Dr.Sahithyaa Assistant professor

Dept. of Community Medicine

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Contents

• Mental health – stigma and problem statement.

• Mental illness - its types and causes.

• Mental health services and program and prevention.

• Alcohol and drug dependence.

• Substance abuse, prevention and treatment.

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Mental Health

• WHO definition of health?

• WHO expert committee in 1950:

- Influenced by biologic and social factors.

- Not static.

- Harmonious relation to society.

- Balanced satisfaction of individual drives.

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Problem Statement

• WHO: 10% point prevalence.

• 450 million worldwide suffer.

• India: mental morbidity: 18-20/1000.

• 47 mental institutions in India with 10,329 beds.

• 896000 adults 22,300 children were treated.

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Problem Statement

• New cases: • 56000 schizophrenia.• 38k neurotic and 31k mood disorders.• Less than 1000 personality disorders.

• Among child:• 317 psychoactive substance users.• 1100 mood disorders• 1000 unspecified mental disorders.

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Mentally healthy person

• Feels secure, comfortable, and has self respect. - Estimates balanced. - Accepts shortcoming.

• Feels right towards others. - friendship and love - responsibility for fellowmen

• Meet demands of life. - solves issues, takes own decision - not bowled over by emotions

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Warning signals

• Constant worry, insomnia, mood fluctuations.

• Unhappy without cause, always fearful.

• Aches and pain without physical cause.

• Prefer loneliness, upset if routine is disturbed.

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Mental Illness- Types

• Major (Psychosis) : Insanity

• Schizophrenia(Split personality).

• Manic depressive psychosis (Bipolar).

• Paranoia: extreme suspicion.

• Minor illness:

• Neurosis: unable to react to normal situations.

• Personality and character disorders.

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Mental Illness- Types

• Vast, broad and difficult to precise.

• Individual suffer one or more disorders.

• ICD-10 classification:

• Organic including symptomatic : Alzheimer.

• Due to psychotropic substances: Alcohol, dependence syndromes.

• Delusional disorders: Schizophrenia.

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Mental Illness- Types

• Mood disorders: Bipolar affective disorders.

• Neurotic , stress related and somatoform disorders: GAD, OCD, Hypochondriasis.

• Behavioural Syndromes: eating disorders.

• Adult personality disorders: Trans-sexualism.

• Childhood psychological development disorders: Hyperkinetic disorders, Autism.

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Causes of Mental Illness

• Multifactorial.

• Organic condition: • cerebral arterioslerosis, neoplasms, chronic diseases

etc

• Heridity: • Child of schizophrenic parents more likely to develop

same condition.

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Causes of Mental Illness• Social patholgical causes:

• Emotional stress , anxieties, broken marriages and homes, Cruelty, rejection, neglect..

• Industrialization, Urbanization, migration, poverty.

• Others:• Toxic substances, Psychotropic substances,

Nutritional factors, Minerals, Infective agents, Trauma and Radiation.

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Crucial points in Life cycle

• Prenatal period.

• First 5 years child requires love and care. Broken homes produce disorders.

• Schooling climate should be good.

• Adolescent period most important.

• Old age.

• Need for affection, belonging, independence are needed for all ages.

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Prevention• Primary: community basis improving social

enviroinment.

• Secondary: early diagnosis of mental illness by screening programs.

• Provision of tretment facility and community resources.

• Family based health services with counselling.

• Tertiary: Reduced duration of illness, prevent further breakdown

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Mental health services

• Early diagnosis and treatment

• Rehabilitation.

• Group and individual psychotherapy.

• Mental health education

• Use of Modern Psychoactive drugs

• After care services.

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Comprehensive Mental Health Programme

• Integration of Psychiatric services with other health

services.

• Community Mental Health programme:

• In-patient services

• Out patient services

• Partial hospitalization

• Emergency and diagnostic services

• Education, Training and research

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Alcohol and Drug Dependence

• WHO Drug abuse : It is defined as self administration of a drug for non-medical reasons, in quantities and frequency which impairs individuals ability and function and result in Physical, Social and Emotional harm.

• Drug dependence: A state, psychic , sometimes into physical characterized by compulsion to take the drug on periodic basis to experience its effect.

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Problem statement• Globally 250 million are drug abusers.

• Abuse of tobacco, alcohol, and illicit drugs exacts more than $700 billion annually in costs related to crime, lost work productivity and health care in USA.

• About 29,247 cases under Narcotic Drugs and Psychotropic Substances Act were registered in 2012.

• As per NFHS-3 less than 1/3rd of men and 2% of women abuse substance.

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Dependence producing Drugs

• Alcohol.• Opiods.• Cannabinoids.• Sedatives or hypnotics.• Cocaine• Caffeine• Hallucinogens• Tobacco• Other volatile substances and steroids

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Drugs

• Amphetamines :• Stimulants and produce mood elevation.• Superman drugs.• Dexendrene, Methedrine.

• Cocaine:• CNS stimulant.• Nodependence.

• Barbiturates: • Sedative, high dependence producing.

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Drugs

• Cannabis:

• Heroin: worst type of addiction.

• LSD: Psychotogenic drug

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Alcohol

• 2 billion consume alcohol.

• Worldwide 2.3 million die from alcohol(6% men ands 1% women).

• 65 million DALY due to alcohol.

• Increasing usage among young people and women.

• In India 20-30% males and 5% of females use alcohol.

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Alcohol

• CNS depressant with physical dependence.

• Alcoholism is a disease.

• It leads to suicides, economic crisis in family, road traffic accidents and many health problems.

• Total family disorganization, crime and loss of productivity for society.

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Tobacco

• Tobacco consumption decreasing in developed but increasing in developing countries.

• Global cigarette consumption steadily increasing.

• 1070 million males and 230 million females smoke.

• China produces 1/3rd of cigarettes in the world and is major consumer.

• Global adult tobacco survey: 48% (males) and 20%(females) including smokeless forms.

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Tobacco

• More death than all substance combined.

• 30% of all cancer death.

• Respiratory and cardiovascular disorders.

• Adolescent experimentation and peer pressure.

• Women at higher risk due to obstetric complications.

• Passives smoking is also dangerous and withdrawal continues for more than a month.

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Prevention• Over – ambitions hopes of eradication in short time

usually fails.

• Change will be slow.

• Legal approach: legislation,ban and restriction at various levels.

• Prohibition of ads, sale to minors, in public places

• Use of health warnings on packs.

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Prevention

• Educational approach:• Programme for school children.• Information campaign.• Integrated plan of action involving other strategies.

• Community approach:• Alternative activities.

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Treatment

• Identification and motivation.• Detoxification.• Post-detoxification and follow-up.• Simultaneous environment and social intervention

needed.

• Rehabilitation:• Mature attitude and avoiding discrimination.• Preventing relapse through vocational training and

work.• Proper follow-up

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Deaddiction centers

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Summary

• Mental health condition is stigmatizing.

• Wide spectrum of disorders.

• Multifactorial with psychosocial and environmental determinants.

• Scientific basis and Community approach for drug dependence.

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• Thank you