Download Mental Health In Australia

WELCOME TO
CERTIFICATE IV MENTAL HEALTH
ONLINE
Week 6
Nerina Rush and Gricel Mendez
WHAT IS A MENTAL DISORDER?
DEFINITION
A mental disorder is a diagnosable illness
which causes major changes in a person’s
thinking, emotional state and behaviour,
and disrupts the person’s ability to study or
work and carry on their usual personal
relationships.
YMHFA Manual p11
72
4 DETERMINANTS
Deviance
Distress
Dysfunction
Danger
MENTAL HEALTH IN AUSTRALIA
Mental illness is extremely prevalent within
Australian society.
 1 in 5 Australians aged 18 years or over met
a criteria for a mental disorder at some
time during 12 month period
 Alarmingly, only 38% of those surveyed with a
mental disorder had accessed health services.
 This suggests a large unmet need for mental
health services.


The National Survey of Mental Health and Well Being (1997)
PERCENTAGE OF AUSTRALIANS AGED 16-85 WITH
A SUBSTANCE USE DISORDER IN LAST 12 MTHS*
Type of Disorder
Males
%
Females
%
Persons
%
Alcohol Use Disorders
6.0%
2.8%
4.3%
Drug Use Disorders
2.1%
0.8%
1.4%
Any Substance Use
Disorder
7.0%
3.3%
5.1%
* Source: National Survey Mental Health Wellbeing (NSMHWB), 2007
N.B. MHFA Manual p.44 shows results from the NSMHWB, 1997
PERCENTAGE OF AUSTRALIANS AGED 16-85 WITH
A MENTAL DISORDER IN LAST 12 MONTHS*
Type of Common Mental
Disorder
Female
%
Persons
%
10.8
17.9
14.4
Affective Disorder
5.3
7.1
6.2
Substance Use Disorder
7.0
3.3
5.1
22.3
20.0
Anxiety Disorder
Any Common Mental
Disorder
Male
%
17.6
* Source: National Survey Mental Health Wellbeing (NSMHWB), 2007
Another 1% of the Australian population will have the low prevalence mental
disorder of Psychosis in one year.
N.B. MHFA Manual p.5 shows results from the NSMHWB, 1997
MENTAL HEALTH IN CHILDREN
 Children
and adolescents > 18 years make
up 25% of the Australian population.

In any 6 month period 15-20% of this
group may have had a mental health
problem.
 The
most common disorders are major
depression, and related disorders
including anxiety.
REASONS FOR NOT GETTING HELP
•
I prefer to manage the problem myself.
38%
•
I don’t believe anything could help.
18%
•
I don’t know where to get help.
•
I am worried about what others will think.
17%
14%
118
PREVALENCE OF MENTAL DISORDERS
46% of females and 25% of males with a
substance use disorder also experience a mental
illness.
 People with a dual diagnosis are recognised as
having poorer health outcomes including
increased experience of psychosis, poorer
treatment compliance, housing instability and
homelessness, medical problems, poor
management skills, greater use of crisis
orientated services, greater risk of suicide and
attempts, increased hospitalisation, are difficult
to engage, and have a poorer prognosis.

MENTAL HEALTH AND YOUTH
Suicide rates have increased, particularly among
young males who are committing suicide at a rate
of 71% higher than 20 years ago.
 Male youth suicide in Australia is ranked fifth in
the world following Finland, New Zealand,
Switzerland and Austria.

DEVELOPMENTS IN MENTAL HEALTH


Australian mental health service has undergone
significant reforms over the last 10 years.
Due to the HREOC activity of the early 1990’s
and the strong level of community dissatisfaction
and community concern of how mental health
services were being delivered.
THE BURDEKIN REPORT



The Burdekin inquiry and subsequent report (a
landmark document) of 1993
The biggest single impact activity in the history
of the Australian mental health sector.
This report was unique in recognising the
negative impact on individuals basic human
rights when forced to experience institutionalised
treatment.


In 1993 Mr Brian Burdekin, the past Federal Human
Rights Commissioner, concluded from the report on
the National Inquiry into the Human Rights of People
with Mental Illness that;
“ people with mental illness are amongst the
most vulnerable and disadvantaged in our
community; they may experience stigma and
discrimination in many aspects of their lives.
Mental illness can be transient; some people
experience their illness only once and fully
recover. For others, it recurs throughout their
lives”.

Changes in service delivery from the
institutionalisation to a community based style of
treatment led to reduction in the overall overt
discrimination
The underlying stigma associated with mental illness
is still evident.
 Before de-institutionalisation basic human rights were
infringed and those with mental illness were often
simply disregarded by society.

