CONTROL & PREVENTION OF MENTAL HEALTH

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2. CONTROL & PREVENTION • OF • MENTAL HEALTH Burden of Diseases

3. Objectives: Students: • 1. To be able to identify the most common mental disorders and risk factors in the society • 2. To be able to identify preventive strategies and explore what suitable society those patients need Burden of Diseases

4. Mental Disorders: Global Phenomenon Now posing special challenge to our AREA Burden of Diseases

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6. Why Mental Health Issues of Importance to Public Health? • 1. Quality of life largely determined by person’s mental health • 2. Large proportion of people seeking medical care has a mental problem • 3. Many physical disorders have an important mental component • 4. As premature death recedes, chronic ailments including mental illness rises Burden of Diseases

7. Size of the Problem • Worldwide: • - Twenty-five per cent of individuals develop one or more mental or behavioural disorders at some stage in life, in both developed and developing countries. • - 450 million people worldwide are affected by mental, neurological or behavioural problems at any time. • - About 873,000 people die by suicide every year. • - Common to all countries and cause immense suffering. • - 1 in 4 patients visiting a health service has at least one mental, neurological or behavioural disorder but most of these disorders are neither diagnosed nor treated. • - Mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Untreated, they bring about unhealthy behaviour, non-compliance with prescribed medical regimens, diminished immune functioning, and poor prognosis. Burden of Diseases

8. We are all vulnerable Burden of Diseases

9. Red Signals:!People with mental disorders often subjected to: • - social isolation, • - poor quality of life and • - increased mortality. • Cost-effective treatments exist for most disorders and, if correctly applied, could enable most of those affected to become functioning members of society. • Barriers to effective treatment include: • - lack of recognition of the seriousness of mental illness and • - lack of understanding about the benefits of services. • Most middle and low-income countries devote less than 1% of • their health expenditure to mental health. • Mental health policies, legislation, community care facilities, and treatments for people with mental illness: NOT GIVEN THE PRIORITY THET DESERVE. Burden of Diseases

10. Mental health in Saudi Arabia • Historical aspects • Two clear phases in the development of mental health care in Saudi Arabia: • - Until 1983, mental health care in the country mainly provided by the Taif Mental Hospital, though meant for 250 patients, but serving a larger number of patients (for example, in 1978, there were 1800 patients). Patients had to travel long distances often resulted in delays in seeking care and, problems of discharge into the community. • - Since 1983, a shift occurred: Setting-up of smaller-sized (20-120 beds) hospitals all over the country along with outpatient clinics. ter • - A later phase: further integration of mental health with primary health care. Burden of Diseases

11. WHAT IS then MENTAL HEALTH A vast subject, broad in its limits and difficult to define precisely!!! • ♣ the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people and the ability to adapt to change and cope with adversity; • ♣ How a person looks at own’s self, own’s life, and the others, how he/she thinks, feels, and acts when faced with life's situations, how he/she evaluates those challenges and problems, and explore choices. i.e. handling stress, relating to other people, and making decisions. Burden of Diseases

12. ♣The capacity of an individual to form harmonious relations with his/her social and physical environment, and to achieve a balanced satisfaction of his/her own drives. • ♣Or when an individual is functioning at a satisfactory level of emotional and behavioral adjustment Burden of Diseases

13.  Being mentally healthy is subject to many interpretations rooted in value judgments, which may vary across cultures. •  Mental health should not be seen as the absence of illness but more to do with a form of subjective/positive well being i.e. individuals feeling they are: • - coping, • - making positive relations with others • - fairly in control of their lives, • - able to face challenges, • - and take on responsibility. ... Burden of Diseases

14.  Mental Health is the appropriate balance between: • - individuals, • - their social group, • - and the larger environment. • which all interplaying to promote: • - psychological and social harmony, • - a sense of : - well being, • - self-actualization, and - environmental mastery. Burden of Diseases

15. WHAT IS THEN MENTAL DISORDER • A mental illness is a disorder of the brain that results in a disruption in a person's: • - thinking, • - feeling, • - moods and • - ability to relate to others. • Mental illness is distinct from the legal concept of insanity. Burden of Diseases

16. Mental health, mental hygiene and mental wellness are all terms used to describe the absence of mental illness. By this definition, mental status has two possibilities: either health or illness. Burden of Diseases

17. How to Identify Mental Disorder?Early Symptoms of Mental Disorders • ♣Mental & Behavioural Disorders produce symptoms observable by sufferers or those close to them • ♣Characterised mainly by disturbance in: • - thinking • - mood • - or behaviour • Out of keeping with cultural beliefs or norms Burden of Diseases

18. In most cases symptoms are associated with: • * Stress • * Interference with personal functions Burden of Diseases

19. Main Symptoms/Signs Include • Physical Symptoms: aches, sleep disturbances • Emotional Symptoms: feeling sad, scared, anxious • Cognitive S: difficulty thinking clearly, abnormal beliefs, memory disturbances • Behavioural S: aggressiveness, inability to perform daily routine functions, excessive use of substance • Perceptual S: sees or hears things others don’t Burden of Diseases

