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Mental Health

Mental Health. 25 June 2007 Presenter: Joanne Corrigall. The MH workgroup…. Authors : Joanne Corrigall, Catherine Ward, Kathryn Stinson, Patricia Struthers, Jose Frantz, Crick Lund, John Joske, Alan Flisher Expert group:

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Mental Health

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  1. Mental Health 25 June 2007 Presenter: Joanne Corrigall

  2. The MH workgroup… • Authors: Joanne Corrigall, Catherine Ward, Kathryn Stinson, Patricia Struthers, Jose Frantz, Crick Lund, John Joske, Alan Flisher • Expert group: Crick Lund, Alan Flisher, Dan Stein, Petro Brink, Venecia Barries, Carol Bower, Carol Dean, Fadia Gamieldien, Bronwyn Myers, Bruce Phillips • Peer Reviewers: Vikram Patel, Andy Dawes

  3. Presentation Content • Definitions • Burden of mental illness • Risk factors for mental illness • Interventions & Recommendations • Mental Health and Development

  4. Definitions • Mental Health: “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” (WHO) • Mental illness : group of disorders defined by specific criteria which describe • a particular severity of symptoms • duration of symptoms • the effects of these symptoms on a person’s ability to function (socially and occupationally) i.e. symptoms result in DISABILITY Example: Depression

  5. Spectrum of mental health Mental Illness Mental Health • Self-esteem • Coping skills, problem solving • Self-efficacy • Impulsivity • Sub-clinical symptoms

  6. Burden of Mental Disorders Socio-economic impacts • Unemployment, poverty • Poor housing • Decreased school completion, academic performance • Decreased Social capital • Increased violence

  7. Burden of Mental Illness Macro-economic: • $ 147 billion annual cost in USA • SA: no data but drug & alcohol costs alone total R10billion • Loss is mainly through effects on productivity, absenteeism

  8. Burden of Mental Illness Disability • Globally: 5 of 10 leading causes of disability are psychiatric • SA: neuropsychiatric disorders are 2nd leading cause of BoD • BoD figures exclude the impact of MH on other BoD components…

  9. Mental ill-health strongly associated with… CHILD HEALTH Injuries CVD CHILD HEALTH HIV CVD HIV Unsafe sex Multiple partners Early sexual debut Smoking Alcohol Abuse Drug Abuse

  10. Mental health/illness Source: Bradshaw et al, 2005

  11. Prevalence in Western Cape • South Africa: SASH study 30% life-time prevalence • No data for Western Cape • Proxy measures: injury data specifically homicide and RTAs

  12. Proxy measures

  13. Aim of MH workgroup • Prevention of common mental disorders • Depression • Generalised Anxiety Disorder • Substance disorders (includes abuse and dependence) • Post Traumatic Stress Disorder • Childhood behavioural disorders 2. Promotion of mental health

  14. Risk/protective factors Living environment Human capital Health • Access to recreation • Built environment (housing, neighbourhoods) • Basic services • Income • Food security • Social grants • Transport MENTAL HEALTH • Mental illness • Health systems • HIV • Substance use • Physical illness • Disability Safety Employment • Education • Pre-school • School climate • Violence • Crime • Family systems • Death/trauma in family Social capital Material goods • Unemployment • Underemployment • Occupational stress • Social capital • Social support • Spatial segregation Family environment

  15. Findings continued • Majority of relationships are bi-directional: Multiple deprivation mental illness • Cumulative effects

  16. Conflict with neighbours Basic services Family environment Food insecurity Unemployment Domestic Violence

  17. Focus Areas selected • Multiple Deprivation • Unemployment • Social assistance • Food insecurity • Housing • Poverty • Trauma (preventing MI after exposure) • Pre-school education • Recreation • Mental Health Services • Substance use (Tik, alcohol & other drugs exlc. Nicotine)

  18. Multiple Deprivation

  19. Interventions • Employment programmes: JOBS programme, public works etc. • Community development, micro-credit • Adult literacy, food security • Child care • Increase access to social assistance • Built environment: • Housing • Neighbourhoods

  20. Trends in Status Quo Existing interventions targeting housing, unemployment, social assistance, literacy, food security BUT insufficient to meet need and/or not optimally effective AND insufficient cognisance of health (including mental health)

  21. Example: Housing Housing factors associated with mental health Type Quality • Single vs multi- dwelling • High floor vs low floor dwelling • Structural deficiencies • Pest control • Dampness • Housing satisfaction HOUSING Other • Tenure • Overcrowding • Involuntary relocation • Affordability of housing

  22. Evidence for interventions • Housing improvements consistently improved Mental Health and decreased Mental Illness • Dose-response relationship • Other positive outcomes: physical health; perceptions of safety; crime reduction; social participation (social capital) ; improved perception of the area as a whole • Effects of neighbourhood improvements : 50% reduction in prevalence of mental illness

  23. Housing recommendations • Improve quality of state-subsidised housing • Increase housing subsidy amount per applicant • Improve capacity of housing applicants to make financial contributions for their homes • Foster community participation & support • Expand neighbourhood renewal projects

  24. Example: Federation of Urban Poor

  25. Likely outcomes Suitable housing Social Capital Human Capital Increased income Economic participation Physical Health Improved Mental Health HOW housing is provided can make a big difference!

