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TOPIC 1-INTRODUCTION TO MENTAL HEALTH DEFITION OF HEALTH WHO (1948) define heath as a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity. WHO (1986) in the Ottawa charter for health promotion (OCHP) said that health is a resource for everyday life, not the objective of living. Health acc o the Macmillan dictionary is the condition of your body whether or not you are ill. Health is a positive resource emphasising social and personal resources as well as physical capacities. Overall health is achieved through a combination of physical, mental emotional and social wellbeing which together is know as the health triangle. Overview of mental illness An essential criterion for defining behavioural patterns or symptoms of psychological distress as a mental disorder is that they become significant enough to be functionally disabling and impose substantial increased risks ranging from an important loss of freedom to suffering pain, disability, or death. Both genetic inheritance and environmental factors influence one's vulnerability to mental illness. Twin and family studies and genetic research have demonstrated the former, though specific genes have been difficult to identify, and there may be multiple genes involved in most psychiatric disorders. Traumatic events throughout one's lifetime, including childhood abuse or neglect, major losses, violence, military combat, and dislocation (as among the urban homeless or wartime refugees) are known to threaten mental stability. Substance abuse contributes significantly to the exacerbation or even precipitation of other psychiatric illnesses and complicates their treatment. Poverty and home-lessness are risk factors for many of these problems, but may also be the outcome of psychiatric illness and the inability to function independently. The Carter Commission on mental health recognised that the risk of mental illness was influenced by a range of socio-economic, inter-personal and hereditary factors. Mental, or psychiatric, illnesses are a major public health concern. They adversely affect functioning, economic productivity, the capacity for healthy relationships and families, physical health, and the overall quality of life. They cut across racial, ethnic, and socioeconomic lines to affect a significant proportion of communities worldwide. They tend to develop and manifest in the early adult years, often preventing individuals from leading full and productive lives. The National Comorbidity Survey of 1994 found nearly half of the individuals in its random U.S. sample had a psychiatric disorder over their lifetime, and almost 30 percent had one in the past year. The World Health Organization's World Health Report 1998 lists mood and anxiety disorders among the leading causes of morbidity and mood disorders as the leading cause of severely limited activity. Mental disorders account for a quarter of the world's disability. Comorbidity (having more than one illness) is common and even further increases the risk of disability. Suicide is the eighth leading cause of death in the United States and the third leading cause in the fifteen- to twenty-four-year-old age group. More people die by suicide than homicide. The definition of mental health as a positive sense of wellbeing challenges the idea tat mental health is the opposite of mental illness.eg a person with a diagnosis of schizophrenia may feel supported, at ease and optimistic-they may be coping well with life and enjoying a high level of wellbeing. Equally many people who are not clinically diagnosed may have a poor sense of wellbeing. DEFINITION OF MENTAL HEALTH Mental health problems are common and widely misunderstood. At any one time, one adult in six suffers from mental health problems of varying severity. Other research suggests that one person in four will experience some kind of mental health problem in the course of a year. A survey of children and young people’s (aged 5 – 15) mental health found that the proportion of children and adolescents with any mental disorder was greater among boys than girls across the age range: 11% compared with 8%. The cost of mental illness in England adds up to £77.4 billion MH is 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. MH is a branch of medicine that deals with the achievement and maintenance of psychological well-being. A person's overall emotional and psychological condition: Since witnessing the accident, his mental health has been poor. Mental health is a contested concept which is defined in a number of different ways. There is a deficit model of mental health i.e. the absence of objectively diagnosable disease. There is a positive holistic model of mental health as a state of physical, social and mental well-being There has been a movement away from a focus solely on individual attributes such as coping skills or resilience, to one which incorporates environmental and social conditions. Definitions of mental health are personal and are dependant upon our individual life experiences and life context. Therefore they can be influenced by our gender, race, religious beliefs, social class, experience of family life, aspirations and beliefs etc. Mental health has been described as multifaceted with six dimensions: affective, behavioural, cognitive, socio-political, spiritual and psychological . The Health Education Authority (USA) defined mental health in 1997 as “the emotional and spiritual resilience which enables us to survive pain, disappointment and sadness. It is a fundamental belief in our own and others’ dignity and worth”. The Mental Health Foundation has defined a mentally healthy individual as one who can: Develop emotionally, creatively, intellectually and spiritually; Initiate, develop and sustain mutually satisfying personal relationships; Face problems, resolve them and learn from them; Be confident and assertive; Be aware of others and empathise with them; Use and enjoy solitude; Play and have fun; Laugh, both at themselves and at the world. These differing models and definitions of mental health illustrate an array of individual and environmental risk and protective factors. The interaction between discrete factors and mental health outcomes is however not clearly delineated. Why a particular risk factor should result in poor mental health outcomes for one individual and not another is as yet unknown. What all these models of mental health acknowledge however is the extent to which mental health is entrenched within social relationships. Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience. Mental health is an expression of our emotions and signifies a successful adaptation to a range of demands. Dianne Hales and Robert Hales define mental health as the capacity to think rationally and logically, and to cope with the transitions, stresses, traumas, and losses that occur in all lives, in ways that allow emotional stability and growth. In general, mentally healthy individuals value themselves, perceive reality as it is, accept its limitations and possibilities, respond to its challenges, carry out their responsibilities, establish and maintain close relationships, deal reasonably with others, pursue work that suits their talent and training, and feel a sense of fulfilment that makes the efforts of daily living worthwhile (p. 34). A healthy pregnancy, adequate parenting, secure attachments to caretakers, regular involvement in groups, and stable intimate relationships all contribute to the development and maintenance of mental health. Mental health can therefore be socially constructed and socially defined that is different professions, communities, societies and cultures have very different ways of conceptualising its nature and causes. Definitions from WHO The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". It was previously stated that there was no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined. Mental health is an integral and essential component of health. The WHO constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important consequence of this definition is that mental health is described as more than the absence of mental disorders or disabilities. A useful definition of mental health is that used by the World Health Organisation: “Mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.” Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. Mental Wellness When searching the literature on mental health, it is difficult to find a straightforward definition of mental wellness. Instead, we define its absence. Although many adults do not fit snugly into descriptions of depression and anxiety, depressive symptoms and behaviours that identify anxiety are seen in many people. Unfortunately, even if these adults recognize their depressive symptoms and feelings of anxiety, and even if low-cost treatment were available around the corner, the stigma of mental illness inhibits many of them from seeking help. Depressive symptoms affect the quality and enjoyment of life. Depressed people tend to exercise less, smoke more and eat less healthily. Sixty to 90 percent of people who commit suicide suffer from depression. Mental wellness can be influenced by: 1. Biological factors - changes in the central nervous system, medications, illnesses and family history 2. Social environment - losses, traumatic events, stress and low economic status Mental wellness is promoted through: 1. 2. 3. 4. 5. 6. 7. 8. Physical activity Good nutrition Adequate rest and sleep Stress reduction An optimistic attitude that can include humour, creativity and faith Optimal medication management Emotionally enriched environments For people to survive their later years, maintaining mental wellness is an essential charge, both for themselves and for those who work with them. An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning. Characteristics of mental health 1) The ability to enjoy life-acc to James Taylor the secret to life is enjoying the passing of time-any fool can do it-there is nothing to it. However we need to plan for the future. But too often we make ourselves miserable in the present by worrying about the future. 2) Resilience-the ability to bounce back from adversity. Some people handle stress better that others-some adults raised in alcoholic families do well while others have repeated problems in life. resilience can be found among those who cope well with stress. 3) Balance-we need to balance time spent alone and time spent socially-extreme social isolation may result in a split with reality-failure to integrate positive and negative experiences that occur between individuals and other people(rather than perceiving scolding from parents as love- a person is always negative. Balance work and play ,rest and exercise. 4) Flexibility-Pple should not have rigid expectations. Emotional flexibility is as good as cognitive flexibility. 5) Self actualisation-mentally healthy people are those who are in the process of actualising their potential. References Office for National Statistics (2000) Survey of Psychiatric Morbidity among Adults Living in Private Households. London: HMSO Goldberg D (1991) Filters to care in Indicators for Mental Health in the Population. Jenkins R and Griffiths S (ed). London. The Stationery Office. Meltzer H, Gatward R, Goodman R and Ford T (2000) The mental health of children and adolescents in Great Britain: Summary report. London: Office for National Statistics. Sainsbury Centre for Mental Health (2003) The Economic and Social Costs of Mental Illness. London:SCMH. World Health Organisation (1946) Constitution. New York: World Health Organisation World Health Organisation (1986) Ottawa Charter for Health Promotion. Ottawa: World Health Organisation Rutter M (1985) Resilience in the face of adversity: protective factors and resistance to psychiatric disorder. British Journal of Psychiatry. 147: 598-611 Health Education Authority (1997) Mental Health Promotion: A Quality Framework. London: HEA. MacDonald G and O’Hara K (1998) Ten Elemen