What is mental health and why is it important?

There is no health without mental health

The World Health Organization constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental health is defined as a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to their community.

Mental health and mental health conditions exist on a continuum that most of us go up or down as we go through life and have both positive and adverse experiences.

Stigma, discrimination and social exclusion

There is stigma associated with mental health distress and conditions in every society. That makes it difficult for a person with mental health conditions, and sometimes also for their family members, to talk openly about the problems or seek help when needed, as they may meet prejudice (negative attitude) or discrimination (negative behaviour) from those around them. Stigma often results from a lack of understanding of mental health conditions through lack of information or misinformation.

It is important to remember

  • Mental health is an inherent and essential element of wellbeing.
  • It is normal that people feel different levels of distress or react in different ways, even when they have experienced the same event.
  • It is common for mental health conditions to occur at the same time as physical health issues (for example noncommunicable diseases such as diabetes, or cancer), or for more than one mental health conditions to occur at the same time (for example depression and anxiety)
  • Many people experience more than one kind of mental distress or mental health condition at the same time, such as people living with depression and anxiety, and non-communicable diseases such as cardiovascular diseases, cancers, diabetes, etc.
  • Crises lead to higher rates of mental distress and mental health conditions.
  • Children and adolescents also experience distress and mental health conditions. More than half of mental health conditions begin by the age of 14 but most cases are undetected and untreated.

Some facts about mental health conditions. They…

  • can affect anyone (regardless of age, sex, socio-economic status, gender)
  • are as important as other health conditions
  • can impair a person’s ability to do normal daily tasks
  • are linked to physical health, daily functioning and productivity
  • can have physical, emotional, behavioural, cognitive or social symptoms
  • are determined by many factors (see below on What leads to mental health conditions?)
  • are not contagious
  • can often be treated
  • can be addressed at the community level through support and services
  • most do not require clinical or specialized interventions.

What are typical symptoms of distress and mental health conditions?

There are five major types of symptoms of distress and mental health conditions:

  1. ‘Physical’ or somatic symptoms – which affect the body or physical function. Examples are aches, tiredness or sleep disturbance.
  2. ‘Feeling’ or emotional symptoms – typical examples are feeling sad, worried, irritable or scared.
  3. ‘Thinking’ or cognitive symptoms – examples are thinking life is not worth living, or thinking someone is going to harm you, or difficulty in thinking clearly or remembering things.
  4. ‘Doing’ or behavioral symptoms – examples include behaving in an aggressive manner, withdrawing, being very restless or fidgety.
  5. ‘Imagining’ or perceptual symptoms – arising from our sensory organs, examples are hearing voices or seeing things others cannot hear or see.

What are common mental health conditions?

  • Depression: there are two main types of depression: moderate – severe depressive disorder
  • Anxiety
  • Psychoses
  • Epilepsy
  • Child and adolescent mental and behavioural disorders
  • Dementia
  • Disorders due to substance use

Mental health in an unequal world
Produced by the International Federation of Red Cross Red Crescent for World Mental Health Day 2021

What can I do personally to help reduce stigma?

  • Educate people by offering the right information.
  • Speak up when you see discrimination or poor treatment.
  • Lead by positive example.
  • Avoid stigmatizing behaviour and discourage others from using it.
  • Treat people with mental health conditions with respect and positivity.
  • Consider volunteering to support people with mental health conditions.
  • Work actively with media.
  • Encourage celebrities to speak publicly about their experiences with mental distress and mental health conditions.

Children’s Mental Health Matters Too
Produced by the PS Centre for World Children’s Day 2021

Self-harm and suicide

Every 40 seconds, a person dies by suicide somewhere in the world. It is the fourth leading cause of death for 15 to 29 year-olds world-wide. Every year, more than 700,000 people die by suicide, and for each person who dies by suicide, an additional twenty people are estimated to have attempted suicide. Suicidal thoughts and acts are often related to mental health conditions.

What leads to mental health conditions?

