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Background information

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Introduction

Mental health problems and mental illnesses or disorders are increasingly becoming a significant public health issue. The consequences for individuals, families and communities are a key challenge for governments worldwide [1]. It is estimated that mental health disorders comprise 10% of the worldwide burden of disease [2]. Specifically for Australians, one in five will experience a mental health problem at some time in their lives [2] and 18% of adults will suffer from a mental illness.

Defining the terms: mental health, mental illnesses and mental health problems

The World Health Organization (WHO) has defined mental health as a state of wellbeing where a person is aware of their own abilities to cope with everyday stressors, work productively and make contributions to their community [3]. The importance of mental health has been acknowledged by the WHO and is considered to be part of their general definition of health which is defined as a ‘state of complete physical, mental and social wellbeing'.

The WHO proposes that mental health is not merely an absence of disease or an illness [3]. Mental health is about having sufficient money to live on, having a job and enjoying relationships and friendships [4]. It is dependent on an individual having a sense of meaning for their life and having control over their life. It can also relate to a sense of belonging or connection. Importantly, mental health is also about having access to treatment and support for any problems experienced.

Mental health problems and mental health illnesses or disorders refer to ‘the spectrum of cognitive, emotional and behavioural disorders that interfere with the lives and productivity of people' [5]. The term mental illness is favoured by many in the community as it acknowledges the legitimate right to health care that people suffering from this illness should have. A mental illness is identified through a diagnostic process, while a mental health problem is considered less severe but still capable of interfering with an individual's life. Mental health problems usually stem from a response to a life stressor and are more common but, have the potential to develop into a mental illness.

Defining the term: social and emotional wellbeing

The WHO has included mental health as part of their general definition of health, a holistic view supported by Aboriginal and Torres Strait Islander people [6]. In the ‘whole-of-life view' included in the National Aboriginal Health Strategy, health is defined as not just the physical wellbeing of a person but the social, emotional and cultural wellbeing of the whole community [7]. This ‘whole of life' view provides the foundation for the term ‘social and emotional wellbeing' which refers to the ability of individuals or communities to develop, live in harmony with others and the environment, and to effect change [8]. Today many health services in Australia use the phrase ‘social and emotional wellbeing' when they refer to mental health in Indigenous communities as it reflects the holistic philosophy Indigenous people have towards (or about) health.

What factors affect our mental wellbeing?

Similar to an individual's physical health, mental health is influenced by complex social, environmental, economic and biological factors [9]. Mental illnesses can affect people of all ages and from different cultures. The suffering experienced from a mental illness can affect not only individuals but also extend to families and whole communities.

Research has identified elements that can have either a positive or negative influence on mental health [2]. Positive influences include environmental quality, self-esteem, emotional processing, self-management skills and social participation. Negative influences incorporate environmental deprivation, emotional abuse, emotional neglect, stress and social exclusion. These elements can work at an individual level, community, family, and workplace or peer group level and at government or organisational levels.

Some of the environmental, social, economic and biological factors which can determine mental health illnesses or problems experienced by an individual include:

How is culture important to the understanding of mental illnesses?

From a cultural perspective it is important that mental health is defined as more than the absence of a mental illness [9]. Scholars worldwide define mental health from different cultural perspectives as they interpret aspects of mental health including wellbeing, competence and emotional potential from their specific cultural viewpoint [9].

The cultural diversity of Australia can influence how individuals seek help for a mental illness, how mental illnesses are expressed and how a person's symptoms are diagnosed and treated [6]. It is important that healthcare professionals and workers understand and continue to develop their understanding of the effects of culture on a patient's mental health or illness [10]. When considering the mental health issues of diverse cultures, it is important to acknowledge there is a wide range of social, cultural, educational and family backgrounds within the same culture and that what is relevant for one group is not always relevant for another group [10]. Healthcare professionals need to determine that the tools they employ to diagnose and treat a particular mental illness are correct for their clients. If they decide the screening tools are not correct then alternative guidelines need to be developed [11], specific to that cultural group.

What are the different categories of mental illnesses?

Mental illnesses are clinically diagnosed by a health professional according to either the five-point multiaxial classification system of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) or the International Classification of Diseases, Tenth Edition (ICD-10) [5].
The symptoms for mental illnesses can differ considerably from one person to another, but they are usually distinguished by some combination of abnormal thoughts, emotions, behaviour and relationships with others which normally follow an expected course unless treatment is provided [9]. The clinical procedure used to identify and diagnose mental illnesses includes collecting a detailed history of the client's life, a physical examination and the application of specific tests to determine mental status [9]. The DSM-IV-TR, referred to in this report as ‘the manual' will be used to give meaning and understanding to the issues relevant to mental illnesses.

The mental illnesses described by the manual include:

Often people experience symptoms relating to one or more of the above mental illnesses or disorders concurrently. This is referred to as co-morbidity. Co-morbidity increases the levels of distress experienced by these people compared to people suffering from only one disorder [12]. The manual uses five axes to explain the full mental and physical wellbeing of an individual. This method is used as it provides a formal assessment of a person's mental health and it identifies the significance of multiple factors in a person's life, both mental and physical, which contribute to their mental health. The axes are:

What causes mental illnesses or disorders to occur?

