Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
The positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
- Mental health is more than the absence of mental disorders.
- Mental health is an integral part of health; indeed, there is no health without mental health.
- Mental health is determined by a range of socioeconomic, biological and environmental factors.
- Cost-effective public health and intersectoral strategies and interventions exist to promote, protect and restore mental health.
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education.
Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health and human rights violations.
There are also specific psychological and personality factors that make people vulnerable to mental disorders. Lastly, there are some biological causes of mental disorders including genetic factors which contribute to imbalances in chemicals in the brain.
More About Mental Illnesses
A mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis.
Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process.
A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits and basic brain structure may play a role, too.
One in 5 adults experiences a mental health condition every year. One in 17 lives with a serious mental illness such as schizophrenia or bipolar disorder. In addition to a person’s directly experiencing a mental illness, family, friends and communities are also affected.
It can be hard to understand what a person with mental illness goes through. These are the most common kinds of mental illnesses, symptoms, common behaviours, and potential treatments. We have curated information about these mental illness below.
Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people.
While some behaviors associated with ADHD are normal, someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.
Signs of inattention include:
- Becoming easily distracted, and jumping from activity to activity.
- Becoming bored with a task quickly.
- Difficulty focusing attention or completing a single task or activity.
- Trouble completing or turning in homework assignments.
- Losing things such as school supplies or toys.
- Not listening or paying attention when spoken to.
- Daydreaming or wandering with lack of motivation.
- Difficulty processing information quickly.
- Struggling to follow directions.
Signs of hyperactivity include:
- Fidgeting and squirming, having trouble sitting still.
- Non-stop talking.
- Touching or playing with everything.
- Difficulty doing quiet tasks or activities.
Signs of impulsivity include:
- Acting without regard for consequences, blurting things out.
- Difficulty taking turns, waiting or sharing.
- Interrupting others.
There are several factors believed to contribute to ADHD:
- Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in families and some trends in specific brain areas that contribute to attention.
- Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.
ADHD is managed and treated in several ways:
- Medications, including stimulants, nonstimulants and antidepressants
- Behavioral therapy
- Self-management, education programs and assistance through schools or work or alternative treatment approaches
Everyone experiences anxiety. Speaking in front of a group makes most of us anxious, but that motivates us to prepare and do well. Driving in heavy traffic is a common source of anxiety, but it keeps us alert and cautious to better avoid accidents. However, when feelings of intense fear and distress are overwhelming and prevent us from doing everyday things, an anxiety disorder may be the cause.
All anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening. People can experience one or more of the following symptoms:
- Feelings of apprehension or dread
- Feeling tense and jumpy
- Restlessness or irritability
- Anticipating the worst and being watchful for signs of danger
- Pounding or racing heart and shortness of breath
- Upset stomach
- Sweating, tremors and twitches
- Headaches, fatigue and insomnia
- Upset stomach, frequent urination or diarrhoea
Different anxiety disorders have various symptoms. This means that each type of anxiety disorder has its own treatment plan. The most common anxiety disorders include:
Characterized by panic attacks—sudden feelings of terror—sometimes striking repeatedly and without warning. Often mistaken for a heart attack, a panic attack causes powerful, physical symptoms including chest pain, heart palpitations, dizziness, shortness of breath and stomach upset. Many people will go to desperate measures to avoid having an attack, including social isolation or avoiding going to specific places.
Everyone tries to avoid certain things or situations that make them uncomfortable or even fearful. However, for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several triggers. To avoid panicking, someone with specific phobias will work hard to avoid their triggers. Depending on the type and number of triggers, this fear and the attempt to control it can seem to take over a person’s life.
Generalized Anxiety Disorder (GAD)
GAD produces chronic, exaggerated worrying about everyday life. This can consume hours each day, making it hard to concentrate or finish routine daily tasks. A person with GAD may become exhausted by worry and experience headaches, tension or nausea.
