An Introduction to
All the contents in this book come from the Canadian Mental Health Association and WHO official websites.
What is Mental Illness?
2 4 5
Adolescent Mental Health
Types of Mental Illness
8 11 13 16 18 21
What causes mental illness? Is there a cure? How is mental illness treated?
Mental health determinants
Anxiety Disorders Concurrent Disorders Dementia Eating Disorders Mood Disorders Schizophrenia
Other Symptoms and Behaviours
Asking for Help
29 29 30 30 31
Self Injury Suicide
Types of help Talk to your doctor Psychiatric care and counselling Medication Additional methods
What is Mental Illness? What causes mental illness?
There is no single cause of mental illness, and no one is to blame when someone develops a mental illness. A complex interplay of factors affect a personâ€™s mental health. Our emotional health is dependent on a combination of attitudes, personality, support systems, and brain chemistry. Positive attitudes and healthy lifestyle choices can help you through many of lifeâ€™s difficulties. A good support system of family and friends is also valuable during challenging times. Psychological and social factors It is commonly thought that mental illness can be triggered by a traumatic life event or situation, and/ or prolonged stress. Some examples of traumatic events are child abuse and neglect, family violence, and severe or prolonged stress.
Brain chemistry A chemical imbalance in the brain is caused by an imbalance of neurotransmitters, which can lead to symptoms such as depression, anxiety or stress reactions. We are all at risk for changes in our brainâ€™s chemistry. Recognizing these changes is an important part of treatment and the return to health.
Genetics Most mental illnesses are more common among close family members, which suggests that genetics plays a role. However, people donâ€™t inherit the illness itself; they inherit only the tendency to get it.
Is there a cure? People with mental illness never get better.
With the right kind of help, people with mental illnesses often recover and go on to lead healthy, productive lives. While the illness may not go away, the symptoms associated with it can be controlled.
If I seek help for a mental health issue, others might think Iâ€™m a wimp or even crazy.
No one should delay getting treatment for a mental health problem that is not getting better, just as one would not wait to take care of a medical condition that needed treatment.
How is mental illness treated? A proper assessment of the personâ€™s condition is the first step. In general once a diagnosis is made, a combination of medication, counselling, support and training will be provided by a team of mental health professionals. The family is often included as part of the team because they need to give, and receive, support. Community support is particularly important for individuals with mental health issues because this is where they live, work and play. Re-integration to their former lives and resumption of their activities are key factors in full recovery. Community mental health agencies are vital in enabling people to achieve these goals.
Adolescent Mental Health
Adolescence (10â€“19 years) is a unique and formative time. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors that may impact their potential to thrive are critical for their well-being during adolescence and for their physical and mental health in adulthood. Mental health conditions account for 16 percent of the global burden of disease and injury in people aged 10â€“19 years. Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated. Suicide is the third leading cause of death in 15â€“19-year-olds. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults. Globally, depression is one of the leading causes of illness and disability among adolescents.
Mental health determinants Adolescence is a crucial period for developing and maintaining social and emotional habits important for mental well-being. These include adopting healthy sleep patterns; taking regular exercise; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions. An estimated 10â€“20 percent of adolescents globally experience mental health conditions, yet these remain underdiagnosed and undertreated. Multiple factors determine mental health outcomes. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health. Factors that can contribute to stress during adolescence include a desire for greater autonomy, pressure to conform with peers, exploration of sexual identity, and increased access to and use of technology.Violence (including harsh parenting and bullying) and socioeconomic problems are recognized risks to mental health. Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. These include adolescents living in fragile settings; adolescents with neurological condition; and adolescents from minority ethnic or sexual backgrounds or other discriminated groups. Adolescents with mental health conditions are in turn particularly vulnerable to social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviours, physical ill-health and human rights violations.Â
Types of Mental Illness Anxiety disorders
Affecting around 12 percent of Canadians, this category includes disorders such as: Phobias A phobia is an intense fear around a specific thing like an object, animal, or situation. Most of us are scared of something, but these feelings donâ€™t disrupt our lives. With phobias, people change the way they live in order to avoid the feared object or situation. Panic disorder Panic disorder involves repeated and unexpected panic attacks. A panic attack is a feeling of sudden and intense fear that lasts for a short period of time. It causes a lot of physical feelings like a racing heart, shortness of breath, or nausea. Panic attacks can be a normal reaction to a stressful situation, or a part of other anxiety disorders. People who experience panic disorder fear more panic attacks and may worry that something bad will happen as a result of the panic attack. Agoraphobia Agoraphobia is fear of being in a situation where a person canâ€™t escape or find help if they experience a panic attack or other feelings of anxiety. A person with agoraphobia may avoid public places or even avoid leaving their homes.
