A discussionBy

Dr David E Bukusi

Yalom (Psychiatrist) suggested that as human beings we have four basic fears;◦ The fear of being alone◦ The fear of dying◦ The fear of making decisions◦ The fear of finding out that all that one has been

doing is meaningless

Definitions:“a state of emotional and social well-being in which the individual ◦ realises his or her own abilities, ◦ can manage the normal stresses of life, ◦ can work effectively, ◦ and is able to play a role in his or her community” (WHO,

1999)

Mental health has been conceived as a medical, psychological and sociological phenomenon

- disease entity approach- normality and abnormality; ‘ideal self’- social construct - ‘deviance’ and social

causation - impact of poverty, social position, poor housing, unemployment, social stressors

The merging of perspectives - biopsychosocial model

Emotional wellbeing - affect/feeling Psychological wellbeing - positive functioning Spiritual wellbeing - meaning and purpose in life Physical wellbeing - physical health and fitness Social wellbeing - relations with others and society

Healthy structures - economic, political, social and cultural framework for developing and maintaining positive mental health

Citizenship - social support, sense of social integration and inclusion

Emotional resilience - self-esteem, coping , life skills, sense of control

Markers of social disadvantage are all associated with poorer mental health

There is a strong association between mental health, social wellbeing and physical health

Promoting mental health is central to population health and wellbeing

Grooming, touch and nutrition Language development Early childhood development/schooling Play- with peers, siblings and parents

◦ Promotes neurogenesis, stable attachments and boundary formation

Nutrition, touch/(hugging-grooming) and play◦ close relationships contribute to resilience in adulthood

High-quality early-childhood interventions◦ parenting programmes- Early attachment, warm and

affectionate parenting; secure and safe home, informal sources of community support

Pre-school education, school-based approaches Sense of connectedness - home, school, community Reduce health inequalities and eliminate poverty

Individual level determinants - life skills and social competencies - protective of mental health◦ Sense of self -control, efficacy and esteem◦ Relationship skills◦ Coping skills◦ Communication ◦ Cognitive style◦ Emotional literacy◦ Problem solving skills

Safe environment Adequate healthy nutrition Space for privacy as well as individual

growth Meaningful supportive family relationships A base from which one can relate to and

contribute to the community and society

Appropriately skilled and challenged at work with commensurate remuneration

Appropriate work relationships with clearly understood targets and boundaries

To be able to achieve work satisfaction To be able to contribute to the community/

society

To establish meaningful relationships◦ Friendly

Reaching out to support Enjoying each others company

◦ Respectful Appreciative of boundaries

◦ Loving Intimacy Passion commitment

INTIMACYliking

COMMITMENTempty

PASSIONinfatuate

Romantic Companionate

Fatuous

Alcohol decreases activity of areas involved with control and increases activity of areas involved with emotional reactivityAlcohol decreases activity of areas involved with control and increases activity of areas involved with emotional reactivity

Effects of Alcohol Intoxication on Brain Glucose Metabolism (Marker of Brain Function)

Decreasesprefrontal cortexcingulate gyrus

Increasesamygdala

Psychiatric manifestations in substance use/misuse1. Psychiatric manifestations of acute intoxication2. Psychiatric manifestations in withdrawal3. Psychiatric complications of substance misuse Dual diagnosis (co-morbidity) 

Normal Brain

A Heroin Dependent Brain

Common psychiatric symptoms in substance

use/misuseDisturbances of perceptionA. HallucinationsPerceptual experiences without external stimulation1. Visual hallucinations: e.g. LSD intoxication (trip)2. Auditory hallucinations: e.g. alcohol hallucinosis (long term use), derogatory voices or pieces of music.3. Tactile hallucinations: e.g insects crawling under the skin in cocain misuse (after effect i.e. Long term use)

An Alcoholic Brain

Common psychiatric symptoms in substance

use/misuseDisturbances of perception

B. IllusionsDistorted perception of external stimuli.Illusion of time and space: e.g. in a cannabis high

 A Marihuana user brain

Disturbances in thoughtDelusions: false fixed belief that

cannot be changed by logic or reality and are not accounted for by the cultural background.

Delusions of persecution in alcohol and in Amphetamine long term use

Delusions of infidelity: alcoholDrug induced psychoses

Amphetamine user brain

Develop and strengthen parenting◦ Emotional support, grooming, stable attachments, safety

Develop and strengthen schooling strategies◦ Appropriate study/sleep balance, balancing knowledge, aptitude and

effort Develop and strengthen Lifestyle strategies

◦ Nutrition, exercise, relationships, spiritual life goals Develop and strengthen workplace engagement

◦ Accomplishment, goals and rewards Develop and strengthen the concept of contributing to the

community◦ Donations, Volunteering, Helping causes

Develop strategies addressing the social determinants of mental health – economic, social, political, cultural frameworks

Integration of mental health in health promotion and public health initiatives

Engaging the political will to promote mental health at a policy level

Mobilising a public demand for a mentally healthy society - concern with emotional and social wellbeing, social values, culture,

economic and social policies

Promoting Mental Health and Wellbeing: Concepts, Practice

and Policy-Professor Margaret Barry :World Health Organisation World Health Organisation

Collaborating Centre for Health Promotion Research National University of Collaborating Centre for Health Promotion Research National University of Ireland, Galway Ireland, Galway Ollscoil na hÉireann, GaillimhOllscoil na hÉireann, Gaillimh

Implementing Mental Health Promotion: M. Barry & Rachel Implementing Mental Health Promotion: M. Barry & Rachel JenkinsJenkins

Think Social Psychology- Kimberly Duff: Pearsons education Think Social Psychology- Kimberly Duff: Pearsons education inc.inc.