Mental Health Awareness and Understanding

Mental Health Awareness – How much do we know and accept for real?

Awareness and seeking of treatment for physical illnesses like diabetes, blood pressure, arthritis, asthma, etc. is high in the population. However, the same unfortunately cannot be said about mental health awareness and illnesses (like depression, anxiety, and other stress-related or mood disorders). Such conditions are not only an ignored health aspect but also associated with myths and stigmas.

1 in 4 people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, making mental disorders a leading cause of ill-health and disability worldwide. In India, 10-14% suffer from mental health problems, with more than 50 million people suffering from depression and anxiety disorders.

The myths and stigmas

Health surveys have revealed that 50-60% of people have inadequate mental health awareness, and have fixed, adverse opinions of people diagnosed with mental illnesses. People have reservations about mixing with them in society and working with them. Most people don’t accept that mental illnesses are real problems like physical illnesses and dismiss them off as mere attitudinal or behavioral problems of ‘difficult’ people.

Often, mental health problems get clubbed as a single entity in a person’s mind, but there are many defined types of mental illnesses, treated differently, and specifically. Sensitivity and understanding of mental illnesses can help in prevention as well as early diagnosis and treatment, which can greatly enhance productivity, individual performance, and the happiness of a family.

TYPES OF MENTAL ILLNESSES

The table below gives a quick anytime reference for mental health conditions.

Vulnerability and Patterns

The 40-60 years age group shows a high vulnerability to mental health disorders, though anxiety-depression may be seen even in younger age groups. Schizophrenia affects both genders equally, however, bipolar disorders affect men more while depression and stress-related disorders affect females more.

Psychosis implies the loss of touch with reality, along with delusions, hallucinations affecting personality, behavior, thinking, and perceptions. It is referred to as schizophrenia or schizophreniform disorder depending on the symptoms lasting more, or less than 6 months respectively.  Sometimes a sudden, and short episode of psychosis that lasts less than a month, can be brought on by intense stress and so is called brief psychotic disorder. Delusional disorders (previously called paranoid disorders) are diagnosed when fixed false beliefs like irrational suspicions of deceptions or conspiracy, grandiosity of self, thinking one is diseased, etc. last more than a month, without other symptoms of schizophrenia. Dissociative disorders make the person block out certain events/identities, have unreal or detached perceptions and rarely acquire alternate personalities, all as coping mechanisms.

Stress-related (neurosis) and mood disorders like anxiety-depression and others are more commonly seen in the population, and sometimes not given enough attention, diagnosis, and treatment. This is because many of the symptoms appear like ‘coping difficulties’ or ‘being hypersensitive, over-reacting or a difficult to deal type of person’ to family members and colleagues. In such conditions, the patient does not have delusions or lose touch with reality. He/she is often aware of the problem and often may not want to share or disclose such issues for fear of social and professional consequences. Some of them seek private therapy, some refuse to accept due to lack of awareness and support, while a few may even be open about it.

Substance abuse (uncontrollable intake of intoxicating substances: alcohol, tobacco, and other narcotic drugs) are a recognized category of mental disorders, more common in men, with an alarming 25% population prevalence. Substance abuse is also associated with mental illnesses like psychosis, mood and anxiety disorders.

Eating disorders like anorexia nervosa (restricts eating severely due to fear of weight gain), bullimia nervosa (overeats then tries to undo it by vomiting/purging), pica (eating normally non-food items), and less severe forms like binge eating or food restriction/avoidance, are recognized mental health conditions. They are often associated with anxiety-depression and substance abuse.

Personality types and disorders with or without the above mental illnesses as shown in the table below are also identified by Psychiatrists or Psychologists.  Every human being shows aspects of many of these personality types based on circumstance and situation.  However, in some people, one of these particular types of human behavior or response is exaggerated and dominantly present in the majority of the situations, as compared to normally seen in people. Understanding personality and behavioral types is also an important aspect of mental health awareness.

MANIFESTATIONS AND SIGNS

Mental illnesses can manifest in multiple ways like aggression, violence, recklessness, inappropriate behavior, change in sleep and eating patterns, anxiety, depression or moodiness, decreased focus and work productivity, social withdrawal, and relationship problems.

Just as someone can have many physical disorders together like diabetes, high BP, or high cholesterol, the same can happen with mental disorders. So sometimes anxiety-depression can co-exist or the patient may present manic and depressive states together in bipolar disorder.  Some may become substance abusers because of depression, may present a mood disorder with psychotic symptoms (schizoaffective disorder), or become obsessive-compulsive due to an underlying anxiety disorder. The COVID pandemic has also adversely impacted mental health due to the suffering induced by the disease itself (post-COVID stress disorder, similar to PTSD), and the loss of normal socio-cultural and economic aspects of life.

