Mental health is about enhancing competencies of individuals and communities and enabling them to achieve their self-determined goals. Mental health should be a concern for all of us, rather than only for those who suffer from a mental disorder. Mental health problems affect society as a whole, and not just a small, isolated segment. They are therefore a major challenge to global development. This presentation focuses on the importance of mental health, the common substance abuse and their influence on mental health.

1. MENTAL
HEALTH
AND
SUBSTANC
E ABUSE Presented By
Dr.Sindhu R
IIIrd Year Postgraduate
Department of Public Health Dentistry

2. CONTENTS
o Introduction
o Classification of Mental disorders
o Biopsychosocial model of mental illness
o Prevalence of mental morbidity in India
o Impact of mental disorders
o High-risk behavior problems in the community
o Prevention of mental disorders
o Alcohol and drug related problems
o Psychoactive substances
• Amphetamines
• Cocaine
• Barbiturates
• Cannabis
• Volatile solvents
• Lysergicacid diethyl amide(LSD)
• Alcohol
• Tobacco
o Magnitude of substance use in India
o Prevention of substance abuse
o Conclusion
o References

3. MENTAL HEALTH
DEFINITION
“A state of well-being in which the individual realizes his or her
own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to
his or her community.”
INTRODUCTION

4. CONCEPTS OF MENTAL HEALT
H
Medical
• Absence of symptoms and signs
Psychological
• Maturity
• Use of mental abilities
Social
• Adapting to the normal roles of society
Concepts of Normality
• Absence of illness
• Optimal level of functioning
• Dynamic interaction between
biological, social and psycholo
gical factors

6. BIOPSYCHOSOCIAL MODEL OF MENTAL ILLNESS
Engel, 1977
I.BIOLOGICAL FACTORS
Failure of neuronal plasticity
GENETICS
• Bipolar mood disorders-75%
• Alcoholism-50%
• Schizophrenia-40%
ENVIRONMENT
• Malnutrition
• Infection
• Disrupted family envir
onment
• Neglect
• Isolation
• Trauma

7. II.PSYCHOLOGICAL FACTORS
 Lack of affection and stable care from care-givers
 Lack of interaction with social environment
III. SOCIAL FACTORS
 Rapid urbanization
Overcrowding, pollution, violence, reduced social support
 Rural life
Poverty, lack of availability of health services, low education, reduced
economic oppurtunities

9. PREVALENCE OF MENTAL MORBIDITY IN INDIA
Murthy RS. National mental health survey of India 2015–2016. Indian journal of psychiatry. 2017 Jan;59(1):21.

10. I. ECONOMIC IMPACT
IMPACT OF MENTAL DISORDERS

11. II. IMPACT ON QUALITY OF LIFE
 Well-being and Ill-being
 Distress from symptoms
 Experience of psychosis/mania
 Depressed mood
 Energy and motivation
 Fear and anxiety
 Symptom control
 Independence/dependence
 Self-perception
 Self-identity
 Self-efficacy
 Self-esteem and self-acceptance
 Self-stigma
 Belonging

12. BARRIERS IN RECOGNITION AND TREATMENT
I. STIGMA ABOUT MENTAL DISORDERS

13. II. MENTAL HEALTH LITERACY
o Ability to recognize specific disorders
o Knowledge about risk factors and causes
o Knowledge about professional help available
o Attitudes which facilitate recognition and appropriate help-seeking
o Knowledge of how to seek mental health information
“Mental health literacy is defined as the knowledge and beliefs about ment
al disorders which aid their recognition, management and prevention”
Jorm AF: Mental health literacy. Public knowledge and beliefs about mental disorders. Br J Psychiatry. 2000, 177: 396-401.

14. HIGH-RISK BEHAVIOR PROBLEMS IN THE COMMUNITY
I. SUICIDES IN INDIA
 Third leading cause of death among 15-35 years age group
DISORDERS
 Major depression -20%
 Alcohol and substance use -15%
 Schizophrenia -10%
 Personality disorders -5%
 Panic disorder -3%

15. http://ncrb.gov.in/StatPublications/ADSI/ADSI2015/chapter-2%20suicides-v1.

16. PREVENTION OF SUICIDE
I. Universal strategies
Target whole population and aim to manipulate the risk factor
s favourably
II. Selective strategies
Target high-risk groups for risk assessment and management
III. Indicated strategies
Individuals manifested with suicidal behavior

17. II. AGGRESION/VIOLENCE
Domestic violence
In India, about 70% Women are affected
(NFHS,2006)
Violence at workplace
o Physical & Psychological
o 53% employees subjected to violence
o Reason for 10-15% of suicides(WHO,2002)
Violence in patients with Psychiatric disorders
o 10% encounter violence
o Most common neuropsychiatric disorders: Mania, alcohol and substance ab
e, schizophrenia, paranoid delusions, delirium, dementia, personality disord

18. PREVALENCE OF TREATMENT PATTERNS AND CHARACTERISTICS
Murthy RS. National mental health survey of India 2015–2016. Indian journal of psychiatry. 2017 Jan;59(1):21.

