Mental health is a level of psychological well-being or an absence of mental illness - the state of someone who is functioning at a satisfactory level of emotional and behavioural adjustment". From the perspectives of positive psychology or of holism, mental health may include an individual's ability to enjoy life, and to create a balance between life activities and efforts to achieve psychological resilience.
According to the World Health Organization
(WHO), mental health includes "subjective well-being, perceived
self-efficacy, autonomy, competence, inter-generational dependence, and
self-actualization of one's intellectual and emotional potential, among
others."
The WHO further states that the well-being of an individual is
encompassed in the realization of their abilities, coping with normal
stresses of life, productive work and contribution to their community.
Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health".
Mental health and mental illness
According
to the U.K. surgeon general (1999), mental health is the successful
performance of mental function, resulting in productive activities,
fulfilling relationships with other people, and providing the ability to
adapt to change and cope with adversity. The term mental illness refers
collectively to all diagnosable mental disorders—health conditions characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning.
A person struggling with their mental health may experience this because of stress, loneliness, depression, anxiety, relationship problems, death of a loved one, suicidal thoughts, grief, addiction, ADHD, cutting, self-harm, self-Injury, burning, various mood disorders, or other mental illnesses of varying degrees, as well as learning disabilities. Therapists, psychiatrists, psychologists, social workers, nurse practitioners or physicians can help manage mental illness with treatments such as therapy, counseling, or medication.
History
In the mid-19th century, William Sweetser was the first to coin the
term "mental hygiene", which can be seen as the precursor to
contemporary approaches to work on promoting positive mental health. Isaac Ray, one of the founders and the fourth president of the American Psychiatric Association,
further defined mental hygiene as "the art of preserving the mind
against all incidents and influences calculated to deteriorate its
qualities, impair its energies, or derange its movements."
Dorothea Dix
(1802–1887) was an important figure in the development of the "mental
hygiene" movement. Dix was a school teacher who endeavored throughout
her life to help people with mental disorders, and to bring to light the
deplorable conditions into which they were put. This was known as the "mental hygiene movement".
Before this movement, it was not uncommon that people affected by
mental illness in the 19th century would be considerably neglected,
often left alone in deplorable conditions, barely even having sufficient
clothing.
Dix's efforts were so great that there was a rise in the number of
patients in mental health facilities, which sadly resulted in these
patients receiving less attention and care, as these institutions were
largely understaffed.
Emil Kraepelin in 1896 developed the taxonomy
of mental disorders which has dominated the field for nearly 80 years.
Later the proposed disease model of abnormality was subjected to
analysis and considered normality to be relative to the physical,
geographical and cultural aspects of the defining group.
At the beginning of the 20th century, Clifford Beers
founded "Mental Health America – National Committee for Mental
Hygiene", after publication of his accounts from lived experience in lunatic asylums, A Mind That Found Itself, in 1908 and opened the first outpatient mental health clinic in the United States.
The mental hygiene movement, related to the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life.
In the post-WWII years, references to mental hygiene were gradually
replaced by the term 'mental health' due to its positive aspect that
evolves from the treatment of illness to preventive and promotive areas
of healthcare.
Marie Jahoda
described six major, fundamental categories that can be used to
categorize mentally healthy individuals: a positive attitude towards the
self, personal growth, integration, autonomy, a true perception of
reality, and environmental mastery, which include adaptability and
healthy interpersonal relationships.
Significance
Mental illnesses are more common than cancer, diabetes or heart disease. Over 26 percent of all Americans over the age of 18 meet the criteria for having a mental illness.
A WHO report estimates the global cost of mental illness at nearly $2.5
trillion (two-thirds in indirect costs) in 2010, with a projected
increase to over $6 trillion by 2030.
Evidence from the World Health Organization
suggests that nearly half of the world's population are affected by
mental illness with an impact on their self-esteem, relationships and
ability to function in everyday life. An individual's emotional health can also impact physical health and poor mental health can lead to problems such as substance abuse.
Maintaining good mental health is crucial to living a long and
healthy life. Good mental health can enhance one's life, while poor
mental health can prevent someone from living an enriching life.
According to Richards, Campania, & Muse-Burke, "There is growing
evidence that is showing emotional abilities are associated with
prosocial behaviors such as stress management and physical health." Their research also concluded that people who lack emotional expression are inclined to anti-social behaviors (e.g., drug and alcohol abuse, physical fights, vandalism), which are a direct reflection of their mental health and suppress emotions. Adults and children with mental illness may experience social stigma, which can exacerbate the issues.
Perspectives
Mental well-being
Mental health can be seen as an unstable continuum, where an individual's mental health may have many different possible values. Mental wellness
is generally viewed as a positive attribute, even if the person does
not have any diagnosed mental health condition. This definition of
mental health highlights emotional well-being, the capacity to live a full and creative
life, and the flexibility to deal with life's inevitable challenges.
Some discussions are formulated in terms of contentment or happiness.
Many therapeutic systems and self-help books offer methods and
philosophies espousing strategies and techniques vaunted as effective
for further improving the mental wellness. Positive psychology is increasingly prominent in mental health.
A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.
The tripartite model of mental well-being views mental well-being as encompassing three components of emotional well-being, social well-being, and psychological well-being.
Emotional well-being is defined as having high levels of positive
emotions, whereas social and psychological well-being are defined as the
presence of psychological and social skills and abilities that
contribute to optimal functioning in daily life. The model has received
empirical support across cultures.