 Life stressors
Most people experience stressful situations and periods of time in their lives, that lead to varying levels of distress or even to the development of mental health conditions. Many factors influence how we are affected by stressful experiences, including the severity of the event or situation, previous experiences, our age, the level of threat we feel, how long the stressful situation lasts, the impact it has on our loved ones and our future, etc. Some stressors are personal, whilst others are global and affect us all. The current Covid19 pandemic, for example, has impacted mental health of people all over the world and especially that of young adults. Other common stressors that can affect mental health are facing poverty and not being able to meet basic needs, living in situations of conflict and uncertainty, and living in isolation.

 

Difficult childhood experiences
People who experience adverse events or situations in childhood, such as neglect, abuse, exploitation, exclusion and violence are at high risk for experiencing distress or mental health conditions in childhood or later in life.

Heredity or genes
There are a few mental health conditions that are hereditary, but it is important to keep in mind that most mental health conditions are strongly influenced by environmental factors, so even if a parent has mental disorder, it is not certain their children will also develop the same problems.

 Biological factors
Malnutrition, especially in children and pregnant women can lead to physical, cognitive, motor and developmental problems for the child, that can all lead to the development of mental health conditions.  Some medical problems (such as kidney or liver failure) or medicines (such as some used to treat high blood pressure) can sometimes lead to the development of mental health conditions. Brain infections, illnesses (including strokes) or injuries can lead to epilepsy, dementia and other mental health conditions.

What is the difference between community mental health care and psychosocial support?

Community mental health care and psychosocial support are interrelated and interdependent. They both aim to promote positive mental health and psychosocial well-being. Red Cross Red Crescent work with MHPSS is guided by the Movement’s mental health and psychosocial support framework , that presents a layered system of complementary support to meet needs of different people and groups. Mental health care activities take place at all layers of the framework, but also refer specifically to the activities and interventions that are represented in the two top layers of the framework: the provision of psychological support and specialised mental health care. Psychosocial support activities are mostly done at the two bottom layers of the framework that focus on basic psychosocial support and focused psychosocial support.

Mental health gap

There is a wide gap between people who could benefit from care and support for mental health conditions and those who are able to access appropriate social care and mental health services. This is referred to as the global mental health gap. An estimated two thirds of people affected by mental health conditions do not receive treatment, even in high-income countries.

In response to this, the World Health Organization (WHO) run a programme called the mental health Gap Action Programme (mhGAP) that seeks to address the lack of care for people suffering from mental, neurological and substance use (MNS) conditions. There are different strategies being used to address the mental health gap, and one of these is to promote and enable community mental health care.

Suicides can be prevented
Produced by the PS Centre for World Suicide Prevention Day 2021

Video podcast: Mental health of young adults during COVID-19

The Red Cross Red Crescent Movement’s MHPSS Framework and the Mocca family

Community mental health care

Community mental health care is care in communities that:

  • raises awareness and understanding of mental distress and mental health conditions
  • promotes mental health and prevents the development of mental health conditions
  • supports people living with mental distress and mental health conditions.

Community platforms
The community platform is a way of bringing health and social welfare services to people where they live and work. It can include multiple settings and a range of providers offering a spectrum of activities. Settings include health settings at or below the level of primary care (such as village health clinics or community outreach teams) and non-health settings such as neighbourhood and community groups, the social welfare sector, schools and workplaces.

Community providers range from community health workers, school nurses, teachers, police, social workers, youth workers, village elders, other community leaders, and members of the community including peers, families and friends of people living with mental health conditions.

 The spectrum of activities and interventions that can be run as part of community mental health care cover the continuum of mental health and range from talking about mental health, mental health promotion and prevention of problems to support for people with mental health conditions and services for recovery and rehabilitation. Some activities are for the whole community whilst others target groups at higher risk of developing mental health conditions, or who are already experiencing such problems.

Promote mental health and prevent the development or worsening of mental health conditions by focusing on healthy lifestyles, early childhood development, strengthening life skills and caregiving skills, suicide prevention, substance use prevention and self-care for community providers. See some useful resources from PS Centre on Life skills, Suicide Prevention and Self-care.