WHAT CAUSES MENTAL HEALTH DISORDERS?

The cause of mental disorders is the imbalance of certain chemicals in the brain and nerves (neurochemicals or neurotransmitters). 

Some chemicals have a calming effect, while some have an exciting effect, so an imbalance towards the excitatory chemical can lead to anxiety. There are chemicals that control mood and prevent depression, and a fall in these can lead to a depressed state, while a rise can lead to a manic state.

These neurochemicals include serotonin and noradrenaline (decreased in depression), GABA (decreased in anxiety), glutamate (increased in anxiety), and dopamine (decreased in Parkinson’s, increased in schizophrenia). Medicines given in various mental health conditions act by modifying levels of these neurochemicals.

HEALTH SOLUTIONS 

Mental health conditions require a holistic and multidimensional approach-

• Counseling
• Cognitive and behavioral therapy
• Medical therapy
• Nutritious diet
• Lifestyle modification – Sleep and physical activity
• Stress management
• Support groups, helplines and community awareness programs.

Counseling: It is usually a short-term therapy over a few weeks to months, for understanding and targeting particular symptoms or current situations affecting the person, and offering suggestions and advice on how to deal with it. It involves listening, conversations and discussions, followed by guidance.

Psychotherapy: It refers usually to a longer treatment that focuses on gaining insight into the person’s chronic physical and emotional problems, one’s thought process and responses, and how these are influenced by past events. It involves cognitive and behavioral therapies (CBT). While cognitive therapy focuses on change in thought processes and beliefs, behavioral therapy focuses on change in behavior and responses to the external environment.

Medical therapy and appropriate drugs are now available which treat most mental disorders. Usually, medicines are given along with or after a trial of counseling and psychotherapy which involve listening, understanding, discussing, and advising suitable lifestyle, and response modifications to the patient. Many mental illnesses in their initial or milder stages and personality disorders can be managed effectively by counseling, support programs, and lifestyle modification alone.

Associated physical illnesses with underlying mental illness which when not addressed, gives the patient incomplete relief from his physical symptoms. This is often seen with chronic pains and digestive complaints. On the other hand, the presence of an untreated chronic physical problem can also cause mental health conditions like anxiety and depression.

Poor diet has been linked to poor mental health regardless of gender, age, education, marital status, and income level. Increased consumption of sugar and high amounts of processed grains and fats in the diet has been linked with depression, bipolar disorders, and overall poor mental health. The vitamins in the diet which have been linked to optimal mental health are vitamin D, vitamin C, folic acid, and vitamin B12. While among the minerals, iron, zinc, and magnesium have shown benefits to mental health. It is also important to test for levels of iron, vitamin D, and B12 if suffering from low moods, fatigue, and stress. The important aspects of a healthy diet are:

• Rich in vegetables, fruits, nuts, yogurt, whole grains, and legumes
• Low in processed/packaged foods
• Include omega 3 fatty acid foods like fish, or flaxseed, and walnuts
• Adequate water intake of at least 8-10 glasses of water (2 to 2.5 liters/day)
• Timely meals, and not skipping meals

Lack of adequate sleep and deterioration in mental health often have a mutual relationship forming a vicious cycle. Therefore improving duration and quality of sleep is an important component of managing mental health conditions. Regular physical exercise has a mood-elevating role and is protective against mental health disorders.

Stress management programs are regularly conducted in institutions to maintain mental health. Relaxation techniques like stretches, breathing exercises, yoga, and sports are known to improve mental health. Indulging in hobbies like music, dance, reading, gardening, and crafts are also helpful for mental health.

Reaching out to support groups and helplines is recommended and can save situations and even lives.

Learn, understand, accept, then help ones in need……

Most people with mental health illness have normal intelligence and are as capable, competent, and talented as any other person. There should be no undue fear, reservation, or hesitation in mixing, interacting, and working with anyone undergoing or in need of treatment for any mental illness.

In fact, with mental health awareness of the types and presentations of mental illnesses, one can help oneself or a known-one to seek help for diagnosis and treatment. This can greatly help in regaining health as well as productivity and normalcy in life, just as would happen after treating a physical illness.

Also read:

Depression and Anxiety – Causes, Signs and Holistic Treatment

10-point approach to stress management

Not getting enough sleep can be detrimental to health: Tackling Insomnia

5 Dietary tips to reduce Stress and improve Mental Health

For any query, additional information or to discuss any case, write to info@drvarsha.com, and be assured of a response soon.

References:

NMHS report: Mental Health 2015

WHO Mental disorders 2017

SUICIDE HELPLINES-INDIA

TLLLF 2018 NATIONAL SURVEY REPORT: Mental Health Perception

National Institute of Mental Health (NIMH)

Diet and Mental Health: Mental Health Foundation