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Mental Health

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Joanne Corrigall, Catherine Ward, Kathryn Stinson, Patricia Struthers, Jose ... Alan Flisher, Dan Stein, Petro Brink, Venecia Barries, Carol Bower, Carol Dean, ... – PowerPoint PPT presentation

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Title: Mental Health


1
Mental Health
  • 25 June 2007
  • Presenter Joanne Corrigall

2
The MH workgroup
  • Authors
  • Joanne Corrigall, Catherine Ward, Kathryn
    Stinson, Patricia Struthers, Jose Frantz, Crick
    Lund, John Joske, Alan Flisher
  • Expert group
  • Crick Lund, Alan Flisher, Dan Stein, Petro
    Brink, Venecia Barries, Carol Bower, Carol Dean,
    Fadia Gamieldien, Bronwyn Myers, Bruce Phillips
  • Peer Reviewers
  • Vikram Patel, Andy Dawes

3
Presentation Content
  • Definitions
  • Burden of mental illness
  • Risk factors for mental illness
  • Interventions Recommendations
  • Mental Health and Development

4
Definitions
  • Mental Health
  • a state of well-being in which the individual
    realizes his or her own abilities, can cope with
    the normal stresses of life, can work
    productively and fruitfully, and is able to make
    a contribution to his or her community (WHO)
  • Mental illness group of disorders defined by
    specific criteria which describe
  • a particular severity of symptoms
  • duration of symptoms
  • the effects of these symptoms on a persons
    ability to function (socially and occupationally)
    i.e. symptoms result in DISABILITY
  • Example Depression

5
Spectrum of mental health
Mental Illness
Mental Health
  • Self-esteem
  • Coping skills, problem solving
  • Self-efficacy
  • Impulsivity
  • Sub-clinical symptoms

6
Burden of Mental Disorders
  • Socio-economic impacts
  • Unemployment, poverty
  • Poor housing
  • Decreased school completion, academic performance
  • Decreased Social capital
  • Increased violence

7
Burden of Mental Illness
  • Macro-economic
  • 147 billion annual cost in USA
  • SA no data but drug alcohol costs alone total
    R10billion
  • Loss is mainly through effects on productivity,
    absenteeism

8
Burden of Mental Illness
  • Disability
  • Globally 5 of 10 leading causes of disability
    are psychiatric
  • SA neuropsychiatric disorders are 2nd leading
    cause of BoD
  • BoD figures exclude the impact of MH on other BoD
    components

9
Mental ill-health strongly associated with
CHILD HEALTH
Injuries
CVD
CHILD HEALTH
HIV
CVD
HIV
Unsafe sex Multiple partners Early sexual debut
Smoking
Alcohol Abuse Drug Abuse
10
Mental health/illness
Source Bradshaw et al, 2005
11
Prevalence in Western Cape
  • South Africa SASH study 30 life-time
    prevalence
  • No data for Western Cape
  • Proxy measures injury data specifically homicide
    and RTAs

12
Proxy measures
13
Aim of MH workgroup
  • Prevention of common mental disorders
  • Depression
  • Generalised Anxiety Disorder
  • Substance disorders (includes abuse and
    dependence)
  • Post Traumatic Stress Disorder
  • Childhood behavioural disorders
  • 2. Promotion of mental health

14
Risk/protective factors
Living environment
Human capital
Health
  • Access to recreation
  • Built environment (housing, neighbourhoods)
  • Basic services
  • Income
  • Food security
  • Social grants
  • Transport

MENTAL HEALTH
  • Mental illness
  • Health systems
  • HIV
  • Substance use
  • Physical illness
  • Disability

Safety
Employment
  • Education
  • Pre-school
  • School climate
  • Violence
  • Crime
  • Family systems
  • Death/trauma in family

Social capital
Material goods
  • Unemployment
  • Underemployment
  • Occupational stress
  • Social capital
  • Social support
  • Spatial segregation

Family environment
15
Findings continued
  • Majority of relationships are bi-directional
  • Multiple deprivation mental illness
  • Cumulative effects

16
Conflict with neighbours
Basic services
Family environment
Food insecurity
Unemployment
Domestic Violence
17
Focus Areas selected
  • Multiple Deprivation
  • Unemployment
  • Social assistance
  • Food insecurity
  • Housing
  • Poverty
  • Trauma (preventing MI after exposure)
  • Pre-school education
  • Recreation
  • Mental Health Services
  • Substance use (Tik, alcohol other drugs exlc.
    Nicotine)

