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Materials relating to mental health, including social and emotional wellbeing), have previously been collected and reviewed to develop the background information that is archived below. An updated review is currently being developed.

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Background information

Note: updated background info is currently being developed. This archived material is provided for those who are interested in aspects of mental health, including the historical background of mental health in Australia.

What is mental health (social and emotional wellbeing)?

Mental health relates to emotions, thoughts and behaviours and encompasses social, psychological and biomedical aspects. Therefore, to fully understand mental health a broad multifactorial and multidisciplinary approach is required.

The Indigenous view of mental health is a holistic one, as embodied in the general definition of health as: '.not just the physical wellbeing of the individual but the social, emotional, and cultural wellbeing of the whole community. This is a whole-of-life view and it also includes the cyclical concept of life-death-life' [11]. The recent use of the term 'emotional and social wellbeing' reflects an increasing understanding of the need to recognise the Indigenous holistic concept of mental health among main stream services and policy makers. 'Social and emotional wellbeing' also encompasses a broader view of mental wellbeing than implied by traditional psychiatric definitions. This term will be used on this website interchangeably with 'mental health' depending upon the term of reference chosen by the particular program, policy or report under discussion at the time.

'A person with good mental health is generally able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society' [10].

Mental Illness is a general term referring to a group of psychological illnesses and/or disorders that affect a person's thinking, feelings, perceptions and reactions to everyday circumstances. Even minor mental health problems may affect everyday activities to the extent that individuals cannot function as they would wish, or are expected to, within their family and community.

One in five Australians will experience a mental illness at some stage of their lives [3]. A qualified professional makes the diagnosis of a mental disorder, once a thorough consultative process has occurred.

The exact causes of mental illness remain unclear. However, it is currently thought that mental illness is triggered by a chemical imbalance in the brain (for example, schizophrenia, bipolar disorder, and major depression) and/or environmental and stress factors (for example, reactive depression, dissociative disorders, anxiety, and phobias).

The good news is that the vast majority of people with mental illness are successfully treated and lead full and satisfying lives. Unfortunately though, there are still those that do not receive the appropriate treatment for their illness. For the health and wellbeing of all Australians it is essential that mental health is understood and promoted, and mental illness is prevented wherever/whenever possible.

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Classification of mental disorders

'According to the ICD-10, a mental disorder implies "the existence of a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions" '[10].

Diagnosis and management of mental disorders is usually based upon either (1) the International Classification of Diseases, 10th revision (ICD-10), Classification of Mental and Behavioural Disorders [13] or (2) the Diagnostic and Statistical Manual of Mental Disorders, 4th edition revised (DSM-IV-TR) [1]. The main diagnostic reference of mental health professionals is the DSM-IV-TR.

The DSM was first published in 1952, and contained only 66 disorders with short lists of symptoms and some discussion of the believed cause of the various disorders [7]. In 1968, the number of disorders was expanded to just over 100 with the publication of Edition II. Edition III of the Manual (1979) introduced a multi-axial diagnostic system of five scales which allowed for a more detailed diagnosis, giving consideration to different aspects of a person's life [7] [9].

The Axis System

  • Axis I - Clinical disorders
  • Axis II - Personality disorders and mental retardation
  • Axis III - General medical conditions
  • Axis IV - Psychosocial and environmental problems (stressors)
  • Axis V - Global assessment of functioning

The DSM IV, the current edition of the manual, was first published in 1994. This edition presents nearly 400 disorders. It also improved diagnostic objectivity by adding prototypes or decision trees outlining defining features of disorders, which lead clinicians through sets of questions regarding the presence or absence of symptoms [7] [9]. With no completely new DSM available until at least 2006, in 2000 the American Psychiatric Association revised the text of DSM-IV to include new research information that had been developed since first publication in 1994. This text revision (TR) included very few changes in the criteria, and was designed mainly to correct perceived errors in the original text and to bring it up to date with current statistics.

Awareness of the cultural diversity that exists within the Indigenous population as a whole, and specifically within individual communities throughout Australia, is required when addressing the complex area of mental health. This cultural diversity is particularly significant to the issue of 'standard applicability' of any mental health diagnostic tools, instruments, and/or methods that may be developed. Subsequently, thought needs to be given to the probability that the DSM-IV classification system may mean very little to the Indigenous community (or to the non-health community for that matter). Many Australian health care professionals and mental health care workers need further understanding and education about Indigenous culture. (It has been suggested, also, that Indigenous peoples need understanding of mainstream health services, including the diagnosis and subsequent treatment of mental disorders [4]).

The following list is a shortened version (incomplete) of the DSM-IV [1]:

Anxiety disorders
Acute stress disorder (acute psychological consequences of previous trauma)
Agoraphobia (generalised irrational fear)
Generalised anxiety disorder (non-specific anxiety)
Obsessive-compulsive disorder (obsessive thoughts and compulsive rituals)
Panic disorder (unprovoked panic attacks)
Post-traumatic stress disorder (non-acute psychological consequences of previous trauma)
Separation anxiety disorder
Social phobia (irrational fear of embarrassment)
Specific phobia (other specific irrational fears)

Childhood disorders
Attention-deficit/hyperactivity disorder (ADHD)
Conduct disorder (the antisocial personality disorder of childhood)
Oppositional defiant disorder (not only for children)