It is unclear what actually causes a mental illness to develop. Studies highlight an often complex interaction between biological, psychological and social factors [9]. Contributing to the knowledge in this area is the work of neuroscience, genetics, psychology and sociology.

Biological factors

Certain mental illnesses have been linked with disruptions of neural communication [9]. The brain consists of millions of nerve cells which utilise chemicals called neurotransmitters to facilitate the communication between nerve cells. For effective communication between nerve cells these neurotransmitters must be in balance. If through damage to the brain, use of drugs or a life changing experience these neurotransmitters are disrupted, long-term changes to the way people think, express emotion and behave can occur [9].

Genetics are also associated with some mental illnesses [9]. Individuals may inherit a genetic tendency to develop a mental illness. However, research suggests a complex interaction between genetic factors and environmental factors which influences whether the onset of a mental illness is triggered. Examples of such environmental factors include family problems, neglect or trauma.

Psychological factors

Research has found that individual psychological factors can influence the development of mental illnesses [9]. The relationship individuals have with their parents or caregivers in terms of affection given, attention to emotional needs and stability within the family has an important role in the future mental wellbeing of individuals. Secondly, human behaviour is to a degree shaped through an individual's interaction with their natural or social environments [9]. Behaviours which are rewarded by the environment are engaged in more often than those ignored or punished. Mental illnesses may be viewed as a maladaption of behaviour learned from the observation of others over the course of their life. Finally, mental illnesses may be a result of a failure to cope with stressful life events [9].

Social factors

Social factors which can have an adverse affect on mental health include urbanisation, remote living, poverty and technological change. For example, people living in remote areas are faced with isolation, lack of adequate transport and communication and limited educational and employment opportunities which may have harmful consequences for mental health. Consideration must also be given to the roles of economic status, sex, race and ethnicity [9].  Research [9]shows for example that people who are the target for racist comments are at a higher risk for developing mental problems or a deterioration of existing ones.

The links between biological, psychological and social factors and the knowledge gained from research in these areas is vital to significantly decreasing the burden of mental illnesses worldwide.

What strategy does Australia have in place for the mental health of its nation?

The National Mental Health Strategy has been in operation since 1991, and initially focused on structural changes in relation to where and how mental services were delivered [13]. This focus has been broadened in subsequent strategies to include promoting partnerships between different sectors responsible for mental health planning and giving greater attention to promotion, prevention, intervention and the roles of consumers and their carers. The importance of mental health issues for the Australian workforce has also gained greater attention together with the need for further research in this area of health. The current National Mental Health Policy 2008 under the umbrella of the National Mental Health Strategy aims to provide a mental health system that:

The national mental health strategy acknowledges the need for collaboration between service providers: government, private, non-government agencies, individuals and organisations in Australia as they aim to improve the mental health of all Australians [13].

The National Mental Health Policy 2008 also recognises Australians' Indigenous heritage and how the unique rights, culture, self-determination and the importance of the land to the Indigenous population are vital to their social and emotional wellbeing.

References

  1. Victorian Department of Human Services (2008) Because mental health matters: a new focus for mental health and wellbeing in Victoria. Melbourne: Victorian Department of Human Services
  2. Keleher H, Armstrong R (2005) Evidence-based mental health promotion resource. Melbourne: Victorian Government Department of Human Services
  3. World Health Organization (2009) Mental health: strengthening mental health promotion. Retrieved September 2007 from http://www.who.int/mediacentre/factsheets/fs220/en/index.html
  4. Wainer J, Chesters J (2001) Rural mental health: neither romanticism nor despair. Australian Journal of Rural Health; 8(3): 141-147
  5. Australian Health Ministers (2003) National Mental Health Plan 2003-2008. Canberra: Australian Government
  6. Social Health Reference Group (2004) Social and emotional well being framework: a national strategic framework for Aboriginal and Torres Strait Islander mental health and social and emotional well being 2004-2009. Canberra: Australian Government
  7. National Aboriginal Health Strategy Working Party (1989) A national Aboriginal health strategy. Canberra: Department of Aboriginal Affairs
  8. NSW Health (2007) NSW Aboriginal mental health and well being policy 2006-2010. Sydney: NSW Health
  9. World Health Organization (2001) The World Health Report 2001: mental health: new understanding, new hope. Geneva: World Health Organization
  10. Brown R (2001) Australian Indigenous mental health. Australian and New Zealand Journal of Mental Health Nursing; 10(1): 33-41
  11. Vicary D, Westerman TG (2004) 'That's just the way he is': some implications of Aboriginal mental health beliefs. Australian e-Journal for the Advancement of Mental Health; 3(3) Retrieved 2004 from http://www.atypon-link.com/EMP/doi/pdf/10.5172/jamh.3.3.103
  12. Australian Institute of Health and Welfare (2008) Australia's health 2008: the eleventh biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
  13. Department of Health and Ageing (2009) National mental health policy 2008. Canberra: Commonwealth of Australia

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