Kaine Grigg | April 9, 2018

Mental Health and Mental Illness

Mental health and mental illness can be thought of as two ends of a broad spectrum. At one end, mental health is a state of emotional and social wellbeing in which an individual realises his or her own abilities while coping with the normal stresses of life. In contrast, mental illness is when an individual is emotionally and socially disturbed to the extent that they are unable to realise their own potential. Mental illness often affects individuals’ capacity to live rich, full and meaningful lives.

The Importance of Diagnosis

A mental disorder is a diagnosable illness that significantly interferes with an individual’s cognitive, emotional, social, and occupational abilities. Moreover, this interference is a change from their normal baseline.

Diagnosis of a particular mental disorder may be made by a suitably qualified health professional. It depends upon the circumstances and the constellation of associated biological, psychological, and social symptoms.

It is important to recognise the difference between stress and having a diagnosable mental illness. Stress is less impactful, transient, and self-resolving. Whereas a mental illness may be long-standing, with greater impact, and commonly will not self-resolve without appropriate intervention  

For all mental disorders, the presence of symptoms alone does not necessitate a diagnosis unless they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Additionally, symptoms must occur frequently and for a significant period of time.

Although diagnosis of a mental disorder can often be viewed as stigmatising, it can also be validating for an individual to be informed that what they are experiencing is a serious illness. Diagnosis can also empower and motivate individuals to seek treatment.

Diagnosis can also serve to streamline communication between professionals, clients, and their treatment team. Finally, diagnosis allows for selection of treatments that are evidence-based, specifically designed, and scientifically evaluated to effectively address particular disorders or presentations.

Causes of Mental Illness

There is ongoing debate amongst the mental health field about the true cause of mental illness. Much stems from the distinct perspectives of different types of mental health professionals. For example, medical professionals are often biased towards seeking biological causes, psychologists psychological understandings, and social workers social explanations.

Our best understanding is that mental illness is caused by a combination of biological, psychological, and social factors, with no one factor yet demonstrated to be the sole cause of mental illness. Some disorders are  more strongly associated with underlying biological vulnerabilities, whilst others have more prominent social and psychological causes. For example Schizophrenia is one of the most heritable disorders, suggesting a strong biological component. In contrast, Post-Traumatic Stress Disorder requires the experience and psychological evaluation of a traumatic event, suggesting a strong psychological component.

Social factors appear to be best understood as an important contributor to the development of mental illness, rather than directly causing mental disorders. Moreover, individual differences are important: distinct individuals are more or less likely than other similar individuals to respond to their environment with the eventual development of mental illness.

Complicating the picture further is that biological, psychological, and social factors can be viewed as the predisposing, precipitating, and perpetuating factors for different individuals or for different illnesses. For example, an individual may have an underlying biological vulnerability that an environmental stressor triggers in the form of expression of a mental illness.

In contrast, the experience of a traumatic event can trigger psychological, social, and biological changes and the development of a mental illness in an individual not predisposed to mental illness. Such complexity demands a nuanced understanding of each individual’s experience in order to determine an accurate diagnosis (where appropriate) and consequent provision of the most appropriate and effective treatment available.

Why Focus on Mental Health?

The annual cost of mental illness in Australia has been estimated at $20 billion, which includes the cost of lost productivity and labour force participation.

In 2003, mental disorders were identified as the leading cause of healthy years of life lost due to disability. In 2007, 45% of Australians aged 16-85 years, (or 7.3 million people), had at some point in their lifetime experienced a diagnosable mental disorder.

Some of the most prominent mental disorders include Anxiety Disorders, Depressive Disorders, and Substance-Related and Addictive Disorders.

Anxiety Disorders

In 2007, Anxiety Disorders were the most common class of mental disorder in Australia, affecting 14% of all people aged 16-85 years in the prior 12 months. Women were more likely to have experienced Anxiety Disorders at %18 compared to men at 11%.

The main features of Anxiety Disorders include:

  • Excessive anxiety and worry (apprehensive expectation)
  • Difficulties controlling the worry
  • The presence of a number of associated symptoms including restlessness, irritability, muscle tension, fatigue, and sleep disturbance.

Depending upon the particular constellation of symptoms, a specific anxiety disorder may be diagnosed. Some of the more prevalent Anxiety Disorders include Generalised Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder.