WHAT IS YOUR UNDERSTANDING OF STIGMA???
STIGMA
The attitude of today’s general public remains
one of indifference and distrust towards those
who experience a mental illness with these
attitudes being most commonly displayed in
the form of stigma.
STIGMA


People have always needed to determine where
they are in relation to others
Reassuring to believe that someone is beneath
you in the “pecking order”
STIGMATISING
The
more visible the
stigmatising mark or condition,
the more society believes the
individual should be able to
control it and the greater the
negative impact of not being able
to do so.
RESPONSE TO STIGMA

• Try to get rid of what is stigmatizing
•
Make special efforts to compensate
•
Refuse to accept societal norms
FOUR COMPONENTS OF STIGMA

• Labelling people with a condition
•
Stereotyping people with that condition
 • Creating a division – “us” and “them”
 • Discriminating against people based on
their label
WHY IS MENTAL ILLNESS
STIGMATIZED?

• Its name implies it is different from
physical illness
 • Sounds as if it’s “all in one’s head”
 • Some people believe it results from poor
choices
Belief that people with mental
illnesses are dangerous and
unpredictable, less competent, unable
to work, should be institutionalized,
can never get better
BBC MENTAL A HISTORY OF
THE MADHOUSE
ANXIETY

What distinguishes fear from anxiety?
Fear is a state of immediate alarm in response to a
serious, known threat to one’s well-being
 Anxiety is a state of alarm in response to a vague
sense of threat or danger
 Both have the same physiological features – increase
in respiration, perspiration, muscle tension, etc.

Comer, Abnormal Psychology, 7e
24
ANXIETY

•
Is the fear/anxiety response adaptive?
Yes, when the “fight or flight” response is protective
However, when it is triggered by “inappropriate”
situations, or when it is too severe or long-lasting, this
response can be disabling can lead to the development of
anxiety disorders
An anxiety disorder differs from normal anxiety in the
following ways:
- It is more severe
- It is long lasting
- It interferes with a person’s work or Relationships
Comer, Abnormal Psychology, 7e
25
GENERAL SYMPTOMS
OF ANXIETY (CONT’D)
PSYCHOLOGICAL
•
•
•
•
•
Unrealistic &/or excessive fear and worry, (about pastor
future events), mind racing or going blank,
decreased concentration and memory, indecisiveness,
irritability, impatience, anger, confusion, restlessness
or feeling ‘on edge’ or nervousness, tiredness, sleep
disturbances, vivid dreams.
GENERAL SYMPTOMS
OF ANXIETY (CONT’D)
BEHAVIOURAL
• Avoidance of situations, obsessive or compulsive
• behaviour, distress in social situations, phobic
behaviour.
DSM-5 ANXIETY
DISORDERS
Separation Anxiety Disorder
 Specific Phobia
 Social Anxiety
 Social Phobia
 Panic Disorder
 Agoraphobia
Generalized Anxiety Disorder