Social anxiety disorder Social anxiety disorder involves intense fear of being embarrassed or evaluated negatively by others. People avoid social situations. This is more than shyness. It can have a big impact on work or school performance and relationships. Generalized anxiety disorder Generalized anxiety disorder is excessive worry around a number of everyday problems for more than six months. This anxiety is often far greater than expectedâ€”for example, intense anxiety over a minor concern. Many people experience physical symptoms too, including muscle tension and sleep problems.
Obsessive-compulsive disorder (OCD) Obsessive-compulsive disorder is made up of unwanted thoughts, images, or urges that cause anxiety (obsessions) or repeated actions meant to reduce that anxiety (compulsions). Obsessions or compulsions usually take a lot of time and cause a lot of distress. Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder can occur after a very scary or traumatic event, such as abuse, an accident, or a natural disaster. Symptoms of PTSD include reliving the event through nightmares or flashbacks, avoiding reminders of the traumatic event, and feeling unsafe in the world, even when a person isnâ€™t in danger. Anxiety disorders can affect anyone at any age, and they are the most common mental health problem. Sometimes, anxiety disorders are triggered by a specific event or stressful life experience. Anxiety disorders may be more likely to occur when we have certain ways of looking at things (like believing that everything must be perfect) or learn unhelpful coping strategies from others. But sometimes there just doesnâ€™t seem to be a reason. Anxiety disorders are often misunderstood. Family and friends may blame their loved onesâ€™ behaviour on a lack of self-discipline or inexplicable fixations. Anxiety disorders are conditions that respond to counselling, group therapy and medication; they can be effectively treated in the community.
Concurrent Disorders Concurrent disorders describes a condition in which a person has both a mental illness and a substance use problem. This term is a general one and refers to a wide range of mental illnesses and addictions. For example, someone with schizophrenia who abuses cannabis has a concurrent disorder, as does an individual who suffers from chronic depression and who is also an alcoholic. Treatment approaches for each case could be quite different.
It is challenging to determine conclusively how many people have a concurrent disorder because existing studies examine different populations and utilize differing screening tools. Further, people with concurrent disorders are frequently misidentified, as diagnosis can be more difficult because one disorder can mimic another. Relapse rates for substance use are higher for people with a concurrent mental disorder, as are the chances that symptoms of mental illness will return for those with a concurrent substance use problem. Depending on the setting, prevalence rates for concurrent disorders have been found to range from 20 to 80 percent. What is known conclusively, however, is that people with mental illness have much higher rates of addiction than people in the general population. Similarly, individuals with an addiction have much higher rates of mental illness than people in the general population. One large US study found that approximately a third of people with a mental or alcohol disorder had a concurrent disorder, and half of the people with drug problems had a mental disorder. A smaller study in Edmonton, Alberta had similar findings. In this study, almost a third of mentally ill individuals also had a substance use problem, almost a third of those with alcohol dependency also had a psychiatric diagnosis, and among illicit drug users, almost half had a mental illness.
Dementia Dementia is a syndrome â€“ usually of a chronic or progressive nature â€“ in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.
Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimerâ€™s disease or stroke. Dementia is one of the major causes of disability and dependency among older people worldwide. It can be overwhelming, not only for the people who have it, but also for their carers and families. There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care. The impact of dementia on carers, family and society at large can be physical, psychological, social and economic. Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of ageing. Further, dementia does not exclusively affect older people â€“ young onset dementia (defined as the onset of symptoms before the age of 65 years) accounts for up to 9 percent of cases. Studies show that people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels, Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity.