Social Anxiety Disorder
Unlike shyness, this disorder causes intense fear, often driven by irrational worries about social humiliation–“saying something stupid,” or “not knowing what to say.” Someone with social anxiety disorder may not take part in conversations, contribute to class discussions, or offer their ideas, and may become isolated. Panic attack symptoms are a common reaction.
Other anxiety disorders include: agoraphobia, separation anxiety disorder and substance/medication-induced anxiety disorder involving intoxication or withdrawal or medication treatment.
Scientists believe that many factors combine to cause anxiety disorders:
- Genetics. Some families will have a higher than average numbers of members experiencing anxiety issues, and studies support the evidence that anxiety disorders run in families. This can be a factor in someone developing an anxiety disorder.
- Environment. A stressful or traumatic event such as abuse, the death of a loved one, violence or prolonged illness is often linked to the development of an anxiety disorder.
As each anxiety disorder has a different set of symptoms, the types of treatment that a mental health professional may suggest also can vary. But there are common types of treatment that are used:
- Psychotherapy, including cognitive behavioural therapy
- Medications, including anti-anxiety medications and antidepressants
- Complementary health approaches, including stress and relaxation techniques
Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience.
Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods—sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.
Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia.
To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
Although someone with bipolar may find an elevated
mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.
Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.
The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide.
The depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.
Scientists have not yet discovered a single cause of bipolar disorder. Currently, they believe several factors may contribute, including:
- Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute: A child from a family with a history of bipolar disorder may never develop the disorder. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.
- Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.
- Brain structure and function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder.
The Four Types Of Bipolar Disorder
- Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.
- Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.
- Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
- Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.
Bipolar disorder is treated and managed in several ways:
- Psychotherapy, such as cognitive behavioral therapy and family-focused therapy.
- Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.
- Self-management strategies, like education and recognition of an episode’s early symptoms.
- Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment.
Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.
Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:
- Changes in sleep
- Changes in appetite
- Lack of concentration
- Loss of energy
- Lack of interest in activities
- Hopelessness or guilty thoughts
- Changes in movement (less activity or agitation)
- Physical aches and pains
- Suicidal thoughts
Depression does not have a single cause. It can be triggered by a life crisis, physical illness or something else—but it can also occur spontaneously. Scientists believe several factors can contribute to depression:
- Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These changes may lead to depression.
- Genetics. Mood disorders, such as depression, tend to run in families.
- Life circumstances. Marital status, relationship changes, financial standing and where a person lives influence whether a person develops depression.
- Brain changes. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.
- Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression. Some medical syndromes (like hypothyroidism) can mimic depressive disorder. Some medications can also cause symptoms of depression.
- Drug and alcohol abuse. Approximately 30% of people with substance abuse problems also have depression. This requires coordinated treatment for both conditions, as alcohol can worsen symptoms.
To be diagnosed with depressive disorder, a person must have experienced a depressive episode lasting longer than two weeks. The symptoms of a depressive episode include:
- Loss of interest or loss of pleasure in all activities
- Change in appetite or weight
- Sleep disturbances
- Feeling agitated or feeling slowed down
- Feelings of low self-worth, guilt or shortcomings
- Difficulty concentrating or making decisions
- Suicidal thoughts or intentions
Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:
- Psychotherapy including cognitive behavioral therapy, family-focused therapy and interpersonal therapy.
- Medications including antidepressants, mood stabilizers and antipsychotic medications.
- Exercise can help with prevention and mild-to-moderate symptoms.
- Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
- Light therapy, which uses a light box to expose a person to full spectrum light in an effort to regulate the hormone melatonin.
- Alternative approaches including acupuncture, meditation, faith and nutrition can be part of a comprehensive treatment plan, but do not have strong scientific backing.
When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder.
Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.
A person with anorexia will deny themselves food to the point of self-starvation as she obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as she attempts to limit, eliminate or “burn” calories.
The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person’s diet, out of fear of being “fat”.
Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.
Someone living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid himself of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person’s life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.
The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.
Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.
Binge Eating Disorder (BED).
A person with BED losses control over his eating and eats a very large amount of food in a short period of time. He may also eat large amounts of food even when he isn’t hungry or after he is uncomfortably full. This causes him to feel embarrassed, disgusted, depressed or guilty about his behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.
Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person’s physical and emotional health, self-esteem and sense of control.
Factors that may be involved in developing an eating disorder include:
- Genetics. People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.
- Environment. Cultural pressures that stress “thinness” as beautiful for women and muscular development and body size for men places undue pressure on people of achieve unrealistic standards. Popular culture and media images often tie being thin to popularity, success, beauty and happiness. This creates a strong desire to very thin.
- Peer Pressure. With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.
- Emotional Health. Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person’s self-esteem and make them vulnerable to developing eating disorders.
Eating disorders affect all types of people. However there are certain risk factors that put some people at greater risk for developing an eating disorder.
- Age. Eating disorders are much more common during teens and early 20s.
- Gender. Statistically, teenage girls and young women are more likely to have eating disorders, but they are more likely to be noticed/treated for one. Teenage boys and men are less likely seek help, but studies show that 1 out of 10 people diagnosed with eating disorders are male.
- Family history. Having a parent or sibling with an eating disorder increases the risk.
- Dieting. Dieting taken too far can become an eating disorder.
- Changes. Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.
- Vocations and activities. Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.
Eating disorders are managed using a variety of techniques. Treatments will vary depending on the type of disorder, but will generally include the following.
- Psychotherapy, such as talk therapy or behavioral therapy.
- Medicine, such as antidepressants and anti-anxiety drugs. Many people living with an eating disorder often have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that these medicines help with underlying issues.
- Nutritional counseling and weight restoration monitoring are also crucial. Family based treatment is especially important for families with children and adolescents because it enlists the families’ help to better insure healthy eating patterns, and increases awareness and support.
Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don’t make sense, they are often unable to stop them.
Most people have occasional obsessive thoughts or compulsive behaviors. In an obsessive-compulsive disorder, however, these symptoms generally last more than an hour each day and interfere with daily life.
Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them.
Examples of obsessions include:
- Thoughts about harming or having harmed someone
- Doubts about having done something right, like turning off the stove or locking a door
- Unpleasant sexual images
- Fears of saying or shouting inappropriate things in public
Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don’t make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.
Examples of compulsions include:
- Hand washing due to a fear of germs
- Counting and recounting money because a person is can’t be sure they added correctly
- Checking to see if a door is locked or the stove is off
- “Mental checking” that goes with intrusive thoughts is also a form of compulsion
The exact cause of obsessive-compulsive disorders is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have an obsessive-compulsive disorder, there’s close to a 25% chance that another immediate family member will have it.
A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.
- Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.
- Psychotherapy is also helpful in relieving obsessions and compulsions. In particular,cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.
Though OCD cannot be cured, it can be treated effectively.
Schizophrenia is a serious mental illness that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. It is a complex, long-term medical illness.
It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability—common and nonspecific adolescent behaviour. Other factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis.
For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning for a least 6 months:
These include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.
These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.
There are the ones that diminish a person’s abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.
Cognitive issues/disorganized thinking.
People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. Commonly, people with schizophrenia have anosognosia or “lack of insight.” This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.
Research suggests that schizophrenia may have several possible causes:
- Genetics. Schizophrenia isn’t caused by just one genetic variation, but a complex interplay of genetics and environmental influences. While schizophrenia occurs in 1% of the general population, having a history of family psychosis greatly increases the risk. Schizophrenia occurs at roughly 10% of people who have a first-degree relative with the disorder, such as a parent or sibling. The highest risk occurs when an identical twin is diagnosed with schizophrenia. The unaffected twin has a roughly 50% chance of developing the disorder.
- Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. Inflammation or autoimmune diseases can also lead to increased immune system
- Brain chemistry. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.
- Substance use. Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk. Another study has found that smoking marijuana led to earlier onset of schizophrenia and often preceded the manifestation of the illness.
There is no cure for schizophrenia, but it can be treated and managed in several ways.
- Antipsychotic medications
- Psychotherapy, such as cognitive behavioral therapy and assertive community treatment and supportive therapy
- Self-management strategies and education
Providing Care To The Ill
Remember, An Illness Is Influencing Your Family Member/Friend’s Behavior
Even when we know someone has a mental health condition, it can be hard to recognize his or her efforts to be well. Sometimes we wonder if a family member or friend is “trying to be difficult.” We may find ourselves looking for something to blame: should we blame them or the mental health condition itself. In general, we should try to give them the benefit of the doubt. Remember that no one chooses to experience these symptoms.
We can support and encourage our family members. We can’t, however, make their treatment decisions for them. We should offer suggestions and input, but be ready to accept and support their decisions.
They may not choose the treatment options that we would prefer, but by acknowledging their right to decide, we create a respectful, healing environment within the family. We improve their immediate quality of life by treating them with dignity. We’re also encouraging them to commit to their chosen course of action.
The reality is that we can only control our own actions. We have to learn to give the people around us responsibility for decisions that only they can make. It’s ultimately up to them to decide on their goals and strategies. You can encourage your family members, but you must let go of the feeling that you have to solve their problems for them.
One of the first things that can be severely lacking is knowledge in mental health and mental illnesses. Our first step should be to learn as much as possible about mental health and your family member/friend’s condition. Knowledge gives you practical insight and understanding. Learn about available treatments. What therapies and medications can help? Do people with this condition typically spend time in residential treatment? What options are available for supportive housing or employment?
One of the most important ways to support a family member is to maintain our own mental health. The healthier we are, the more energy we have for problem solving and offering encouragement. We can then offer practical support, such as the following:
- Show interest in your family member’s treatment plan. Doctors and other medical providers cannot talk to family members without a patient’s permission, so ask your family member to arrange this permission. Talk to the medical team about what to expect from the treatment plan. In particular, ask about possible side effects of medication.
- Encourage your family member to follow the treatment plan. This might mean offering transportation to therapy sessions, or reminders to take medications as prescribed. Because daily prodding about medication can easily insult or anger an adult, handle this carefully. Talk to your family member about his or her preferences. Try to set up a simple system to reassure you that treatment is continuing as planned.
- Strive for an atmosphere of cooperation within the family. Cooperation means not just offering support. It also means communicating with everyone in the family and distributing responsibility equally. Don’t try to “spare” family members from stress by leaving the caretaking to one individual.
- Listen carefully. Simply listening is one of the best ways to show your support. If your family member says hurtful things, it helps to listen for the emotion behind the words rather than focusing on the words themselves. Try to recognize and acknowledge the pain, anxiety or confusion rather than getting into unnecessary arguments.
- Resume “normal” activities and routines. Don’t let life revolve around your family member’s mental health condition. Return to a regular routine within the family. Spend time together on activities unconnected to illness, such as watching a movie, eating dinner out or visiting a favourite park.
- Don’t push too hard. At the same time, remember that it takes time to heal from an acute episode. Allow your family member to rest. Offer him or her opportunities to ease back into routine activities rather than requiring participation.
- Express your support out loud. Spoken encouragement can reduce stress levels. You don’t need to say anything fancy. Practice a few simple, gentle statements: “I’m sorry you feel bad and I want to help,” “It isn’t your fault. It’s an illness that can happen to anyone,” “Hang in there because you’ll feel better down the road.”
- Don’t give up. A person with a mental health condition benefits enormously from having social support. Remind your family member that you’re there to help and you’re not giving up. When setbacks occur with one treatment strategy, look for alternative strategies. Try something new, and encourage your family member not to give up. A good life is possible.