Eating disorders
Anorexia nervosa (self-imposed starvation)
Bulimia nervosa (binge eating and dieting)

Mood disorders
Bipolar I disorder (mania with/without major depression)
Bipolar II disorder (hypomania with major depression)
Cyclothymic disorder (numerous brief episodes of hypomania and minor depression)
Dysthymic disorder (prolonged minor depression without mania/hypomania)
Major depressive disorder (major depression without mania)

Personality disorders
Antisocial personality disorder (impulsive, aggressive, manipulative)
Avoidant personality disorder (shy, timid, 'inferiority complex')
Borderline personality disorder (impulsive, self-destructive, unstable)
Dependent personality disorder (dependent, submissive, clinging)
Histrionic personality disorder (emotional, dramatic, theatrical)
Narcissistic personality disorder (boastful, egotistical, 'superiority complex')
Obsessive-compulsive personality disorder (perfectionistic, rigid, controlling)
Paranoid personality disorder (suspicious, distrustful)
Schizoid personality disorder (socially distant, detached)
Schizotypal personality disorder (odd, eccentric)

Psychotic disorders
Brief psychotic disorder
Delusional disorder
Schizoaffective disorder
Schizophreniform disorder
Schizophrenia
Shared psychotic disorder

Substance-related disorders
Alcohol dependence (alcoholism)
Amphetamine dependence (stimulants, speed, uppers, diet pills)
Cannabis dependence (marijuana, grass, pot, weed, reefer, hashish, bhang, ganja)
Cocaine dependence (coke, crack, coca leaves)
Hallucinogen dependence (psychedelics, LSD, mescaline, peyote, psilocybin, DMT)
Inhalant dependence (sniffing: glue, gasoline, toluene, solvents)
Nicotine dependence (tobacco)
Opioid dependence (heroin, methadone, morphine, demerol, percodan, opium, codeine, darvon)
Phencyclidine dependence (PCP, angel dust)
Sedative dependence (sleeping pills, barbiturates, seconal, valium, librium, ativan, xanax, quaaludes)

Other disorders
Adjustment disorder
Autistic disorder
Delirium
Dementia
Multi-infarct dementia
Tourette's disorder

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Mental health in Australia

Despite the improvements in physical health and living conditions of Australians over the past century (notably excluding many Indigenous Australians), mental health has not experienced such positive change. Subsequently, efforts to improve mental health and reduce the impact of mental disorders in Australia have received increased impetus in recent years.

One of the outcomes of an increased focus upon mental health has been its identification as one of five National Health Priority Areas [3]. Another outcome has been the launch of the National Mental Health Policy in 1992 [2], under which there were major reforms in both public and private mental health services.

Interestingly, despite these positive moves, Australia still spends a small proportion of its health care budget on mental health services (less than 7%), compared with more than 10%-12% in the United Kingdom, Canada and New Zealand [12]. Before more is spent however, '...we need to determine what priority should be given to the search for preventive strategies, new treatments, or new ways of delivering existing treatments. There is a clear need to move from simple advocacy for more services to a wider population health-based research and evaluation agenda.This population-based need has been defined by the National Action Plan for Promotion, Prevention and Early Intervention for Mental Health, and the National Action Plan for Depression' [6].

Mental health and mental disorders are now high priorities on the Australian health agenda - due to a multiplicity of factors, including prevalence, associated costs, and the heavy burden of suffering that they impose [5]. The recognition of mental disorders/illness as a national priority is an important and positive step in the direction towards mental health for all Australians.

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References

(1) American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TRT).
(2) Australian Health Ministers (1992) National mental health policy. Canberra: AGPS.
(3) Australian Institute of Health and Welfare (AIHW) & Commonwealth Department of Health and Family Services (DHFS) (1997) First report on national health priority areas 1996. Canberra: AIHW & DHFS.
(4) Brown R (2001) Australian Indigenous mental health. Australian and New Zealand Journal of Mental Health Nursing;10(1):33-41.
(5) Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare (1999) National Health Priority Areas Report: Mental health 1998 - A report focusing on depression Canberra: Australian Institute of Health and Welfare.
(6) Hickie I (2002) Preventing depression: a challenge for the Australian community. Medical Journal of Australia, 177(7): S85-S86.
(7) Holmes DS (2001) Abnormal psychology. Boston, MA: Allyn & Bacon.
(8) Jorm A, Griffiths K, Christensen H, Medway J (2001) Research priorities in mental health. A report commissioned by the Mental Health and Special Programs Branch of the Commonwealth Department of Health and Aged Care. Canberra: The Australian National University, Centre for Mental Health Research, Available at www.mentalhealth.gov.au/resources/reports/rpimh.htm
(9) Kendall PC, Hammen C (1998) Abnormal Psychology: Understanding Human Problems. Boston, MA: Houghton Mifflin Company.
(10) Nagle C (1999) Mental health and wellbeing: profile of adults. Canberra: Australian Bureau of Statistics
(11) New South Wales Department of Health (1997) NSW Aboriginal mental health policy: a strategy for the delivery of mental health services for Aboriginal people in New South Wales. Sydney: NSW Department of Health, Centre for Mental Health.
(12) World Health Organization (2001) Atlas: country profiles on mental health resources, 2001. Geneva: WHO, Department of Mental Health and Substance Dependence, Mental Health Determinants and Populations.
(13) World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders. Geneva: WHO.

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Last updated: 19 September, 2008