Mental health

Dr. Dalia El-ShafeiLecturer, Community Medicine Department,

Zagazig Universityhttp://www.slideshare.net/daliaelshafei

Mental Health:

• State of well-being in which the individual:• Realizes his own abilities, • Cope with normal stresses of life, • Can work productively • Able to make a contribution to community.

Mental Illness:

• Any disease or conditions that affect way a person• Thinks,• Feels,• Behaves• Ability to relate to others & to surroundings

1) Emotional balance.

2) Social adjustment.

3) Perceiving things the way they are.

4) Achievements consistent with individual's abilities & opportunities.

Criteria of Mentally Healthy

1. WHO suggests that half the world's populations are affected by mental illness with an impact on:

their self-esteem, relationships and

ability to function in everyday life.

2. Good mental health can improve one’s life, poor mental health can prevent someone from living a

normal life.

Importance of Mental Health:

1. Genetic predisposition: vulnerability to most major psychiatric disorders

2. Age: High prevalence in old ages e.g. Alzheimer's disease

3. Sex: Anxiety & depression are more common

among women, substance abuse is more common

among men.

Risk Factors of Mental Disorders:

4. Infections: Parasites such as malaria & encephalitis →epilepsy - meningitis.

5. Toxic substances: alcohol and opiates.

6. Environmental exposure: lead in children → MR or ↓ intelligence.

7. Homeless people: schizophrenia or substance abuse.

8. Malnutrition: deficiency in vit. B & protein deficiency in Kwashiorkor

9. Living in high floors housing, loneliness.

↓ iodine during pregnancy & oxygen at birth, injuries & early childhood brain infections →MR. Nutritional deficiencies such as PEM →MR. Depression interacts with cardiovascular illnesses &vice

versa. Anxiety, depression & substance abuse can also

complicate existing physical disorders.

Interaction between Physical & Mental Health Problems:

Physical causes Mental disease Mental diseases Physical illness

Impaired intelligence Behavioral disorders as maladjustment & absenteeism. Psychosis & depression SchizophreniaPsychopathic disorders: aggressive antisocial acts

Types of Mental Disorders:

Mental illness & poor mental health are public problems Great impact on:

The Impact of Mental Disorders:

Individuals

Family

Community

Individuals

• Distressing symptoms. • Unable to participate in work & leisure. • Quality of life continues to be poor: stigma & discrimination.

Family

• Economic burden• Disruption of house hold routine & restricted social activities. • Lost opportunities prevent them from achieving their full

potential in work & social relations.

Community

• Cost of providing care. • Loss of productivity. • Legal problems including violence.

2ry3ry1ry

Prevention of Mental Illness

1. Mental health promotion: improving ability of people to deal more effectively with everyday life stresses.

Mental health education to improve mental abilities through Mind's education with special programs directed to vulnerable groups; children, adolescents, youth & elderly.

A- Primary Prevention 1ry

2. Genetic counseling, antenatal care: normal fetal development, no exposure to X ray & no self intake of drugs.

Natal care to prevent birth trauma can reduce occurrence of mental disorders (Down syndrome).

3. Education, employment, social well-being, availability of food, housing

Important role in preventing mental disorders & promoting

mental health.

4.Raising public awareness about mental health disorders.

Patients need ttt & kind care rather than punishment.

5. Awareness of psychological development: development of human being's cognitive, emotional, intellectual, & social capabilities is functioning over course of life span from infancy through old age.

6. Life skills education: Interpersonal communication skills, Cooperation & teamwork. Decision-making Critical thinking skills. Skills for managing feelings. Skills for managing stress.

1- Detection of mental disorders/illness in PHC: Screening: for early detection of developmental delay at nursery,

school, university, military and work. Early diagnosis: progression from asymptomatic to symptomatic

mental health disorder is subtle. Mental disorder may exist for longer periods till recognized. Early

diagnosis needs capacity building of lay person, other professionals & general practitioners.

B- Secondary prevention 2ry

It refers to intervention undertaken to reduce complications & all specific treatment-related strategies.

