Understanding Mental Health
Mental health can be defined as a wellbeing state whereby individuals realise their own potential. They could also cope with the common stresses of life and able to work in a fruitful and productive manner while contributing to their community in positive manner (World Health Organization [WHO], n.d., as cited in Queensland Health, 2017). It is often viewed as a positive concept related to social and emotional wellbeing of individuals and their communities. However, mental health exists on a continuum and is not fixed; it could range from an individual functioning healthily to another individual experiencing severe symptoms of mental health conditions. These mental health conditions are also known as mental health disorders or mental illnesses.
Mental Health in Australia
It was estimated that almost half (46%) of the people in Australia aged 16-85 experienced a mental disorder during their lifetime (AIHW, 2020). With the high prevalence of individuals experiencing mental health conditions in the country, Australia has a wide range of mental-health related support services are available in the country for individuals to access. The aim is that with the appropriate supports and interventions, individuals are able to manage and improve their symptoms/mental health conditions, and to maintain mental health. Ultimately, the goal is for individuals to achieve recovery in their own terms (Department of Health, 2021). Keeping in mind that restrictive practices were commonly used in the past, Australia is committed to minimise and if possible, eliminate the use of seclusion and restraint among individuals who are receiving mental health-related support (AIHW, 2020).
Individuals can experience mental illness when their thinking, emotional state, and/or social abilities are being affected. Typically, this manifests as a disturbance to their work, daily functioning, and/or interpersonal relationships; these disturbances can take place suddenly or gradually in the long run. While different types of mental illness have their own specific set of symptoms, there are still some general signs of mental illness that you should be familiar with. Individuals displaying the below signs may be experiencing mental health conditions, and appropriate support should be provided such that they can receive the relevant treatments to achieve recovery. Listed below are some signs of mental illness that you should be familiar with:
- unusual or illogical thoughts
- unreasonable anger or irritability
- poor concentration and memory, not being able to follow a conversation
- hearing voices that no one else can hear
- increased or decreased sleep
- increased or low appetite
- lack of motivation
- withdrawing from people
- drug use
- feelings that life is not worth living or more serious suicidal thoughts
- becoming obsessed with a topic, like death or religion
- not looking after personal hygiene or other responsibilities
- not performing as well at school or work
The signs above are helpful in assisting you to identify whether your clients and/or those around you may be experiencing mental illness. However, you should always remember that these signs are not definitive that they are experiencing mental illness, and you should never provide a clinical diagnosis of your clients’ situation unless you are qualified and trained to do so (e.g., psychiatrist, clinical psychologist).
Depression is one of the most common mental illnesses in Australia, whereby around one million people in Australia experience depression every year, or around 1 in 16 Australians. Depression can influence how an individual think, act, and feel, whereby they may feel hopeless, guilty, worthless, and unmotivated to carry out their daily activities. According to Mind (2017), individuals who are experiencing mild depression may still lead their life as usual, but everything may become harder or less worthwhile for them to perform. On the other end, those who experience severe depression may have suicidal thoughts and behaviours, which can be life-threatening. Depression can also be described as an individual experiencing extreme distress whereby they are in a persistent depressed mood for at least two weeks.
We all can experience symptoms of depression from time to time and that does not mean that we are depressed. It is important to understand there is a difference between the symptoms of clinical depression and an individual feeling unhappy or sad. But of course, if you think that your client or anyone around you may be experiencing depression, in line with your duty of care, you should always direct them to the appropriate support for further care (Betterhealth Channel, 2018).
There are several types of depression that are all characterised by intense low mood, though with some important differences. These include major depression; melancholia; dysthymia; psychotic depression; antenatal and postnatal depression; and seasonal affective disorder.
Just as other mental illnesses, there is no single specific cause that leads to an individual experiencing depression. Every individual who experiences depression has their own personal circumstances that contribute to their mental health condition. Despite not knowing the exact cause of depression, it is still extremely helpful to understand the different factors that play a part in an individual developing depression (Healthdirect, 2020b).