Sometimes things don’t go our way or bad and unexpected things happen. It’s normal to get upset or sad during upsetting times, but if you feel that your friend isn’t responding normally it might mean that there’s something more serious going on. Here are some signs to look from your friend.
- Withdrawing from social activities or appearing down for more than 2 weeks. This could mean crying regularly, feeling tired all the time or not wanting to hang out anymore.
- Self-harming actions such as cutting or burning. Some people may begin to wear long sleeves or pants to cover up signs that they are doing this.
- Threatening to kill his- or herself or making plans to do so. Although you may not know whether your friend is serious or not, it’s better to be safe and take things seriously.
- Extreme out-of-control, risk-taking behaviors. Behaviors that can endanger his- or her own life as well as others, such as speeding excessively and not obeying traffic laws, might be a sign that something is wrong.
- Sudden overwhelming fear for no reason, including intense worries or fears that get in the way of daily activities like hanging out with friends.
- Not eating, throwing up or using laxatives to lose weight. Pay attention if your friend isn’t eating much at lunch or going to the bathroom right after meals.
- Severe mood swings. Life is stressful, but if there seem to be outbursts that go beyond how other people would often act, it might mean something more serious.
- Repeated use of drugs or alcohol. Coming to class hung over, showing up to sporting events intoxicated or wanting to bring drugs or alcohol into daily activities is not normal.
- Drastic changes in behavior, personality or sleeping habits. Your friend might be sleeping much more or much less or get agitated more frequently.
Share your observations with your friend. Focus on being nonjudgmental, compassionate and understanding. Use these “I” (instead of “you”) comments to get the conversation started.
- I’ve noticed you’re [sleeping more, eating less, etc.]. Is everything okay?
- I’ve noticed that you haven’t been acting like yourself lately. Is something going on?
- It makes me afraid to hear you talking like this. Let’s talk to someone about it.
If a friend is in need, you don’t need to go at it alone. Involve others who can provide added support. Try to find someone who might be understanding of your friend’s situation or be able to help. Your friend may feel cornered if you start involving others, so make sure to talk to your friend first.
Keep in mind that your friend might not be ready to talk about what they’re going through or simply may not want your help right now. You cannot force someone to get help, so just do your best to be there with your friend through their journey and be ready if and when they do finally reach out.
You can play an important role in helping a friend build a positive, social support network. Here are ways to do that:
- Check-in regularly. Call or text your friend once or twice a week. Check in with them after their therapy appointments to see how things went. Let them know that you are there.
- Include your friend in your plans. Even if your friend doesn’t always come, they will probably appreciate being included.
- Learn more about mental health conditions. Find out more about what your friend is going through so you are better able to help in future situations.
- Avoid using judgmental or dismissive language, such as “you’ll get over it,” “toughen up,” “snap out of it.” Your friend needs to hear that they are not alone and that they can get through this. Reassure them that everything will be okay and that you are there for them.
Being a friend means being there in easy times and more difficult times. If your friend is experiencing a mental health condition, this is a time when he or she needs you the most. And sometimes just talking about it might help your friend feel less alone and more understood. You can be the difference in helping a friend who needs support but is too afraid to seek help. Just a simple conversation can go a long way in helping your friend. You can make a huge difference in someone’s life.
Stigma Around Mental Health
What Stigma Means
Beyond any definition, stigma has become a marker for adverse experiences. First among these is a sense of shame. Mental illness, despite centuries of learning and the ‘Decade of the Brain’, is still perceived as an indulgence, a sign of weakness. Self-stigmatisation has been described, and there are numerous personal accounts of psychiatric illness, where shame overrides even the most extreme of symptoms. In two identical UK public opinion surveys, little change was recorded over 10 years, with over 80% endorsing the statement that “most people are embarrassed by mentally ill people”, and about 30% agreeing “I am embarrassed by mentally ill persons”.
