PUBLIC HEALTH

MENTAL HEALTH

OCT 29, 2020

DR ASAD

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After attending this lecture, the students will be able to:

• Define Mental Health

• Differentiate various determinants of mental health
• Describe the history of mental health
• Explain the features and attributes of normal mental health
• Identify the characteristics of a mentally ill person
• identify the warning signals of poor mental health
• List the types and causes of mental illness
• Explain the Preventive measures
• Argue the state of affairs affecting the mental health in Pakistan
• Analyze the role of Mental health services and comprehensive
health programs in Pakistan

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MENTAL HEALTH

A state of BALANCE between the individual

and the surrounding world, a state of
HARMONY between oneself and others, a
COEXISTENCE between the realities of the
self and that of other people and that of the
ENVIRONMENT

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MENTAL HEALTH
• Recent research says, THAT PSYCHOLOGICAL FACTORS
CAN INDUCE ALL KINDS OF ILLNESS, NOT SIMPLY
MENTAL ONES LIKE,
• Peptic ulcer
• Hypertension
• Asthma
• Musculoskeletal
• Sexual
• AND MANY MORE

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EMOTIONAL DIMENSION

• MENTAL HEALTH RELATES TO “ KNOWING ” or

“ COGNITION “

• While EMOTIONAL HEALTH RELATES TO

“ FEELINGS “

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SPIRITUAL DIMENSION
• Refers to that aspect of the individual which REACHES
OUT AND STRIVES for meaning and purpose in life
• It is the “ INTANGIBLE SOMETHING ” that transcends
physiology and psychology
• Includes ethics, integrity and principles

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MENTAL HEALTH

• Is not exclusively a matter of relation b/w persons

• It pertains also to the relations of an individual toward the

community he lives in, society, social institutions which
guide his life, determines the way of living, leisure,
working, the way of earning and spending money

• The way he sees happiness, stability and security

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HISTORY
• FOR LONG THE MENTALLY ILL WERE CONSIDERED TO BE
POSSESSED BY DEVILS
• Patients were locked up in jail like buildings, far removed from
the centers of populations, alienated from the rest of the society
• 20th century – psychiatry made scientific advances
• Publications of Sigmund Freud gave new concept in the
treatment
• Empirical treatments in 1930’s and 1940’s – insulin coma
therapy, electric shock treatment [ECT]
• Then the TRANQUILIZERS came in, making possible to treat
patients in general hospitals – the concept developed
• CURRENT TREND- complete integration into the normal pattern
of treatment with continuity of care

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ECT

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Devices

ECT machine from ca 1960.

Most modern ECT devices deliver a brief-
pulse current, which is thought to cause
fewer cognitive effects than the sine-wave
currents which were originally used in ECT.
[1] A small minority of psychiatrists in the
USA still use sine-wave stimuli.[53] Sine-
wave is no longer used in the UK or
Ireland.[55] Typically, the electrical
stimulus used in ECT is about 800
milliamps and has up to several hundred
watts, and the current flows for between
one and 6 seconds.[56]

In the USA, ECT devices are manufactured

by two companies, Somatics, which is
owned by psychiatrists Richard Abrams
and Conrad Swartz, and Mecta.[64] In the
UK, the market for ECT devices was long
monopolized by Ectron Ltd, which was set
up by psychiatrist Robert Russell.[65]
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FEATURES OF A MENTALLY
HEALTHY PERSON
• Free from internal conflicts, not at WAR with
oneself

• Adjusts well with others, accepts criticism and is

not easily upset

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• He searches for identity

• Has a strong sense of SELF–ESTEEM

• KNOWS HIMSELF ; his needs, problems,

goals, [this is self actualization]

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• Has good self-control-balance rationality
and emotionality
• Faces problems, tries to solve them
intelligently, i.e., coping with stress and
anxiety

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MENTALLY HEALTHY
-CHARACTERISTICS
• Feels comfortable about himself, reasonably secure and
adequate, neither under/overestimates his own
capabilities, accepts his shortcomings, has self respect
• Feels right towards others, is able to be interested in
others, loves others, has lasting and satisfying
friendships, is able to like & trust others , takes
responsibility for neighbors and fellow men
• Is able to meet the demands of life, does something
about the problems as they arise, is able to think for
himself and to take decisions, sets REASONABLE goals
for himself, shoulders his daily responsibilities, not
bowled over by his OWN emotions of FEAR, ANGER,
LOVE or GUILT

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POOR MENTAL HEALTH –
WARNING SIGNALS, ask yourself…
• Are you ALWAYS WORRYING ??
• Are you unable to concentrate – UNRECOGNIZED REASON ??
• Are you CONTINUALLY UNHAPPY without JUSTIFIED CAUSE ??
• Do you lose your temper easily and often ??
• Is Regular insomnia troubling you ??
• WIDE MOOD FLUCTUATIONS ?? [depression–elation-depression]
which incapacitates you ??
• Do you continually dislike to be with people??
• Are you upset if the routine of your life is disturbed ??
• Children consistently get on your nerves ??
• Are you constantly bitter and “ BROWNED OFF ”
• FEAR without cause ??
• Are you always right and others wrong ??
• Do you have numerous ACHES AND PAINS without a physical cause??