The Mental Health Continuum-Short Form (MHC-SF) is the most widely used
scale to measure the tripartite model of mental well-being.
Children and young adults
Mental health and stability is a very important factor in a person’s everyday life. Social skills,
behavioral skills, and someone’s way of thinking are just some of the
things that the human brain develops at an early age. Learning how to
interact with others and how to focus on certain subjects are essential
lessons to learn. This spans from the time we can talk all the way to
when we are so old that we can barely walk. However, there are some
people out there who have difficulty with these kind of skills and
behaving like an average person. This is a most likely the cause of
having a mental illness. A mental illness is a wide range of conditions
that affect a person’s mood, thinking, and behavior. About 26% of people
in the United States, ages 18 and older, have been diagnosed with some
kind of mental disorder. However, not much is said about children with
mental illnesses even though there are many that will develop one, even
as early as age three.
The most common mental illnesses in children include, but are not limited to, ADHD, autism and anxiety disorder, as well as depression
in older children and teens. Having a mental illness at a younger age
is much different from having one in your thirties. Children's brains
are still developing and will continue to develop until around the age
of twenty-five.
When a mental illness is thrown into the mix, it becomes significantly
harder for a child to acquire the necessary skills and habits that
people use throughout the day. For example, behavioral skills don’t
develop as fast as motor or sensory skills do.
So when a child has an anxiety disorder, they begin to lack proper
social interaction and associate many ordinary things with intense fear.
This can be scary for the child because they don’t necessarily
understand why they act and think the way that they do. Many researchers
say that parents should keep an eye on their child if they have any
reason to believe that something is slightly off.
If the children are evaluated earlier, they become more acquainted to
their disorder and treating it becomes part of their daily routine. This is opposed to adults who might not recover as quickly because it is more difficult for them to adapt.
Mental illness affects not only the person themselves, but the
people around them. Friends and family also play an important role in
the child’s mental health stability and treatment. If the child is
young, parents are the ones who evaluate their child and decide whether
or not they need some form of help.
Friends are a support system for the child and family as a whole.
Living with a mental disorder is never easy, so it’s always important to
have people around to make the days a little easier. However, there are
negative factors that come with the social aspect of mental illness as
well. Parents are sometimes held responsible for their child’s own
illness.
People also say that the parents raised their children in a certain way
or they acquired their behavior from them. Family and friends are
sometimes so ashamed of the idea of being close to someone with a
disorder that the child feels isolated and thinks that they have to hide
their illness from others.
When in reality, hiding it from people prevents the child from getting
the right amount of social interaction and treatment in order to thrive
in today’s society.
Stigma
is also a well-known factor in mental illness. Stigma is defined as “a
mark of disgrace associated with a particular circumstance, quality, or
person.” Stigma is used especially when it comes to the mentally
disabled. People have this assumption that everyone with a mental
problem, no matter how mild or severe, is automatically considered
destructive or a criminal person. Thanks to the media, this idea has
been planted in our brains from a young age.
Watching movies about teens with depression or children with Autism
makes us think that all of the people that have a mental illness are
like the ones on TV. In reality, the media displays an exaggerated
version of most illnesses. Unfortunately, not many people know that, so
they continue to belittle those with disorders. In a recent study, a
majority of young people associate mental illness with extreme sadness
or violence.
Now that children are becoming more and more open to technology and the
media itself, future generations will then continue to pair mental
illness with negative thoughts. The media should be explaining that many
people with disorders like ADHD and anxiety, with the right treatment, can live ordinary lives and should not be punished for something they cannot help.
Sueki, (2013) carried out a study titled “The effect of suicide–related internet use on users’ mental health: A longitudinal Study”.
This study investigated the effects of suicide-related internet use on
user’s suicidal thoughts, predisposition to depression and anxiety and
loneliness. The study consisted of 850 internet users; the data was
obtained by carrying out a questionnaire amongst the participants. This
study found that browsing websites related to suicide, and methods used
to commit suicide, had a negative effect on suicidal thoughts and
increased depression and anxiety tendencies. The study concluded that as
suicide-related internet use adversely affected the mental health of
certain age groups it may be prudent to reduce or control their exposure
to these websites. These findings certainly suggest that the internet
can indeed have a profoundly negative impact on our mental health.
Psychiatrist Thomas Szasz
compared that 50 years ago children were either categorized as good or
bad, and today "all children are good, but some are mentally healthy and
others are mentally ill". The social control and forced identity
creation is the cause of many mental health problems among today's
children. A behaviour or misbehaviour might not be an illness but exercise of their free will and today's immediacy in drug administration for every problem along with the legal over-guarding and regard of a child's status as a dependent shakes their personal self and invades their internal growth.
Prevention
Mental health is conventionally defined as a hybrid of absence of a mental disorder and presence of well-being. Focus is increasing on preventing mental disorders.
Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.
Some commentators have argued that a pragmatic and practical approach
to mental disorder prevention at work would be to treat it the same way
as physical injury prevention.
Prevention of a disorder at a young age may significantly
decrease the chances that a child will suffer from a disorder later in
life, and shall be the most efficient and effective measure from a
public health perspective. Prevention may require the regular consultation of a physician for at least twice a year to detect any signs that reveal any mental health concerns.
Cultural and religious considerations
Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures,
institutions and professions have very different ways of
conceptualizing its nature and causes, determining what is mentally
healthy, and deciding what interventions, if any, are appropriate. Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment.
