Mental health

     Since the inception in 1946 of the World Health Organization (WHO), its Member States have always considered mental well-being as an integral part of the general definition of health. In the Preamble to the WHO Constitution, health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

     Mental health is a complex phenomenon which is determined by multiple social, environmental, biological and psychological factors and depends in part on the successful implementation of public health efforts to control neuropsychiatric disorders such as depression, anxiety disorders, schizophrenia, dementia, and epilepsy.

    Today, as many as 1500 million people worldwide are estimated to be suffering at any given time from some kind of neuropsychiatric disorder, including mental, behavioural and substance abuse disorders. A third of them may be affected by more than one neuropsychiatric ailment. Three-quarters of those affected live in developing countries.

     Mental illness accounts for a significant proportion of disability due to disease and imposes a heavy burden in terms of human suffering, stigmatization of the mentally ill and their families, and direct and indirect costs.

     The major types of psychiatric and neurological disorders, generally perceived as public health problems, include:

MOOD (AFFECTIVE) DISORDERS which affect around 340 million people worldwide at any given time. They are characterized by a change in mood, which a person cannot control, to depression or elation. Such disorders typically take the form of either bipolar affective disorders or unipolar depressive disorders.

• In bipolar affective disorders, the patient goes through repeated episodes of elation and overactivity (mania) and lowered mood and decreased energy (depression).

• Mania can be accompanied by delusions and hallucinations (disembodied voices or visions), uncontrollable excitement, incessant talking, decreased sleep, and loss of normal social inhibitions.

• Depression has the same clinical characteristics as those found in unipolar depressive disease: unaccountable sadness, diminished pleasure in daily life, weight change, disturbed sleep patterns, fatigue, feelings of worthlessness and self-blame, as well as diminished ability to concentrate and indecisiveness. Chronic depression, or dysthymia, is characterized by the persistence of such symptoms over several years.

• Depression is estimated to be present in 10% of all those seeking care at primary health care facilities worldwide.

• In the United States alone, depression costs some US$44 billion annually, which is about the same as the costs resulting from heart disease. It represents some 30% of the total estimated annual cost of US$148 billion for all mental illness.

• The worst consequence of depression is suicide. Together with alcohol and drug abuse and psychosis, depression is implicated in at least 60% of suicides, which in 1990 accounted for 1,6% of the world's deaths.

• Depression is estimated to rank fifth in illness burden among women, and seventh among men in developing countries.

ANXIETY DISORDERS are estimated to affect some 400 million people at any point in time. They are characterized by symptoms of anxiety and avoidance behaviour and include panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.

• Panic disorder is marked by unpredictable episodes of intense fear or discontent, which can last for minutes or hours, and include shortness of breath, dizziness, palpitations, tremor, sweating, and often a fear of dying or "going crazy".

• Phobias are characterized by a persistent and uncontrollable fear of certain situations (for example, where physical escape would be difficult, embarrassment or humiliation possible, etc.) or of a particular stimulus (such as dogs, snakes, insects, blood, etc.).

• Obsessive-compulsive disorder is distinguished by intrusive, distressing, and senseless thoughts and by repetitive illogical behaviour to ward off misfortune, such as unnecessary and uncontrolled washing of hands.

• Post-traumatic stress disorder (PTSD) manifests itself after a catastrophic or unusual experience and persists long after the event and, in certain cases, interferes with an individual's functioning. Typical symptoms include flashbacks and dreams of the traumatic event, insomnia, numbness, detachment from other people, and an avoidance of activities and situations that can reawaken painful memories.

• PTSD is common among victims of man-made and natural disasters, military activities (for both soldiers and civilians), violence, ethnic cleansing and genocide, torture and repression, as well as among refugees.

SCHIZOPHRENIA includes a group of severe psychiatric disorders that usually start in late adolescence or early adult life and often become chronic and disabling. These disorders place a heavy burden on the patient's family and relatives, both in terms of the direct and indirect costs involved and the social stigma associated with the illness, sometimes over generations. Such stigma often leads to isolation and neglect.

• There is an estimated 45 million people with schizophrenia in the world, more than 33 million of them in the developing countries.

• In acute schizophrenia the clinical signs and symptoms are more pronounced and may include delusions (false beliefs), hallucinations, jumbled and incoherent thoughts, a mood out of keeping with thoughts, and lack of awareness of being ill.