Provide support for people with mental health conditions involves promoting their human rights, learning to identify mental health conditions, engaging and building relationships with people living with mental health conditions, providing psychological interventions, referring for more care and services and providing support to careers and families.

Scalable psychological interventions

Scalable psychological interventions are ones that can be offered to many more people than regular psychological treatments, and reach is therefore scaled up. Non-professionals can be trained and supervised to deliver low-cost, low-intensity, scalable psychological interventions in a stepped care approach.

Stepped care is a person-centred, staged approach to the delivery of mental health services, that includes a hierarchy of interventions—from the least to the most intensive—matched to the individual’s needs.

Promote recovery and rehabilitation for people with mental health conditions with community follow-ups, vocational, educational and housing support, social recovery and connectedness, self-management and peer support.

Specific considerations need to be taken in community mental health care when working with the following high-risk populations

  • with people with co-morbid physical and mental health conditions
  • with children and adolescents
  • with pregnant women or those who have recently given birth
  • with older persons
  • in emergencies and conflict settings

Communities play a vital role in

  • Raising awareness
  • Addressing stigma and discrimination
  • Promoting mental health
  • Preventing escalation of distress and mental health conditions
  • Providing support
  • Promoting recovery and rehabilitation

Talking to children about mental health

UNICEF provide guidance for parents and caregivers on how to talk with children of different ages about mental health concerns: What’s on your mind? | UNICEF

Mental health care in the Red Cross Red Crescent Movement

Why should we focus on mental health and psychosocial support in National Societies?
During armed conflict, natural disasters and health emergencies, the need for mental health and psychosocial support increases dramatically.  Existing support systems are often strained.

Explain the different structures in Movement, and where mental health is and ideally should be included?

In health departments? Examples of different NS and where they have ‘positioned’ mental health in their organizational structure

  • IFRC
  • National Societies
  • ICRC
  • Partners

Integrating mental health care into primary and community health care
Integrating mental health care into the services provided through existing health care structures and systems has many benefits, including access to persons needing care, sites for providing care; it is often less stigmatising to access help at existing health care centres; it is a good way to address shortages of staff and specialised services; it is cost-effective, and provides a good opportunity for advocacy, awareness and education on mental health.

Care in communities
IFRC are developing guidelines on how to design, implement and evaluate Care in Communities programmes. These programmes involve community and home-based care and support for physical and psychological well-being. The guidelines include a chapter on psychosocial support and community based mental health care.

 What are the steps we should take in our NS if we want to work more with mental health?

  1. Service mapping in your community
  2. Cross-sectoral collaboration
  3. Training and supervision of community providers
  4. Integration into existing programmes and activities

 Examples – of offering services at top of pyramid (e.g. Swedish RC, or building capacity to task share and offer scalable interventions (e.g. Kenya RC), or promoting comm mental health care in families and community structures,

What does this mean for psychosocial support activities and approaches? (Should National Societies now focus on MH and less on PSS?
No, there is as much need for psychosocial support activities as ever.  In the RCRC movement we need to strive to achieve is a continuum of care across the different layers of interventions. Adding focus on community mental health care in your work complements existing psychosocial support work,  aiming to help those with more severe distress than usually targeted with psychosocial support. Psychosocial support activities that promote social connectedness are also part of community mental health care in promoting healthy living, supporting people living with mental health conditions, and promoting recovery and rehabilitation.

What can we do collectively to help improve mental health care in our own communities?

  • raise awareness
  • integrate attention to mental health
  • advocate for more attention to and funding for mental health care.

What can you do in your NS to include or improve focus on mental health care in your work?Include or improve focus on mental health and psychosocial well-being in all integrated responses and programs (including budget allocations).

Build understanding and skills in mental health to prevent the development, and to respond to, severe distress or mental health conditions. Key activities are to train NS staff and volunteers in Psychological First Aid (PFA).