Mental Health. Part 2: Understanding Mental Health Disorders

Mental disorders are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behavior, and relationships with others [1]. Mental disorders include depression, bipolar disorder, schizophrenia, and other psychoses, dementia, and developmental disorders including autism [1]. Unfortunately, the prevalence of common mental disorders such as depression and anxiety is estimated to more than double in a humanitarian crisis. A study by WHO revealed the review of 129 studies in 39 countries showing that among people who have experienced war or other conflicts in the previous 10 years, one in five people (22%) will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia [3].

Now let's look at some mental health disorders and try to understand them.

Depression: Depression is a common mental disorder and is one of the main causes of disability worldwide [1]. An estimated 264 million people are affected by depression globally and is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration [1]. It can be long-lasting or recurrent, substantially impairing the individual's ability to function at work or school and to cope with daily life. Depression can lead to suicide at its most severe stage. There are also effective treatments; "Mild to moderate depression can be effectively treated with talking therapies, such as cognitive behavior therapy or psychotherapy. Antidepressants can be an effective form of treatment for moderate to severe depression but are not the first line of treatment for cases of mild depression [1]. Management of depression should include psychosocial aspects, including identifying stress factors, such as financial problems, difficulties at work or physical or mental abuse, and sources of support, such as family members and friends".

Bipolar disorder: this disorder affects about 45 million people worldwide [1]. It usually consists of both manic and depressive episodes separated by periods of normal mood [1]. Manic episodes involve elevated or irritable mood, over-activity, rapid speech, inflated self-esteem, and a decreased need for sleep, while bipolar disorders are classified as people who have manic attacks but do not experience depressive episodes [1].

Schizophrenia and other psychoses: Schizophrenia is a severe mental disorder, affecting 20 million people worldwide [1]. Psychoses are characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior [1]. Common psychotic experiences include hallucinations (hearing, seeing, or feeling things that are not there) and delusions (fixed false beliefs or suspicions that are firmly held even when there is evidence to the contrary) [1]. Factors such as stigma and discrimination can result in a lack of access to health and social services. "Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life and be integrated into society" [1].

Dementia: approximately 50 million people have dementia, worldwide [1]. Dementia is usually of a chronic or progressive nature in which there is deterioration in cognitive function i.e. the ability to process thought beyond what might be expected from normal aging. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment [1]. The impairment in cognitive function is commonly accompanied and occasionally preceded, by deterioration in emotional control, social behavior, or motivation. Although there is no treatment currently available to cure dementia or to alter its progressive course, many treatments are in various stages of clinical trials [1].

Developmental Disorders: Developmental disorder is an umbrella term covering intellectual disability and pervasive developmental disorders including autism. Symptoms of pervasive developmental disorders, such as autism, include impaired social behavior, communication and language, and a narrow range of interests and activities that are both unique to the individual and are carried out repetitively [1]. "Family involvement in the care of people with developmental disorders is very important. Knowing what causes affected people both distress and well-being is an important element of care, as is finding out what environments are most conducive to better learning [1]. Structure to daily routines helps prevent unnecessary stress, with regular times for eating, playing, learning, being with others, and sleeping. Regular follow-up by health services of both children and adults with developmental disorders and their careers need to be in place".

The community at large has a role to play in respecting the rights and needs of people with disabilities.

Panic attacks and obsessive-compulsive disorders: panic attacks are usually a sign of anxiety i.e. someone having a panic attack experiences a sudden and intense sensation of fear [2]. They may breathe rapidly, sweat, feel very hot or cold, feel sick, or feel nauseous [2]. While obsessive-compulsive disorder (OCD) is a common form of anxiety involving distressing repetitive thoughts. Compulsions are the actions that people feel they must repeat to feel less anxious or stop their obsessive thoughts [2].

Moreover, WHO-endorsed interagency mental health and psychosocial support guidelines for an effective response to emergencies recommend services at a number of levels – from basic services to clinical care. These include:

1. Community self-help and social support should be strengthened,

2. Psychological first aid

3. Basic clinical mental health care

4. Psychological intervention

5. Protecting and promoting the rights

6. Links and referral mechanisms

Clinical care for mental health should be provided by or under the supervision of mental health specialists such as psychiatric nurses, psychologists or psychiatrists.

Furthermore, it is vital to know how to respond to crises that may arise involving an individual suffering from mental health disorders. These crises may include breaking down in tears, having a panic attack, feeling suicidal, or experiencing their own or a different reality and in such situations, it is important to stay calm [2].

Gently remind the person who you are and why you are there. Do not reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

Let the person know you are there for them and available to listen. Acknowledge what they are feeling and ask them what you can do to help. You can start off by explaining why you’re concerned and offer examples. In addition, you could offer support by; starting slowly, try small actions first, such as going for a walk or visiting a friend, encouraging them to get enough sleep, eat healthy food, and exercise. Discouraging them from self-medicating with alcohol or drugs, inviting them out, and encouraging them to seek help immediately if they are at risk of suicide or self-harm [4]. People with mental health problems deserve to be treated with the same dignity and respect as everybody else. Sometimes they may need a little extra support and the simple act of listening can mean a lot for them.

Well-being is about being emotionally healthy, feeling able to cope with normal stresses, and living a fulfilled life. Well-being is also affected by whether or not we feel in control of our life, and feel involved with people and communities; also by feelings of anxiety and isolation. We are all affected by these things but for those of us who are lucky enough not to be living in desperate poverty, we can have an over-riding sense of wellness [5]. Moreover, major mental illnesses such as schizophrenia or bipolar disorder rarely appear “out of the blue.” Most often family, friends, teachers, or individuals themselves begin to recognize small changes or a feeling that “something is not quite right” about their thinking, feelings or behavior before an illness appears in its full-blown form. Learning about developing symptoms, or early warning signs, and taking action can help to delay or prevent a major mental illness from occurring.

1. WHO. Mental disorders. 2019. Available at : https://www.who.int/news-room/fact-sheets/detail/mental-disorders

2. Mental Health Foundation. How to support someone with a mental health problem. Available at: https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem. ND

3. WHO. Mental health in emergencies. 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-in-emergencies

4. Health Direct. Supporting someone with a mental health issue. Available at: https://www.healthdirect.gov.au/supporting-someone-mental-health

5. Ministry of health and medical services. Mental Health Wellness. 2018.