Research has shown that there is stigma attached to mental illness. In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma. Due to this stigma, responses to a positive diagnosis may be a display of denialism.
Family caregivers of individuals with mental disorders may also suffer discrimination or stigma.
Addressing and eliminating the social stigma and perceived stigma
attached to mental illness has been recognized as a crucial part to
addressing the education of mental health issues. In the United States,
the National Alliance of Mental Illness
is an institution that was founded in 1979 to represent and advocate
for victims struggling with mental health issues. NAMI also helps to
educate about mental illnesses and health issues, while also working to
eliminate the stigma
attached to these disorders such as anxiety and depression. Research
has shown acts of discrimination and social stigma are associated with
poorer mental health outcomes in racial (e.g. African Americans), ethnic (e.g. Muslim women), and sexual and gender minorities (e.g. transgender persons).
Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association,
however, far less attention is paid to the damage that more rigid,
fundamentalist faiths commonly practiced in the United States can cause.
This theme has been widely politicized in 2018 such as with the
creation of the Religious Liberty Task Force in July of that year.
In addition, many providers and practitioners in the United States are
only beginning to realize that the institution of mental healthcare
lacks knowledge and competence of many non-Western cultures, leaving
providers in the United States ill-equipped to treat patients from
different cultures.
Emotional improvement
Unemployment has been shown to have a negative impact on an individual's emotional well-being, self-esteem
and more broadly their mental health. Increasing unemployment has been
show to have a significant impact on mental health, predominantly
depressive disorders. This is an important consideration when reviewing the triggers for mental health disorders in any population survey.
In order to improve your emotional mental health, the root of the issue
has to be resolved. "Prevention emphasizes the avoidance of risk
factors; promotion aims to enhance an individual's ability to achieve a
positive sense of self-esteem, mastery, well-being, and social inclusion."
It is very important to improve your emotional mental health by
surrounding yourself with positive relationships. We as humans, feed off
companionships and interaction with other people. Another way to
improve your emotional mental health is participating in activities that
can allow you to relax and take time for yourself. Yoga
is a great example of an activity that calms your entire body and
nerves. According to a study on well-being by Richards, Campania and
Muse-Burke, "mindfulness
is considered to be a purposeful state, it may be that those who
practice it believe in its importance and value being mindful, so that
valuing of self-care activities may influence the intentional component
of mindfulness."
Mental health care navigation helps to guide patients and families
through the fragmented, often confusing mental health industries. Care
navigators work closely with patients and families through discussion
and collaboration to provide information on best therapies as well as
referrals to practitioners and facilities specializing in particular
forms of emotional improvement. The difference between therapy and care
navigation is that the care navigation process provides information and
directs patients to therapy rather than providing therapy. Still, care
navigators may offer diagnosis and treatment planning. Though many care
navigators are also trained therapists and doctors. Care navigation is
the link between the patient and the below therapies. A clear
recognition that mental health requires medical intervention was
demonstrated in a study by Kessler et al. of the prevalence and
treatment of mental disorders from 1990 to 2003 in the United States.
Despite the prevalence of mental health disorders remaining unchanged
during this period, the number of patients seeking treatment for mental
disorders increased threefold.
Emotional issues
Emotional
mental disorders are a leading cause of disabilities worldwide.
Investigating the degree and severity of untreated emotional mental
disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative, which was created in 1998 by the World Health Organization (WHO). "Neuropsychiatric
disorders are the leading causes of disability worldwide, accounting
for 37% of all healthy life years lost through disease.These disorders
are most destructive to low and middle-income countries due to their
inability to provide their citizens with proper aid. Despite modern
treatment and rehabilitation for emotional mental health disorders,
"even economically advantaged societies have competing priorities and
budgetary constraints".
The World Mental Health survey initiative has suggested a plan
for countries to redesign their mental health care systems to best
allocate resources.
"A first step is documentation of services being used and the extent and
nature of unmet needs for treatment. A second step could be to do a
cross-national comparison of service use and unmet needs in countries
with different mental health care systems. Such comparisons can help to
uncover optimum financing, national policies, and delivery systems for
mental health care."
Knowledge of how to provide effective emotional mental health
care has become imperative worldwide. Unfortunately, most countries have
insufficient data to guide decisions, absent or competing visions for
resources, and near constant pressures to cut insurance and
entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, United States), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the People's Republic of China),
Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine),
and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower middle-income (China, Colombia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income.
The coordinated surveys on emotional mental health disorders,
their severity, and treatments were implemented in the aforementioned
countries. These surveys assessed the frequency, types, and adequacy of
mental health service use in 17 countries in which WMH surveys are
complete. The WMH also examined unmet needs for treatment in strata
defined by the seriousness of mental disorders. Their research showed
that "the number of respondents using any 12-month mental health service
was generally lower in developing than in developed countries, and the
proportion receiving services tended to correspond to countries'
percentages of gross domestic product spent on health care".
"High levels of unmet need worldwide are not surprising, since WHO Project ATLAS'
findings of much lower mental health expenditures than was suggested by
the magnitude of burdens from mental illnesses. Generally, unmet needs
in low-income and middle-income
countries might be attributable to these nations spending reduced
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Treatment
Older methods of treatment
Trepanation
Archaeological records have shown that trepanation was a procedure used to treat "headaches, insanities or epilepsy" in several parts of the world in the Stone age. It was a surgical process used in the Stone Age. Paul Broca
studied trepanation and came up with his own theory on it. He noticed
that the fractures on the skulls dug up weren't caused by wounds
inflicted due to violence, but because of careful surgical procedures.