18
Multiple Deprivation
19
Interventions
  • Employment programmes JOBS programme, public
    works etc.
  • Community development, micro-credit
  • Adult literacy, food security
  • Child care
  • Increase access to social assistance
  • Built environment
  • Housing
  • Neighbourhoods

20
Trends in Status Quo
  • Existing interventions targeting housing,
    unemployment, social assistance, literacy, food
    security
  • BUT insufficient to meet need and/or not
    optimally effective
  • AND insufficient cognisance of health (including
    mental health)

21
Example Housing
Housing factors associated with mental health
Type
Quality
  • Single vs multi- dwelling
  • High floor vs low floor dwelling
  • Structural deficiencies
  • Pest control
  • Dampness
  • Housing satisfaction

HOUSING
Other
  • Tenure
  • Overcrowding
  • Involuntary relocation
  • Affordability of housing

22
Evidence for interventions
  • Housing improvements consistently improved Mental
    Health and decreased Mental Illness
  • Dose-response relationship
  • Other positive outcomes physical health
    perceptions of safety crime reduction social
    participation (social capital) improved
    perception of the area as a whole
  • Effects of neighbourhood improvements 50
    reduction in prevalence of mental illness

23
Housing recommendations
  • Improve quality of state-subsidised housing
  • Increase housing subsidy amount per applicant
  • Improve capacity of housing applicants to make
    financial contributions for their homes
  • Foster community participation support
  • Expand neighbourhood renewal projects

24
Example Federation of Urban Poor
25
Likely outcomes
  • Suitable housing
  • Social Capital
  • Human Capital
  • Increased income
  • Economic participation
  • Physical Health

Improved Mental Health
HOW housing is provided can make a big difference!
26
Pre-school
Pre-School
27
Window of opportunity
  • Early childhood is a sensitive period, and
    competencies become cumulative. Thus, without
    intervention, gaps between better and worse-off
    children widen over time the earlier the
    intervention, the less it costs and the lower the
    gap (Heckman, 2006).

28
Outcomes of high quality pre-school
  • Improved school
  • readiness
  • Improved cognitive
  • abilities
  • Lower failure rates
  • Higher school
  • completion rates
  • Decreased antisocial
  • behaviour
  • Decreased substance
  • abuse
  • 40 reduction in
  • arrest rates
  • 40 increase in
  • employment rates
  • Improved maternal
  • employment and
  • education

Benefits of preschool have been noted up to
27yrs!!
29
In Western Cape
  • ECD a priority of WCED and DSD
  • Audit done by DSD shows lack of access to
    pre-school and poor quality of existing
    preschools, unqualified teachers
  • Another audit currently underway by DSD

30
Recommendations
  • Develop high quality teacher training programmes
  • Develop high quality pre-school programmes
  • Resource roll-out of pre-school across Province
    (urgently in high risk areas 15 high priority
    areas)

31
Recreation
32
Evidence
? Arts, music, dance
Physical exercise
Recreation
Leisure boredom
Recreational environments
? Other
Mental Health
33
Major Gaps
  • Focus on team/competitive sports
  • Relative exclusion of other forms of recreation
  • Insufficient facilities, access to facilities,
    resources
  • Lack green spaces
  • Lack of access cheap transport

34
Recommendations
  • Review support provision of sports AND
    recreation activities
  • Protect and promote green and natural spaces
  • Provide affordable and safe transport to
    recreational facilities or areas
  • Support SR interventions that build social
    capital

35
Trauma
Trauma
36
  • Violence
  • Community (gangs or crime)
  • Domestic violence
  • Rape
  • Child Abuse
  • Psychological
  • trauma
  • Individual
  • Family
  • Community
  • Police
  • Increased mental illness
  • Drug and alcohol abuse dependence
  • Post-traumatic stress disorder
  • Depression, anxiety
  • Decreased Mental Health
  • Hostile/harsh parenting
  • Loss self-esteem, self-efficacy, coping skills

37
  • Psycho-behavioural
  • Outcomes
  • Decreased inhibition, reasoning
  • Increased risk-taking
  • Increased libido
  • Increased mental illness
  • Decreased mental health
  • Decreased parenting skills
  • Poor interpersonal relationships

Drug Alcohol abuse Itself a mental health
problem
  • Violence
  • Community (gangs or crime)
  • Domestic violence
  • Rape
  • Child Abuse