The type of treatment administered for individuals with depression is dependent on a few factors such as the type of depression, severity of symptoms and whether it is a first or recurring depressive episode. With that said, depression is commonly treated with antidepressant medications to assist individuals to manage their symptoms by regulating their mood. However, it may require some time for the antidepressant to work fully, and it may also require the individual and their doctor to work together to find the right type of antidepressant and dosage. This is often complimented with other treatment approaches such as lifestyle changes, psychological treatments (e.g., CBT and mindfulness), community support programs (e.g., training and education, mutual support groups) and physical therapies (e.g., electroconvulsive therapy; SANE Australia, 2021).
Anxiety and Anxiety Disorders
It is a fairly common experience for individuals to experience anxiety when faced with threat, danger, or stress, e.g., facing a job loss, major accident or sudden death of a loved one. These life events typically induce feelings like being upset, uncomfortable, and tense (e.g., pounding heart and rapid breathing) but they usually go away after a short period of time. However, for individuals who have anxiety disorders, their anxious feelings are often excessive and irrational, which could interfere with their daily lives as these feelings are persistent. Hence, similar to depression, not everyone who experiences anxiety have anxiety disorder.
About 25% of Australians have an anxiety disorder that requires treatment and support, while another 25% of Australians experience less severe anxieties such as fear of snakes or spiders.
While most of the anxiety symptoms are common between the different anxiety disorders, there are still some stark differences between each of them. A few of the most common anxiety disorders include generalised anxiety disorder; social phobias; panic disorders; agoraphobia; obsessive compulsive disorder; and trauma and stress-related disorders (Betterhealth Channel, 2020).
There are no known exact causes of anxiety disorders, and it is usually due to a mix of different factors. When determining which treatment or intervention for an individual with anxiety disorders, there are many considerations to take into account. For example, what type of anxiety disorder and its severity; individuals with milder form of anxiety disorders may alleviate their symptoms by implementing lifestyle changes while those who have more severe forms of anxiety disorders may require medicine. Typical treatments for anxiety disorders are as below include cognitive behaviour therapy; exposure therapy; anxiety management and relaxation techniques; and medication (Betterhealth Channel, 2020).
- Anxiety management and relaxation techniques: for example, deep muscle relaxation, meditation, breathing exercises and counselling.
- Medication: this may include antidepressants and benzodiazepines
Bipolar disorder is a severe mental health condition that was known as manic depression. This is because individuals who have bipolar disorders experience extreme moods; low (depressed) and high/excited (manic). Individuals who experience these mood and energy changes can also experience changes in their behaviour, which changes their daily functioning. While it is a common experience that our mood shifts to respond to the different life events, individuals who have bipolar disorders tend to have their moods fluctuate more than usual. According to Healthdirect (2020a), about 1 in 50 Australians (1.6%) are affected by bipolar disorder each year; more women are affected than men.
Individuals will experience extreme moods at different times for a period of time: manic (or hypomanic) episodes and depressive episodes. Different individuals experience the moods for different periods of time, whereby an episode can last for weeks for some, and it can last for months for others. Individuals will develop different symptoms depending on whether they are experiencing a manic or depressive phase (Healthdirect 2020a). Some individuals with bipolar disorder may also experience psychotic symptoms. These symptoms include hearing voices or delusions that are usually in the context of their current mood state/episode. For example, if the individual is in a depressive episode, they may believe they have severe physical health problems or they are in poverty. Individuals experiencing a manic episode might think they have special powers or special mission (Queensland Health, 2017).
While there are different types of bipolar disorders, the two most common types of bipolar disorders are listed below (Healthdirect, 2020a):
- Bipolar I Disorder: Individuals who have extreme, long-lasting highs (mania) and depressive episodes are diagnosed with it. Individuals who experience psychosis may also be diagnosed with this.
- Bipolar II Disorder: Individuals who experience highs that are less extreme (hypomania) and depressive episodes are diagnosed with it; a hypomania episode may last for only a few hours or days.
