This document discusses mental health and mental illness. It provides statistics on the global burden of mental disorders, including that 450 million people worldwide have a mental disorder at any time, and over 800,000 die by suicide each year. The text defines mental health and mental illness, and notes that mental disorders are influenced by biological, psychological and social factors. It emphasizes that mental health is closely tied to physical health, and discusses the impact of mental illness on individuals and communities.

1. MENTAL
HEALTH
Professor Syed Amin Tabish
FRCP (London), FRCP (Edin), FAMS, MD
(AIIMS)

2. Mental Health
•Mental, Physical &
Social health are vital
strands of life that are
closely interwoven and
interdependent

3. Mental Health
• Mental health includes
subjective well being,
perceived self-efficacy,
autonomy, competence,
international dependence &
self-actualization of one’s
intellectual & emotional
potential

4. Mental Health: snap shot
• 450 million people worldwide are
affected by mental, neurological
or behavioural problems at any
time.
• About 873,000 people die by
suicide every year

5. Mental Disorders
• Any illness with significant
psychological or behavioural
manifestations that is
associated with either a
painful or distressing
symptoms or impairment in
one or more important areas
of functioning

6. Mental Illness
• A mental illness can have an
effect on every aspect of a
person’s life, including
thinking, feeling, mood, and
outlook and such areas of
external activity as family
and marital life, sexual
activity, work, recreation,
and management of material
affairs.

7. Mental Illness
• Mental illnesses are
common to all countries and
cause immense suffering.
• People with these disorders
are often subjected to social
isolation, poor quality of life
and increased mortality.

8. Magnitude
• One in four patients
visiting a health service
has at least one mental,
neurological or
behavioural disorder but
most of these disorders
are neither diagnosed nor
treated.

9. Impact
• Mental illnesses affect and are
affected by chronic conditions
such as cancer, heart and
cardiovascular diseases, diabetes
and HIV/AIDS
• Untreated, they bring about
unhealthy behaviour, noncompliance with prescribed
medical regimens, diminished
immune functioning, and poor
prognosis.

10. Present Scenario
• Cost-effective treatments
exist for most disorders
and, if correctly applied,
could enable most of those
affected to become
functioning members of
society.

11. Present Scenario
• Most middle and low-income
countries devote less than 1% of
their health expenditure to
mental health.
• Consequently mental health
policies, legislation, community
care facilities, and treatments for
people with mental illness are
not given the priority they
deserve.

12. Impact
• Today, 450 million people
suffer from a mental or
behavioural disorder
• This growing burden amounts
to a huge cost in terms of
human misery, disability &
economic loss

13. Etiology
•Mental and behavioural
disorders are the result
of a complex interaction
between biological,
psychological and social
factors

15. Burden of mental disorders
• According to WHO, mental
disorders affect more than
25% of all people at some
time during their lives.
• They have an economic
impact on societies and on
the quality of life of
individuals and families

16. Disease Burden
• Within next 15 years, depression
will have the dubious distinction
of becoming the second cause of
the Global Burden of Disease
• Worldwide, 70 m people suffer
from alcohol dependence, 50 m
have epilepsy, 24 m have
schizophrenia and another 20 m
attempt suicide every year

17. Burden of Disease
• Mental disorders are present at
any point in time in about 10%
of the adult population
• Around 20% of all patients seen
at PHCs have one or more mental
disorders
• One in 4 families is likely to have
at least one member with a
mental disorder

18. Depression
• Depressive illnesses often
interfere with normal functioning
and cause pain and suffering not
only to those who have a
disorder, but also to those who
care about them.
• Serious depression can
destroy family life as well as
the life of the ill person.

19. Burden of Disease
• An estimated 39% of all Disability
Adjusted Life Years (DALYs) in low
and middle income countries were
attributable to non-communicable
diseases
• Neuropsychiatric conditions account
for 10% of the burden from NCD
• Unipolar major depression was the
4th leading cause of DALYs both in
high & middle income economies

20. Determinants of mental
disorders
Factors that determine the
prevalence, onset & course of
mental disorders include:
• Social & economic factors
• Demographic factors (sex, age)
• Serious threats such as conflicts
& disasters
• The presence of major physical
disease
• The family environment

21. Determinants of mental
disorders
• Poverty
• Unemployment
• Low educational level
• Deprivation
• Homelessness
• Conflicts (war, civil strife)
• Disasters