  26. Pre-school Pre-School

  27. Window of opportunity Early childhood is a sensitive period, and competencies become cumulative. Thus, without intervention, gaps between better and worse-off children widen over time; the earlier the intervention, the less it costs and the lower the gap (Heckman, 2006).

  28. Outcomes of high quality pre-school: • Improved school • readiness • Improved cognitive • abilities • Lower failure rates • Higher school • completion rates • Decreased antisocial • behaviour • Decreased substance • abuse • 40% reduction in • arrest rates • 40% increase in • employment rates • Improved maternal • employment and • education Benefits of preschool have been noted up to 27yrs!!

  29. In Western Cape • ECD a priority of WCED and DSD • Audit done by DSD shows lack of access to pre-school and poor quality of existing preschools, unqualified teachers • Another audit currently underway by DSD

  30. Recommendations • Develop high quality teacher training programmes • Develop high quality pre-school programmes • Resource roll-out of pre-school across Province (urgently in high risk areas: 15 high priority areas)

  31. Recreation

  32. Evidence ? Arts, music, dance Physicalexercise Leisure boredom Recreation Recreationalenvironments ? Other Mental Health

  33. Major Gaps • Focus on team/competitive sports • Relative exclusion of other forms of recreation • Insufficient facilities, access to facilities, resources • Lack green spaces • Lack of access: cheap transport

  34. Recommendations • Review & support provision of sports AND recreation activities • Protect and promote green and natural spaces • Provide affordable and safe transport to recreational facilities or areas • Support S&R interventions that build social capital

  35. Trauma Trauma

  36. Violence • Community (gangs or crime) • Domestic violence • Rape • Child Abuse • Psychological • trauma • Individual • Family • Community • Police • Increased mental illness: • Drug and alcohol abuse & dependence • Post-traumatic stress disorder • Depression, anxiety • Decreased Mental Health: • Hostile/harsh parenting • Loss self-esteem, self-efficacy, coping skills

  37. Psycho-behavioural • Outcomes • Decreased inhibition, reasoning • Increased risk-taking • Increased libido • Increased mental illness • Decreased mental health • Decreased parenting skills • Poor interpersonal relationships Drug & Alcohol abuse Itself a mental health problem • Violence • Community (gangs or crime) • Domestic violence • Rape • Child Abuse Psychological trauma

  38. Bottom line Preventing and treating mental illness is an important part of violence prevention Violence prevention is an important part of preventing mental illness Preventing mental illness and restoring mental health after exposure to violence is crucial

  39. Recommendations • Training: trauma-informed non-health sectors • Consistently fund, support & roll-out NGOs • Develop resources for emergency placement • Provide mental health services in workplaces with high trauma exposures (police, teachers, social workers, NGO workers) • Make sufficient provision for psychosocial needs in disaster management • Develop post-graduate training programmes in trauma

  40. Recommendations cont. Health: • Training: trauma-informed general health sector • Integration of mental health staff into general health services e.g. surgery • Provide adequate mental health services • Create strong referral networks with trauma-related NGOs

  41. Substance use Substance use

  42. Background • Substance use e.g. nicotine, alcohol, ‘tik’, heroin • Substance abuse/dependence are defined mental disorders • Substance abuse/dependence also increases risks for other mental illnesses; high comorbidity

  43. Alcohol • Likely to be the commonest SOA in the Western Cape • Why? • Socially acceptable • Legal production and consumption • Active promotion (media) • Perceived to be benign • Norms: culture of excessive use (abuse) • Dop system • Wine country • Cheap!

  44. Impact of alcohol Violence Road Traffic Incidents HIV Mental Health CVD Child Health (FAS) Out of he Social impact Economic impact

  45. Tik • High profile Why? • Illegal: associated with criminal activity incl. gangs • Socially unacceptable • New drug • Negative consequences of use occur sooner: abusers deteriorate more quickly • Severe effects in users BOTH problems need to be addressed

  46. Evidence for interventions • Not effective • Media campaigns with no other measures • Scare tactics • School-based information interventions • Law enforcement of DUI laws

  47. Recommendations Decrease Demand • Restrict advertising of alcohol • Conduct concurrent anti-alcohol and drug media campaigns that challenge prevalent beliefs and ‘norms’ • Increase references to substance abuse in other health promotion messages • Include evidence-based substance prevention programmes in school curricula • Training of primary care and other health workers • Provide adequate treatment services

  48. Decrease Supply: • Substantially increase the cost of alcohol & drugs • Reduce the availability of alcohol & drugs • Enforce existing laws on alcohol and other drugs. • Incorporate addressing substance abuse into multi-faceted community development interventions General • Improve co-ordination of involved departments: DSD, DEADP, DOH, DCS

  49. Mental Health Services

  50. Background • Mental Health services: Hospital to community based • Scope Promotion, Prevention, Treatment, Rehabilitation • Nature of mental illness Typically chronic requiring long-term service use

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