Depressive Disorders

In 2007, Depressive Disorders and Bipolar and Related Disorders (previously collectively considered Mood Disorders) affected 6.2% of Australians aged 16-85 years in the prior 12 months. Women experienced more Mood Disorders than men, 7.1% to 5.3%. The majority of diagnosed Mood Disorders were Depressive Disorders.

The main features of Depressive Disorders include:

  • Depressed mood
  • Loss of interest or pleasure in normally enjoyable activities
  • Significant change in weight / appetite
  • Sleep disturbance
  • Physical agitation or retardation
  • Fatigue or lethargy
  • Feelings of worthlessness
  • Difficulties concentrating
  • Recurrent thoughts of death

Substance Related and Addictive Disorders

In 2007 in Australia 5.1% of people aged 16-85 years had a Substance-Related and Addictive Disorder in the prior 12 months. Substance-Related and Addictive Disorders were more common in men than in women.

The main features of Substance Related and Addictive Disorders include:

  • Using a substance in larger amounts and for longer than intended
  • Wanting to cut down or quit but being unable to
  • Spending a lot of time obtaining the substance
  • Craving
  • Failing to carry out major occupational and social obligations
  • Using despite social or interpersonal problems
  • Reducing social, occupational, or recreational activities
  • Using in physically hazardous situations
  • Using despite physical or psychological difficulties
  • Tolerance
  • Withdrawal

The specific type of Substance-Related and Addictive Disorder depends upon the substance being used.

Treatment

The core schools of treatment generally stem from the psychological and biological understandings of mental illness.

Psychotherapy has been utilised in differing forms for over a century and there now exists a plethora of psychotherapeutic interventions that are of varying effectiveness for different conditions.

Psychotherapeutic schools include:

  • Psychoanalytic Therapeutic approaches
  • Psychodynamic Therapy
  • Cognitive Behavioural Therapeutic approaches
  • Cognitive Therapy
  • Acceptance and Commitment Therapy
  • Mindfulness-Based Cognitive Therapy
  • Dialectical Behaviour Therapy

These approaches focus on the unconscious or conscious mind and the impact the mind has on the individual’s self and behaviour.

Behavioural approaches focus purely on behaviour of an individual and utilise the principles of reinforcement to shape future behaviour without giving consideration to an individual’s cognition.

Pharmacological approaches view the development of mental illness as stemming from an imbalance of particular neurotransmitters in the brain (e.g., serotonin in Depressive Disorders and dopamine in Psychotic Disorders). As a consequence these approaches treat individuals with medications that are purported to re-balance these neurotransmitters (e.g., anti-depressants and anti-psychotics).

Best practice may be the provision of medication or psychotherapy alone or in combination.

How to Get Help

The first step in addressing a mental health issue is the development of awareness such that a problem is identified as an issue that needs to be addressed. The second step is seeking treatment. The mental health system in Australia is complex, which can be a considerable deterrent to help-seeking behaviour.

If you are being impacted by a mental health issue and want to seek treatment, the best first point of contact is your local General Practitioner (GP) or community health service. Your GP or community health service is able to make an initial assessment to determine if further assessment or treatment is required and refer you to a specialised mental health professional.

To assist in understanding the different types of mental health professionals and roles they may play in your treatment.

Medicare Endorsed Mental Health Professionals

  • General Practitioner
  • Psychologist
  • Occupational Therapist
  • Mental Health Nurse
  • Psychiatrist
  • Accredited Mental Health Social Worker

Non-Medicare Endorsed Mental Health Professionals

  • Counsellor
  • Psychotherapist
  • Life Coach
  • Spiritual Leader

Why Regulation Is Important

Each of these professionals may have received considerable training and provide an exceptional quality of service. However, for professionals that are not registered by the Australian Health Practitioner Regulation Agency (AHPRA), regulation and consumer protection against poor quality services cannot be guaranteed.

For example, any individual can practice as a Life Coach, regardless of training, and even if a Psychotherapist or Counsellor engages in misconduct and is expelled by the Psychotherapy and Counselling Federation of Australia they can continue to practice as a Psychotherapist or Counsellor.


References

American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Australian Bureau of Statistics (2010). 1301.0 – Year Book Australia, 2009–10. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1301.0main%20features12009-10


Originally published in FreoPages