Alzheimer’s disease accounts for 60 percent to 80 percent of dementia cases. The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.
Eating Disorders While the label â€œeating disorderâ€? leads one to think these conditions are about food fixations, the truth is they are actually about deep-seated problems that people find too difficult or painful to deal with directly. They mask issues about identity, self-concept and self-esteem and are more prevalent amongst females than males. This type of mental illness has the highest mortality rate of any other mental health challenge; 10 to 20 percent of people with eating disorders die from the disease or complications relating to it. There are three main types of eating disorders. The signs of an eating disorder often start before a person looks unwell, so weight should never be the only consideration.
Anorexia nervosa A person who experiences anorexia nervosa may refuse to keep their weight at a normal weight for their body by restricting the amount of food they eat or exercising much more than usual. They may feel overweight regardless of their actual weight. They may think about their body weight often and use it to measure their self-worth. Restricting food can affect a person’s entire body. Anorexia nervosa can cause heart and kidney problems, low blood iron, bone loss, digestive problems. As many as 10 percent of people who experience anorexia die as a result of health problems or suicide. Bulimia nervosa Bulimia nervosa involves periods of uncontrollable bingeeating, followed by purging (eliminating food, such as by vomiting or using laxatives). People who experience bulimia nervosa may feel overweight regardless of their actual weight. They may think about their body weight often and use it to measure their self-worth. Health problems caused by bulimia nervosa may include kidney problems, dehydration, and digestive problems.Vomiting often can damage a person’s teeth, mouth, and throat. Binge-eating disorder Binge-eating disorder involves periods of over-eating. People who experience binge-eating disorder may feel like they can’t control how much they eat, and feel distressed, depressed, or guilty after bingeing. Many people try to keep bingeing a secret. Binge-eating can be a way to cope or find comfort, and it can sometimes develop after dieting. Some people may fast (not eat for a period of time) or diet after periods of binge-eating.
Mood Disorders The onset of these types of disorders commonly occurs during adolescence and has a major economic impact on our society in terms of lost work productivity and increased health care costs. Depression Depression is a mental illness that affects a person’s mood— the way a person feels. Mood impacts the way people think about themselves, relate to others, and interact with the world around them. This is more than a ‘bad day’ or ‘feeling blue.’ Without supports like treatment, depression can last for a long time. Signs of depression include feeling sad, worthless, hopeless, guilty, or anxious a lot of the time. Some feel irritable or angry. People lose interest in things they used to enjoy and may withdraw from others. Depression can make it hard to focus on tasks and remember information. It can be hard to concentrate, learn new things, or make decisions. Depression can change the way people eat and sleep, and many people experience physical health problems.
Bipolar disorder Bipolar disorder is another mental illness that affects mood. With bipolar disorder, people experience episodes of depression and episodes of mania. An episode of depression in bipolar disorder is the same as other types of depression. Mania is an unusually high mood for the person. People may feel like their thoughts are racing and may feel hyperactive. They may feel unrealistically confident, happy, or very powerful. Many people donâ€™t sleep much when they experience mania. They may act without thinking and do risky things they wouldnâ€™t normally do. People usually experience periods of wellness between episodes of depression or mania. Episodes of depression or mania generally last for a period of time, though a small number of people may experience episodes that change quickly. The frequency and type of episode can also vary greatly. For example, some people experience many episodes of depression with only a few episodes of depression or mania. Others experience long periods of wellness with only a few episodes during their lifetime. Seasonal Affective Disorder (SAD) Depression that appears to follow a seasonal pattern, typically experienced in the winter. Depression responds well to medication and counselling; bipolar disorders also benefit from appropriate medication and psychotherapy. SAD has been successfully treated with light therapy, increased exposure to sunlight, exercise, antidepressants and counselling.
Schizophrenia is a mental illness that affects the way you understand and interact with the world around you. Schizophrenia is a chronic (lifelong) brain disease that affects a personâ€™s ability to understand what is real and what is not. As a result, people with schizophrenia can have psychotic episodes where they experience hallucinations, delusions and paranoia, however proper treatment can relieve these symptoms and prevent relapses. A person who experiences multiple personalities has a rare condition called â€œmultiple personality disorderâ€?.