19. PREVENTION OF VIOLENCE
 Explore the individual risk factors
 Awareness and sensitization
 State level effective and regulatory mechanisms (Effective implemen
tation of Domestic Violence Act,2005)
 Addressing larger issues of social inequality, gender bias, social
and cultural norms

20. PREVENTION OF MENTAL DISORDERS
• Primordial
1.Improvement in
general social
conditions
2.Stress
management
programs
-Effective use of
leisure
-Relaxation
-Coping
• Secondary
• 1.Facilitating
identification of
mental illness
2.Program for
high risk groups
3.Ambulatory
care
Primary
1.Preschool educati
onal and parenting
program
2.Prevention of Chil
d abuse/neglect
3.School mental he
alth program
4.Increasing commu
nity awareness
Tertiary
1.Rehabilitation
2.Models for Psyc
holgical Rehabilita
tion
-Half way homes
-Large homes
-Large sheltered h
omes
-Religious homes

23. DRUG
“any substance that, when taken into the living organism, may modify on
e or more of its functions”.
DEFINITIONS
DRUG ABUSE
“self-administration of a drug for non-medical reasons, in quantities and frequencie
s which may impair an individual’s ability to function effectively, and which may res
ult in social, physical, or emotional harm”.
DRUG DEPENDENCE
“a state, psychic and sometimes also physical, resulting from the interaction between a living organism
and a drug, characterized by behavioural and other responses that always include a compulsion to take
the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to a
void the discomfort of its absence”.
(WHO)

24. ALCOHOL AND DRUG RELATED PROBLEMS

25. Psychoactive substances

26. SEDATIVE HYPNOTICS
Barbiturates
Benzodiazepines
STIMULANTS
Amphetamine
Methylphenidate
Pemoline
Caffeine
HALLUCINOGENS
Lysergic acid diethyl amide(LSD)
Mescaline
VOLATILE SOLVENTS
Toluene
Ethyl acetate
Trichloroethane
Butane
Propane
Nitrous oxide
Amyl nitrate

27. AMPHETAMINES
 Synthetic drugs, similar to adrenaline
 Uses: to treat obesity, mild depression, narcolepsy and
certain behavioural disorders in children
Therapeutic dose: 10-30mg/day
Brands available: Benzedrine, Dexedrine, Methedrine
CNS Effects: mood elevation, elation, feeling of well-being, increased alertness and a sense of heightened awareness
“Supermandrugs”
Results in Psychicdependence

28. COCAINE
 Derived from “leaves of coca plant”
 Formerly used: potent local anaesthetic
CNS effects: sense of excitement, heightened and distorted awareness and hallucinations
Practiced commonly: Bolivia and Peru
Produces “No physical dependence” No tolerance”

29. BARBITURATES
Sedative hypnotics
Usedin “sleepingpills”
Commonlyused: Pentobarbitol,Secobarbitol
Resultsin Craving,Both physical and psychicdependence

30. CANNABIS
 Most commonly used
 Ancient drug obtained from “hemp plants- Canna
bis sativa, C. indica and C. Americana”
 In USA- “marijuana”
 Used in cigarettes, drinks, sweets and cakes
 Effect lasts upto 1-4hours(oral consumption mor
e longer)
 Effects: altered consciousness relaxation, eupho
ria, increased tendency to laugh, greater awaren
ess of colors and sounds, interference with perce
ption of time and space and paranoia
Hashish/chara
s
Bhang
Ganja(resinou
s mass of sma
ll leaves)

31. LYSERGICACIDDIETHYLAMIDE(LSD)
Potent psychotogenic agent
2-25g : subjective disturbances
100-250g oral dose: intense depersonalization
Effects: intensification of color perception, auditory acuity, body image distortions, visual illusions, fantasies
pseudohallucinations, deranged subjective timing
Does not result in addiction, physical dependence

32. VOLATILE SOLVENTS
CNS depressants
Effects: Initial euphoria and exhilaration, followed by confusion, d
isorientation and ataxia
Increaseddoses:Convulsions, coma and death
Inchronicabusers:damage to Brain, peripheral nervous system, k
idney, liver, heart or bone marrow

33. ALCOHOL CONSUMPTION
GLOBAL SCENARIO

35. Magnitude of Substance use in India

36. https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.

38. https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.

39. https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.

40. https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.

41. PREVENTION OF ALCOHOL AND DRUG ABUSE
I. LEGAL APPROACH
Legislation may be directed at controlling the manufacture, distribution, prescrip
on, price, time of sale, or consumption of a substance.
“Shanghai commission” – to control psychoactive substances
In India..
2 Approaches
Narcotics Control Bureau(NCB)
Central Bureau of Narcotics(CBN) and Customs
Ministry of health and family welfare
Ministry of Social Justice and Empowerment
Government of India
Supply reduction
Demand reduction

42. II.EDUCATIONAL APPROACH
 Educational programmes for school children
 Public information campaigns on electronic media
 IEC activities involving different types of media
 Education to public and vulnerable groups

43. III.COMMUNITY APPROACH
I.HOME AND FAMILY BASED MEASURES
 Parental monitoring
 Supervision
II.SCHOOL PROGRAMS
 Self-control
 Emotional awareness
 Communication
 Social problem-solving
 Academic support
 Peer relationships
 Self-efficacy
 Drug resistance skills
 Reinforcement of anti-drug attitudes
 Strenghthening of personal commitments against drug abuse
III.COMMUNITY BASED PROGRAMS
Community prevention programs reachin
g population on multiple settings:
 Schools
 clubs
 Faith based organizations
 Media
Long-term/booster programs

44. CONCLUSION
Mental disorders can be prevented through stress management
programs in the earlier stage.
Substance abuse can be prevented through various approaches.
“BREAK THE STIGMA”

45. REFERENCES
 Gupta P, Ghai O. Textbook of preventive and social medicine. New Delhi: CBS Publishers; 2007.
 Park K. Park's textbook of preventive and social medicine. Jabalpur. Banarasidas Bhanot. 2011;463.
 Murthy RS. National mental health survey of India 2015–2016. Indian journal of psychiatry. 2017 Jan;59(
1):21.
 http://ncrb.gov.in/StatPublications/ADSI/ADSI2015/chapter-2%20suicides-v1.
 https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.