• Epidemiological studies in Europe and North America have shown schizophrenia to be more prevalent in low-income populations. Individuals from lower income groups, whose values, socioeconomic background, education and culture are different from those of the professionals who treat them, are more readily diagnosed as schizophrenic.

• To date, research has provided little evidence for understanding the social origins of schizophrenia. But it does provide strong support for the hypothesis that social and cultural factors affect the course and prognosis of the disease.

• People affected with schizophrenia who live in developing countries seem to be more responsive to treatment than those in developed countries. A WHO follow-up study of people, diagnosed as suffering from schizophrenia in nine countries, suggested that two years after the first treated episode of the disease, 58% were reported to have recovered in Nigeria, 50% in India, and only 8% in Denmark.

• The cost of schizophrenia to society is enormous. In the United States, for example, the direct cost of treatment of schizophrenia has been estimated to be close to 0.5% of the gross national product.

DEMENTIA is a brain syndrome usually of a chronic or progressive nature, which is manifested by a decline of memory, comprehension, learning capacity, language and judgement, as well as of the ability to think and to calculate. This syndrome occurs in Alzheimer's disease (AD dementia), in some but not all cases of cerebrovascular disease, and in other conditions affecting the brain, such as Pick disease, Creutzfeldt-Jacob disease and Parkinson disease.

• Worldwide, around 22 million people suffer from dementia.

• Global incidence rates for dementia of all types have been estimated to be less than 1% per annum, with the risk of the age-specific AD and vascular dementia rising steeply above the age of 60 years.

• AD and vascular dementia far outnumber other cases of dementia and are the two principal kinds of dementia in the elderly (senile dementia). The senile dementias have assumed great importance in public health because more people today live into the age of high risk.

• The number of people suffering from senile dementia in Africa, Asia and Latin America may exceed 80 million in 2025.

• Because of the increasing number of road-accidents and strokes, which can cause brain damage, presenile dementia is a major problem in many countries.

• There is an association between a past history of heavy drinking and the onset of dementia or depression in later life.

EPILEPSY is a neurological disorder which is characterized by totally uncontrollable fits that occur repeatedly, sometimes more than once a day. They start suddenly, are accompanied by convulsions and stop abruptly with or without loss of consciousness.

• Epilepsy is estimated to affect approximately one in every 130 people worldwide. In all, there are more than 40 million people of all ages and social conditions who are affected by epilepsy with 2 million new cases each year. Eighty per cent of those affected live in developing countries.

• People affected with epilepsy are highly stigmatized. One of the reasons is that in many countries, epilepsy is erroneously perceived as an infectious disease. The affected people and their families are shunned to the point of isolation.

• More than 80% of newly-diagnosed patients with epilepsy can be successfully treated today with anti-epilepsy drugs and lead normal lives. In many cases adequate treatment can be provided at an average cost of US$5 per patient per year. Unfortunately, half of those affected are treated improperly or not at all.

• Some infections and brain injuries are among the major causes of epilepsy. Epilepsy may be caused by genetic factors and infectious diseases in the prenatal period, by birth asphyxia and brain injury during labour, and, in the post-natal period, by febrile convulsions, infectious (e.g meningitis, encephalitis) and parasitic (e.g. malaria, schistosomiasis) diseases and brain damage caused by alcohol, trauma or toxic substances (e.g. lead, pesticides).

• Prevention of epilepsy is possible through prenatal care, safe delivery, control of fever in children, reduction of brain injury, control of infectious and parasitic diseases, and genetic counselling.

Current research provides strong evidence that mental disorders are of biopsychosocial origin.

• There is a strong interrelationship between some tropical disease and neuropsychiatric disorders and impairments. Infestations of cysticercosis (tapeworm), for example, may result in brain lesions leading to epileptic seizures.

• The quality of a person's social environment influences both his or her vulnerability to mental illness and the course of that illness. Poverty, overcrowded living conditions, job insecurity, marital problems, man-made and natural disasters, ethnic violence and violence against women, children and the aged, wars - all of these influence negatively the mental health of the world's populations.

• Demographic factors such as population ageing and urbanization accentuate the public health and social magnitude of mental illness.

• Substance abuse - harmful use of alcohol, illicit drugs and other psychoactive substances - aggravates all other forms of mental illness and has also been proved to have a major negative impact on public health in general.
  

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