20. Classification of Mental /Psychiatric Disorders: • American Psychiatrists Association Classification of Mental Disorders: • Diagnostic & Statistical Manual of Mental Disorders now in its 4th edition: DSM 1V. • Clinical diagnosis is basically a comprehensive mental examination focusing on the patient’s: • 1. intellectual ability • 2. current state of consciousness/confusion/contact • 3. mood/affect • 4. connectedness of thought patterns/hallucinations/delusions • 5. personality: passive/helpess/aggressive/rebellious • 6. complaint bringing patient to care Burden of Diseases

21. Classification of Mental /Psychiatric Disorders: • Affective Disorders[Major Depressive episodes; Maniac Episodes; Dysthmia] • AnxietyDisorders: • [Panic disorders; social phobias; simple phobias, generalized anxiety disorders] • Substance Use Disorders: • [Alcohol abuse without/with dependence; drug abuse without/with dependence] Burden of Diseases

22. Nonaffective Pyschosis • Other Disorders: • - Schizophrenia; • - Organic states • - Delirium,dementia • - Personality Disorder • [Abnormal personality, Psychopathy] • - Learning disorders • Subnormality Burden of Diseases

23. Depression • Common Mental Disorder: P.R: 5-10% * * More in women • * 121 million worldwide • Characterised by: sadness/loss of interest • / decreased energy/ suicide common • [Depression & Schizophrenia responsible for 60% of all suicidal tendencies] • Causes: Psychological, genetic, biological factors Burden of Diseases

24. Schizophrenia • 24 millions worldwide • Severe disturbance of late adolescence and early adulthood • Affects men /women • Profound disturbane of thinking affecting language, perception with psychotic experiences i.e. hearing voices or delusions Burden of Diseases

25. SUBSTANCE ABUSE DISORDERS • There are a number of disorders resulting from the use of psychoactive substances including alcohol, opioids such as opium or heroin, cannabinoids such as marijuana, sedatives and hypnotics, cocaine, other stimulants, hallucinogens, tobacco and volatile • solvents. • Conditions include acute intoxication, harmful use, dependence and psychotic disorders. • Tobacco and alcohol are the substances which are used most widely across the globe • and which pose the most serious public health consequences. • Prevalence: • -Tobacco: Today, one in three adults or 1.2 billion people use tobacco. By 2025, the number is expected to rise to more than 1.6 billion. Tobacco was estimated to account for 4 million annual deaths by 1998. This is expected to rise to 8.4 million deaths by 2020. • - Alcohol: There are an estimated 70 million people who have alcohol use disorders, including harmful use and dependence -- 78% of whom remain untreated. The rate of alcohol use disorder for men is 2.8% and for women 0.5 %. • - IV Drugs: An estimated 5 million people worldwide inject illicit drugs -- there is a high prevalence of HIV infection among injecting drug users, making it a major public health concern. Burden of Diseases

26. ALZHEIMER'S DISEASE • Alzheimer's disease is a degenerative brain syndrome characterized by a progressive decline in memory, thinking, comprehension, calculation, language, learning capacity and judgement. Depression is a common symptom. • An estimated 37 million people worldwide live with dementia -- with Alzheimer's disease causing the majority of cases and about 5% of men and 6% of women over 60 years of age are affected with Alzheimer's. Currently no cure for Alzheimer's disease. Burden of Diseases

27. DISORDERS OF CHILDHOOD AND ADOLESCENCE: • Mental and behavioural disorders are common during childhood and adolescence. An estimated 10-20% of children have one or more mental or behavioural problems. Many disorders commonly found amongst adults (eg. depression) can begin during childhood. Burden of Diseases

28. General Categories of Mental Disorders of Children • Mental disorders with onset in childhood and adolescence fall into a number of broad categories, most of which apply not just to children but across the entire life span. • Two broad categories specific to childhood and adolescence: • - Disorders of psychological development e.g. dyslexia/autism; • - Behavioural and emotional disorders e.g. attention deficit/hyperactivitiy disorders (ADHD) or conduct disorders. Burden of Diseases

29. Selected mental disorders of childhood and adolescence: •  Anxiety Disorders •  Attention-Deficit and Disruptive Behavior Disorders •  Autism and Other Pervasive Developmental Disorders •  Eating Disorders e.g anorexia nervosa •  Elimination Disorders e.g. enuresis, encopresis •  Learning and Communication Disorders •  Mood Disorders (e.g., Depressive Disorders) •  Schizophrenia •  Tic Disorders Burden of Diseases

