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 ones 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 persons 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 14. 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 15. 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 16. 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 17. 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. 18. 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 19. 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 20. Determinants of mental disorders Poverty Unemployment Low educational level Deprivation Homelessness Conflicts (war, civil strife) Disasters 21. Determinants of mental disorders All significant events in life act as stressors and, coming in quick succession, predispose the individual to mental disorders 22. Determinants Social & environmental factors within the family play a role in mental disorders (e.g. schizophrenia) 23. Top causes of disability Neuropsychiatric conditions: Depressive disorders Alcohol use disorders Schizophrenia Bipolar affective disorder Dementias Migraine 24. Stop exclusion: Dare to Care 25. 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 26. 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 27. 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 28. 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 29. 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 30. 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 31. 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 32. 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 33. 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 34. 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 35. 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 36. 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 37. Womens 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. 38. Womens 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). 39. Womens 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. 40. 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). 41. 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). 42. 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). 43. 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. 44. 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 45. 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. 46. 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. 47. 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. 48. 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. 49. Saudi Arabia 50. 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. 51. Thank You Very Much 52. 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 countrys development. 53. 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. 54. 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. 55. 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). 56. 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. 57. Talking about mental disorders means talking about poverty: the two are linked in a vicious circle 58. Mental health promotion 59. A stitch in time 60. A wide gap between the burden of neuropsychiatric disorders and the mental health budget 61. Much can be done;everyone can contribute to better mental health