"Doctors used sharpened stones to scrape the skull and drill holes into
the head of the patient" to allow evil spirits which plagued the patient
to escape. There were several patients that died in these procedures,
but those that survived were revered and believed to possess "properties
of a mystical order".
Lobotomy
Lobotomy
was used in the 20th century as a common practice of alternative
treatment for mental illnesses such as schizophrenia and depression. The
first ever modern leucotomy meant for the purpose of treating a mental illness occurred in 1935 by a Portuguese neurologist, Antonio Egas Moniz. He received the Nobel Prize in medicine in 1949. This belief that mental health illnesses could be treated by surgery came from Swiss neurologist, Gottlieb Burckhardt.
After conducting experiments on six patients with schizophrenia, he
claimed that half of his patients recovered or calmed down.
Psychiatrist Walter Freeman
believed that "an overload of emotions led to mental illness and “that
cutting certain nerves in the brain could eliminate excess emotion and
stabilize a personality", according to a National Public Radio article.
Exorcisms
"Exorcism
is the religious or spiritual practice of evicting demons or other
spiritual entities from a person, or an area, they are believed to have
possessed."
Mental health illnesses such as Huntington’s Disease (HD), Tourette syndrome and schizophrenia were believed to be signs of possession by the Devil. This led to several mentally ill patients being subjected to exorcisms.
This practice has been around for a long time, though decreasing
steadily until it reached a low in the 18th century. It seldom occurred
until the 20th century when the numbers rose due to the attention the
media was giving to exorcisms. Different belief systems practice
exorcisms in different ways.
Modern methods of treatment
Pharmacotherapy
Pharmacotherapy
is therapy that uses pharmaceutical drugs. Pharmacotherapy is used in
the treatment of mental illness through the use of antidepressants,
benzodiazepines, and the use of elements such as lithium.
Physical Activity
For
some people, physical exercise can improve mental as well as physical
health. Playing sports, walking, cycling or doing any form of physical
activity trigger the production of various hormones, sometimes including
endorphins, which can elevate a person's mood.
Activity therapies
Activity
therapies, also called recreation therapy and occupational therapy,
promote healing through active engagement. Making crafts can be a part
of occupational therapy. Walks can be a part of recreation therapy.
In recent years colouring has been recognised as an activity which has
been proven to significantly lower the levels of depressive symptoms and
anxiety in many studies.
Expressive therapies
Expressive therapies are a form of psychotherapy that involves the arts or art-making. These therapies include music therapy, art therapy, dance therapy, drama therapy, and poetry therapy. It has been proven that Music therapy is an effective way of helping people who suffer from a mental health disorder.
Psychotherapy
Psychotherapy
is the general term for scientific based treatment of mental health
issues based on modern medicine. It includes a number of schools, such
as gestalt therapy, psychoanalysis, cognitive behavioral therapy and dialectical behavioral therapy.
Group therapy involves any type of therapy that takes place in a setting involving multiple people. It can include psychodynamic groups, activity groups for expressive therapy, support groups (including the Twelve-step program), problem-solving and psychoeducation groups.
Meditation
The practice of mindfulness meditation has several mental health benefits, such as bringing about reductions in depression, anxiety and stress. Mindfulness meditation may also be effective in treating substance use disorders. Further, mindfulness meditation appears to bring about favorable structural changes in the brain.
The Heartfulness meditation program has proven to show
significant improvements in the state of mind of health-care
professionals.
A study posted on the US National Library of Medicine showed that these
professionals of varied stress levels were able to improve their
conditions after this meditation program was conducted. They benefited
in aspects of burnouts and emotional wellness.
People with anxiety disorders
participated in a stress-reduction program conducted by researchers
from the Mental Health Service Line at the W.G. Hefner Veterans Affairs
Medical Center in Salisbury, North Carolina.
The participants practiced mindfulness meditation. After the study was
over, it was concluded that the "mindfulness meditation training program
can effectively reduce symptoms of anxiety and panic and can help
maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia."
Spiritual counseling
Spiritual
counselors meet with people in need to offer comfort and support and to
help them gain a better understanding of their issues and develop a
problem-solving relation with spirituality. These types of counselors deliver care based on spiritual, psychological and theological principles.
Social work in mental health
Social work
in mental health, also called psychiatric social work, is a process
where an individual in a setting is helped to attain freedom from
overlapping internal and external problems (social and economic
situations, family and other relationships, the physical and
organizational environment, psychiatric symptoms, etc.). It aims for
harmony, quality of life, self-actualization and personal adaptation across all systems. Psychiatric social workers are mental health professionals
that can assist patients and their family members in coping with both
mental health issues and various economic or social problems caused by
mental illness or psychiatric dysfunctions and to attain improved mental
health and well-being. They are vital members of the treatment teams in
Departments of Psychiatry and Behavioral Sciences in hospitals. They
are employed in both outpatient and inpatient settings of a hospital,
nursing homes, state and local governments, substance abuse clinics,
correctional facilities, health care services...etc.
In psychiatric social work there are three distinct groups. One made up of the social workers
in psychiatric organizations and hospitals. The second group consists
members interested with mental hygiene education and holding
designations that involve functioning in various mental health services
and the third group consist of individuals involved directly with
treatment and recovery process.
