Mental Health & Well Being
Mental health is as important as physical health and needs to be looked after and protected just as we look after and protect our physical health. As a phenomenon Mental Health is evolving and many aspects are contentious and crowded with powerful and vested interests.
Broadly the term describes how we think and feel about ourselves and others, how we perceive and interpret what’s going on in our lives and on our ability to cope and deal with change, transition and significant events. Sometimes, however feelings become so intense that they interfere with day to day activities producing physical or behavioural symptoms. Mental health is a continuum which spans positive mental health through to mental distress, mental ill health and/or mental illness. Mental ill health is used to describe a range of psychiatric illnesses including depression, anxiety, bipolar and schizophrenia. It accounts for one of the largest and fastest growing categories of the burden of disease with which health systems cope, often accounting for a greater impact on health budgets than cardiovascular disease and cancer. The economic cost of mental ill health in Ireland in 2006 was estimated to be €3 billion or 2% of GNP. The majority of these costs occur outside the healthcare system largely in the labour market as a result of unemployment, absenteeism, lost productivity, early retirement and premature mortality. Other costs fall on informal care, hostel accommodation and criminal justice agencies.
The history of mental health policy in Ireland begins with the building of Asylums in the 19th and early 20th century which institutionalised people assessed as having a mental illness. This culminated with over 21,000 people residing as patients in the 1950’s, followed by the gradual halt in the building programme and then the introduction of a policy to close institutions from the 1980’s onwards. Deinstitutionalisation then slowly became the direction of policy on foot of the introduction and use of psychotropic drugs combined with the evolution of occupational therapy, rehabilitation and Community Care. Community care and alternative services were not and are still not in place in the manner and to the extent they were envisaged or indeed are required.
Psychotropic or psychoactive drugs affect the central nervous system and change behaviour or mood, they are used to treat the symptoms of “mental health disorders” The use of these drugs is the subject of much debate with regard to, for example, ethics, benefits, side effects and over prescribing.
There are six main groups of medications used in psychiatry;-
- Antidepressants, which treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.
- Stimulants, which treat disorders such as attention deficit hyperactivity disorder and narcolepsy, and suppress the appetite.
- Antipsychotics, which treat psychoses such as schizophrenia and mania.
- Mood stabilizers, which treat bipolar disorder and schizoaffective disorder.
- Anxiolytics, which treat anxiety disorders.
- Depressants, which are used as hypnotics, sedatives, and anesthetics.
The latest admission statistics indicate that there are approximately 1200 people in psychiatric hospitals in Ireland.
Note there is an important social context during this period which links deprivation and poverty to mental health disorders along with the admission of people as mentally ill who were viewed as outside the “norm” of family, community, social, religious or gender expectations.
The landscape of mental health during this period includes the development of a theoretical framework which sought to define and determine “mental illness” by looking for genetic, organic, chemical, psycho-social and psychological antecedents.
The development of Psychiatry has included a wide range of treatment approaches including psychosurgery, electro convulsive therapy and pharmacology along with alternative or complimentary approaches of rehabilitation, psychotherapy and other talking therapies. The profession of psychiatry has grown substantially and can be sub divided into general adult psychiatry, the psychiatry of old age, learning disability psychiatry, forensic psychiatry, child & adolescent psychiatry and substance misuse psychiatry.
The main psychiatric treatment today is pharmacology, rehabilitation and perhaps some talking therapy.
An alternative approach to this traditional stance would be to view human beings as complex organisms with an emotional, rational, spiritual and physical presence. We all experience periods when we feel hurt, sad, and out of control – it is part of being human. This may lead us to behave in ways which distress and frighten us and may be linked to feelings and events we are aware of or indeed remain unknown and unconscious. These periods may be intermittent and pass or they may be ongoing. We get through these periods tapping in to our own resilience with the help of others, e.g. partners, family and friends and we may also turn to professional help.