Individuals with bipolar disorders typically requires long-term medication to help manage their symptoms. Other than medications, they may also receive psychological therapy and alter their lifestyle. Individuals with bipolar disorders are typically prescribed with medications to alleviate their mood swing symptoms, e.g., mood stabilisers and/or antipsychotics (if there are psychotic symptoms present). Some individuals may receive electroconvulsive therapy (ECT) for individuals who do not respond to treatments for their mood episodes (Healthdirect, 2020a).
About 1 in 100 Australians are affected by schizophrenia, which is characterised by disruptions to thinking and emotions. Individuals with schizophrenia typically experience reality in an altered way, which are usually manifested in psychotic symptoms. According to Betterhealth Channel (2014), 20% to 30% of individuals with schizophrenia experience only a few brief psychotic episodes (i.e., psychosis) while it is chronic for others. During a psychotic episode, individuals can lose touch with reality and have reduced motivation, flattened emotional expression, and may find it challenging to process information. You should also keep in mind that individuals with schizophrenia are at a higher risk of suicidal behaviours.
Schizophrenia has a wide range of symptoms and it can vary across everyone and they are typically categorised into psychotic symptoms and non-psychotic symptoms. These symptoms can have negative consequences in the individual’s life, especially in relation to their daily functioning. As a result, individuals may be socially isolated and alienated by those around them. This is because individuals who experience the symptoms are often unable to participate in normal conversations or social events. Some of them may also lack enough motivation to carry out simple daily activities such as bathing or cooking. Some individuals with schizophrenia may also lack insight into their behaviours’ appropriateness and how that could appear to others (Betterhealth Channel, 2014).
Some individuals can recover from schizophrenia completely while some others may experience episodes, whereby they experience their symptoms come and go. Typically, individuals with schizophrenia receive a few different types of treatments to help manage their symptoms and achieve the best outcomes in their life. Medications such as antipsychotics are the main form of treatment for schizophrenia to help reduce and manage psychotic symptoms. Individuals would also receive psychological interventions to assist them to have a better understanding of their symptoms and learn how to manage and cope with them. Interventions usually include CBT and family therapy. Individuals with more severe symptoms (or out of control) could be admitted into hospital for further medical care to manage these symptoms (Healthdirect, 2020d).
Individuals who have personality disorders experience long-term thinking patterns, and behaviours and emotions that are extreme, inflexible, and dysfunctional. Consequently, individuals may find it challenging and distressing to perform daily activities. It can also be challenging for them to change or alter their behaviours and/or adapt to different situations; some individuals find it difficult to form positive relationships with others and/or maintain work.
It is important to recognise that personality disorders are distinct from personality traits. The latter can be explained through theories such as different personality types. For example, some individuals are more conscientiousness, whereby they are more careful and are able to exercise high self-discipline to achieve their goals. On the other hand, individuals with personality disorders often experience severe symptoms that could cause distress to their life and often find it challenging to control their own behaviour (Healthdirect, 2020c).
There are a wide range of personality disorders and hence different ways to classify these disorders. In general, they exist on a spectrum along with the normal personality traits, which means that some individuals may possess some features of a personality disorder without necessarily having the entire disorder, i.e., not experiencing every symptom of the disorder; some individuals could also exhibit symptoms of more than one personality disorder. With that said, personality disorders are loosely classified into three main groups, or clusters.
- Cluster A: Individuals are described as having odd or eccentric thoughts and/or behaviours.
- Cluster B: Individuals are described has having unstable emotions and dramatic impulsive behaviours.
- Cluster C: Individuals are described as having anxious and fearful thoughts and behaviours.
The main form of treatment for personality disorders is psychotherapy, which can effectively help individuals to manage their symptoms. Psychotherapies can also assist them with working on their lifestyle such as establishing satisfying and stable interpersonal relationships and making positive behaviour changes. These therapies include CBT, dialectical behaviour therapy (DBT), psychodynamic psychotherapy, and psychoeducation.
Editor’s Note: This is an excerpt from the unit Provide Recovery Orientated Mental Health Services in AIPC’s Diploma of Mental Health.
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Betterhealth Channel (2020, May 18). Anxiety disorders. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-disorders
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