30. WHY PEOPLE BECOME MENTALLY DISEASED:CAUSES & RISK FACTORS • Multiple! Some Known, some unknown! •   Of the Known Factors: •  ORGANIC CONDITIONS:e.g. cerebral atherosclerosis, neoplasms, metabolic, neurological diseases & endocrine diseases, chronic diseases in general: TB, Leprosy, Epilepsy, HIV/AIDS • HEREDITY:e.g. child of two Schizo. parents 40 times likely to be Schizo. •  SOCIAL ENVIRONMENPATHOLOGICAL FACTORS:Personal Adversities: specially when genetically predisposed e.g. life worries, tension, anxieties, broken/unhappy marriages, economic instability/poverty/, pop. Mobility, rejection, neglect cruelty, industrialization, urbanization . • Communitywide Truamas: natural disasters extra Burden of Diseases

31.  Non Psycho-social Environmental Factorsi.e. Physical Environment:Occupational exposures e.g toxic substances [lead poisoning], psychotropic drugs [barbiturates, alcohol, nutritional deficiencies [thiamine, pyridoxine, iodine], traumatic shocks… • 5. Sex differences men more affected by alcoholism, depresnxiety states: • 6. Age: Affective & Aars5 yenxiety states: more in 18-35 years • 7. Social class: schizo, depression, alcohol abuse, anti-social personality: more in poor social classes • 8. Ethnicity; in USA whites are more affective disorders, succide • 9 Marital Status: being single/recently divorced: more depressions, alcohol/drug abuse Burden of Diseases

32. What about the Unknown factors? Those that can’t be seen by the eyes, touched by the hands or diagnosed by the lab??? • ∑ Lack of Spirituality, • ∑ Materiasm: indulgence on material life and forgetting religious life, Belief/Faith, Holy Book of the Quran and the Sayings and traditions of the Prophet Mohammed peace and • prayers be upon him. • ∑ Presence of other factors like work of magic and the envy of eyes are part of our belief as Muslims and can be prevented and treated by Islamic ways like prayers, dawa, Zikhr Allaah Burden of Diseases

33. What are those human basic needs that keeps Mental and Social Integrity • At all stages of human developmental milestones and life cycle our needs are the same: •  the need for affection •  the need for belonging •  the need for independence •  the need for achievement •  the need for recognition/approval •  the need for a sense of personal worth •  the need for self-actualization •  the need for spirtuality, faith worshipping Burden of Diseases

34. PREVENTION & CONTROL OF MENTAL ILLNESS • WITH REVIEW OF SAUDI NATIONAL PROGRAMME OF MENTAL HEALTH Burden of Diseases

35. Preventive NetworksMasaajed, Family, Home, Friends, Work Burden of Diseases

36. PREVENTIVE INTERVENTIONS: THREE LEVELS FOR PREVENTING MENTAL DISEASE • PRIMARY • * To operate on community basis, now to be integrated at PHC Level: • “Improving Social Environment” • “Promoting social, emotional, physical & spirtual well-being of all people” • Role of Primary Preventive Networks Burden of Diseases

37. Primary prevention efforts also include: • - addressing asymptomatic individuals in high-risk groups/situations i.e. students, adolescents and youth for drug abuse • - identifying and preventing environmental factors associated with mental disorders: high level exposure to heavy metals like lead, mercury result in mental and neurological disorders • Examples of disorders eradicated by primary prevention intervention: • 1. pellagra psychosis • 2. brain damage from measles and rubella Burden of Diseases

38. SECONDARY PREVENTION •  Early diagnosis of mental, social and emotional disturbances through Screening programmes specially of high-risk groups in: • - Schools • - Universities • - Industry •  It requires Provision of: • - Treatment Facilities • - & Effective Community Resources • Family-based & Family Counselling Mental Services and Agencies can have a great role to play Burden of Diseases

39. Some Psychiatric disorders requiring Screening for early detection: • 1. dementia • 2. depression • 3. suicide • 4. alcohol and drug abuse Burden of Diseases

40. TERTIARY PREVENTION • Seeks to reduce duration and severity of mental illness, its stress on the family and community. • Usually hospital-based or occasionally Traditional Healing Centres, like Religious Sheiks extra Burden of Diseases

41. The Saudi National Mental Health Programme • Developed in 1989. Its Objectives: •  to make essential mental health services available to all citizens and residents in the country, paying more attention to those who are more in need of these services and to underserved areas •  to develop a mental health care model in keeping with the social, cultural and religious values of the country • quality of life •  to decrease the untoward impact of social and economic development on society such as drug abuse, smoking, delinquency and crime. Burden of Diseases

42. Strategies for the programme: : integration of mental health services with general health services • primary health care through existing health staff by suitable additional • training •  providing mental health services to the more vulnerable groups •  providing the essential neuropsychiatrIc drugs at primary health care level •  cooperating with non-health sectors, (community leaders, nongovernmental organizations, religious establishments, etc.) in planning and implementation of the programme. Burden of Diseases

43. OWN WILL Burden of Diseases

44. Jazakumu Allaah Kheir!!! Thank you Burden of Diseases