In the United States, social workers provide most of the mental
health services. According to government sources, 60 percent of mental
health professionals are clinically trained social workers, 10 percent are psychiatrists, 23 percent are psychologists, and 5 percent are psychiatric nurses.
Mental health social workers in Japan have professional knowledge
of health and welfare and skills essential for person's well-being.
Their social work training enables them as a professional to carry out
Consultation assistance for mental disabilities and their social
reintegration; Consultation regarding the rehabilitation of the victims;
Advice and guidance for post-discharge residence and re-employment
after hospitalized care, for major life events in regular life, money
and self-management and in other relevant matters in order to equip them
to adapt in daily life. Social workers provide individual home visits
for mentally ill and do welfare services available, with specialized
training a range of procedural services are coordinated for home,
workplace and school. In an administrative relationship, Psychiatric
social workers provides consultation, leadership, conflict management
and work direction. Psychiatric social workers who provides assessment
and psychosocial interventions function as a clinician, counselor and
municipal staff of the health centers.
Roles and functions
Social workers play many roles in mental health settings, including those of case manager, advocate, administrator, and therapist. The major functions of a psychiatric social worker are promotion and prevention, treatment, and rehabilitation. Social workers may also practice:
- Counseling and psychotherapy
- Case management and support services
- Crisis intervention
- Psychoeducation
- Psychiatric rehabilitation and recovery
- Care coordination and monitoring
- Program management/administration
- Program, policy and resource development
- Research and evaluation
Psychiatric social workers conduct psychosocial
assessments of the patients and work to enhance patient and family
communications with the medical team members and ensure the
inter-professional cordiality in the team to secure patients with the
best possible care and to be active partners in their care planning.
Depending upon the requirement, social workers are often involved in
illness education, counseling and psychotherapy. In all areas, they are pivotal to the aftercare process to facilitate a careful transition back to family and community.
History
United States
During the 1840s, Dorothea Lynde Dix,
a retired Boston teacher who is considered the founder of the Mental
Health Movement, began a crusade that would change the way people with
mental disorders were viewed and treated. Dix was not a social worker;
the profession was not established until after her death in 1887.
However, her life and work were embraced by early psychiatric social
workers, and she is considered one of the pioneers of psychiatric social
work along with Elizabeth Horton, who in 1907 was the first psychiatric
social worker in the New York hospital system, and others.
The early twentieth century was a time of progressive change in
attitudes towards mental illness. Community Mental Health Centers Act
was passed in 1963. This policy encouraged the deinstitutionalisation
of people with mental illness. Later, mental health consumer movement
came by 1980s. A consumer was defined as a person who has received or is
currently receiving services for a psychiatric condition. People with
mental disorders and their families became advocates for better care.
Building public understanding and awareness through consumer advocacy
helped bring mental illness and its treatment into mainstream medicine
and social services.
In the 2000s focus was on Managed care movement which aimed at a health
care delivery system to eliminate unnecessary and inappropriate care in
order to reduce costs & Recovery movement in which by principle
acknowledges that many people with serious mental illness spontaneously
recover and others recover and improve with proper treatment.
Role of social workers made an impact with 2003 invasion of Iraq and War in Afghanistan (2001–14) social workers worked out of the NATO hospital in Afghanistan and Iraq
bases. They made visits to provide counseling services at forward
operating bases. Twenty-two percent of the clients were diagnosed with post-traumatic stress disorder, 17 percent with depression, and 7 percent with alcohol abuse. In 2009, a high level of suicides
was reached among active-duty soldiers: 160 confirmed or suspected Army
suicides. In 2008, the Marine Corps had a record 52 suicides.
The stress of long and repeated deployments to war zones, the dangerous
and confusing nature of both wars, wavering public support for the
wars, and reduced troop morale have all contributed to the escalating
mental health issues. Military and civilian social workers are primary service providers in the veterans’ health care system.
Mental health services, is a loose network of services ranging from highly structured inpatient
psychiatric units to informal support groups, where psychiatric social
workers indulges in the diverse approaches in multiple settings along
with other paraprofessional workers.
Canada
A role
for psychiatric social workers was established early in Canada’s history
of service delivery in the field of population health. Native North
Americans understood mental trouble as an indication of an individual
who had lost their equilibrium with the sense of place and belonging in
general, and with the rest of the group in particular. In native healing
beliefs, health and mental health were inseparable, so similar
combinations of natural and spiritual remedies were often employed to
relieve both mental and physical illness. These communities and families
greatly valued holistic approaches for preventative health care.
Indigenous peoples in Canada have faced cultural oppression and social
marginalization through the actions of European colonizers and their
institutions since the earliest periods of contact. Culture contact
brought with it many forms of depredation. Economic, political, and
religious institutions of the European settlers all contributed to the
displacement and oppression of indigenous people.
The first officially recorded treatment practices were in 1714, when Quebec opened wards for the mentally ill. In the 1830s social services were active through charity organizations and church parishes (Social Gospel Movement). Asylums for the insane were opened in 1835 in Saint John and New Brunswick. In 1841 in Toronto,
when care for the mentally ill became institutionally based. Canada
became a self-governing dominion in 1867, retaining its ties to the
British crown. During this period age of industrial capitalism
began, which lead to a social and economic dislocation in many forms.
By 1887 asylums were converted to hospitals and nurses and attendants
were employed for the care of the mentally ill. The first social work
training began at the University of Toronto in 1914. In 1918 Clarence
Hincks & Clifford Beers founded the Canadian National Committee for Mental Hygiene, which later became the Canadian Mental Health Association.