At the beginning of an episode, people may feel that things around them seem different or strange. They may start to experience problems concentrating, thinking or communicating clearly, or taking part in their usual activities. At the height of the episode, people may experience breaks from reality called psychosis. These could be hallucinations (sensations, like voices, that aren’t real) and delusions (strong beliefs that aren’t true, like the belief that they have superpowers). Some people feel ‘flat’ or numb. They may also experience changes in mood, motivation, and the ability to complete tasks. After an episode, signs can continue for some time. People may feel restless, withdraw from others, or have a hard time concentrating. The exact course and impact of schizophrenia is unique for each person. Some people only experience one episode in their lifetime while others experience many episodes. Some people experience periods of wellness between episodes while others may experience episodes that last a long time. Some people experience a psychotic episode without warning while others experience many early warning signs. No matter how someone experiences schizophrenia, researchers agree that early treatment can help reduce the impact of episodes in the future. While there is no cure for schizophrenia, people can and do recover. Recovery may mean learning to reduce the impact of problems, work around challenges, or maintain wellness. Some people need to spend time in hospital if they experience a severe episode of psychosis. This is a time to figure out the best treatment for you and begin your journey to health.
Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour.
Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false beliefs).
People with schizophrenia are 2-3 times more likely to die early than the general population. This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease and infections.
Prevalence of Schizophrenia 40-50% 10-15% 1% Worldwide about 1 percent of the population is diagnosed with schizophrenia, but the occurrence rises to 10-15 percent when a sibling or one parent has schizophrenia. When both parents have schizophrenia, the risk is approximately 40-50 percent.
Other Symptoms and Behaviours Self Injury
People cope with difficult thoughts, feelings, or situations in different ways. Some people cope by injuring themselves on purpose—and it may be the only way for them to feel better. Selfinjury may seem frightening, but it’s important to look beyond the injuries and see what’s really going on. Self-injury means that someone hurts themselves on purpose but doesn’t intend to end their life. Common acts of self-injury include cutting skin, burning skin, hitting yourself to the point of injury, and preventing wounds from healing. Self-injury itself isn’t a mental illness, but may be a sign that someone needs care and support. In some cases, selfinjury can be a sign of a mental health problem. People self-injure for many different reasons. People who self-injure are not trying to end their lives, but they can experience those thoughts. When they self-injure, they are trying to cope with difficult or overwhelming thoughts or feelings.
Why Do People Self Injure? Experts describe it as faulty problem- solving. People who self injure are seeking relief from psychological pain, unbearable tension, loneliness, depression, anger or numbness. Some do it to feel euphoria; others do it to punish themselves for being “bad”. They either cannot or have not learned how to express those feelings appropriately. Self injury usually starts during puberty or adolescence. It can last for up to ten years, but if left untreated, it may persist. Episodes are usually responses to a “trigger”, such as a perceived rejection or other emotional pain. Cutting behaviour can spread, and there is a rising trend for teens to discuss cutting on the Internet and form cutting clubs at school. There is no single pattern or profile for self injurers. According to research, most are from a middle to upper-class background, with average to high intelligence, and low self esteem. Some 40% have a history of eating disorders. Almost half report physical or sexual abuse during childhood. Almost all say that they were discouraged from expressing emotions, especially anger and sadness. By physically harming themselves, self injurers feel relief from the emotions that overwhelm them. They feel pain on the outside, not the inside.