PANIC DISORDER
A person with a panic disorder suffers from
panic attacks and is afraid that a panic attack
might occur.
PANIC ATTACK:
•
Sudden onset of intense apprehension, fear or terror.
•
Can begin suddenly and develop rapidly.
•
The intensity of the fear is inappropriate for the
circumstances.
49
30
PHOBIC DISORDERS
•
A person with a phobia avoids or restricts
activities because of fear.
•
This fear appears persistent, excessive and
unreasonable.
•
Commonly feared situations include leaving
home, crowds or public places, open spaces,
speaking in public, travelling in buses, trains, or
planes and social events.
•
Phobic disorders include: agoraphobia, social
phobia and specific phobias.
31
AGORAPHOBIA
•
Involves avoidance of situations because of the
fear of a panic attack occurring.
•
Some people avoid leaving their home through
fear of a panic attack occurring.
•
Others avoid certain situations (e.g., shops, being
in a car) where a panic attack has occurred.
32
SOCIAL ANXIETY
•
Is the fear of any situation where public
scrutiny may be possible.
•
Involves being fearful of behaving in a
way that is embarrassing or humiliating.
•
Has the key fear that others will think
badly of them.
•
Often develops in shy children as they
move into adolescence.
•
Occurs in interactions with peers as
well as adults.
33
SPECIFIC PHOBIAS
•
This includes the fear of spiders, blood or
receiving an injection and fear of heights.
•
Because they only involve specific situations,
these phobias are less disabling than agoraphobia
and social phobia.
34
GENERALISED ANXIETY
DISORDER (GAD)
•
Overwhelming, unfounded anxiety and worry.
•
Multiple physical and psychological symptoms.
•
Anxiety or tension occurs more days than not, for at
least six months.
•
Excessive worries include health, money,
appearance, work, relationships and other regular
activities.
•
Impacts on concentration at school, functioning at
home and generally getting on with life.
48
35
OBSESSIVE COMPULSIVE
DISORDER (OCD)
OBSESSIONAL THOUGHTS:
•
Recurrent thoughts, impulses or images
experienced as intrusive, unwanted and
inappropriate and cause marked anxiety.
•
Most obsessive thoughts are about fear of
contamination or harm.
57
36
OBSESSIVE COMPULSIVE
DISORDER (CONT’D)
COMPULSIVE BEHAVIOURS:
•
Repetitive behaviours or mental acts.
•
Individual feels driven to perform in response to an
obsession.
•
Performed in order to reduce anxiety.
•
Common compulsions include the need to wash, check
and count.
•
OCD begins in adolescence, is often a lifelong illness
with a waxing and waning course.
37
1. THE TWO MOST COMMON OF THE ANXIETY
DISORDERS ARE:
 A)
phobias and generalized anxiety
disorders.
 B) posttraumatic stress disorders
and social phobias.
 C) panic disorders and obsessivecompulsive disorders.
 D) generalized anxiety and PTSD.
2. WHEN ONE CHECKS THE STOVE 10
TIMES TO MAKE SURE IT IS TURNED OFF
BEFORE LEAVING IN THE MORNING, ONE IS
EXHIBITING A(N):
 A)
obsession.
 B) compulsion.
 C) panic attack.
 D) phobia.
3. RELIGIOUS RITUALS AND SUPERSTITIOUS
BEHAVIOR (SUCH AS NOT STEPPING ON
CRACKS) WOULD BE CONSIDERED
OBSESSIVE-COMPULSIVE BEHAVIOR:
 A)
when done to provide comfort and
reduce tension.
 B) when done more than once a day.
 C) never.
 D) when they interfere with daily
function and cause distress.
4. ONE WHO MADE SURE THAT HE HAD HIS
PASSPORT, AIRPLANE TICKET, AND HOTEL
RESERVATION FORM EXACTLY EVERY 5 MINUTES
FOR AN ENTIRE DAY IS EXHIBITING A(N):
 A)
cleaning compulsion.
 B) checking compulsion.
 C) order compulsion.
 D) touching compulsion.
5. ONE WHO IS ANXIOUS UNLESS HER BOOKS
ARE PERFECTLY LINED UP ON HER DESK AND
WHO MUST EAT THE FOOD ON HER PLATE IN
A BALANCED ORDER IS EXHIBITING A:
 A)
checking compulsion.
 B) counting compulsion.
 C) symmetry compulsion.
 D) cleaning compulsion.
STRESS, COPING, AND THE ANXIETY
RESPONSE
 The
state of stress has two components:
Stressor – event that creates demands
 Stress response – person’s reactions to the
demands


Influenced by how we appraise both the event and our
capacity to react to the event effectively

People who sense that they have the ability and
resources to cope are more likely to take stressors in
stride and respond constructively
Comer, Abnormal Psychology, 7e
43
STRESS, COPING, AND THE ANXIETY
RESPONSE
 When
we appraise a stressor as
threatening, the natural reaction is fear

Fear is a “package” of responses that are
physical, emotional, and cognitive
 Stress
reactions, and the fear they
produce, are often at play in psychological
disorders

People who experience a large number of
stressful events are particularly vulnerable to
the onset of anxiety and other psychological
disorders
Comer, Abnormal Psychology, 7e
44
STRESS, COPING, AND THE ANXIETY
RESPONSE
 Stress
also plays a more central role in
certain psychological disorders, the two
most common ones are :


Acute stress disorder
Posttraumatic stress disorder (PTSD)
Comer, Abnormal Psychology, 7e
45
STRESS AND AROUSAL:
THE FIGHT-OR-FLIGHT RESPONSE

The features of arousal and fear are set in motion
by the hypothalamus

Two important systems are activated:
Autonomic nervous system (ANS)
 An extensive network of nerve fibers that connect the
central nervous system (the brain and spinal cord) to all
other organs of the body
 Endocrine system
 A network of glands throughout the body that release
hormones

Comer, Abnormal Psychology, 7e
46
STRESS AND AROUSAL:
THE FIGHT-OR-FLIGHT RESPONSE
When we face a dangerous situation, the
hypothalamus first excites the sympathetic
nervous system, which stimulates key organs
either directly or indirectly
 When the perceived danger passes, the
parasympathetic nervous system helps return
body processes to normal

Comer, Abnormal Psychology, 7e
Hypothalamus: Part of
the brain that contains a
number of small nuclei with
a variety of functions. One
of the most important
functions of the
hypothalamus is to link
the nervous system to
the endocrine system via
thepituitary
gland (hypophysis).
47
Comer, Abnormal Psychology, 7e
The sympathetic nervous system's primary process is
to stimulate the body's fight-or-flight response
the parasympathetic nervous system stimulates the
body to "rest-and-digest" or "feed and breed".
48
STRESS AND AROUSAL:
THE FIGHT-OR- FLIGHT RESPONSE