Stigma Causing An Endless Loop
People with mental health problems say that the social stigma attached to mental ill health and the discrimination they experience can make their difficulties worse and make it harder to recover.
But even though so many people are affected, there is a strong social stigma attached to mental ill health, and people with mental health problems can experience discrimination in all aspects of their lives.
Many people’s problems are made worse by the stigma and discrimination they experience - “from society, but also from families, friends and employers.”
Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.
We know that people with mental health problems are amongst the least likely of any group with a long-term health condition or disability to:
- find work
- be in a steady, long-term relationship
- live in decent housing
- be socially included in mainstream society.
This is because society, in general, has stereotyped views about mental illness and how it affects people. Many people believe that people with mental ill health are violent and dangerous, when in fact they are more at risk of being attacked or harming themselves than harming other people.
Stigma and discrimination can also worsen someone’s mental health problems, and delay or impede their getting help and treatment, and their recovery. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness.
The situation is exacerbated by the media. Media reports often link mental illness with violence or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives.
According to an Institute of Mental Health study in Singapore, nine in 10 people believe that those with a mental illness “could get better if they wanted to”.
Half of those surveyed said that such problems are “a sign of personal weakness”, while six in 10 also said that such people are “unpredictable”.
Researchers said that such stigmatising attitudes may lead people to avoid seeing a doctor and getting diagnosed for fear of being labelled as mentally ill.
The fact, however, is that problems such as depression, obsessive-compulsive disorder (OCD), and even alcohol abuse often have a biological basis, and can be treated by a health professional.
Suicide As A Last Resort
There is no clear list of warning signs for someone who is thinking about suicide. However, sudden changes in actions, behaviour, or attitude are some of the warning signs. On the other hand, someone who is thinking about suicide may not show any warning signs.
Close to 800 000 people worldwide die due to suicide every year, which is one person every 40 seconds. Many more attempt suicide.
In 2016, 429 people in Singapore killed themselves.
Self-Stigma & Eliminating It
In the 1940s, it was cancer.
In the ’80s, it was HIV.
Today, the condition that’s battling pervasive social stigma is mental illness.
As with cancer and HIV in the past, the stigma comes at a high cost: millions of Americans go untreated because of misconceptions and shame. “Mental illness is much like cancer 75 years ago, because it’s scary and unpredictable. And because it’s still mysterious, people want to keep their distance,” says Stephen Hinshaw, PhD, Co-Vice Chair for Psychology in UCSF’s Department of Psychiatry.
Others with a mental illness may not be as proactive about seeking out treatments if the stigma from society filters down to them.
“There is a high degree of what is called self-stigma,” which involves people taking on and internalizing the attributes of societal stereotypes, Hinshaw says. There are many people around the world taking medication for illnesses, and many who should be and are not because of the stigma.
Researchers have created scales to measure how much a person stigmatizes himself or herself – high levels of self-stigma predict that people either won’t go to treatment or drop out early of treatment. He says it becomes a vicious cycle: Society stigmatizes, a person picks up the message and self-stigmatizes, he or she doesn’t get engaged in treatment, and the symptoms and impairments of mental illness are never tackled.
Compounding the problem is ostracism through what is known as social distance. Here, members of society rate how close they would be willing to be in contact with a certain group, such as living in the same city, being neighbors, being friends, dating, or allowing their child to marry.
First Steps To Eliminating Stigma
First, we must recognize that mental illness is just that—an illness. Those who suffer from a mental illness are not mentally deficient in their mental capacity; they just have had a chemical imbalance or a severe head injury that hinders their ability to function normally in a certain part of the brain.
For instance, those who have depression are not considered to be insane, and are usually prescribed medications and take psychotherapeutic treatments to help them recover. However, those who do take medications and treatments for depression are afraid to mention that to people because they do not want to be perceived of as mentally unstable or mentally deficient.