In the 1930s Dr. Clarence Hincks promoted prevention and of treating
sufferers of mental illness before they were incapacitated/early
detection.
World War II
profoundly affected attitudes towards mental health. The medical
examinations of recruits revealed that thousands of apparently healthy
adults suffered mental difficulties. This knowledge changed public
attitudes towards mental health, and stimulated research into preventive
measures and methods of treatment. In 1951 Mental Health Week was introduced across Canada. For the first half of the twentieth century, with a period of deinstitutionalisation
beginning in the late 1960s psychiatric social work succeeded to the
current emphasis on community-based care, psychiatric social work
focused beyond the medical model’s aspects on individual diagnosis to
identify and address social inequities and structural issues. In the
1980s Mental Health Act was amended to give consumers the right to
choose treatment alternatives. Later the focus shifted to workforce
mental health issues and environment.
India
The earliest citing of mental disorders in India are from Vedic Era (2000 BC – AD 600).
Charaka Samhita, an ayurvedic textbook believed to be from 400–200 BC
describes various factors of mental stability. It also has instructions
regarding how to set up a care delivery system. In the same era In south India Siddha was a medical system, the great sage Agastya,
one of the 18 siddhas contributing to a system of medicine has included
the Agastiyar Kirigai Nool, a compendium of psychiatric disorders and
their recommended treatments.
In Atharva Veda too there are descriptions and resolutions about mental
health afflictions. In the Mughal period Unani system of medicine was
introduced by an Indian physician Unhammad in 1222. Then existed form of psychotherapy was known then as ilaj-i-nafsani in Unani medicine.
The 18th century was a very unstable period in Indian history,
which contributed to psychological and social chaos in the Indian
subcontinent. In 1745 of lunatic asylums were developed in Bombay
(Mumbai) followed by Calcutta (Kolkata) in 1784, and Madras (Chennai) in
1794. The need to establish hospitals became more acute, first to treat
and manage Englishmen and Indian ‘sepoys’ (military men) employed by
the British East India Company.
The First Lunacy Act (also called Act No. 36) that came into effect in
1858 was later modified by a committee appointed in Bengal in 1888.
Later, the Indian Lunacy Act, 1912 was brought under this legislation. A
rehabilitation programme was initiated between 1870s and 1890s for
persons with mental illness at the Mysore Lunatic Asylum, and then an
occupational therapy department was established during this period in
almost each of the lunatic asylums. The programme in the asylum was
called ‘work therapy’. In this programme, persons with mental illness
were involved in the field of agriculture for all activities. This
programme is considered as the seed of origin of psychosocial
rehabilitation in India.
Berkeley-Hill, superintendent of the European Hospital (now known as the Central Institute of Psychiatry (CIP),
established in 1918), was deeply concerned about the improvement of
mental hospitals in those days. The sustained efforts of Berkeley-Hill
helped to raise the standard of treatment and care and he also persuaded
the government to change the term ‘asylum’ to ‘hospital’ in 1920.
Techniques similar to the current token-economy were first started in
1920 and called by the name ‘habit formation chart’ at the CIP, Ranchi.
In 1937, the first post of psychiatric social worker was created in the
child guidance clinic run by the Dhorabji Tata School of Social Work
(established in 1936), It is considered as the first documented evidence
of social work practice in Indian mental health field.
After Independence in 1947, general hospital psychiatry units
(GHPUs) where established to improve conditions in existing hospitals,
while at the same time encouraging outpatient care through these units.
In Amritsar a Dr. Vidyasagar, instituted active involvement of families
in the care of persons with mental illness. This was advanced practice
ahead of its times regarding treatment and care. This methodology had a
greater impact on social work practice in the mental health field
especially in reducing the stigmatisation. In 1948 Gauri Rani Banerjee,
trained in the United States, started a master’s course in medical and
psychiatric social work at the Dhorabji Tata School of Social Work (Now
TISS). Later the first trained psychiatric social worker was appointed
in 1949 at the adult psychiatry unit of Yervada mental hospital, Pune.
In various parts of the country, in mental health service
settings, social workers were employed—in 1956 at a mental hospital in
Amritsar, in 1958 at a child guidance clinic of the college of nursing,
and in Delhi in 1960 at the All India Institute of Medical Sciences and
in 1962 at the Ram Manohar Lohia Hospital. In 1960, the Madras Mental Hospital (Now Institute of Mental Health),
employed social workers to bridge the gap between doctors and patients.
In 1961 the social work post was created at the NIMHANS. In these
settings they took care of the psychosocial aspect of treatment. This
had long-term greater impact of social work practice in mental health.
In 1966 by the recommendation Mental Health Advisory Committee,
Ministry of Health, Government of India, NIMHANS commenced Department of
Psychiatric Social Work started and a two-year Postgraduate Diploma in
Psychiatric Social Work was introduced in 1968. In 1978, the
nomenclature of the course was changed to MPhil in Psychiatric Social
Work. Subsequently, a PhD Programme was introduced. By the
recommendations Mudaliar committee in 1962, Diploma in Psychiatric
Social Work was started in 1970 at the European Mental Hospital at
Ranchi (now CIP), upgraded the program and added other higher training
courses subsequently.