22. Determinants of mental disorders
• All significant events in
life act as stressors and,
coming in quick
succession, predispose the
individual to mental
disorders

23. Determinants
• Social & environmental
factors within the family
play a role in mental
disorders (e.g.
schizophrenia)

24. Top causes of disability
Neuropsychiatric conditions:
• Depressive disorders
• Alcohol use disorders
• Schizophrenia
• Bipolar affective disorder
• Dementias
• Migraine

25. Stop exclusion:
Dare to Care

26. Psychopathology
• Systematic study of the
significant causes, processes &
symptomatic manifestations of
mental disorders
• The meticulous study,
observation, and enquiry that
characterize the discipline of
psychopathology are in turn the
basis for the practice of
psychiatry

27. Psychiatry
• The science & practice of treating
mental disorders
• Dealing with their diagnosis &
prevention
• Wide spectrum of techniques
include: use of psychoactive
drugs to correct biochemical
imbalances in the brain or
otherwise to relieve depression,
anxiety, & other painful
emotional states

28. Psychotherapies
• Seek to treat mental disorders by
psychological means and which
involve verbal communication
between the patient and a trained
person in the context of a therapeutic
interpersonal relationship between
them
• Behavioural therapy: concentrates on
changing or modifying observable
pathological behaviors by the use of
conditioning etc

29. Neurosciences
• The adult brain is made up of
about 100 billion neurons and
1000 billion neuroglia
• Weight: 1.3 kgs
• Parts: brain stem, cerebellum,
diencephalons (thalamus &
hypothalamus), cerebrum
• Brain stem is continuous with
Spinal Chord & consists of
medulla oblongata, pons &
midbrain

30. Behavioural medicine
• Concerned with the integration
of behavioural, psychological, &
biomedical sciences knowledge
relevant to the understanding of
health & illness
• Physical & mental health
mutually influence each other
over a period of time

31. Health Behaviour
• Health behaviour can affect
physiology, while physiological
functioning can influence health
behaviour, resulting in
comprehensive model of physical
& mental health, in which the
various components are related
and mutually influential over
time
• Thoughts, feeling & behaviours
have a major impact on health

32. Social Psychology
• The scientific study of the
behaviour of individuals in
their social & cultural setting
• To reduce racial conflict, to
design mass
communications, to advise on
child rearing
• Popular books
• Periodical press

33. Enlightened Mental Health Policy
• Provide treatment in primary
care
• Make psychotropic drugs
available
• Give care in the community
• Educate the public
• Involve communities, families
• Establish national programs
• Develop resources
• Link with other sectors

34. Actions required
• Cover the total population
• Train all health professionals on
essential mental HC
• Mental health can be introduced
in schools & workplaces
• Use the mass media to promote
MH
• Create drug & alcohol policies
• Surveillance studies

35. Minimum actions required
• Include the recognition &
treatment of common mental
disorders in training curricula of
all health professionals
• Refresher training to pry. Care
docs
• Ensure availability of essential
drugs
• Survey high risk populations
• Conduct research

36. Community Mental Health
• Providing good care
• Development of a wide range of
services with local settings
• Services that are close to home,
including general hospital care
for acute admissions, & longterm residential facilities in the
community
• Interventions related to
disabilities as well as symptoms

37. Community Mental Health
• Treatment & care specific to the
diagnosis & needs of each
individual
• Services that are coordinated
between mental health
professionals & community
agencies
• Ambulatory rather than static
services
• Partnership with carers

38. Women’s Health
• Women are integral to all
aspects of society
• The multiple roles that
they fulfill in society
render them at greater risk
of experiencing mental
problems than others in
the community.

39. Women’s Health
• Women bear the burden of
responsibility associated with
being wives, mothers and
carers of others.
• Increasingly, women are
becoming an essential part of
the labour force and in onequarter to one-third of
households they are the prime
source of income (WHO, 1995).

40. Women’s Health
• Women are more likely than
men to be adversely affected
by specific mental disorders,
the most common being:
anxiety related disorders and
depression; the effects of
domestic violence; the effects
of sexual violence; and
escalating rates of substance
use.

41. Saudi Arabia
• Saudi Arabia is a country with an
approximate area of 2150 thousand
sq. km. (UNO, 2001)
• Its population is 24.919 million
• the sex ratio (men per hundred
women) is 116 (UNO, 2004).
• The proportion of population under
the age of 15 years is 39% (UNO, 2004)
• The proportion of population above
the age of 60 years is 4% (WHO, 2004).
The literacy rate is 84.1% for men
69.5% for women (UNESCO/MoH, 2004).