2- Proper management and/or referral to psychiatrist:

Complete psychiatric assessment.

Detailed personal history &diagnosis.

Counseling, psychotherapy & medical ttt.

Admission to psychiatric word/hospital.

Recovery

3- Crisis intervention: In wars, disasters crisis situation

Mental health problems increase

Need immediate intervention

Social support ↓

Course of disease

Duration intensity

2ry

It can be achieved by: 1. Increasing society understanding of causes of disabilities &

abilities of needy/disabled group. 2. Attempting to reverse peoples & children negative attitudes.3. Improving health-workers approach toward needy/disabled

groups. 4. Improving self-esteem & confidence of needy/disabled groups.

C- Tertiary Prevention: 3ry

Interventions that reduce disability & all forms of rehabilitation as well as prevention of relapses of illness. The integration of needy

groups in the society is needed.

5. Showing needy/disabled groups can take care of others, not just themselves.

6. Increasing opportunities for physical & socio-economic integration of needy/disabled groups in daily activities.

7. Presenting abilities of needy/disabled groups through public information campaigns to reduce stigmatization of mental problems.

8. Training health workers about the needs of special groups.

9. Providing facilities/ services-day care centers & counseling sites to families of needy/disabled.

10. Orientation of children about disabilities in schools, helping regular schools integrates disabled children & promotes inclusive education.

11. Communicate to parents about disabilities of their disabled children.

12. Improve physical accessibility to public places, like mosques, governmental offices and schools.

13. Create incentives for employers to hire disabled people

In Egypt the national mental health program focuses on: 1. Decentralization of mental health care & community care in

different governorates. 2. Inclusion of mental health in PHC. 3. Training of family doctors to deal with main mental disorders. 4. Awareness-raising among public regarding recognition of mental

disorders & methods of referral. The new policy of deinstitutionalization & provision of community

care may reduce number of psychiatric inpatients but will not solve problem.

After-care services in Egypt are still limited because of poor understanding of most people is in need for follow up care after initial improvement.

Mental Health Program in Egypt:

SUBSTANCE ABUSE

Substance abuse = Drug abuse: any use of non prescribed, non controlled substances or drugs without medical reason.

Drug Misuse: prescription medications with clinical efficacy but abuse potential & known adverse effects linked to improper use as:

psychiatric medications with sedative, anxiolytic, analgesic, or stimulant properties.

Drug Dependence: state of psychic or physical dependence on a drug occurring after periodic or continuous administration of that drug.

Definitions

*Addicted Person: person who is unable to free himself from a harmful habit or he is unable to stop that habit.

*Psycho Active Drugs: exogenous substances that affect CNS for

calming, energizing or pleasurable. Excessive use of these drugs leads to tolerance.

*Tolerance: need for increasing dose of a drug to reach original effect of it.

Drug users in Egypt range from 1-6 million people, with most drug users being in the 15-25 age groups.

Accurate statistics are difficult to obtain nature of drug abuse & the stigma associated with being an addict.

Magnitude of the problem in Egypt

Narcotics: Morphine, Heroin & Codeine

Depressant: Alcohol &

Barbiturates

Stimulants: Amphetamine & Cocaine.

Hallucinogens: (LSD)

Cannabis:

Hashish & Marijuana

Psycho active Drugs

1- Drug pharmacological effects, its ability to form psychic dependence & tolerance.

2- Availability & easy accessibility of drugs. 3- Immature aggressive persons & sociopathic personality. 4- Psychic & neurological illness. 5- Parents or friends are addicts. 6- Rapid socioeconomic changes & deterioration of family & social

life. 7- Work problems. 8- Youth & adolescents use drugs to escape from a problem, to have

new experience & to express independence.

Etiology of drug addiction

1-Adverse physical, mental, social & economic consequences.

2- Alters neuromuscular coordination, reaction time & judgment &↑ accidents.