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MAJOR MENTAL ILLNESSES -
TYPES
PSYCHOSES ? Insanity –out of touch with
reality, SCHIZOPHRENIA, MANIC
DEPRESSIVE PSYCHOSIS, PARANOIA
[UNDUE and EXTREME SUSPICION]

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MINOR ILLNESSES

NEUROSIS OR PSYCHONEUROSIS – morbid

fears, compulsions and obsessions, unable
to react normally to life situations ,
associates do not consider him insane

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MENTAL HEALTH

The five most common mental health

disorders include depression, anxiety,
eating disorders, substance abuse and
attention deficit disorder ADD/ADHD.
Millions of people suffer from
these disorders in the United States and
around the world.

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Around 1-in-7 people globally (11-18 percent)
have one or more mental or substance
use disorders. Globally, this means around
one billion people in 2017 experienced one.
The largest number of people had an
anxiety disorder, estimated at around
4 percent of the population.May 16, 2018

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PERSONALITY &
CHARACTER DISORDERS
[are the legacy of
UNFORTUNATE CHILD-
HOOD EXPERIENCES and
PERCEPTIONS]

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MENTAL ILLNESS - causes
• Multiple and numerous causes – since human mind is
very complex
The known causes are:
ORGANIC CONDITIONS
Metabolic disorders (Diabetes etc., cerebral
arteriosclerosis, neoplasm, endocrine ,neurological, and
chronic diseases like, TB ,epilepsy, leprosy

HEREDITY (Important factor)

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MENTAL ILLNESS – CAUSES cont’d

SOCIAL PATHOLOGICAL
There usually is a combination of genetic and
environmental factors to produce a disease, the
social and environmental factors could be:
worries, anxieties, tensions, frustrations,
unhappy relationships, broken homes, poverty,
changing family structure, economic/life and
property insecurity [nowadays Pakistan specific],
cruelty, rejection, neglect

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LIFE CYCLE – CRUCIAL STAGES
• 1. PRENATAL PERIOD
• 2. FIRST 5 YRS OF LIFE roots of mental health develop, should
have a continuous warm relationship with parents.
• 3. SCHOOL PERIOD may satisfy or frustrate the child’s emotional
needs
• 4. ADOLESCENCE THE BASIC NEEDS ARE
A. Need to be needed by others
B. Increasing independence
C. Adequate adjustment to opposite sex
D. The need to rethink the cherished beliefs of one’s
elders
• 5. OLD AGE organic condition of the brain, economic insecurity,
poor status, lack of home,

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CLASS ARGUMENTS

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MENTAL HEALTH –
PREVENTIVE ASPECTS
• PRIMARY Community basis, improving the social
environment and promotion of social, emotional, and
physical well-being
• SECONDARY SCREENING PROGRAMS, early diagnosis
and treatment family health services , counseling,
reduce family conflicts
• TERTIARY Basic aim to reduce further break down,
seeks to reduce the duration of mental illness thus
reducing the stress for the family

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MENTAL HEALTH SERVICES
• NOT ONLY CONCERNED WITH EARLY
DIAGNOSIS AND TREATMENT BUT ALSO WITH
PREVENTION AND PROMOTION OF GOOD
MENTAL HEALTH
• Early diagnosis and treatment
• Rehabilitation
• Group and individual psychotherapy
• Mental health education
• Modern psychoactive drugs – usage
• After – care services

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COMPREHENSIVE HEALTH
PROGRAM
• Current trend is FULL INTEGRATION of
psychiatric services with other health
services
• The community mental health program
includes all community facilities pertinent
in any way to prevention, treatment,
rehabilitation

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COMMUNITY MENTAL HEALTH
PROGRAM – ESSENTIAL ELEMENTS
• Inpatient services
• Out patient services
• Partial hospitalization
• Emergency services
• Diagnostic services
• Pre-care and after-care services including foster home
placement and home visiting e.g. FOUNTAIN HOUSE
LAHORE, UNDER CONSTRUCTION AT PESHAWAR
• Education services
• Training and research and evaluation [very important]

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• CLASS DISCUSSION

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The social environment, not only determines
the individual’s attitude but also provides
the “ FRAMEWORK “ within which the
mental health is formulated

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ENVIRONMENTAL FACTORS
Health specialists should pay special
attention to:
•1. TOXIC SUBSTANCES lead, tin, mercury, asbestos, carbon
disulphide, carbon itself and many more
•2. NUTRITIONAL FACTORS deficiency of thiamine, pyridoxine
•3. MINERALS deficiency of iodine
•4. PSYCHOGENIC DRUGS alcohol, barbiturates etc.
•5. INFECTIONS measles, rubella, during prenatal and postnatal period
•6. TRAUMATIC FACTORS- ROADS AND OCCUPATIONAL ACCIDENTS
•7. RADIATIONS/ELECTROMAGNETIC FIELD CNS is the most sensitive
during neural development
•8. CELLULAR PHONES ??? (strong evidence) Being researched

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WISDOM

“ The intellect is what arrives at what is

correct through reasoning and recognizes
what has not yet happened through what
has already taken place.”

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 Paying people a compliment
appears to activate the same
reward center in the brain as
paying them cash, Japanese
research says.
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thanks

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