However we cope, being able to access a range of quality services that respect, value and listen to us quickly and appropriately is important. Further, the role the person themselves play in their own mental health support, treatment and recovery is crucial as is the level of control they experience in the relationship with those who are supporting them, whether they be family, friend, psychiatrist, therapist, advocate or other support. Such an approach seeks to address the behaviour and feelings the person experiences rather than label and cathagorise symptoms.
The language used in the field of mental health is incredibly important and debated vigorously. Terms such as suffering, commit, schizo, copycat, mental disorder and mental disability are used inappropriately and can offend and stereotype. (See media guidelines & good practice booklet)
Finally to conclude this section, there are important issues with regard to ethnicity, gender, class and sexuality which relate to mental health policy, practice and service provision. These are not elaborated upon in this briefing but they need to be recognised and acknowledged. They can be taken up more specifically once the focus of the mental health platform within the campaign has been agreed and fine tuned. There are of course also differences in services between the public and private system.
The Scope of the campaign;-
There are 3 messages which cross boundaries of age, gender, class, ethnicity and sexuality and will relate to people where ever they live since few families or communities have not been touched by the issue of mental health. Firstly, your mental health is as important as your physical health so look after it, secondly, find out about suicide, how to prevent it and the help there is available, and thirdly learn from and listen to people with mental health issues. This scope will help promote good mental health and confront stigma and fear. It will communicate a message about hope without being simplistic. I believe this scope also affords us strong possibilities to develop synergies with Culture and Enterprise and tap into the importance of creativity and innovation. These are qualities which strike at the heart of mental health and well being. Finally, this is an international issue of concern so there are opportunities to gain traction at home and abroad.
1 Your mental health is as important as your physical health so look after it, protect it and talk about it…
We need to look after our mental health in the same way as we look after our physical health – but whereas discussing our physical health is more or less common practice and acceptable there is still a way to go when mentioning or discussing mental health issues. According to the World Health Organisation, in Europe one in four of us will experience a mental health problem at some time in our lives and 30% of consultations with GP’s are related to mental health issues. In Ireland, according to the Health Research Board, approximately 10% of people had spoken to their GP specifically about a mental health problem.
People with mental health problems tell us that the reaction of family, friends, neighbours, work colleagues and employers was harder to deal with then the mental health issue itself. Ignorance, fear and prejudice are still all too often the reaction, so speaking out about mental health and facilitating a voice for those experiencing mental health issues connects with a wide section of the population that crosses age, gender class, ethnicity and sexuality.
Risk factors which can increase the likelihood of mental health problems include isolation, relationship loss, unemployment, long term illness, poverty and inequality. The abuse of alcohol and /or other legal or illegal drugs is also linked to mental health problems. These are also linked to suicide and deliberate self harm. Poor mental health is associated with rapid social change, unemployment, stressful work conditions, gender discrimination, social exclusion, risks of violence, physical ill-health and human rights violations.
There are many ways to protect your mental health, e.g. accept yourself, get involved, keep active, eat well and healthily, keep in contact, do something creative, relax, don’t binge drink, share your worries, stress and feelings and ask for help when you need it.
Alcoholism, depression and suicide have been identified as the 3 most important mental health problems by Irish Adults. (Mental Health in Ireland-Awareness & Attitudes 2007) Please note that some of those working in the field of Suicide and DSH would have different views as to whether Suicide and DSH should be linked in with mental health issues.
To conclude, the promotion of good mental health is a powerful message and a direct and practical way of confronting and addressing Stigma. Feeling good about yourself, having self confidence, feeling valued and respected, having something worthwhile to do are all fundamental to good mental health and are crucial for all of us as individuals, families, communities and as a nation. Looking after our mental health is not only possible it’s crucial and being able to talk about mental health without experiencing prejudice, discrimination and being stigmatised is an important first step.
2 Speak out about suicide, the help available and how to try to prevent it.
What’s the problem?
Suicide is among the top 20 leading causes of death globally for all ages. Every year, nearly one million people die from suicide.
Suicide rates in Europe range from Lithuania at 30% and Greece at 3.5%.