Those who suffer from mental illness are not mentally deficient. If a person has a severe case of double pneumonia, we do not say that they lack lungs, or that their lungs have been deficient since their birth and they should be put into a residential care facility. We take the person to the hospital, get them treatments and medications, and try to help them recover. While most do recover from such things as this, they usually do come home with still a bit of recovery left to do.
It should be the same with the mentally ill. If they are able to come home (many do stay home, and just have visits with their psychiatrist and take their medication), and stay on their medical plan, they usually are just as unnoticed as a person who has received hospital care for a physical illness. There may still be some lingering problems, but as long as medication is taken, and the patient takes care of him- or herself, a lot of the visible effects are gone.
Many of the mentally ill do suffer alone, or suffer only with their immediate family members. There are those who do not know that cheaper medications are available, or available for free for those who cannot afford them at all. Family physicians and psychiatrists can help patients find such programs.
Mentally ill people must be more willing to talk about how they feel to others, and those who are listening must not be judgmental or make the person out to be mentally deficient if they seem to be having problems with a mental illness. A person seeking help for a mental illness is stronger than those who do not, because they know the risk of asking for help from others who may not have the illness.
How You Can Contribute
“I fight stigma by talking about what it is like to have bipolar disorder and PTSD on Facebook. Even if this helps just one person, it is worth it for me.”
– Angela Christie Roach Taylor
“I take every opportunity to educate people and share my personal story and struggles with mental illness. It doesn’t matter where I am, if I over-hear a conversation or a rude remark being made about mental illness, or anything regarding a similar subject, I always try to use that as a learning opportunity and gently intervene and kindly express how this makes me feel, and how we need to stop this because it only adds to the stigma.”
– Sara Bean
“I fight stigma by reminding people that their language matters. It is so easy to refrain from using mental health conditions as adjectives and in my experience, most people are willing to replace their usage of it with something else if I explain why their language is problematic.”
– Helmi Henkin
“I find that when people understand the true facts of what a mental illness is, being a disease, they think twice about making comments. I also remind them that they wouldn’t make fun of someone with diabetes, heart disease or cancer.”
– Megan Dotson
“I offer free hugs to people living outdoors, and sit right there and talk with them about their lives. I do this in public, and model compassion for others. Since so many of our homeless population are also struggling with mental illness, the simple act of showing affection can make their day but also remind passersby of something so easily forgotten: the humanity of those who are suffering.”
– Rachel Wagner
“I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself.”
– Val Fletcher
“I fight stigma by saying that I see a therapist and a psychiatrist. Why can people say they have an appointment with their primary care doctor without fear of being judged, but this lack of fear does not apply when it comes to mental health professionals?”
– Ysabel Garcia
“If I watch a program on TV that has any negative comments, story lines or characters with a mental illness, I write to the broadcasting company and to the program itself. If Facebook has any stories where people make ignorant comments about mental health, then I write back and fill them in on my son’s journey with schizoaffective disorder.”
– Kathy Smith
“I fight stigma by not having stigma for myself—not hiding from this world in shame, but being a productive member of society. I volunteer at church, have friends, and I’m a peer mentor and a mom. I take my treatment seriously. I’m purpose driven and want to show others they can live a meaningful life even while battling [mental illness].”
– Jamie Brown
This is what our collective voice sounds like. It sounds like bravery, strength and persistence—the qualities we need to face mental illness and to fight stigma. No matter how you contribute to the mental health movement, you can make a difference simply by knowing that mental illness is not anyone’s fault, no matter what societal stigma says.
We have curated information from
- WHO, World Health Organisation;
- NAMI, National Alliance on Mental Illness
- The Mental Health Foundation
- UCSF Department of Psychiatry
We will continue to work on this info page as we find new and useful information. These are what we think are important and what everyone should know about mental health and mental illnesses.
Page Curated By:
Sean, Editor & Social Media Manager
Any queries/clarifications/take-down notices can be sent to us at firstname.lastname@example.org.