental Health

❑ PSYCHIATRIC INTERVIEW:
• How to Approach to Mentally ill
• How to Conduct Interview
• Supportive interventions on Interview
• Challenges during Interview
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1. INTRODUCTION
What is Health:
(WHO) defines health as a “state of complete physical mental and
social well being and not merely the absence of disease and
infirmity (Hood & Leddy, 2002)
Mental health is a state of well being in which the individual realizes
his or her own abilities, can cope with normal stresses of life, can
work productively and fruitfully, and is able to make contribution
to his or her community. (WHO)
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What is Mental illness?

• The definition of mental illness remains elusive and is usually

based on what constitutes socially accepted behavior norms.

• APA’s definition of mental illness or mental disorder is; “Illness

with psychological or behavioral manifestations and impairment in

functioning due to a social, psychological, genetic,
physical/chemical or biological disturbance
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• Or Clinically significant behavioral or psychological syndrome

experienced by a marked distress, disability or the risk of suffering,

or loss of freedom. (APA)

• The disorder is not limited to the person but to relations between the

person and the society. The illness is characterized by symptoms

and impairment in functioning.
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• Psychiatry is defined as branch of medicine deals with ‘mental

illnesses’ or ‘psychiatric disorders’

Brainstorming
• What are common misconceptions and public attitude towards

mental health & illness?

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Misconceptions and public attitude towards mental illness

• Mental illnesses are due to punishment for sin, or by black magic,

evil powers and witchcraft.
• Mentally ill patients are different from other people.
• Psychiatric illness is not like physical illness and psychiatric patients
never get better.
• Psychiatric patients should take drugs throughout their life time.
• Psychiatric patients are always violent and dangerous.
• Professionals like psychiatrist, psychiatric nurses who work with the
mentally ill persons are likely to become disturbed themselves.
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Mental Health situation in Somaliland

• Somaliland is one of the highest prevalence of mental illness worldwide
• Two out of every five people estimated to be living with severe mental health
disorders.
• People with mental disorders are highly marginalized in the Somali community and
are often isolated at home with chains, abused, and sometimes even kept in prison for
many years
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• Very few have access to modern treatment because of stigma.

• Insufficient number of people trained in mental health care, and the huge
shortage of health-care providers
• Uncontrolled substance of abuse
• History of war, poverty and multiple risk factors
• Scarcity of mental health care facility and poor services
PERINATAL MENTAL HEALTH
• Up to 20% of women develop a mental health problem during pregnancy or
within a year of giving birth.
• 1/10 women develops postnatal depression
• 40% of women experienced traumatic birth
• Suicide is the biggest cause of death for women during pregnancy and first
year after birth.
• Prenatal mental health impacts emotional wellbeing of the whole family
• Can also affect bonding/attachment,feeding and caring for baby
• Can have a negative impact on child development and long term emotional
and behavioral health
PSYCHIATRIC INTERVIEW
HOW TO APPROACH MENTALLY ILL?
Psychiatric interview
• Most powerful tool in assessing psychiatric problems
Expected Skill
• Facilitate expression
• Weigh the relevance of information
• Concise recording of clinical data
Psychiatric Interview
Medium
• Conversation
• Observation
Gather information on:
• Patient’s inner life
• Past experiences
• Behaviors
• Mental capacities
Psychiatric Interview
Important things:
• Listen the patient’s story carefully

• Assess the mental state

• Create conducive environment

• Respect for the dignity of patients
• Keep appropriate confidentiality
Conduct of the interview
General principles:
• Primary goal - To facilitate communication
• Sufficient time
• One hour for the first interview
• Free from interruptions
• Private setting
• Comfortable seating
Conduct of the interview
• Compromise when the patient is too ill

• Safety concerns:

– Allow other staff or the police

• Introduce yourself and explain – the purpose, scope & length of the interview

• Be warm and pleasant but not over familiar

Conduct of the interview
• Demonstrate your interest
• Be attentive to what is being said
• Be constantly alert to the patient’s needs
Opening the interview
• Set the patient at ease
• Initial inquiries focus on neutral subjects
• While listening observe behavior and emotional responses
• Encourage talking: - verbal and non-verbal
• A receptive nod, leaning forward
• Open ended inquiry: “could you tell me what problems brought you to the
hospital?”
Course of the interview
• Explore many areas using non-directive questions

• Direct questions – to clarify details

• Try to understand the person’s circumstances

• Summarize your understanding back to the patient

Course of the interview
AVOID:
•Premature false reassurance of the patient
•Normalizing the patient’s experience
•Impatience during the interview
•Appearing inattentive to your patient during the
interview
Supportive interventions
✔ Encouragement
✔ Reassurance
✔ Acknowledging emotion
✔ Empathy
Empathy
• It is our capacity to understand emotionally the experiences of our patients.
• It is an essential skill that can be focused and deepened through training,
observation, and self-reflection.
• It facilitates rapport and has therapeutic value
E.g. “It sounds as if your feelings were hurt”
Concluding the interview
• Check if the patient wishes to raise any other matters
• Thank the patient for his/her cooperation
• Seek consent to interview other informants
• Respect their wishes if consent is not granted
• If additional information is still needed, try another approach later
Challenges in the interview
• Psychiatric interview might be difficult in certain situations:
• Lack of trust
• Tearfulness
• Anger and hostility
• Over familiarity
• Non-communication
• Problems with the interviewer
Interviewing significant others
Purpose:
• For better understanding of the problem
• To understand the family dynamics that may have contributed to the problem
• To discuss possible care and support with families
• Prepare for possible family therapy
THANK YOU