Suicide is a major cause of mortality in Ireland and has increased steadily. The latest CSO show that 231 people killed themselves in the first two quarters of 2010 and given that there are slightly more deaths by suicide in spring and summer, it is estimated that the suicide rates for 2010 may be about 12% per 100,000. This was 10.6% in 2007 and has been gradually rising since. Suicide rates amongst men in the Traveller community are seven times higher than the national average
In Ireland more men die by ending their lives than die in Road Traffic Accidents
Suicides in males aged 15–34 have increased from being 11.6% of all accidental, poisoning and violent deaths in 1980 to 44.2% in 2003 and have in part replaced other such deaths.
In keeping with universal international experience (with the possible exception of China) Irish male’s suicide rates are and always have been three to four times greater than those of females.
The recorded increase in Irish rates of suicide over the later decades of the twentieth century has been greater than in other European countries because of increased suicide rates in young males.
The last quarter of the twentieth century in Ireland has been a period of great cultural, social and economic change equalising Ireland with most of our near European neighbours. It is not clear whether there is any link between these changes and the increase of suicide amongst young men.
The general demographic features of Irish suicide differ from those of other European countries in having a disproportionate number of male suicides in younger age-groups and lower rates amongst older people.
Increased suicide rates among the hospitalised mentally ill have reflected increase increasing rates in the community.
There are things we can do to help prevent suicide, speak about it, use the word, hear the language and challenge some of the myths surrounding it.
Myth People who think about suicide are mentally ill.
Fact: Feelings of desperation and hopelessness are more accurate predictors of suicide than mental illness.
Myth People who talk about suicide aren’t really serious.
Fact: They are. It is very important that anyone who talks about suicide is taken seriously. It is not attention-seeking.
Myth A person who has tried to kill themselves is unlikely to try again.
Fact: They are 100 times more likely than the general population to do so.
Myth Talking about suicide is a bad idea as it may put the idea into someone’s head.
Fact: It won’t. By asking directly about suicide you give people permission to say how they feel.
Myth If a person is serious about killing themselves then there is nothing you can do.
Fact: Feeling suicidal is often a temporary state of mind. While someone may feel sad or low for a long period of time, the actual suicidal crisis can be relatively short term. Offering appropriate and timely help and emotional support to people can reduce the risk of them dying by suicide.
Myth People who are suicidal want to die
Fact: The majority of people who feel suicidal do not actually want to die; they want the pain they experience to stop.
Myth Most suicides happen in the winter months
Fact: Suicide is more common in the spring and summer.
It’s difficult to be specific about what constitutes risk with regard to suicide, a number of factors have been identified as posing risk but, research, people working in the field and those who have experienced suicidal thoughts cite a number of factors coming together as prompting risk rather than any one single factor. This is why the importance of education, knowledge, prevention and crisis support are key messages to communicate. Risk factors which have been identified include depression, alcohol abuse, violence, loss, feeling trapped, and/or expressing suicidal thoughts. People who have been in this situation say what they wanted was for the pain they were experiencing to stop.
Some people would say that;-
“Suicide is not chosen; it happens when pain exceeds resources for coping with pain”
Why include it as part of the Mental Health pillar?
People are dying and more can be done to reach out and do something positive about this. Though the issue of suicide is more open than it used to be there is a long way to go. We need to continue to break the silence, fear and ignorance about it. The message that it is alright to talk about suicide, that help is available and there are ways to try to prevent it is a powerful and important one.
3 Open up a dialogue with people who have/are experiencing Mental Health issues.
Establish relationships and an ongoing rapport with people affected by mental health issues through reaching out to service users and the groups which they have started. Making a direct connection with people who use services will bring into sharp focus the everyday struggles, prejudice, fear, support and help that are part and parcel of people’s lives and show David doing something real and tangible. Meeting with and listening to people who use services breaks down barriers and provides a compelling and powerful reality to the other two messages of looking after your mental health and speaking about suicide. There is nothing as powerful as listening to people who have firsthand experience of services. Consistently now the role that people play in their own recovery is shown to be very important – it ties in with trust, confidence and power already mentioned in this briefing.