2. WHAT IS MENTAL HEALTH?
Mental health refers to an individual's emotional and
psychological well-being. "A state of emotional and psychological
well-being in which an individual is able to use his or her
cognitive and emotional capabilities, function in society, and
meet the ordinary demands of everyday life.“
It is the successful performance of mental function, resulting in
productive activities, fulfilling relationships with other people, and
the ability to adapt to change and to cope with adversity.
A mental health problem is a disruption in the interactions
between the individual, the group and the environment producing
a diminished state of mental health.
The branch of medicine that is concerned with study of mental
disorders is called psychiatry.
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3. GLOBAL BURDEN O MENTAL HEALTH PROBLEM:
About 450 million people suffer from mental and
behavioral disorders worldwide. One person in
4 will develop one or more of these disorders during
their lifetime.
Neuropsychiatric conditions account for 13% of the
total Disability Adjusted Life Years (DALY) lost due to all
diseases and injuries in the world. unipolar depression
alone accounting for 5.7% of DALY.
Estimated to increase to 15% by the year 2020.
•Five of the ten leading causes of disability and
premature death worldwide [WHO’s World Health Report
2001].
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4. SOUTH ASIAN REGION
The south Asian region accounts for 1/15 th of psychiatrically ill patients in
the world.
the total number of mentally ill people in the region turns out to be 150-
200 million.
IN NEPAL
About 10% of Nepalese people suffers from one or more mental illnesses
and an estimated 1-3 % of the population suffers from chronic, severe
mental illness (WHO, 2001).
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5. CAUSES OF MENTAL ILLNESS:
The exact cause of most mental illnesses is not known, it is
becoming clear through research that many of these
conditions are caused by a combination of biological,
psychological, and environmental factors.
Biological Factors : Some mental illnesses have been
linked to an abnormal balance of special chemicals in the
brain called neurotransmitters. Neurotransmitters help nerve
cells in the brain communicate with each other. If these
chemicals are out of balance or are not working properly,
messages may not make it through the brain correctly,
leading to symptoms of mental illness. In addition, defects in
or injury to certain areas of the brain have also been linked
to some mental conditions.
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6. CAUSES:
Genetics (heredity): Many mental illnesses run in families,
suggesting that people who have a family member with a mental
illness are more likely to develop a mental illness. Susceptibility is
passed on in families through genes.
Infections: Certain infections have been linked to brain damage
and the development of mental illness or the worsening of its
symptoms.
Brain defects or injury: Defects in or injury to certain areas of
the brain have also been linked to some mental illnesses.
Prenatal damage: Some evidence suggests that a disruption of
early fetal brain development or trauma that occurs at the time of
birth -- for example, loss of oxygen to the brain -- may be a factor
in the development of certain conditions,
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7. CAUSES:
Substance abuse: Long-term substance abuse, in
particular, has been linked to anxiety, depression.
Other factors: Poor nutrition and exposure to toxins,
such as lead, may play a role in the development of
mental illnesses.
Psychological factors: that may contribute to
mental illness include:
Severe psychological trauma suffered as a child, such
as emotional, physical, or sexual abuse
An important early loss, such as the loss of a parent
Neglect
Poor ability to relate to others.
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8. ENVIRONMENTAL FACTORS:
Certain stressors can trigger an illness in a person who
is susceptible to mental illness. These stressors
include:
Death or divorce
A dysfunctional family life
Living in poverty
Feelings of inadequacy, low self-esteem, anxiety,
anger, or loneliness
Changing jobs or schools
Social or cultural expectations (For example, a society
that associates beauty with thinness can be a factor in
the development of eating disorders.)
Substance abuse by the person or the person's parents
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9. CLASSIFICATION:
There are many classification of mental illness given by different
organizations. International classification of psychiatric
disorder ICP-10 [1992] classify the mental health problems in
following categories:
organic disorders
Mental and behavioral disorders due to psychoactive substances
Schizophrenia and delusional disorder
Mood affecting disorder
Neurotic, stress related and somatoform disorder
Behavioral syndrome
Disorder of adult personality and behavior
Mental retardation.
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10. EXISTING MENTAL HEALTH FACILITIES IN NEPAL :
50 bedded mental hospital in the capital city.
12 beds in psychiatric department of teaching institutes in
Kathmandu
14 beds available in National Army Hospital, Kathmandu.
50 beds available in 3 different private hospitals for acute
and chronic mentally ill patients in Kathmandu.
30 bedded Treatment and Rehabilitation Centre in
Kathmandu
15 bedded community mental health centre in Kathmandu.
10 of 75 districts have psychiatric treatment facilities.
The Government spends about 1% of the health budget on
mental health.
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11. point should be consider in prevention :
Effective prevention can reduce the risk of
mental disorders.
Implementation should be guided by
available evidence.
Successful programmed and policies should
be made widely available.
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12. RISK FACTORS IDENTIFICATION IN PREVENTION
Academic failure and scholastic
demoralization
Attention deficits
Caring for chronically ill or
dementia patients
Child abuse and neglect
Chronic insomnia
Chronic pain
Communication deviance
Early pregnancies
Elder abuse
Family conflict or family
disorganization
Loneliness
Low birth weight
Low social class
Medical illness
Neurochemical imbalance
Parental mental illness
Parental substance abuse
Perinatal complications
Personal loss – bereavement
Poor work skills and habits
Reading disabilities
Sensory disabilities or organic
handicaps
Social incompetence
Stressful life events
Substance use during
pregnancy
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13. PREVENTION:
Universal prevention is defined as those interventions that
are targeted at the general public or to a whole population
group that has not been identified on the basis of increased
risk.
Selective prevention targets individuals or subgroups of
the population whose risk of developing a mental disorder is
significantly higher than average, as evidenced by
biological, psychological or social risk factors.
Indicated prevention targets high-risk people who are
identified as having minimal but detectable signs or
symptoms foreshadowing mental disorder or biological
markers indicating predisposition for mental disorder but
who do not meet diagnostic criteria for disorder at that time.
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14. OTHER INTERVENTIONS:
Improving nutrition.
Improving housing.
Improving access to education.
Reducing economic insecurity.
Strengthening community networks.
Reducing the harm from addictive substances.
Promoting a healthy start in life Pre-school educational
and parenting interventions.
Reducing child abuse and neglect.
Early screening and intervention in primary care.
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