Psychological trauma
38
Bottom line
  • Preventing and treating mental illness is an
    important part of violence prevention
  • Violence prevention is an important part of
    preventing mental illness
  • Preventing mental illness and restoring mental
    health after exposure to violence is crucial

39
Recommendations
  • Training trauma-informed non-health sectors
  • Consistently fund, support roll-out NGOs
  • Develop resources for emergency placement
  • Provide mental health services in workplaces with
    high trauma exposures
  • (police, teachers, social workers, NGO workers)
  • Make sufficient provision for psychosocial needs
    in disaster management
  • Develop post-graduate training programmes in
    trauma

40
Recommendations cont.
  • Health
  • Training trauma-informed general health sector
  • Integration of mental health staff into general
    health services e.g. surgery
  • Provide adequate mental health services
  • Create strong referral networks with
    trauma-related NGOs

41
Substance use
Substance use
42
Background
  • Substance use e.g. nicotine, alcohol, tik,
    heroin
  • Substance abuse/dependence are defined mental
    disorders
  • Substance abuse/dependence also increases risks
    for other mental illnesses high comorbidity

43
Alcohol
  • Likely to be the commonest SOA in the Western
    Cape
  • Why?
  • Socially acceptable
  • Legal production and consumption
  • Active promotion (media)
  • Perceived to be benign
  • Norms culture of excessive use (abuse)
  • Dop system
  • Wine country
  • Cheap!

44
Impact of alcohol
Violence Road Traffic Incidents HIV Mental
Health CVD Child Health (FAS)
Out of he
Social impact Economic impact
45
Tik
  • High profile
  • Why?
  • Illegal associated with criminal activity incl.
    gangs
  • Socially unacceptable
  • New drug
  • Negative consequences of use occur sooner
    abusers deteriorate more quickly
  • Severe effects in users
  • BOTH problems need to be addressed

46
Evidence for interventions
  • Not effective
  • Media campaigns with no other measures
  • Scare tactics
  • School-based information interventions
  • Law enforcement of DUI laws

47
Recommendations
  • Decrease Demand
  • Restrict advertising of alcohol
  • Conduct concurrent anti-alcohol and drug media
    campaigns that challenge prevalent beliefs and
    norms
  • Increase references to substance abuse in other
    health promotion messages
  • Include evidence-based substance prevention
    programmes in school curricula
  • Training of primary care and other health workers
  • Provide adequate treatment services

48
  • Decrease Supply
  • Substantially increase the cost of alcohol
    drugs
  • Reduce the availability of alcohol drugs
  • Enforce existing laws on alcohol and other drugs.
  • Incorporate addressing substance abuse into
    multi-faceted community development interventions
  • General
  • Improve co-ordination of involved departments
    DSD, DEADP, DOH, DCS

49
Mental Health Services
50
Background
  • Mental Health services
  • Hospital to community based
  • Scope
  • Promotion, Prevention, Treatment, Rehabilitation
  • Nature of mental illness
  • Typically chronic requiring long-term service use

51
  • The greatest risk factor for mental illness is
    previous mental illness

52
Major Gaps
  • Insufficient community-based services (schools,
    workplace, home-visits, community-based care)
  • Community-based care for mentally ill
  • Residential care
  • Day services
  • Need post deinstitutionalisation
  • Poor integration of services particularly need
    in maternal health, HIV, trauma services
  • Grossly insufficient MH services across the board
    but esp. community-based health services
  • Impact of general health services on mental
    health

53
  • General approach to all interventions

54
Targeting interventions
  • Areas with highest violence and highest Multiple
    Deprivation Index (including 15 priority areas)
  • Vulnerable groups
  • Critical periods
  • Some interventions universal

55
Content Process of interventions
  • Importance of multi-faceted interventions
    growing human, economic and social capital
    (multiple deprivation)
  • Participative justice community participation
    and empowerment is vital
  • Address cross-cutting risk factors e.g. alcohol

56
Relationship to PGDS
57
Relationship to development
  • Development impacts on mental health
  • Small investments in health have large impacts on
    income, education, democracy
  • Global MDG interventions MH component embedded
    in these
  • Mental Health is an essential Capability
    (economic approach)

58
  • Where to from here?

59
Discussion points
  • General comments
  • What are the most appropriate forums for taking
    this work further?
  • Most feasible recommendations/ least feasible?
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