Overview of Mental Health and Mental Illness

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What are mental health and mental illness?

In Malawi, if you ask somebody “What is mental illness?”, they are likely to answer “misala”. And if you ask them to describe someone with misala they will say that the person is likely to be talkative, not talking sense, wandering aimlessly, taking off his clothes, and even harming others or property.

The person they are describing is likely to be someone with an acute severe mental illness such as mania or acute psychosis. In this quick reference guide you will learn that:

  1. Most people with “misala” do not harm others, can recover with the correct care and treatment, and can live fulfilling lives in the community.
  1. Mental health problems are more varied than just “misala”. Instead they include all the problems described in this guide, and many more not covered here.

 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organisation)

There can be no health without mental health.

 

People with good mental health have a positive sense of wellbeing, can enjoy relationships with others, and feel spiritually at ease.

Just as the physical body can become ill, so can the mind. A mental illness is any illness that:

  • affects an individual’s thoughts, emotions or behaviour

AND

  • causes a negative effect on the person’s life, including family life, work and physical health.

Sometimes people have experiences that appear similar to mental illness but that are normal emotional reactions (e.g. bereavement), or are culturally understandable (e.g. some strong religious experiences). We must be careful not to mistakenly diagnose this as mental illness.

Mental illness affects an individual’s thoughts, emotions or behaviour and causes a negative effect on the person’s life.

Types of mental illness include:

  • organic mental disorders - injury or disease affecting brain tissues or caused by chemical or hormonal abnormalities in the body
  • substance misuse
  • psychotic disorders
  • mood and anxiety disorders
  • developmental disorders
  • behavioural disorders affecting children.

Mental illness is common. It will affect 1 in 5 people at some point in life.

As health workers we need to take time to look after our own mental health, recognise colleagues who are struggling, and provide support to each other.

The Bio-Psycho-Social Approach

The causes of mental health problems can be biological, psychological, and social. There may also be spiritual and cultural factors. Usually multiple factors interact to cause a person to have a particular mental health problem at a particular time.

  • Biological (physical) factors include alcohol and drugs, diseases directly affecting the brain, malnutrition, and family history of mental illness (genetic influences).
  • Psychological factors are those that arise from the typical way that a person thinks or feels e.g. a tendency to think that the worst things are going to happen, difficulty in trusting others, unhelpful ways of coping with problems.
  • Social factors include early childhood difficulties including abuse, current relationship stresses, and challenging socio-economic conditions such as poverty, unemployment, community violence, and war.

We have to consider all these areas - biological, psychological and social - when looking to understand the causes of mental illness, and in planning its treatment. This is called the bio-psycho-social approach.

The Stress-Vulnerability Model

Some factors can make someone vulnerable to mental illness whilst others act as stressors or triggers for an episode of mental illness.

It is also very important to think about the positive factors in a person’s life that make them less likely to have mental health problems or make it more likely that they will recover from an episode of mental illness. These are called protective factors.

Vulnerability – The factors that make an individual more vulnerable to mental illness include:

Psycho-social

  • any kind of trauma as a child (including bullying, abuse, neglect, physical illness)
  • living in a community that is not their place of origin

Biological

  • family history of mental illness (a “genetic” vulnerability)
  • poor childhood nutrition

Stressors and triggers – some stress can be a positive motivating factor to enable people to achieve their goals, such as studying for an exam.

However, stress can also contribute to mental health problems, particularly if there are many stressors or if the stress goes on for a long time. Stressors and other triggers of mental illness include:

Psycho-social

  • relationship, money, family, school, work or housing problems
  • bereavement or any other type of loss
  • being a victim of crime, assault, abuse or bullying
  • belief that one is under the power of witches

Biological

  • physical illness e.g. HIV/AIDS, malaria
  • use of drugs or alcohol

Coping skills – Different people ‘cope’ with stress in different ways. Helpful coping mechanisms include talking to family or friends about the stressful situation. Unhelpful coping mechanisms can perpetuate mental illness. Drinking alcohol, taking illicit drugs and social isolation are all unhelpful coping mechanisms.

Support and security - Being able to confide in others, feeling safe in your home, having financial security, fulfilling a meaningful role within the family or community are all protective factors that can prevent the onset of mental illness and promote recovery from an episode of mental illness.

The Stress-vulnerability Model explains how vulnerability, stressors, coping and support interact to lead to mental health problems:

Vulnerability + stressors (+/- coping +/- support) = risk of mental health problem