Suicide Suicide is not a mental illness; however it can be a tragic outcome for someone who is experiencing mental health challenges as well as life events that leave them feeling hopeless, helpless and desperate. Suicide is a serious global public health issue. It is among the top twenty leading causes of death worldwide, with more deaths due to suicide than to malaria, breast cancer, or war and homicide. Close to 800 000 people die by suicide every year. The rates, characteristics, and methods of suicidal behavior vary widely among communities, population groups, and over time. Suicide is stigmatized (even illegal) in many countries. As a result, obtaining high-quality data on suicidal behavior is difficult, particularly in countries that do not have good vital registration systems (that register suicides as such) or good data collection systems on the provision of hospital services (that register medically treated suicide attempts). Suicide risk factors related to the health system and society as a whole include barriers to accessing necessary health care and other help; the ease with which the means of suicide may be obtained; and media sensationalism of suicides, which may heighten the risk of copycat suicides. Other influences also are at work, such as the stigmatization of those who seek help for suicidal behavior (suicidal ideation or planning) or people with mental or substance use disorders.
Suicide rates (per 100 000 population), 2016
<9.9 â‰Ľ10.0 Data not available
Community-associated risks include wars and disasters, the stress of acculturation (e.g., among indigenous populations or displaced persons), discrimination, a sense of isolation, abuse, violence, and relationship conflict. Individual risk factors include, most notably, previous suicide attempts, mental disorders, harmful use of alcohol, financial loss, severe chronic pain, and a family history of suicide.
Ask for help Types of help The treatments that a doctor prescribes could include one or more of the following: • Medication • Psychotherapy and/or counselling • Alternative/complementary methods • Community support services Just as there are different causes and symptoms of mental illness, there are also many different ways to treat it.
Talk to your doctor The first step to getting help begins by visiting your family doctor. Talking to a doctor as soon as possible about any mental health concern can clarify options for assistance and determine, or rule out, any physical causes for mental health issues. Although it’s sometimes uncomfortable or frightening to talk about, the sooner you seek help, the better prepared you will be to manage a mental illness. Reaching out also reminds us that we are not alone— there are professionals with expertise who can help.
Psychiatric care and counselling Psychotherapy and counselling are valuable components of most mental health treatment programs. Psychiatrists are mental health professionals who may diagnose, prescribe medication and provide psychotherapy for people with serious illnesses. A doctorâ€™s referral is required for psychiatric assessment and therapy. Psychologists can provide support and psychotherapies, such as cognitive therapy, that help patients learn to effectively change their thinking, feelings and behaviour. Psychologists work on a broad range of issues and often specialize in a particular type of psychology. Counsellors can also provide support, resources and assistance to students or others who need help making positive changes and/or informed choices in their lives. The counsellor will talk with the person to get a clear idea of the problem and will then be able to offer treatment options. Social workers help people deal with personal and social problems, either directly or by planning or implementing programs that benefit groups or communities.
Medication Medication can be a crucial component of the treatment of certain mental illnesses. Physicians and psychiatrists are medical doctors who assess a personâ€™s condition, work with
patients to determine a diagnosis, and prescribe medication and/or other treatments necessary for that person to get well. Because everyone is different, no one treatment or medication works the same for every person. Sometimes, patients must try different medications until they find the right one that makes them feel better without disruptive side effects. Furthermore, psychiatric medication can take some time to stabilize a mental illness. While experimenting with medications can be frustrating, it is worthwhile following through to find the medication(s) that work.
Additional methods There is a wide range of alternative methods to improve mental health; however, these methods should not be a substitute for a physicianâ€™s diagnosis or treatment. Some examples of alternative treatments are physical exercise, yoga and meditation, all of which help people relax and improve their mood. Self-help groups give people in similar situations a chance to advise and support one other. Nutritional counsellors can provide education on making healthy food choices for a balanced diet to improve overall health. Naturopathic counselling emphasizes the bodyâ€™s potential to heal itself, and focuses on prevention and balance.
References “Adolescent Mental Health.” World Health Organization, World Health Organization, www.who.int/news-room/ fact-sheets/detail/adolescent-mental-health. “Recovery College.” Go to CMHA Central Alberta Region., reddeer.cmha.ca/documents/fact-sheets-and-booklets/. Suicide in the World - World Health Organization. apps.who. int/iris/bitstream/handle/10665/326948/WHO-MSD- MER-19.3-eng.pdf. “What Is Dementia?” Alzheimer’s Disease and Dementia, www.alz.org/alzheimers-dementia/what-is-dementia.
All the contents in this book come from the Canadian Mental Health Association and WHO official websites.