42. Saudi Arabia
• The country is a higher middle
income group country (based on World
Bank 2004 criteria).
• The proportion of health budget
to GDP is 4.6%.
• The per capita total expenditure
on health is 591 international $,
• The per capita government
expenditure on health is 441
international $ (WHO, 2004).

43. Saudi Arabia
• The life expectancy at birth is
68.4 years for males and 73.9
years for females (WHO, 2004).
• The healthy life expectancy
at birth is 60 years for males
and 63 years for females (WHO,
2004).

44. SA: Mental Health Resources
• A mental health policy is
present; initially formulated in
1989.
• The components of the policy
are advocacy, promotion,
prevention, treatment and
rehabilitation.
• A substance abuse policy is
present; initially formulated in
2000.

45. SA: NMH Program
• A national mental health programme
is present; formulated in 1989.
• Aim: integrating mental health into
primary and community care,
developing a model keeping in view
the social, cultural and religious
values of the country in perspective,
using mental health principles in
promoting social health, decreasing
untoward impact of social and
economic development on society like
drug abuse, smoking, delinquency

46. SA: Drug Policy
• National Therapeutic Drug
Policy/Essential List of Drugs
A national therapeutic drug
policy/essential list of drugs
is present
• It was formulated in 1988.

47. Mental Health Legislation
• A mental health act is awaiting
approval.
• The General Directorate for
Mental Health has developed a
manual of procedures and
regulations for mental health
institutions in the country until
the mental health act is
approved.

48. Mental Health Facilities
• Mental health is a part of primary
health care system.
• Actual treatment of severe
mental disorders is available at
the primary level.
• All anti-depressants and
neuroleptics and some antiepileptics are exempt from
control and so all primary care
physicians can prescribe most of
the drugs.

49. SA: Community Care
• There are community care
facilities for patients with mental
disorders.
• Rehabilitative services were
planned following a Royal decree
in 1988 but it mainly
concentrated among private
organizations and self help
groups like the Patients’ Friends
Committee, etc.

50. Saudi Arabia

51. Programmes for Special
Population
• The country has specific
programmes for mental health
for children.
• Child psychiatric services are
mainly provided as out-patient
care and emergency cases are
admitted in pediatric hospitals or
general hospitals.
• Six school units are operational
in Riyadh.

52. Thank You
Very Much

55. Prevention, promotion and
management programmes
• A combination of well-targeted
treatment and prevention
programmes in the field of mental
health, within overall public
strategies, could avoid years lived
with disability and deaths, reduce
the stigma attached to mental
disorders, increase considerably
the social capital, help reduce
poverty and promote a country’s
development.

56. Mental Health
• A state of well-being whereby
individuals recognize their abilities,
are able to cope with the normal
stresses of life, work productively and
fruitfully, and make a contribution to
their communities.
• Mental health is about enhancing
competencies of individuals and
communities and enabling them to
achieve their self-determined goals.

58. BOD
• More than 150 million persons
suffer from depression at any
point in time
• Nearly 1 million commit suicide
every year
• About 25 million suffer from
schizophrenia
• 38 million suffer from epilepsy
• More than 90 million suffer from
an alcohol- or drug-use disorder.

59. BOD
• Among the 10 leading risk
factors for the global burden of
disease measured in DALYs,
three were mental/behavioural
(unsafe sex, tobacco use, alcohol
use) and three others were
significantly affected by mental/
behavioural factors (overweight,
blood pressure and cholesterol).

62. The burden of substance abuse
• 76.3 million persons are diagnosed with alcohol
disorders;
• At least 15.3 million persons are affected by
disorders related to drug use
• Between 5 and 10 million people currently inject
drugs
• 5%–10% of all new HIV infections globally result
from injecting drugs;
• More than 1.8 million deaths in 2000 were attributed
to alcohol related risks
• 205,000 deaths in 2000 were attributed to illicit drug
use
• The government, drug abusers and their families
shoulder the main economic burden of drug abuse
• For every dollar invested in drug treatment, seven
dollars are saved in health and social costs.

63. Talking about mental disorders means talking
about poverty: the two are linked in a vicious circle

64. Mental health promotion

65. A stitch in time

66. A wide gap between the burden of
neuropsychiatric disorders and the mental health
budget

67. Much can be done;
everyone can
contribute to better mental health