Dept. of Community Medicine
• 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.
• 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.
• 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.
• 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.
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
• Constant worry, insomnia, mood fluctuations.
• Unhappy without cause, always fearful.
• Aches and pain without physical cause.
• Prefer loneliness, upset if routine is disturbed.
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.
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,
• Delusional disorders: Schizophrenia. 9
Crucial points in Life cycle
• Prenatal period.
• First 5 years child requires love and care. Broken homes
• Schooling climate should be good.
• Adolescent period most important.
• Old age.
• Need for affection, belonging, independence are needed
for all ages.
• Primary: community basis improving social
• Secondary: early diagnosis of mental illness by
• Provision of tretment facility and community
• Family based health services with counselling.
• Tertiary: Reduced duration of illness, prevent further
Mental health services
• Early diagnosis and treatment
• Group and individual psychotherapy.
• Mental health education
• Use of Modern Psychoactive drugs
• After care services.
Comprehensive Mental Health Programme
• Integration of Psychiatric services with other health
• Community Mental Health programme:
• In-patient services
• Out patient services
• Partial hospitalization
• Emergency and diagnostic services
• Education, Training and research
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
• Drug dependence: A state, psychic , sometimes into
physical characterized by compulsion to take the
drug on periodic basis to experience its effect.
• 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
• About 29,247 cases under Narcotic Drugs and
Psychotropic Substances Act were registered in
• As per NFHS-3 less than 1/3rd of men and 2% of
women abuse substance.
Dependence producing Drugs
• Sedatives or hypnotics.
• Other volatile substances and steroids
• Heroin: worst type of addiction.
• LSD: Psychotogenic drug
• 2 billion consume alcohol.
• Worldwide 2.3 million die from alcohol(6% men ands
• 65 million DALY due to alcohol.
• Increasing usage among young people and women.
• In India 20-30% males and 5% of females use 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.
• 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.
• 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. 29
• Over – ambitions hopes of eradication in short time
• Change will be slow.
• Legal approach: legislation,ban and restriction at
• Prohibition of ads, sale to minors, in public places
• Use of health warnings on packs.
• Educational approach:
• Programme for school children.
• Information campaign.
• Integrated plan of action involving other strategies.
• Community approach:
• Alternative activities.
• Identification and motivation.
• Post-detoxification and follow-up.
• Simultaneous environment and social intervention
• Mature attitude and avoiding discrimination.
• Preventing relapse through vocational training and
• Proper follow-up
• Mental health condition is stigmatizing.
• Wide spectrum of disorders.
• Multifactorial with psychosocial and environmental
• Scientific basis and Community approach for drug