When confronted by stressors, the hypothalamus
signals the pituitary gland, which stimulates the
adrenal cortex to release corticosteroids – stress
hormones – into the bloodstream
Comer, Abnormal Psychology, 7e
49
STRESS AND AROUSAL:
THE FIGHT-OR-FLIGHT RESPONSE
The reactions on display in these two pathways
are collectively referred to as the fight-or-flight
response
 Each person has a particular pattern of
autonomic and endocrine functioning and so a
particular way of experiencing arousal and fear…

Comer, Abnormal Psychology, 7e
50
THE PSYCHOLOGICAL
STRESS DISORDERS
 During
and immediately after trauma, we
may temporarily experience levels of
arousal, anxiety, and depression

For some, symptoms persist well after the
trauma

These people may be suffering from:
Acute stress disorder
 Posttraumatic stress disorder (PTSD)


The precipitating event usually involves actual
or threatened serious injury to self or others

The situations that cause these disorders would be
traumatic to anyone (unlike other anxiety disorders)
Comer, Abnormal Psychology, 7e
51
THE PSYCHOLOGICAL
STRESS DISORDERS

Acute stress disorder


Symptoms begin within four weeks of event and last
for less than one month
Posttraumatic stress disorder (PTSD)

Symptoms may begin either shortly after the event,
or months or years afterward

As many as 80% of all cases of acute stress disorder develop
into PTSD
Comer, Abnormal Psychology, 7e
52
WHAT TRIGGERS A PSYCHOLOGICAL
STRESS DISORDER?
Can occur at any age and affect all aspects of life
 Around two-thirds seek treatment at some point
 Ratio of women to men is 2:1



After trauma, around 20% of women and 8% of men
develop disorders
Some events – including combat, disasters,
abuse, and victimization – are more likely to
cause disorders than others
Comer, Abnormal Psychology, 7e
53
WHAT TRIGGERS A PSYCHOLOGICAL
STRESS DISORDER?

Disasters and stress disorders

Acute or posttraumatic stress disorders may also
follow natural and accidental disasters
Types of disasters include earthquakes, floods, tornadoes,
fires, airplane crashes, and serious car accidents
 Civilian traumas have been implicated in stress disorders
at least 10 times as often as combat traumas

Comer, Abnormal Psychology, 7e
54
WHAT TRIGGERS A PSYCHOLOGICAL
STRESS DISORDER?

Victimization and stress disorders
 People who have been abused or victimized often
experience lingering stress symptoms
 Research suggests that more than one-third of all
victims of physical or sexual assault develop PTSD
 A common form of victimization is sexual assault/rape
 Around 1 in 6 women is raped at some time during
her life
 Psychological impact is immediate and may be
long-lasting
 One study found that 94% of rape survivors
developed an acute stress disorder within 12 days
after assault
Comer, Abnormal Psychology, 7e
55
WHAT TRIGGERS A PSYCHOLOGICAL
STRESS DISORDER?

Victimization and stress disorders


Ongoing victimization and abuse in
the family may also lead to stress
disorders
The experience of terrorism or the
threat of terrorism often leads to
posttraumatic stress symptoms, as
does the experience of torture
Comer, Abnormal Psychology, 7e
56
1. THOSE MOST LIKELY TO EXPERIENCE
SUBSTANTIAL STRESS SYMPTOMS AFTER THE
TERRORIST ATTACKS IN THE U.S. ON SEPTEMBER
11, 2001:
A) lived near New York City, or watched a lot
of TV.
 B) lived near New York City, or watched very
little TV
 C) lived far away from New York City, or
watched a lot of TV.
 D) lived far away from New York City, or
watched very little TV.

2. AT WHAT POINT IS DISTRESS THE
GREATEST AFTER A RAPE?
A) immediately after the assault.
 B) within one week after the assault.
 C) within one month after the assault.
 D) more than several months after the
assault.

18. IDEALLY, CRITICAL INCIDENT
STRESS DEBRIEFING OCCURS:
A) immediately, and is long-term.
 B) immediately, and is short-term.
 C) after a “recovery” period, and is longterm.
 D) after a “recovery” period, and is shortterm.

21. THE PART OF THE BODY THAT RELEASES
HORMONES INTO THE BLOODSTREAM IS THE
____ SYSTEM.
A) nervous
 B) exocrine
 C) endocrine
 D) autonomic

A FLASH FLOOD HITS A SMALL RURAL COMMUNITY.
THOSE PROVIDING CRITICAL INCIDENT STRESS
DEBRIEFING INTERVENTION WOULD:
A) provide long-term psychological therapy
for flood survivors.
 B) provide short-term counseling services.
 C) keep their efforts separate from those of
disaster relief agencies such as the Red
Cross.
 D) all of the above.

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