lecture

1. PUBLIC MENTAL HEALTH
Dr Zahiruddin Othman

2. CURRENT SCENARIO
• People are living longer and getting sicker
• By 2020 the WHO estimates that unipolar
depression will be the leading cause of
disability, responsible for 1 in 10 years of life,
worldwide
• Pharmaceutical company

3. STRESS – BASIC CONCEPTS

4. STRESS IN MODERN SOCIETY

5. ROLE OF STRESS IN ILLNESS

7. DEFINITIONS OF PREVENTION
• Primary prevention
– Prevention of disease before it occurs
• Secondary prevention
– Prevention of recurrence or exacerbation of a disease that
has been diagnosed
• Tertiary prevention
– Reduction in the amount of disability caused by a disease
to achieve highest level of function
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8. IOM (1994) DEFINITIONS
• Prevention
– Prevention to ward off the
initial onset of a mental
disorder
• Treatment
– Identification of an
individuals with mental
disorders and the standard
treatment for those
disorders
• Maintenance
– Intervention that are
oriented to reduce relapse
and recurrence and to
provide rehabilitation
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9. EARLY INTERVENTION IN SCHIZOPHRENIA
Universal Prevention
• Raising the awareness,
promoting referrals
from PC physicians
• PUFA, especially
omega-3 in fish oil,
and vitamin D
Selective Prevention
(targeted prevention)
• Prenatal infection or
malnutrition, perinatal or
obstetric complications, older
paternal age, winter season of
birth, separation from primary
caretakers during the first year
of life, absence of protective
family environments,
childhood physical and sexual
abuse, urbanicity, cannabis
use, unemployment, never-
married marital status, and
history of migration
Indicated Prevention
• PACE: CBT +
risperidone;
• PRIME: Olanzapine;
• RAP: Antipsychotics
vs. antidepressants;
• OPUS: Standard vs.
integrated treatments;
• EDIE: Cognitive
therapy;
• GRNS: Amisulpiride;
• VGH: Omega-3
Mohammadreza Mokhtari, Rajaprabhakaran Rajarethinam. Early Intervention and the Treatment of Prodrome in Schizophrenia: A Review of Recent Developments. Journal of Psychiatric Practice. 2013;19(5):375-85
PACE: Personal Assessment and Crisis Evaluation; PRIME: Prevention through Risk Identification, Management, and Education; RAP: Recognition and
Prevention; EDIE: Early Detection and Intervention Evaluation; GRNS: German Research Network on Schizophrenia; VGH: Vienna General Hospital

10. ULTRA HIGH RISK (UHR)
FOR PSYCHOSIS
1) Attenuated Psychotic Symptoms (APS)
– Sub threshold, attenuated forms of positive psychotic
symptoms
2) Brief Limited Intermittent Psychotic Symptoms (BLIPS)
– episodes of frank psychotic symptoms that have not lasted
longer than a week and have spontaneously abated
3) Trait and State Risk Factor (Trait)
– first-degree relative with a psychotic disorder or
– schizotypal personality disorder in addition to a
significant decrease in functioning
Trait<APS<BLIPS
B. Nelson, K. Yuen, A.R. Yung. Ultra high risk (UHR) for psychosis criteria: Are there different levels of risk for transition to psychosis?Schizophrenia Research 125 (2011) 62–68

11. CONS OF PREVENTIVE INTERVENTIONS
• Low predictive value
– High false positive rates
• Stigmatization and labelling of at risk individuals can
cause unnecessary anxiety and demoralization about
prognosis
– Unnecessary treatment of individuals who are not
truly at risk
• Pre-emptive use of antipsychotics, with potentially
serious metabolic and neurological side effects.
Mohammadreza Mokhtari, Rajaprabhakaran Rajarethinam. Early Intervention and the Treatment of Prodrome in Schizophrenia: A Review of Recent Developments. Journal of Psychiatric Practice. 2013;19(5):375-85

12. Traditional
•Neurocognitiverisk
factors
Cutting edge
•Attenuated
schizophrenia-like
behavioural indicators
Future
•Validationof predictors
Cutting edge
•Prevention
Current
•Reducingthe DUP
Current/traditional
•Relapse prevention
Traditional
•Symptoms control
PREMORBID PRODROMAL EMERGING PSYCHOSIS INITIAL EPISODE
MULTIEPISODE
(CHRONIC)

13. EARLY AND LATE INITIAL PRODROMAL STATE:
A CLINICAL STAGING APPROACH

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MODEL OF MENTAL HEALTH SERVICES
MODEL BASIC
CONCEPT
TARGET
POPULATION
COMPONENTS PRACTICES EXAMPLES
Institution /
Hospital-based
Mainly
medically
oriented
Mentally ill
person
Custodial
Curative
Whole of life
Minimal outreach
/ aftercare
Admission
Diagnosis
Treatment
Discharge
HBUK
De-institutional
community
based
Mainly
psychosocial
Mentally ill
person
In closing of
mental hospital
Treatment in the
community
Arranged social
environment
Train living and
coping skills
Surrogate
parent
model
Integrated /
decentralization
Wellness
concept
Healthy
At risk
Mentally ill
Promotive
Preventive
Curative
Rehab
Mental health
promotion
Early detection
Treatment
Psychosocial
rehab
As proposed
by WHO
(1990)

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to those involved in any planning and
implementation towards improving mental
health and well being of entire population
for population at risks of developing
psychosocial problems
for the mentally disordered in the provision
of care and protection by the family,
community and relevant agencies
To provide a
basis in developing
strategies
To improve mental
health services
To improve
psychiatric services
NATIONAL MENTAL HEALTH POLICY

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“Mental Health And Mental Health services”
“Life Skills For Mental Health”
“Mental Disorders In Primary Care”
Module 1
Module 2
Module 3
TRAINING MODULE

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MENTAL HEALTH PROMOTION
MATERIALS
32 various topics of mental health
Some 200,000 leaflets covering 13 various
topics e.g. mental health, mental illness, mental
health for children, misunderstanding of mental
illness, stigma and mental illness, stress etc
"Apakah itu Kesihatan Mental" (1997) and
"Tangani Tekanan Mental"(1998)
Posters
Leaflets
Television
documentaries

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Kempen Cara Hidup Sihat

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MENTAL HEALTH SERVICES
IN EXISTING CLINICS
• By Sept 1999, 129 clinics nationwide have establish:
– Health talks on mental health topics
– Early detection
– Treatment and referral to psychiatrists
– Follow up of stable cases
– Home visits (defaulter tracing, check drug compliance,
administer injection)
– Counseling
– Health education for patient, family and community
– Training (echo and in-service/attachments)