A new initiative to integrate mental health with general health services started in 1975 in India. The Ministry of Health, Government of India
formulated the National Mental Health Programme (NMHP) and launched it
in 1982. The same was reviewed in 1995 and based on that, the District
Mental Health Program (DMHP) launched in 1996 and sought to integrate
mental health care with public health care. This model has been implemented in all the states and currently there are 125 DMHP sites in India.
National Human Rights Commission
(NHRC) in 1998 and 2008 carried out systematic, intensive and critical
examinations of mental hospitals in India. This resulted in recognition
of the human rights of the persons with mental illness by the NHRC. From
the NHRC's report as part of the NMHP, funds were provided for
upgrading the facilities of mental hospitals. This is studied to result
in positive changes over the past 10 years than in the preceding five
decades by the 2008 report of the NHRC and NIMHANS. In 2016 Mental Health Care Bill was passed which ensures and legally entitles
access to treatments with coverage from insurance, safeguarding dignity
of the afflicted person, improving legal and healthcare access and
allows for free medications.] In December 2016, Disabilities Act 1995 was repealed with Rights of Persons with Disabilities Act
(RPWD), 2016 from the 2014 Bill which ensures benefits for a wider
population with disabilities. The Bill before becoming an Act was pushed
for amendments by stakeholders mainly against alarming clauses in the
"Equality and Non discrimination" section that diminishes the power of
the act and allows establishments to overlook or discriminate against
persons with disabilities and against the general lack of directives
that requires to ensure the proper implementation of the Act.
Lack of any universally accepted single licensing authority
compared to foreign countries puts social workers at general in risk.
But general bodies/councils accepts automatically a university-qualified
social worker as a professional licensed to practice or as a qualified
clinician. Lack of a centralized council in tie-up with Schools of
Social Work also makes a decline in promotion for the scope of social
workers as mental health professionals. Though in this midst the service
of social workers has given a facelift of the mental health sector in
the country with other allied professionals.
Prevalence and programs
Evidence suggests that 450 million people worldwide are impacted by mental health, major depression
ranks fourth among the top 10 leading causes of disease worldwide.
Within 20 years, mental illness is predicted to become the leading cause
of disease worldwide. Women are more likely to have a mental illness
than men. One million people commit suicide every year and 10 to 20
million attempt it.
Australia
A survey conducted by Australian Bureau of Statistics
in 2008 regarding adults with manageable to severe neurosis reveals
almost half of the population had a mental disorder at some point of
their life and one in five people had a sustained disorder in the
preceding 12 months. In neurotic disorders, 14% of the population
experienced anxiety disorders, comorbidity disorders were the next
common mental disorder with vulnerability to substance abuse and
relapses. There were distinct gender differences in disposition to
mental health illness. Women were found to have high rate of mental
health disorders and Men had higher propensity of risk for substance
abuse. The SMHWB survey showed low socioeconomic status and high
dysfunctional pattern in the family was proportional to greater risk for
mental health disorders. A 2010 survey regarding adults with psychosis
revealed 5 persons per 1000 in the population seeks professional mental
health services for psychotic disorders and the most common psychotic disorder was schizophrenia.
Canada
According to statistics released by the Centre of Addiction and Mental Health one in five people in Ontario experience a mental health or addiction problem. Young people ages 15 to 25 are particularly vulnerable. Major depression is found to affect 8% and anxiety disorder 12% of the population. Women are 1.5 times more likely to suffer from mood and anxiety disorders. WHO points out that there are distinct gender differences in patterns of mental health and illness.
The lack of power and control over their socioeconomic status, gender
based violence; low social position and responsibility for the care of
others render women vulnerable to mental health risks.
Since more women than men seek help regarding a mental health problem,
this has led to not only gender stereotyping but also reinforcing social
stigma. WHO has found that this stereotyping has led doctors to
diagnose depression more often in women than in men even when they
display identical symptoms. Often communication between health care
providers and women is authoritarian leading to either the
under-treatment or over-treatment of these women.
Organizations
Women's College Hospital
is specifically dedicated to women's health in Canada. This hospital is
located in downtown Toronto where there are several locations available
for specific medical conditions. WCH is an organization that helps
educate women on mental illness due to its specialization with women and
mental health. The organization helps women who have symptoms of mental
illnesses such as depression, anxiety, menstruation, pregnancy, childbirth, and menopause. They also focus on psychological issues, abuse, neglect and mental health issues from various medications.
The countless aspect about this organization is that WCH is open
to women of all ages, including pregnant women that experience poor
mental health. WCH not only provides care for good mental health, but
they also have a program called the "Women's Mental Health Program"
where doctors and nurses help treat and educate women regarding mental
health collaboratively, individually, and online by answering questions
from the public.
The second organization is the Centre for Addiction and Mental Health
(CAMH). CAMH is one of Canada's largest and most well-known health and
addiction facilities, and it has received international recognitions
from the Pan American Health Organization and World Health Organization Collaborating Centre.
They practice in doing research in areas of addiction and mental health
in both men and women. In order to help both men and women, CAMH
provides "clinical care, research, education, policy development and
health promotion to help transform the lives of people affected by
mental health and addiction issues."
CAMH is different from Women's College Hospital due to its widely known
rehab centre for women who have minor addiction issues, to severe ones.
This organization provides care for mental health issues by
assessments, interventions, residential programs, treatments, and doctor
and family support.
United States
According to the World Health Organization in 2004, depression is the leading cause of disability in the United States for individuals ages 15 to 44.