3- ↑ Money expenditure for ttt of abusers. 4- ↑ Morbidity, withdrawal symptoms & premature death

due to over dose intake. 5- ↑ Absenteeism from work. 6- ↓ Quality & Quantity of work products. 7- ↑ Crime & violence.

Impacts of drug abuse

2ry3ry1ry

Prevention of drug dependence

Eliminate illegal drug use.

Empower laws & legislations that prevent cultivation, importation & selling these drugs.

Health education for adolescents, students & workers for hazards of drug abuse & their sequences.

Encourage youth for physical exercise & safe recreation activities.

Control family & social problems.

Parental supervision & control influence of bad peers.

Primary prevention

Early diagnosis of cases & continuous supervision.

Hospitalization of severe cases.

Hot line service for rapid management & confidential service.

Follow up of recovered cases.

Secondary prevention

Rehabilitation of addicts, find suitable jobs & no community stigma

Tertiary prevention

It is unexpected, unplanned event that produces injury, death, property loss or damage.

Increasing problem in developed & developing countries.

Types of accidents:1- Road accidents 2- Home accidents3- Occupational accident 4- Natural disaster 5- Birth injuries 6- Sport injuries

7- War

ACCIDENTS

Causing laceration, contusions, bleeding, paralysis, fractures, amputation, death etc.

1) Traffic accidents:

Road defects (Enviroment): Narrow , Crowded,

Inadequate lightening, Lack of traffic signs.

Pedestrian (Host): Extreme of age,

Impaired alertness, Negligence of traffic signals

Obesity.

Driver (Host): Impaired alertness due to fatigue,

Drug abuse, Worry,

Inadequate training, Psychic upset.

Vehicle defects (Agent): Old models,

Bad maintenance, Variability in size.

Risk factors

Road: Town planning,

Clean & wide roads, Good lightening & traffic

signals.

Vehicle: Period inspection repair of vehicles.

Rules for maximal speed.

Driver: Health appraisal before license,

Training, Use of seat belt,

Health education of pedestrians.

Prevention

Animal bitesBurns: matches, boiling fluids, fire

Chemical poisoning: drugsCollapse of old building.

Electric shock: neglected maintenance, exposed wire.

Fall on stairs, striking against furniture, slippery floor

Wounds by sharp knives, pointed articles.

2-Home accidents

Extreme of age.

Epilepsy, fainting, loss of consciousness

Over confidence in repairing electric appliance.

Bad illumination,

Slippery floor or stairs, derangement of furniture,

Presence of drugs at reach of children.

Risk factors of home accidents

- Storage of medications & toxic substance (caustic soda, pesticides) in high places, closed, & away from children hands.

- Close windows, balcony guard.

- Matches, sharp knives should be put in hidden place.

- Children should not stay with mothers in kitchens during cooking.

- Use special adhesives to cover electric opening in wall.

- 1st aid must be present in every house to help in emergency.

Prevention of home accidents

Definition: accidents occurring during work.

Examples: Falls, fractures, amputation, electric shock, burning, explosion, & chemical toxicity.

3) Occupational accidents

Personal causes • Age: Extreme of age.•Poor physical health “fever, epilepsy, hypoglycemia, defective hearing or vision, low intelligence”• Psychological upset, stress, fears.• Negligence of wearing PPE• not follow instructions of

machines.

Environmental causes• Bad environmental sanitation:

bad ventilation, bad illumination, low or high temp., noise, crowded places.

• Unsafe machines: exposed electricity, bad maintenance, lack of safety measures.

Risk factors:

Impact of accidents on workers & industry:

Impaired health, disability and handicapping.

Increased expenses on medical care, rehabilitation & compensation.

2ry3ry1ry

Prevention of accidents

Primary prevention of accidents:

Sanitary environment.

Good machinery design, safety & good maintenance.

Health education of workers, good training before work,

Prevention of fatigue, solving psychological troubles.

ttt of any illness, good nutrition.

Prevention of accidents in work:

2ry prevention

• 1st aid & emergency services for proper management of injuries at all work places

3ry prevention

• Placement in another job, training • Artificial limb in amputation, special aids

for handicapped persons.