Absence from work in the U.S. due to depression is estimated to be in
excess of $31 billion per year. Depression frequently co-occurs with a
variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention). In 2004, suicide was the 11th leading cause of death
in the United States (Centers for Disease Control and Prevention),
third among individuals ages 15–24. Despite the increasingly
availability of effectual depression treatment, the level of unmet need
for treatment remains high.
By way of comparison, a study conducted in Australia during 2006 to
2007 reported that one-third (34.9%) of patients diagnosed with a mental
health disorder had presented to medical health services for treatment.
There are many factors that influence mental health including:
- Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment.
- Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability.
Emotional mental illnesses should be a particular concern in the
United States since the U.S. has the highest annual prevalence rates (26
percent) for mental illnesses among a comparison of 14 developing and
developed countries.
While approximately 80 percent of all people in the United States with a
mental disorder eventually receive some form of treatment, on the
average persons do not access care until nearly a decade following the
development of their illness, and less than one-third of people who seek
help receive minimally adequate care.
The government offers everyone programs and services, but veterans
receive the most help, there is certain eligibility criteria that has to
be met.
Policies
The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the "mental hygiene" movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.
In 1843, Dorothea Dix
submitted a Memorial to the Legislature of Massachusetts, describing
the abusive treatment and horrible conditions received by the mentally
ill patients in jails, cages, and almshouses. She revealed in her
Memorial: "I proceed, gentlemen, briefly to call your attention to the
present state of insane persons confined within this Commonwealth, in
cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods,
and lashed into obedience…."
Many asylums were built in that period, with high fences or walls
separating the patients from other community members and strict rules
regarding the entrance and exit. In those asylums, traditional
treatments were well implemented: drugs were not used as a cure for a
disease, but a way to reset equilibrium in a person's body, along with
other essential elements such as healthy diets, fresh air, middle class
culture, and the visits by their neighboring residents.
In 1866, a recommendation came to the New York State Legislature to
establish a separate asylum for chronic mentally ill patients. Some
hospitals placed the chronic patients into separate wings or wards, or
different buildings.
In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.
One year later, the National Committee for Mental Hygiene (NCMH) was
founded by a small group of reform-minded scholars and scientists –
including Beer himself – which marked the beginning of the "mental
hygiene" movement. The movement emphasized the importance of childhood
prevention. World War I
catalyzed this idea with an additional emphasis on the impact of
maladjustment, which convinced the hygienists that prevention was the
only practical approach to handle mental health issues.
However, prevention was not successful, especially for chronic illness;
the condemnable conditions in the hospitals were even more prevalent,
especially under the pressure of the increasing number of chronically
ill and the influence of the depression.
In 1961, the Joint Commission on Mental Health published a report
called Action for Mental Health, whose goal was for community clinic
care to take on the burden of prevention and early intervention of the
mental illness, therefore to leave space in the hospitals for severe and
chronic patients. The court started to rule in favor of the patients'
will on whether they should be forced to treatment. By 1977, 650
community mental health centers were built to cover 43 percent of the
population and serve 1.9 million individuals a year, and the lengths of
treatment decreased from 6 months to only 23 days.
However, issues still existed. Due to inflation, especially in the
1970s, the community nursing homes received less money to support the
care and treatment provided. Fewer than half of the planned centers were
created, and new methods did not fully replace the old approaches to
carry out its full capacity of treating power.
Besides, the community helping system was not fully established to
support the patients' housing, vocational opportunities, income
supports, and other benefits. Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.
After realizing that simply changing the location of mental
health care from the state hospitals to nursing houses was insufficient
to implement the idea of deinstitutionalization, the National Institute of Mental Health
in 1975 created the Community Support Program (CSP) to provide funds
for communities to set up a comprehensive mental health service and
supports to help the mentally ill patients integrate successfully in the
society. The program stressed the importance of other supports in
addition to medical care, including housing, living expenses,
employment, transportation, and education; and set up new national
priority for people with serious mental disorders. In addition, the
Congress enacted the Mental Health Systems Act of 1980 to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.
Later in the 1980s, under the influence from the Congress and the
Supreme Court, many programs started to help the patients regain their
benefits. A new Medicaid service was also established to serve people
who were diagnosed with a "chronic mental illness." People who were
temporally hospitalized were also provided aid and care and a
pre-release program was created to enable people to apply for
reinstatement prior to discharge.
Not until 1990, around 35 years after the start of the
deinstitutionalization, did the first state hospital begin to close. The
number of hospitals dropped from around 300 by over 40 in the 1990s,
and finally a Report on Mental Health showed the efficacy of mental
health treatment, giving a range of treatments available for patients to
choose.
However, several critics maintain that deinstitutionalization
has, from a mental health point of view, been a thoroughgoing failure.
The seriously mentally ill are either homeless, or in prison; in either
case (especially the latter), they are getting little or no mental
health care. This failure is attributed to a number of reasons over
which there is some degree of contention, although there is general
agreement that community support programs have been ineffective at best,
due to a lack of funding.
The 2011 National Prevention Strategy included mental and
emotional well-being, with recommendations including better parenting
and early intervention programs, which increase the likelihood of
prevention programs being included in future US mental health policies. The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.
In 2013, United States Representative Tim Murphy introduced the Helping Families in Mental Health Crisis Act, HR2646. The bipartisan bill went through substantial revision and was reintroduced in 2015 by Murphy and Congresswoman Eddie Bernice Johnson. In November 2015, it passed the Health Subcommittee by an 18–12 vote.
